Kebbi CDTI annual project technical report submitted to Technical Consultative Committee (TTC) : January 2006 to December 2006

IKEBBI STATE COMMUNITY DIRECTED TREATMENT WITH IWRMECTIN PROJECT ORIGINAL: Enslish I COUNTRYAIOTF: NIGERIA Proiect Name: KEBBI STATE CDTI Approval vear: SEPTEMBER 1999 Launchins vear: DECEMBER 1999 Reportine Period: From: JANUARY 2006 To DECEMBER 2006(Month/Year) (Month/Year) Proiectvearofthisrenorfi (circleone)l 2 3 4 5 6I 8 9 10 NGDO Partner: SIGHTSAVERS INTERNATIONAL Date submitted: MARCH 2007 : Jt,u Nlt r Ogui 3 FIFTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMTTTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) & ;" ll rlat Ft E'il ilsK[R.'* s E o).1 oI C d o ta .d At r-r1 rlc)hr'F <-? ft o tD 8 ., t 'r.) U 2 0 JUlt. 200A7 >R)@ fr.+e L( D/APOC 6 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE F'OR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) I r* 5o + For Acticn Tor 95 c biL 4. & $ u For lnfonnotlo, r"'_biR CoP- kfte BFO tu 2 0 JUlt 2007 Mtr+* fl.g,hfiC I AI\NUAL 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 County: NIGERIA National Coordinator N*r",fu AI.CJ.A ..e.eu- Signature: 'W** Date i: 1#.lg Zonal Oncho Coordinator Name ; Zcp-} va6.- ' r':)t ' ' 9i :S:'Lw'l Signature Date: * 5-..-(,.. + NGDO RePresentative Name: S a.IC*- Signature: . ^\-q=-: Date: ...??- O+ This report has been prepared by Narne : Aliyu Salisu Bunza Coordinator c__ , Signature: Date lL ri .i :tI r & l= G Table of contents DEFINT[IONS......... ..............vII FOLLOW I.JP ON TCC RECOMMENDATIONS .......1 EXECUTIVE SUMMARY........... ...............3 SECTION 1: BACKGROLIND INFORIUATION ..........................4 1.1. GnnnarINFoRMAnON .................4 1.1.1 l)escriptionoftheprolect(briefly) ............4 1.1.2. Partnership ...........7 1.2. PopuLAnoN ................10 SECTION 2: IMPLEMENTATION OF CDTI........ ...........'........11 2.1. TIIVIELINE OF ACTIWIIES ..",.I2 2.2. ADvocACy .................13 2,3 . MoBtr,TZAnoN, SENSITIZATIoN AND HEAITH EDUCATIoN OF AT RISK COMMUNMES I 4 2.4. ColnavrmurvINVoLVEMENT ......16 2.5. Cap,q,crry BUILDING... ......,...,'..17 2.6. TnBanvmtrs ......'..'.....19 2.6.1. Treatmentfigures........... .......20 2.6.2 What are the causes of absenteeism?........... .-.-....-...-.22 2.6.3 Vl/hat are the reasons for refusals? ................ ............222.6.1 BrieJly describe all lmown and verified serious adverse events (SAEs) thnt....23 2.6.5. Trend of treatment achievement from C.DTI project inception to the anruent year242.7. ORDENNIC, STORAGEANDDELIVERYOFIVERMECTIN ............ ,...,.,......,.25 2.8. CoL,,trvnrNlTysELF-MoMToRINGANDSrarpgotoBRsMEETNc ...........27 2.9. SupBRvrsroN .... ..... ...28 2.9.1. Provide aflow chart of supervisionhierarchy. ...............29 2.9.2. Whatwerethemain issues identifiedduringsupervixonT.......-..-...'...'..'.""29 2.9.3. llas a supervision checHrst used? .......'29 2.9.4. V4hatwere the outcomes at each level of CDTI tmplementation supervision? 29 Z.9.5. Was feedback given to the person or groups supervised ? . .. . . 29 2 9.6. How was the feedback used to improve the overall performonce of the project? SECTION 3: SUPPORT TO CDTI ...........3o 3.1 Equieurnlrr . .. '......30 3.2. Fnq$+CrIT CONTRBUTIONSOFTHEPARTNERSANDCOMMUNITIES..........................3I 3 3. OiTtnFoRMSoFCoMMUNTTYSITPPoRT. 3l 3.4. E>cpENomnrpERAcrrvITY ., . .32 SECTION 4: SUSTAINABILITY OF CDTI ..............32 4.1, . INTERNAL; INDEPENDENT PARTICIPAToRY MONIToRING; EvALUAnoN . . . . . . . . . . . . . . ... . .32 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhichare applicable)............ ........32 4.1.2. Ilhatwere the recommendations? ...........3J 4.1.3. Howhavetheybeenimplemented?................ ............35 4.2. SusraNasLITy oF rRoJECTS: pr.AN AND sET TARGETS (MANDAToRY ATYR 3)...,..35 4.2.1. Planningatallrelewntlevels . ...........35 4.2.2. Funds........ .........i5 4.2.3 Transport (replncement andnwintenance) ......... .........35 4.2.4. Other resources... ..................35 & i I E Ir 4.2.5. Towhatextenthastheplanbeenimplemmted..-.-.... """""""""'i6 4.3. INTEGRAnON ..............36 4.3.1. Ivermectin delivery mechanisms ...... -....... 36 4.3.2. Training.... """"" 36 4.3.3. Jointsupervisionandmonitoringwithotherprograms..... ..''''""'36 4. j.4. Release offundsfor project activities ...'-.i6 4. 