Community Directed Treatment with Ivermectin (CDTI), Jigawa State, Nigeria: report of the independent monitoring team

AFRICAN PROGRAMME FOR ONCHoCERCIASIS CONTROL (APoc) COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (cDTr) JIGAWA STATE, NIGERIA REPORT OF THE INDEPENDENT MONITORING TEAM AUGUST 2OO1 REcu 0 I 0cr. 2001 APOC/DIR Table of Content 1) Appreciation 2) Team members 3) Monitoring team 4) Executive Summary 5) lntroduction/Background 6) Terms of Reference 7) Maps of Jigawa State 8) Study site: Jigawa Srate 9) Methodology . Training . Sampling o Limitations in sampling 10) Instruments t 1) Results Ilighlight 12) Output Indicators 13) Input Results and Discussion 14) Observations 15) Communities perceptions 16) Sustainability 17) Strengths (Best Practices) 18) Weaknesses l9) Unique features of Project Area 291 Recommendations 2l) Annexes - F(jD, Instruments etc. I i ii r-2 3-4 4 5-6 7 8-10 t2 t4 t6-26 27-32 32 32-36 36-37 37 37-38 38-39 39-40 reciation The members of the monitoring team hereby acknowledge with gratitude the opportunity given to them by APOC to participate in the CDTI monitoringin Jigawa State, Nigeria. The team is also grateful to all those who contributed to the success of the exercise, particularly the National Coordinator NoCP/Nigeria, state and local government officials. Members of the Monitorin g Team 1) Dr. Y. Fayomi (Internal Monitor) Zonal Coordinator Zone C National Onchocerciasis Control programme 1, Golf Course Road P.O. Box 503 Kaduna, Nigeria Tel. 062-242533 2) Mr. Elisha Agagak (Internal Monitor) Helen Keller International 1A Akila W. Machunga Road Opposite National Ltbrary P.O. Box 6661 Jos Nigeria Tel.073-462672 3) Hajiya Bilkisu (mni) (Principal Monitor -Team Leader Crttzen Communications Ltd. 4, Sultan Road GRA P.M.B. 2334 Kaduna, Nigeria Tel.062-244165 E-mail - fomwank @ yahoo.cont II The monitoring team was assisted by the following persons: Remi Fayon-ri Osagie Ebuehi Data assistant Computer Operator Field Assistant Field Assistant Drivcr Driver Driver State Oncho Coordinator and several LOCTS List of Acro MS NPI - National Programme on Immunisatiott APOC - African Programme for Onchocerciasis Control CBM - Christoffcl Blindcn Mission LGA - Local Govemment Arca CDD - Community Directed Distributor CDTI - Community Dircctcd Trcatment with Ivetmectin NOCP - National Onchocerciasis Control Programmc SOCT - State Onchocerciasis Control Tcam LOCT - Local Onchocerciasis Control Tcam PHDC - Pubic Health Services and Diseases Control Teanr (l) Executive Surnrnary In August 2001, an indcpetrclcnt r.nonitoring tcam was appoinl.ed by APOC to monitor CDTI implcmentation in Jigawa State, Nigcria. Menrbcrs of the teant were, Dr. Y. Fayomi, Mr. Elisha Agagak and }lajiya Bilkisu. The purpose oIthe exercise was to assess thc irrplcmentation of CDTI in tlic Jigawa project which is in its second year. Thc monitoring team, using APOC designed monitoring instruments collected infomration on the n-rethods used in the selection of CDDs, and other aspects of community participation. Other infomration obtained lre thc trcatmcnt proccdurc, conrrnunity perception, quality of record keeping and health education given to thc comnrurrity, coveragc of treatment, integratiorr of CDII into thc PFIC, strcngths, wcakncsscs and prospccts for CDTI sustainability. The tearn observcd that CDTI has been intcgrated into tlre PHC systent. Horvcver, onchocerciasis officials at statc and local govcrnmcnt level combine their CDTI assignments with others such as irnnrunization and gencral health eclucation. In<leed, the onchocerciasis control progranrme is under thc Vector Bonrc Diseases Control Uriit of the Prinrary Health Carc Agcncy. An inrprcssivc aspcct ol'apprcciation and intcgration of thc CDTI is the lcvcl of laovernnlcnt's cournritnrcnt to pnyrrtcnt of counte4rart funding. So far the govenrmcnt has spent ,/.9 rnillion Naira on CD'l'1, 2.9 niillion Naira ntore than the APOC grant. This is an indication of willingncss on thc part of govemnrent to sustain CDTI at the end of APOC intcrycntion. On the level of conrnruuity participation in dccision nrakirtg, the tcam observed that the communities participatcd in village nrecting where the ('l)Ds werc selccted but did not play an important role in dctermining thc modc and month of treatrnent. Thc rnajor components of CDT'I that have fully taken off are drug collcction liorn a central point, community sclcction of CDDs, willingness o I thc cornmunity to take invennectin and the willinguess of the CDDs to continue drug distribution. The team observed ccrtain lapses in thc CDTI implcnrcnlation arnong thern are poor record keeping, exclusion of some "8" villages i.e. at risk commurities from treatrnent and lack of community incentives for CDDs. Thc tcant visitcd 40 villages andT category "A" villages aud 33 "B" villagcs. Thirteen out of the 33 "B" villagcs wcrc not treatcd for (2) political rcasons. In spite ol- tlieir proximity to "A" villages, they were under a different district. Although the year 2000 trcatment took place in October, treatment suplmary forrns were not available in tl're comttrunities during the nronitoring. Apart fi'on difficultics i, cornpleting summaries, the CDD registers rcvealed their inability to determine community d*g requirement, recording :rbsentees, refusals and cases of adverse reactions to ivermectin. It was also difticult to asscss actual treatrncnt coverage as the men collccted ivermcctin lor thcir wives and other householcl nrembers. This treatment by proxy is difficult to tleasure, particularly when the mcn also insisted on responding to the household questionnaircs on bdrarf of other lanrily mcnrbcrs. Although all the commttnities said thcy hacl receivcd healtlr oducation and were huppy with the CDTI interver-rtions, thcrc was little or not support flur the CDDs. Most of the community members patticularly the women, revealed during FGDs that thcy were not aware that they were supposed to support the CDDs. In spitc of lack of incentives, thc CDDs indicated thcir willingness to continue ivennectitl distribution. This is an aspect of thc strcngth in the CDTI implcmentatiol. Others are the number and high rctention rate o[ trainecl CDDs. The team interviewed 32 CDDs, however whilc tlteir knowlcdge of thc causcs, symploms and other aspects of onchocerciasis was quite high, the serious flaws in record kccping unclerscore tlie need for re-training and effective supervision. Other weaknesses of the programlne ipclude complete marginalisation of women in all CDTI proccsscs and their reduction to perpetual minors for whom decisions conceming their welfarc urust be taken by others. It is important that the gender component of CDTI is addressed in order to make it fully participatory. It is an irony that in a state whcrc sharia is practiccd and male CDDs do not have access to the households, the neecl to appoint fcurale CDDs has not bcen addresscd by the commuuity. The team suggests that massive enlightcnnrcnt programmes should be organised, CDDs and health pcrsottncl should bc trainccl particularly in rccorcl keepilg and supervision of CDDs should bc intensified. (3) 1.2 Introduction Bac nd The African Programmc for Onchocerciasis Control (APOC) was established in December 1995 with thc sllccific ob.icctivc to set Lrp an cllcctivc and sclf-sustaining programme of community-directed ivermcctitr treaturcnt for onchocerciasis throughout the 19 endemic countries in tropical Africa whcre 50 million peoplc are at risk of tlie disease. Onchocerciasis is a nrajor llublic health problen-r in l\igeria with ovcr a million persons estimated to bc infected and ncarly 30 rnillion persons at risk. A field survey showed that the communities at risk are capable of managing ivermectin treatment. APOC projects are thereforc dc.signed 1o implement this Community-Directed Treatment with lvermectin CDTI. Thc <lrug, Mectizan (ivermectin) is donated by Merck and Company Inc and APOC, workir.rg iu partncrship with National Onchocerciasis Control Programrnes (NOCPs) ancl scvcral Non-govemmental Development Organisations (NGDOs) has established a comnrunity base for participation in the treatment. Each project is funded for a maximunr of'{lve years and over the five year period, it is expected that APOC will rcduce its suppofl an<l the clevolution of project would have been achieved; and the comrnunitics would continue to effoctively manage the CDTI processes iu patlnership wi(h states ancl local govenmlents for the next 15 years. The self sustaining contponent r,vhich is critical to 1he success of the APOC programme is community ownership. Under thc CDTI, the Conrmunities selected Community Directed Distributors, CDDs who are therr trained to nlanage dmg distribution. The communities are also expected to dec,ide rl.ri: point lor drug collection, the mode of drug distribution, detemrine the dato of distribr.rtion ancl cnsurc that the CDD keeps adequate records of trcatment to cnsurc succcss of thc programme. This community input is expected to reduce the cost of treatmcnt by 90 percelt and thus enharrce sustainability. Thus the CDTI approach is clcsigncd lo enrpower the contnrunities (4) a to transform their lives by increasing their decision-rnaking and problem solving capacity. This community participation clearly distinguishes CDTI from the fornrer Community Based Treatment with Ivermectin CBTI. Regular monitoring and subsequent review to finetune irnplementation are critical to the success of such an innovative approach to disease control. ApOC has been monitoring CDTI implementation in Nigeria, Uganda and Sudan, an excrcise that has proved useful in assessing the prospects and constraints of the CDTI approach. This report is a component of the regular APOC monitoring of projects in eldemic communities in Nigeria. 1.3 Terms of Reference Succinctly document how ivemrectin trcatments wcrc undcrtaken in a number of communities in the Jigawa State CDTI project. Assess community involvement in drug collection, decision making during tl.re period and the mode of distribution, selection of distributors, and the willingness of coilmunity to bear these responsibilities as designed in the CDTI project. Document community perceptions of CDTI processes, especially the issue of ownershrp ald expectations for onchocerciasis, and based on these perceptions and expectations, dcterminc the degree of satisfaction of the community with ih" dlff"."nt programme activitics and outcomes. Assess the quality of training received by community selecte<J distributors (CDDs). Examine the record books of the CDDs and assess the quality of record-keeping and their ability to keep accurate rccords The same applies to the health services staff on thJ projects. Determine the number of community and eligible persons treated and compare your findings with the records of CDDs and the records at the othcr lcvel (e.g. district). Determine whether health personnel participated in ivermectin distribution, and assess thede8ree and the quality_ of supervision by health staff (and the quality ol training and/or orientation of such staff to CDTI). Identifu constraints in the distributions and makc recomnrcndations to the NOTF and management of APOC on corrective measures necessary bcforc the next treatment. a a a a a a a Discuss the project sustainability based on the findings above iIG ,,,1 ll(.o ,:. I 7 ! o -rl(- o lJ1 -{{ rn z cl 3t o @ o C c ao t^ 6.:ro C, o 'l x- o c 3noc o {o c lo I I !9 3 o ,c f =e. r,/3 o o :. r6'o oEto 5 @ x coc x ot o 3 o CLot. c o @ aJ{0 Gl{o a 3 o c _-. ,Frg'i 2 MAP OF JTGAWA STATE SHOWtr.to vtt_laors MONITORING OF C DT I, 2OO,I SAM PLED Roni MorgotoriSute Tonkor .Gwino Brrnrwo GuriBo buro Hod ejio Gorki G umeI rngore r kor Mondo(ntl f) K U oom umuwo 0o leGAoaL I U bb cdpo u qgom ,M orke rYeIGotodf Motorn Ringim o Chori a du tseTsoko ni Auyo Loliyq.Sodo 'Intlso Touro . Dorowo , K undu oh un K/HaM igo Kiyowo Birin/ K udu a TryONJ Soirorr n a, lIo I :s/G .S/G ALhqri .sioo&Ho Kozomo Uniwor Ko-yo(ntl .a Burji rKomngo r Solokoi .Jigwo 'Sok wo Gworom 'Jiro. oFoni KEY , : 'A' Vrttoges o. : 'B' VittooesDt; not trEoted \ (7) Stu Site: JIGAWA STATE Jigawa State, the study site lor tl-re Year 2001 CDTI monitorirlg was carved in September 1991 out of Kano State. Likc all the six statcs in thc Northvvest