Borno State CDTI annual project technical report submitted to Technical Consultative Committee(TCC): January to December 2009

OYO STATE 2OO9 CDI/CDTI PROJECT fi emilaadero n ke@y ahoo. com) OzuGINAL :Enelish COUNTRYTNOTF: NTGERIA Proi Name:BORNO STATB CDTI PROJECT Approval year: 1999 Launchinq vear: 1999 Beportine Period From: ...JAN 2009 To: DEC 2009 , (Month/Year) ( Month/Year) APOCfundinsvear: (circleone) I 2 3 4 5 6 7 8 (9) 10 11 12 13 APOC Proiect im entation vear reDort: (circleone) I 2 3 4 5 6 7 8 9 [10] 11 12 13 Date submitted: June 2009 NGDO Partners: HELEN KELLER INTERNATIoNAL 1 'iI t .do Fq Actoo Tot .at' for l*rdon To, ItE cs(L, , \1r . rja 4n' r 2 6 JUtil 20t0 APOC / Orn RECU LE WHO/APOC, l4 September 2009 ) l, BORNO STATE CDTI 2009 )ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t { ,. u : a t ll WHO/APOC, 14 September 2009 t a ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSTILTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: ? a Country: NIGEzuA National Coordinator Name: ... Signature: Date Zonal Oncho Coordinator Name Signature Date NGDO Representative Name: ... Signature Date This report has been prepared by Name : . Designation : ... Signature Date Itr WHO/APOC, 14 September 2009 Table of contents ACRONYMS VI DEFINITIONS..... FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY... IvII I SECTION I: BACKGROUND INFORMATION I. 1 GENERAL INFORMATION l.l.I Description of the proiect[briefl l.1.2. Par'tnership 3 t.2 POPULATION.. 8-9 SECTION 2: IMPLEMENTATION OF 2.2ADVOCACY... . 2.3 Mogtl.tzarloN.seNstrtzerroN aNo poucarroN or er Rtsr cot\4t\4trNtrres. 2.5 CAPACITY BUTLDING. . . 2.6 TREATMENT 11 11 2.6.1 Treatment figures... ... 2.6.2 what are the causes of absenteesim? 2.6.3 What are the reqson for refusals? 2.6.4 Brie.f describe all known andveri.fied serious adverse events ISEAJ that occured. 2.6.5. Trend of treatment achievement from CDTI proiect inception to the curuent year. 2.7 ORDERING.STORAGE AND DELIVERY OF IVERMECTIN ..29 AND S 2.9 SUPERVISION 31 2.9.1 Provide a-flow chart o.f supervision hierarchlt. 2.9.2 What were the main issues identi/ied durinp suoervision? 2.9.3 Wqs suqervis ion checklist used? 2.94. Wat were the outcomes at each level of CDTI imolementation suoervision? 2.9.5 Was feed back siven to t, Dersoa or Rroups supervised? 2.9.6 How was the feedback used to the overall oerformance of the oroiect? I SECTION 3: SUPPORT TO CDTI......... ,32 3.I eOUIPMENTj 2 FTNANCTAT, CONTRTBI ITIONS OF PARTNERS AND COMMI INITTtrS 1 ? r)TI{trP Fr)PI\/S r)F COMMUINTY S IppoRT 3.4 expeNpruRE PER ACTrvrrY. 39 SECTION 4: SUSTAINABILTY OF CDTI 40 4. 1. INTERNAL : INDEPEND ENT PARTCIPATORY MONITORTNG: EVALUATION 4.1.1. Has the oroiect gver been evaluated /monitored? fTick anv ofthe followins which are applicablel lv WHO/APOC, 14 September 2009 ) 14 4.1.2. What were the recommendations? 4.1.3 How have they been impLementetL? 4.2. SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS IMARNDATORY AT YR3. 4.2.1 Planninq at all relevant levels. 4.2.2. Funds 4.2.3 Transport [replacement and maintenance 4.2.4. Other resources 4.2.5 To what extent has the plan been imolemented. 4.3. INTEGRATION. ...41 4. 3. l. Ivermectin delivery mechanism. 4,3,2 Trainins 4.3.3 Joint supervision and monitoring with other proer 4J-4-Beka;e of funds for oroiect act 4.3.5. Is CDTI included in PHC budjet? 4.3.6. Describe other health proqrammes that are usinq the CDTI structure and hov, this was ochieved .What was the achievements? 4.3.7 . Describe other issues considered in the integration o-f CDTI... ... ... ... ... ... ... ....43 4.4. oppneTloN RESEARCH. . .........44 4.4.I Summarize in not more than one hal-f of a paqe the operational research under tsLent4 the proiectgtcuyjlhin the rgportinq oeriod... 4.4.2. How were the results applied in the pro-iect?.......................................................46 SECTION 5: STRENGTHS.WEAKNESSES.CHALLENGES AND OPPORTUNITIES..............................,.....................................................47 SECTION :6 UNIOUE FEATURES OF THE PROJECT/OTHER MATTERS.........47 a v WHO/APOC, 14 September 2009 I Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNTCEF UTG wHo CSM LLINs VAS CDI GCCC AIDS DSN FLHS IEC MDP RBM NOCP NOTF ZOTF CBO CDA African Programme for Onchocerciasis Control Arurual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govemmental 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) Training of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Community Self Monitoring Long Lasting Insecticidal Nets Vitamin -A Supplement Community Directed Intervention Government Counterpart Cash Contribution Acquired Immune Def,rciency Syndrome Disease Surveillance & Notification First Line Health Facility Staff lnformation Education Communication Mectizan Donation Programme Roll Back Malaria National Onchocerciasis Control Programme National Onchocerciasis Task Force Zonal Task Force Community Based Organization Community Development Association. t , vl WHO/APOC, 14 September 2009 ,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 lation calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in rneso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) (v) Ultimate Treatment Goal (UTG): 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 cov.erage (normally the project should be expected to reach the UTG at the end of the 3'o year ofthe project). Therapeutic coverage: number of peopte treated in a given year over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the totainumUer of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Integration: delivering additional heatth 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 h-ealth problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. Community self-monitoring (CSM): The process by which the community is -mpo*e.ed to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full .".ponribility of ivermectin distribution and make appropriate modifications when necessary. (vi) (vii) (viii) (ix) vll WHO/APOC, 14 September 2009 )> vlll WHO/APOC, 14 September 2009 I )I FOLLOW UP ON TGC REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 29 a 1 Number of Recommendalion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 4.18.2 National Coordinator and NGDO representative to endorsed report. The pages of Endorsement sheets had been submitted to NOCP for onward transmission to TRC. 3. Provide information on funding/other support bY IFESH. The project does not enjoy any financial support from IFESH. 