3.5. Is CDTI included in the PHC budget? .... . 37 4.i.6. Describe other health programmes that are using the CDTI structure and how thiswasachieved. Whathavebeentheachievemenfs?.....'..'.... '....'i7 4.3.7. Describe others issues considered in the integration of CDTI.-.-.'..................37 4.4. OpERAIoNALRESEARCH.............. .....37 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. . .. .. . 37 4.4.2. Howweretheresultsappliedintheproiect?............. ......-..-........37 SECTION 5: STRENGTHS, WEAKNESSES' CHALLENGES' ANI) oppoRTUNrrrES....... ............38 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........39 b T t t E & Acronyrms APOC ATO ATrO CBO CDD CDTI CSM FLHF IEC LF LGA LOCTs MOH NGDO }.IGO NOTF PHC REMO SAE SHM SOCT TCC TOT I.INICEF IJTG wHo African Programme for Onchocerciasis Conuol Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with lvermectin Community S elf-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-Gov emmental Organization National Onchocerciasis Task Force Primary health care Rapid Epi demi olo gical M apping of Onchocerci asis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Uruted Nations Children's Fund [Jltimate Treatment Goal World Health Organization .*. & 5 aL r lL Definitions (1) Total population: the total population living in mescy'hyper-endemic cqnrrnnitiee within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in meso/hi,per- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): ttre estimAed rn:mber of persons living in meso/tryper-endemic areas that a CDTI project intends to treat with ivermectin in a grven year. (iv) Llltimate Treatment Goal (UTG): calculated as the maximum number of people to be reated annually in mesoy'hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of tle 3'" year of the proJecQ. (v) Therapeutic coverage: number of people fieated in a given year over the total population (this should be orpressed as a percentage). (vi) Geographical coverage: nrunber of communities treated in a given year over the totai number of meso/lryper-endemic communities as identified by REMO in the project area (this should be o<pressed as a percentage). (vii) Integration: delivering additional health interve,ntions (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 by conmumty distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to frmction effectively for the foreseeable future, with high treatment coverage, rntegrated into the available healthcare service, wrth strong community ownerslup, using resources mobilised by the commruriry'and the government. (ix) Communitv self-monitoring (CSM): The proc€ss by which the commtrniry* rs empowered to oversee and monitor the performance of CDTI (or any communiry*- based trealth intervertion prograrrne). with a viem to ensrning that the programme is being executed in the way intended. It encouages the communig to talie full responsibility of ivermectin distribution and make appropriate modifications when necessary. ;, * I { l r l. E. FOLLOW UP O]I TGG REGOTTENDATTO]IS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. Recommendations from 23'd TCC session has been addressed in the 6'h year project report, which is yet to be reviewed by TCC. TCC session 23d (Please add more rows if necessary) 8 L ,i JL ;t ;Ifl & T fj & Nurnber ot Recommendotion inthe Rqort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC/AMC MGT ASE ONLY r'+ Executive Summany Prqare an Executive surnmaql of the report in not more than one page- / Background on treatment and population data - Total communifies, communities treated, total population, WG, ATO and persons treated. / Background on population movements, / Training data - CDDS, healthworkers, Total population (community) per CDD tained. y' Challenges and how theywere overcome Executive Summary Kebbi State is located in the North-western 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 lvermectin Treatment (CBIT) with support from Sightsavers International while the Implementation of Community Directed Treatment with lvermectin (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, Sakaba, Danko Wasagu, Zuru and Fakiao rvhile Sightsavers tntemational supports control activities in the 3 hlpo-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 1673OS were treated with457,726 tablets of Mectizan@ r:2O2 endemic commtrnities out of a population of 192,428 thus