Ebony State CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): September 2003 to October 2004

ttI To: For EBOTWI STATE CDTI PROJECT NIGERIA lf ilrlllf,!lliJ'-\iJril.t',r,li.il \i.il{}lIr,1i['ti\i lk.( l'lX l-i\lt.lj-l'\i1 t,l]il'l]rr\1'l \l',i, I [' rrl' Il r,l tI.i I!lllIt- L: li\.\ lEor lnformotlon TOr Mft EIir) tf,It l1 llitit't-l ORJGINAL: English 4 , : CO A{OTF: NOTF-I{IGERIA Pro Name: EBOI{YI STATE CDTI PROJECT Approyal year: 1998 Lau ng Year: r998 Reportins Period, 2004 From: SEPTEMBER 2003 To: OCTOBER 2004 r Month/Yea Proiect vear of this report: (circle one) 12345678910 Date submitted: MAY zOOs NGDO partner: GLOBAL 2000 l ? 6 luru eoos UAI\NUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please conlirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country NIGERIA National Coordinator DR J. Y. JTYA Date: May 2005 Zonal Oncho Coordinator Name: Dr E. Signature {. Date: May NGDO Representative Name: Mrs Chinyere Maduka Date: May 2005 This report has been prepared by Name: STEVE O. OROGWU Designation: PROJECT COORDINATOR Signature Date J !; i I F i : + { I I f f i I I I aANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLTNE FOR SUBMISSION: To APOC Management by 31 Januarr for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) aTable of contents ACRONYPIS......... VI vII FOLLOW Lip ON TCC RECOMMENDATIONS .........................1 EXECT]TTVE STIMMARY ) SECTION I: BACKGROTIND INFORTIATIONERROR! BOOK\{ARK NOT DEFINED. l.l. GsNmArDrFoRMATroN.......... I.t .I Description of the prolict (brieJiy) 1.1.2. Partnership 1.2. PoprnanoN SECTION 2: IMPLEMENTATION OF CDTI.....,.. 2.1. Tnvrprnm oFACrrwrIEs .............. ..., Ennon! Booxtu,mrNor DEFTNED.2.2. ADVocACy ...................9 2.3. MOEtrJZANON, SENSITIZATION AND H-E,AL-TH EDUCATION OF AT RISK COMMLTUUES .. 92.4. Cotwrur.ttTyrr{voLVEMENT ...........142.5. CaracrrYer[on.rc ......................162.6. TnEatrrNrs Ennon! BooxtuanxNor DEI,.INED.2.6.1. Treatment-fig;nres............. .......................202.6.2 lfhatare the caases of absenteeism?.._............. ........,222.6.3 Wat are the reasons for refusals? ................ ............222-5-4 Briefly de.vcnbe al! knou,n snd vertfred serious adr.,erse et)ents (-sAEs) that....22 2-6.5. Trend of treatntent aeliieveinentfrom CDTI projefi iriception to the curilenl year2l 2.7. ORDERING, SToRAGEAND DELTVERY oF IvERMECTIN.......-...., ...............252-8- cr,liu,ivIiilliT'r' SEi.F-ivtoi'liroRiiic.,r.r-\r]D st'axmioiluis ]vfrnni-ic ...........2s2.9. SrrpERllrsroN ..... .........2i 2.9 .1 . Provide a Jlow chart of supervision hierarchy. . .. . .... . 272.9.2. What were the main j.ssues icientiJieti tluring rupervision! ...... .... ..........2u2.9.3. Was a supentision checklist used? ...........2g2.9.4. Wat were the outcomes at each level o.f CDTI implementatiott supert,ision? 282.9.5. Wasfeedbackgiventothepersonorgroup.rntperui.sed? .. . ..........2g2.9.6. How was thefeedbackused to improve the overall perfonnance of rhe project? 28 SECTION 3: SI-IPPORT T0 CfiTI Ennon! Booxrr.mr Nor DEFINED. 3 5 ! 7 3.1. Equnr,mvr 3.2. FN.iENCNT CONTRIBIiTIONS OF THE PARTNERS AND COMMI,DITIES Ennon! BooxpmRrNoTDEFINED. 3.3. OTHER FoRMSoFCoMMLINITY SIjPPORT-..-. 3.4 ExpenorniRE pER ACTr\art' ... - -... SECTION 4: SUSTAINABILITY OF CDTI 4.1. INTNTNAT; INDI]PENDI]I\rT PAII.TI(.'IPATORY MONI'IOzuNr_i; EVAUIA'I-(]N4.1-l Was Monitoring/evaluation carried out during the reporting periorl? (tick an1, of the follou,ing u,hich are opplicohle) 324.1.2. Wat u.,ere the recontneHdatiotts? .. ..324.1.3. Howhave theybeenimplemented?......... ....... ...... 324-2- S1t31-.\n'.r.4nII-ITI'of FF-o.IF{'Ts: pIAr{}-ND snr rARCItrs (la.oru--rarorr-\, A-T.......... ..... -72 29 Yn 3) 32 4.2.1. Planning at all relevant levels .................32 4.2.2. Futtds........ ..........32 4.2.3 Transport(replacementandmaintenance) .....................32 4.2.4. Otherres(rurces... ......33 4.2.5. Towhatextenthastheplanbeenimplemented............. ...............33 4.3. [rrrecnanroN ..............33 4 .3 .l . I+'ermectin delivery mechanisms . . . -. . -.. . -3J4.3.2. Training.... ................Drror! Boo*ma* notdelined.33 4.3.j. Jointsuperuisionandmonitoringwithotherprograms....Error! Bookmarknot dejiited.33 4.3.4. Release offundsfor project activities ..............8rror! Bookmark not dejined.3 4.3.5. Is CDTI included in the PHC budget? ...............8rror! Bookma* not delined. 4.3.6. Describe other health programmes thal are using the CDTI struclure and how this was achieved. Wat have been the achievements? .....Error! Bookmar*. not defined. 4.3 .7 . Describe olhers issues considere.d in the integratian of CDTI. . . . . . -14 4.4. OpEnanoNALRESEARCH ....................34 4.4.1. Summarize tn. not more than one half of a page the operationol researclt undertaken. in the project area within the reporting period- ....... .. ...34 4.4.2. How were the rerults applid in the project? ............... .....34 SECTION 5: STRENGTHS, WEAI(NESSES, CHALLENGES, AND oPPORTUNITTES..... ..............3s SECTION 6: UNIQUE FEATURES OF' THE PROJECT/OTHER MATTERS ........... 36 a Acronlrms AD'l1a ATOs CBIT CDDs CDTi CSM Ei LIA FP GHARF GRBP HSAM IDP IEC LGA MOH NGDO - NGOs NOCP - PHC PHCC REMO SOCT wHo Afri can P:'ogramme fo,r Onchocerciasis C ontroi Annual Treatment Objectives Com:'aunity Based ll'ermectin Treatment Communiry Directed Distributors Commua it.;,* Directed tieatmen t with Iverme cti n Comrnunity Self Monitoring First Liae Heaith Facilit5r Family planning Gobai Heafth Awareness Research Founciation Global 2OOO River Blindness Programme Heaith Education, Sensitization, Advocacy & Mobilizati on Ivermectin Distribution Programrne Information, Education anci Communi cation local Governrnerrt Area iocal Governmenr Onchocerciasis Controi Team Ministry of Health Non-Governmental Developmen t Or ganization Non-Governmental Organi sations Nationai Onchocerciasis Conrrol Programme Primary Health Care Prima4l Heaith Care Coordinator Rapid Epidemiological Mappin g Onchocerciasi s State Onchocerciasis Conrroi Team World Health Organization Definitions (i) Total ppulation: the total population living in meso&yper'endemic communities within the project area (based on REMO and censs taking)- (ii) Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic commuaities in the project area. (iii) Anmral Treatment Objective: (ATO): the e$imated number of persons living in meso/hyper-endemic areas th.at a CDTI project intends to treat r+4th i-. ermectin in a given year. (iv) Lrltimate Treatment Gcal (LTTG): calculated as the maximum number of people to be keated annually in mesdhyper endemic areas within the project area, ultimately to be reached when the projeA has reached firll geographic coyerage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (u) Therapeutic coverage: number of people treated in a given year oYer the total population (this should be expressed as a percentage). ("i) Geographical coverage: number of commurities treated in a given year over the total number of meso/lryper+ndemic communities as irientified by REMO in the project area (this shouid be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, al-bendazole tbr LF, screening for cataract, etc.) tbrough CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower commrrnities to solve more of their health problems. This does not include activities or interventions camed out by community distributors outside of CDTI. (viii) Sustainabiliry: CDTI activities in an area are sustainable when they continue to function etl'echvely tbr the tbreseeabie future, with hrgh treatment coverage, integSated into the arailable healthcare service, with strong cormnunity ownership. iisinq resoiirces mobilised br- the communif-ri aaci the Po'v€Irrfil€ff. (ix) Coinrnunity self-monitoriug (CSM): The process by which the cornmunity is empow'ered to oyersee and mmitor the perforiiiance of CDTI (or any community- tnsed