4 Clarify treatment data provided for Surulere LGA.If CDTI has not commenced in the LGA. No treatment data has been provided on behalf of Surulere LGA, we only provide data on total population and total number of endemic communities and the project has embarked on the training of Health facility staff and CDDs hence the distribution has now commenced at the LGA during the period under review. Replaced non functional equipment. The State Gort. has provided the project with new Desktop Computer, while APOC Management has given to the project a Desktop computer and a Laptop. 6 Train more CDDs and health staff. 4,869 CDIs/CDDs, Old 1342 and New 1837 CDIs were trained especially on CDI strategy. While 1,142WWs both old and new ones on CDYCDTI WHO/APOC, 14 September 2009 ) 7 Upscale CSM/SHM The Up scaling of CSM/SHM would be carried out in the current year. 8 Implement sustainability plan. The project has been implementing sustainability plan since 3yrs ago, more so the State GCCC has been increasing on yearly basis. Number of Recommendatiort in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 4.18.2 National Coordinator and NGDO representative to endorsed report. The pages of Endorsement sheets had been submitted to NOCP for onward transmission to TRC. t Provide information on funding/other support bv IFESH. The project does not enjoy any financial supporl from IFESH. 4. Clarify treatment data provided for Surulere LGA .If CDTI has not commenced in the LGA. No treatment data has been provided on behalf of Surulere LGA, we only provide data on total population and total number of endemic communities and the project has embarked on the training of Health facility staff and CDDs hence the distribution has now commenced at the LGA during the under review 5. Replaced non functional equipment. The State Govt. has provided the project with new Desktop Computer, while APOC Management has given to the project a Desktop computer and a Laptop. I , 2 (Pleose add more rows if necessary) WHO/APOC, 14 September 2009 ,Eiecutive Summ ary Oyo State is one of the States in South Westem part of Nigeria and is located in B Health Zone. The population according to the 2006 National population census ts 5,225,329. Yorubas are overwhelmingly the major ethnic group. Such other groups as Hausas, Fulanis, Igbos etc have migrated to the area. The partners involved in project implementation within the project area are LINICEF,4{IGERIA, NOCP (National and the B-Zonal Offices) the State Government, the various Local Governments and the endemic communities A total number of 2,385 communities were treated resulting in a geographical coverage of 100%. 785,171 persons were treated out of a total population of 1,036.329 giving a therapeutic coverage of 76%o. The UTG/ATO is 852,587s. The number of trained/retrained CDDs/CDIs was 4,869 and has decreased the CDD/population ratio to 1 : 100. A total of 1,142 FVWs were traine d1645 ] were new while 508 were old ones during the reportin gyear. The constraints/challenges faced include: untimely release of state counterpart funds, inadequate logistics in some LGAs (15 out of 23 LGAs only have replacement for their motorcycles), and inadequate counterpart funds release by some LGAs. The challenges were addressed through: - Advocacy visits made to the State and LGA policy makers which have increased the level of awareness and political will, which in turn translated to release of government counterpart funds both at State and LGAs. - The LGAs with problems of inadequate logistics used other PHC programmes' equipment/motorcycles to carry out CDTI activities. a J WHO/APOC, 14 September 2009 SEGTION {: Background information 1.1. l.l. General information Geographical location, topography, climate Oyo State is one of the States in South Western part of Nigeria and is located in B Health Zone. It is bounded on the South by Osun State, on the East by Ogun State, on the North by Kwara State and on the West by the Republic of Benin. The State is highly urbanized, although substantial proportions of the population still live in rural areas. The State has two distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June to October. Farming activities begin in April and ends in October when harvesting is carried out. Dry season is from November to March. Population : activities, cultures, language The population of Oyo State is 5,225,329 (2006 NPC). The Yorubas are overwhelmingly the major ethnic group, although some minorities such as the Hausas, Igbos, and Fulanis live peacefully with the indigenes. Majority of the people are farmers that engage in one form of agriculture or the other. The State is noted for is traditional cloth weaving (Aso Oke). Communication systems (roads...) The urban roads and other major roads are tarred though most of them are not properly maintained. The access roads to most of the endemic communities are in poor condition and most of them are not passable during the rainy season. Despite this, road transportation still remains the major means of communication with the communities. Other forms of communication for dissemination of information include IEC materials, electronic media, print media, use of GSM and community announcers. Administratio n s t r uct ure There are 33 Local Government Areas in the State. The Local Government Areas are Afrjio, Akinyele, Egbeda, Ibadan North East, Ibadan North West, Ibarapa Central, Irepo, Iseyin, Kajola, Lagelu, Ogbomoso South, Ogbomoso North, Ogo-Oluwa, Oluyole, Ona-Ara, Oorelope, Orire, Surulere, Atisbo, Oyo West, Itesiwaju, Saki East, Atiba, Olorunsogo, Iwajowa, Ibarapa East, Saki west, oyo East, Ibarapa North, Ibadan South west, Ido and Ibadan South East. The Chief Administrative Officer of the LGA is the elected chairman. A legislative arm made up of elected Councillors selected from various wards supports him. The Administrative capital of the State is Ibadan and the Executive Governor is the head of administration. An elected legislative arm, the Judiciary and Commissioners support the Governor. Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available) Number of health staff involved in CDTI (Please add more rows if necessary) I t 4 WHO/APOC, I 4 September 2009 ){ DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI Ba Percentage Br=Brl Br *100 Atiba 78 70 90"/, Atisbo 149 140 94% Ibarapa Central 90 80 89 Ibarapa North 94 90 96 Ibarapa East 139 130 is+ I ldo 126 ] rzo 95 Isef in 139 t20 86 Irepo 126 100 79 Itesirval u t76 t20 68 Iwajow'tr 176 r60 9l Kajola 176 150 85 Lagelu 2n 60 28 Orire I 15 90 78 Oluyole l6l 120 75 Olorunsogo t l'7 90 77 Oyo East 57 57 100 OyoWest 95 60 63 Ona -Ara 151 l3 t 87 Oorelope 56 50 89 Saki East 66 50 78 Saki- West 82 80 98 Surulere 75 40 53 Egbeda 204 50 25 Total 2,859 2,158 75% Partnership The following partners are involved in the project: Communities, LGAs, MOH, IFESH, NOCP Q.{ational &. Zonal) and International Organizations such as WHO/APOC and LINICEF. Some local NGOs and CBOs such as Boys' Scouts, Civil Defense Corps, Okada (Motorcycle) Riders' Associations, Girls Guilds, Lydia Groups and Man O War Units, community development associations (CDAs) are also involved in CDTI implementation. The overall working relationship has been cordial over the years. 5 WHO/APOC, 14 September 2009 The State and LGAs through their Onchocerciasis Control Units are involved in health education, planning and management of project implementation, training of field personnel and community mobilization. supervision and monitoring, mectizan procurement and delivery. TINICEF and NOCP assist in supervision, advocacy and technical assistance including advocacy where necessary. The communities select distributors, ensure collection of Mectizan, and other intervention materials such as Vitamin A Supplementation, and also determine mode and period of distribution conduct census update and supervise through the trained District Implementers /community supervisors. The mobilized local NGOs and CBOs assist in community mobilization and health education for the community members to know the importance of multiple health service delivery. State plans, tf uny, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. There is a plan to organize a mobilization and sensitization workshop by the State for the LGA Policy Makers, local NGOs/CBOs to create more awareness at the LGA level. Indicate the partners involved in project implementation at all levels [MoH, LTNICEF, APOC , PIs .[Principal Investigators ] affected communities, endemic LGAs , local Non Governmental organizations/ Community Based Organizations [NGOs/CBOs etc.]. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if zily, to T t 6 WHO/APOC, 14 September 2009 o, ON o -o c) o.o U) $ O - o t-- N (r.) € c.) oo ca o\N $ c- ('- c- $\o o\ .ri$ (-- oo(r) +tr) ooca O\o+ ttr) oo o\ r-N tr- ca\o 6l ca \o^ N o\ N ta) € + ca car- oi \o\oC\ aatr) Fp :tr6 = uv o\+ * (r) Nc'I c- N $ ca + @ co6 c\ tr)$ co t-- o\N \o € + il E .0) -qro .= o-N :\Ei r3 o\ \$\ $@ $\o o\\o c'}(r) + rn + oo o\ (r) ca ca ootr) F- r N N+ C..l ca\o(.) ++ $N\ on .+ (a) o\ cA ca o\ c- @ tr) c.) 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() o 0)k o C..iCI c.)k 0,))L a a.; CtI .n (d oF )SEGTION 2: lmPlementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activirtes for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 14 September 2009 o\ N Lo -o o o-oa$ o-. - o I -:\ q 4q) u g q l \ q) LU N q) a q) 5 L(d() >. C)$rti o() () doH an(u 0) lid (l) 9 k .o c/)() ! 9odqr o 0) (.) F ..ir a)I -oldtFI o a q) a o: \JO o() L! do IJ c; C) H o z o 0) L.l o z o C) LJ o C) t-l o z (.) C) IJ o o IJ oZ oz oz oZ q; 0.) ! z o z o c) t-J o z P-c o z o z o z oZ bo o z o z oz o z - cd (! z d d o z U) a0 vo o c) oC) t-.1 o o a bo 4 o() z o z o z €p- o(n () 0) o(.) ! €oc Io o-() a oc o C)o oc oo oz z a0iE 9o o ro o Poc () o o o o (J +j"oc o ob q) o bo o - 0) G tt) rh 0) Q qr: \Jo oc o oo L a. oc o oc !o o C) .io o €o o C) bo L o. L o- roc L o. L o. Ioo z S-=Ftr a.oa a.(.) a a. 0)a j o IJ. ! a.() a L o. Ip. C) U) !p- (.) a -o() Il. P o CN o. C)a -oo E. -c;() fr. -o() -oC)q. 9 a.() a -oq) E .o(.) fri Ov) L(n z o0 cl F o: (.) c ol, oc d 2 o Io Ioc Io ^ oc oo o. k L9- Lo. Po o L o. ! Po o L o- Er= rh- bo bb bb L a. bb eo. C)a ob bb cd oo bo L cO z L z (d z -o(.) fr. bb oL(! I z oo H(d :6) .E .E s= oo =()a o: QO Vo Oz oz oz o!(B o z o(! z oz oz ; oL 2 oz oz oLd (-) L cd Z I z oL(! z oz ; o 6i 2 ; oLd z oz ; o (d 2 P-e IJtr a- ! o. L o. L a. s(.)f! a. -i C) E =o. .oo E L a. () tl. j() I! lj 0) f& A 0)lr- L a- -oC)t! -o(.) IL L (d Fl (J tr o n (c -o -: o -oU) c.i L oU (g a.(! l< ".; 0(! r! 6 6rr6iE + E o z (n o.dl<(d -o .ri o \c; o ol< t- 0.) U) di 'a , rt, o oi B 'a B G 'a v obo(dJ c.i C)L L c.i C) o >. o + o oo o C') ar; U) r! o o \o (/) 0) >'o r- o(! IJ] &(!a od ch(.) '- !da o\ c! o .o bo rl.] cl o\O(\ r() -o q) o.o c/) * () - o. o > o z z o 0) o o z o o oc o() t-.1 bb oo o z L o. L o. Ioo -o() IJ. -o0) g ! C) U) kg 9 a. 0)a L(! z L Z bb ; o(! z ; oL(n z o >, 2 (! o -ic.l C)a o 0.) o c.i o] C)L 0) rr a c.; c.l a o) ts o(-) t 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Table: Mobilization and ad visits to LGAs +The policy makers mobilized for continuous support include the Chairmen, Director of Personnel management, Director of finance, Supervisory councilor for health and leader of the legislative council. Community leaders in 2,385 communities were mobilized by, LGA and FLHF. Few communities in, Almost all the LGAs supported their CDDs by giving incentives. Mobilization in the LGAs resulted in the provision of additional fund for CDI implementation in l0 intervention LGAs. Atisbo LGA emulated the State Ministry of Health by Kick- starting Community Directed Intervention strategy and also distributed 550 T-Shirts and a S/N LOCAL GOVERNMENT AREA NO OF POLICY MAKERS MOBILIZED NO OF PHC COORDINATORS MOBILIZED I Atiba 3 1 2 Oyo East 4 1 J Oyo West 2 1 4 Iseyin 4 1 5 Itesiwalu 4 I 6 Ibarapa Central J I 1 Ibarapa North 4 1 8 Lagelu 2 I 9 Ido 4 I 10 Kajola J I 11 Saki West 5 1 t2 Saki East J I l3 Atisbo 5 1 t4 Orire 5 I l5 Irepo 5 I t6 Iwajowa 4 I t7 Ibarapa-East 5 1 l8 Oluyole 5 1 t9 Olorunsogo 5 I 20 Egbeda J I 2l Ona Ara 5 1 22 Oorelope 4 I 23 Surulere 4 1 Total 9t 23 t2 WHO/APOC, 14 September 2009 Caps for the community Directed implementers and FLHFS to serve as a sort of motivation for them. C o n s t r aints/c h allen ges - Some policy makers were difficult to reach especially the chairmen - Wrong priorities of the political office holders which has led to inadequate funding of the programme. Suggestions on how to improve advocacy - Continuous mobilization of both State / LGA policy makers - Advocacy workshop can be organized at the State level for the