Kebbi State CDTI annual project technical report submitted to Technical Consultattve Committee (TCC): January 2006 to December 2004

KEBBI STATE COMMUNITY DIRECTED TREATMENT WITH IWRMECTIN PROJECT ORIGINAL: Enslish Proiect Name: KEBBI STATE CDTICOUNTRY/NOTF: NIGERIA Launching vear: DECEMBER 1999Aoproval Year: SEPTEMBER 1999 Reportine Period: From: JANUARY 2006 To DECEMBER 2006(Month/Year) (Month/Year) P.oiictv"a"ofthir."po"t (circleone)l 2 3 4 5 6l 8 9 10 NGDO Parfner: SIGHTSAVERS INTERNATIONAL Date submifted: MARCH 2OO7 Jtm MtcI 6 FIFTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE coMMrrrEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) -{I _l r-Jl.-\ A,\r1 8 5e*n=LB B ,,.4 q -fl o it o iI )\1\2 0 JUlt 20047 =\>\7EaoF'iB- t J r--6.'L OfDi ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3L Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) ----5g._ Foi /:-e5: r To:9, For lrilorn,,.,,,, , I" -DiR isA Jrv bltl CoP- kfte B-fr tu 2 0 JUIL 2007 M!'!w, ll. b.*.nV II I I I I I i I I I I I I I I I I I I I I I I I I I : I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rePorh Country: NIGERIA National Coordinator N*rc'ffiI At.cJ.k ..e.AU) bfuE Signature Date Zonal Oncho Coordinator Name Signature Date: * 5-'-(. NGDO RePresentative Name: RIC--- This report has been prepared by Name : Aliyu Salisu Bunza Coordinator Signature: ... v r(. [,-j. .)F. ... . Date 9i::! -:?.r.p: i: 1*4 zc-=,} I t Signature: . Date: ...? + D el- Table of contents acRoNyMS............... .............vI DEFINITIONS """"' """""""vII FOLLOW UP ON TCC RECOMMENDATIONS .......1 EXECUTM SUMMARY............ ..............3 SECTION 1: BACKGROUND INFORMATION ....""4 1.1. GrusnarINFoRMATioN............... .............'.......4 1.1.1 Description of the project (brieJly) .........-.'4 1.1.2. Partnershrp ...........7 1.2. Poprn-ATroN ................10 SECTION 2: IMPLEMENTATION OF CDTI........ ....................11 2,I. TN,ffiLtr\iE OF ACTIVITIES .,...I2 2.2. ADVocACY ..... .....1,? 2,3 . MOBII,ZANON, SENSITZATION AND HEALTH EDUCATION OF AT RISK CON,IN,flINruES I 4 2.4. Covr lqryrNvot.vEMENT ...........16 2.5. Capacrrv BUILDING .....17 2.6. TRpanm{rs....,.... '....19 2.6.1. Treatmentfigures........... ......'20 2.6.2 ll'hat are the muses of absenteeism?........... .............22 2.6.3 Ll'hat are the reasons for refusals? ................ ............222.6.1 Briefly describe all lmown and verified serious adverse events (SAEI thnt....23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the ctttent year21 2.7 , ORDERING, STORAGEANDDELIVERY OF IVERMECTIN ............ ,.,.,.,.....,'.25 2.8. Cor"cvrururvSELF-MoNTToRINGanrOSrareHOI-OERSMnErn9c.............................27 2.9 SupsRvrsroN ..............28 2.9.1. Provide aflow chart of supervision hierarchy. ..........29 2.9.2. llhatwere the main,ssues dentified durmg supervision? .........................."'29 2.9.3. Was a supervision checklist used? ..........' 29 2.9.1. What were the outcomes at each level of CDTI implementation supervision? 29 2.9.5. Was feedback given to the person or groups supervised? ...........292.9.6. How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI ...........3o 3.1. Equreunvr 3.2. FI.TANCIAL CONTRIBI.-TIONS OF THE PARTNERS ANDCOMMT]NITIES 3.3. OrsBn FoRMS oF coMMUNITy suppoRT................ 3.4. E)GENDILIRE PERACTIVITY ............. 30 3l 3l 32 SECTION 4: SUSTAINABILITY OF CDTI ..............32 4.1. INTERNAL; INDEPENDENTPARTICIPAToRYMoNTToRINc;EvaLuanoN................,..32 1. 1.1 llas Monitoring/evaluation catied out during the reporting period? (tick anv of the followingwhich are applicable) ............ ........32 1.1.2. Vl/hatwere the recommendations? ...........33 1.1.3. How have they been implemented? ................ -...........35 4.2. SusraNasLITy oF rRoJECTS: eLAN AND sET TARGETS (uaxoaronv AT YR 3)...... 35 1.2. 1. Planning at all relevant levels . .. '... 35 1.2.2. Funds........ ......... jj 1.2.3 Transport (replacement and mointenance) ......... .......35 4.2.4. Other resources... ..................35 I 1.2.5. Towhatextenthas theplanbeenimplemented......... ...................36 4.3. INTEGRATIoN ....-.--...........36 4.3.1. Ivermectindelnery mechanisms ...............-.--36 4.3.2. Training..... .........36 1.3.3. Joint superwsion and monitoringwrth olher programs........... ...--.-...36 1. 3.4. Release of funds for projecl activities ...... 364.3.5. Is CDTI included in the PHC budget? ..........37 1.3.6. Descrbe other health programmes that are using the CDTI structure and hov' thiswasachieved. Whnthavebeentheachievements?............. ..'...............37 1.3.7. Describe others issues considered in the mtegratton of CDTI. .....37 4.4. OPERAIoNALRESEARCH.............. ......37 1.1.1. Sumrnarize in not more than one half of a page the operational research undertaken in the project area within the reporting perrcd. ...... 37 4.1.2. Howwere the results applied in the project?............. . ................37 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' ANI) oPPoRTUNITIES....... ............38 SECTION 6: UIIIIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........39 \l Acronyrms APOC ATO ATrO CBO CDD CDTI CSM FLHF IEC LF LGA LOCTs MOH NGDO NGC NOTF PHC REMO SAE SHM SOCT TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objecti ve Communi ty- Based Organization Community-Directed Distri butor C ommunity-Directed Treatment with Iv ermectin Community Self-Monitoring First Line Health Facility lnformation Education and Communication Lymphatic Filariasis Local Govemment Area Local Onchocerciasis Control Teams Ministry of Health Non-Govemmental Development Organization N on-Govemmental Organi zati on Narional Onchocerciasis Task Force Primary health care Rap id Epi demi olo gl cal M apping of Onchocerci asi s Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization It t Definitions (i) Total population: the total population living in meso/hyper-endemic commurrities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in meso/hiper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimded rnrmber of persons living in meso/tryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesoy'hy,per 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" year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of meso/lryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lntegration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out bv commuruty distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high ffeatment coverage, integrated into the available healthcare service, with strong community orvnership, using resources mobilised by the community and the government. (ix) Communitv self-monitoring (CSM): The process by which the community rs empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the prograrnme is being executed in the way intended. It encor.nages the community to take full responsibility of ivermectin distribution and make appropriate modifications when nec€ssary. \V FOLLOW UP OlI TGG REGOTTENDATIOilS tJsing the table below, fill in the recommendations of the last TCC. on the proyct and describe how they have been addressed. Recommendations from 23'd TCC session has been addressed in the 6th year project report, which is yet to be reviewed by TCC. TCC session 23d (Please add more ror,r,s if necessary) Number of Reconunendalion in the Rqort TCC RECOMMENDATIONS ACNONS TAKEN BY THE PROJECT FORTCC/APOC MGT USE ONLY a! Executive Summary Prepare an Executive summary of the report in not more than one page- / Background on tredtment and populatton data - Total communities, comrnuntfies treated, total populanon, WG, ATO and persons treated. / Background on population movements. / Traming data - CDDS, healthworkers, Tolal population (community) per CDD