health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full respomiUility of iverinecan disfnbution and make appropriate modifrcations when necessary. FOLLOW UP OH TCC REGO*i*!Ei'DATIOi'S Using the table below. fill in the recommerrdations of the last TCC on the project and describe how they have been addressed. TCC session Pro!:ct to subrnit technical reports for each State in fuhrre using the new rcprriing lbnrci ('Please add more rou,s if netessan,,) 'I*hic rcmrf ic fnr Ebonyr State Project only and is being mamrad rrcino fhcser.b +I! TCC Annual reporting fornrat final version of Nov. 20M I FORTCC/ITOC MGT ASE OiiLY Numhcr o! Recommendaiion in the Report TCC RECOMMENDAT1ONS ACTIONS TAT(jN BY TTIE PROJECT 2 NOCP to read the repxt "oeiore senciing ir in order ro ensure that data are accuratc and consisterrt NOCPhas read this report and sent it lsnlr tn lhc mniecf fnr corrections. The corrections have been effected. Advocacy was ,:ndelteken at State. LGA and down to the gsrrunrrnities levels which ha-s nrade State. LGAs and even the Conununities to tow release fi.rnd ancl other materials in kind for CDTI activities accordingly. ., I Pro1ect to inteflsily a<ivocacy at ali leveis ftrr releasing funds from States and LGAs /L $,f IO1.^JOC. 24 Novcmber 2004 Executive Summary Comrmiry Directed Treatment with fvermectin (CDTD commenced in Ebonyi State in October 1998. The state completed its frst (5 years) phase of APOC assistance in September 2003. This report is for the sixth year (October2003 - September 2004). CDTI activities for the sixth year commenced in the state with initial advocacy visits to State and Local Government Poticy makers to eticit their response towards supporting various implementation aspects of the programme. Advocacy visits were simultaneously carried out with targeted mobilization at State, LGA and Community levels. Mobilization was centered on those LGAs that have not been releasing firnd for CDTI activities and also for those communities/villages that have not been payry their CDDs. State project visited LGAs while LGAsrTront hne Health Facility Staff visited communities, A total of 305 Health Staff consisting of LOCTs, PHC Coordinators and Health Center staff ; and.1827 CDDs were trained on targeted areas within the period under review. A total of 973 villages were mobilized and Health Educated on targeted areas. All the 971 villages selected their CDDs, and as well collected their drugs. w'hile all the villages decided on the period of distribution. All the 973 villages decided on the method of distribution. In all, a total of 494,183 peisoris representing 85.5% of the 6otal ircprlation of 57765E frour 973 villages (1009/, Geographical coverage) were treated. A total of 197 out of the 971 villages treated (40.8%) compensated CDDs in either cash or kind. The State cc,ntrih:ted the sum of t'*'o million, five hundred thousand Naira (N2.500.00) while the LGAs contributed the sum of one million and forry* thousand Naira SJi, 04C, m0.t$) as coimteryait f.:nd fbr ihe p'ogSanmle . This is beside monthly topup allowances paid to Heath service Staff involved in CDfi by the various LGAs. A total of tiu-ee hund-red and fiort-y iwo thousand. six hiindreti anii rriiieiy five liaira (N342695.00) was used by the various villages to corlpensate their CDDs- It ii necesse'-i to ffioie hei'r tha€ ti:e fund {$36SCi apgE:or€d bi'APGC firr ilie Eiroieci for the 6e vear was not received. The entire fund used for CDTI activities for the 6h vear ^^*^ r-^- +L- s+^+- ^.-; +L- r f. a -- 4!!!L'i.aiii:- aI aiiti .ric \tBrrs 4]lgr!!!=_!::&_g!i: Though the problem of late release of State and LGA fitnd was encountere<i. Health workers demomtrated strong commitment and willingness to cafia'on the activities pending the time Government will release approved firn<l. From all indicatrons. CDTI has been instifirtionalized in Ebonyi State as conimunities have been empowered on virnrally all respects to organize and conduct treatment with little or no supervision from the up.oer levels. Cornmunity, Self Monitoring has been expanded to reach many villages. In conclusion. the uroject has oerformed well this 6th year as it has been able to carry out CDTI actrvities successfully wtthout any fbmr of externai hrnding. b rr.a ir r/ ^ a!'r, i, \' ,. ,..--L .- arvr/Ygi r(r,'F,: t.'( -J r\itvEllllril ir,rii SECTION I. CTION: 1.1 BACKGROUND Ebonyi State is among the seven South Eastern States of Nigeria formerly benefiting tlom the Lions Clubs/Global 2AO0 Riverblindness Programme. The State is however part of Global2000 RBP Enugu/AnaurbralEbonyi States' project. 1.1.2 GEOGRAPHICAL LOCATION Ebonyi State is located betrveen longituds 7".45' and 8o. 30'E and latitude 5". 40' and 7'.00'N of the equator. It is bounded on the North by Benue State, on the East by Cross River State, on the South, by Abia State and west by Enugu State. The State has a total of thirteen (13) Locat Government Areas. It has an approximate population of 1.8 million based on the l99l National Population Census Estimate. There are over six different dialectic local languages in the State. Howev-er. based on the population update/registration of CDTI communities, there are about 700,000 persons living in onchocerciasis endemic villages in the state. I.I.3 CLIMATE- LA AND VEGETATION Ebonyi state consists of the rugged and undulating landforms in South, which tapers to a tableland with intermittent escapernent of the Central and North Zones. The Cross River terrain is mainly m alluvium tableland- which favours most agricultural activities. The vegetation arrangement consists of malrgrove forest sparsely distributed around tlie Cross River basin of the boundary of the State. w. ith a rnixtr:re of the deciduous arrd evergreen types of trees. The topography consists of undulating elevation of approximately -51t[ts1 above sea level in the South ard extends to the rugged terrain of the central. The Northem part is citaractenzed ht' unifonn landscane wit-h intennittent escaoement. T.he Cross River -J *"' terrain is mainly an altuvia tableland, which favours most agricultural activities. fltere are teu CDTi I G-As in the State ce'nsisting of rwo hyper and eisht E)eso- endemic. APOC find for CDTI implementation in Ebonyi State is being jointly receive<i alons witir Enugu and Anambra States., 3 'v\T IO/APO[-'. 24 i.r-oveniber 2 004 I.2.I POPTILATTON AND HEALTTI SYSTEM There are 13 local Governmert Areas in the State. Two Q'1are Hyper endemic, Eight (8) are meso endemic while three (3) arehypo endemic. The total population of the 973 Meso/Flyper villages in the l0 CDTI LGAS is 577658 persons. In this report, a village means the lowest organized settlement structure with detined leadership- It has house -holds as the lower level to it and Local Government as the next leadership level. There are 973 CDTI villages in the project area. Table l: BASE DATA ON POPLiLATIOiT- ON HEAL.TH SYSTEM ACCESSIBILITY Table l: Number of health staffinvolved in CDTI (Please adrl more rov,s i|'neee$ary) B.#-r,T -l Number of he*Eh stellinvolved in CDTI adivities Totalliumlrcr of hcelth saffin thc enfire projeet erea Br \J,mber ofhealth rtelf involvcd in CDTI B2 Pereentsge 6fllr/ lir -lUU lkwo 57 38 6.6 lzzt 45 ?{^r 85.6 Ohaozara 4t 32 78.0 Onicha 5U J-1 66,0 Ezza North 37 Nt 81.0 Ezza South 35 28 71.4 lshielu 29 t8 62.A Ebonyi 33 24 72.1 Ivo 37 30 8t,0 Afikp North 4t 3-1 80.4 'I'otal 4u5 305 i5.3 4 Numbero/o Observation Total number of LGAs l3 ML Total nurnber of CDTI LGAs based on the REMO rsults t0 NIL 9/o No of LGAs covered by the prolect in the currerrt year I fit\o/- NIL Total population of CDTI LGAs 577658 NiL Total population of CDfi Villages in the current year 5i7658 N-IL IYHO/AFOC- 24 Novernber 2004 I I.I2. PARTNERSHIP The putners involved in CDTI Tmple,mentation at Minisby of Healttr, Local Government Area and villages levels include APOC, Government (State and LGA), Global 2000 as the supprting NGDO and benefiting Cornmunities. However, there hasn't besr cash contnbr:tion from APOC and Global 2000 shce the comme.ncement of the sixth year. There has been a harmonious work-rng relationship Lretween the pa,rtners with each turderstanding their roles and their expectations. Plaruring, supervision advocacy and rnobiliza-tion a-t a-ll levels are ca:'ried or:t bv the va-nous na-rtners WHO/A.PO['. 