of Nigeria, Jigawa falls within the sudan savannah vegetation. The state has dry climate although rapid changes in temperature and humidity do occur. Hurnidity sometimes rises up to about 100 percent, an unusual feature of arid zolles. Thc mcan daily maximum and minimum temperatures range from 9l.o0r 1::.10C) and 60.60F (15.850C) rcspectively. There are two seasons, the dry season, which lasts from October to May being the longest. The harmattan, which is severe during the months of December to January, is accompanied by a dusty haze, which impairs visibility. The temperature could fall as low as 500F 1100C) during this period. Temperatures begin to rise from March ancl it steadily gcts hot reaching lO0C 1m0f;. Rainfall in Jigawa is concentrated from June to Septernber often with violent dust storms preceding the rain. Jigawa state is generally unclulating with ancient pre-cambrian rocks. Birnin Kudu boulders aud Gwaram's rocky terrain of smooth rounded inselbergs provide the state,s several picturesque scenery. Two large rivers, River l{ade.iia which is 32g kilometres, River Chiyako and their tributaries fonn a remarkable lbaturc of the state. The flood plain o[ River Hadejia serves as major site for agricultural activities while the fast flowing tributaries provide breeding sitcs for black flies. Jigawa state has twenty seven'(27) Local Government Areas. The state lies within the four health zones delincated for the Onchocerciasis Control programme. Seventeen (17) of the twenty-seven I-ocal Governments are endemic for Onchocerciasis. The CDTI funded by APOC is being inrplemented in eight (8) Local Govemments that are mesoendemic. They are Bitrrin Kudu, Gwararn, Kafin Hausa, Kaugama, Birniwa, Ringim and Taura. Among these Gwaranr is the most endemic. Treatment with Ivermectin began in 1996 in a collaborative programme between Christoffel Blinden Mission (CBM), the State Ministry of Health and the Local Governments. Under the Cotnnrunity Based Treatment with lvennectin CBTI ,36,75g (8) persorls were treated in 1996 in cight Local Govemment Arcas. By 1998 124,744 persons were treated in 17 LGAs. Comrnunity Directed Treatment wilh lvennectin CDTI strategy was introdrlcecl itr 1999 tlrrourgh collabortrtion betwecn thc Jigawa Statc Government, APOC and a Non-Goventtnental Development Organisation NGDO, the CBM. The aim of the CDTI project is to treat 135,480 persons by the year 2003.In the year 2000, which is the pcriod being mot'titored, a total of 107, 605 pcrsons were treated in 8 Local Govemment Arcas. A total of 278 Community Directccl Distributors have also been trained for CDTI implemerrtation in the areas being trcated. 3) Methodology 3.1 Trainin The monitoring teanr ntentbers comprising two Onchocerciasis coordinators from the Federal Ministry of Health, an NGDO thc Flclen Keller Forurdation and an independent scientist have considerablc expeliences in CD'[I implementation and monitoring. Two of the team members lrad two and tlrree monitoring expcriences irnrJ both had participated in either in country training and out of country dcvelopment of rnonitoring instruments. A one-day training was organised for the two field assistants in Dutse the Jigawa State headquarters on August l3 before field visits began the following day. 3.2 Sampling The monitoring team conrnenced work at Jahun in Jahun Local Govemment where the Jigawa Primary Health Care Agcncy is based. Backgrouncl documents on ApOC funded CDTI project was collected. Using a nlap, the 8 Local Goverrrment Areas were identified and all thc crtdentic villagcs wcre Iisted. They werc classificcl into those wit6 and those rvithout health centres. Thc multistage sampling was used after listing all the villages. The distance between the villages and thc heaclquarters and the direction mainly nofth, central alrd south of the LGAs and acccssibility of villages rvcre used as a criteria for the selection. Sarnpling was done with the assistance of the SOCT and LOCT in charting a meaningltl itinerary and ease of mobility in thc selectccl LcAs. (e) All the criteria set out in the'monitoring guidcliries ,,rrcrc met. However, it was impossible to meet tlre criteria of monitoring a catcgory "A" village that had no healthcare but near to hcadquarters. All tlre villages that could pass for category "A" village and near to the headquartcrs had hcalth ccntres. Five ol'the 8 LGAs were selected for the monitoring and 7 caLegory "A" villages wcrc covcrerl. Going by thc original data collection format, 6 catcgory "A" villages are suppose<l to bc monitore6. However, a, additional category "A" village was included in the selection. 'l'his was done to enable the team to explore further thc possibility that distance lronr hcaclquarters, communicati6n and transport problems might affect the efficiency with which supervision and prompt supply of ivermectin is conducLecl in rcmot.e communitics. T'he results of the monitoring did not reflect this concern. 'fhcre was a rcmarkable sirnilarity in all the "A" villages monitored as the outcome of the suniey reveal. The only freak one among the category "A" villages is Larrabawa Samarai in Dutse LGA. This unusual sample is discussed below under limitations in sampling. Two category "A" villages were thus selected in Dutse LGA which is the LGA in which Dutse town thc state capital is located. The sampling produced 7 category "A" villages and 33 "8" villuges. For cach category ,.A,, villagc, 5 category "B" villages were selectcd. (Tablc 1). 'l'hc category ..A,, villages selected were as follows:- 3 with health centres and far from headquaftcrs. 3 with health centres and near to headquarters. 1 without health centre anC far from heaclquarters. 3.3 Limitations in sampling In order to present a replica of the 8 LGAs under treatmeut sarnpling was extended to cover 5 LGAs instead of [our. One recurring limitation was the fact that sarnpling was done using the criteria listcd above bcfore actual field worl< comnrcnced. There are 14 SOCTS in Jigawa state, with various LGAs undor their supervision. It was therefore, (t 0) irnpossible for the SOCT attached to the.tcam to givc all the detailed information requirecl to make an informed decision on all category "A" villages ancl ascertain the presence and number of "B" villages sumounding the fonncr. Often, altcrations had to be made while in the field. There was a nrarked siniilarity in all the "A" villages monitored, as the outcome of the survey reveal. 'rhe only unique sample was a category .'A,, village Larrabawa Sarrarai in Dutse LGA which was initially cannarkecl for a category ,.B,, village surrounding an "A" village Zobiya during sampling. I-[owever, during thc actual survey it was discovered to be very far from Zobiyathe first "A" village and had its own surrounding villages which werc very close and were not being treated for political reasons. Further inquiries reveal that in addition to LGA delincation, treatment in Jigawa is done on district basis. T'herefore, although Zobiya and Larrabawa Sarrarai which are far from each and other fall within the juris<Iiction of the sanre district head, 7 of their surrounding villages which belong to another district are trot being treated. They are clearly marked so in Table l. (1 1) TABLE: 1 LOCAL GOVERNMENT AREAS AND COMMUNITIES COVERED Total 7 - Category 'A' Villagcs Total 33 - Category'B'Villagcs r(ex WHC: With Health Care WOHC - Without flealth Care Local Government Area CATEGORY - A Status of Village (:A'TEGORY - I} Total I Dutse I Dutsc II Zobiya Larabawa Sararai WI{C and far fronr Headquarters WOI{C and far from Headquarters Sahon Gari Alhaji Warwade Jidawa Karrka I Kanka II Slrarin rafin waru Unguwar Kaya Zango Jigawa sada Sabongari Kazama 5 CDDs 4 Villageleaders I Health Personnel 5 Flouseholds surveyed 2 CDDs 1 Village Leader 14 Household surveyed I Ringim Yan duste WHC and near to Headquarters Malamawa Chori Tsakani Galadi 2 CDDs 3 Village Leaders I Health Personel 12 Households surveyed J Kaugama I Kaugama II Marke Ubba WHC and near to I{eadquarters WHC and near to Headquarters Dirrgare Durmumuwa Kuikar Gidan Babale Gidan Barde Gidan Gamji Mana Yelwa Nomc Ivlanda Maigawo 5 CDDs 4 Village Leaders lHealth Personnel I I Households survcyed 4 CDDs 4 Village Leaders I Health Personnel l2 Households survcyed 4 Taura Kunclu WI{C and far from Headquarters Sadawa L,aliya f)orawa Kalga 6 CDDs 6 Village Leaders I Health Personnel l5 Flouseholds surveyed 5 Gwaram Saku,a WHC and far from I{eadquarters Karangiya Jigwa Farrisan Jira Salakai 7 CDDs 3 Village Leaders 9 Flouseholds surveyeed Total 7 33 (12) The feudal institution atrd the power dynamics it generatcs is clearly at play with district heads granting permission for treatment of villages under them and discouraging the extension of treatment to those outside their jurisdiction no matter how near they are. The implication of this is that thc blackfly which is no respecter of district delineation would continue to infect the urttreated population in the surrounding villages and subsequently reverse succcss made in others due to thcir proximity. I1 Larrabawa Sarrarai the "A" village, one of the untreated "B" villagcs Sarrarai is just a stone throw fiom the latter. 3.4 Instruments All the APOC monitoring instrunrents were used for data collcction in both catego ry "A,, and "B" villages. They are the indepth interview questionnaire administered to the Community Directed Distributors CDD ih category "A" villagcs; focus group discussion FGD questionnaire was uscd to extract infomration from male groups comprising at least 6 to 8 people for both thc men and women's groups. In all 14 IrGDs were organised in the 7 category "A" villages, seven for men and 7 for women. Tho FGDs were recorded on audio tapes, labeled and also transcribed on paper (attached as appenclix). Where more than one CDD was abailable, two or more were interviewctl separately. One unique feature was Yandutse in Ringim I-GA which had six CDDs vvorking in different wards but sharing 3 registers. In each category "B" village, the village head and CDD were interviewed using a modified version of the instruments administcred in thc catcgory "A" village. These instruments were not as dctailed as the ones clcsigncd for tlrc "A" village. The health personnel were also intervicwed to collect infonnation on (lDD training and the role played by the health centres in the storage and distribution of ivermectin. In each category "A" village, Houschold survey fomrs were administercd. The absence of household census in almost all the treatment rcgisters made rerndom selection of houses the only option. In a village where most of the rnen were away vvorking on the farm the (13) shortfall was made up with a survey oI additional households in other villages under survey. All the six instruments used are attached as appcndixcs. The measuring device was inspected, information on left over drugs collcctcd and recorcls of treatment recorded in the registers were examined. The various officials of Statc and Local Governments LOCTS and SOCTS and NOCT were iutervicwed using thc interview guide for policy makers. 