Cross river NOTF/WHO-APOC CDTI sixth year technical report to Technical Consultative Committee (TCC): July 2003- June 2004

MINISTRY OF HEALTH, CALABAR, IYIGERIA, 6TH YEAR TECHNICAL REPORT COUNTRYAIOTF: NOTF NIGERIA Proiect Name: CROSS RMR NOTF/WHO-APOC CDTI PRJ. Approval vear: 1997 Ldunch ins vear: 1998 Reporting Period (Month/Year) JULY 2OO3 - JUNE 2OO4 Date submitted: I -n lrty,zool NGDO oartner: UNICEF CROSS RIVER STATE 1 m I tf rl \xu - r: I P$ ,^ i \ccl l5 C5DCL\f(.^P Btrl ar[ tSvt f-o Ac. _f,arcstot, i. ffi 5rB- P,o 2 0 aout lonq WHO/APOC, 26 September 2003 ISIXTH YEAR TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) 11 WHO/APOC, 26 September 2003 {SIXTH YEAR TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMN{ITTE,E (TCC) ENDORSE,ME,NT Please Conlirm you have reacl this report by signing in the appropriate sPace. OFFICERS to sign the report: Country NIGERIA t; lt l! National Coordinator Name: Dr Signature: .. Date Jiya ) Zonal Oncho Coordinator Name: Dr. U'E' Udofa Signature t4vl rtDate This report has been prepared by Name : Adie, Hilary Adie Designation : Ac Coordinator Signature Date tlr WII ,rl'OC '6 Septernber 2003 Table of contents ACRONYMS ............... DEFINITIONS ......... FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARY......... SECTION 1: BACKGROUND INFORMATION........ 1.1. GeNenelINFoRMATIoN............ l. L l. Description of the project (briefly) l. L 2. P artnership........ 1.2. PopulartoN AND Heelrn sysrEM 8 ............9 ,.........10 .......... I 0 ......,., 1 0 ....,..., 1 0 10 SECTION 2: IMPLEMENTATION OF CDTI. ll 2.1. PEnroo oF AcrrvrrEs............. ...........1 1 2.2. ORoeRrNG, sroRAGE AND DELIVERY oF IVERMECTIN ............14 2.3, Aovocncv eNo SENsllzATIoN..... .....................15 2.4. MoslLtzerroN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES..........................16 2,5. CouvullrtEs INVoLVEMENT IN DECISIoN-MAKING ...-..........17 2.6. CepRctry BUILDINc ........EnnOn! BooruARK NOT DEFINED. 2 6. 1 . Training.... ..... Error! Bookmsrk not deJined. 2.6.2. Equipment and human resources.. ..............24 CoNprrroN oF THE EeurpMENT * PLsnse srATE .............24 2.7. TRperrraeNTS............. ......26 2.7.1. Treatment figures Eruor! Bookmark not deJined. 2.7.3. Trend of treatment achievement from CDTI project inception to the current year 3l 2.8. SuppnvtstoN............... SECTION 3: SUPPORT TO CDTI.... 3.1. FmaNcrnl coNTRIBUTIoNS oF THE PARTNERS AND coMMUNITIES 3.2. Oruen FoRMS oF coMMUNITy suppoRT................ 3.3. ExpeNprruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI........ 4.1. INteRNnl; INDEeENDENT PARTICTPAToRY MoNIToRINc; EvalunrloN........ 4.2. CovtvuNtry sELF-MoNIToRING nNo StereHoLDERS MeErtNc 4.3. SuSTaINaSILITY oF PRoJECTS: PLAN AND SET TARCETS (MANDA,I'ORY A]. YR 3) 4.4. INrscRettoN............... 4.5 OppnerroNAl RESEARCH. SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES ...32 ...35 ...3 5 ...3 5 ...36 ...37 ...37 ...3 8 ...39 ...40 ...41 ...41 1V WHO/APOC, 26 September 2003 Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHFS LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LTNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Frontline Health Facility staff Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Or ganization WHO/APOC, 26 September 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). ( ii) Elieible pulation: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment ObjceUye (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) imate Treatment Goal calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) GesffaphlaallaygIacgi number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). VI WHO/APOC, 26 September 2003 FOLLOW UP ON TGG REGOMMENDATIONS Using rhe table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 17 Number of Recommendat ion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 111 Why counterPart contribution was not Paid bY the Government and the delay in scaling uP csm. Advocacy from NOTF and NGDO Partners was not adequate, The advocacy visit by APOC delegation that came to the State in Feb.2003 yielded positive results as Government released the sum of two million, one hundred thousand Naira (N2,100,000) and LGA Councils released One million, four hundred thousand Naira (N1,400,000) for oncho. activities in 2003, in 2004, Government also released 2.8 Million Naira for oncho. Control and Vitamin A supplementation. The delay in scaling uP CSM was not deliberate, the concept of CSM and SHM are difficult and time consuming to implement' Time was required to build the capacity of implementers, also LOCTs were told to implement the concept in a gradual manner and leam from mistakes in the field before expanding to other communities, during this reporting period, CSM was implemented in 395 communities 'r)a Clarification on reduction of communities from 932 to 930 in2002 and reduction in poputation from 926,091 in 2001 to 902,544 in 2002 Two communities, one each irr Biase and Akamkpa LGAs are no longer in existence due to communal clashes.these communities are Itan and Isoba communities respectively, so the total number of communities in the two LGAs reduced from 33 to 32 and 94 to 93 respectively in 2003. There was good population update in2002. The unit noticed low tlrerapeutic coverages in Obudu and Ogoja LGAs and embarked on spotchecks in the communities in these LGAs. It was noticed that community members were unwilling to exclude their relatives that were not living in the communities out of the treatment register. Mass mobilization in the two LGAs and proper enumeration reduced the population to 902,544 in 2002 from 926 091 in 2001 WHO/APOC, 26 September 2003 Executive Summary ln1997, APOC approved the commencement of the Cross River State CDTI project and in 1998 implementation of CDTI commenced in five LGAs. Currently the project is in all 14 endemic LGAs out of the l8 LGAs in the entire State. This sixth year of CDTI implementation was aimed at ensuring continuity of CDTI implementation through release of counterpart funds, empowerment of all CDTI communities on the addition of Vitamin A supplementation and ensuring practical integration into PHC system. The project treated a total of 534,781 persons in 692 communities from July to Dec. 2003 and 188,886 persons in246 communities from Jan. To June. 2004, the total number of persons treated for the period is 723,667, Therapeutic coverage is 78o/o. The total population of meso and hyper communities is 930,951. A total of 13,643 post partum mothers and 297,831 children 6months to 59 months recieved supplements of Vitamin A using CDTI structures for supplementation in June 2004. The UTG is 782,000, the relocation of three campuses of the Cross River State University of Technology to three core endemic LGAs has caused movement of people from the Capital city to Ogoja, Bekwarra and Akamkpa LGAs. During this period, 570 peripheral health staff were trained on CDTI, Community self monitoring, organization of stakeholders meetings and Vitamin A suplementation, A total of 2416 CDDs were trained during the reporting period, the CDD ratio is I :385 persons. The major challenges in the CR- CDTI project are : o Ensuring the continuation of counterpart funding by Government. o Collaboration with other service delivery organrzatrons in promoting total blindness control in the communities . Involvement of women in CDTI activities. To address the challenges,there is a budget line item for onchocerciasis control activities in the State Plan,networking with eyecare providers for community eyecare,mobilization of community members involve women in decision making process. 