ftained. { Challenges and how theywere overcome. Executive Summary Kebbi State is located in the North-westem Nigeria with an estimated population of 3.08 million people (based on 1991 census). Onchocerciasis control programme commenced in the state in 1995 with Community Based Ivermectin Treatment (CBIT) with support from Sightsavers Intemational while the lmplementation of Community. Directed Treatment with Ivermectin (CDTD with support from the African Programme for Onchocerciasis Control (APOC) commenced in 1999. Out of the 2l administrative LGAs, Onchocerciasis is meso-endemic in 6 and hypo-endemic in 3 local govemments. APOC supports the project in the 6 meso endemic local govemments of Bagudo, Ngaski, Saliaba, Danko Wasagu, Zuru and Fa1ii4 while Sightsavers lntemational supports control activities in the 3 hypo-endemic local govemments of Bunz4 Suru and Shanga in addition to the 6 meso endemic local govemments. The project completed its seventh year of CDTI implementation in December 2006. A total population of 167,3OS were treated with 457 1726 tablets of Mectizan@ in2D2 endemic communities out of a population of 192,428 thus attaining 87o/o therapeutic coverage and geographic coverage of l00o/o. Principally most people are Moslems and stable with nomads who move southwards during the dry season for greener pasture for their livestock and retum at the commencement of the rains to either same or different locations with a resultant effect on both therapeutic and geographic coverage. Trainings were conducted for one hundred and eighty eight (1S8) Front Line Health Facility Staff out of a target of 196, and 777 CDDs out of a target of 1,110 from the six endemic local governments. All of them achvely participated in the implementation of the CDTI activities. The LGd and Sightsavers Intemational provided funds, which were used for the implementation of CDTI activities during the treatment year. APOC frmds arrived after the completion of activities. The project has many difficult-to-reach areas, and the monitoring by the state was by spot-checked during implementation. The inadequate monitoring and supervision by the health workers at the first line health facilities continuous to be a maf or challenge. Other challenges were attrition of community distributors due to poor incentive from communities and confusion of CDTI with other community based health programmes where incentives are paid. Efforts to reach women in purdah have been slow due to cultural and religious hindrances. Though several efforts were made for FLHF staff to YL ensure adequate monitoring and supervision towards proper implementation of the progriillme, community members to kindly compensate their distributors after distribution, and community/religious leaders to let awareness reach their women u'ho are on purdah for their participation towards sustaining the programme. )Pr s SEGTION {: Background information 1.1. General information i. Description of the project (brleny) (t) (ii) (ii, (tv) (v) Geographical location, topography. climate Population: activifies, cultures, language Communication systems (roads.. ) Admini s trati on structure Health system & health care delivery (prowde the number of health postsicentres in the prolect area f the information is awilable). Number of health staffin project area and number oJ'health sto.ff involved in CDTI activities. (vi) Kebbi State is located in the Sudan and savannah grassland of north-westem Nigoria covering a landmass of 36,229 square kilometres (almost same size as Guinea Bissau - 36,120 sq. km, or half the size of Sierra Leone - 71,740). The stale is made up of twenty-one (21) administrative local govemment areas with an estimated popuiation of 3.08 million people based on the 1991 population census. It borders Niger and Benin republic both francophone West African countries to the northwest and Niger State to the south. It shares its northeastem borders with Sokoto State and its eastem borders with Zamfara State. The state was created out of the then Sokoto State in 1991 from the 4ft century Kebbi Empire, a remnant of the historical Songhai Empire (which covered northem parts of present day Nigeria and Ghana), which was founded b1'Muhammed Kotal Kanta a famous warrior of the Kabawa decent (an ethnic group now livrng m the norttrem parts of the state). Relative to its geographical locafion, the climate in the state is characterised by two seasons. Rainfall begins in April and ends in October and heaviest in July and Augiist. The dry season is from November to March wrth dry Harmattan winds between November and February. The mean annual temperature is 100"F/40oC, while annual raintall is 500mm. Most of the roads leading to the local govemment headquarters are motorable, but the roads to the communities are mainly laterite roads, whrch become inaccessible in the rainy season. Access to these communities is usually by bicycles, motorcycles, four wheel drive or foot paths. The existence of many rivers in the state particularly "Gulbin Ka " (River Ka/ and River Niger along with their tributaries provide fast flowing rivers for breeding of black flies, which transmit Onchocerciasis. The predominant tribes in the stale are Haus4 Fulani, Kabawa and Dakarkari wrth Islam being the dominant religion. The tenets and laws of Islam as practiced in Sharia Law guide the people of the state. The marn occupations of the rural people are farming (subsistence farming), fishing, trading and animal husbandry and nomadic herdsmen. The state and looal govemments provide formal employment. So% of the people live below $1 a day which makes services such as health and other social services unaffordable, and thus puts the people at the rural level at a disadvantage. The significance of this is thai services have to be free or highly subsidised for them to afford. About TOYo of the populatron live in rural communities with poor accessibility particularly in most of the rainy seasorl while 30% lives in urban and semi urban centres (Bimin Kebbi, Argungu, Yawi, Jega and Zuru). During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to )rr + earn a living. They however retum to their communities in the rainl' season for agricultural activities. There are two main tiers of govemment operating in the state - the state and local govemments. An elected Executive Govemor, state house of assembly members, and elected Executive Chairmen and Councillors at the local governments govelns respectively. There are also the traditional and religious institutions of leadersirip, which have an influence in the administration at the state and local govemment. The Kebbi State Ministry of Health is structured in line with the Nigerian health structure which is based on the concept of the Alma Ata declaration of 197t1 which states: "Primary health care as essential health care based on practical, saentrfically sound and socially acceptable methods and technologt made universally accessible to mdrwduals and families in the community through their full partrcipation and at a cost that the community and country can afford to maintam at every stage of their development in the spirit of self reliance and sel.f determination". Based on the above the national health care delivery system is structured into primarl', secondary and tertiar-v levels of care assigned to the local, state and federal governments respectively. There is a Federal Medical Centre in the state at Birnin Kebbi, which is supported by the federal govemment and provides services to all the citizens of the state. The state govemment through the Ministry of Health is responsible for secondary health care and supervision of primary health care delivery. The local govemments provide primary health care in their respective