3.5 Limitations Certain socio-cultural practices hanrpered cffective adrninistration of these instruments. The research procedure for admitristration of the household survey questionnaire requires that all the members of each seler:ted household should be listcd and asked individually to respond to questions on the adrninistration of ivermectin within their household. In all the villages visited and surveyed, only the household heacls (husband and"/or father) responded on behalf of othcr household mcmbcrs. Due to thc socio-cultural practice of Kulle (purdah) the women are secluded in the houses an<l the men did not give the monitors permission to intcrview them. Another limitation was tlte practice oI using onc CDI) to clistribute ivern'rcctin in more than one village. This meant sharirrg one trcatment register ancl treatment records for the two villages were not separated. Other limitations arc the absence of household numbering and total population figures frorn the CDDs registcrs in the majority of the villages visited. Poor record keeping thus made it difficult to extract the following information in order to complete the CDD qucstionnaire: . Total population . Age cornposition of people below 5 years and above. . Sex composition of the population (male, fcrnale). . Number of persons treated (male, female). . Nlmber of persons unde:r 5 years who received treatment . Number of rcfusals. . Number absent during last trcatment. (14) . Number with severe side effects. . Number of tablets received. . Number of tablets used. o Number of tablets left in the drug kit. 3.6 Results Hiehlieht Number of Local Govemment Area visited - 5 Number of Category "A" villages visited - 7 Nurnber of Category "B" villages visited - 33 Number of "B" villages not treated - 13 Number of key informants interviews with "A" village leaders - 7 Number of key informant intervieu,s with "B" village leaclers - l8 Number of indepth interviews with village "A" CDDs - i4 Number of indepth interviews with village "B" CDDs - l8 Number of interviews with health personnel - 5 Nurrber of household surveys - 78 Number of focus Group Discussion (FGD) in "A" villages - 7 Number of FGD with male groups - 7 Number of FGD with female groups - 7 Indicators E-1- Proportion and nurnbcr target communities which tlecided on period and method of treatment. E-2-Proportion and numbcr of target communities where thc "community, selected their own CDD. E-3-Proportion and number of target communities, which decided on the method of distribution or treatment. Decision Making Processes at the Comnlunity Level On decision-making process at the community level, the rcsults showed that according to the village leaders, 40.7% of the communities decided on thc month of distribution at village meetings whilc 48.1% of villagcs said the health worker decided for them. For the (1s) modc of ivermectin distribution, rnost of thc leaders said that this was decided at village meeting 74.1%. On the selection of the CDDs, 63% of thc village leaders said it was done atvillagemeetingswhileonly 1l.l%saiditwasdonebyvillagechief andanother3To/o said it was done by the hcalth workers. The majority of thc CDDs 77.8% said they were selected at the village rneeting and that the mode of distribution 55.6% and tinte of distribution 66.7% were also decided at the village meetiug. The communities also confirmed this during the FGD with the rnen 100%. However, the ntajority of the women 85% said they did not knou, rvho selected the CDD because they were inside their houses and 100% of them did not parlicipatc in villagc mccting. (Transcript of FGD with wornen). (16) TABLE: 2 DECISION MAKING PROCT]SS AT THE COMMUNITY LEVEL NOTE: ' The record above indicatcrl thc 2? cornnrunitics actually trcatcd orr( o[ thc 40 comnrunitics actually sanrpled. ' Proportion and rtumbcr of communities which decided on the period of treatmcnt : ll(4}.Toh) Proportion altd ltulnber of cortrnnrnitics rvhich dccidcd on thc rnelltod of distribution = 20(74.1. ) Proportion and nutnber of communities whcrc thc conununity sclectcd thcir own cDD:l7(63.0%) a a Questrons Villagc mecting Vrllage eldcrs Village chref Ilealth workcrs Village Flcalth comrnittec Village committce Others gc A&B Who decrdes on the * Month of distribution * Mode of distribution * Selection of CDDs r1(40.7) 20174.1%) 17(63.0%) 1(37%) 2(14%) 2(74%) t(37%) 3(r1.1%) 5(18.s%) t3(48.1%) t(37%) 2(14%) 0 0 0 0 0 t(3.7%) t(3.7%) 1(3.7%) 2(7.4%) CDD: A&B age * Time of distribution * Mode of distributron * Selection of CDD 18(66.1%) 1s(ss.6%) 2t(77.8%) 2(7.4%) t(3.7%) 1(3.1't) 2(1.4%) 7(26.0%) 8(2e.6%) 2(1.4%) 0 0 0 0 0 1(3.7%) 0 2(7.4%) r(3.7%) Group Discussion village "A" * Tinre of distribution * Mode of distrrbutiou * Selection of CDD 6(8s.7%) 7(100%) 7(t00%) t(t4.3%) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (17\ CHARTS FOR VILLAGE LEADERS Decision Making Process - MONTH OF DISTRIBUTION Chart I Other Village Committee 4o/o 0o/o Health Worker 47o/o @ Village Meeting I Village Elders tr Village Chief tr Health Worker I Village Committee X Other Village Meeting 41o/o Village Elders 4o/o MODE OF DISTRIBUTION Chart - II Village Chief 4o/o Village Committee Other 13o/o Village Mee 37o/o Health Worker 21o/o SELECTION OF CDD Chart - I[ 8o/o Village Chief 25o/o Village Elders 4o/o 13o/o Oo/o 25% 1 (1 8) OUTPUT: 0-1- 0-2- Proportion and number of refusals two months aftcr distribution. Proportion and nunrber of absentees later treated. TABLE:3 ABSENTE,ES AND REFUSAI,S I,GA Villagcs / Comnrunitics Absentees Refusals LOCT Record Villagt: rcgister record LOCT record Village register Dutse I, II 5 377 NA t28 NA Ringim 5 549 NA 8 NA Kaugama I,II 7 220 NA 42 NA Taura 4 394 NA 43 NA Grvaram 6 363 NA 5 NA T'otal 27 1891 226 AII the village registers did not record and/or collate tl-roir absentees and refusals. From available records, which were only obtained fiom the I.OCT only 1,897 absentees were recorded in 27 commuuitics and 226 refusals were also rcc:orded. (Table 3) (1e) Chart IV: Total number of Abseritees and Refusals. Total Number of Absentees and Refusals 100 Dutse I llingim Kaugama 'l Category'A Village Treatment Rcgister E Absentees 1 R,-f rrsals 600 500 '400 -9o. oo o.E soo o .o E =z 200 Taura Gwaram 0 (20) 0-3- 0-4- Proportion and number of at risk village treated. Cost per person (Be1'ond the scope of the study) TABLE 4: TREATED POPUI,ATION OF SAMPL IID COMMUNITIES * Record of treatment not al.ailable. Based.on thc record available a total of 27,282 porsons (78.30,,;) out of the total population of 34,845 people in thc taiget conrmunities lrave rcccivcd treatment LGAs Comm sampled 'l'otal Jropulation of sampled comnr. No o[ incligible person including childrcn No o[ eligible pcrsous l)opulation lrcated No of Treatcd houschold No of Health Centers /clinics Dutse Zobiya Sabongari Alhaji Wariryade* Jidawa Larabawa Sararai 1440 2154 NA 5068 2154 939 295 130 NA 296 504 110 1 t45 2024 NA 4772 1 650 829 953 500 I{A 4680 1 500 770 178 NA 503 203 103 1 NA I I 4 Ringim Yardutse Malamawa Chori Tsakani Galadi * 1428 r 828 797 603 NA 202 460 94 80 NA 1226 r 368 703 523 NA 1 063 1154 5rJ6 4(i0 hlA 203 200 101 70 NA 2 1 1 I NA Kaugama Marke Dingare Durmumawa Kirkar Lrbba Mana* Nome* 2873 1978 671 NA 2230 NA NA 560 97 39 NA 82 NA NA 23r5 1881 632 NA 2t48 NA NA 2?06 i 788 605 NA 2t13 htA NA 368 250 180 NA 200 NA NA 1 NA 1 NA NA Taura Kundu Tsadawa Lafiya Dorawa Sakuwa Karargiya+ 2657 242t) 908 NA 1 353 NA 67 174 48 NA {200 NA 2s90 2255 860 NA 1 153 NA 2360 2125 783 hIA 1{)33 NA -lTroo -3t7 5-,t0 650 511 602 205 NA 75 NA NA I NA Gwaram .ligwa Fansan Jira Salakai l3t7 378 780 800 139 62 118 t13 1238 32s 662 687 112 83 68 15 i 2 Total 34,845 4,870 30,997 7,71282 4290 18 (21) Chart V - Treated population as pcrcent of total population treatment coverage 14000 1 2000 1 0000 8000 6000 4000 2000 olt E f z o g =o o o- Total Population and Treated Population Dutse Rinsim -i:ffJ, raura g 1-otal Pbpulation l Treated l-rapulation Treatment Coverage Based on avarlable record the total popuiation of thc samplcd corrnrunify is 38,E45 and out of these, 2J.282 pcrsons (78.3 perce ut) wcre treated. 'l'hc total rLr-rn'ibcr of rncligible persons, incluciing chrldt'en rs 4,870 wille -1,290 houscholds rvcrc treate<I. lt is irnportant to note that reliable celtsus figures werc not available as there werc no householcl survey census figures in all the CDDs' registers. The CDI)s also failed to cnter accurate l-igures of treated population. However, the tally sheets frorn the LGA showed tirat from the t,utal of 40 at lisk communities sanrpled 27 (67.5%) rvere treated while 13 (32.5%) werc not treated. The implication of this is that a third of 1l-re targct population is not bcing trcatcd. This is a largc number and if it represents the pattern in other areas not sampierj, iL rcndcrs the treatment ctTori incffective. As stated earlier, politicql reasons were identified in many of thcse cascs becausc Lrntrcated communities, in spite of their proximity to thc "A" vrllagcs wcrc undcr anothcr distrrct. 0 Gwaram (22) 0-5- Proportion and nuntbcr of communities wherc CDDs were changed by the community after first trcatment. TABLE:5 CDDs CHANGED Table 5 shorvs that out of thc 27 comrnunities sampled, only 1 | (40.7%) changed their CDDs. LGA Comm that changcd CDDs No of CDDs changed Dutse Warwado Jidawa I Ringinr Chori Dunnurnawa Kuikar I 1 Taura Kundu Lafiya Karangiya 1 1 1 Gwaran-r Jigwa Feruisu .lira 1 1 1 '-[otal 11 I I (23) 0-6-Proportion and number ol communities in which CDDs were supervised by healthcare system. 0-7- Proportion and number of target communities which reccived education about importance of extended ivermcctin treatrnent TABI-E:6 PROPORTTON QF COr\tiVl uNr' I'IES THAT ITECEIVEI) HEAI,'TH EDUCATION AND CDDs TIIA'I WERE SUPERVISEI) BY }IBAT,TH PERSONNEL LGA No ol'comm Comm. that rcccived Flealth Educatir:n A&BCDD supervsied by Health system Dutse I 6 2(33.3%) s(100%) Dutsc Il 6 1(50%) Ringrm 5 6 2(40.0%) 8(100%) Kauganra I 3(50.0%,) s( 100%) Kaugama II 6 2(33.3%) 1(s0.0%) Taura 5 4(80.0%) 4(100%) Gwaram 6 s(83.0%) s(83.3%) Total 40 18 29 CDDs supervision The monitors discovered that out of the 32 CDDs in the targr:t cornntunities,2g (90.6%) were supen/ised by the heaith pcrsonnel. (Tablc 6). This is qLrite high and if indeed the CDDs were adequately supervised during distribution, the quality of record keeping would har,'e been better Health Education Receivecl. Table 6 also shows that out of thc 27 communities, 18 (6(t.7o/o) had received health education on the importance of extended treatrncnt with ivcnrectin. \ (24) Chart VI: Number of CDlls suD,crvised and I-lealth Ilducation Received CDDs :supervised and Health Educatiorr Received 10 oog o o! E l I I 7 6 4 3 Dutse I Dulse ll ECDD supervrsed R.ingrm Kaugama 1 Kaugama ll LGA I llealth Educatrcn Recerved Tau ra Gwaram O Vrllage Total Although the comrt.ttlllitics ccrtairily rcccivcd hcalth cducation on thc importance of ivermectin treatment, tlte tearn discovered that the level of kno\)/ledge was high only among lnen. During FGD, lhc women showed that thcy had sonte knowledge of the drug but the quality of health education was poor. In the seven FGDs conducted ill"A" villages all the worlen 1\0o/o of tliese did not know that ivermectin would be taken for several years. 6'We have not heen tolcl for how long rve'll be taking this drug. But we have taken it for three ),ears". Lv'omen in Marke village o.f Kaugutrta Locul Covcrntnettt Area tluring FGD. "We do not know for ltorv long we'll be taking it but rve take the clrug when it is given to us. But if they do not give us we can not do anything,,. L[/omen in Zobiya, Dutse Louil Goyernrnetfi Arcu tluring FGD. 0 (2s) Informatiotl, education and conrmunication IBC nratcrials play a vital role in health education' There were vcry fcw IEC materials in the commurrity visitcd. Apart from a few T'Shir1s, [Iip charts itnd posters scen in officcs, thcre iverc none in the trcated communities. Interviervs 'uvith policy makers also revcalcd tlrat the majority of them required more health education on CDTI. I a(26) SUMMARY OF RESUI,TS The proportion and nuntbcr of cornmunities, which clccideci ,;n thc nronth/period of distributi<rn, were 1I(40.7%) orrt of the targct conrnruuitics. rvlrich decided on the time and period of treatnrcnt. Proportion and number o{'corr.^ nunilics, which decidccl orl rlic nrethocl of distribution, was20(74.1%) out oIthc 27 target cc,mmunitics which decilled on the mode of distribution. Proporlion and nunrbcr o1'cornmunitics whcro the cor.nrnunity selcctccl their CDD. 17(63.0%) out of thc 27 target cornnrunities selccted their ou,n cDD. Proporlion and nutnber oJ'corunrunities that reccivcd Health Eclucation on impoftance of extended Ivermectin h'e.rtment. lS(6().7%) out of the27 target commuirities received Education about the importance olextended treatnrcnt with lvermectin. Proportion and numbor of CDfrs that wcrc sLrpervised by Ftcllth facility, 29(90.6%) out ol Lhe 32 CDDs in thc l.argct comrnunitics wcrc sultcrviscd by l-Icalth Personnel durir-rg distribution. Proporlion aud numbcr ol'comrnunitics with trained CDDs, 24(85.9%) out of the 27 target communitics havc had thcir CDD reccived lorm at training on CD'II. Proportion and number ol'communities that cxperiencc latc supply or shortage of Ivermectin, 8(29.6%) ot.t of 2-l conrnrunities expcriencecl iate supply. 