9 WHO/APOC, 26 September 2003 SECTION 1: Background information 1.1. General information 1.11 Description of the Project STUDY AREA cross River state is one of the 10 States in south Eastern Nigeria Primary Health care (PHC) zones. The state is situated within the cross River Basin between latitude 5032'North, and 40 27'East. Ebonyi, Abia, and Akwa lbom States bound the state in west, in the North by Benue state. The southern boundary is the Atlantic ocean and it has international boundary with the Republic of cameroon in the East' The main occupations of the people are farming, fishing and hunting. The state is situated within the tropical rainforest, one of Africa's most dense forest found on the eastern borders with the Cameroon and the secondary forest and guinea savannah in the western and nodhern part of the State. The climate is tropical, however temperate climate is found in Obudu plateau where altitudes are in the region of 1,S00metres above sea level. The topography is mountainous in the cameroon border, plain fields are found in Yala and ogoja axis. The population is approximately 2.4 million as projected by the 1991 population census. The state has three main languages, Efik, Ejagham and Bekwarra. one major festival celebrated in the State is the new yam festival which takes place in the rainy season. There is a good road network which links the State with other parts of the country. The state can be accessed through land, air and water. There is a two tier administrative structure at this level. The State executive council is headed by a democratically elected Governor. The local councils are headed by the local Government chairmen who are also democraticallY elected. The health system is divided into the primary, secondary and tertiary levels, the primary level which is community base is run by the Local Goverment administration 10 WHO/APOC, 26 SePtember 2003 rn conJunctron with the State tt/inistry of Health. The secondary level is managed by the State Mrnrstry of Health and takes care of referrals from the primary level. The tertiary level is managed by the Federal Government and comprtse of the teachrng hosprtal rn the university college where spectal cases are referred to for specral care. There are 296 health centers and posts in the project area' l. l. l. PartnershiP ['5e pro.yecr is implemented by the F'ederal Ministry of Health. AI'}OC-WHO- State Mrnrstry of Health, The LGAs, the communities. UNICEF and st'veral other NGOs u hich include: South Eastern Nigeria Outreach Eyecare Services (SENOES). youthcare. Ogoja Catholic Diocese Eyecare Services, Opthalmology Department I niyersity ot'Calabar, Cross River National Park, Cross River Forestry Commissiott a,cl I'Lrlsi Chanrai tbundation.'fhe CBOs who are working in partnership include: (ireat Friends KIub of Obudu, Pacesetters Klub Exclusive of Calabar, Calabar Leo Klub and ('atholic Nurses Guild.The State Ministry of Health provides the manpower needs tbr the implementation of the project. provides counterpart funding tbr activities and monitors overall implementation strategy and administration.The NGDO (UNICEI") partner provides part funding, logistics and expertise advice for project implementation. T.he local NGOs and CBOs e.g the Cross River National Park and Forestry commission are responsible for delivery of Mectizan, training of CDDs in their catchment areas. The projcct has up scaled activities and is looking at integrated eyecare service now. People ti.om endemic areas residing in Calabar and other major towns in the State are treated in churches by other CBOs like the Catholic Nurses Guild, Archdiocese of Calabar. the Great Friends Klub of Obudu, The Pacesetters Klub Exclusive of Calabar. A good number of policy makers worship in these churches also and are mobilized during such tbra to support CDTI activities. 1l WHO/APOC, 26 September 2003 ca al () -o Eo o. 0)a \o C.l U - o. (J Ct.l 0! o 0 .o d MItrlr6 6 loItr ( La lE L 60 L u0 U q) T\ U -x q) U) q) o_U -i Lroq o0 ! o 0) Li o bo *r o L< Eo Cdotr 0)l-r o l-r() o o)t. G I c) L q) L q) () .PEco':s-Yh.2 >tiot6 sqgq/ I!GAO=rFg r-o -g9_ -QLdIEE L a q q) u a) E3O'.= .E 'E rE= -)cext? *l .olNbt rdlFFI q + t- N6l*. co C.ls o\ €lr) t-* o\ ra) o\ cn caN N N $ r- oo cn tr) oo ca o.l t-- rnN\o oo\o+ tr- cn tr) N NOt (r)$ &+ co cn ol(n oo co $N c-.ltr) s co$s r-- FP q)e : o- E EeDI \o$ o.l ra o\ ?a o\ t r- tr) oo tr* C.l \r1 (-- o\N coN$ ca tl^) \o$ * tr) ca oor)$ N(n tr-$tr) Ots$ t-- t $ o\ oo $s \o oo(.)$ a.l o1\o C.I \o @ oo .6, -0ro .= qN il( c F 8,8 oo oo$ ca s$ tr- $ ca$NN o.l$OtN ca c.l$ \o$ oo \o F- CO ca $\o $+ ca oo C.]+ C-l cn v$+ N ca ca\o v+ o!1 . oE E .'.-9- a 0)'- '(.) >,€ () q) -FL o\ \o F- (\l ?n ?a ?a ca @ \o(a) oo ca cn tr-rr N o\ o\ o\N \o O, c.t N *NF- o\N ca\or-\oN co @ c.l r- o, rr)(r)\o ol $\o F-N\o c-+ ca Ot$ Otoo c..l @ o\ + oo o\ ca $ Gt 'EcE Ya)() os= E c..l ?a o\\otr) $o\ca (r)\otr-\o $C.lo\oi $o\C\lca o\NN ca \oscao\ ILq) oN Gq) ra tr-Ntr) o.rncn &coca \oNo\\o $ € oIco$ ca (.) .9 .1i- 0r= tr o) :''i()E El- cqotr >r q)ETE N raia\oo\ rr)c.l(r) @cat/^) \ocao\ $\o lr)@ca cArn N o 'EEE Y(rorgsi I L 0) z (o$rN r to o) o(v) CD o$ l- ro @f-N tr,of- O)N r cf)Ns cf) r.oo(o$s ro CO @tos N tr)l-$tr) o o)$$f- $rs LO O) @o rs$r F(o @tr)$ FoNN(o N (o @ @ .icc -6)oo= .r L trEE: -+ F Eq i;'FVUF-Ft aE a I -1 F F-)o(, o t-tfY l ol co o 2 o-Yl o o l\l Jz co o t c0f co o (, zfF tu o Y r.u U) c0 =o d] o f c0 (L :z dt = Y uJ co o-Y V uh: eq)C) .3f.* *sEc .=.-^GlA,--l- =< fl * Arl F l.L o ao uJo a)zt= -r LL oo o o a o o a o) (U a z =Fo oo oo o_ oo z oo o_ oo(f) z oo o-$@z t o Ioz o= :.u E ; E se E u € b3"9loE59.Ets=frz-o.2356 3 .q OE ou, hcD 4E =EzE -EL o-tA 12ii =r; E >\(/)3>E3E:p8E i8 PIEEi sE Ed ezEdz6o> oru!u= H8o-E ild g_ 3g - Fc .= io =oP 5E€E b E:e E 9'E AiEEE E0-(Eo.cooC = = * ) l =et/,o(U(/) c)I Et E EE E EF g:E e (l) o-o(J 0-(E (U Eco c;t .9 I e!itr (EfE8__E6*O*:ltY.hX i;TE $ Er=EH9E = a ur.= O- o) .9 (U CEoo) E.= -OOi^ ao o.= 6 lrJ =trl! IJJ = (r)ooN o) -oo o o ab o=Ntr P O(oO-(J-r 3ER cf)ooN o o) f ooo I!coOrio6U)N o z o o E o=Lo(!Fr- g P'6otJo ?E,..89[E E; O rt o > 6 t\ L A = Lv rr t tDr F o) 8?f $gt" gg IBSE E99 E.S O rl o > 6.\ , A P8 E H,i E H' 8T E'E66 E'Eaao-tJJo-> ='o (5 F-OEOOO6Eoor o oa=o--i,,- o uJ tr Fo :(Es_ _ m j2 3P.? gE:d.E =.OJE - 9 or.9.96 E.S E E - q)x o o)6 S6EE o-.