24 Noverntrer 2004 I 6s ,s bq) P'\ q) 'l: E ,{ =\!q)t st P e)a o \0 rt a o 'a E. on o o o E. on Ea Eo €c -$o4 B .! G;Fg ri ':oea€ >9 o- !OE!dF H"8Iou4 .9, eEao .E€ lqs'; -ot'EE€E?IBaEqoo!E$B -3R =E5E}9E.-5k60IH El5 e,E Eo-o o-E €k$€ ,>e5 -qi3 ao a & s s oI I o2'r Exol .EE8 E.Y oo 'oq> E€ IE8 l3: IE!l .EE=' t! EIiE ,[E'€o'oZ-Fi ,5T AE Ei.= 3 ,!E 9a 22Btr* G. -P.( q) d t, L ,tl$ L q){ t,\Eq) q) "* s 15b. L) q) .s -s aB P o\q) oq) a- $' q) .o\ o .t ,1 o -q) P\ t) ,s >. B E o s- q) 00 Pq) I o ,.E $ ooo a) b0 €'\q)t BI ri Ps o .9. P'\ L E. rS b 3 s s B \! \Sq) st q) € o s s $ s q) .\ ?,\t I 15ttr cl Ps 6.F e E Att-rtg(, E E, r r r N F 8I O I I N INI 6 r F N o N oo N o FI +I f I *r €E od EE -Eaa -o r! tI rr @ o d N o @ N 6 rr .B EF:a ie i+ 15}E F $@ N 6 3r o 0 r No o r N FI o 5Ea ,roE E EoN E EE A E aI B.r o E I F Nod o 6t @I@ r BRFr E 0g T e 5 Ell oF E o o o o o F6 r o o N N o N oI N E ta o08Agi oP 6 r N o oo F A d a Et eE E Eo o € ,z E Eo E EEt a a E 3i A E rr E cEoo EEBA eftE -Eaaa EEE oo rr o N I NI6 o e tr F.t oz R H i Frotr o B H N N fr s o f,o t 2 o Ec z N N trl E 5 oo sN ,4 Jg.l Hb EoElrl Eg a n EEF Eg' EE H6O '-l t 'o & I .9t & o € I a .E c E E o!ott E a E n ,t I t 2tt 2 c ! .1 x .t tIriOL FEad c.E r.EIE o ,{} ?H 2.1 $EGTIOII 2: lmplementation of CDTI IMPLEMEI\ITATION OF CDTI: (Trble 3) Community Directed Treatment with Ivennectin (CDTI) is aimed at institutionalizing communitv based Ivermectin delivery to members of the community. The emphasis is therefore placed on establishing Ivernnectin delivery mechanism in which the primary responsibility of obtaining the required metizan, distributirg it to the at-risk population, supervising the activities of CDDs and keeping relevant records at community level will be devolved to the communities themseives, Tt is still the additional responsibility of the community to decide on CDD selection, time and method of treatnrent as well as CDD compensation- As rtsrtal, CDTI activities for the 6th year commenced in the State with ilitial advocacy and targeted mobilization visits to State, LGA and community policy makers and opinion leaders. Health y,orkers invoh,ed in the programme y,ere trained/retrained on targeted areas of the programme implementation- Tltese areas include planning and pian developme-nt, integrationl ce.nsr-rs update, CSM and SHM and improved record keeping. These activities were followed by coltection of Ivennectin by L.GAs arrd Health Facilit--v levels from where CDDs pickecl theur after training/retraining. As at no\tr, CDTI has formed integral part of primary health care activities in the State Health staff-s at Sta-te. LGA- and conrmunitv levers a_re involverl in CDT I impl ernentation. Above all, there is full integration of Health pro-qm-lnrnes especially at the village level as the same CDD is involved in Guinea wofln eradication, polio eradication as well as leprosv arrd TB Control activities. CDDs hawe denronstrated cornpetelce apd willingness in carrying addd responsibitity to Ivermectin delivery. + WH(]/Affi('. 24 Noverr-rtrcr 2i){)4 lF.l 10, ler' l(! 1,,, ; o o o+) F) c) o v) *o'H o Ho 0, u) |-t(D 0) ate o o HEo (D t E6' aq cu D$ o(\\ q atGGq ,1 Xts o z oF -l o EI EE oz a rl trlFe la,NN v) o erl tl,NN z oFFl oz o * o -* oN F ttNN x{o U 6 i 6 F o oo od(D r-l AE =!9Ed +E ?(t rtoo =BE-:id(D'U2^ v) oE tD o - o EEgE o 4 o (D)d(-9 ,.t ag!le E4 ETE Fi B re EodH D) .{ o EEOE =g s,q AE =tDE3FF o(D v, 0 C (D a o .d croH o B=oft ,al odE! =?E* =E rc| EAa o (1 d oE o E= E= = z o p d(DH a9 Ee -E -oq rh .D q) o a oE o oB trEt =936- oo { o P ? tJ5 -o' (D Edot tJ 5 2.2. ADVOCACT A. State level 29 persons were mobilized including His Excellency the Executive Governor, Members of the State Executive Council and Permanent Secrehries. B. LGA Level 170 Policy makers consisting of LGA Chairmerr, Vice Chairmen, Secretaries, Treasurers and wives to LGA Chairmen. C. Conrmunity levei: 510 community leaders, religious leaders, women groups, haditional rulers and opinion leaders. Advocacy visits were carried out to the aforementioned stakeholders to elicit their resporse positively to contfurue supporting CDTI activities. Community members have supported the programme md there is very high compliance rate to drug intake. The outcome of the a<ivocacy visits has been '.,ery positive as the State an<i the LGAs have consistently been releasing fund to zupport CDTI activities- The difficuities encountered during acivccacy include the consistent absence of policy rnakers and key players during advocacy visits despite early information on the visit. It is a pleasant cieveiopment that a meaing .,vas arranged for ail the LGA Chairmen by the office of the Deputy Governor from where the advocacy messages were delivered to the Chairmen. In some instances, repeated visits rvere made and advocacy meetings heid. 2.3. EIOBILIZATIOil, SEHSITIZATIOI,I AilD HTALTH EDUCATIOI.I OF AT RISK COUUUN]TIES Successitti targete<i and specific mcbiiization and h-relth education rvere crucial activities, which created awareness of the problem of Onchocerciasis at the State, community and village levels as well as soiicit support and patronage of the entire citizens towards effective implementation of the contro[ programme and its sustainability.The ultimate aim was to have a sustained high dernand for mectizan tablets for prevention of blindness due to Onchocerciasis. Advocacy visits were made to top State and LGA government officials to acquaittt them with the probiem of Onchocerciasis an<i the need ior the governmurt at all levels to support the programme in various ways. Communities were mobilized with the help of Health Staff, CDDs and rnernbers of V-HCs usirrg ail available avenues both fonnal and infonnal and appropriate health education messages conveyed by use of a variety of cuituraily-relevant media. ivfobiiizarion a rimes targeted women anci minority grollps so as to sensitize them for effective participation. s \ivlHO/APCiC. 24 Ntrvernber 2004 INFORMATION ON THE USE OF IVIEDIA AND/OR OTHER LOCAL SYSTEMS TO DISSEMINATE II\FOR}TATION A The channels useri for disseminating information in the prqect varied from community to community and viltage to village. The methods used were: - ELECTRONIC MEDIA: Radio jingles, radio discussionVinterviewJbroadcast. Radio jingles were prepared and aired constantly, especialiy, during the Onchocerciasis Week, which was observud by the project in February 2004. Radio stations in the State were involved in the mobilization activities. During this period, messages were relayed to the public as news insert or during important progftIrnmes. The use of radio proved very effective because the project was getting feedback from a lot of people. Information released through the radio travels very fast and gets into the nooks and corners of the project area, TELEVISION: Television was also widely nsed, but coverage was iimited by lack of electricity iu most of the communities and villages. Luckily enough, most of the community leaders are rich enough to own television sets and radios. During training of trainers, TV/Video films were used in some LGAs that have electricity while some commnnities provided generating sets to errable the trainers use the equipment during training of CDDs. Onchocerciasis Messages were also given by way of PowerPoint presentation and prepared documentary. PRINT MEDIA: Those use<i inciude posters, brochures, newspaPer publications, pictures or photographs, fl ipcharts, handouts, handbills and calend ars. LOCAL SYSTEfuiS: These are the traditional methods applicable to different communities and villages and relate to varied traditions. The locai methods include: TOWN ANNOUNCERS: These are people chosen by the communif tbr the pulpose oi lnovirtg round tite villages or market squares with metal or wooden gongs or drums disseminating infornration to tile peopie. The viiiage or cornnnlniry through their conrnton purse usually compursates them. They move around the markets during the day, but around the viiiages at dawil or at nigirt. Tiris metiro<i'.vas very effective. 