areas. The Ministry has the following 8 departments: Administratioq Public Health Services. Primary Health Care, Pharmaceutical Services, Nursing Services, Planning. Roscaroh and Statistics, Finance and Supplies and Inspectorate Services. Other parastatals under the ministrl, are School of Nursing and Midwifery, Bimin Kebbi, School of Health Technolory Jega and Hospital Heatth System Management Board. The state has twelve secondary health facilities in Birnin Kebbi. Argungu, Yauri, Zuru, Koko, Zuru. Dandi. Ribah, Maiyama and Jega. There are 240 first line health facilities in the six endemic local govemments, 79 of which serve the endemic communities with only 35 involved in CDTI implementation. The programme plans to increase this number to at least 120. The activities of the State's Ministry and health services provided are funded from budgetary allocation from the state govemment. The eye care and the onchocerciasis control prograrnme have budget lines at the state level, while Onchocerciasis control is under the PHC budget in the local govemments. The state and local govemments hare consistently contributed a range of $4,500 - $10,500 annually since 2000 as counterpart contribution for CDTI implementation. ln the year under review the govemment paid counterpart funds of $13,953. One cannot discuss Kebbi State without considering the traditional structures, whioh play a very important role in the development and lives of the people. The extended family system is the basic unit of the community structure in the state. A household head that is usually the eldest male family member i.e. the father or grandfather heacis each exlended family. The population in these households ranges from 5 to 40 persons per household. The head of the household takes all decisions, including finance and health issues in households while the mother ensures implementation of domestic issues. The poor and women are disadvantaged and marginalized. Most women in the V5 state are in purdah and are not involved in decision-making. A group of households tbrm a communit-v in Kebbi State as in most part of northem Nigeri4 which is headed by a communitv leader known locally as Maiungrwa (Head of community, names vary depending on tribes). The "Maiunguwas" (r'illage or community head) govern their communities in consultation wrth and assistance from heads of households, religious leaders (Imams) and opinion leaders llke"Maga1rya" (head of fema-les) a-nd "Sarkin Samari " (head of male youth) in the communities. Kebbi State has four emirates - Gwandu, Yauri, Argungu andZuru, headed by emirs. The communit)'and ieiigious leaders report to therq while general communal activities are carricd out under the coordination of the village development committees. y6 AI,.GIE AreINGU GVIANDT.l KEB I(AGO .EA DA.lDl MAYAMA EESTF htIT MAPOFXE SB]E STPWNG CUn l.GAs I AR)G srppored I NoN-APoc srpported W+ Table I : Number of health staff involved in CDTI (Please add more rows i.f necessary) District/LGA Nrunber of health staff involved in CDTI activities. Total Number of health steff in the entire project rrea Br Number of health stelT involved in CDTI B, Percentage f,.=$/ Bq *100 Bagudo 54 37 690/o Danko Wasagu 96 48 5j%o Fakar 3l 27 87o/o Ngaski 36 32 89o/o Saliaba 47 36 77% Zuru 2t l8 86% Total 285 198 690/o These stalf supervises distribution of Mectizan@. The project plans to continue to train more additional health workers in the endemic local govemments on CDTI as part of the projects sustainability plan. These training will however be based on need. Ltg 1. Partnership (vi) Indicate the partners involved in propct implementation at all levels [MoH. NGDOs (nationalt'international). communi tie s. local organizations, etc.J(tiii) Describe overall worhng relationship among partners, clearly indicating specific areas of project activities (planning. supervision. advocacy, planning, mobilization, etc) where all partners are involved. Staie plans, ,f any, to mobilize the state/region/district/LcA decisrcn- malers, NGDOs, NGOs, CBOs, to assist in CDTI tmplementation. The partrrers involved in the project implementation at all levels were: 1. Kebbi State Ministry of Health 2. Kebbi State Ministry for Local Govemment and Chieftaincy Affairs (representing the endemic LGAs) 3. African Programme for Onchocerciasis Control(APOC) 4. Federal Ministry of Health (National Onchocerciasis Control Programme) 5. Endemic Communities 6. Sightsavers Intemational Kebbi State Ministry of Health, Birnin Kebbi, Nigeria Thc Kebbi State Ministry of Health and its structure including function aiid responsibilities had earlier been described under background. In addition it provides the project staff and infrastructure for the programme. The staff are involved in all aspects of the project implementation from planning, advocacy. Mectizan@ procurement, training, monitoring/supervisioq community health education and mobilization (as observers) and reporting. The Ministry pays stalf salaries and allorvances and has consistently contributed counterpart funds since the inception of the programme, but unfortunately in 2006, the state could not release counterpart funds budgeted by the project. Kebbi State Minishy of Local Government and Chieftaincy Affairs All local govemments' activities in the state are under the supervision of the Mudstry of Local Govemment and Chieftaincy Affairs. The Ministry is headed b)' a Commissioner who liases with the Local Govemment Service Commission in the employment, posting, promotion and discipline of staff of the local governmcnts urd monitoring of utilization of statutory allocations from the federal govemment. It also sets up general guidelines for staff matters, including human resource development and serves as an appellate body for local govemment issues. The Ministry is invoiveci in planning and ensures that local govemment for implementation of project activities releases counterpart funds. The Ministry was able to get the LGAs to release $13,953 out of S38,759 budgeted for the implementation of CDTI activities within the project ueain2O06. In each of the 6 endemic local govemment area there is a local Onchocerciasis control team headed by an Onchocerciasis Coordinator, which is mainly responsible for training of Community Directed Distributors, ensuring that the communities collect and distribute the Mectizan@ and commurity health education and mobilization. The 6 Onchocerciasis @ntrol teams also monitor the overall distribution in the communities, ensuring that records are kept at the first line health facilities and communities. They treat cases of severe or mild adverse reactions and reporting. 