attaining 87Vo 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 return at the commencement of the rains to either same or different locatrons with a resultant effect on both therapeutic and geographic coverage. Trainings u,ere conducted for one hundred and eighty eight (188) 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 govemments. All of them actively participated in the implementation of the CDTI activities. The LGA" and Sightsavers lntemational provided funds, which were used for the implementation of CDTI acfivities during the treatment year. APOC frnds 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 momtoring 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 purdatr have been slow due to cultural and religious hindrances. Though several efforts were made for FLFtr staff to i- 9 { I T E r* ensure adequate monitoring and supervision towards proper implementation of the programme, community members to kindly compensate their distributors after distribution, and community/religious leaders to let awareness reach their women who are on purdah for their participation towards sustaining the programme. i{ l t g l0 SEGTION {: Background information 1.1. General information i. Description of the proiect (bdeny) (,(i, (iii) (w) (v) Geographical location, topography, climate Populati on : activities, cultures, language Communication $)stems (roads . ) Admini stra ti on s tructure Health system & health care delivery (provide the number of health posts/centres in the proiect area if the information is avwilable)' 'Number of health staf in proiect area and number of health sta-f involved in CDTI activities. * (vi) Kebbi State is located in the Sudan and savannah grassland of north-westem Nigcria covering a landmass of 36,229 square hlometres (almost same size as Guinea Bissau - 36,li1 sq. hn, or half the size of Sierra Leone - 71,740). The state is made up of twenty-onelZf ; aOministrative local govemment areas with an estrmated 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 by Muhammed Kotal Kanta a famous warrior of the Kabawa decent (an ethnic group now living in the northem parts of the state). Relative to its geographical location, the climate in the state is characterised by two seasons. Rainfall begrns rn April and ends in October and heaviest in July and Augiist. The dry season is from November to March with dry Harmattan winds between November and February. The mean annual temperature is 100'F/40oC, while annual rainrail is 500mm. Most of the roads leading to the local government headquarters are motorable, but the roads to the communities are mainly laterite roads, which become inaccessible in the rainy season. Access to these communities is usually by bicycles, motorrycles, four wheel drive or foot paths. The existence of many rivers in the state particularly "Gulbin Ka " (River Kd and River Niger along with their tributaries provide fast flourng rivers for breeding of black flies, u'hich transmit Onchocerciasis. The predominant tribes rn the state are Haus4 Fulani, Kabawa and Dakarkari with Islam being the dominant religion The tenets and larvs of Islam as practiced in Sharia Law guide the people of the state. The marn occupatiors of the rural people are farming (subsistence farming), fishing, tradrng and animal husbandry and nomadic herdsmen. The state and local govemments provide formal employment. SOo/o of the people live below $l 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 that services have to be free or highly subsidised for them to affiord. About 7Oo/o of the population live in rural communities with poor accessibility particularly in most of the rainy season, while 30% lives in urban and semi urban centres (Birnin Kebbi, Argungu, Yauri, 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{ r fl1 I r +;& l1 +eam a living. They however return to their communities in the rainy 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 govemments governs respectively. There are also the traditional and religious institutions of leadership, 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 1978 which states: "Primnry health care as essential health care based on practical, scienttfically sound and socially acceptable methods and technologt made universally accessible to mdividuals and families in the community through their full participation and at a cost that