11 B. L i t0 W}IO/APOC. 24 Nr.tvctnber 2004 I lt CHURCH ANNOUNCEMENT: The rnain religion of the inhabitants of the project area is Christianity. There are churches in the entire town and are built through communal contributiotr. They are usually centrally located and important messages disseminated througfi the churches reach evay household. SCHOOL ANNOUNCEMENT: Education is one of the valuable assets recognized in the project area. Each farnily. no matter how poor makes effort to hain its children. Messages passed through school children get to the households very fast. VILLAGE/COMMIJNITY HEADSIEZES : The village head is a good charurel for message dissemination. As the liead of village or corlmunity, he is entitled to call meetings of his cabinet chiefs or other members of the comrnunity or give oral directive to his subjects through the village chiefs or sectional heads like ward heads and heads of households. VILLAGE ivIEETINGS/GROUP MEETII{GS: These are very effective channels for information and were very much utilized by the prqect. The project teams usuaiiy collect the <iates of vitlage rneetings or, iaunchings, or group meetings and usuatly assign the Heatth facility staff via the LOCTs to communities in orcier to talk tc them at the meeting sessions. The YHCs and CDDs who are now much more in number than before had been very useful in this aspect. RESPOI\rSE OF TARGET COI,IIv{IDiITIES/VILLACE Target Communities reslrcnded positivety as the demand for Mectizan was high ancl there is strong contntitment by the Statq LGAs and benefiting Communities ii the programme. ACCOMPLISHME}iTS The use of media and other local system of disseminating infonnation were very effective and gave satisfactory resuits from the target villages. The effectiyeness is reflected by the increased commitment of the cornmunit5r teadership and distributors attd the high degree of involvement of the cornrnunities and their rvillingness ro commute available local resources to the distribution process. Furthermore, there was increased respoltse fronr isoiate<i hanrlets, rvhich hitherto \vere rlor reached in the past. llr tv Y -!L WIIO/AP(J(-'. 24 i.rovember 2ti(,)4 WAYS TO IMPROVE MOBILIZATION AND SENSITIZATION OF TIIE TARGET COMMI]NITIES. a. Increased logistic support particularly motorcycles for LGA staff participating in CDTI implementation. b. Provision of bicycles for heatth centre staff and CDDs involved in the CDTI implementation to enable the.m cover the villages more effectively. c. Use of mobile public address systern for better outreach of the population. d. Repeated visits to the target group. ,13., -WflOiAPO(1. 24 Nt-,veniber 20U4 l= I'l&| lolsa (lc)oo= gE (D-. D'O ir(! Fd E' o)tD o* o o UFl e x- N %(\ \o s{ N o(\4 % .\ -lo -l r< 41 Xt o z oF -l A o frj Ed z u) tfr rrJF frlNN a oi -l +i frlNN zoF -l ;ri z.do Jr o FoN F NN x o U C q F \o\t(, ot\) o\ oo\ @ \oo\ oo\ \oo\ ot, -l E G ==ELo 6A XE _o!r 'i6-:AE P EI. e8t0- o z E G o I c< l!0 ::m)c).@ o< ao E o Ett ts \o{w Ot\) o\ Oo\ 6 \oo\ oo\ \oo\ oU) 2Ea7iEEE *re: E U qF E! \o -ItJ) Oo C) oo oo oO OO Oo OOoo 6 l! EN6 EE *ll tJ5 s o\oo b'J5 N)N) u) \o s}J N)\o o\o\ u)I'J 3lc G o L', !9cd' z ot o =a ^ts== G lJt m 'Jro\ +\o oo O(, u.)5 {t.J o\ -l ttt s -i o\A *tJ{ U{ -I t.J t\)(Jt s{ oc t-) \o t'J t, '.oo\ a E I l0 +t! (, -.1 tsJ IJ bJ IJJ L'! I ^r UJtJ (JJ - l tJ tJJ (n + 3.? z s;E gYE EE PPg JZ oa i, =.I G.Y li5dtrAE. ou 5 L '*.) ooi, (j) o\ (Jr UJi.(,r s :J UJi UJ UJs ia LJ N) [-r UJ !^ Lar t\) s o gE(! EE FYtil ,o o >H (!o 0rO o.. o oE *(D' o o ori v) o+) (D o o Ol (D A, (D a. c, F' o oo oao HH6lraro(DA' +id EEoo.(/:t)qA ;+o =(!oo 8+r Ef6rO'T<Ko=5oO\ts o\o\O5 O\P ^o9oF1 r-t aq(D;i otiRo -.)o9UdU3vrc 04 (t'- !OrO D,' 5 o-ts @\ +5 9-65gotr' >Y oo -0OH +B +OooF+F ?o (Ia=(nE o9 Er6 ^ra< yi' fi!D iri'* =a t!o o8 (J(} f+) (D. - o (D (D b 5 otFU o r) N)s ,z o o o'(DE tJO - t FEMALE ATION IN CDTI Today, decision-making as to thehow md method of Ivermectin distribution in the community is entirely community dfuected. The performance of fernale CDDs in many instance are quite impressive and a times, not only better than that oftheir male counterpmt but quite outstanding. Females also participate in village decision-making meetings though their number has always remained low. In some instances, distribution of Ivermectin during the evening hours affects female CDDs performance. This is because; females generally use the evening to prepare their supper. INCENTIVES PROVIDED BY COMMUNITIES FOR THE CDDS: A total of 40.89/o of the 973 Communities treated provided incentive to CDDs in either cash or kind. The project believes that the number could be more than 4O.8%o because of the poor reporting from the community level. ATTRITION OF CDDS: IS ATTRITION A PROBLEM FOR THE PROJECT? IF YES, HOW IS IT ADDRESSED? CDD attrition is not quite significant. Only in few cases as a result of death, new ernployment or population movement can one experience change of CDDs but as stated above, this is not significant to cause a problem. 2.5. CAPACITY BUILDING Describe the adequacy of al.ailable knowledgeable manpower at all levels. Personnel involved in CDTI activities in the State were trained at three separate levels. These are A . The State level - Training of LOCTs B. LGA level - Health facilitv staff C. Village level Training ofCDDs It is necessary to point out that trainings undertaken were not routine but targeted on specific areas like planning, drug determination, census update. record keeping etc. As a resuit of the number of Community Directed Distributors to be trained in the project area, CDD training is tuostly done at the nearest Health facility rather than the community tevet. The project's annual training objective and percentage of the objective achieved are shown in table 5. The percentage objective achieved is quite high and met the training targets. t I 16 WHO/APOC- 24 November 2003 (u) (b) Besides, the issue of frequeat transfer of trained Health service in the 10 endernic LGAs is not frequent. Also, not less tha 80% of the total Health Staff in the LGAs are already trained on CDTI and issues of transfers will not affect the Programme implementation. TRAINING MATERIALS: Types of materials developd and used for training health Staff and CDDS. Materials were developed by the project and used in training health staff and CDDs. These materials include: POST AND PRE-TEST: They are used to assess the effectiveness of communication of trainers on the course of training. and also an instrument for evaluating the knowledge of the trainees before and after haining sesslons. POCKET TREATMENT GUIDE: This is used as a reference material for LOCTs, DHS, HFS and CDDs with a view to understanding: (i) What Onchocerciasis is (iD Their roles in Oncho. Control (ii) The CDTI concept (iii) The difference between 'C' above and the system formally in place. (i") Communitymobilizationstrategies (v) The new integration initiative TREATMENT TECHNIQUES AND MANAGEMENT OF SIDE REACTION FLIP CHART: This is a training material diagrammatically designed to ease teaching -learning process (d) Samples of meastning stick and village treaffnent registers. (e) Radio and television jingles (Reversed edition in both English and Local languages) (fl Audio-visual materials (g) Hand bills in iocal languages (h) Mectizan talUsummary sheets l+ WI-IOIAPOC. 