63 African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is a WHO organ, was established in 1995 with the sole objective of supporting ttre control of Onchocerciasis in sub Saharan Africa using the Community Directed Trealment with Ivermectin (CDTD stratery. APOC has supported the project with funds and capital equipment since 2000. A team of independent monitors appointed by APOC carried out an independent monitoring of the project in 2004 A management plan was developed from the recommendations of the report, which was used for the implementation of the project in 2005 and 2006. A team of evaluators was appointed to evaluate the proj ect for sustainability in 2O06: unforturalely two of the participants lost their lives as a result of a plane crash thus resulted to suspension of the evaluation. Federal Ministry of Health (National Onchocerciasis Control Programme - NOCP) The National Onchocerciasis Control Programme (NOCP) is an organ of the Federal Ministry of Health, which is responsible for overall implementalion of the programme in Nigeria. NOCP is a unit of the department of public health and is headed by a National Coordinator. There are four zonal offices - Zone A (Enugu), B (Ibadan), C (Kaduna) and D (Bauchi), which are headed by Zonal Coordinators and have the responsibility of monitoring CDTI activities in their catchment states. The NOCP on behalf of federal govemment endorses all MoUs with APOC and states and receives support from APOC. The zonal office in Kaduna is responsible for monitoring the implementation of the programme in Zone C. where Kebbi State falls under. The office also provides techrucal support to the project. Endemic Communities A community or village in Kebbi State refers to people in either small or large groups, u,ho live in the same place, share the same culture, customs and traditions with a common leadership. In the project area there we 2O2 endemic communities, which fit these descriptions. These communities have been receiving Mectizan for between 8 - 12 years. The traditional structure and decision making process as explained earlier is what is fourd in these communities. These communities play a major role in the implementation of CDTI in their various communities, and these include selection of volunteers to distribute the drug, actual collection of drugs from central collectton point, distribution of the drug. provision of incentives and reporting among others. Si ghtsaveis Internation aI Sightsavers lntemational has supported onchocerciasis control in nine loca] govemments (Sakaba Zuru, Ngaski, Danlio Wasagu, Fakai, Bagudo, Suru, Bunza and Shanga) since 1995. Since the commencement of CDTI, this was introduced in aii 9 local govemments with APOC supporting 6 and Sightsavers Intemational continued support to the programme in the other three LGAs (Suru, Shanga and Bunza). They have provided logistic support (vehicles, spares, transportation of Mectizan@ etc). technical support - planning, advocacy, monitoring, provision of IEC materials and reporting forms, support training of health workers and CDDs on primary eye care etc. In general the relationship existing between the parbrers mentioned above has been cordial and where necessary, roles/functions are cascaded for effectiveness of project implementation. Support is still being solicited for commitment to CDTI activities at V /1ro the grass-root. Communities were re-mobilized on their responsibilities as partners based on CDTI principles, so that at the end of APOC support the project can be sustainable. W 44 Ft oFt F N F,t a F)F too tD z 0e O) .D ,t E o)r!) U A: tfo B o, 0a EE!) oa o. o AI riiJLV!r. A Fl EE T; 'rl-6?'3 t.aaD;++E \o t\, 5 t\)6 5 @ @ (, @ -t{5 sN @{ o\ @(J) \o 5 fo @5@ 9-9E -€i (DE =E's s !lg=F =65o.d5D, -. (]) t.) (Jl t)ot\, U) U)o\ @u.) Est e:. I a s 3.5 $EE. o O t\) t\) (, u) o\ oatf) (,) N u)N N E iJio< 5(D!9 +? = =rb ts.5 6=' Fl 6t9 au NO 6E(! ? il + z - o (-rf ao (D a D ,Qoa \o}.) A b.)6 5 3o @5a tf) N(, o 5 @ @ (,l Po{{s O O \o t\) A t\)6 5 @ @ (,t -oo{{5 5 J-, @{ AN @{ :__- I @(,\o O I @(, \o 5 9o @s @ lf) "t.J (.,l O EsFE. l, o3 3.6 *l =!0 -ta36E. .E.9 s E r tD o o-t<r3;'gE lo +=.!; F- ' 5B *3 Hi q3 NrO ='5.r(!r q\ lt + l-l rli> rlgNlror lsr ':!q)o H1'EC H -En3.| F'o(nf o, a Eo F' o t t/)F t) o (D .6 E n .o (D .) D -a (D (D H (D cit(D .t (D A) o- o ,.i a- t 0a (D (D oi.t oa ,D .i o o. (\ $ o\(\ o G sGo(\ rE o ct oE = *=u \ s9€E zd EB>5 s -- ec -i. llE$xr+E s*2SsEPZ ts ="EH;a 1t* e;*T N"3+a\v'\br *EpE s*E ELHE $ii ss3i siq iid* lsE Eete t*!- qHeS sq<o o.wE E. d\q = - lrl * = f.t'7' <l-;r0a Rs;. =tLJ(D - i.OE Fl-sF XBE'l,59Fe €sg *a'[E sR" € +e?3 -\$F ': tr !D-da X e'a €: -'o !\(u :taD (D - S S. *0 hS 8E i FE? ;9. - ;qH =JrD I (\ i.3 =': d s -g.- Hle' tE3 +l:J N +E' q'E ir'r2tl-\ a OlE. doL 5lg Rs = 5l- s*h Elf sxo ='r0 ci $o <t(D6 - l:y :s{ € qE :'!E S.lt I :. =' =l-J >$: €ls [S = .t3 .;:5 -t(D >Ya: [lA ]Q + 2lp l.q = <t(D I\h E. =IB \S= 'ol \EE El $S'ro5_\"E9 p-$ \ o - E5 .d+3. Frp isE EI8 S:B + -lv\ .l Gdq86+ (\da):lr S6-S o\ (D c cr5 ! -)(D O -3EE* H =FxE I,sSui :aO l B ?a$ +otrc ^roo=.3.s*iils;s EEES| 6o's *-@A -irv\,/ts\.(D d +s r)+(D(dPotsX =c'4u*oZ* : g'E $; ai 6'S(D Q.+*s ^'tciY-to5 =rE \- 9, E"H € -(D5S5r(D=I ='- {JJ-\. A' =$ Y -Db$L.(D =1 *.o.< H s;8Es O'a(\ g 3 E: z.ad^<!rE-C) ff 6 H'; sIrN+ ^ =hI.E $ saio:oK +Fa5-!c(Dil +P i'Ptp€ ^ (D O-or^r\ E 6a S5'o- g dUA9I+ =J - - x E: isH. -r ri : gE f $ 3€ s 3 rH HBH'8 etz5', +S.!a E H'6 +6j T[E vYHiF B ?EBZ(Dr)9 ='I E 5fi 9g H 9t ag= lo=- i: i+ a(! a o s(,l "5 @ oo o\ O tJ @ (,l O UJ(.) N) (,lt)(.){o{ \S P o\ € o H oFl F N U) o)ts S)d s) zge A) ID ,r Fi x- ID to A'- Pa1a) 7'dao EU s) oatr o.o a J. a) F 'rl (D dFt FD a? Frl (D Ft FO .? rTl (D Ft O) .z 11 (D -Fl F) a Frl (D E O) a? E @q Ele .z a? :!, FE' ? Eo ? F]H C) ? 8e o ? A)to 7 F'to ? FOHo o ll iJ9ro ol, z8E5E JNtr!r =otDJoo E EFt H E H Fl -u)E* E= m ? A) z D) ? A) 7 o) z o) ? E o tsE o '.1al 19 ,Q A) o) a? B A) a? A: o) a a< A) FD .Z ol q O) s) -o E'* +Er'oa Fl1 (D cr E A) .? Ef, (D dFt sl .{ rTj (D dr.t e)q 11(D E F) a? Etj odH to a? 11 o -Ft s) a? o E3 ErE: oo t) .D g D (D a(D (D d(DFt oo od(D H r> E t oo o (D H 7 A' -a !l.+ oo od(Dt oo od(DFt ?A E U(D o @ (D tst U @o(D d(D r-t o 9u EE: o a l" - 'Qlg a ,J.E o ? Hq 7 F) o ? FDto s)to z o) C) ? o)to rk oe zo (D d(D zo (D C'(D r-t zo (D d(DFt zo tD d(D zo (D 6(DEt zo (D -(D oo 91, F6 o!, (r) (D 3. O o R.=.\P Ot=imr:-os$J{N.\rI F.l" t O ''-i- xs:i.-iLO NsS'O .r =$ rQSB isxi.ri; z'E\u i:. -t I\F s. o{.8 3xO\fRtrus \6GrrROd"fIopIrNo .stE{ \I *. o n Oa t (\ S(\ h. a si a 4 q G h E ts6 q 3(\ o e -l (D (D o F+) o) a) (D U) o'Ft (D s) (D D'a (D A' (D a. (D o >-t ,-t(D (! 4 d sq E-€ E E P > .,p d' 3i= *U. d S5+ :Acl tD :2 a (D(D$!!x(,6=xD=(Di'.{Z a 1i o,O^.!.AlQO?= 3 6E?38 6 <i.i:9? =: BH'EEF. = ;aFdf3 t g;*91 t.) c ):S-< r =-OE 69 6: +i8()-uFE u 9=5'E=' 7 @Bsr88. E =ES6 o o 9 e.o'd r (J J ' -Fe i 5;tss= I :Eeo =1 5 :.(D 55B F +9+ ..6 :i s ='-q P Er oo EEPd, i, a'-b $r = Q6o-oo: E X*,tra .-1 _ ! c o-E-Z+ 6 i oGf1 F =.*=+3s i Hfi' - - ') -EIVF)!0 - -3 *: E =ddE=S+'"<Ooa P -h -)HH E, 369q^-:-+|* (D Fi-OX - O vr'\)*+iU .D 'PaDo 6' , *- -1 = ! a I?! =. {Fss ' H8 =.5 d5 JiiaE- =I '9H B (n-:J; gA bAr-o 99P:' ro Pc C)irg .> +8- Nai-!) -aF585 F' 16a, o=a ><; U,dx ():1 = 91J (J =Co) {- = s6 +- .) rre 8-g (D o\S o 2.2. Advocacy State the number of policy/deaston makers mobilized at each relevant level during the current year: the reason(s) for undertaking the advocaclt and the outcome. Describe dtfficulties,/constroints being faced and sugE;estions on how to improve advocaq,. The project has continued to advocate for sustainability of CDTI activities post APOC support. Advocacy was carried to govemment at the state and local govemment levels and other stakeholders. Advocacy was carried out early in the year before acfual commencement of CDTI activities and subsequently during implementation of CDTI activities. This was done to ensure that the projecl gets the needed support toward sustainability. As a result of this govemment support to the programme in terms of provision of counterpart funding has been cheering. The project's advocacy objectives for 2006 were to solicit for early approval and release of funds, political and moral support. As a result of this the local govemments release counterpart funds ($13,953) for CDTI implementation. This is very important because the funding at this level was discovered to be a major factor in the monitoring and supervision of CDTI by the Local Onchocerciasis Control Teams (LOCTs) in all the f ,Gfu. Based on the traditionaUreligion structure, both traditional and religion leaders had a big role to play in ensuring that women in purdah are reached, get their communities to provide incentives for the CDDs and the selection of female CDDs. Advocary was made to policy/decision makers in the Ministry for Local Govemment and Chieftaincy