policy makers to attend, so as to create awareness, and increase the level of support for this programme 2.3, Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information The communities were mobilized and health educated through radio jingles on local radios, town announcers and face-to-face discussions with over 200 community leaders in 6 low performing LGAs which has increased community participation and involvement coupled with press release/briefing by the Hon. Commissioner for Health Dr. Babalola Owolabi on the importance of multiple Health lntervention Strategy in Oncho endemic LGAs in Oyo State. Types of IEC materials used Integrated Posters, Brochures, stickers, T-Shirts and Caps Mobilization, sensitization and health education of women and minorities - method and response Usually, women involvement in CDTI/CDI in the state is not a problem. They were part of the people mobilized in the communities. Respo ns e of target co mmunities/villages 2,385 communities/villages mobilized responded to the mobilization and health education carried out by the LOCT, FLHFS and the CDDs/Community Directed Implementers,. They came forward to collect their mectizan.lYit-A Suppliment. The awareness of benefits of multiple health intervention for the health care delivery is increasing; this will be extended to the remaining 13 CDTI LGAs in 2010. Accomplishments Accomplishments include :(l) Increase in awareness on co-implementation. (2) More awareness on ivermectin /Vit -A Supp./LLINs benefit l3 WHO/APOC, 14 September 2009 (3) Greater involvement of local NGOs/CBOs in community mobilization and Health Education.(4) There were Greater involvement of the PHC Coordinators, other relevant programme managers, FLHFS and Super for health in CDI process. Suggest ways to improve mobilization and sensitization of the target communities. (l) Sensitized more local NGOs and CBOs to help in resources mobilization and sensitization of communities. (2) Collaborating with information and social mobilization officers/community development associations [CDA] at the LGA level to support in mobilizing communities for all CDI /CDTI activities. (3) Production and distribution of adequate number of revised integrated IEC materials(4) Greater involvement and capacity building of FLHF staff to organize community Self Monitoring. and stakeholders meetings ICSM/SHM] with communities within their areas ofjurisdiction regularly to enhance greater involvement.(5) Airing of Radio and TV jingles to increase public awareness in the state/LGAs. 2.4. Community involvement Table 4: Communities participation in the CDTI (Please add more rou,s if necessary) t4 WHO/APOC, 14 September 2009 DistricULGA . l. Ibarapa C. 2. Ibarapa N 3. Atiba 4.Oyo East 5. Oyo West 6. rio 7. ..ajola 8. Iwajowa 9. Lagelu 10. Itesiwaju I l. Iseyin 12. Atisbo 13. Orire 14. Irepo 15. Saki East 16. SakiWest 17. Oluyole 1..-lorunsogo 19. Ibarapa - -East 20. Egbeda .2l.Ona Ara 22. Oorelope 23. Surulere Total Comment on: - Attendance offemale members of the community at health education meetings Attendance of female members of the community at health education meetings is good the females that attend actively participate during the health education sessions. Number of communities /villages with female CDDs Number of CDDs and the communities involved Number of communities/villages with community members as supervisors Number of communities with female CDDs Bro Percentage Btr= Blo/8.* 100 Percenta ge Br= BJ Br * 100 B7 Male CDDs BE Female CDDs Total Be= B?+Bs B. Total no. communiti es in the entire project area Number with community members as sgperviso rs Bs 100%160 361 r22t22 122 100 201 54 180 91 100%97 97 100 t26 159 100%94 299 64 363159 1s0 t00%210 80 350 163t63 163 100 140 231 40 44%91 91 100 9t 260 53 82%65 100 6s 19s65 151 100%100 107 93 200l5t l5l 3l 300 79 100%79 79 100 t23 72 209 28 20%131 131 100 t31 510 60 32%96 187 383187 180 64 r00%100 260 95 35s64 64 r00%315 501 179179 170 95 186 350 50 52%96 96 100 96 254 46 100%46 100 r89 172 36146 105 44%130 250 380241 24t 100 r00%t66 42 208 2424 24 100 I 8 1 40 s0%80 80 100 80 l0l 25 40%63 100 63 111 17463 228 30 28%100 r06 122106 106 4t%86 48 47 95 2970 60 75 125 t7 44%39 0 0 50 170 50 55%70 77Yo 70 1009l t4%32 39 1l 535 3,001 6,223 1,586 66"h2,385 2255 9S'/. 3,082 t5 WHO/APOC, 14 September 2009 - In general, how do you rate the participation of femate members of the community meetings when CDTI issues ore being discusses (attendance, participation in the discussion etc). Because of the gender balances women are now allowed to participate and contribute to the decisions during general community meeting. On special or key decisions on community matters, elderly men/ward heads/ women leaders are the decision makers. - Incentives provided by communities for the CDDs More communities supported their CDDs in provision of incentives, some provided for transportation, drug distribution, training and even meetings. -Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Attrition of CDDs is no problem to the project since the project has trained/retrained more CDDs. /CDIs. During the period under review, 3,l79CDIs were trained and retrained under co-implementation while 1,493 CDDs were trained/retrained under CDTI. Which gives a total trained to be 4672 CDDs/CDIs? 986 H/Ws were trained/retrained on both cDycDTI implementations. Other issues I l6 WHO/APOC, 14 September 2009 ) 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained stgff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are.frequently transferred during the course of the campaign). t7 WHO/APOC, 14 September 2009 oQ Lo z !EuQ L9 = .U =r q $ € (-- tr- c.l tn a.] O oo (..l aa\o : \o c..l F- OO ca c{ O O c..l \o :. $ : $ s ol O € ca o\ a.l t- :1- O$ \o : o\ r- O ol ca co : c-) o, tr) r- $ \o$ o\ : : $ ca$ ca : O : ?! OO OF c.l N ca\o e G .=0 E z L\-/ 9 .U $.ic<v zv (..l C..1 c..l a.l (\ a.l (..l N N c'.1 N C! ol c.l (\ c..l c..l (-.l N (\ (-.l c..l c\ I C\ c\ c'l N (.{ C\ (-.l N a.l c..l N c\ (-.l UL c.l N c'.1 (..l C! c.l N c.l .c.l (-l N c.l c.l a'l o.l a.l C.l o.l ts G i o o! GL ! E z .ra E.t+F-d &,U Uz : t s 'i- tr) -d- .i- a.l$ $ ai c.t ca $ ca : N c- : aa F- $ ca \o co \o ca sj- : N o\ <- c! (..l oo : : oo l $ C..l N l : O ca : a.l \o t-r : : c- a.l l : c.l U cn c.l c.) co (/.)