= E (D o RE '- aQ PH.fi q(, >,E !2 6E; r = 3og trco': €o b E5:E ok E @ "io-(EFj=@:'F 6 a F A;:B?ES E dE ,9> oA .qo Nl(s -o c2o hr = 6u) tu9>lrF i-i o EUJ st =s'oo () Q*ro(Dr B .Q c-> -C (EIHE: LLL E- =H .P E E -E.s sgagetE oz o N c.to N C) -o 0) o. 0)a N U a) o ca FI(Jl lrJl -lolEI o-l zl FI ol uJl =le Hlsl -lRIElul =lzlulJl2tat Eldl klRl Hl:l ---.: Flll E ol3 E Elul E fil3l 9 trlirl9olalF :ltlJl .= Lt>t B =lrlz =l8lE 8 5Erl/ol -i rl-lIIEZIx<t Edl >,zl -o ol :g ?l C)(c bI) '5(s oE ; '.= H +r o d = liq) a o otr#tr a-#(, G|I o ! ot-L oE IlF aN Fa(J F o tr ,9# IEfl tr o E .9c E ITN z o IF(, ul o .l ^) ') el c *O aOJ > nrPor- qooET *9(gq) : E< Iooc: rOt-tJEc6oJ 0)= >Z.o>a G :3s, .^a=Y!EE€9 O'F::+s6 a&de6 : ooa v- 0) =E9E*iiFl =rlo=(t YO tr > jg c o<> o o $OoN C(! - o roS .iOOUNN =0)l- O-aa oo 6qNOC)OcN, 2.-]U -F 0) E -tr o U),J ll r\ T r O) IuI go-o.,o- o C(! -C qg o- =< 0) E(Eo- 5) o Oo -EI = a'"iq a.: ,"h e >ti o;60 o a o) f or aoc q ^.-= -OEEE =oo: O(ooo *c oiP e! -C(/)-Y E ;:EB;H EE=3'P-EEgE PEETEigE a o () o E Lr)(O ! c(! a 0) 9 -co o ts : G o_ E 0) E -\a ,._- _ ) I ioiC)lO 0) (g U) G) (o U) o 0)(! a oo o_ O @N oOo oo oo o- o N tL o) O o, ai I I c o- O r, -,=:-L^=do).(s -c;iotr h Y.0) -:^\A o oo C )aaa 0)o o o a o'- ;c) oo(go o o o c 0) E o I 69 oO =>aqn-C O) oGo ;-. v'lr) X (trS r_ str-'bOD;i >oc:or Gi o al o, O,l(I1l ci ol E] 1 I o o (g Ei; c-+ sLJ c,o0r- n >9' 6:^C(E-o.r alo: La>=(!LL:' =aV*> \) a a E (o cOC') aic >o u= 6E Fsi; pf-E5-o 6 -(oC*0)--Oo(o.9O.:,l! >-^\=nt-(o eEH,il PhaPbbo*b=P;8 B p Bp= FO)0()t-o2= a Fo9 c f E E oO o(o o () 0) c oL aaP .Y o)=:l =- ccc(, o o) E o o:oo (!0)f vcl *-tra! ro u_: -,^ c :(ofc(o(rru13 ftl h ^ c c =E?;s=€l> 6'9 E 9b 3 $l -. 1 6 c clFaE< = rn OJ 9 E 0)E c o s(r) O) ;o oo a L E c_= *11E* U xc.-o=;bb R = (! p A?EEEEO (o.C E'-E cfcoEo :Gooo-o- tDL oE (/)coQF o=t o.zEO=.ii0) 'QOEE;E,Plo7il. c lE.i O o.t C.)ooN o 0) a cr)oON o_ 0) U) 0) rr 0) - A /\ F = uv =,\ t OI E o(/)U s H'o- sOIT PC<< Pr0o- c 9OO Y o-A./)0-ErJa G (g 0) .\ 0) F o /\ F = Lv = .. E OI E o(/)5gH',o- s(J-r ?c(( ?r00- v 9(,(, YLo(/)o-t-JJo o og inOJ6a6 a -\ o) -: rEox(u=6r (l)9-60x 168a I t- a . l E E o O o a ,9 6 N n o ,] L+io C o =(g O) 0) c t- I o o U) O O. olr) EE_A 3ooE or I .= c LE' (uo-oO(U >(/)-o F <l.t :htrlU,(aa!EiEHg6 d _< E'.E> o(, o E o(o--.t o oo o 0)d o o Oo =_9DOc= -e6(J> (orOsco c.) o] L() -o () o. 0)a \o N () o o. o o G a o (E a Ooo- oO(.) oo o- o ro N a-o.:OLrr (E O P> 86F9.g; o) _9 pEb'e (EB.:< =(o 0)E o o -o E z -_SoYl a>Y HE P 3, :.E c)Ea==o -o tr; =c==o i888 p( (E.= oL= ggHE ngOCI€ or I sedE(5=E O- PU E E o I -v.o E o o o- E oEfCU)(UC s89or, rtgEps o =E o (E sooN E.o o = o$ €otoONO-c!! EE -z o o9OtrIE0g << s)(r(, g l-JJ O o o O) 11 O)F o r\ F .r t OI E O(/)U g PL gOI-PC<<P :f(Lo-YqOOYo-o(r)o- b-JJ o- O) /r (l) E eU ee. O.,8EH,[ E$O?EI E'E55 EEEilo6o- E:= a>c) tr')C 0) o oo EC b ? =o cc-.! nfl €€f H * x E.N.q 6 }iEEEEfi LL L g EEg;EEIi q36o) oo() ra >o 6 or E 6 P'E =*eEEo T Eu o-c o(Jloo 0) o =ooco (,Oor O)(!0E e9= =d=(,cEc()oLIJOO @ o) sO ol -: Oc $O N do o $ N o C) n $ N do a sO (..l d(,) IJ dO c.l d() c $ cn oo o $ N d() t-l $ N do n $OO c.l d 0) t-.1 OON d 6)lo <- N d 0) o o] d 0) o C..l d() a EE o Q caO N o -o () o.oa \o C.] O -q o O N ca (-.l ca o] 6 O ol coOO C\ ca N ca N coO o]N ca N OON coOO c.l o1 o! cq a ao N $O cl o() $ O c] oo o $ O c..l o(.) L.] t cl o(.) $O noo o $ O c.l (-) (.) iJ cl oo o sO N C;() o d no 6.) ! cl oo o $O n o 0) n O c..l o() a t c] o C) o $ O cl o n\Jo coOON ca (-l coO C..l coO c.l O N c.)O C..l O N O N caO o.l coO c.l ca c.] o.lc.l ca N o!- 1itr 6= a- L o) <- c..l o z cl o z $OOCl o z s O c] o z sOO c'l o z $ O n o z s O cl o z s O n z t ONi o z s O cl o z sOoNi o z sOO C z s O c] z s ONi o z o.=aZ Q ao N i Z ON i o z N ; o z OON i o z O C\t o z ca ON o z o ONt o z N o z ca (-n t o z c.) N i o z O olt o z N i o z ca Nt o z bo- :tr a- ca N i z al c) q) rrt Fl cl q) cl a d U)q) I q) 0) c) q,) CBlra !o -oo o o r() -oo o o (.) -oo o Lo -oo o o Lo -oo o L' 0) -oo o o C) -oo - ! 6) -oo o o 0) -o o o g o -ooH (J 0) -oo C) r() -o ? o !() -o o 9:a.5 U caO CH cl o.()a c.) c! p.()a co cl o.q) a n o.q) a c.l o.()a cl o.oa ca n o 0.)a ca n ()a caO cl a()a coO .1 o-oa caOO cl o.()a caOO n o.()a cnOO C o.oa 6OON I o-()a oD-E ,t- 1|Jtr a- -a C€trE !t o) FA a tu J tu r=rZa U c..l o o c.)OO c.! o() q Ocl o() o O n o L-l O cl o() LT ca c..l (.) o o c.lOO c..l (,) o t-.1 ca c'l C) a co q o o .'l o() a ca n o C) o n(-)() IJ c.l o() IJ 9: *o U coO c.l o() tl caOO cl o() o co cl o C)c caOO .l o 0) n ca c..l o(.) t-.1 ca no() o OO no C) caO cl oo IJ OO c] o C) o caOO e.l o C) o O c..l o() L.l c.l O cl o() o cn O cl o(.) o cn cl o(.) IJ cl()(.) o bo- :,tr d: a- U) 0,, > t,tE iA u)o.::ts :)Hlr = s, >X . -gtE !-oul .S li ooeE >tr trc *'E 6lA0O 6)L0) $ cl (! s n $ cl (€ $ cl + n (! $ cl $ c (€ $ cl d $ cl d $ .l d $ cl $ .1 $ cl Cd ?>F()0z $ C.l (d 2ilie -q dFduU = EF ttfY 1 fol c0 o -o o o z LYl o o t c0l c0 o oY fY Jz c0 o=om (, zfF tIJ tt =Y[! co TUa o 0-Y V o f c0 o-\l J (, L U) -:\ 9q q a)U a) q + s* \)L *Y ! q q) 5 I(n() >. (.) t- o 0) 0) (d otr a C) ti(s 0) l-r a C) o($ +i o 0) o E F oi1 ot -otdtFI 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate answer) MOH (NOCP' tr WHO tr UNICEF NGDO Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH NOCP) tr WHO tr UNICEF tr NGDO Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities NOCP orders the total drug requirement for the country, UNICEF facilitates clearing of the drugs from the ports and storage in the central stores in Lagos. The State Ministry of Health authorities collects the State consignment from Lagos and the drugs are stored in the Onchocerciasis control unit stores in Calabar. The LGA councils sponsor the collection of the drugs from the store in Calabar. At the LGA level, the drugs are stored in the LGA central drug store. The drugs are distributed to the health districts in the LGAs. The communities around the districts come to the District headquaters to collect the drugs for the end users. t7 WHO/APOC, 26 September 2003 tr Nu-be. of Mectizano tablets ExpiredReceived Used Lost WasteState/District/LGA Requested 220,000 201,444 94 0 AKAMKPA 220,000 155 0 AKPABUYO 98,000 98,000 97,635 2 700 BE}(VVARRA 120,000 r 20,000 l 16,505 0 BIASE 228,505 228,505 192,s63 68 293,694 32 1 000 BOKI 3 10,000 3 r 0,000 0ETUNG 129,650 129,6s0 il4,788 1014 168,700 148,662 30 I 000IKOM 168,700 0OBANLIKU 95,000 95,000 104,421 l6 85,890 79,615 75 0ODUKPANI 85,890 3,300OBUBRA 1 3 5,000 135,000 90,471 56 54.83 8 75 1,068OBUDU 86,237 86,237 OGOJA 150,000 150,000 143,85 5 47 1,300 66 2,000YAKURR 74,918 74,918 65,9ss YALA 245,000 24s,000 225,t58 s96 0 Clinic base SOCU UNIT l3l,4l8 l3l,418 131,418 TOTAL 2,220,273 2,220,273 2,061,022 2,257 10,368 Mectizan@ 2003 add more rows l8 WHO/APOC, 26 September 2003 Table 38: Mectizan@ Inventory 2oo4(please add more rows if necessary) YAKURR I ynm Clinic base SOCU