the community and counffy can afford to maintain at every stage of their development in the spirit of self reliance and self determinntion". Based on the above the national health care delivery system is structured into primary, secondary and tertiary 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 government and provides services to all the citizers of the state. The state govemment through the Ministry of Healttt is responsible for secondary health care and supervision of primary health care delive.ry. The local governments provide primary health care in their respective areas. The Ministry has the following 8 departments. Administration, Public Health Services, Primuy Health Care, Pharmaceutical Services, Nursing Services, Planning, Rcsearoh and Statistics, Finance and Supplies and Inspectorate Services. Other parastatals under the ministry are School of Nursing and Midwifelv, Birnin Kebbi, School of Health Technolory Jega and Hospital Health System Management Board. The state has twelve secondary health facilities in Bimin Kebbi, Argungu, Yauri, Zuru, Koko,Zurru, Dandi, Ribah, Maiyama and Jega. There ue 24O first line health facilities in the six endemic local governments, 79 of which serve the endemic communities with only 35 involved Im CDTI implementation. The programme plans to increase this number to at least 120. The activihes of the State's Ministry and health services provided are funded from budgetary allocation from the stde governrnent. The eye care and the onctrocerciasis control programme have budget lines at the state level, while Onchocerciasis control is under the PHC budget in the local governmsnts. The state and local govemments have consistently contributed a range of $4,500 - $10,500 annually since 2000 as counterpart contribution for CDTI implementation. ln the year under review the government 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 heads each extended 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 5 dt tt & It IE i,i 12 state are in purdah and are not involved in decision-making. A group of households form a commrrrity in Kebbi State as in most part of norlhem Nigeri4 which is headed by a communiS leader known locally as Maiunguwa (Head of community, nalnes vary depending on tribes). T\e "Maiungweas" (village or community head) govem their communities in consultation with and assistance from heads of households, religious leaders (Imams) and opinion leaders like "Magaiiya" (head of females) aad "sarkin Samari" (head of male youth) in the communities. Kebbi State has four emirates - Gwandu, Yauri, Argungu and Zuru, headed by emirs. The community ald religious leaders report to thenr, while general communal activities are carricd out under the coordination of the village development committees. & t tI. I t G tl l3 AreTNGU HEE mlcO .EA DAT{DI MANMA EESCF NLlt MAPOFXE SB]E $PWNG CTIII IGAS I AR)G srpporGd f NoN-APoc $rpported { & rL I' It t - rj t4 i+ Table l: Number of health staffinvolved in CDTI (Please add more rows if necessary) District/LGA Nrunber of hedth strlTinvolved in CDTI ectivitiec. Totrl Number of lrcdth stell in the entire projcct erea B1 Number of hedth stalf involved in CDTI B, Percentage 3r:32/ Br *1@- Bagudo 54 37 69Yo Danko Wasagu 96 48 50o/o Fakai 3l 27 87o/o Ngaski 36 32 89o/o Sakaba 47 36 77o/o Zutu 2t l8 860/" Total 285 198 69o/" 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. l5 rE II J, T ii l5 1. Partnership (viil Indicate the partners involved in project implementation at all levels MoH, NGDO s (nationnl/int ernati onnl), communi ti es. local organizations, etc.J(viii) Describe overall working relationship among partners, clearly indicating specrfic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. Siate plans, if any, to mobilize the state/region/distria/LGA dedslon- mal<ers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The parftrers involved in the project implementation at all levels were: l. 