10(37.0%) out of the 27 communities have cxperienced shortagcs. Proportion and number of communities that collectccl drugs frorn collection point/Health center. Thc 27(100%) communities collecte<l lvcnnectin from collection poinUHeaith center. Proportion and nuntbcr o1-CDDs r,vith measuring clcvice for lrcigltt, 23(79.3%) out of the 29 trained CDDs had nteasuring dcvicc. Proportion and number c,{'conrrnunities with treatment rcgir;tcrs. 25(92.6%) out of the 27 targct communitics irad conlmurrity treatment registers. a a o a a a a a a (27) INPUT - Results and Discussiolr 1-1-'fraining of CDDs The team discoverecl that 24 (88.9%) out o[ thc 27 cornnrunitics have traincd and rc_ trained their CDDs. In mos[ of thcsc villagcs a]l the CDDs have bcen trairred and 100% record of training was achi,:r,ec[. Thc indcpih intcrvicw also showcd that CDDs had high level of knowledge of thc cillrses, synptonrs of river blinclncss and administration of dosage. I-lowevcr, the qualily of training ntust bc improvcd l'rccausc the CDDs are still unable to keep an adequatc trealnrcnt rccord. ln a particulal villagc, Laratrawa Sarrarai, the CDD did not receive an1' foun;rl training. Givcn rheir lorv level of eclucation, the CDDs would requirc il rnol'c i;rtensive training in ordcr to imlirove orr rccorcl kecping. 1-2-Drug f)elivery and Distribution Metlrod In Jigawa state, the ch-ug dclivcry proccclurc is lor ths NOCP headquarters to collect ivermectitt for onwarcl deliv'cn' ttr [)1s NCDO rvorking in thc a1ca, thc Christolfcl Bli,clen Mission (CBM). 'l'he NGDO thcn allocatcs thc rcquircd nr.rrnbcr ol- ivemrectiri to the SOCT and LOCT who dclivct it to the lrcalth centres in cacl; villa.qr: which are used as the collection points atrd aiso the training ccntro ibr Lhe CDD:^. Altcr training, the CDDs collect their supply of ivcrrtrectin and cornnrcnce clistribLitjo6. This cornplies with the APOC guidelines for clrug dclivery and distribution. (28) Table 7: INPUT INDICATORS 0 tIt Villagcs wilh hcight tnc:tsuring dcvicc LGA No of viil. Semp No ol trrined CDDs Lalc supply l)rug shortrge Latc Supply of l'unds C<rllcctiou fronr dcsignatctl point 'frcetmcnt rcgistcr availablc irr villagcs Surnmary form available in district officc Rcaction records availablc in Ilcalth cc n ter Dutse I 6 5(r00%) 0 0 NA 4(t00%) 4{ l(x)%) 1(t0o%) NA NA Dutse II 6 r( r00%) r(r00%) NA r( r00%) lt l()0?6) 4'din'A r( r00%) NA NA Ringim 5 7(87.s%) 0 t(20.0%) NA s( r00%) 5( 100,)/") Nr\ NA Kaugama I 6 5(100%) t(zs.0%) t(zs.0%) NA 4(100%) 4(100%) 4(to0%) NA NA Kaugama II 6 2(100%) t(33.3%) t(33.3%) NA r( r00%) Ir.\ !.3%) 2(66.7) NA NA Taura 5 4(r00%) t(zs.0%) t(25.0o/,) NA 4(100%) 4(100%) NA NA Gwaram 6 s(83.3%) 4(66.'t%) 4(66.7%) NA 6(t00%) 6( 100%,) NA NA ). {li (2e) Chart VII: Input Indicators INPUT INDICATORS - Tratned CDDs / Late Suppty / Drug Shortage ? oF o o .D o coo o o. 100 80 60 20 100 Dutse I Dutss ll l?ingim 40 0 Kangama I VlllagGs / Communltirs Kangama ll Taura Gwaram INPUT INDIGATOf,; PolntT Hetght ENo. Tralned COOS - Golloctlon from t Late Supply O Orug Shortage Register 80 t{ oF o o^^Er ou 6 tr oo q, o- 40 20 0 Ringim Kangama I Kangama ll Vlllages / Communltles Taura I_-l -1 I 1 1 7 ,l I I Ij .t- 1 1 I I I l .i ,,i ,i I 1 a Dutse I Dutse ll Gwaram i 1 I 't I t I I 1 I I Ij I I i I -l I I I I t I ,i, ,I t" ,l i. Ir :ll' ,11 ,,i il (30) In the 40 comtnunities sarnpled only 8 (20%) experienced late supply of ivermectin and they attributed this to the fact that they did not determine the time of drug supply. In the FGDs conducted with wourcn, all of them said they did not cletermine the time for drug supply and distribution. When interviewed, 260A of the community members said the health worker decided whilc 66% of the community people interviewed saicl the village meeting decided the timing. (Table 2). 1-3- Drug shortage On adequacy of drugs, only 9 (22.5%) out of the 40 communitics sampled complained of inadequacy of drugs (Table 7) and this was correc,ted by making a request for more. The problem of drug sliorlage occurs as a result of the cleficiency in the CDDs record keeping. In all the villages visited, the treatment registers did not have calculations for future projection of under aged children who would be eligible for the next round of treatment. Tally sheets and community registerd were also not available in some communities. Because the CDDs did not calculate their drug requiremcnt, they accepted whatever amount of ivemectin allocated to them. This number is usually determined by the LOCTs with the assistance of the health rvorkers, based on an estimate of the communities, population, nurnber of CDDs and/or expanse of area treated. The tearn discovered during the monitoring that the drug clistribution was on going. It was observed that all the I.OCTs kept an excrcise book in which they recorded the quantity of dnrgs supplied to each CDD who signed to certify that drug was actually collected. 1-4- Late Su of Funds Interviews conducted with NGDO policy makers and the SOCT revealed that delay is often experienccd in the release of counterpart funding from the state. At the time of monitoring (August 2001) the 3.5 million Naira from the Jigawa State govenlnent had not b6en released. Timeliness, Adequacv/shortryg_qt_D1gg! (3 !) l-5- Drus colleq$g4.[Iq41q 9e[q4 p9 From the result of thc sur-/cy, ail thc cor-unrunitics collcctcrl their ivennectin from a central point within the conrnrurritl'(T:rble 7). l-c-I4eqqqu4sdevpelor LelsLt Measuring devicc nrade fron'r wcod and painted in dil-f'ercnt colours to rcflect dosage points were supplied to tiie CDDs. In ail the contmtruities visited, the FGDs revealed that the comntrnity including its \r/onre 11 had knowlcdge oI ihe dcvr,;e and what it is used for. However, a colllllrot-l llracl,icc is lor CDDs to rncasure thc rvonren oncc to dctermine dosage and to give subsequent drugs to the husbands arrrlior household heads for distribution to rnembers of thc householtl.'l'he practice of kul!<z purtlah restricts acess to the women in scclusion anti since husbancls are not trairiud CDDs this practice of treatment by proxy must have resrrlted in wrrtng dosage or druu dumping. "Our husbands bring the drug tt) us". Women during I|GD in Yantlutse v'illctge Ringim Locul Goyenttnertt Areu *Cf)D measured us once only alrd has been supplying us wilh the drug',. Women during FGD in Ubba villa.qe of Kauganru Loc'ul Govet'nnrcttt Area. 1-7- Availabililvptlie4r Eq!8 qsu!e!_qAll the villages visitcd had thc standard APOC/NOTF approvcd registers (Table 7), although a few surrouuding comulurlities in Gwaram Local Ciovemment Area and Dutse Local Govemmenl. Areas shared rcgisters.'fhis urade rctrievai of records difficult as the communitics werc not scparatcd ilr the rcgistcr. 1-8- Sur4mary forms, Mectiz:rn invcn torv etc There were no sumnlary lonns available at district oI'fice. (Tatrie 7). This is an important aspect of the CD'tl implenrentation r,r,hich was quite deficicnt. l'he CDDs did not seem to appreciate the fact that thesc tlistri,;t level rccords are intportarrr and they clid not bother to learn how to keep thcm. On furthr:r protiing, most of them saitl summary fonns were not supplied to ther-n. Yet thc CDT'[ guidolines stipulatcs that r]ata should be collected at district level and kept in thc villagcs for future rcference. Anothcr :rea of deficicnr:y is thc poor feedb:rck to thc cornmunities concerning the result of the annual [reatnrcnt cxercisc. (32) 1-9- Side Reaction Record There was no record kept on thc adverse reactions to the rh-ug either at all the health centres nor in the CDDs registers. (Table 7). There should have been rccords at both levels to indicate any side reactions and CDDs should have becn able to refer people with adverse effects to health centres according to thc ApoCAIoTF guidelines. OBSERVATIONS Communities' Perceptions. Expectations and Satisfaction The FGD's reveal that most of the community members have considerable knowledge of the disease. They identified it as a serious health issuc ancl arc aware that the drug is given free of charge. They refer to the disease as "Ciy,ott dttndumin ido" an aihnent of the eye that causes blindness. Virtually everybody, from the men to the women in seclusion know that dosage is detennined by height. They arc also quite aware of those excluded from treatment and the tact that ivermectin will be taken every ycar for several years. Community members are also quite informed about their CDDs whom they see as trainee health workers. The CDDs and health workers are iclentificd as the distributors and suppliers respectively. There is a high degree of appreciation of the drug, which is acknowledged as effective for preventing blindness, expclling worms and killing lice. The comnrunity is happy with an<[ willing to takc thc drug as thc FGDs rcvcal. "We are healthy and want drugs to be supplied regularly.,, Adult women in Ubba village, Kauganta LGA during FGD. otYou can look at our eyes in order to measure the success o[the drugs.', Adult men in Salka, Gwarant LGA during FGD. "'we want the government to continue to herp us by supplying flre drug,,. Adult'men in Salka, Gwaram LGA during FGD. However, the community members are yet to understand their role as the key participalts and that the CDTI is people focused and people driven. 'fhc programme is viewed as another govemment health progranlme and the people are unaware of the change from the CBTI to CDTI. The only chartge noticed by thc people was the change of CDDs and they were changed only in a few communities. Most of the conrmunity members felt that (33) the CDDs should be paid by the local government whose health workers they assist with drug distribution. When they were told that the CDDs are not paid, many of the men recalled that they were indeed asked to support the CDDs in cash or kind. Many of the men also acknowledged that such support if and when given to CDDs which is not often, it is regarded only as alfarnru (token apprcciation) and cannot be a substitute for regular salary. In the FGDs many women claimcd to be unaware of the lact that community members are supposed to give incentives to CDD. The few who knew believecl that their husbands must have been told and would havc given sornething to thc CDDs. .'We were not told to give anything to the CDD. It must have been discussed with the men. We only pray for the CDDs." (Women during FGD). Community Involvement in CDTI Although there is high level of awareness about the drug. The CDTI concept of community being at the core of the programme is yet to be understood. The only crucial CDTI role performed by community members is in the selection of CDDs. Most of those interviewed confirmed that CDDs were'selected by the community and made it clear that the criteria used was level of education, willingness to servc and good conduct. It was clear from the FGDs that thc CDDs wcre selected at villagc meetings. However, women did not participate in any of these meetings and <lid not even know that the CDD was selected by the communities. "We do not know who selected the CDD and we just saw them and they gave us drug. women's response during FGD in Marke village of Kouganta LGA. The community members did not evcn know that they are supposed to participate in other important aspects of community decision making such as selcction of the time and mode of distribution of ivennectin. "We did not select the mode of distribution and we take the drug when it is delivered to us." Male respondent during FGD in Yandutse village. 