24 November 2004 CALENDAR: Year 2004 calendr were printed md distributed to all concerned. Necessary messages that capfure the eye were clearly written. Also pictures depicting the r:langers of the disease as well as expected outcome for prolonged treatment with mectizan were clearly printed out. The outcome of the perfonnance of health staff and CDDs in the pre and post-tests indicatsl a significant difference between the pre and post training knowlulge. This therefore, justifies that CDDs understood their roles in the implementation of CDTI. The following are rrecessary to continue iuproving tlre qualiry of training of heal'tli staff and CDDs. (u) Coritinuous use flip chaits, and other iEC uirterials priiited in locirl lariguages and used during trainings (b) Printfurg of posters in locai l:urguages to sho*- netrJ f<rr sustairitxl treatttent. i8 WHOr'APOC. 24 November 2003 -lo E EEE6 o EI Ed o z t-t a E't-q EINN a o sts rflNN zoFFl F o z. o *r o +r oN fr NN F{ o G $.o t-'o o\o o\ o\ o\o\ o\ O, o\ o\ o\ o\ t _q z)lir-t o +\J A,A (Dt1ra rr o o o E t4 oo o o ooo o ooo =t o\ C\ 01 C\ o\ o\I t o\o\ o\ o\ ,# + o\oc rO 6\ o\ o\ a o\ o\ o\ o\ o\ o\6 .Q^-'+ L, o' oilE t'Js9r t') -J N)A oo N} N)tg N)s b.) -l n) IJJ(J.) UJN) z EIr oH) H *r tD A) o(D o .\ oo o tr .r ...1 i x\r -Q.^,-r+;,9(1rr a a o oI I o o tJsUr tJ\r s oo N t'.)t-J l-Js I.J{ tj)r$bJs IJJtJ NJso rO o\ hJ{ t\)5 oo t\) N)N N){N'5 t,(].)N)o\ IJJ\J Ur o Ur (Jl UT (Jr (JriUT Ur (Jl (Jr Ur url z sldP.r ot9,9 .(DErOslJaiq'l'v5 tq o +) o o o o o *r ^' 9t (n (.}.| (,l (n (,l (, Ur (i (, t.,r n: rrt c 10o\ (Jr lJr (Jr (.,r 9r (,r (Jr (.,t Ur (Jr o6. O! r)ilL \os o\ rc o\ TQOs N)NJ tJ tu UJ tJ N)N \c)t\, o. I t\) E IJ N \ot9 O tJt')t\) ---! t\) o\ f.) t'J -J o rt .o zF HrH o+ o H .-4 l! oa -I \o s sNN) -I N)O N o\ -Ih- N) a!:;'s t'J -l \o \ l..O { -l tJ l-,) L,I -I NJ \o O NJ(, ( ai ^q ; lFl lD)ld lo t, - ;H 0, i-) oq 0) o. I!(I' -o o o a oFt o U -l E o H (D H F'+ 6- Nh(! *{ rd q \ o 4h \o =E t o t) l-)5 6- (D (D Trainees Type of hainine CDDs Other Commmity members e.g Cormuuify supervisors Health Workers (frontline health facilities) MOH staffor Other Political kaders Others(speci&) Program management No No Yes Yes No No How to conduct Health education Yes No Yes Yes No No Management of SAEs \res No Yes Yes No No CSM Yes Yes Yes Yes Yes No SHM l\In Data collection Yes No Yes Yes No No T\^a^ ^-^1.,^:^u4la au4rJ )r) 1\() rgb !/ - -I9S 1\U 1\U Report writinp Yes No Yes Yes No No Others (specifo) Table 6: Type of traiuing undertaken (Tick the boxes where specific training was corried out during the reporting peiod) 2.6.i. TREATIVIENT FIGLJRES The number of people treated in Ebonyi State within the period (January to December 2OO+) is 494.183 persons. The project's Therapeutic Coverage rate (TCR) against the total population of endernic villages in the State (577658) is 85.s% while all973 CDTI viiiages rvere treate<i thus attainin g i0lYo Geoppaphicai Coverage Rate (GCR). ZU WHO/AI{X-'. 24 I\ovember 20U3 { o{ F P F B zo3lr o rn E El @ (, c rrlNN 8s a t It EI N N zo =It oF .) EE o !eoNsHp g Fto >Uha >5. c) \o -Jur t-) o\ o\ 6 \o o\ o o\ \o o\ o H(! 5 < O 'l --aH =g e,HE$EiPE E.3:+g ? FE a@\ o 5 (} 0)0at! @ I \o{ Ot.) o\ o\ @ \oo. o\ \oo\ t, C"J>.x-g Exhdgrb <Qop \oJ(, oi.) o\ Oo\ @ \oo\ o\ \c O(r, zd oI oF+) ao TJ5 d oa (D;. +- efi U \o o\o \oo\ \o O\o a s o\o \o \oo\ o s s;* .<6 :-1 ai#Eotr. ED \ll * {{g\ CAIJ\o 6 o\ @ @ t\o u,N o\ t-J oo so\O oo \o { -Io\ u, o\ co o\ IO \o+{ gtssEi *fi "i s J\ 6(a 3. P6 Egr g U FUofo s) o s{ 6s\o NJ t.Js\o @ 'vlr o\ tJ(,J -Jo\ {(, 6 \6 stJ5\otJ o\5A cc oO -tNJ J -.1 -Js O*l>dil EJ 6p= ).1F$ U6 s\os 0p s o\ \o Ooo { o\s 5\o t'J $ ooO 5 @ o\ t-J * \t6t\) { N) mN) @ a 1v NH =H69E;f -@ @ !^ @{i, -J \o b {?\] @poo @90 6:J @9 -Jts @\o5 -:o Fll\o #JO C0<= Elduatr(DE *\ ll t-) { { t-) { \o t)& Erri! <a).-! d *-d 'aA E O? EH & arij 9rpq {\t oo t-J -J{ { \o tJs tJ5 qfia2-5:ioi, O O O O O O o> -7 "i;rA1 o E rq?E.E 3:+=gl>;x.5 B F d Uti n *a-'-+E.a9o *:d+,F*H l*l ls l6- l-r -lts6 A) i(D Ba ro lnq(t o. q 3.o F FD 0l a OD ,f e "1G a. o\a d dq\ Go$ s Ittla Elg l;lr lo HE E lFlo Hlc ,3- l3 IEl4 to 18la r IE lE lelo IE lca 6,F66q93 IEB9 ^o ^6SL Sq -q -vvd ojjGr60 1E o Fl o o -t5ts !! \s dqn6sr6+ i:o$E ts- I = o F\ TI?:IE$ ix-IE rt tlE' T E.E S ei5 E'B IAI- TH ^ ^l*i +lxI El=1\' QO QO ndii: uBic .or ritr r.= lo jY-Ltr. sti TH S6 :.E .iE Ns --E !E a ,l o :F AN S: qj -it =s rd qJs sI SEGf,Ss L* a{tr3\G.Oq.i} gX s<th sx\xds .\' * o\3s b o s9 d x\- Q E. G a = \a ... = E tJ \< ts a- S s +\ 'ci 0q d x s o a 09 6 r's x€ tJa :t de -.'@: IJ: tv tvlb lEtL t--ti ti dls ,18EIE E IS eiE riTBE EIe rE iE1l& 9l*P lE -l-E 13 =:186t. llFlc mnto ='EIF Egix E ir lQ iz ti Ii8E Eti E:OcOAE Etr6=. B6 Ft e J_.(a E'Fc. z =t' *a Btr €. 2 6 lz Itr IPlc l{ rE E t9.Lto slB HF Bl- (J IOg 6 *. ll il 2.6.2 Whet re tLe cruses of ebscntcehm? Cases of absentedsm is negligibte but reasons me always due to havels and farm work 2.6.3 What rrc the relsons for refusels? Refusals occur as a result of previous reactions- 2.6.4 Briefly describe ell known end verified scrious adverse events (SAEs) that occurred during the reporting perbd and provide (ln table 8) the required information when available. There were no cases of serious adverse evelts. & In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report flq WIIO/APOC. 24 }Jovember 2004 th 2 * z o z o 0c o (A ox -] Fi 9<oa= bd6(} i ETF *NOE 6baHiJ <Y! riHo-=oo9 .r F- x.5- E F - Fg F HE o F$E F'(D E s Fa oe@ - 6\:Es ; Ero ^ o o o sD' i' E t,o9@p g6bO -(D!?+) Ed F tsE h al.q -G@ X+ ko (fc6' E^ @plnc o ooHE5X e..l @EE H obE -s-!j !.8i.)E]mo00 ^ - tr F l! tal ?E>e5[ -GU o l-l la)lcr l(D lm : o,tn o v) o+) U)or-t o q) g, o. oH(h o(! a V) (A rn D) () o Hit (D o- o. J.H oc o BoFd oH 0q o t G D4 a \$- rS\ s G a$ % a * w(!\ S s. a\ .U Sr s N) L)J I n o != o? TJ5 o @ d e tJOoA $O c.l ku !I 6) o z + at dI !r F $CI Eq)E H '.{-i O)o trr(Ao HE id= H hI)0) t{i €tr(HO oE o5 'ds FT (Jt.q 6E() (!X 0)-2E COC,J(J i1 6)qEt rl-(l 3ESl-rx gE .,n ()tr q)'jfo .r)L .-i .i .LiAE E1.o rzr (ul'r\L 'd:E s(!d;^ o)=YEEHg '13 H'itr.q Bo\J oPoltr -S q.) s€s *'d o.)uL' '.=if '=oo) E boHEE6(: >lE l.j .d q) o 0)-Qt<9I cd- .iUtrotrE€ CU €uo oiI 9(g (! q,l no€ trd ts.= €f=(g q) = .h,.9 <.rPl-)l -'-'1 HUFOr--= -dcutr=Lbo= H\J u U' c 6 c| 6lo (9 E!!l6t *9r>\olu(, .: rttL.P i.J -i cn \GI ritr F-trsq, 9E Gqo gg EH 9u.' 0Joa2 uv lr O\ .osH6)ru$ .r 6I =l 6.) 6il P -r cldl ool --t oali!I 6r.>oO lrr;Pcr eo o!darl<5Ecs9) ll etl ol ol eA el u Fl Fr F a 6) bo E e5 -c O q & F-. di6 a .r; @ a- r- @ ra) oio\ t-- +O o cd oA Q de ri o6 tr ti;€ o al 6 t*-. € a r-, a- ca c? o\ o\ r- +o Gq '5o9boo d^ qo Fr a? oc\c) n OC \t? @\o r- t: o. c- n € -aE ,o *Q a5EoEE2t 'q Ci €I\ o\ \o m C{ co o\ a.)\o$ r- C.t \o \or-N o\$ t-.r-(--ON 6 $ o\sf =o! i'rlFloE=o r/ tl, .b' \o c.t <- t\ ar)rt t\ <- rl-(\i \o c'l N o\$ € t-'t !x .,8v xo - E FEd'= o 4., - = = i*.=.