UNIT TOTAL 2.3. Advocacy and sensitization A delegation from the sight savers intemational were in the state for the planning of an integrated eyecare programme for the state, the team seized the opportunity of the visit to pay a courtesy call on the Governor and advocate on the need to support all issues concerning the control of blindness.A letter from the Permanent Secretary, Federal Ministry of Health was also received, the letter reminded Govemment on the need to continue the support of the control of River blindness in the state. During this period, 6 policy makers in the Ministry of Health were mobilized on the need for increased funding for field activities since the unit has taken an additional role of Vitamin A supplementation in the l8 LGAs of the State. State/District/LGA Number of Mectizan tablets Received Used Lost Waste AKAMKPA 188,556 r 885s6 l4,l13 NR NR NR AKPABUYO 70,365 70,365 27,509 NR NR NR BEKWARRA 1 19,000 I 19,000 I16,555 NR NR NR BIASE 740,942 140,942 NR NR NR NR BOKI 296,306 296,306 123,500 NR NR NR ETUNG ll4,g62 114,962 NR NR NR NR IKOM 160,039 160,03 g NR NR NR NR OBANLIKU 90 ) 579 90,579 NR NR NR NR ODUKPANI 86,275 86,275 27,795 NR t7 NR OBUBRA 149,529 l4g,52g NR NR NR NR OBUDU l0l,3gg l0l,3gg 57,497 NR NR NR OGOJA 746,145 146,145 62,295 NR NR NR 78,963 78,963 16,143 NR NR NR 194,942 194,942 10,000 NR NR NR 16,500 16,500 NR NR NR NR 1,943,301 1,943,301 449,397 NR NR NR t9 WHO/APOC, 26 September 2003 Requested Expired I4 P|imarl Healthcare coordinators were also mobilized on their new roles with the additio, ot'vitamin A and rnobilization fbr free cataract slrrgery. they have take, up the roles hence the ,umber of people screened for cataract and number supplemented. The constraint faced now in mobilization which is beyond our control is the high turn over of policl'makers and tiequent transfbrs in the Local Government system thereby requiring remobilization of new set of policy makers, this is time and fund consuming. 2.1. Mobilization and health education of at risk communities 'fhe project intensified mobilization and Health Education of endemic communities on the need tbr them to continue treatment even when the symptoms of the disease may have subsided. the addition of vitamin A as responsibility of CDDs was also highlighted in the health education messages. Mobilization was done through the media, with production ofjingles in the three major languages in the State, Government subsidized the airing of the jingles on the state owned media houses located in calabar and Ikom for State wide coverage. Recently another fbrm of mobilization of policy makers and church congregations was the inclusion of good wiil messages in annual harvest builetins. 'l'he use of media houses has advantages of covering a Iarge portion of the population and women and minorities who are usually side lined because of cultural beliefs. There is awareness on the need for treatment compliance for the required number of years, this is translated in the great demand for the drugs by the communities. 1'he CBos(Great Friends of obudu, Pacesetters Klub )have also been useful in mobilization of people and treatment of people from endemic areas residing in calabar. The onll' constraint is the limited funds available to carry out theatrical drama on need for sustained treatment and need fbr vitamin A supplements to the target groups(post partum mothers and children 6 to 59 months on the television. 20 WHO/APOC, 26 September 2003 coO N !(.) -o () o.oa \o C..l (J o o N i \oo.lc.l€Ct o oo o Lo 0. \oc.lc.l qa t=6 Or: L}o.^ -o tiEEO >= EE* I =5iE E=6zZ, s0a\o O+ \o i .I \o6$ <fa.l C.l @ 6l \o \o +O \o \o c..l r- ol 6l a.l 66 an o, + @$ + t-- 6l c.l N+ U o O _o U Lo z CB 9-caE^ o a\ t--$ o\c.loocl+ +oo o.in o oo cg o q) + 6I € a-+ alNof.) E >,2 ti E r.Ei::. eEia zuE0 N (.) o\ o.l + o.lr- \o o\ c.l o\ a.l <f o\No\ ol ;'E ! E LEErr GE"E -E ;5'aF:-L >o a'=qa DO: Bn tro trt q(, otr oa ze s\o\oa.l 00F-t-- +o\00a..l\o\o c.ltrr o\$i o u0 c! o o o (a .or- oo\o <.sl@+\orA !ts tre E'- A-0 ilA!-c >7r E! Or)2EZ' ca alt00 r-a{ € \o(\ o\@ ca+ @\or-c.l o{r- rr F Q o :-o 0'a o o z .r E.! FE:E; zAv.? cE:! o .o G.: q € F ttrf\z J f ol c0 o -o o o = o-Yl o o t dlf c0 o (, zfF r.u o Y fY Jz c0 o tll U) d] =oc0 o l c0 LY tt = Y l'U m o_Y q) q s. q) s. N ! q)q -q) F l-.1O o tr cr)() ) H E O + o E .IJ(! EI E o a- o '6 o! .= # E o E o .z o .E o o a-fl .E -J E E o o ut $i Female attendance at meetings and health education sessions was poor at the beginning of the programme. The issue was of great concern. Careful observations and questioning revealed clues that helped in improving Female participation in CDTI activities' Some sessions of the population in Northern Cross River state were known to have practices which bar females from sitting with their male counterparts in the community hall or play ground except if they were invited, females cannot also attend meetings that are convene in sacred halls e'g Ekpe halls (Traditional society that maintains discipline in the communities, it serves as political, spiritual and a social group and is a cult meant for only initiates who are males only. When the women are allowed in some cases, they are not supposed to talk? With this knowledge communities were mobilized on the need for them to involve the women and hold meetings in venues that the women will attend too. The mobilization has yielded dividends as more women are now involved than when the programme started, though there is still more to be done and the project has written an operational research proposal to APOC on the need to identify the various practices hampering women participation in CDTI' 22 WHO/APOC, 26 SePtember 2003 caO N L o. OU o. $ \o co c.t N oa.l o o\$$ \o t al \e 6 $ c.l GI oo\o o\+ coc- $ co\o oo\o o\o\ $ r-\o * o\ $ s ?.)t alo< 00 ao N oo a.l \o t sf, N N o\ F-co NN c.r co co =\o(.lz r- N c.l N c! O r-. o\(+) a.t q) 6l ah nQ q) z L \o sf t--\o or- co aaN $O r- O..l Os ooco N s t-co ca Ir- r- oo (\ F- oo oo 00 \o(\l 6 ai t- F- € N c- 00 oo oo \oNq o @ 2 &z &z &z &z &z ilz &z &z &z &zz &z &z &z &z o o C.l + qh q) .