$ r- Ooo r-. c.t t-- \o O \o a.t c.) r- € ( 6 L z ori + U o * e t-* c.t t-- c\ r-. F- N N C.l tr- $ aa F- C\ N (\ F- I N a\l (r) c.l N C..l c.t N C\ ol UL t-- r-. Ir-- t-- tr-- r- rn c- c- r- tr) r- () (d 9-(gk cds -i z(! o-(dL(d -o c.i cr; ch El o + a 0) o >. ,r; s o 'a v \o o an t- B (r) o € cd 'a B O. 0)L L o oq o L< -: 0)b[ GIJ c.i o '1C c.; o C) !6a + o(g sl !(Ba ,.i o!(h \o 0) o t- o cO rr.l (! L(d3 orj o\O N C) -o C) o.q) a $ U o a.) @ d o o\\ o t q $_ o Cd () o F a(J lff o o () () _ (.) E o (g bo d F .;1 ol .ol(dl FI c.,l a.) \o -.: I Ns s $ (r) I o\O c.l I() -o Eo o.oa =U o o > bb o o o -o E o ra) q) L< C) o\ (d (.) Lr U) o JZ Cd z x o (d o oo E og V)o!! o(-) o C) € olrq o Cd Cd (c o +r .tr 0,) * Bo z * i ia o\ = O O ol O O $\o C\ + (r) c.l ca O (\I al Nr-\o t N\ot al s €in q) q) e q) s €s 6 N o.l c\ c.l (-.l c'.1 a.t (..l tt tt q) o q) (J \o c.l (-.l (\ (\ =t c- : ca c- ol c.) ca c.i aa O c.t : I r C\ \o6 o\ s\o ra GIclt s$r- o q) q) o \o oo $ a.) ?.)(.l c..l aq (\ c'.1 c..l c\I c.l a.l c.l a.l I € .I f.) o\t c\ \o q) 0) q) () lr) i,a(a obo oa E o (n '13 c) -o o0 rI] ocl (BL (d o -:c.l C) o.9q) o o c.i c.l C)Lo li U) c-tN 6t otr Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(CBOs) Program management ^/ { How to conduct Health education ^/ ./ { Management of SAEs ^/ CSM ^/ n ^/ ^/ {SHM { { ^/ ./ i Data collection { ./ Data analysis { ^/ Report writing { ./ Others (speci&) Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) Any other comrhents 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. 20 WHO/APOC, 14 September 2009 o. N rq) -o () o.() a !i- O o o. \-, J. > N H!9( o='a ,a-*6o vt = O > a !: iitHEF.tr*gqY odg o- o o Lo E z .bq hE oilJ Zoa !;$a*. 5 E* ii 3z i.'ia' Eo6Y?eB36 N o\ -$ O oo c.l ca s $ 00 ot ooN a{ F- .+ + .I o. .l c..l + @ c.l + (\ alol ^ Y* !a!oLEL>O= =5- €Sr7DE o\$ o\r- + r a.l@ a.lr- (\ N cl s d alol O. l ll * o '50 o d^CLro6 oo\ oo F \oo\N € \o t*- o\:i- oo o\ @ o\ oo c- o\ ol co o\s ca \o € o\ € o\ <. € o\ oo o\ m € 6l € \o @ o\ r- \o oi oo o\ @ \o F- o\ r- € ol oo o\ t- o\ r- i 2-o3=O Eoir(!2 Es 6 a\ c- co N o\ oo ri(-- o\ co\ .i- c- ooq a a] € \o r- a- o\cl c{ \o at o. € ot oq * r- ri C.l cr oo o\ + € t-- a.r\o c.f+ \c) c.l oo oo o\ c..t \o+ r- o\ oo" = r- a- clrI r- @ aoq o\ al =9 .Z =E-- tJE(!LooEO=<F 5 @ c.l @ o.i oo v\oq .f t'- @ <: t-' oo 6 oo \o N a- \o a.t \o a.l c{ €^ t ca @ o.l \o CY c- oi \o a- ai+ o\!+ o\ co+ + FT al FT r- r- o\ a.t = o\ \o als !+ H LA -::d) - u6S'E o h. ' a frgo c= o o\\odI o. q oo o\ o\ \$ s coq s\o N N € a\ $ a.l n \o oo r-. al C.l ol $ + o\ oo GI r- al at a.t d] F- \o c- t-r $ @ o\ N a! \o oo (-. @ a r- c- rh o bo(d (, o E tr U I ll * o., Eb0 ^ d^ ii !: o\boa- de O OO E.o _- .8 E SHtr tr= ii fc>Pz6 o o\ tr- al(.l r- \o \o d + t'- oo e- r- \o o\ oo \o o\ o\ \o o\ +a.l $(\ F- :o d o.= =Eo < E€'FU o\ o\t-- C.lN a-o\ \o \o \o+ + c- oo r- r- o\ @ \o o\ sa..l +6l r- IBE T $ -.: c oE+ c I h. - E E $E E" o>*6 o. o\ c- c.l c.l t- o\ \o \o \o<t $\o t- @ o\ c- r- \o o\ € \o o\ o\ o\ $6l sa.l r- .9< ;qo\ coF o cna F st<F E6 <Ed?4&do -z Q. r-<uil4<rig< oIJ o o.r!& Z rr.la D B a rrlF B o ? = -.1o V D -.]r! J r!d &o rr.lJ o DJ o oa zD& oJ IJ & z lrlAoJ rl]d o o Fa o o Fa rl] ts o o F v) I! u a 3a lJ.) v U) ! a ca tI] r!& rr.lJ D d, a -:\ %4 AJQ q l \ q)\ N ! q) 4 q) a_\- .V ah li a(€ 0)Lr(s o Fl o k t, -o(r) rr.l a cC 0) (d (,)trF tt- I rl -ot(!l FI I Io, N Lo -o q.) o.oa =() L-) o > c.t oI 0o\ \ !v $l-0. !o 0i CiL93(!* ?E o .:\ -'.\i\a. !: U.\ .= 3.S +E*;.:n a.=ri3EtH s3 :.i:E.s:'0).=i :ri 0.)llsl.PE 0-6c! !!ql5'€ i8sEd) s 's-\s=trEf,.i = s ig\\+E .-o .si39 5 EF *l o.r c: ES xlo ts PX El e s .ir EIE ! SSjrlts : i\-C)l o- .Y Yt!El.* S b S o[ o S \: 81 r s €stslE $ $iLl = X SY3l tr s' .sS trl E E s. =l E P 3szt? .i Nt60 crBs' €\ 'l osti ,' : t\ " . t- Ft -[ *$cl lu ..\ S.si ET !!S: s.s:\-bX \r S*E E S$ -c r da-9 3 Srru u ui rrtSSry t\ t\='Frr n!D o s\\o t\ !\P6\ \ aS C) o 0)5c o 0) F (0 X 0.) 0.)L9 OEo o ;l o L() -ol zl o (B ()() 'a L o- 4,, r!& -o () t- o ,; q C) E E oo o E 0.) o Ik() a. o(h o E +. o Lr 0) E oF o (d o bo L 0.) oo o- -^\ (! Lbo oo (.) ! o C) 'a L o- 0) =.= a(.) E E oo o EoC)o IEXti6.9o-(d ! ot ; o.)ol () ol -1 -(g.,t E ^l a '= 9l ep 3 .rl .!Lt > t.: -o)l = -t -Ha+5 E Vl .- L Hloq Uq.l 5 (*olo- o LI ULol o- 0.) -ol - -oltrl <r trl Hl!Ll =tb =lztt- zt al ol b0dtLI6)l >l ol ol EIol -qlo.l(€t l-{l o0 OI 0)l s cldt .rl 9I ol oldtLI()I -tr1 a .Et9l ol EI olol -l €l cl 5l EI olfr.l + oo o\ t-. oo\o+ ^\ oo @ @ c..l 00\o6 F- o{r- oo ci € ^f € 6i J F F 0) L() bo !w^ o\ o oF (.) 6L (.) bo Lo (.) O,^ '- \o o Lo L IIilil t2.6.2 What are the causes of absenteeism? Rural urban migration in search of greener pasture Farmers or others who had gone for their trades or occupation during the time of treatment, and were not followed up In some cases, the Fulanis, Jukus and Igedes who have settled in the state migrate to other places after the rainy seasons. This has caused absenteeism in many parts of the state during distribution. 2.6.3 What are the reasons for refusals? Long term treatment has caused fatigue in some communities. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box No SAE case to report ./ 23 WHO/APOC, 14 September 2009 ao. N L C] -o o o.() a s () u o > .i-N q) q) !\q) .a \-q)q l( q 4 a) Qq) a \ a)L t q)q v a) 5 Lo o. bo ! o o. C)rr C) bo l< oE li C)oo (€ ch rr.l a t, () o o(hk C) U) o troaqr o t, 0) rh(! U #r o)l .ol(gl FI -E:o99 07 g lJ>v <.EE L - on q.lO0- I c'= E ed.I:(qo6 E s5;=Pr!55 o o.2E2UC S2 oo (, o- 0)-ex(EY aE ^ d.= (l)qE tr E (H;o- o o-E iA .=o c E!9LL'- cBaO(JOE.Ee o VqEP vli- lJ d -c (E € - 9 ep.!EE€.=tsi;_rE> o o- a -^=(J -YLo+c)9L x>,o.l-1 66Gl H!? .Nt 9!?- o>; o a)o0c G.- =bO zo x() a 0) o0 * a l I l i L t o\ ON !o 0) o.()a$ O o o. o > tr) c.l I o oo ri CB ^Y L'^F ()N - ><-ro U \o o\ 09 ca tr- o\ .^ \o v] (r-(-- \o =t t-tt-- \o oo \oo\ co o\ @ \o € \o $ @ \Q \o o\ o (c ll * .5 GJ o ^oo F Oo\ o o\s o\cl N o\ o<,\o o\ n ca o\ o\ n oo oo o\ r\ o\\o r- o\ o. o. o\$ 00 -oo\ c.l o\ o\\o o. ll * o r.l' Q o '.5 0 =boO 6^CLrC6 ?o- oosoa \o v1 o - o\ <1- c c\ @ -i o\ \o r; o\ oo o\ a- \oo\N oo o\t 00 o\ t-- tr- o\ oo ti -o ,a o6 3,^ Z?Do N oo v} sc1 N c\ m c\F- N N \ Oq c-$ r-a-q $ oo \o a- t-- NO\o" o\ cn t-t t-- @ a- (-- o\ od ca 00 ooq 6 @ rd tsod u.= 4 -o .o' Fe O O O O O c.) N t o. r- oo r= N\ F-\o r- N$ $ \o N oo oo LA e kaicxL *6 ' a 39 o- o\ r-. @ c.i ca v} $\o v) oo ..i o. c.lO O. N @r- N \oc\ oo\o\ c.t\on$ <. .{ \oq o\ F-. c- \o co(\ ooN$ o\ \o .l oo oo O" t-. c.lt-- rli O^ q() bo(! 