1i (34) '6We can not say whether rlrug supply is tirncly bccause n'e do not determine when it is delivered. We take it wXrenevcr it is given to us." Atlult wontcn at Ubba village i(augama LGA dttring FGD. Drug is collected at the health centre by the CDD and the peoylle are unaware of their role in community monitoring. None of those interviewcd during [rGD mentioned this. When the monitors seizcd the oppofttrnity to educate them on the CDTI, community members expressed an interest in participating. "If we are told to supporl the CDDs we can contribute too"' Adult women at Larabctua Sarrarai Dutse LGA tluring lr(]D. "We have a sense of cornrnunif'y spirit, we can help the (lDD" The health centre in this village was built solely through community effort". Men during FGD in Yondutsc village of Ringitn LGA. The communities have expressed their willingness to support the prograrnme. This is underscored by their acceptance of the programme, selection and support to CDDs in some of the villages. The team observed that some CDDs in Galadi in Ringirn Local Governtnent Area have been distributing without requesting lor incentives frorn their community members. In addition, all the CDDs iuterviervcd cxpressed their willingness to continue drug distribution in spite of thc meager incentives they get. Coverage The treatmeut figures of the areas sampled was quite trigh but this is rendered meaningless if the surrouuding villages that were not treated rrre taken into consideration. However, the areas treated recorded impressivc treatrnent coverage. Assuming that the census figures are reliablc, for example in Zobiya village (Dutse LGA) which has a population of 1440 had 953 trt:ated out of 1145 eligiblc persons (53.2%). In Jigwa (Gwaram LGA) with a population of 1377, the treated poprrlation was 1066 out of the 1238 eligible persorts (86.1%).l'he nurnbcr of incligible wal; quite small in both cases and there were no recorcl of revie',r, of absentees and refusals and some of those in these (3s) categories were not even recorded. While the percentages arc relatively small, the fact that there are lapses that could have re-occurred in several villages should raise some concern. Supervision of CDDs The team discovered thtt 29 out of 32 CDDs (90.6%) in thc target communities said they were supervised during distribution. The monitors also saw evidence of good supervision by the SOCTs at the LGA level and in some communitics. Ilowever, in several others some LOCTs were reluctant to cany out supervisory visits to the comrnunities even when their allowances were paid. Tl-ris rcsulted in non-trcatment of atrsentees. For example, all the 5 "8" villages of Larabawa Samarai in Dutse LGA were not treated. If there was effective supervision these would have been discovered and action taken. The same lapses could be attributed to the non-treatnrcnt of at risk population in Yelwa, Nome and Manda Maigawo which were the suruounding villages of Ubba in Kaugama LGA. Lack of supervision also made it possible lor some CDDs to deprive people of ivermectin. In villages such as Gidan Gamji in Kaug:rma LGA, CDD refused to treat households that did not pay the N20 meant to be the incentive for CDDs. Such an attitude would have serious implications on the at risk population that is supposed to be treated free ofcharge. Intesration into Primary Health Care There was evidence of intcgration of CDTI into the health system. At the state level, CDTI is under the Vector Bome Diseases Control Unit of tlrc state Primary Healthcare Agency. At the local level, the LOCTs are in charge of CDTI. However, separate departments have not been createcl for onchocerciasis control and the LOCTs are also in charge of other health programmes such as immuni'zation, tnalaria control and general health education. This could overtrurden the LOCTs and lead to neglect of the CDTI. An important component of thc CDTI that has not receivcd adequate attention is the integration of treatment of adverse reactions to ivermectin iu the primary health care centres so that the CDDs could refer such cases to the health personnel for treatment. (36) Sustainability Success and sustainability of the CDTI are hinged on effective education and mobilisation of the communities to fully understand the APOC philosophy of community ownership of the progralllme. The NGDO and the healttr workers have achieved an impressive level of community cducation on the drug, training of CDDs and community decision making in selecting their own CDDs. The decision making role of the community members in selecting the time and mode of distribution and support for CDD should be highlighted since the nrajority do not know that they are expected to participate in these. Provision of inccntives to CDD is not taken seriously even among community menrbers who know their role. Anothcr critical aspcct in sustainancc of CDTI is govcrprncllt's corrnritment at state and local govemment level. The team discovered that all local governmelts do contribute their counterpart funding which ig used for mobilisation, payment of allowances to LOCTS and transportation during supervision. It was diflicult to ascertain the exact amount budgeted by each locitl government for onchocerciasis control because the amount expended is drawn from a departnrental budget for Diseases Control. On its part the state government has shown a strong commitmcnt to lund the CDTI. Funding has increased to reflect an exparsirln in the number of villa,ges treated. It budgeted one million Naira in 1999, 2.7 nrillion Naira in 2000 and 3.5 million Naira in 2001. The state has spent a total of 7.9 million Naira on CDTI, which is 2.9 rrillion Naira more than the 5 million grant from APOC. This certainly underscores thc fact that Jigawa state is determined to sustain CDTI whcn APOC funding cnds. How,ever, not much of the fund released by the state goventment is visible in CDTI funcling particularly given the dearth of IEC materials, which is important for health education. 'fhe state government is also exploring inter-scctoral collaboration to strengthen local governments' commitment to onchocerciasis control. In line with this, the state ministry of health sought the cooperation of the Ministry for Local Government and Community Development and initiated a policy of setting aside the sum of 77,500 anlually by all the endemic local govemments for the onchocerciasis control programme. The policy is conrtnendable and if properly implerncntcd would farther enhance sustainability. The team however observed fiom intervicws with policy makers that delay (37) in release of approved funds could hamper mobilisation and supervision at state and local govenlment level. At thc tirnc of monitoring (August 2001) tl-rc funds allocatecl for the year had not been released. However, thc rnonitors werc able to confirm the release of funds during the report writing session. In all the intervicw,s with policy makers they expressed their desire to continuc to fund onchocerciasis control. "This Local Government is one of the most endemic areas in Jigawa with 19 communities being treated. We are determined to continue to fund the onchocerciasis control programme. After all hearth is wearth,'. Vice Chairman Gwaram LGA. "Sustainability of CDTI is guaranteed. If we get ivcrmectin it shall be distributed. The local government officials are also keen on supporting it,'. Executive Secretary, Printory Ilealthcare Agency, .ligawa State. Strengths (Best Practices ) The team observed the following which are considered to be the strong points in the CDTI in Jigawa State. o Integration of Onchocerciasis control into Public Flealth Services and Diseases Control. ' Communities' appreciation oFthe drug and willirrgness to continue taking it. o The state and Local Governnrents commitment to funding CDTL o Dedicated and committed programmc staff cspecially SOC'Is. o The state initiation ol' inter-sectoral collaboration with the Ministry for Local Government in funding CDTI. The Ministry has dirccted each LGA to release N77,550 for the year 2001 Oncho programme. . Willingness of CDDs to continue ivermectin distribution. Weaknesses The team observed some dcficiencies in the CDTI implcnrentation as follows: o Deficient record keeping by CDDs. . Absence of community treatrnent records at district level. o Non-review of cases of absentees and refusals by CDD. (38) . Delay in the releasc of counterpart funding. . Paucity of Inflormation, Communication and Education IEC materials such as stickers, posters, handbills in all the communities. o Poor supervision of CDDs. o Selection of six CDDs treating different wards in an "A" village. o Absence of female CDDs and non-involvement of women in community decision making. o Treatment by proxy whereby CDDs give drugs to husl>ands/household heads for distribution to family nrembers which could lcad to wrong dosage or drug dumping. o Basing treatment on district delineation and subsequcnt exclusion of at risk villages from treatment. . Inadequate community health education on providing incerrtives to CDDs. . Sharing of treatment registers by CDDs distributing drugs in different villages. . Low level of commitment of some LOCTs. o Inadequate training of PI{C staff. iect Area The team found two peculiar features in the project area that deserve special attention. One is the politicization of treatment wliereby districts are used as the basis in determining the at risk villages that should be treated. This has led to non-treatment of at risk population in surounding areas sirnply because thcy do not fall w'ithin the jurisdiction of the district heads in charge of village "A" ijettlements which are being treated. This practice would retard progress made in the Oncho control programme. TIre second is the practice o[' kulle seclnsion and the abscnce of women CDDs. In a state like Jigawa where sharia law is practiced, the CDTI inrplementing bodies should have made extra effofts to identify female CDDs so that thcy can have free access to all households from which rnale CDDs are often barred. Sharia underscores the need for women to be educated arrd to contribute to societal development through community service pzulicularly through serving other womcn. Unique Features of the Pro (3e) It is therefore, wonisome that in all the cornnrunitics visitcd, the team found only one female health worker and did not find a womall CDD. I'he marginalisation of women in decision-making and non-involvement in CDTI health education was also palpable. However, in one of the comrnunities, Marke village of Kaugan-ra LGA, the women suggested that a woman CDD should be appointed for thcir community to promote CDTI implementation. They identified a potential CDD who is edr,rcated. "In this community only Jummai Bulama can do it". Adult wotnen in Marke village of Kaugama LGA during Ircl.'.t. Further inquiries was made and the person identified was interiewed. She has a secondary school certificate and participates in the immunization programme in the community. Recommendations Based on the team's findings, the following recommendations are made in order to improve the implementation of CD'II in the next few years. On sustainability 1) Sustainability of the CDTI after APOC's intcruention will rcquire political will on the part of the govemment officials at both state and local lev,:ls. A seminar on the CDTI should be organised for policy rnakers to enlighten them on the project and elicit their support. 2) Comnrunity participation is tire foundation on which the CDTI is based. Critical to its sustenance is the need to cducate the communities on providing incentives to CDDs. 3) The communities should be educated on the necd to estatrlish participatory activities which are critical to the success of the CDTI such as villagc meetings, establishment of village development committees which would enhance comrnunity participation and self monitoring. 4r' Appendix II People met:- l) Malarn Tukur Makama, Oncho Coordinator, Kano. 2) Dr. Abba Umar Zakari, Executive Secretary, Primary I-lealthcare Agency, Jahun. 3) Malam Lawal Al-Kassin, Vector Bome Diseascs Control Unit. Primary Healthcare Agency, Jahun. 4) Alhaji Abdul Hadi Hassan, Oncho Coordinator PFIC thit, Jahun 5) Alhaji Shehu Suleinran, Deputy Hcad of Hcalth Dcpartmcnt, Dutse LGA. 6) Malam Lawal Bala Kazaure SOCT, PHC, Jahun. 7) Malam Sani Ado LOCT Ringirn LGA. 8) Malam Salisu Manu Gujungu, LOCT, Taura LGA. 9) Malam Mohammcd Mai-Sarnari, LOCT, Kaugama LC}A. 10)Malam Shehu Sulciman, S.K LOCT, Dutse. I 1) Mr. Chris Ogoshi CBM Jos, Telephonc collversation. 12) Dr. J.Y. Jiya National Coordinator, NOCP. 13)Alhaji Mohammed Hussaini Shuarin, Deputy Direclor Health Dept. Gwaram LGA. 1a) Alhaji Haruna Bako, Head of Dept. PHC Gwaram LGA. 15)Alhaji Ahmed Rugai Said, Vice Chairman, Gwaram LGA. 16) Alhaji Muhammad La'uval Kauganra, Secrctary, Kaugzurra LCA. 17) Alhaji Yusuf Isiyaku, Deputy Healthcare Coordinator, I(augama LGA. 18) Malam Bala Umar, Deputy Director, PLIC Ringim LGy'. 