=66lfrrii t- Fro: -Ooq)qr9 r- 6l6,)L z c.t ol o\ o\ t o\ N cr) $s aaaa co \oc-l v \o$ $ \o$ r- Lo s\o6 6 \ot $ ca ca t \o N \o (^..l c.l O o\ F- alq C..l N ON N N $N N ca ON c.l N ON $ \o o\ cl = \o N oN N ON N \oia\o q) g! .tE E --- ZE, q) o F o c.) s co + O ooN \o co $ \o$ €$ $co $\o O N o, o\ O s o' O N N v\o( F cr) .! A< co c{ o\ o\ o $ o\ C.l c-.1 t\o I z I I (\ $\o CE ah o -l9eo0) tc! o o z L co N I o\ o\ t o\ N F] Er F o o q) \c I q) o a o-Y V o f c0 TLY tt = V [rJ d] uJa m ? od] ozlF I.JJ oY lY Jz (D o =(L Ylo o t mf c0 o fol c0 o -)o(9 o trtfY 1 caN go o € o\ o p ! s $ o B o bo .E o\\ o I t o\ s s ! Bt E ; l) s !) \\ B cl F U ta o 6) () L c)Fr q) G CELF ia q) Gt- II Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci!) CBOs Program management How to conduct Health education {< * * Management of SAEs CSM :|< :& SHM * {< Data collection :* * Data analysis :* Report writing ,F ;r Others (speciff) Participatory rural appraisal :F Vitamin suplemntation A ,F * * * * 24 WHO/APOC, 26 September 2003 2.6.2. Equipment and human resources T +Conditron equrpment (Functronal, Currently non lease add more rows ne 'functronal but repairable, Written off) Status of OthersNGDO/ UNICEF MOH DISTRICT/ LGA APOC Condition of the equipment * Please state Source Type of I Functional1 Functionall. Vehicle 37 functional 1 written off l9 functional 1 written off 2. Motor cycle 2 Functional, I non functional but repairable 3. Computers 1 functional 2 written off lfunctional4. Printers I functional5. Fax Machines 6. Others 1 functionala)Generator lfunctionalb)Television lfunctionalc)photocopier 25 WHO/APOC, 26 SePtember 2003 The Cross River State Government is aware of her responsibility in the maintenance and replacement of existing capital equipment in the project area. The State demonstrated that since 2002 when they ieplacea tni printers that were supplied by APOC and had gone bad with one new laser print.r. Funds released as counterpart for 2003 were also used panly for the maintenance of the vehicles and motorcycles at both the State and LGA levels. Computers were also maintained with the funds. There are however no concrete plans on ground for the replacement of logistics. There is usually supply of motor cycles from other viable PHC p-g.u*rn"s like the National Programme on Immunization (l'{Pl).There are no plans for the replacement of the vehicle. There is adequate manpower at the State and LGA levels, but there is need to train more CDDs to meet the ratio :250 persons. The manpower at the state level has trained personnel handling all the key aspects of the overall implementation process. There is an agreement reached with the State PHC department concerning posting of staff involved in CDTI activities. The unit does not discourage posting of Staff, but the core staff involved in CDTI like the district officers are usually posted from one CDTI area to another CDTI area. Where the health service cannot reach, efforts were made to involve other service providers in the area, e.g the forest rangers in the Cross River National Park and Forestry commission. The ,ung.r, help in very difficult to reach communities in Obanliku, Boki and Akamkpa LGAs. In some other LGAs, teachers have also been trained to provide support manpower for data processing by the CDDs and CSM implementation. 26 WHO/APOC, 26 Septembet 2003 at L() =0) o(.)a \o at (,(, o- > q: vt\ q)\ o ! S t-- c.l 0) o ; (€ J(h ! (€ t, q) l-r (d J o ti a a r! a (d 0.) E (€(.) LF id II o o -o E z o L a) rl.]= E9( os 5-ca-=q9 -9 6 9 €EHE;oqY o>ooOL I O ril €?2V) AO ..l ca\o o n6 N F- \o c.) \o \or-dz &z & z /. z(\$ cO\oN ts dz \oo\ bE .ocE3 zd t a\| o.$ \o <f,&z & z !f, ca oo c.l oor-$&z o\ N & z & z a.lN a.l o,\o c.l (ho +E!tr^-o9 0:l'o tr E[;EE ;;?O al o\\ov \o c.lN o\4z &z &z \o o, \o I\oh(\ o\N6 &z o\ ilz o !O , hIJo c6^ F-oo\ oo .< oF \oo\ a oo oo. € = o\ \o r-r- N t\o c.l oo&z & z & z & z c.) o\ ,o^ r- o\@ <f, & z F-\o od o a-bEU EbE = o., z o. d ca a..ls o. ol @ Ir- N o\$N $ t-. @ a.l co\o o, o. a.l NN (\ o, o, :t c.lr- N\o @\o\lr- oo co $ c.)$tr- coN 00 c.) o.tN c.l €+ 00 tsoE 6.2aEr^ :=ot utrFv Oc.)c\t $ r- co a-N \o <f, c.l O o\stF- rf, \o <t$ co co s rr o,N ON o.l\o $ t o\ oo \f$ N r-$ tro ao O. .=rd6 qts = o ScgLs)o --q?o .6 E5F N \o € € \o co $ \o o\ o€\o ol&z \o N co ro \o N o\\oo\ oo$ &z &z d7 6\ an \o c-)s o\O & z .9o c OIt ie Oo'&,:- ;o O ol aal d z N F-. ooNN\o & z & z & zo' $ \orf, dz =oL.L O Yq E oollor(€zE =tr>-Aa o o. |..i\o \o s C.l$o\ F.\o $N o\c.)\o$ Ncn OtC\ o\N =uE 6.= )o-D Fe cno\ Nca o N o(e O) o,(o lo(o (orr) $ro,N $o, N(o tNNCO (os NCO o)N Chq) bo(€ a 0.) tr E oQ \Oo6-.rGq o= - o 'J--^= +a-> -aaE.!d F o'> cP E d)V L € Espi v>o CO O) J J F F = o_Yf o o -o o o tt :)Y o Y fY Jz co o t d]l co o :f ofdl o tt = Y uJ co LU U) co =o c0 ozfF r.u o-Y =)z o l d] o-Y .9<;vo\ oI c o Ea,t! oLF \N I I I I ca o.l o -o OJ o- c)a \o N (, L.' o B coN q) q > \. q) t\ o t ! q) 9 ca cl o(.) ; (dts- ! C') lr (d a(B(.) L(d J () H C) (hI! a (R o E (d oL{ -jj oo() -odF I o o ,o E z o V*,ee*o-E; oisPii€Etr!:-tio(i oi9 o- I O 11\ €<\a zz ca N NN cnN r- ON @ tAt €6 al b.e E9 =-ozd ooC.l O co \o N(r- N oo o\ o\ C.l o\\o N co c-N t-- ca r.) t-- qo - ;i O^Uf- -o;-c 6 trE::39E foqyzoa <f, oo t co trrt oo co @ oo s$ o\ F.- oo\o + o\ r- o\$ o\ c.t oo t-- t--Olr) r-- co (..l @ 'f, o\s oN \o cO o\\o c.l oo\o NN r-\o co oo $ (\l ?o F- o;C) =ooO C6^ A-9o\9e F t--. aot-. t * aa NO\o\o$ c.l r-r- cos O oo N c.l o\ + N t-- c'l\o oo\o <- t-- oo co c.l o\$N $ t-. oo c..l co\o o\ o. ca cnN a.)ON$ o. N €r- o 6_ o:o trho = o--z $ c.)t$r- caN 00 ca o\$NN coN cnO oi$ o\ N6 F-- =o6 o.= r, ()3' FV !f, ca <-$r- caN co aa o\$NN 00$ co N N o\ o\ t c.] c- c.l\o oo\o <f t.- a.) co aa c.l o\$N $ t'-. oo N oo\o o\ Os t-- oo tr-N \c)t N ta o\ rO o\ d a. o E{ .9 .,8E 09 = u Pcd6-c io -"no oF ol \o oo @ \o 00 $ N ..l $ $ o\ ooO $$ N F-t O o\t$r- $O\o$$ ca @ $ t-. o\N cn N .f, ao O O O OO s€ o\ E .99 EAA6^$E"sbo<- uo C.I oo O O $ N ?o o\ :o 3 E SH za o \ot'- Nca $ Nco c{ o\N $o\ tr-\o N co N $ F-\o $N o\co lr)\o \o s O N (.) o\ =od o.= < 94FU cn c.lca \o$ Ncn o\N sN o)co LO(o (oto OrN o c) C') (.n 0) b0 th(,) E U \OoA--td!.oE b Ie!-^= + c - >',, E F *9 E L C= Oir ^- F =o>-d (o O) Ncf) (os Nc) o)Nr o)N sO) f-(o -o(, o t E, :)V -J ,] F F .9<;q (L Y V o f6 0-Y ttr = Y I.JJ m tua m v o c0 ozlF uJ oY lY Jz d) o t c0 :) c0 o f ofo a = o-}z :f o o Form Therapeutic coverage rate (%) communities within the project area Geographical coverage rate (%) identified by REMO in the project area cal Number of le treated x 100 Total population living in meso/hyper-endemic Number of communities/villages treated x 100 Total number of meso/hyper-endemic communities as ATO = The estimated number of persons living in meso/hyper-endemic areas lhat a CDTI projecl inrends to treat b'ith ivermectin in a given year. UTG = The maximum number of people lo be treated in meso/hyper-endemic areas within the project area, ultimalely ro b_e reached when the proiect has reachedfutl geographical coveiige (normatly the pruject sho;U'be expected to reach the IJTG al the. end of the 3'd year of the projecl.lt tni proiect rs not achiivrng I 00% leographrcal coverage and mrnimum of 650Ztherapeutrcal coverage rate or coverage rati rs huctuatrng, itate reasons and plani berng riadi to remedy this - There has been population movement and sometimes total displacement of communities in the southem senatorial district of the State. This is as a result of high concentration of non indigenes from the neighboring Akwa Ibom State who in many ociasions settle and form autonomous communities. When there are communal disagreements, a whole community can disappear from the community listing. Sometimes the community members are subsumed into the neighboring communities or they totally move out of the State to their State of origin that case when the communities were planned for treatment but did not take the treatment, the geographical coverage will be less 100%. What are the causes of absenteersm? Two main reasons for absenteeism have been identified in Cross River State: ATO coverage rate (%) %UTG achieved : areas within the project area (UTG) 272 2.7.3 Number of people treated x 100 Annual Treatment Objective Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic of serious adverse event (SAE) during this reporting l) There is movement of young people to westem Nigeria to work in cocoa farms in the rainy season. Where community census update was done before they left and treatment took place in their absence, there is usually high absenteeism in these communities, especially when follow up on absentees was poor. The project have however mobilized the communities on the need for them to select treatment periods that coincide with when all their members are present/available. 