-i L=-OE ' d. 8PE EH \o o\ c-\o oI .:\ t-- a.t r- c\ \o @ c-t-- C) o E Eo I lrt tF rL r'l o ^bo() d^ 4>J sO sO sO O sOO sOO sO f=f,aii Fts5 3gr,1rn Oqrr) s U x O N U ;< O HEa.2fr^ E E 3OE '. tr= iJE EI! ,a6 ('- t-' o\ F- r- t-.o\ t--o\ 2oE U.'EEE ) 'p "D'FU t- i- !t- N t- *l(! =a:t.,dH.t O Q P E qE h-: a.E.s <'E d A I C 6 ii r: E o 9i tro oo r- F- t- c- c-o, t- r', E] o\6I o O c'l o N c.lOo ot OO oa \tO Ct ln 2.7. Ordering, stonge rnd delivery of ivcrmedin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answe) MoH fI wHd TiNICEil NGDO Other (pLease specifu) Mectizan@ delivered by - Qtlease tickthe appropriate answe) MoH E wHil LTNICEII NGDO Other (please specify): Please describe how Mectizan@ is ordered and how lt gets to the communlties Mectizan request is first obtained by the rough estimation of the total pollution of each of the 973 endemic vill4ges by the FLFIFs & CDDs. Each FLF{F collates the entire drug requirement by the villages within the Health Facility and forwards same to the LOCT ilc. LOCT collates request from all the FLHs and forward same to the State. Request for Mectizan for the State is made by the Project to the NGDO Zonal office of Global 2000 from where all the requests for other State Projects are collated and forwarded to the NGDO National oflice. The butk Mectizan requirement for the Global 2000 Assisted States is collated and forwarded to the NOCP for the ordering of Mectizan from MDP. Drug is delivered in the reverse order according to the request made by each of the segments. Table l0: Mectizan@ Inventory (Please add more rows if necessary) StatelDistrict/ LGA F{umber of Mectizent t"b["tt Requested Rccelved Ils€d I-ost Wested Erplred Remelnlng Ikwo 219522 2t76tO 2t76tO 0 0 0 19t2 lrui 216951 2 1695 l 2169_s l () o 0 0 Ohaozara 94800 94800 94800 0 0 0 0 Gnicha ls33 I 4 I y-)-; i r I933 i4 rr 0 n n Eza North 127476 t27476 127476 0 0 0 0 Eza South ttt857 I I 1867 I i 1867 U 0 0 0 Ishielu l57l 28 l 57128 l 571 28 I I 0 0 0 0 Ebonyr 98t 19 98 ll9 981l9 0 0 0 0 ivo 9749+ 97494 974e4 0 0 c 0 Afikpo North 96300 96300 96300 0 0 0 0 TOTAL t4t297t l4t1059 141 1059 0 Ii 0 {, t9t2 15 !Ytlt/Al-\r\. z+ l\ovcmDcr ziiii+ - IIow ere the remrfoiing ivcrmectin ttblets collected end where are they kept? The rernaining tabl€fs are are collected through Health Staff ard sent to the State from where it is sent back to the NGDO from where they are reassigned to the Project' - List and briefly describe the activities under tvcrmectin delivery that are being carried out by health Gare personnel ln the proJect area' The foltowing are activities under Ivermectin delivery that are being carried out by Health Care personnel in the Project Area- o Community mobilization and Health Education o Training of relevant personnet involved in Ivermetin delivery o Distribution/Allocati,on of Mectizan to either fellow health staff or CDDs o Supervision and monitoring of Mectizan distribution including poputation udate o Collection of Mectizan from upper levels o Recording and record keePing o Execution of other health activities in combination with CDTI. 2.S.Communityself.monitoringandStakeholdersMeetlng Has any training (of trainers) for community self-monitorlng been done in the proiect area? If so, when? Health Staffwere trained irl 2002 on Communify Self Monitorfurg' Table I l: community self-monitoring and stakeholders Meeting (Add rows iJ'needed) 87 54 87 DistricU LGA Total # of communities/villages in the entire project area -No of Coulmrnities that l carried out self monitoring(csM) No of Communities that conducted stakeholders meeting (SE!4 ) II{WO IZZI OHAOZARA 103 1il 96 69 84 52 ONICHA 106 77 64EZZA,NORTT{ 96 59 EZZA SOUTH 81 63 69 52IVO 62 44 EBONYI 106 74 8l ISHIELU I tI I 79 79 AFIKPO NORTH t02 63 65 715TOTAL v73 664 .1fi {\J WHO/APO(.. 24 Novon.rber 2(tCt4 IDescrlbe how the remlts of the communlty seE- monitoring end stakeholders meetings have effected prolec.t hplemcntrtion or how they would be utllized during the next treatmcnt cych. The results from the community self - monitoring and stake - holder's meeting have positively a{fected the project's implementation in the State. This is because findings during evaluations provided the situation of things with regard to the prograrnme. These situation results are often discussed during stake holder's meeting and the main concerns raised addressed. The final outcome is better quality CDTI implementation. 2.9. Supervision 2.9.1. Provide a flow chert of supervision hierarchy. NG\ NOCP SOGT MOH LOGT {- PHC DEPARTIITENT FLHF I GDDS GOMMUNITY LEADERS}IIP SIMPIE SUPERVISION MECHANISM OF CDT( ACTIYITIES IN EBOTNY STATE I I 9+ WHO/APOC. 24 November 2004 2.9.2. What were the mein kmes Hentffied during upervkion? The main issues identified during supervision include:- a. Inaccurate population registration b. Poor recorrd keeprng/ data management c. Complaints of non-release of counterpart fturd by LGAs for LOCTs and IIFS (only in 2003. d. Failure to use already prepared supervisory checklist e. Complaints of inadequate/or absence of transport facilities f. Failure to use appropriate IEC materials supplied 2.9.3. Was a supervision checklist used? Supervisory checklist were developed and used at LCA, FLItrs and Conununity levels However, there are instances checklists were not used- 2.9.4. What were the outcomes et each level of CDTI lrnplementation supervlsion? The supervision afforded the supervisors opportunity to address the issues highlighted on 2.8.2 above. On the-spot corrections were made and better quality CDTI activities were put into place. Overall treatment coverage per village remained high. 2.9.5. Was feedback given to the person or groups supervised? Supervision is carried out in the presence of the supervised. The supervised was always corrununicated both orally and in writiug on the findings and necessary rneasures to undertake with a view to improvement- 2.9.6. How was the feedback used to improve the overall performance of the project? Outcome of the supervision was cofilmunicated to the supervised and necessary corrections made. This has resulted to better data managelnent, improved data entry and overall quality programme implementation. 9E WHOiAPOC. 24 Nl-ovember 2tjti4 SEGTION 3: Support to CDTI 3.1. Equipment Tabie 12: Status of equipment (Please add more rows if necessary) Source Air conditioner Genemlor Functlonrl Non functional Functionel Non functionel APOC' I (l I 0 MOH NGTX) I 0 0 o 0 rr 0 0 *Colditiou of the equipment (F:Functional. CNFR{urrently non-functioual but repairable, WO=Written ofl. How does the project intend to mafirtain zurd replace eristing equipmeut and other rnaterials? The State and LGA have since 2003 undertakm the replacement of capital items Source Vehlcles ComJrutem Prlntqs Frr mechlnes Functlonal Non functlonrl Funcflonel Non functlond Functlond Non funcdonrl Functlonal Non functlonal APOC I I I MOH I 1 I NGDC) Source Motorcvcles Pholocopier 'fY/Video mechine Refrigerators Functlonal Non functionel Fumtlonal Non functional Functbnel Non functionsl Funetlonal Non functional APOC I 4 0 I 0 0 0 0 MOH 5 I 0 0 0 0 I 0 NGDO 2 4 0 0 I I 0 0 qs WHO/APOC. 24 November 2(t04 t Fct .8I 6) oz\tN :1g B @ -l € t\ <t t- lt\o =l a{ \o do oldl vt f,/ E0 a 0d oF E ri cl o tt ! IE 6 6 +, o E E sa E E ortsI c si: o\ al Ea'a E -gEvt d=a' * (5 'S5E o a la !o o o e oa o € € I oi a.t +9\o ol dn? D Fr €cl oO rl tr =ts \o c.t r-ioo al <r c3o o& a-. € .l \oi cl O rc+ 4 , Eq L t- € D.. O a.l o o o Fr o O o cI r-r- al !o o{ tq QF O eO -C -+ I € O at OO a.l ci o Eo od E F. oo{. c,i O € fl oi a{ O oI c-.1 ..1 N o{ cq otr cl 6 a.t N cl CI c.l o\ o\ o 4 o o4 .o O<f ci o <lor- .t € .l !o o F" O C a!1 @@q I J ^oUtr !Jh Y.* oz a t's cts o 3 Y 5U E(, EF Y2 ^=}A a J I 3. SUPPORTS TO CDTI Table I I contains a breakdown of fte contribution by the various partners (in US Dollars) for the years l-5. An interesting issue here is that communities and LGAs make contribution to CDTI. It is also necessary to note the following:- (a) APOC contribution as reported for the l"t to 3d years are the total contribution to Enugu/Anarrbra./Ebonyi State's Project as one block. The money was not split among the component states. The provision for the 46 and 56 years is as it concelns Ebonyi State only. (b) There has been no firnd from APOC since October 2003 to Decemb€r 2004. The entire CDTI activities executed have all been with State/LGA counterpart fimd. (c ) There were delays in the release of fund from Ministry of Health and Local Governments. These poble[rs were addressed by repeated advocacy from the NGDO and state team. 3.2. OTHER FORMS OF COMMTINITY SUPPORT INCLUDE. (a) Food to CDDs during distribution (b) Free land allocation forcultivation (c) Yams, rice and other food items (d) Exemption from corununity levies (f) Nomination for appoinbolents as Councilors or LGA Chainnan 3.4. Expenditure per activiq/ - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate erchange rete us€d here; $1: Htl32 Table 14: Indicate how much the proiect spent for each activity listed below during the reporting period Activity Expenditure (s us) Source(s) of funding Drug delivery from NOTF HQ area tocenhal collection point of coq qryry Mobilization and health education of corrmunities Training ofCDDs health staffat all levels and distribution activities visits to health and authorities IEC materials !