19) Malarn Ali Sule, Zobiya villagc leader f)utse LGA. 20)Malam Yusuf Ibrahirn, Health personnel, Zobiyavillagc, Dutse LGA. 21) Malam Yusuf Shehu, CDD Zobiya village, Dutse LGA. Z})Malam Mohamnred Usman, CDD, Zobiya village, Dutse LGA. 23) Malam Tanimu Musa, CDD, Jidawa village, Dutse LGA 24) Malam Tijjani Abdullahi CDD, Sabon Garin Alhaji, Dutse LGA. 25) Malam Ado Suleiman, CDD, Wa5wache, Dutse LGA. 26) Malarn Yahaya Mohammed, CDD, Laraba Sararai, Dutsc LGA. Z7\MalanBello Inuwa, CDD, LarabawaSarrarai, Dutse LGA. J(l 28) Alhaji Adamu Muhamma,l, Sakwa, Village Leader Gwaram LGA. 29) Malam Bello lJsmau,s Flealth personnel, Sakwa, Gwar:tm LGA. 30) Malam Uzairu Waziri CDD, Sakwa, Gwaram LGA. 31) Malam Salisu Yusuf CDD, Jira, Gwaram LGA 32) Malam Hamisu Isa Sakwa, CDD, Fanisau, Gwaram LCiA. 33)Malanr Sulairnan Yau, CDD, Karangiya, Gwaram LGA. 34) Malam Muhantmad Musa, CDD; Sallakai, Gwararn LCA 35) Malam Saidu Shuaitru, CDD, Jigwa, Gwaram LGA 36) Alhaji Isa Usnran Ubba, village leader Ubba, Kaugama LGA 37) Malam Idris Kafinta, village leader, Ubba, Kaugama I.GA 38) Alhaji Adamu MaiGari, villagc leadcr, cidan Gamji, Kaugarna LGA 39) Alhaji Muhammadu Dan Munkaila, village leader, Kundu, Taura LGA. 40) Urnaru Nabawa, village leader, Lafrya, 'faura LGA. 41) Isa Hassan, Health personnel, Kundu T'aura LGA 42) Ibrahirn Yahaya, C-DD, Kundu Taura LGA 43) Sayyadi Idris CDD. Kundu Taura LGA 44) Sabo Audu, CDD, I)araw:r Lafiya, Taura LCA 45) Harsanu Umar, CDD, Tsadawa, Taura I-GA 46) Ado Danjumai, village leerder, Tsakani, Ringim LGA 47) Arninu Sani CDD, Yandutsc, fungim LGA 48) Ali Usman CDD, Yandutse, Ringim LGA 49) Sabo S. Aska, CDD, Yandutse, Ringim LGA 50) Idris Abdtrllahi CDD, Cori, Ringim LGA 51) Yahaya Inusa CDD, 'fsakani, Ringirn LGA 52) Awwalu Ibrahirn CDD, Galadi, Ringim LGA 53) Adamu Zaki Habib, CDD, Malamawa, Ringim LCA 54)Haruna Mohamrned, CDD, Malamawa, Ringim LGA 1t- (Aff) On Public Enlightenment 4) A massive enlightenmeut campaign should be organiscd to cnlighten the people on the CDTI programme and their role in its implementation. ' Various civil society groups such as CBOs, intermccliar y NGOs, trade groups, in- school and out-of-school youth groups, wontcn's organis;itions etc should be used as an entry point for the enlightenntent canrpaign. o { special advocacy package on. how to nrobilize women using religious groups, especially the neiglibourh ood Islumiyyu schools, preac'hcrs, particularly at the grassroots should be designed ar-rd implementcd. ' More IEC nraterials, particularly in Hausa should bc prodrrccd and distributed, but the regular IEC conccpt should bc broadcned to includc tlic usc of alternative mcdia such as songs, drama, poetry and school based enlightenment programmes. On Canacity Buildins for CDDs and flealth Workers s) More training and re-training should be organised for CDDs and health workers. The duration of the training should be increascd and focusecl on record keeping.6) Women CDDs should be selected in thc communities rvlrere there are willing and capable women. 7) More supervisors should be appointed to cover areas that are underserved.8) Supervision of CDDs during distribution and after should be intensified. The NOTFiAPOC chccklist for on-the-job training sliould lorm part of the supervision. 9) Adequate feedback should be given to the communilies afler each distribution period. 10) The use of one register for several villages should be tliscouraged. On Exclusion of at-risk villages in the treatment 11) To avoid the powcr dynarnics that results in non-treatrnent of some surrounding villages delincation of trcatntent areas shoulcl be bascrl on cornmunities within a LGA and not on district lcvel only. To neutralize atTy feelin-e of marginaiisation, advocacy visits should be paid to all the community leadcrs in viilages carntarkcd for trcattlent. 43 fi,1'I {i t { Qt-<- C- I N I)tUz|t.() t(.S titrlf trc.t' ll- I !''( )t( I N I )tat,tiNl ) I,;N.t, n t < lrul,l.r ) tt I I,t( j lr::ll1::,'li" :tit<l ttrtrrtirt'r ,l'{:ri8ct c()rr)r(rrririt's rvlriclr rlci:rtlr.,l .ri rtrc ,t:rirri ,r rrrr.rlr,tl .t li,- 2 I)t'irI:oilrotr trrrrl rrurttllct rrl lltrllr.:l c()l1trl,riiir,r;,.,,,111.sc,11,, orvrr CDI) UIJ'I'I'U'I' "( {rinnllnrl\," \(, 1(.c(crl llrr.il 0-l 0-2 0_3 X tl-< o-5 I)to1lr-lIti0rr lrirr rrtilrrr;,:t qrr rr-.ltrr,,l,s t\tr,o ,l(,rrrls irr(cr.trir,trii;rrrr,rr Itr,1l,i(i.rr;rrrrl rrrrr.trcr.r( ullsc,ticus llr;rt r,,,e rr., l,(cr lrt,;rlcilp51rJlrlrti,, ;r,tl rrtrrrrlrcr rr[,r(.r irk vill;r;1r.s trc;rictl Cosl pcr l)cr.s()ll lrcir(r.rJ :;,::;;:jll _,, :1",,,;:::,rr or r oirrrntrrriricii ,,,,,"," (jr)r\s \\,(jrc ( ir;rrrlictr t,.y rrrr: corrrrrrrrrrirl, I'ro,or (i,rr arrtl rrrr,rl>cr .1.<:.trrrilrrrritics ilr *,lriclt tlrc cil[c.s].sIc!11. I)r,,o1{,i'rt arrd rrtrrrrlrcr t;( l;rrrlct t:.,rrrrrrr.r riit.a u,l,ial, ittr;191'1i111cc ul' c.r(cirrlcil i r,cr rtrcctirr {r c;r I rr r.r.l rt. Propor(io, atttJ rrrrrrr[1c.,[ 1li'r.srlrrs 5 yr,irrs ;rrrrr .rlr)r,e i'rril rcr.ciycrr 0-6 0-7 0-8 iNI'U'f I-t t-2 I)ro1;ort ir;r r a rril nu r rrircr o I rjqrrr r rr rr,,i it ics Pro;lr-lrtioir arrrl lrtlrrttcr o l. r.onrrrrtr n it icr;; slror(agc ()l' ivcl.!ncctlt (.1)l) ir ,.rrrpcr yi:;ctl lr1, 11," lrc;r Illr I ct:r..ivcrl,.:rltrclt( ion irlrrrtr( i,,,t:t illt'cIitr tt'iilr' (r irirrctl CI ) Lrs 'pt r,r jt.c(.s tlttrt t:xpci icrrt.,,rl l;rtc,. ri1rpl;11, rrr l-3 I)roltortiorr r -4 I)r.r1lor(iorr llittJ tttllttl;ct ,l'lit triccl''; r'lricli t.rPer it:rrccrr l;r(c sr1r,,r1, ,t lr,rtls.attd ttttiltltcr ul'tirr1t,.( r.urrrrrrrrnilicr; rr,lriclr r:ollct.tr.rl ,r.crrrlc.r:(irr Irorrrcollcction Iroirri/(lrc lrcirltlr (.(:ir I r c. * I( i.s srrggr.stttl {lr .r( ,{lrOCl i\llrrrrylr,nrerr I corrsirlcr,., ,,,1,1,.ar*ill1, 11,1,s' i.rtlit.:r(ol-5 pt.oprt(iolt ar;tr ttrrtttlcr ,r.( r)r)s rr,rrr, '- "' rt r\i r t's('[)tlt';t(clt t-6 I)rr1;rr{i,rr ;rrrii rrrrrrrrcr. ,,, ..,,,,,,,'],,11,',,1,- :.]]l' Iirtg 'dcvicr-' Iirr rrci*rrr i-7 I)ro,.rri.t-rir arrti ,rirrrrrcr r;f rr. ,,:;':1,',;; ,, ,,:.-:::,;11""' '""'''"'' Of.llCe . .. ,!., \\ rur s^trtnillltr1, (ir,ut._ ;l{ llr(, rlil;{tre l Irlu;111q11 trr,, 1r,,.1r,111y,,11,, l. :rrrrl,,rl,r . l\ I :t), r r),rr) It T T I I I I I I I I I I w 1h .liqlt r l gltuirlft lsr:iquiJi tL:-r gt t ._e-: r 1 t c r. s Villlge Nlnrc:('orrrrlrt': I)nle ol l:tge Corlc:_ I)istrict/t,(jA: ttst rtistribiririr I' l)lcasc,.ll u:l!1,]l,t any progranllllc corrccrrrirrq orrchoccrcilrsis trt,alrrrclt ilr tlis 'illlr[c,.)( PLtrASIl No'rE Tl l Al' t'i t u t'o t-t.owt Nc i.s.su r,s A rui A r) r)rui.s.\ r:D) ' rr,ho brouglrt thc itlca of ttrc onclroccrciasis Jrrpgl;1111,Ic l() tSis *ill:rr:c,.) rvlrcn did thc pcrsorr(s) cornc ttrlk rvitlr y()g ;llx)ltt {)llclr6gglcl;sr,i.,.r . did thc pcrsolt(.s) rncct rvith 1,11p:urtt otlrcr vill:r[c lc:rtJcrs 6rst..) ' rvltlt tlid hc tcll you1, (1,^lhc frlr corrrrrrurrit],.r'rrcrslriP.f p11rg1u,lrlc.lrtl c.,r,ru'it'rcsponsibility) i -'-' I'ruFrrrrrrrrrr (rr . Did hc ask for you to arriulg,e a ntcclirrg:) 2' llrnv rvas lhe titnc (trronttr/scas,n) frr tlistrihutirur tlccitlctll at a villar:c tncetin.q _ cvcr\,onc rtisc115q,.,; villagc cldcrs viIlagc chic[/lcarJcr hcalth rvorkcr villagc conunit(cc othcr (spccity) 3 \\'lrat nrodc of distribution \\,as dccidcd,l vit I 2 3 4 5 6 I I I 2 3 4 housc-(o-lrousc cclr(rnl pl:rcc (spccify liotlr lrousc-lo-lrousc ir otlrcr ( r,d ccrrtrul pl:rcc ) 4 IIorv rvas lhc ntotlc oI distriburiorr dccidcdi) I. at a vill:rgc rucclilrg _ c,/cr),onc tliscussctl2. vill:rgc cltJcrs 3. vill:rgc chicf/lcadcr 4. hclltlr rvorkcr 5. villagc corrurrittcc6: o(hcr 5 llow many pcr'son.s in this villagc (cDDy givc out.llc d^rg [.r .,clrrxcrci:rsis,l I Vll.t.ACE A-l.l:A t)l:l( -.tI)Ot-_ I rl I Lr o* (t l lkll uruny nralcs'l llow rnany tcrrrulcs'l llorv rvcrc tlrc pcrsons (Cl)D) sclcctcd ro tlo rlrc work,l rt a villagc rrrccting - cvcr)'ollrj tlrscussctl t'illagc cldcrs v illagc clriclTlcatlcr lrc:.rltlr s,or Lcr villugc corruuittcc ullrcr ti \\'h1' did yuu clr,rsc llrcsc pcrsuu(s)'l (l,r,hirrg lbr crircriu) I 2 3 .l 5 (r I 2 .l { 9 lluvc thc CDDs rcccrvcd urry truirring.l l. \,cs ll'1'cs to Qt). s'lrcrr rlid rlrcy.t.ccclvc rruinirrg.l Bclilrc tlrc lirst tllstributiorr Durrrrg tlrstributrolr .Surrn altcr tlrc lrrst dlstributiurr l)un't Lno*'/Can't rcrrrcnrhr 2. No 3. Can't rcrucnrtrcr l0 lr I 2 l 4 I L llurv wcll havc rlrc Cl)Ds tlonc tlrc work? l. vcry wcll 2. luir 3. poor ( l:rplain) rl ) lluvc you clrulrgcd your CDD? ll' 1'cs lo Q t 2, rvlry'l l. ycs 2. No 3. Dorr'l knorv ll.rrc 1'.u (llrc etlrrrrrrurtrrl.) t'uccrvcd crlucalr,rr tltr ltrc lrrurualll, ltrr scvcrll 1'curs'l lnUx)tt.lnec ol t.rkrrrg rr.cilrrccttI lulllct l. \'cs 2. Ntr J. (lurr't rr:rrrcrrrllur VIl.l-ACti A.l-li,\l )l:l( .'l o( )1..2 F 45 t5. ll'ycs to Ql4, nsk: Wltcrt ttid you rcccivc tlrc ctlrrcariorr'l ('l'ick:rll t1:rt 1pplr,) During thc first rrrccting Bcfrrrc tlrc first ttislrilrutiolr During distrilrution Soon aftcr distributiorr l(r lf ycs to Ql4. rvlrat werc you lold? (l,rohc lor :rrrnual trealnlclll for scverat yclrs corrrrnunity rcsponsihil it t7. Was tltcre any conlmunity ttccision on horv ttrc tlrug strorrttl he coltcctctl lrrurr a cottcctiolrpoirrtl l. Ycs2. No l. [)un't knorv I8 [)itl ,'y nrenrhcr.f thc c{rnr1111sr1,, crrilccr rtre ttrrrg [r.rrr a c.il1.r.g1,,,, p.irrt.J l. Yes 2. No 3. I)on.l krrol 19. If lro to Qt8.\r,tryl) 20. Whcrc is ttrc.coilccrion poirrtl 2t t)id you cxpcricncc rarc su,pry.Idrug trurirrt rrrc r:rst rrisrrirrutr,rr,., l. Ycs 2. No 3. Don.t know I)lcasc cxplairr 22 Ditl you cxpcricncc slr.rrrrge oItlrugs ttrrrirrg t1c llst ttisrrirruri.rr.., l. Ycs 7.. No 3. Don.t krrrrv 23 lf ycs to Q22, trow rvlrs ltrc pr<lbtcnr solvctP I 2 3 4 n h c Docs thc tornrnunity havc :r trcllnlenl rcgistcrl l. Ycs2. No 3. I)on.t knorv 24 Vll.l.AGl: A.l.t:At )t:t( .'t oOt.-.1 ll n A'l 25. Il'ycs ro Q24. rvhcrc is thc rcgisrcr kcpt.l 'l() \\'lllll lrlL')'otll'stl8,8,c5tl(llls un llorv llrc corrrrrrurrity coutd hc rrxrrc invrrlvsd irr trcating its rrrcltrhcls rvitlt ivcrtrtce tin lrrr scvcr:rl ycur.s,l 17, ls rlrcrc anyrtring you wrll tikc ro rcil/ask us? I I I ! Vl l.l-AUli A -1..[Al)t:t( .'t OOl.-4 [,r, --F' ffi E r:ig, 4ivrve,.e r1 [], *,, ,,t.iTo.be a&uittktered ouly in g17)up "ll" villages. hilerviett, 2 CDDs village if ilere ore ,ilore llnu oueCDDs, pertti At tlrc eud of tlrc inrcniew u.rk tlrc distributor to ler yort see his lools : ilrcasuring tlevise, reg$tersrenrainilry drug d awilable. When a questiott requires nrultiple re,'spotr$es, clo not lorget to pttt a circle,,', arouttd each appticabte response code. probe rvlrcre opprcipri.tte [: ; i S, E tL t. ; L t L L IL L Narne of Village I DistricUstate Nartre of CDI) 2. Male Monlh arrrj year of last clistribution ,,,1 , i i sclccted to do tlre work? ll I ., *..- Sex: l. Fernate 'r'-'i- :*,,*lrutn Occupatiou: -'tf!' qft+ ' l. llow wcre you i ;I r l. 2. 3. 4. 5. 6. 6. at a village urceting village elders' lneeting village chfef/leader lrealth, worllcr, , village heahh"cornrtrittee I I t 2' llas a,y cDD beerr crranged afrer trre trst distriburiorr? nits, other (specity) j I t_ I L 3. l{ave you ever been supervisetl ? village corrrrrriilee rrrcetirrg 3. Don't krrow/cart't ra,,,r,,,lra, I ! l. Yes l. Yes 2. No [- J,:'','4' lf yes to Q3, *l,o::q:lise. you ? (lt; Nn ME WAS.MItN't.toNED, r,LEn sE ASK FOt(-, rDENrrryrpobrrroru/ii;ii;; oF rrrE pnnsoN) t'ldalth statf Yilr^g" health conrrrritrec rrrerrrbcrNGO parltler 2. No 3. Don't know Conrrrrun ity'rrrerrrberlchieI Olher (specify educatiorr orr ttre irr,orra'cc of takirrg ivcrrrrccrilr (arrrcrs ar,ruary ftrr t, 2 3 4 5. 5. Have you received scveral years? l. Yes 2. No 3. Carr't terrrqrrrber 6' Did you receive any trainilrg orr irow ro (rea( corr,rrurriry rrrcrrrbcrs? 2. No nl l. Yes Muritorlng tnslrurEnB Krnrpolo , Moy 199(, l,r ,l it ) .1 , i. tr' tf St s&t 'Lit' H';' bl, 7 ls rrrcasurirrg device firr hciglrt prescirt,/ $,i. ,', . .'I .iil -"i{fllpr rr-r, . i",/ 4,5 tt' 'r &I tilrtl :itfi rF ra ','ri -yr*,i l.'Yes, seen 2. yes, but not3. 'No,'(explai 'Iil , seen fi!d jF ,T ,.f #"* i,i 7 Nuruber 8 Nuruber 9 Nurnber I i,"li8;l,ir'ffi ;f il,lT,i,,t 'r.REn.r.MEN,t.t(u(;oN: _ t.s.t.tjtt ANI) oB,l.AtN .t.uE " lfi i-l' .ril*i ! l.?brat F - -m i,ri '2.Age colllposiliotr of pcoplc: Uelow 5 ycars r}. u{ 5 6 3. Sex conrposition o[ the 4 Nurrrber o[ persorrs lrea Nurrrbcr of persons Nurnber of refusals absent tluring last freatnrerrl rvith severe sitje ell.ccts <lf tablets received l0 Nurnber uf ,rbl",, ur".i,, r of tablets.lel"r irr. the rJrug kit ,frecords --- 5 ycars arrd above --PoPulatiotr: Male _ Iielrrale letl_ IVlale.