Affairs, the Ministry of Health and six endemic local govemment areas. A total of 37 persons were mobilised to support CDTI implementation and they include Hon Commissioners of Health and Local Govemment and Chieftaincy Affairs, Permanent Secretaries in both Ministries, relevant Directors, lnformation Officer ar the state level; Chairmen of the six LGAs, Directors of primary Health Care Services at the LGAS, Councillors for Health and Information Officers at the LGA level were also visited. At the community level 35 community leaders/representatives, ieligious leaders and women leaders were also mobilised. The outcomes of the advocary were; all the policy/decision makers at the statdlGA Ievels and most of the community/traditional rulers promised to ensure that counterpart funds and incentives are provided to SoCT/LoCTs and CDDs respectively, endemic communities also consider the inclusion of female CDDs, and during monitoring and supervision some among the communities visited kept to their promise. The issue of women in purdah is religious and cultural and thus not much can be done, commitment to CDDs compensation is also an issue to the proiect. These are challenges to the project that we would continue to advocate for. rtrtt+ 2.3. Uobilization, sensitisation and health education of at risk communities Provide information on The use of media and,'or olher local systems to disseminate information \tpes of IEC materials used Mobilization and health education of communttrcs includingwomen and rnin-orilies Re s pon s e qf tar ge t communit i e s /villa ge s Accomplishments Suggestways to improve mobilization and sensitisatrcn of the target coifiinuiiities Information on CDTI was disseminated to the endemic communities through the use oi <iistributors (CDDs) in collaboration with community leaders during community meetings and town criers. Religious leaders and Islamic scholars were used to mobilise the people in mosque and Islamic schools. IEC materials (posters and flip charts) were also used extensively to disseminate information, health educate and mobilise communities. Endemic communities were mobilized and health educated annually based on need in some occilsions since the inception of the project. During the year under review, targeted community mobilization was carried out to address problems identified during monitoring/supervision to 35 communities in five of the endemic LGAs (Zuru. Danlio Wasagu, Sakaba" Fakai and Ngaski). The communities have continued to demonstrate good knowledge and awareness of CDTI and response during mobilisation, which has been encouraging. This is demonstrated by the performance of their roles and responsibilities and the request for their drug for annual treatment. The response in the provision of incentive for CDDs has continued to be poor despite the repeated mobilisation and sensitisation. The use of electronic media i.e. radio station and identifu other forms of communication within the communities to sensitise, health educate and mobilise communities wuls given a consideration, but due to non budget allocation to such specifically this was not used, though the project hopes to implement such in the future. Loudhailers provided by the supporting NGDO (SSI) were used during commumtv sensitisation and health education, this was to ensure that women in purdah got adequate information and to fully comply with CDTI. 1t5 Nurnber of communities/villages with community members as supervisors Number ofCDDs Number of communities /villages with female CDDs Ntnnber of cornmunities with female CDDs Percentage Brt= .100 Total no. communities in the entire project eree B1 Number with community members as supervisors Percentege B6 By' B. ^100Bs Mrte CDIX B1 Female CDDs & Total Bs= By'Br Bagudo 32 l5 47Yo 210 6 216 6 r8% Danko Wasagu 83 26 3lYo 330 t2 342 t2 l4Yo Fakai 11 7 64Yo 99 2 l0l 2 tE% Ngaski 36 22 6t% 240 3 243 J 8% Sakaba Zwt 30 20 6 67% 60Yo ll0 8 4 118 8 a10/Lt /o 10 76 80 4 40% Total 202 96 48Vo 1,065 35 1,100 35 lTVo 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance offemale members of the communit.v at health education meetings - In general, how do you rate the participation offemale members of the commuruty meetings when CDTI issues are being discusses (attendance, participation in the dtscussion etc). - Incentives provided by communfiies for the CDDs - Attrition of CDDs. Is attrition a problemfor the project? Ifyes, how is it addressed? - Other issaes a a Female attendance to community health education has not improved. This is due to the Islamic norns and culture that prevents women from freely nii.{iiig with males, though few old women and young girls attended meetings. Loudhailers were usd to ensure that the females in purdah are informed about the programme during mobilisation and sensitisation sessions. Attendance and participation of women in the discussion and implementation of CDTI contmue to be poor due to the lslamic way of life that does not allow at free mixing of males and females. Compensalion to distributors has continued to be a problem in most communities. These incentives are not provided in a good number of communities and where they are provided, they are not regular. Though the project is tryrng to make communities see the need for the provision of incentives, through encouraging them to provide incentive in hnd irsteari of cash. CDD attrition was an issue of concemed too; this wils its a result of non- incentives to the selected distributors. However there are CDDs who hal'e been in the programme for quite a number of years and have continued to o 2{/h Bta o serve their communities without ashng for any form of incentives. The project has continued to request communities to select new CDDs in a situation where there is attrition is found. Local govemments are also encouraged to use CDDs for all health and development prograrnmes in the communities. For example thq'should be use as guides during Nalional Immunization Dals so that thev get some incentive. The provision of incentives for other community ba-sed health prograrnme like the National Immunization Programme has not helped in resolving the incentive issue. ?.{'/+ 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staffoccur, state what the project is doing. or intends to do, to remedy the situation (The most tmporlant issue to describe is v.,ha! measures were taken to ensure adequate CDTI implementation v,here not enough knowledgeable manpower was available or if staff are frequently tansferred during the course of the campaign). Since the inception of APOC support for CDTI activities in Kebbi State, human resources had been developed and contributed to the success of the control prograrnme Onchocerciasis. A total of One hundred and eighty-eighty (188) members of the Local Onchocerciasis Team and health workers, seven hundred and seventl. seven (777) community distributors were only retrained out of the target of 196 and 1,1 10 respectively during the year under revielv to manage the project based on CDTI principle. Transfer of trained staff was experienced by the project particularly in all the endemic LGAs. Some were within the endemic area and few staff outside, wluch the projeot found very fair unlike the previous years were most of the staff were transferred from the endemic areas. Decision is still on to address such issue by training all the health staff at each of the endemic LGAs on CDTI implementation to address such experiences in future. Itt sa! (! 5(! I s Ft Fi F N 't aots E:d Ol z qq oF Frl !) ,f F: to o)-gtrr EU F] oad o.o t r! F o O O O -lAI z E6Oa Dlo =t= e.3 =3.(!aat F o a O o o 6- b s, .?