_q*!qgry{._"pq1["gl!orm-_&t_f_et@Sn!_ VehicleV maintenance _O_ff ige__Eaurpgglt_(g.g_cgtrrgr!g!s,pmryge_lql Others 2325 LGA MOII/LGA LGA MOIYLGA 1t62.9 2300 1493.1 95s 500 250 200 roo 1250 9550 i irs MOIYLGA MOII/LGA MOIVLGA MOIYLGA MOIYLGA MOIIILGA MOH MOH TOTAL 19076 MOTYLGA Total number of persons treated 494183 Exchange Rate: $l : i+132.00 3t WHO/APOC- 24 November 2004 SECTION 4: SustainablliQr of GDTI 4.1. Internal; inde.pendent pmticipatory monitoring; Evaluation 4.1.1 Was Monitoring/waluation carried out during the reporting period? (tick any of the following which are aPPlicable) Yea I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other parhrers a' 4.1.2. 4.1.3. The Project was not monitored during the period under review What were the recommendations? Not Applicable How have they been implemented? Not Applicable 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the proJect evduated durlng the reportlng Not Applicable Was a sustalnabtfltY Plan wrltten? Not Applicable When was the sustolneblttty pten submltted? Not Applicable What arrangements have been made to sustain CDTI after APOC firnding ceasqs in terms of: 4.2.1. Planning at all relevant levels Sustainable CDTI Plans for post APOC period have been developed at State' LGA & Health facility levels. Communities have organized structure and system that has plans to continue Mectizan intake after APOC Period' 4.2.2. Funds The plan referred to on 4.2.1 has budgetary provision for the various parhrers/levels 4.2.3 Transport (rephcement end maintenence) The project has comrnenced replacement and mafurtenance of transport facilities with fund from the State and LGAS. More so, adequate provision has been made with other projects like Health Systems Development Froject (HSDP) - a World Bank Assisted Project to provide some capital equipment' 39, WHO/APOC. 24 November 2004 I4.2.4. Other resources Adequate arrmge,me,lrts have bee,n made for other resources for the programmes sustainability. 4.2.5. To what ertent has the phn becn implemented The three year post APOC plan has been imptemented successfully for the l't year There was no fund fiom APOC and the supPorting NGDO to the Project. The prograrnme still went on well because of the strong political commihnent by Government at the State and LGA. 4.3. INTEGRATION Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: There is integration of CDTII into the PHC structure in the State. The Drector of PHC is the supervising Head of CDTI activities at the State tevel. All the SOCU team members are Staff of PHC Department. At LGA and Health facility levels, all the staffare PHC staff while therei s inter-prograrilne usage of resources and staff. 4.3.1 IVERMECTIN DELIVERY MECHANISMS Distribution of Mectizan within the Health service follows the PHC structure of the state to LGA PHC to FLTIF to community. 4.3.2. TRAINING: Training are a times integrated as two or three prograrnme officers plan for joint training at LGA and Health facility levels to minimize cost. Also, trainings are not routine but specific and targeted in area of need. 4.3.3. JOINT SUPERYISION AND MONITORING: There is inter- progmmme supervision and monitoring- 4,3.4. FUND RELEASE: Fund release has been a diffrcult area in Integration. Each project has budgetary provisions in the State but not all (infact few of the) programmes eventually receive fund. It will indeed be difficult to integration firnd usage because of accountability problem- Rather resources like staff and equipment/facilities are inter used. 4.3.5. CDTI IN PHC BUDGET: CDTI is appropriately accotnmodated into PHC budget. WHO/APOC. 24 November 2004 43.6 OTHER PROGRAMME USING CDTI STRUCTURE: Other programmes using CDTI strucfires include Guinea Worm Eradication, National Programme on Immunization, and Nutrition Programmes. Since one programme offrcer at LGA and Heatth facility co-ordinates two or three of these programme, the issue of prograrrme integration appear easy. Also at the village level, one CDD uses bicycle provided by Guinea worrn prograrnme to distribute mectizan while the same CDDs are used as village guides during immunization campaipps- The achievements have been that it has made the project coordination easier and less costly. 4.3.7 . Describe others issues considered in the integration of GDTI. Integration can be Inore successful if there is joint funding' 4.4. Operational research 4.4.1. Summarize in not more than onehalf of a page the operational research undertaken in the project area within the reporting period' No operational research has been undertaken in the project since inception. 4.4.2.HOWWERE,THERESULTSAPPLIEDINTHEPROJECT? Not Applicable I t 3+ WHOiAPOC. 24 November 2004 ISEGTIOI{ 5: STRET{GilI|S' WEAKNESSES' GHALLENGES, AND OPPORTUNITIES + - List the strengths and weaknesses ofCDTI implernentation Process. STRENGTH . The strong potiticat support which has translated to continuous release of counterpart frrnd on yearly basis. . The present approval for LGAs annual contribution by Executive Governor r Commitment of well lettered State and LGA Oncho team members. o Availability of literate CDDs o IJse of CDTI as a vehicle for delivery of other Health Services at Community level e.g. Guinea worrn eradication, polio campaign etc. o Availability of basic office equipmenUfacilities o Commitment of some communities in supporting their CDDs. WEAKNESS o Non-effectiveness of Primary Health Care System o Non-Provision of support to CDDs by many villages o Absence of fravel logistics for LOCTs and IIFS to take care of Large and scattered settlement. List the challenges and indicate how they were addressed. - Absence of bicycles for District Health staff and Health Facility staff and some CDDs who live in areas of scattered setttement- - Villages now have added responsibility because of increased CDDs. - Non release of approved firnd for the 66 year by APOC - Scattered pattern of settlement in some communities. - Poor road network throughout the state. 1( WHO/APOC. 24 November 2004 SEGTIOil 6: Unique features of ltre proiecUother matters The Ebonyi State CDTI Project which has just concluded its 66 year ofr CDTI implementation has succeeded in institutionalizing Community Directed approach in the delivery of health services to the inhabitants of the state especially those living in Onchocerciasis endemic axeas. The Project has bee,n able to carry political leaders at both State and LGA levels along. The peopte are quite receptive md accommodating hence the success of the progmmme is attributable to the willingness and proactive attitude of the people. The Project has planned to integrate other aspect of heath care delivery into CDTI. Such Programmes like vitamin A supplementation, Lymphatic Filariasis elimination, Schistosomiasis control and reproductive Health services. It is expected that the relevant partners wi[[ continue to provide needed technical and financial support. 