-_ I,crriale aged 5 years arrd alnrve wlro receive, ,r;;- rn iI I I Nunrbe l2.Uprjate r.& tl( | | '.t., 'lt:[ ,rlll;r,rtr. , ;:t ,!,1, , .,i, bt , ,,1r,,, '.t,,it, . , ,tt., .tl c\ AlrtrIlori::.. llrtlltrrrrr.rrtr r. ,r,11-l . Al.r. lrr.)r) 1, lg yillttyt: if tltct r: ttt e tt .t((, ll.t toolt; ttiett.itt I (t ( ut.lr, tttt)untl t,tr, it ,H, -X&l'' or cDI) Scx: l. l;crrralc 2. N4;rlc iii' nti,l,, occupa riorr ;i; Yr:i,,l,urrtJ ycar r:I tjrsr cD.l.l disrriburiorr irr rlrc viililg c IMorrtlr ur;d ycar of lasr CD.l.l tJisrribu(rt_r.. , .. ' e- .-r-- . tr tr,r (lrc villirgc t . l. llorv vras tlrc tirr 1''l'(1"'::1'r/sc,s,tt) frrrr ^ at a vittlrgc r,,..1',,i,' tlistrilrtrli,rr rlccitlctl'/t t. .]ijl,,o" ckh:r.s,,,,*,:,,,,,, q. lrcaltlr rvurkcr i 5. 6' lill::t: rrc.l(rt co,r'r;r((ccr: ,,:, !.:iii:iiil:i'l;1,..,rc,'(i,,* 2.,,W1,0, rrlodc oI distributrurr ,",,, u;;'1, Ir..j i : i;.1 r ..+j| . ir :"I i, lr0ucc-lu.lrurrscj, flili[trfu11,,.,.i1,i,;,, .",,,, :,,;,:iccI J . jHr.rw was llrc rno<lc si rJis(riburiorr dccitl =-:- ct.l'/ l. t. 2. 3. 4. 5. 6. 7. nt.a vill:r,;c nrcr:tirrr ;;llx: :lff;"t llii,,,,, trcalllr workcr {x fifl i{:: r ;::,: i:rr;,_ i L Alrrttllurrrr6 lrr:1rr,,14,11, l(rlrrprll , Mty llgt) r- l. I' I I J i :.,-| ,,,1 ; t,r : t;, l.,i [: . ;.)' , 1.; ir. : ,l ; i t, i . );.t t -'1;iffJ, I i i:' '- ti ' TI T I I t I I T I I I I I I T T I I T f r., lr tJ fi tt', It' 5) I t't I 'l , llorv \vclc y()u sc/cctctl to tlo lf lg w(I k,/ rrl.u vtllrrgc rrrccfirrg .:lll.*,, ckler.s' nrcetinBvrllagc clric [/lcadcr Itcrrl(lr wrlr.hcr I 2 3 4 5 6, 7. ! II i, villagc lrcal villagc colrr otlrcr,(l1lcc lt cornrrrillee iltt(cc ttlcctinI rv) ,l,ih, i.rt ,.' 5. ,l.la.s urry CDIJ bccrr t. yes 6. li yES ro e5 clr;urgctj :rltcr thc Iir.s z. N<r 3. u',.:.',t' ,','uu"u"2on"l knoy \Vhy rvas rlrc Cl)l) clrangetl? I 7 I i I i l'l:rvc you cvcr b<:crr suJlerviscrl ? i , l. yes ?-. No ', B.'iffiilffu,},,,;,i)ffiiiijr,;; ill[ ]i,t3[,n* riN roNED ,,r r,^sri A.S,4 I:6;1, l. llcaltlr .sraff j : Yl1r. hcltrtr corrrrnitrec lrrcrrrtrcrJ. NCO llnrtrrcr i Corlnruniry,rrcrrrbci/chicfJ. Otlter (.spccrl.y) 8tr. Whar rJid thc supcrvl.5111 delr Dorr't krrorv n. tl I Chcckcti (ltc ivcrrrrccf irr irrverrtorv , _a Clrcckcrl.llre rer.o : coIarcrJ,,,.,.,,o111.*rrrcn(,rc.r rJsi.*r", : Atlviscrl orr rlrc tri5. ort,a, 1,,yraai -* tcflltllcrt( <tf nllserrtec.s 9. Ar rvha t occilsiot)s wcrc you su1:crvisccJ? (ClltcLE nLL Tl IA'I'A J'I'LY) . l. Dclorc rlistriburiorr ') D l. )'es ' 3. ,,t" "tt' rli'rlt ilrrrti.rr r.rr ^frcr ,ri,,,rirr,,i;u,, l. ;::;l0;r. JIavc )0u rcccivr rrrrrrrily ,,,.. -;ll lu:'t:rliotr ott tltc irrr.r,cr;rr yr,;rr:.7 tu)orl;lrlcc of t:rki ').. No Nrr No ng ivcrrneclirr t;rblct.s 2 Nrr l Cntl'l rcrrrt:rrrlrcr Motritor,,r* lntltuntctllr K.,,1rol, . Mof lr)99 1 ;I rl I I . Yr:.s t I rt i I I I I I I I I I I . ....i ,,y Jii1,g' ,. ,\f rtrf ')' t\) lOLr. Il" yes wltat wcrc,you tolrll il Did you provrdc (lr l. ycs ''',,ll,r^11,i,$,|.|i,*,,., rtitl you providc rlrc ct,ucari'rr rr.r (trc crr rrrnurriry? (Cil{CLE A I-L c corrrrrrurti(y witlr educatiolr orr ivcrrrrcctilr (rca(rrrcrr(? Z. No Durrrrg tlrc [i rst nrcctirrg rs( dls(ribu riorr l. )'csl. )'cs l. Ycs l. ycs During clisrri bu tiorr ycs to Qll, rvhat rlirJ 1,ou tcll tlre corrrrnurrity? (cl I(cl_ll A LL l.l tA.r, A l.,r)L\,) lJcfr.lrc (llr: tt Soon aftcr d i.srributiorr Otlrcr (s1rr:cr ty) Nd rcccivc trairrir16? rcr. (slzc uI tlrc grutrp)./ I 2 3 4 5 Z. Nrr Z, Nu 2. No ?.. No 13. tr t4. Di<l vou l. ycs ?. 15. lf ycs to Ql4, rvlrcrr ditl ),uu 16. WJro rrairrcd you? vcr;rl 1,t.;rr.., Ollrcr,(spccr11,) rcccivc arry traitrirrg orr Irow to trca( bottrrrrunity ,,,.,,,t.rrZ ,1:]. ,,p ivc.rrrrcclirr arrrrrraily frrr scUcnc ll(s r.rl. (rca(tttcnt ,il'lii::;I,' c-,0,,sibirirv I 2 3 \ 6 I Yc.s I Ycs ' I CSj ycs ?-. No 2. No 2. No 2No I 1L 3 4 I'lcaltlr pcr.,;orrrrc l/( )rrr. NG Do';;;;;'l:;:',',i; "" s'r''l <i i,,a(or /\iloUlcr CDD ------ Otlrcr (.spcciiy) 17. l-lorv lorrg dicl rlrc rrlirring l;x.t? l,,trairrirrg 2,., tr.i . r-,,., ,'lliiliL'--_--railtl lg.. IIurv rrrutty CDDs \vcrc tl;rrrrc.tl (ogc(l l" trairring Lusr trnirri[]_ i4xr-.1,,...,.,... I8 NlIrrrt,r1l111 lrrrtrurrrcIlr Knrrrpalr . Nlry I ()9r) t; i:; 'J|., ,. .1, :, .)., J.i: .'; {1,. ,F' Vrr.'I 5L ,it ;i , ,'t, i ,lr'l il ,*l r^it ,.1 t9 WItcrc was (lrc vcrruc oI tlrg l;rst rr:rirring./. I Witllilt tlrc corrrrrnrniryI Otr(.rlrJc rlrr: corrrrrltrrrily 1 l.lcal(lrcarc [lciliry/lrospir;rlt[. Otlrcr (spccity) 20. Wus tlre vcrruc oI trairrirrli l. ycs Z. No r)cirr to your coltllrlurtity,/ lr )) Wlull \vct.(: y()U lilltglrt rlrrr irr11 trrr irrirrl, rrlrotrl orrt.ltrlt:<:rr:irtlriri (("llt('t,ti Al.t. .t.tln.l. n t,t,t.\,) Wlra( rvcrc y<lu ruu;llrr ;rbou( tllc d.r*./ (Cll(CLE ALL,l.l.lA.l ,l I Cuusr:2. .Syrnp(onrs I Sbcio.ccorrornic irrrlrortarrcc i Coilrrrrrrrrily rrrolrilis;rtiorr,,,,,l,.,1,r..;,ti,,,,). Ivcrntectirr as (rcl)(t. ar,i*r'i.i,..i'f, tr c:rlrrrcrl( [irr ;r ltlttg tirrrc Dtrration of trc;rtrrrcrrt Covcrngc oI rlir;tr ilrrrriorr uosage dc(errrrirr;r t ior rfff r:r ;ij[#:iri::iri:irr!##t],'1, *., .Sirrc crfc.crs i;;;;,;;::;"' utttr rcruralr u^.trsio,,'.ri;;;;;"""1" ttrtrr rt:rt:rrrtl) . [lecrtr<l ker:,.inri Ccrtsus Ollrcr (spcci[,) _.... . Ycs Yt's Ycs \'r "r Yt:s n l,l)t_Y) 2. Nu ?.. No 2. No ').. l..lo 2. N<r t.) 3. ,4, 5. 6. 7. 8. 9. l0 L Ycs l. Ycr I. Yes l. Yr:s I Yr:r; l. Yr::, l. Yc.s I Yr.s L Ycs L. t\{) ). Nrr 2. Nrr 7 N,t 2. lrlrr '). No 2. No 2No 2. No ll ),1 WIlill \vcrc yorr trrrrglrt trl_r()tr( rclrut f irrl;./ l. Nurrrlrcr uf uc1 N;;;;;; ;;i;;',,,1;: ,,c,,(c(, 1 Nrrurlx.r rrI nlrrr.utr.r.< : NutnLrer ol.c.rcluclc<J l)crs()nlI Nrrrrrlrr rvirlr :6. o,r,;; (;p.:;i.,,\ev('r(' rrrrc r.[[,.t.rs (clt(ct-u.n t-L .l I tA.t. n t,r,L.),) l. Yu.s l. 'Ycs ,l \,, . .. l. Ycs I \',". '2 2 ?. ) No No fl, r I'l c., N,r Did (lrc .illty ntclt)bcl or lllc co last distribuf iu,,l,,,, urlttltllullt(/ c()llcct tlrp. rlr rrg [tttttr ;r collccriorr Jreirrr rlurirrg l. )'cs 2. No 3. l)r,rr.r krrow ,..,rt. l[ ,.rro,' to e,l,l , wtty.l 41,,,"r,,,1,r,t t,r.,,.,rryIlr korr1,,,t11.i Al,ry lrirl,, t. l t. i- t. I I 53 ).t WIrutc ii tlrc collce trulr l,ulut/ Dld you cxllcricr 'I . ycs 2. No Plcase cxplain llrtrv rlrr y(), ,(,rrrrr,lly rlr:lcr,,, " ,;:.;:;r';; ly gl rlrrr;-irr tcc l;rtc suPllly oI drugs durirrg tlrc l:rst c,li.st.i ')'t ', tt 29ir '19b 30 l,lrr (iotr'? I L-cnsu:.,rcgistra(iurr rccord : l'lcvrrrrri rrcr(rlrcil( tccUt.tJsi 3,u,::,ilii::l,f,| ,,,,,,,r,",. ur lorlagc r,I rlrugs rlurirrI (lrc l:rst rli.strilrrrtiorr? 2 t.J,r rur;rrlr crl lry tlrc. uurrrrtrrrlly./ Irotr sclro lr1.., rnrtivirlualZ (Cl I((:1.t1 A Ll., 2. .|Vu,, '). Nu 2. No Z. Nr.r rrornral rJ islribution pcriod? uAlju cil(cLtj ALI_ .t.l tn.l I Ycs l.l. Ye.s Z.l. ycs zL Ycs Z.l. Ycs Z. )1. \Vlrlt do you tlt.r it(ruu t irrd iv itJu,rl:, r of tilblc(s (o givc lo arr l. ycs l. ycs l. Ycs l. ycs \vlto arc a[.lscrr( rJurirrg rvlrU rc l usc t r clr(rr tcr rtT worrlrl 1,1y1;-nu( g,ivc tlru trql11c1, 11,1 Did you c.rpcricrrcc sl l. \.,.. I l' ycs, plclsc c.r1rl;rrrr -.___ ""I,li IT,l,lfi.'i""" (rtc'rrrrr"c :, Takc lrciglrt nrcilsurcnrcnt :, vuc rvciglll :. Visual obscrva(iurr . 4. A8c 5. Orlrcr.(spcci U) _ \Vlrat do you do abou( ilrtlivirltr;rlr: JI '1'l Wlricli cntcgoric.s o(. lAlrlray") rL') ('r l)col)lc I 2 l 4 5 6. lrrrllvirlrrrrls lrcltru, 5 \Preg'arrt r;";;;,, ') ycrrr "r 'r[ .gc/ uclurv g()crrr Y,^:':.':.*]':r tlclivcrcd rr:.r., rrrrrrr ,rrc wcckotck irrdivirlrr;rls """r vrrq bcl,r r.. rlil;tr iburlr.rrrVlsitors Orlrcr (.rJreci fil.- -... fJrr No Nu No Nu .t.t llurv 1f11 y,, Irc,l tlIlen t? jr )t,t ctr.tutc llttrl llrt:lrc crrtr:llr rllcr tr{' ;rcrrlllc cvcrr(rrlllly r ce clvc I I I'lorritorrrl l,,rtrunrtnu Krrrprlr , Mty l.)t)t) IB t t T I T T T t T t T t T I I I t t t ' It'{: I I,:!rt l.\:li.',r'I "'!ri 'r);l ,.: ,.;, ,..r-r, ,,?5.b; '.1'* rrary dirys tritr you (ake (u curlprcrc trrc rast dis(ributiorr,l Di ' 36., Wlrcrc do yori nonnilly kccp rlrc rirtrlcrs? 37:, Do you,rlavc tJrugs to rakc carc uI irrirror sidc c[[ects,l l. Ycs Z. No l'ransllortatiorr [or tlrug collcctiorr Inccntivcs (spccify) Othcr (spccify) 39 DO yoq ltavc rrroblcrns witlr rccortl kccllirrg? 5,, 35a; IIow lorrg'tJoi$ou rtortttally kcc, tlrc r^btc(.s irr thc c.rrrrrrrrrrity,i_--_ 'tl rI' lifr' t: I k t'; [iir:.. ,, !1lrl\rl \t " 38' wrrat ki.d oI su,por( rJo you rcccivc frorr trrc corrrrrrurity,iYP ,rlr arlrl y,..,, .,, .,1 , .,_r.,-.1,, . I 2 l , lr I l. Ycs l. yes l)lease cxplairr PLEASE ASK INFOITMATIO t' ,t '..t t llre prograrrrrrre rvitlr 2. No 2. No r (, r 40, If ycs lo e39, plcr,ic cxp lairr j, I 4 l. Plcase.lell us horv you leel ubou 4l 43. a) sustairtrng tlrc prograrrrrrrc b) corrrrrrurrity,rcs[)unsc c) coustra ints Wlrat tlo y<.ru tlrirrk slrorrltl bc tlun,. lr.r irtrlrrovc Arc you rvillirrg (o c<jnrirruq as ;r CJ)D,i rclil)cc( (o tllc 1rr ogr:rr :rr rrc.) l Jl l: FOI{ ltlj(;ls't't:tt ANt) MEASUITtNC DEv,l.SI: .t.() l,n()Vu)l Is rlrclsur irrg dcvicc [or lrciglrt prescrr(? I:Ol-l-o\vlN(; t' , 44n l,to[llorrlrg l,tJlru,lEnlr Karrrgrola , Nlay l,r,)9 l. r :l 5s I ir.'' I I t',. l' I I I I I I io"" t. 1""t'lt, I l,'.' i i-' t.. t. l' ).l'. I it- I ; 1' I I , ,)'uU, 5u c u 2, Ycl, I'rl( lrol rccrr (lixFlirirr) ,,*1 , l,tr.,rrl.r Ntl,.tjxpllirt ,llr. llrlw rlo )',rrr usc it? ls (rcatrrrcrtt I cL,.\tcr llrcscu(? . Ycs, sccrr . \'cs, [rut llut ccclr (Dxlrluirr) , N0, cxlrlrin lrQ'|5 ir "Ycs, sr:crr" IXAMINIiI'1LEA'rMEN'f REGts.ft:l( AND oul-AtN..t.ttul:OLLOWINC tN t.OtUvtA't'tON ON : Total populatiorr gc corrrpositiurr of pcoptc: Ucluw 5 y.curs-- Sc x cor r r1>os iriu r r ur' tr," 1,r1,u r uii J,:l [ .l,'J' alr,vc .r,45. I rl I i r It,., il 4(t I ., 3 I 2 l. :1, 5, 6, 7. L 9, IU II lr:rrurlt i Nutlbcr of llcrsons trc:r(cd___ Uotc=-.._-. [;crrralc N u r r r bc r o I pr c r s o r rs u, r..t. r. iy-"iiiill,u,.i I u.,tli ;.,, ;, ; ;;' " Nrrrrrlrcr rrI rcfrrsnlI Nurrrtrcr rbscrrr,.turiig- Nurrrlrcr rvitlr scvcrc ri,lr. cffcr.ts Nurrrbcr of la'ulr:ts rcccivctl Nurrrbcr uf (ublcts uscd Ntrrrrllcr oI trblcts lc{'r irr.,rc drug kit lils( ttcllilllcilt I'lutllurlIg lrrltrylr*,r,. Krrrqrrb, M.y lrrru l'- i li ,1 t_l;..- : i I'," . . [. I i lr. , .. t [t'' ; li 9:,. l): !, lr t I I I I I I t t I I I T I T I T T I T T + tr I I JL- F It, E I I 'l -t tr, L-:'- Br :L s( FHnexc- 6 . .-,J l, '-tl,', . . r! ..! qvPSTtoNNAI RE FO It II EALT'.t t P EITSON N IiL ?'lis questiotutaire is adninistered on any lrcaltlr workcr iu lhe ureu wlto is directly ittvolved in CD'l'l progrdnune i.e the lrcaltlt sltqff ucaresl lo lltc villnge. Tltg. uutnber <[ heultlt personnel to be irileruiewo<! clcpcttcls ott tlrc situatiott o,, tltc grouttd. .A ninittuut of 3 health pcr.ronnel wlto ore xqtentisors of CDDs shoulcl bc itrtcntieved witltirt tlrc ptoject drEa. AIter tlrc interttiev ask llrc lrcaltlt personnel for tlrc docuntents ttse.t lor CDTI activities. LGA/Subcounty State/DiStrict Country Ndlrrc of health per'sonrtel Scx: l. Malc 2. I;crttalc No. of Oncho. Villages ' tt' ' ' Position: No. of CDDs in villages covercd__ Qualilicatiorr: fr; t+' u il I 'llesponsibilities in Oncho control Prograrttttte: I Oncho Coortliltator 2 CDD supcrvisor' 3 othcr' (specily)_ 1. Ditl you receive any gerrcral orierrtation on CD'tl? l. .Yes 2. No 2a. Did you receive training on horv to traiu CDDs? l. Yes 2. No 2b. Ifyes, how long?, 2c. List the uraiu topics covercd I i t"-" L 2d. Were,you tauglit lrow severc sidc cffects shoukJ bc rrrauagcd? l.'Yes 2. No '3ll'leasclell us what you krrow about tlre CD'fl t)rog,rauune rvirh respccr to 1. Corrununity 2. ltrvolvertrcrrt of the liealth systerrr irr CD'l'l I 4i Was tltere an initial rneeting with the conununity rvhcre CD'l'l was introduced'/L- l. Yes 2. No L Molitoring lnsln nEnts Knnprlo , Mny 1909 {. I . Yc.s I. Yes l. )'cs 2. No 2. No 2. No s? rtiz, rrl.:. ':' / .b.! T i.,,'i.lT,l;Q4' rvhat role ditl the lrealttr stal^f ptav irr arrarrgirrg for rhe rirsr rrrceting? (crRLcE A[.i],, leg rF tuii bJ 'E ,t: rl iD ,rI *ir I;acilitate<I ilre nrcet irrg Met with village leader to arrange firr tfie rrreetirrgOther (specify) Who lecl the facilitaring teatn to ltre corrurrulriry? health srafT govenunen( adlrrirristrative sta [f (rrorr-lrealtlr)NCDO sraff other (specify) Nobuly lffiji" cotttrtturtilies (wltere you worketl) e<.lucare<.r orr rrre i,,rpo,tr,,." or.treatrrent witrr iverrnectirr l. Ycs 2. No 3. Dorr't krrorv ll'ycs ro Q7, rvtrar were rhey ror<J? (CIRcr-E Ar-L TIrA-r.Aprrly) Arrrrual lrcalnrelrl for scvcrat years lJenefits of trealrnent Cornruunity responsibiliry Others (specify) were cDDs itt llte coltttttutrilics (rvherc y,u rv'rkett) trairrcrt rur trre CD.r'r llrograrrr,c?1. Ycs Z. No 3. Dorr,r know ll'1'ss 11; Q9, did you parriciparc irr rrrc trairrin_u of cr)r)s,/ l. Yes 2. No I0t) Il'yes. horv lolrg rJid rhis rrairrirrg se.ssiorr last,/ lnitial trairri ilg I{etrairrir lo I la. Wlro .supervise<J the CDDs I . Not supervisetl 2. Villa-rre lrcad 3. Village health cornnrirtee ruerrrber4. lrealth persorrrrel 5. Orlrcr 1. 