^-r+1r9. olr g ir s o o o I o\J. s \o o\ tJ t.J { N) -l i.J o\ H6 o ztr t!i += DD!I EErtDite t! a)a(! +!rt t, €6 66 t-)6 NJ @ -l *.t t.J tJ sA AA tJ l-.J $g $& ,tr^a+i.,9 oll!L G G (D 3 O O O O o O O 'l a o *7 =5 Eg, a= ^;'g1 (! YET7e. (D t, O O o s)Fs€ sq n = A-l+ -'o oll!L s (.)E.BO -o<o\ t! 3(! ll I t @ 00 tJ+u) tJ)If..) b.Jo\ OEo6 ,f,tz -i= E. t! P9. o t, tJ5\o (, hJ : -l -I -l tJ o\{ NJt) i-.J -lA 5 \o o, { o\ \o { o\ I.J tJ s \o t-J A o\ .OF\€ sq o.npt l.l la)l(t I(Dl(, ;I TD 0a FD ln a- (D'Ft fD (D (D o|+) o UJ ..-7 0 (D o) E(\ G S = o\(\\ o o 4% .-.) * q- s s S o =5 \ o =6. s o \ o : oa o a a . 5 k o & s s T qa .\* -'{- *i9 FqiS -Giq FQNts A(a\= =dst Nts3.€ sl (\R +"$!r *siF ESR$ (!= \-: S €si-8 -ti{x Q1 -,(!SB EF(N\ \r\ s\i\\i do SS .S <G si6 s S G .a \ s\a l.l lo)lq 16" lcr, .-. I *o (\+ qr. FDp5EE'%0a €c(\o-]o\!l \FGfD R' h < q R\\(\ C \ lsh G\ N o\ oa (\\ e (! a 0 tl() J U ST E:(! Fo rd o4 zH 0a U A) FD l0 S) @ o U O) F) o o () C) o Otr ? oa azPo)rn !J aS) oe(D a0 t Jr +{E9 Po =oh5o 5' ., TFU Pcidq9Ue AigH (D ll D' c(D6 OrJ !i lD =5 00 (D @ * (Dq (D @ o U U EY 9E !0tr =la< (! :Ei+6 rD! Glc-3O HP Ega oo Ell {a o0 ()0 (D@ oa (}a (Da (Da 3.e g ='a = =.=ltld * u_* td oz r'r O E:E .E ii r<E(DO *3. aE EY g. rD <4 S*\c^ N o \ \ 4 D .l o \ Gja E a) o: = rs -! \ s o ci a 4\ ! d s o sta nil x'\ o D (< o (D >t o o (D tt) u C:o 2.6. Treatments 2.6.1. Treatment figures - If the project is not achteving 100% geographical coverage and a minimum o.f 65%o therapeutic coverage or the coverage rate n Jluctuating, state the reasons and the plans bemg made to remedy this. in the period under review the project attained 100% geographic coverage with a therapeutic coverage of 87%o. The project in the past reported having 210 communities, during monitoring and supervision some places were found to be one community but have sections, which were classified as communities. This was found to be as a result of tryrng to have more recognition to such places, but clarity was made which they accepted, as such this brought about the present 202 as total number of endemic communities within the project area- But it has to be noted that such places have same communitl' household treatment register, though with list of households accordingly and based on which section of the community a household falls. It should be noted that there is a drop in total population and population treatcd compared to the last year's (2005) treatment, this accounted to migration by nomads and some few indigenes from Ngaski LGA, this happened before treatment commenced. zr L4 Ft oFt F N F.t tr O o)Fg) d tD z 0q O) ch f ,Ll A)t FO toDiPae_ff6 EU A) oa o- 5B-" >d' t.)ol\) t]) (, o\ @(]) (, t..) -o a O >.E = "H +g+F= E- F) ilii @ o 3 +@=.;@=* - + = aq o o a (D o) 0aot) tJoh) u) tr) o\ m(}) t, l.) l.-l d6i P 6EH .'iE ='E s(!= [J t\) u) t, @ UJ u) tt) o o 24 *=c =6YI q:l*3.o oao c s O 5\ 10o\ ^\ 1O 1Oo\ ^Oxo ^>oq96:I9ts€ oa5o6'g t- -w -vrl \ol\) 5 N)6 5 @ @ () po{{5 5 .!r) @{ o\ @ tf.)\o 5 so oo5@ (]) t.,) (^ oo X ro I H of r 6 6 >-'=aD:lJ +ts 6'@ =.= G =.L iu o A) o { N) \o (,l o\5 UrFN{(}) (j){ ".,.l 5{ J.,l @\o\o 5 +. Ol l.)I()) t'.)N oJ-ga P oiE :5rod= o\ -J(./o6 5 o\N Urs t') (,| (,I(/r lJ.) o\ (,,l "o\(, tj) 5 J')N(Jl N) tJ5 o\tJ gE 5 rq g 6{ s @(, -o o\ \o t')\o @ L,T\oo\ oo N) -o6\ @ o\ o\ @ !or#O65EiEE@OQE@4 o \o -v -v t\) -I t..){ t\)N()) tJ)5 (,rl5 l.J\otJ E*$ tE "? E. " E 5 g -r, (r) \o Ut o\5 o\ (r!@ @ N(]) l\) L^L,I \t(/r O BzQC ax oX aZ >o=l)' 'r E*; z.?-6 rae &E =gIa.FggEr Y.=--" o @ ^pv+ la lF0 lo l-r i (Ds = tD A' o-(u rn Oi o- aq' o -o ED trr (D A)th A) r'! 'V)F E R 4 G S \(\\ s (\ o <a <a \l lE1loIH IE lD)t*I6' l-t iC) l9 ttrlcl+ IIJ ool* I(Dl-la)tt l(D IE l6{s lo- 0a t(Dlo boIH lg)lclli'lr.l.) IA' la)lol1 lrdlr to: oo I(DlVt H (D nA'E(D ro* :/o o (D ng) ga(D t o) (D o .D o 0a !o all .o) 6' f)o .D F' oco o) (D -l C) o ro ti o\HvD) 0a(D E c0 El .o o' o\se =rtr o@H:< x(D5o- .9 (D o 6(D (Dq) +il(Dll =' O lr,614OItr >t3{a ldtto(D l-?togr d- tEgl8 6le D)IHtf to[i t9 aKA - Ip.5.lx !t l- 515 (} rd €.(D o D) @ s) .l o9 R t\ ; $\S cJsSuttG NN ^ \i:lS'G GQse!ES. ss E ss \l\a! \SE .^! =" ilXGN "{\:$stix!E-r t srG-tis xsdr)-*.RT: sRRr su N s'.S s.rE s.R $ ss$dT E sGl: s*s RSHSaq\s = €.RRJF S$e a a:\j({ tr.Y T,S E\e s* !r!\ F*.q\{ **Y\qsEqB AF i':-E+ s\Fi .t l- Sd ss *6 s$+*.srq- $k.G: sk\s .S q. +s RE3\ \ Oa I s! Nr co to lt >lz. 1tz..t25lc OIE olE = lC FD l:J cD 13 E F ;F ;I8'sJH t l1 O lr -r to !l to 'o to .d I+t a l+ tr l+)Bl8 E18 ilHEIE e^E elEii l(! -'l= - l(D Elg slg E.E;ll EIF 51118 eE g18 el; €5lo fd5.8' Eal* .tolx li F.l l- O-Ee g E.6g+- o?DO0- ap o-Foe'i+(D @ ;il @): e. .9E F= I.I,J .D o .4.E'(Dta) +- :t ot .DH r5g .0.I+ slf(D o) il aa a a I 2.6.2 What are the causes of absenteeism? There is always a higf migration of male youth and some heads of households to urban settlements during the dry season to engage in petty trading and other unskilled professiors to earn a living. Thev however retum to their communities in the rainy season for agricultural activities. The nomads around endemic communities do move southwards annually for pasture for their animals during the dry season and retum in the rainy season, which of course they may settle in the initial point or make a change. There are also people who have to go to schools in other towns/communities and only come back to their communities during vocation. 2.63 What are the neasons for refusals? Religious belief and norrns 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the repofting period and prrvide (in table 8) the rcquircd infonnation when available. ln case the project did not have any cases of serious adverse events (sAE) during this reporting period, please tick in the box. No SAE was reported x L3 l-l l19IE laDle o t, o0 o 0o o ta2 Ita (! d o o r! O O lrl U) t, aa rt .6 oe o d o t. 0q o 'J.6 #S v) G = rS dq G t! a S- + C.r\' $(\\ G ooH ry7 iE Q3 =P@ots9=. R#oo t /+3 Pe5[ '-3 xc00 (, * ooo U)(D I o1 l6 ,;da ":.6 {UD0)q6 ,f s.(DG 5o NN >o =I es N.O LiPFsl - 7ib, db (, o a E:S Yli.= 6' p-5 t- .7)i'4o -ts.- E TFV =51ligrE'o -o@+D!D$ zeF s Ie " tG Xrx+ g q ql6 oxq= d;' <D o \ tr € liJ N,Jldh 16- !r,lp- .rtHO .d= O'E *o5-rO+ ae F+ *o o5O+(srs58,5qs 6'(v <ld(Dt<= lo619=l(D+ Iia -lE3.oli=k-(DAqu r+r i E'r!(Do o?'Eii ai=E8 (Do65 E: 8+ .DQ3s;i{ -r RE :h.: =d -. S9 s. G\Gs G (D DT0O a aD (D o F.l l/ e n (D o(.) p r! (D P o\ € ao(D O n(D !i EA (D a(D o B' orl !, tt o .)p a t, o t, N O N)O \o N)O oo N)O -) N) o\ t)O N)o5 tJ UJ N o b.J t\)OO N)OOO \o\o\o \o\o @ \o\o -I rd N)Ot.) f.J N.) f.J t.) @@ Ur@ o\(, Ui(, (r(,) o o8a HTfr3ZQ : F Y- E'il. tD - < d.o + A E. >9,E,' =0roo 1..) tJ N) NJ N) O N.) @@ lJr @ o\ O -H .dni P okl =6E@* N) 1..) f.) tJ \o f.) oo - 00 o\ (, O! -sl 9 3E llE IEfiEi it+ \o -Js \o o\ o\ \o Ur s o\ 10 \o O o\ trroOrr_oe - r^ < - Ir"rtsa sq9r ll :.oi -si =oa'6 i. o\ \o -JrO ^\ \o o\ s \o \o ,o o\ OO o\ \o oo o\ \o m s \o m\o c_ E' FI * ll oo-G6 P.e#o (! oo 5 (? o oa(D0 \o I.)5 N) oo 1..) \o -ItJ oo -Ii N) 5 5 )oNJ l'.) 5 -l +. { -It.J o1 aj,l tJ o\ -I -po\(,) 9a EE'E E.FE.