0) o(-) ll + i.5' ki t{ oooa o 0- k3 o\ o. o\@ o\ .o o\ oo o\ o\ c\q o\ o\ c.) oo \o @ o. \oo\ F- co \o @ o\ o\ o\ o\ o\ \o o.o0= d- €^il; F3 EEh;- OoEl o\ o\ \o o\@ o\ o\ € o, o\ olq o\ o\ n oo o\ o\ oo o, o\r- @ \o co o\ o\ O o\o' o\ \o Ii qo o'E q) b E SPU = Ei:706 \o\o c.i ca ot co w ca c.t tr- o\ F- c\l $N r- N al \o\o c.l c.l O aoN @ ."1(\ ti =u -cd o .: =EoE 8.949-o' FU s N oo N o\ o, r-.N t-. o.$N \o c.lN o, c.l ol ooq N co c.l c.i oo C6 =@tI g E-E +ue^ OaqaaI- tr u 9! EO o o\ N o s a.l o' o,r- c] F- o\$ a.l o\\o(-.l a.l o\ al N @ co o.f coC'I c.I d rr.l r- o\ o\ oo o\ o\ o\ o\ o\ o c.l c\ a.to c.t cooo al too al oo c\l \ooo a..l c-ooN @oo(\l o\oo a.t c! o\O N Lo -o 0) o- 0.)(r) rf, Q - U > \o N -ra) I I ._ ! -I c!(.) c) o0 xlql:' t) I\UP 'r .i l,s-$p\ AJ CE .\ \L .- .S r-\w\t$R vE3E:'ido .-\ ^Ar -q)EVt,P6i9 --+i()Gtu) C)rc! -qc)o)eq)L .+4 :i.9p -X a t- 'Ee.Z 6l; 0)irIBEg 6-8e()e€ '=l]tax-€ rtrua -r GtUEI 9,, d9l o ol !'t ..! El .E-U.BI XU -U8r9 oi:! '= (.) t- Yorr V rtEEY0()cFEdpPAdviitrEr<o! P- .. F VHoEGE9.9F-.5U( tiH L6) r; 91 2\ci €l -Ec.i Fl 0r a 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH tr WHO N UNICEF tr NGDO f] Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH tr WHO tr UNICEF E NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The mectizan ordering and delivery in Oyo State CDTI project originates from the endemic communities through the CDDs. The populations of the treated communities from the mectizan treatment / census registers are collated by the LGA health staff. The LOCTs compile this information from the various communities in the LGA and forward it to the State Oncho Control Office who uses the population figures to determine the total number of Mectizan tablets required. This is then submitted to the Zonal Office for onward transmission to the NOCP Headquarters. The NOCP Headquarters collates all the requests for mectizan and make application to MDP. On approval, the consignments are shipped to Nigeria, cleared by UNICEF, and stored at TINICEF Central Store on behalf of NOTF. From here the State picks up its consignments and delivers to the communities through the LGAs and the FLHFs. Table 10: Mectizan@ Inventory (Please add more rows if necessary) State /District tLGA Number of Mectizant tablets ' In stock from previous year Requested Received Used Lost Wast ed Expire d Rem ainin o ATIBA I14,365 l14,330 I14,33 0 ATISBO 240,000 248,000 208,25 4 39,74 6 IBARAPA EAST 65,000 65,000 59,559 128 5,313 IBARAPA CENTRAL 1000 137,892 137,892 I 3 7,89 2 1000 IBARRTHAPA NORTH 8,7 t2 163,760 163,760 l3 1,59 3 40,87 9 IDO t41 I tts,207 115,000 114,46 I 517 1433 IREPO 77r 154,063 154,063 152,36 4 2470 ISEYIN 4,148 76,',|67 76,767 76,078 4553 ITESIWAJU 200,000 200,000 200,00 0 IWAJOWA 6786 104,555 104,555 1 I 02 )0 1 t7 9,31 3 KAJOLA 85,375 85,500 83 824) 36 1,64 0 LAGELU 47,000 47,000 46,772 9l t37 OzuRE 2,999 176,000 176,000 1 6 66,23 122 12,6 4l OLUYOLE 131,000 131,000 127,98 3,01 27 WHO/APOC, 14 September 2009 6 4 OLORTINSOG o 687 93,500 93,500 92,221 13 1,95 J ORELOPE 100,000 I 10,00 I10,00 0 ONA-ARA 3+,464 34,500 34,500 EGBEDA 45,000 45,000 45,000 OYO EAST 41,792 41,792 4l ,505 r38 49 OYO WEST 70,000 70,000 70,000 SAKI-EAST 2.338 217,455 215,000 209.62 5 7 ,71 J SAKI-WEST 53,000 53,000 53,000 SURULERE 43,268 43,268 36,233 1266 5,76 9 TOTAL 28,852 2,509,463 2.524.92 7 2,4134 44 )1) 8 137, 623 a How are the remaining ivermectin tablets collected and where are they kept? The remaining ivermectin tablets are collected by the Front Line Health Facilities from CDDs and initially stored at their various health posts. These are later taken to the local government headquarters and kept in the storage box by the coordinator. They become opening balances for the next treatment cvcle. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Collection of mectizan tablets Mobilization of communities Hqalth education and advocacy to the community on cooperation and support to CDDs Sup'ervision of CDDs during distribution of mectizan Report of treatment data to the LGA HQs Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO, the project could not implement CSM/SHM this year; this will be carried out next year [2010]. If so, When? Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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 stakeholders meeting (sHM) 28 WHO/APOC, 14 September 2009 ) Irepo 46 Iwajowa 79 Orire 96 Saki East 241 Saki West 24 Atisbo 179 Oyo-East r63 Oyo West 91 Atiba 159 Lagelu t37 Iseyin 64 Kajola 151 Ido 65 Ibarapa North 97 Ibarapa C 122 Itesiwaju t87 Oluyole 80 Ibarapa East 106 Olorunsogo 63 Egbeda 70 Ono Ara 39 Oorelope 91 Surulere 35 Total 2,385 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. - Since this activity could not carried out there is no result available. 2.9. Superuision 2.9.1 Provide a flow chart of supervision hierarchy. NOCP QUARTERLY MONITORING ZONE STATE, LGAS AND COMMUNITIES NOCP ZONAL OFFICE-MONITORINGAND SUPERVISION OF STATE LGAS/AND COMMUNITIES ZONAL NOCP IBADAN STATE ONCTIOCERCIASIS CONTROL TEAM (SOCT) STATE-ROUTINE MONITORING AND SUPERVISION OF LGAS AND SPORT CHECK ON COMM. NEEDS LGA-ROUTTNE MONITORING AND SUPERVISION OF COMMUNITIES - CDDS FLHFS OMMUNITY - CDDS COMMI.INITIES _ COMMLINITY LEADERS AND COMMLTNITY BASED ORGANISATION 2.9.2 What were the main issues identified during supervision? The main Issues identified are: o Inadequacy of other intervention commodities such as Anti -Malaria drugs and LLINs. o Add-On has increased the number of Community Implementers and has minimized the demand for incentive. o Community members complained of late distribution of ivermectin o Almost all the LGA Oncho coords are newly appointed so the SOCTs needed ektra effort. 2.9.3 Was a supervision checklist used? lntegrated supervision checklist was used during the supervision exercise at the all levels. 2.9.4 Whht were the outcomes at each level of CDTI /CDI implementation supervision? Since there was inadequate supply of intervention commodities like Anti-Malaria drugs and LLINs, the CDIs have decided to distribute only Mectizan andvit-A Supplements There were adequate supervision at the LGA, Facility and community level. The Facility staffs are more committed. Improved prograrnme integration at State and LGA Levels. LOCAL GOVERNMENT ONCHOCERCTASIS CONTROL TEAM (LOCT) 30 WHO/APOC, 14 September 2009 2.9.5 Was feedback given to the person or groups supervised? Yes Feedback was given at all levels of implementation by organizing a feedback meeting with the affected LGAs at the end of all exercises. 