1 76 WHO/APOC. 24 November 2004 ti 3. SUPPORTS TO CDTI Table I I contains a trskdown of the contribution by the various parhers (in US Dollars) for the years l-5. An interesting issue here is that communities and LGAs make contribution to CDTI. It is also necessary to note the following:- (a) APOC contribution as reported for the l"t to 3d years are the totat contribution to Enugu/Anambra/Ebonyi State's Project as one block. The money was not split among fte component states. The provision for the 46 and 5th years is as it concerns Ebonyi State only. (b) There has been no fund from APOC since October 2OO3 to December 2004. The entire CDTI activities executed have all been with State/LGA counterpart fund. (c ) There were delays in the release of fund from Ministry of Health and Local Governments. These problers were addressed by repeated advocacy from the NGDO and state team. 3.2. OTHER FORMS OF COMMUNITY SUPPORT INCLUDE. (a) Food to CDDs during distribution (b) Free land allocation forcultivation (c) Yams, rice and other food items (d) Exemption from community levies (f) Nomination for appointments as Councilors or LGA Chairman 3.4. Expenditure per activitt/ - Indicate in table 14, the amount expended during the reporting perid for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate erchanqe rate used here ; $l: l{132 Table 14: Indicate how much the project spent for each activity listed below during the reporting period a 4S!i"ity Expenditure ($ us) Source(s) of funding Drug delivery frorn NOTF HQ area to central collection point of Mobilization and health education of corununities Tlaining of CDDs health staffat all levels CDDs and distribution Internal q19g!tgrin_g ofCDTI activities yiqrts_ts lqqlt and authorities IEC materials forms for keatment Vehicles/ maintenance Others 2325 1162.9 LGA MOIYLGA LGA MOIYLGA 2300 t4g3.t 955 500 250 200 300 1250 9550 1il5 MOIVLGA MOIYLGA MOIYLGA MOH/LGA MOIYLGA MOIYLGA MOH MOH TOTAL tgw6 MOTYLGA Total number of treated 494183 Exchange Rate: gl: |S132.00 1l WHO/APOC. 24 November 2004 Cff"q Eqglpqg"_t (e_,g ggqrpgters, printers etc) &yggrqv SEGTION 4: SustainabiliQr of GDTI 4.1. Internal; indeperrdent pmticipatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which me applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other parfirers a a 4.1.2 4.1.3 The Project was not monitored during the period under review What were the recommendations? Not Applicable How have they been implemented? Not Applicable 4.2 Sustainability of projects: plan and set targets (mandatory at Yr 3) Wastheprolecteveluateddurtngthereportingpertod?-NotApplicable \tas r sustalnebllity plan wrltten? Not Applicable When was the sustalnabtllty plm submitted? Not Applicable What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.I. Planning at all relevant levels Sustainable CDTI Plans for post APOC period have been developed at State, LGA & Health facility levels. Communities have organized structure and system that has plans to continue Mectizan intake after APOC Period. 4.2.2. Funds The plan referred to on 4.2.1 has budgetary provision for the various parbrers/levels 4.2.3 Transport (replncement and maintenance) The project has corrunenced replacernent and maintenance of transport facilities with fund from the State and LGAS. More so, adequate provision has been made with other projects like Health Systems Developrnent Project (HSDP) - a World Bank Assisted Project to provide some capital equipment. 2,',1 WHO/APOC. 24 November 2004 a a II 4.2.4. Other resources Adequate arrmge,men8 have bee,n made for other resources for the programmes sustainability 4.2.5. To what extent has the plrn bcen implemented The three year post APOC ptanhas beor implernented successfully for the 1" year' There was no fund from APOC and the supporting NGDO to the Project' The programme still went on well because of the strong political commitnent by Government at the State and LGA- 4.3. INTEGRATION outline the extent of integration of cDTI into the PHC structure and the plans for complete integratton: Th; is integration of CDTII into the PHC structure in the State. The Director of PHC is the supervising Head of GDTI activities at the State level. Atl the socu team members are staff of pHC Department. At LGA and Health facility levels, all the staffare PHC staff while therei s inter-progrzrillme usage of resources and staff' 4.3.1 IVERMECTIN DELIVERY MECHANISNIS Distribution of Mectizan within the Health service follows the PHC structure of the state to LGA PHC to FLF{F to community' 4.3.2. TRAINING: Training are a times integrated as two or three plogmlnme officers plan for joi't training at LGA and Health facilrty levels to minimize cost. Also, trainings are not routine but specific and targeted in area of need' 4.3.3. JOINT SUPERVISION AND MONITORING: There is inter- programme suPervision and monitoring' 4.3.4. FUND RELEASE: Fund release has been a difficult area in Integration. Each project has budgetary provisions in the State but not all (infact few of the) programmes eventually receive fund. It will indeed be diffrcutt to integration fund usage because of accountability problem. Rather resources like staff and equipment/facilities are inter used' 4.3.5. CDTI IN PHC BUDGET: CDTI is appropriately accommodated into PHC budget' ??, WHOiAPOC. 24 November 2004 4.3.6 OTHER PROGRAMME USING CDTI STRUCTURE: other prografrrmes using cDTI stnrctures include Guinea worm Eradication, National Programme on Immunization, and Nutrition Programmes. Since one Programme officer at LGA and Health facility co-ordinates two or three of these programme, the issue of programme integration appqr easy. Also at the village level, one CDD uses bicycle provided by Guinea worrn programme to distribute mectizan while the same CDDs are used as village guides during immunization campaigns. The achievements have been that it has made the project coordination easier and less costly. 4.3.7. Describe others issues considered in the integretion of CDTI. Integration can be more successful if there is joint funding. 4.4. Operational research a a 4.4.I. 4.4.2 Summarize in not more ttran one half of a page the operational research undertaken in the project area within the reporting period. No operational research has been undertaken in the project since inception. HOW WERE THE RESI.LTS APPLIED IN THE PROJECT? Not Applicable t ?A WHO/APOC. 24 November 2004 tt : SECTIOI{ 5: STRENGTHS, WEAKilESSES, cllALLENcES, AND OPPORTUNTT!ES List the strengths and weahresses of CDTI implementation process. STRENGTH o The strong politica[ support which has translated to continuous retease of counterpart fiurd on yearly basis. o The present approval for LGAs annual contribution by Executive Governor o Commitment of well lettered State and LGA Oncho team members. o Availability of literate CDDs o IJse of CDTI as a vehicle for delivery of other Heatth Services at Community level e.g. Guinea worrn eradication, polio campaign etc. r Availability of basic office equipment/facilities o Commitment of some communities in supporting their CDDs. WEAKNESS o Non-effectiveness of Primary Health Care System o Non-Provision of support to CDDs by many villages o Absence of travel logistics for Locrs and HFS to take care of Large and scattered settlement. List the challenges and indicate how thev were addressed. Absence of bicycles for District Health staff and Health Facility staff and sorne CDDs who live in areas of scattered settlement. Villages now haye added responsibility because of increased CDDs. Non release of approved fund for the 6m year by APOC Scattered pattem of settlement in sorne cornrnunities. Poor road network throughout the state. at ?( WHOiAPOC. 24 November 2004 )SEGTION 6: Unique features of the proiecUother matters The Ebonyi State CDTI Project which has just concluded its 6e year ofr CDTI implementation has succeeded in institutionatizing Community Directed approach in the delivery of health services to the inhabitants of the state especialty those living in Onchocerciasis endemic areas- The Project has been able to carry political leaders at both State and LGA levels along. The people are quite receptive and accommodating hence the success of the programme is attributable to the willingness and proactive attitude of the people. The Project has planned to integrate other aspect of heath care delivery into CDTI. Such Programmes like vitamin A supplementation, Lymphatic Filariasis elimination, Schistosomiasis control and reproductive Health services. It is expected that the relevant parbrers will contfurue to provide needed technical and financial support. I .- I a a 2,4 WHO/APOC. 24 November 2004