2. .> 6. 'if t-E ,.Fi rJ ,E '*r r-S [I ,4 , r,fl IJ .T d I 2 3 4 5. 7 E 9 I0u 1 2 3 4, llh ll"sulrcrviserJ' ^ow rrrarry cDDs did y,u su,ervise trurirrg rrrc rasr disrriburiorr? t? ll' rrot super.viscrl, rvhy? t tvlticlt occasiorrs.did you visit rlre Clluz (CllrCLE ALL .lIIAI. AlrpLy) l. Ycs 2. No 'i ..i . ',:t,:' ["t 'll -lj 3 ,,i i -i ,l ,-t 1 .fl ,1 *.{l .ilrij h -., i{ fi "rl ,, I ti:,,,:tv,i,.;l(l,l l].A l.lehrr c <.1i.sr ribri r ion Mrrrritrrrilg lIslnllEnls Karrrpala, M.ty lg1)g i .i *1, I t 56 '.t'{ i During tlistributiolr Soon aftcr' rlistribution Otlrcr (specify) l. Collection of unused drugs after distribution2. Review of records 3.. Manageurcnt of sidc effects4. Supervision of rl rug distributiorri.{ 5. orher 2 3 4 l. Ycs 2 l. Ycs 2 No No t )o{tsi- ri t*r ( I' t 'l! 4-i, ' 14' what futtctiotts rlo you pcrftrrttt <Juri4g your visit kr rhe cDD? (clltcLE AI-L -l.llAT AppLy) ., l. Yes l. Ycs l. Yes l. Yes 2. No 2. No 2. No 2. No t. pls' wlrnt cottstrailtts r'lo you ttavc irr suPcrvisirrg rhc CDD? (clltcl-D n Ll-.1l^.r Apl,Ly) l. No constraints 2. inadequate/lack of rneans of transport/fuel3. Too much work 4. Ilradequate/lack of supervisiorr allowarrce5. hracccssibility 6. Orhcr (spccify l6a. Havc there beerr any delays irr receivirrg ivcnrrcctirr,/ li yes 2. No l6b. lf ye's, explairr l6c' llave tltcrc bcctt arry tlclal's irr c,llectilrg iverrrrectirr lly.rlrc crrrrrrruriry? l. Yes 2. No 17. If ycs ro el6c, please explain l8' wlrat co.strairlls lta'e you exPerie,cccl i, gelri'g ttre dnrgz (clltcl.lj Al-L .l.llAT. Apl)l-y) L Yes 2. Nol. Yes 2. Nol. Ycs 2. Ncrl. Ycs 2. No l. Ycs 2. No l. None 2. Transport problenr 3. hudequate supply4. Dclay iu supply l. Yes l. Yesl. Yesl. Yc.s 2. No 2. No 2. No 2. No5 Otlrer (spccify) 19. llow do you esrirrraae the quanliry of clrug require<J? l. Not responsible 2. Nulnber used <Jur irrg last llea(nlent 3" Bhsecl ort requests.fronr (lle CDDs4. 'lbtat population (with the forrnu la)5.. Orher (specify) 20. Did you get ilre drugs wlrcn rcquir.ctl? l. Yes 2. No Morril(lrirrg l,rslruillcnls Klrrrplrlu . lvlry lrrr)() L $-*ti - "li t' !r v I I I )r+ 21.' lf no ro eZO, why? t. 2. 3. Shortagc a Mearrs oi wlrat otrrer rreartrr activiries do you corrrbirrc wi(rr orrcrr, CorrrrorACtiVitiCS.(PIIOIJE FOIT I IEALiTiNCL:iVI'.Y IN'IlIU CD'.I C ?7., How do you feet about the CDl.l progranune? 5s Frt' n t stale, regiorral levet transport Other (specifr) '22. Do you lrave facility for.storage of iverrnectin,/ l. Yes 2. No 3. Dolr't krrorv .,23. Ilave you experienced loss of tablcts due (o pil(.crage,/ l. Yes 2. No 3. I)orr,l know 24 Wcie cases of severe si<Je eflecrs repor(ed to you? l. Yes 2. No 25 (ct.tECK AVA Ir-AIltLI.rY) l. .Available 2. Not available 2(t I i *i lr i t l, I F I)r<lg rar tu rre oMMUNt]lES)? Nlrltiftuirrg lnsllultcnls Xnrrrp:rla . N41). lrrr)() I I { I I t tt I i i I I i l\ ,, I ,,k r-ry] -r{ I t il .rm + U iI' i, flxnrsxe i 6o I I I i I I I I I GROUP DISCUSSI.N GUIDE AM.NG ..MMUNITY MEMBERS:VILLAGE Aln each cateSoty A viltage, orrc Male artd orte Fennre qdurt group d,iscussio^ nrust becottducted' h three .! ilrc-sk category A litlagcs, grru; dirrassiorrs trtust be conducted witrtttnle youtlts-and in tie re.nruirdtttg irri'uittog"i, aiiiioir",uuro be trctd witrt fenrure youtrts.For noniroring GDTI projer,ti, ,;u;i;r";r" definett o, tiir-iirnls betweert I5 atiii y"orr. The cDD ntust arratl1.e_Iotr a cottrfoflobre prace ilnr oflers sorne privacy ana atougrtplaces b sit . Each group ttrtst co,tsist ofb-a ltcopr"'iir)r*i,tg.ort culture, tlrc groupttiscttssiotts,,,oy,,rii.ii[,o;,;;;;',;:;;;;,:;7,oyfoy.,,.,ate arutfenmte s, ttnr peoltte cartspeakfi'eerv. one of rhe i*ennt,,ro,uidrr rtriutd be,,r"ii,iiii,or whle a rocar guide.takes notes (recordlfl. n," grorp iirrurlio,, tttust be rape_rccorded. At tlrc end of rhe scssio-tt' play back rlrc t.ltefor afew rr,,,tttres ro be.rure trnt the discussio^ ruasproperty recorded. Ia.bet'ttti corrr*-iuoirifyi,i, ,i,irn-"i,orr, the group idenrily, date). If,}::}"RoUPS: ADULT IT,IALES; ADULT FEMALES; YoUNG MALES oR I,. I r wllat you llnow about trrc onctrocerciasis treatrrle,t progra,,lllc (,LEASETr-rE FOLLOWTNG rssuES. ) the person(s) who brought the idea of tlre onchocerciasis programrne to trris vi,age ., trre tirne wrre, (rre per.son(s) carne to tark witrr you about oncrrocerciasis whether ilrere was a village rrreeting at tlla( linle Issues (hat were discussed at tlte nleeting . ownership of the progratnnle . expechtion frorn tlte prograurnre . responsib.ility of the cornnrunity Pi._uf" cJescribe how the comnrunity (ook dof disrribution. pLEASE pROBE FOR: eclsron on the rinre (rnonth/season) and rnode persons involved in decisibn_rnaking Tirne of distribution Why tlre tinre was chosen Mertrod of diitribution . WJry ttre rnettrod of distribution was choserr Please rlescribe rrow.lrre cornr,unity took decision on trredistributing ilre drugs to communi,y ,i,",n"u"qu. pLEAsE pRoBJ?JIls responsibre for . Persons irrvolved in decision_rnaking . Who wiil be responsibte fo, oiri.iOriion Please tell us PROBE FOR ii F' F 2 3 Monitoring tnstrunrnts Ktmpth ,Mzy l(I)9 _ i -*,-: $r . How the persons were selected . Why the persons were setected . Method of clrug-collection Has iltere bee,,ary crrange in dre person.f.plr]bl. for drug distribution (cDD) sincettre beginning'of rrre programme? (pLEAsE fEitlus w;;)r "'ttt'outton r Has there been any cirange in the programme ? ,; tr\ 4a 4b 5 . Who brought the ctrange . What was the change i\ r r )l wltat were you toltl about tlte need for conrrnunity (rearrnent with ivermectin? (pRoBrFOR ANNUAI- TITEATMENT FOR SEVERALYEARS, T}IE BENEFIT, SOURCEOF INFORIVTATION, COrr,rrrAUruiiV RESPONSIIJIT-iTV AND HEALTHEDUCATION) l' 7 (r. How is tlre drug nornrally brou ntenrbers? PROIIE FOR ght into the cornmuniti, and distributed to cornmunigl . point of collection . person responsible for bringing it to the cornlnunitl,, ' person responsibre for distribution within the cornrirunity . lnode of distribution . rvhen was tlle drug srvallowed would you please rell us tltose wlto should not bc treated witlr ivennectin (exclusion c ri te ria )? I9y \\'as dosage derernrined by trre cDDs during trre rast distribution? pRoBEFOI{ T/lEASURING DEVICE what probletns ltave yorr had rvith rcsl)ccr ro rhe distriburion of the drug? pRoBE F.oR o tinreliness o[ supply to the contrnunity . adequacy of supply . storage What problerns have I,ou hacl afrer takin! the drugs? r How prepared is the cotltrnunity to take control of iverrncctin distribution progranrme?(l{ow does tlte cotlttnunity intend to sustain the exercise ftir several years?) what support rras the corlrnrnrty give. to trrc cDD? pRoBE FoR : 8 9 r0 II t2 a a a Incen(ives in cash or in kind Provisiorr of ruearrs of transport Mobi ! ization of cornntunity Monitoring lnstrutncnls Krnrpah ,May l9g9 4',| NT t- ,:lt; */r.' I3rr.suriug courgtliaucc \ l3- Could you please.tell trs ltou, you woultl uleasure the success of tlre CD'tl progranrlrc'/ ,1 ,, 14. How well lms the CDD perfour)ed/ (t,ltol-)D IiOR A'fl;lT'UDE). 15. What suggestions clo you'lrave to inrprove the progralrrnre? I ; it P Monitorirrg lnstrunrnts Krntpalo , May l9()(,) I L-. rl ,l *L' ,*,iJ-"'ltrD l: a I -,1;j L_ 65fi,v^{exG & I tNrunvlDw cuIDE FoR I'oLICy-MAKItIrs/ vvlIo nEpRltsriN'r'ATrvE/pnocltArvrML IVIANAGIIRS/ COOITDINATOIIS r'!r"l .l ' j L T'ltis interuiew is adninislered on Co'ordinators, Progranune t,m,tagers, represeiltatives of NGDOs ittvolveditt CDTI, Mittistty oJ lrcaltlt policynnkct's ctttd tne litto reprcsentttive itt rhe coultt!. Il is sitttilctr to tlrc , inte'view of heakh persourcl. Doctt,,rc,ils sacll ns registers'sitoukl be requestecl befoie tlrc forn*l i,ilervie*I so tlnl infonnaliott can be extracted for tlrc report 'i t" ,' f ':$, )il $ tf, sEcrloN A: PRoGRAMME MANAcERs/ oNCHo cocr(DTNAToRSl' Please describe ltow ttre CDTI progiatnure is beirrg iurplcnrented irr your area PIIOBE FOR fl. The approaclr usetl lbr introducirrg cD1'l to tlre corrrururrities b. Eletneltts o[ collaboratiou be(ween Couuuuuity, i{ealtlr sysreul antl NGDOs SPECtFTC ROLES) c. Cetteral re-orietttatitlrt of ltealtlr personncl [owards CD'l'l prograrnnle d. lvlobilisatiorr of rhe c()nllnunities e. Trairring oI healrlr sraff as trainers Please explain process of recr:iving iverrrrectirr. PROBE FOII : a. Delays in suppiy . a( wllat lcvel and rvlry? c. Adcquacy of rlre quantity reccivcd/slrortagc tl. Storage e. Distribution to coutnrurrities f. Consl,raints (stor.age, trans[)ort, etc) g. Pilflerage FUNDINC: please probe lirr a. Delays in errdorscnrctrt oI lcttcrs of agrecrrrcrrt (IDENTIFY * i 2 J JJ; i . l i i Il{ Why? b, Delays irr receivirrg [unds o a( rvlrat level arrtl rvlry? : Dclays irr disbursurrcnt o[ furrds . At what level aud wIry,/ 1 I It- sl l',lrxrilorirrg Jrrslrunrrrls Krntllnln, May l ggrt ^_-_1_ .i 6t^ ir Orrcho Corrtrol prograrrmre 4 5 d. lrradequacy of previctis burlget c Furrd arlnrirristratio,ri .l*rays i, subrrrissi'rr ,[ rrra^ciar rcporrs,disbu rselrielrt.and r.ti r.,,nui' prJi.Uu r.r,deravs i' reedQack i;';;';;lb-at""rrqr.r,"rs orr ,,a^ciar rcporrs l)leasc ctescribc rrre ,rograrrrarc,s ;rlarrs f,r irrrpr.t.lvirrg sustairrar.ririty Wlli:'l other healrh acriviries; do rtre Oncircactivities? I .sttpcrvisors corrrtrine witlt (lle would yuu llrease ex,rai, rrre r)r0grarrrte-s rcc,rd kcc,irrg ,r,ccauresEXAM INE TI IE FOLLOU'INC' ;i;;6ffi, Surnrnary sheets: L Available 2. Not available (r 7 I'X'IITACT INIiOdi\,IA]'I Or\I ON stirte alrd LGA) a. Total Iropulariorr I'IIE I'OLLOWING (relare to ttre level of operalion e.g b. Nunrber o[ villages irr tlre area c. Nurrrber of villa_gc.s rvith surrrrrrary fonrrs d. Nurrrber oI villa-ues rru:atcrl Nunrber rvilh severe sicle r:ffects . f' Evi<Jetrce r:f report updatc (chcck alrrrual reluill.s al-rcr tJistributiorr) I. Updared Z. Not upctared sEcrloN B: IVIoII PoLICY l\lAK'ERs ( Perttrarrerrr. secrcrary/Di.cctor Disease corrrror) 3l;,,ilrli.l,l':::Jritt'orral Plart lbr the corrrrol of t.urctrrrce.ciasis ( pftrbe ro, tr," irnprrrarce auacrretr ro 8ll. Wlrat kirrd of sunrrrrrr rtrr r,.,,, rr-....i.t- r ^lNpur) -r ppu t tlo -vuu providc ftrr onclro. cr;rrtrol acti,riries (lrltoBE,Folt FINANCIAL 9 llow rJo you perceive rhe cD'l'l stralegy ,f AI'oc ( Probe for persorrar opilliorr a,t] officiat policy ,rrCDTI) lo Is the oncho Prograrrtltle itrtegralecl i,,:" ll: lrealtlr sysrcrl ( Irrutre for activities rv'ictr i,tlicateitttegratiott arrd ownership/ I)larrs for sustairral_rility. tcrl 't b [<r l hict ntlica , e Morrilrrrirrg lnslrutrEnls Kornpola,May l99t) p Z T x/n o\ tn\ t'.U o) 9idiETo I a'E E 3TEil JxqQ 6'3 d o bt 6B5 @ -drD>-{)raJ 5,iEoB;;5i#:a '4, -, tsP;'.E'E -, i ari 4 FlJ ,,s. S' B' I 5 3'z 9-P6E5' =oB {.^-'o 6 :JiH ?.ouc .E E. T€ ,N.;;TD '6 <a- 2 o IlJ6:836; ;;,F3 r(D:Jc :g rEY6TD = _.o - -.5 "r P -tr- -t5a=J9 ? H:{Hod8.c-bsil s. g'<6 =5 rns* r5B: *<q, t f Koart(pd8.;+ 'g 3 q -ooDrrt 7=JO El 3:r ==oi? E1)='- ud5 0u,o P d3fl -_H = 5'99d>2a*ilro:J =Bd E 5$' 6,qgc*6 A(D =Ja31o- S. 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'= ,,' t:Il';TE-'[ E E E,E ; + EI € Ag c'; o at r2- .:? o E = = dt = o to rn ct llilH 3:qqE .E tr <ru- ll tr E=FgDE 5lt .= n)'E :4 iJ x'IJ {,gEEE (, .(, oo * * 6o t--ll 9oc c ooll Ot}\ 'i.E H ll rrotr.59 -9,ll ii,o:co c e'5 g 3:i E; E }'E H g; E E"UE E O*O9ll [^.33E ELj tt tt;E'EIgp0., s, 6 br) g r.rrc E (u q.:j(g o-r-.=NlJ *" 3 3E.EE ., I ,' ,,, (j( :11 I r..- '1. P 4) 1 t.t' l)l ,i 0) , I r t: l- .l t, I ,) , I I i J , t: 'lJ 6) ^J() I 'I ) '' 'ii 1lal r-l qr i< .i "'l (. t., t, ' Il' J lisl.i i':l:,i ml'l r1 -H .) ,I) .t: \, ( r) s lrl(l(t I !) fl t. -., .'l I I .t ,ir I I i-I f, I t', t_. L: 0r .: I ,:' r,, ,,1 :r ,.i ) -:r 1 'j /