2) The high non indigent communities have generated high population movements, so in non indigent communities it is possible to find large number of community members absent during treatment rounds. community participation and leadership is usually weak. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 9 the required information when available. The project started treatment 9 years ago, at this period of the project life, SAEs are not common again since there is no expansion to any new area. 2.7.4. In case the project has no case period, please tick in the box. No case to report 26 September 2003 (A 2 * 0qo (/) ox :- o) oa(D oFn I oa { <plBH +N rds Nqa- *uv 9{-(D=(D E l'. (h o @ :rF.|du?ll F53"Eg s.6a@=: B [J,TP UA X f o) € 53 o o s+su a)O@A) i. - r (v uj 5@ O -ss'i 3 5ioCD ='@ -6@ g(} q q A-d6BIoa3 d;' @ o 9.a rn .i5e -,8 I @a)N i.r N i+ 8dT =3 Pe5[.-= 5roo -j (D li la)lct l.D Ito ; FD V)o(t +) v)(D Ft o v) t0 o- (D r_t U)(D (D (D v) a ln(r) oo C) r-tHo a- a-t>t oq + o Fi o oF.t 0q or.l oo e(\ i.r(\ :t S\G\o a \ (\ o(\ V1 U1 .\ s- * h(\\ a ArG\ (\\ (\ UJ :q o o "o N) o\ ao (D 3dot N) (,) t.) -I(, a (D o tD D tD !9 (D o t! o rl oa t! (D a (! o -l -lFt (D o J a S9 a- o lD o o- FDFt +o' '-t (D(! i tD i r! o leFl (D D' s G (\\ NO \o\o\o \o oo \o\o ! ln /J NJ N)OO NJO s tJO (]) N) NJ NJ O l.J l..J O\o b.JOO oo NJ { o o= ed e E Jx o _.= * "V-^+o.;5;; a I. >9, a= p 0c \o UJ O (,) NJ \o as \o 5 \o\o oaU { \oUJ \o\o oo UJ -J \o ci-d.t PqE= ?q9ro=\o UJ O (,) NJ \o(}Js \o UJ 5 -82 .i<5= Q(E 5 E*3 a oNJs o\ oo\o()) \o N) oo N..) @{{ oa5 \]{ \o5 \os @o\ \o{ { oO ^Oci eo?9.ts Lts oo!t9 o\ \oo, \o\o \o @ o\ \o{ \o -l o o \oo J9ts.i rra -o o o 5J (D !D oa .D NJ o\ \oo\ \o\o \os \o UJ A {A 24 :- ..? o =.6=U .dg = \o \o \o O\o \o t.J As \o NJs oos -J -lN)A -JUJ 5{{ -I O { o\{s \o s\o @ @5 N) (r) \c) u){ @ N) --l;e > o== ='o D a= { oo l.JO O { @tJO { O A -l{ @ oo s N) o\AO N.) oo o\ NJ -o Gaz oiBpo@oo -oo @ o\ {()) N)\o5 -l \o o\5\o o\(,) o\ N) -J\o -loo { o\\o o\ o\\o NJ -l oo -rj orra tr o \o UJ -J -J @s o\ oor .oG J o tD NJs \os oo- ^{ d ..r:-: .\ Oa @ { @ NJ -J oo NJ { -oo t, o\ -J\l o\ "tJ {{ "oa oo oo -J o\ NJ O -04 -J@ N) 5 o\ s rl (D D' (D t, oe 0a rt b.J 5 !9 (D s9 q) i (D a (!(, D) D (D ET O (D O A' (,.) { I o op N) o\(h (D (D 5 (D a t\.) 2.8. Supervision 2.8.1. Provide a flow chart of supervision hierarchy SUPERVISI N HIERACHY IN PROJECT NGDO LTNICEF NOCP NOTF Zonal Onchocerciasis Control Team (ZPM, consultants, & slafJ) State Onchocerciasis Control Team (State Coordinator, SOCT, Dir. PHC, PHC Coordinator) Local Government Onchocerciasis Control Team (LOCTs Lesder, LOCT, PHC Coord., H ealth S upervisor, District Superv isor) Community-Directed Treatment with Ivermectin (Community Leader(s) Village Heallh Committee, Communitv memhers. CDDs) 32 WHO/APOC. 26 September 2003 2.8.2. What were the main issues identified during supervision. Routine supervisory visits are duties of the LOCTs at this stage of the project life but where very serious issues concerning the overall CDTI implementation were detected, the SOCTs with the LOCTs intervened to curb the problems. Such supervisory vists identified the following: The population of reporting communities was higher than the population reported in2002 for Ogoja LGA and therapeutic coverage was low for Obudu (less than 65%) The total number of people treated in Obubra LGA was seen to be more than the UTG. A number of people that were enumerated during census update in January in Yala LGA were usually not available for treatment when treatment was given later in the year. In Yakurr LGA, migrant fishermen that were not usually available during census update were treated. 2.8.3. Was supervision checklist used? Yes, an integrated PHC supervisory checklist that was developed by the state CDTI project in collaboration with other PHC programmes was used, trip authorizatrons also contained other salient issues that were not reflected in the checklist but came up and was pertinent to be checked. 2.8.4. What were the outcomes at each level of CDTI implementation supervised Spot checks on the communities where population increase was noticed in Ogoja revealed that with the establishment of the satellite campus of the University of Cross River State, most of the indigenes who were usually not listed during census had come back home and also, whole families who were workers in Calabar have come back to their communities. The LOCTs were advised to be careful not to enumerate students who are temporal residents but bonafide indigenes were enumerated and treated. The low therapeutic coverage noticed in Obudu was discovered to be from Alege District where census update was faulty. Some persons residing in the towns were enumerated and were not available for treatment. The community leaders have been mobilized on the importance of accurate census figures for planning in CDTI and have resolved to strictly list only persons present in the community during the next distribution. High therapeutic coverage (88%) in Obubra LGA which is more than the UTG was also queried and was discovered to be due to treatment of migrant fishermen who were not present during enumeration but came in during treatment. The communities have been mobilized to treat the fishermen under Clinic base, since they are not members of the community. In Yala LGA the communities in Ukelle axis which have three health districts have been mobilized on the need to change their treatment period to coincide with the period their kith and kin are back from Western Nigeria where they go for jobs and come back only during December period. JJ WHO/APOC, 26 September 2003 The same scenario is applicable in Yakurr LGA. It can be appreciated that 10 out of the 14 CDTI LGAs in Cross River State are riverine and have population of fishermen who come during the dry season which is also treatment period in most communities for fishing, they are equally treated in these communities. Where there are clinics or health posts and a clinic based distribution exists, the persons are advised to take their treatment there but most of these communities do not usually have health facilities, the communities have all been mobilized to open up separate treatment registers for such persons. 