>r5S NJ I H St' + { NJ \o o\@ -t O O F.) Ur -I O o\ (,r O \oS -Ib.J o\ @(Jr "r.J o\ -.I -N)o\ ta, ^Fl -o'ai P o aEoHrl +H E6A o\ -I(}) 6 o\ :c\o N) 5 m .i @5 \o @5 i o\ l'.) .!5^\o |,.J \oI o\ 6F \o{ -l -I 92,gE b*!rEtD'Bg o oo -t @ \o oo(, \v @\o o\ @N) @t.) .o o\ @tJ\o \o\o \o\o s \o -) E tr,r ll !o=loo ro rd A)o\t€vs o0aco i'.o 10 \o ,o9\ N.)5 v t.) 10 \o\o s .oo\ \o ^\ \o\o 1O \o{ s E' T' * ll oo- a<J> \o(! Je# cj @ I'uo o) \o -I o\ o\ \o Ur .o o\ \o oo o\ -t o\ \o @ o\ 00{ o\ \o\o s \o\o o\ \o -l\o oo- -? \i)YO Fi:,8 ci oa .D \ lo \r1 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer\ MOH tr WHil UNICEF tr NGDO N / other (please specify) Mectizan@ delivered by - Qtlease tick the appropnate answer) MOH tr wHil UNICEFE NGDo t] ,/ Other (please specify) Please descnbe how Mectizan@ is ordered and how it gets to the communities The LGA Coordinators compiled the Onchocerciasis treatment report and Mectizan@r used in their various endemic communities and submit it to the State Onchocerciasis Office. The quantitl' of Mectizan@ tablet required by each communiry' for the next year treatment round is based on total population of that commrurity after the previous treatment round (distributors do update census while distributing) and multiplied b1' three (x 3). This is then collated at the local government level and sent to the state level then to the supporting NGDO (SSI) which in-tum places orders Mectizan@ for the project through NOCP to the Mectizan@ Donation Programme. After approval and shipping by Mectizan@ Donation Programme, LINICEF thereafter talies charges of the Mectizan@ clearance after arrival from the airport and its storage before collection by the supporting NGDO (SSD. The state then receives its own allocation based on the total number of people to be treated likewise the local govemments and all the endemic communities at agreed points of collection. At the commuruty level the first hne health facilities receive and store the required drug for communities within their area of supervision. Communities are then informed to send their distributors/representatives to collect their Mectizan@ allocation after pre- distribution activities have been concluded. o?-6 LGA Number of Mectizant tablets Number in stock Requested Total Rcceived Used Used/Person treated Lost Wasted Expired Remaining Bagudo 3,O20 I10,000 105,980 73.92t 24,620 2 0 0 2,< ^11Danlio Wasagu ll,2gg 140,000 130,000 r50,746 42,252 161 0 0 -9,609 Fakai 5,166 15,000 12,000 76,496 5,633 664 0 0 6 Ngaski 1,680 100,000 95,000 80,867 36,536 58 0 0 15,755 Sakaba 60 130,000 125,000 124,996 54,205 4 0 0 60 Zuru 1,774 17,000 15,000 10,700 4,062 0 0 0 6,074 TOTAL 22,999 512,000 482,980 457,726 167JoE 889 0 0 47,364 Table l0: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining ivermectin tablets collected and where are they kept? The distributors (CDDs) retum balance of the Mectizan@ tablets along with their communit)' treatment reports to the front line health stalf (supervisors) at the first line health facility These are then passed on to the LGA Coordinator from all FLHF staff along with treatment dat4 he/she collates atl the reports and drug for all first line health facilities and submit same to the State Onchocerciasis Coordinator who retums them to the medical store where they were first collected for storage against the next treatment I Utlrltr. Ltst and brieJly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Front Line Health Stalf at the first line health facilities calculate the amount of Mectizan@ required from the updated census done by the cDDs, this is done by' each of the endemic communities under their supen,isions, and submits their request to the onchocerciasis coordinator at the LGA. Based on their request Mectizan@ is issued to them from the Medical store. They keep the drugs in the first line health facility from where the communities come to collect their allocatiorr after notification of the availability of the drugs. a - Any other comments None a,+ 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monfioring been done in the propct area? This was not done in the year under revieu,. This rvas scheduled but could not be held due to late released of funds. Nevertheless as a result of community mobilisation and sensitisation conducted, some of these endemic communities were able to carry out CDTI activities for the year under review, though there are plans to conduct this training and before the next round of treatment. If so, when? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the commuruty self- monitonng and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 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 stakeholel-crs meeting (SHM) TOTAL A+ru 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. NOCP (ZONAL OFFTCE) NGDO (STGHTSAVERS rNT'L) STATE ONCHO TEAM LOCAL ONCHO TEAMS FRONT LINE HEALTH FACILTY SUPERVISORS COMMUNITY LEADERS CCMMUNITY MEMBERS COMMUNITY DIRECTED DISTRIBUTORS *( Z9 2.9.2. What were the main issues identified during supervision? o Lack of female distnbutors in most communities o Non-community self-morutoru:rg. a Poor health education and mobilization of women in purdah as a religious belief and culture. CDTI records were fairly kept at FLI#. Monitoring and Supervision by local Onchocerciasis team was inadequate Transfer of trained health staffto non-endemic communities. Attrition of selected community distributors as a result of not getting any form of incentive. Treatment record at community level by CDDs is poor in some instances a a a a 2.9.4. what werrc the outcomes at each level of CDTI implementation superuision? LGA/FLHF: At the LGA level it was noted that some health staff still have the impression that CDTI is not part of their primary assignment, as such they should be paid. This attitude has aIlected the implementation of cDTI activrties. Follow up wils done several times by their coordinators and NGDO before treatment reports done by endemic communities were submitted. 2.9.3. Was a supervision checklist used? The supervision checklist was used in some few cases as noted dunng monitoring and supervision exercise, even though this was provided. Community: Compliance to treatment by community members was encouraging, drug shortage was not an issue, and CDDs were poorly' motivated as such they distributed the drugs at their convenience. community mobilization and health education was carried out in affected communities with emphasis was on provision of incentives in kind to motivate CDDs. a o a o 2.9.5. Was feedback given to the person or gnoups superuised? o Feedback was grven to both LGAs/FLHF and communities concemed. 2.9.6. How was the feedback used to improve the overail performance of the project? o The response to parmers concemed stressed issues and recommendations. Thq' were motivated to fully continue participating as parmers tllough kl 3o carryng out their roles and responsibilities; thrs of course resulted to a success. SEGTIOII 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please add more rows i.f necessary) *Condition of the equipment (F:Fmctional, CNFR= Currently non-fimctioral but repairable, WO:Written off) How does the project intend to maintain and replace existing equipmcnt and other malerials? The project intends to marntain existing equipment through repairs using the state and LGAs counterpart fund on existing equipments; there do still exist plans for the replacement of the existing equipment and materials through an approach partners and the use of counterpart fund too. *T Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Cmdition No. Condition No. Condition No. Condition l. Vehicle I F 2. Motor cycl{s) 6 CNFR 7 4- WO 3. Computer(s) I F 4. Printer(s) I CNFR 5. Photocopier (s) I CNFR 6. Fax Machine(s) 0 7. Others a) Television 1 F b) Video Recorder I F c) Air Conditioner I F d) Calculators 0 25 wo e) Bicycles 30 CNFR 2t wo 0 Overhead proiector I F g) Generator I wo 34 Contributor Year 5 (2004) Year 6 (2005) Year 7 (2006) TOTAL AMOUNT (cAsH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASH) Budgeted (US$) TOTAL CASII Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Relcarcd (us$) MOH (Central + ProvinciaVState) 28,985.5 7,246.3 78.740 7,874 38.759 0 MOH (Drstrict/LGA) 18,260.86 13,913 23,763.7 I l,8l I 38,759 13,953 I ocal NGDO(s) ( if any) 0 0 0 0 0 0 NGDO parmer(s) 10,265.83 9,470.43 9,251.9 I 1,186 6.157.48 6,156.14 Others 0 0 0 0 0 0 APOC Trust Fund 8,750.00 8,750.00 142,030 0 7,920 0 TOTAL 66,262 39,3E0 111,898.6 30,871 91,595.4E 2O,lO9,l4 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years Exchange rate: Year 5 - $1 - NL38, Year 6 - $1 - N|27, Year 7 - $l : Nl29 IJ-there are problems with release of counterpartJunds. how were they addressed') Effort was really made by advocating to the stakeholders concemed at the Ministry of health and Ministry of Finance, but despite the advocacy visit on the need for the govemment as a partner to talie up it's responsibilities towards sustaining the programme nothing was done. 3.3. Other forms of community support Describe (indicateforms of in-kind contnbutions of communities i.f any) a a The forms of support to community distributors were in cash and in-kind (food items), though this was from few members within the communities 3.4. Expenditure per activity Indicate in table 11. the amount expended durmg the reporting period.for each activtty listed. Write the amount expended m IJS dollars using the current -l]ruteci Nations exchange rate to local currency. Indicate exchange rate usecl here - $1 = NI27 .w 3 7- Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community lMobilization and health education of communities I Training of CDDs Training of health stalf at all levels Supervising CDDs and distribution ,lntemal 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 562 3,713 3,291 1,736 s62 2,213 984 412 412 6,003 220 0 SSI LGAs/SSI LGAs/SSI LGAs/SSI SSI LGAs LGAs SSI SSI LGAs/SSI SSI TOTAL 20,108 Total nqmber of persons treated 28E,151 Table l4: Indicate how much the prdect spent for each actrvrty listed belou, during the reporting period. Any comments or explanations? *r 33 SEGTIOII 4= Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the rrcporting period? (tick any of the following which are applicable) Year I Participatory Independent morutoring: NONE Mid Term Sustalnability Evaluation: NONE 5 year Sustainability Evaluation: NONE Intemal Monitoring by APOC: NONE Other Evaluation by other partrrers: NONE 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4-2. sustainability ofi proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporhng period? No Was a sustainability plan written? No When was the sustainability plan submitted? NA_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of 4.2.1. Planning at aII relevant levels There will be a meeting to develop a sustainability plan meeting with relevant stakeholders Advocacy would be made to the relevant stakeholders both at the govemment and community levels to support the sustainability plan. Each LGA will meet with stakeholders including religious and communib' leaders to discuss and implement decisions taken on sustaining the projeot Communities will be health educated and sensitised on their roles as parfrrer toward sustaining the project. 1{ a a o a 3+ 4.2.2. Funds a Advocacy as continuous process since the inception of the project will be intensified to relevant partners to release counterpart funds to support the CDTI project. a 4.2.4. Other nesounces a Other resources for the successful implementation of a sustainability prograrnme wrll be discussed and explored during the planning meeting. 4.2.3 Transport(replacementand maintenance) It is hoped that counterpart funds would be released and used for the maintenance of project vehicles at the state and local govemments. No specific plans have been made to replace the transport and capital equipment. The project would however approach parhrers for a one off donation to support the programme. o 4.2.5. To what extent has the plan been implemented o The plan is not ready, but the project has commenced sensitisation on the sustainability plan and it is expected that stakeholders would accept the idea 4.3. lntegration Outline the extent of mtegranon of CDTI into the PHC structure and the plans for complele integration: 4.3.1. Ivermectin delivery mechanisms lvermectin delivery has been integrated into the PHC system from the state to the front line health facility. When ivermectin is received it is stored in the state Medical store from where LGAs collect their allocations. The allocation to the LGAs goes through the PHC drug delivery system and stored in the medical stores from where the supervisors from the front line health facilities collect for the communities thry supervise. 4.3.2. Training Training of personnel for cDTI activities is yet to be integrated into the PHC system as all prograrnmes hold their trainings separately. Attempts have been made to train some Traditional Birth Aftendants on CDTI stratery when they are being trarned on matemal and chrld health in a few communities. 4.3.3. Joint supervision and monitoring with other programs There is yet to be a formal arrangement for this, nevertheless, state and local control teams are encouraged to supervise CDTI when they a a o A,T 35 supervise National Immuruzation Programmes in their areas. It is expected that this would be discussed and agreed as a strateg)' for the sustainability of the programme. 4-3.4. Release of funds for project activities The commitment by the state and LGAs in the release of counterpart fund has been quite encouraging to an extent; these are however released separately at the state and LGA level. 4.3.5 Is CDTI included in the PHC budget? Yes at state and LGA levels o 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Sightsavers supported the training of supervisors and CDDs on primary eye care services with the hope that would help in the screening. identification and referral of eye patients in their communities. It is expected that the CDTI structure would be used to achieve this; the performance of the supervisors and CDDs on this has not been evaluated. a o 4.3.7 . Describe other issues considercd in the integration of CDTI. The state and local governments stands the chance to reach people at the grassroots with the neressary awareness related to public health services and to incorporate members of the community to take ownership of most primar)' issues regarding their health. It is cost effective for all partne$ that may be involved in implementing CDTI principle. 4.4. Operational research 4.4.1. Summarize in not morr than one half of a page the operational research undertaken in the prcject area within the rrcporting period. o No operational research was undertaken during the reporting penod. 4.4.2. How were the results applied in the project? o NA. a 4d 1€ SEGTIOil 5: Strengths, weaknesses, challengGsr and opportunities List the strengths andwealmesses of CDTI implementation process List the challenges and indicate how thelt were addressed. Strengths: Continuous compliance to treatment by communities.a a Commitment by some health stallto monitor and supervise implementation. Good community awareness about the programme. Distribution of Mectizan@ by most CDDs despite non-provision of incentives by their communities. Financial and logrstic supports from Sightsavers Intemational. Non-release of fund by the State Ministry of Health during the year. a a a Weakness: Ghallenges: a Poor involvement and participation of women in CDTI activities due to religious and traditional believes. o Lack of female distributors in most communities. o Poor motivalion and incentive for CDDs by some communities leading to CDD attntron every year. o In adequate monitoring and supervision by some supervisors. o Lack of counterpart fundmg for the year from the state govemment. I Most health workers see CDTI not part of their primary assignment. The project has continued to advocate for sustainability of CDTI activities post APOC suppori. As such advocacy was carried out to the state and local governments. Health workers at the health facility level were at all times made to knorv it is their responsibility to handle CDTI issues even as they do for other health prograrnmes. 49 3? SEGTtOil 6: Unique features of the projecUother matters 5tr 38