2.9.5 How was the feedback used to improve the overall performance of the prri'ject? The feedback is used to prepare both the Govemment at all levels and also the communities for their continual support. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR: Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materiak? The maintenance of the equipment would be done out of the State Counterpart Account. The 23 LGAs are releasing imprest every month for the maintenance of the project motorcycles in Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtr on No Condltlon No Condrtron No Condrtro 1. Vehicle 2 F 2. Motor cycle(s) 24 l5F 9 CNFR 9 9CNFR 3. Computer(s) J F 1 F 4. Printer(s) I F but aged 5. Photocopier (s) 2 1F lCNFR 6. Fax Machine(s) 1 CNFR 7. LCD Projector I F a) TV I F b) vcR 1 F c) Public Address System 2 CNFR d) Air Conditioner J 2F 2 F e) Generator I F but aged 31 WHO/APOC, 14 September 2009 their respective Local Government Areas, the LGAs are also releasing additional funds for the effectiveness of the programme. 32 WHO/APOC, 14 September 2009 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and l3c If there are problems with release of counterpart funds, how were they addressed? 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F-i (ot N691 Oi F l-'| l rlI\Pibi 3Xi --r +dili 5II o!todI I I Nl (O'o' (o(Oi l'* rr (ol (t tJ) tl)- 4 i(r)'loilo: -l I I Iir-l@ i@- -l N(')l rr) ce_l sl I (.) cor(r), Fi c)(O|r) l(oI6t-3l E col -i (9 (Y'(r) (f)o O) I I I(f)t col(ol -l (o at C.r- 6t(\1 o ID ,l rl N 9i d (Ori- riollr olirtol ,-: 3: Si E-i 3: 'alFlrrl (.' c) ,\ 6.ta I I , c"ll fl, ir-i(f)r ('); @i @l oN(\t oNN .9, o OG Et .o '= o =roo+'Eefr#cl G EE 7oB!,ol c -l = .UI o ElE gliEtzl I l aao e!E ot o CL E gl c oa tr UJ Gt,tr -gclo tr o J .Ct L c oo Fz uJ =zt IIJ o o (\t o: C' U' -i oiNt (Oiri O'(ol -l@i @lii I lrrt o$ o- F; @i i t''' Ii (ol(.)l idlit--loi @, ,DlO' r'N-i Nl iNl-l iot@l i otodq pl o!(f); -, (r) o, [-; , (o, @, (r)lo lo- @, (') lO ro- @ llJz J IU oof @ o s o GN t4 o t4 s(, Go o !-ab i'E6FE9 s€sots -8{C c o (E .N 5 o i c o (u o E o =(Uq) - a tE o IaS U, c o o .N .=oc o U) ..i o(E o o E 1l c?] rl c o GI .E u.t 6 't o o E i o c, T]ol alst U,I 6t o; o!Oi oL o) .Y o = .C, =G o - o oiCI 'EI EI Etb/EI :_El(Ul Fl 6il oil :E EF - o.i G o IaIq i I i I I Jtrl trl lEIq c o o <.i G o aaS U, c o o! o LrJ "i(9..ic., o o) o) ooL o o o o o o U) o .9 f -o .9o C oo EL o -=; + g o o o v,li. o t G o g o a4 o so E o tr) G (! E E tr G s o Ta 'tr o E (, o o c.lt G o aa5 .4 q o)@ dG' t(t co a) o)(o N{ co- @ soo olo to- C')N @G'd cl, ot(oq (o oIolo- (DNo J o oz G(, I I I I I o o'O(\ ro -o !) o.o U) $ () \J L] 'F B (t ai,(.r- (\I @ c,- cat\t.- @ F.- oN].,. 6 @ @N oo @ oNtr N G) 1r, G o IaI ctt c! lo oq) o o U) -d ro ori l(,(oO (ooNdo soo o@ (D O !tG' -?- a oI\- o oF. 6 J oF oz E,(9 I 3.3. Other forms of community support 3.4. - Describe (indicate forms of in-kind contributions of communities if any) Exemption from community contribution. Clearing, planting and harvesting of farm products for Community Directed Implementers ICDIs]. Expenditure per activity Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations change rate to local currency. Indictate exchange rate used hereeXr 1$ #150- Table l4: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? Activity Expenditure (s us) Source(s) of funding Drug deli very from NOTF HQ area to central collection point of $ I ,553 State/LGAS Mobilization and health education of communities+ s7,455 State/LGAs ofCDDs $2,200 State/LGAs of health staff at all levels $12,167 State/LcAs S CDDs and distribution -F $1,307 State/LGA Internal moni of CDTI activities $3,733 State Ad visits to health and litical authorities $ 1,060 State IEC materials $12,373 State/LGA forms for treatment Vehicles/ es marntenance s4,1 33 State for various activities in LGAs $l1,360 LGAs A for SOCT/LOCT $5,206 UNICEF Incentives for CDDs $333 Communities TOTAL $62,890 Total number of treated 836,993 38 WHO/APOC, l4 September 2009 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.t.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.1 What were the recommendations? Report of monitoring yet to be received. 4.1.3 How have they been implemented? No recommendation. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? January 2006 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levek Annual CDTI work plans are usually developed by the state and LGAs to include all proposed activities for the year with greater amount budgeted for the MOH and LGAs. 4.2.2. Funds The state government has regularly released the counterpart contribution for the programme. This is expected to sustain the activities even when APOC funding ceases. Total sum of $ 170,786was released in20O7,while $291,550 was released in 2008. In 2009 $191,801 was released for the project as State Government Counterpart Cash Contributions. Despite slight drop in amount released 2009 as compared to 2008, there is a show of commitment by the government for the project's sustainability. Several LGAs are releasing monthly impress to the LGA Coordinators. 39 WHO/APOC, 14 September 2009 4.2.3 Transport (replacement ond maintenance) APOC has replaced a vehicle to support CDTI activities and maintenance of equipments will be sourced from counterpart funds. At LGA level, it has already been stated that quite a number of LGAs has started releasing amounts monthly, part of which is expected to be used for maintenance of the motorcycles. Moreover, some of the motorcycles gave for NPI, HIV-AIDs, Roll Back Malaria (RBM) M&E. Activities are also being used for oncho control activities through an integrated monitoring mechanism under PHC structure. 4.2.4 Other resource. Resources mobilization workshop for LocalNGOs,/ CBOs and community development associations at the LGAs level will be carried out to enable project secure other needed resource. 4.2.4 To what extent has the plan been implemented The 3-year sustainability work-plan for both the State and LGAs developed shortly after the evaluation, has been revised. For 2009. about 90oh of activities planned were carried out. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI has been integrated with some other health programmes like the prevention and controlling of Malaria in children less than 5years of age, and prevention of Vita min -A deficiency in children and lactating mothers. 