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project Feedback was given to all the levels and the communities have deliberated on some of the issues in their stakeholders meetings. Intervention measures that have been done will manifest during the next treatment season when population and treatment indices are supposed to change for the better. 34 WHOiAPOC, 26 September 2003 SEGTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table 11 Financial contributions by all partners for the last three years Note that the year inputs are for UNICEF and Government. Efforts have been made to remind Government on the need to continue the payment of counterpart funds which they started in 2003,this year, Government has paid the sum of 2.Smillion Naira already for activities on CDTI and Vitamin A supplementation. The funds will be conscientiously and judiciously used to encourage Government to continue funding of the project. 3.2. Other forms of community support - Descrrbe (rndrcate forms of rn-krnd contrrbutions of communrtres rf any) Communities in Yakurr (Assiga communities) have actually given land to CDDs to cultivate cassava as a form of incentive to motivate them to work. There are also a good number of communities who are giving yams to their CDDs after harvest. Other communities have excluded CDDs from communal work and levies. Year 6 (JULY 2003 TO JUNE 2004) Year 4 (JULY 2001 TO JUNE 2OO2') Year 5 (JULY 2002 TO JUNE 2003) TOTAL Released (US$) TOTAL Budgeted (US$) TOTAL Released (us$) TOTAL Budgeted (US$) TOTAL Released (us$) TOTAL Budgeted (us$)Contributor 24.000 17,500 10,044.50 23,333.33Ministry of Health (MOH) 101.9r3 9s0 Local NGDO(s) ( if any) 10,935.82NGDO partner(s) r 8.083. r 8 2,049.27 37.870 r5.833 12.000 11,666.66 10.221.56District/LGA 20.000 427 Others 561.03 I,l2l.l5a)Cross River National Park b)Youth Care 397.83 c)Great Friends of Obudu 354.33 3,334.72Communities r36.r00 1,030.94 I 65,500 2,435.54 59,875 56,925APOC Trust Fund 79.950 41,008 336,046. I 8 46,029.24 391,327 90,400.51 27.099 06 37,603.87TOTAL 35 WHO/APOC, 26 September 2003 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 12: Indicate how much the project spent for each activity listed below during the reporting period Comments Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities on CDTI and Vitamin A supplementation. lTraining of CDDs Itraining of health staff at all levels I Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) Others 235.71 5,525.99 7,771.42 8,497.25 3,480.94 657.14 285.71 3,207.35 t07.14 3,683.50 1,304.28 1,750.08 STATE, COMM. STATE GOVT. STATE GOVT. TINICEF TINICEF STATE GOVT. STATE GOVT. STATE GOVT. STATE GOVT. STATE GOVT. STATE GOVT. STATE GOVT. TOTAL 30,500.51 Total number of persons treated 684,890 36 WHO/APOC, 26 September 2003 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2 What were the recommendations? The recommendations of the evaluation team were : o Low treatment coverage o Non integration of CDTI in the PHC structure o Lack of state and LGA comprehensive post APOC plans o Collection of mectizan dependent on APOC funds o Excessive monitoring and lack of monitoring checklists o Training needs not identified and targeted o Inadequate funding of o Replacement of old vehicle 4.1.3 a a o a How have they been implemented? Low treatment coverage, this was tackled by intensive radio and TV jingles and mobilization of communities, treatment coverage increased from 7l % in the fifth year to 74oh in the current year. Non integration of CDTI in the PHC structure, this was tackled by advocacy to the State ministry of health by the APOC mission team to the state and the NGDO partner and onchocerciaisis control is highlighted as a budget item in the state rolling plan now. Lack of state and LGA comprehensive post APOC plans, this was tackled by calling a joint meeting of state and LGAs and plans have been already drawn. Collection of mectizan dependent on APOC funds, since the fifth year the state has taken over the responsibility of collecting Mectizan from Lagos and distribution to all LGAs. 37 WHO/APOC, 26 September 2003 Excessive monitoring and lack of monitoring checklists, an integrated PHC monitoring tool has been developed by the project and is been field tested now, monitoring and supervision is now targeted according to need. Training needs not identified and targeted, training now is based on needs assessment and targeted at persons who require update of skills to function properly. Inadequate funding of project, the Government has released a total of 6.3 million naira since the fifth year ended and has promised to do that, this has been institionalised by provision of a budget for oncho. Control. Replacement of old vehicle, this has not been done and the project vehicle is in its 8th year now, it has been subjected to wear and tear now and will require replacement. 4.2. Gommunity self-monitoring and Stakeholders Meeting Table 13: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) a a o District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeho lders meeting (SHM) AKATVIKPA AKPABUYO BEKWARRA 93 32 32 33 t4 8 25 l3 4 BIASE 46 9 2 BOKI 129 93 24 ETUNG 29 11 10 tKotu 94 15 t2 OBANLIKU 67 23 18 ODUKPANI 65 7 5 OBUBRA 24 2t 8 OBUDU 39 21 10 OGOJA 50 )1 9 YAKURR l4 t4 l3 YALA 210 104 17 TOTAL 930 39s 170 38 WHO/APOC, 26 September 2003 o Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Community self monitoring exercise in Yakurr LGA identified reasons for inconsistency in the population figures of Assiga district. The monitors identified that fishermen from the neighboring Ebonyi State usually come to the area for fishing in the dry season after census update must have been completed in the first quarter of the year. The fishermen were treated within the community so the number of people treated is usually almost as the total population. The communities in Assiga district have decided to direct the people to take their drugs under clinic based. 4.3. Yr 3) Sustainability of projects: plan and set targets (mandatory at 4.3.1 Planning at all relevant levels. There is joint planning for all PHC programmes and an integrated monitoring checklist is on field test, this is aimed at reducing cost of monitoring and ensuring that there is sustainability in terms of monitoring and supervision of PHC activities since any programme with funds to be in the field can monitor all aspects of PHC with the integrated checklist. Joint planning on utilization of vehicles, motorcycles and other resources has been discussed in recent PHC for a in the State to encourage sustained and reduced running cost in PHC programmes. 4.3.2 Funds Resources have been got either directly or indirectly from local NGOs and CBOs, A list of areas where Local NGOs and CBOs can help in directly without providing physical funds have been made and circulated, trainings and supervision in the National Park and Cross River Forestry Commission operational area are done by the forest rangers, the Cross River broadcasting corporation are willing to air jingles at subsidized rates to mobilize the populace. There are budget line items specifically for CDTI activities at the LGA and State levels and there is a standing order by Government on contribution into an account of the sum of 200,000 Naira by all the l4 endemic LGAs in the State for CDTI activities and that has been implemented this year, (2004). 4.3.3 transport (replacement and maintenance) About 5,160 US Dollars from the State counterpart funds were devoted to maintenance and servicing of the vehicles at the State and LGA levels, two 4WD Toyota hilux vehicles donated by UNICEF and APOC were serviced and maintained at the State level though the IINICEF hilux has broken down again as at the time of this report,43 39 WHO/APOC, 26 September 2003 motorcycles were refurbished with the funds provided.Outright replacement of the logistics will be difficult because there are no concrete plans on ground to replace the existing ones especially now that the APOC vehicle is six years old and the UNICEF vehicle is 9years old. 4.3.4 Other resources Local CBOs have been mobilized to provide or fund some activities for the project, the Great Friends Klub of Obudu produced community mectizan retirement forms for the LGAs of Obudu and Obanliku.T- shirts worth 424U5 dollars were produced by the same Klub with health education messages. 4.3.5 Please provide a written plan with set targets and achievements so far. The project has submitted a three year sustainability plan already to APOC management. 4.3.6 To what extent has the plan been implemented The f,rrst six months post APOC have seen the project implementing the initial key aspects of sustaining the project, the logistics have been improved with the repairs of the vehicles at the State and Local levels, the planning meetings, All the items for the last part of July to Dec. 2003 have been implemented. 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectindeliverymechanisms Plans have been made with the PHC directors of all the l4 LGAs on the need to seize the opportunity of collection of supplies for routine immunization in the first part of every year to collect their Mectizan, so mectizan drug requirements for the following year are got by December, for proper requisition. 1.4.2. Training. The state unit participated jointly with the nutrition unit and the ministry of education in training of health workers on integrated health packages which CDTI was one. 4.4.3. Joint supervision and monitoring with other programs There is in place an integrated monitoring checklist which is under test run for refinement. This checklist contain supervisory indices for all components of PHC This is to help joint supervision at the State, LGA and Community levels. 4.4.4. Release of funds There is a poll of funds that is approved every year for all TINICEF assisted programmes which onchocerciasis is one. The state unit also benefited to the tune of 1,336 US dollars from the funds. 40 WHO/APOC, 26 September 2003 4.4.5. Is CDTI included in the PHC budget? The project is in the post APOC era. The rolling plans for the ministry of health contain a budget line for the control ofonchocerciasis. 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Over 1 ,200 Cataract surgeries were done by the Tulsi Chanrai Foundation in 2003 and 325 cases have been operated in the first quarter of 2004, the patients were mobilized for the exercise using the State CDTI structures. The unit also participated in the Loiasis survey in Kogi and Niger States and provided assistance in Angola for the delinatation of areas where precautions should be taken in mass administration of Mectizan The Project successfully distributed Vitamin Ato 297,831 children under five years and 13,643 post partum mothers. 4.4.7. Describe others issues considered in the integration of CDTI. Joint advocacy and release of funds for integrated approaches in health interventions are planned for the coming year at both state and LGA levels. The CDDs are also going to identify cataract cases in their various communities for the ophthalmology society of Nigeria who are having their annual conference in the State in October 2004. The society will use the opportunity to operate the identified cases of cataract. 4.5 (lperational research 4.5.1 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out during this period but two proposals on integrated health approaches using CDTI structures and factors militating against the involvement of women in CDTI are before the APOC management for approval. 4.5.2. How were the results applied in the project? The results of the operational research that was carried out on the involvement of CDDs in other health and development activities were positive, i.e communities agreed that CDDs are able to add on other activities to their distribution activities and that provided the indicators that encouraged the project to add on Vitamin A supplementation. SEGTION 5: Strengths, weaknesses and challenges STRENGHTS: . Clear vision and dogged commitment of the implementers at all levels o Prudent utilization of the counterpart funds provided by the state. 4l WHO/APOC, 26 September 2003 o Commitment of the stakeholders to the success of the project. o Addition of Vitamin A which is now given to people who were excluded before now. . Good working relationship between the project and the NGDO partner UNICEF WEAKNESSES o lnability of PHC structures to support CDTI activities due to inadequate manpower and absence of health facilities in some remote areas of Akamkpa and Obanliku LGAs. . Inadequate community participation due Leadership and Communal clashes and distortion in PoPulation o Inadequate community participation due to weak community' structures in the heterogenous area of the southern senatorial area of the state' CHALLENGES AND HOW THEY WERE ADDRESSED. o To achieve l})%geographical coverage, other service providers who are offering community services in the rugged areas where the health service is abseit were used in the delivery of mectizan, training of CDDs and retirement of drugs' o Mobilization, advocacy and prudent management of released funds have promised to be the sure way to achieving early release of counterpart funding and that has been pursued vigorously' o The southern senatorial area where stranger elements abound have had low indices in community participation generally, efforts were made to improve participation by using other organizational units like the churches to mobilize them. Lrst the strengths and weaknesses of CDTI implementatton process Lrst the challenges and tndlcate how they were addressed 42 WHO/APOC, 26 September 2003