4.3.1 lvermectin delivery mechanisms Ivermectin delivery has been fully integrated into the Primary Health Care structure. PHC facilities are used for drug storage, HWs assist in the collection and as well as supervision of mectizan distribution. The CDDs go to the nearest health facilities to collect mectizan. 4.3.2 Training The project targets have trained almost all health workers employed by the Local Governments to solve the problem of frequent transfers. These health workers are involved in other health activities apart from CDTI and combine its activities with other responsibilities ICDII Strategy , Some CDDs has also been trained on how to distribute Virsupplement and sensitize their community on HIV/AID awareness creation. [n addition, PHC coordinators were more involved, in the implementation of CDI in their local government areas. 4.3.2 Joint supervision and monitoring with other programs Presently there is joint supervision with other health prograrnmes. At the LGA level, occasionally when LOCTs are on other PHC assignments like routine immunization they check on CDTI activities. The involvement of the nutrition officers,RBM 0fficers to be part of the supervisory and reporting system. The M & E officer in the State who is equally the data manager for CDTI project went on supervision with one of the SOCT member in his team. The conscientious health workers at the FLHF level integrate a lot of their activities during their home visits to the communities. 4.3.3 Release offunds for project activities Funds are released through the routine PHC channels at all levels, but they are not utilized on an integrated basis. 40 WHO/APOC, 14 September 2009 4.3.4 Is CDTI included in the PHC budget? Yes 4.3.5 Describe other health programmes that are using the CDTI structure and how this was achieved. What have beefi'the achievements? The operational research on CDI carried out and concluded in2007 to determine the effectiveness of the CDI process for the delivery of interventions such as Vitamin A Supplementation, Insecticide Treated Nets; this has been implemented in 10 LGAs of Oyo State. APOC/State support has the purpose of scaling up multiple health interventions and ensuring sustainability of CDTVCDI when combined with other health interventions. The operationa! research on CDI carried 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc...)? o Explain what are the combinations of interventions co-implemented? r How were the interventions implemented? (at the same time?) 4.3.7. a a Describe others issues considered in the integration of CDTI 4I WHO/APOC, 14 September 2009 to\O c.l L(.) -o E o o-() a =(,o-' o. > ci$ o I ol-q () o q) z .B F (r) v} (a) r- ca l- F-\o =J:$ oo ao cg 0)E \f, Fi ooN tr- $$tr) a 4) c! 2. ca ra) tr) @ € \o ca q) q) oo Cq o q) c) z CE F \o \o ca\o + (r) ra) o\ oo q) G ()h N c- cn (r) $ c,) c! a \o $ ca o\ O tr) N U.o ,oEi o> z F o.r- c.) o\ (r- ca oo C! ola r- ca @ tr- ca oo oq) CB!ra trr\o N r-\o C.l =.8 -a=EE z6 c) o C) G() & $ oo + € E(l) q) EO €ltF + oo + € a.e .oL E-2 =Ez q) Q)il O () () b! cBF a2. x.s 9E ES c)S 6t .lE.5 q)i o!*dg *i 4'-'= SH ,=sts-*Eg*E;gl oaa >' -o 0)PA 50 .EU .9 o.rA-Cl-1 ij a l: .= oH lJr >>,LLC) -C .:ot,'Eoi LL o, r, >= a o clU .9oPNf(! _o'o '-C PU oE a o_ coo= =(o €+ .:'F6l! Oo- a oqJ co oN '- (E -A -- o.l{: -oti O) ot a I o .9 = -o 't6 --z oi a OJE(! - gE 9(o(!FcC ^(!- -Eo a E(I,PC<ocE '=a IY O- >6o a a a oo F.: -r-. OFe (h (n(s C) t-< C)()_O.i -cIo: o E.s .Qt v)O. ctl li li rh(! tr o(r) o C) o Aqt Frr Fa L< oo(ll kd (6 z H o d L< d z o p CB z 6J o C)(rl kF U) o CB!d cd C) tI .- +J G +J i() -HI c) x tsrI ! U t F( 0) - -clt Fi o'O N E 0) -o OJ oa s O IJ o- o c.)$ q q) R\) ,qJ 4 q) s.. q) \) q) q q q) \q) a) a R a a a a a a .>. aH 9Uto. o\O N 0) -o E() ooa =O o o. !+ + U) o) c) +r o q) o o q o o Cg cg o c0 o! o q) aHgE*E l!Fl-+r(gi-0)l&6eI <o) ! \Ji:Qa)a 60 a2:_a 5v 2 oQ> ua .= ll.tr a E- I E. CE o 4) q) O ai '; H-C) *=b+r tul) ia 6 d= lo r:- (J !.= J-,d E ii 6c,tr >\g o-9 -q.== tr LL,/ CLJE,= O] a l-.t(, 3nP -ts =.9 )'=C)= F'5 E -f'I 3g -c E'P= U9 ,.ti IJ. H* 9 - -E " E.e88 E E oo C) o oQ =6) =a) 'AEq 9q)q)= qE a1 o5 E Q o0 'Ee s(, 0) oc)aa oo ) oXo (.)xzox ,t I Lq) aL)^O 6J=znx q c) c) .N .B ot- ct) -a _ zE O -o<'E ia 2Q o o C) q) q) 3 .E3TE9; (lJ(./)>t a o c(u .9o9Nf(E _o 'o .=o .(^ !oE a (F o_ coJoF to €+b'il6(! '-LOo- a o(u cE oN '- (O -Q €b .b -o(,,)OJ OE a z = -t o c .o P = -o .C .9o a c(u E(u oo rcco.Q E6 oEEEos -o o c o ,F(, c <(ucE '= oJq- roi > -r^ a a a a a a o q) F a o(0 oLoc- -EPo= L., o o c, L d rE o 6J o. Fl a (r)(! o ch o o oa Fa L oo (g L c, (d z o oo(! L(!(! L cd a d o o c, F an od cl G,(J a o o) o. ar) t) l<() o q) v s. $ v') \) *a u (.) o U) cU oo tr a a c) d a0 o A. l-<() rii r-l q) € cll Fr ll o.O N H() -o Eo o-o U) $ O \-JA o I > (r) <' q q) s_ l< a) ,$) q g s. ! q) q) q) q 4 ! u rr a) q) na e a a a a 4.4. Operational research 4.4.1. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out during the reporting year. 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities STRENGTHS . Upward review and regular payment of GCCC. o Active participation & Involvement of other relevant programme Managers. the PHC Coordinators and the community leaders in the CDI implementation strategy. o Participation of Surulere LGA in CDTI, the LGA has made the release of NI00,000 for the training of FLHFS and 50 community Directed Distributors o The Hon. Commissioner of Health kick-start Community directed Intervention in 10 LGAs of Oyo State, by distributing some intervention materials e.g. mectizan drugs, Vit -A Supplementation, anti- malaria drugs integrated posters, information brochures, T-shirts and Caps. o Increased female participation WEAKNESSES. Lateness in the release of GCCC. Late supply of intervention commodities which has affected the'regular and early Mectizan distribution even in CDTI LGAs. Transfer of almost all the LGA Oncho coordinators. CHALLENGES Inadequacy of some intervention materials like LLNs Anti-Malaria This has been addressed by distributing the available commodities and we have proposed for enough funds out of the Government counterpart contributions for the procurement of intervention commodities for 2010. I a t SEGTION 6: matter Unique features of the proigct/other Political will through constant increase in the Government Counterpart Cash Contributions lGCCCl. 46 WHO/APOC, 14 September 2009