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 5. Siglrtsavers lntemational Kebbi State Ministry of Health, Birnin Kebbi, Nigeria Thc Kebbi State Ministry of Health and its structure including function and 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/supervisiorq community health education and mobilization (as observers) and reporting. The Ministry pays staff salaries and allowances 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 Ministry of Local Goverrrment and Chieftaincy Affairs All Iocal govemments' activities in the state are under the supervision of the Ministry of Local Govemment and Chieftaincy Affairs. The Ministrv is headed by a Commissioner who liases with the Local Government Service Commission in the employment, posting, promotion and discipline of staff of the local govemmcnts and monitoring of utilization of statutory allocations from the federal government. It also sets up general gUidetines for std matters, inc-luding human resource dwelopment and serves as an appellate body for local govemment issues. The Ministry is invoived in planning and ensures that local government for implementation of project activities releases counterpart funds. The Ministry was able to get the LGAs to release $13,953 out of 538,759 budgeted for the implementation of CDTI activities within the project ue'ain2006. ln each of the 6 endemic local government area there is a local Onchocerciasis control team headed by an Onchocerciasis Coordinator, which is mainly responsible for training of Community Drected Distributors, ensuring that the communities collect and distribute the Mectizan@ and community health education and mobilization. The 6 Onchocerciasis control teams also monitor the overall distribution in the communities, ensuring that records are kept at the first line health facilittes and communities. They treat cases of severe or mild adverse reactions and reporting.ifr ri, t !t ia l6 African Programnrc for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Connol (APOC), uitrich is a WHO organ, was established in 1995 with the sole objective of supporting the control of Onchocerciasis in sub Satraran Africa using the Community Directed Treatment with Ivermectin (CDTI) 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, wtrich was used for the implementation of the prolect in 2005 and 2006. A team of evaluators was appointed to ivaluate the project for sustainabihty in 2006; unfortunately 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 Contrul Programme - NOCP) The National Onchocerciasis Control Programme (NOCP) is an organ of the Federal Ministry of Health, which is responsible for overall implementation 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 wrth APOC and states and receives support from APOC. The zonal office in Kaduna is responsible for monitoring the implernentation of the programme in Zone C, where Kebbi State falls under. The office also provides technical support to the project. Endemic Communities A community or village in Kebbi State refers to people in either small or largo groups, who live in the same place, share the same culture, customs and traditions with a cornmon leadership. ln the project area there are 202 endemic communities, which fit these descnptions. These communities have been receiving Mectrzan for between 8 - l2 years. The traditional structure and decision making process as explained earlier is what is found 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 collection point, distribution of the drug, provision of incentives and reporting among others. Si ghtsrveru International Sightsavers lntemational has supported onchocerciasis control rn nine local govemments (Sakaba, Zuru, Ngaski, Danko Wasagu, Fakar, Bagudo, Suru, Bunza and Shanga) since 1995. Since the cornmencement of CDTI, this was mtroduced in aii 9 local govemments with APOC supporting 6 and Sightsavers Intemational continued support to the progruunme 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. ln general the relationstrip existing between the parErers 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 ie I I -1! ti 17 the grass-root. Communities were re-mobilized on their responsibilities as parhers based on CDTI principles, so that at the end of APOC support the project can be sustainable. i 4 fr l, l F & t8 TD oi oac o.o I r'89.AFtrt{tE-trutD I rrE'hlr@ ,jr+ U-?'ts d.t?rtti-o Fl oFl F Nt = O o,F s,(' D) z@ ott,c El o,ts o) U o) *o { B ot oad \o h) 5 NJO A @ @ (, so{ -ls 5N @ -l I @t,\o 5 Po @5@ tj) N (.,l ESE! .d (DE :+ -89*= E.6o .6=h? E' (, t, o\ @t, tJ)l.J Estt'E ?A F. II = =r!gEE. h)o t\) z ort crf t\)ot\) u) O tr) o\ @(f) lJ) t) N9r(Dt< Ei(! rc -1: !16ltoE =(!c.5g;' Fl 6tg 6'g NO HE ID T \o h) 5t)6 c 5 @ @ O (,l @ -t\)S O 5 l..) @ -J tl) tJ (,t o\ @(f) 5po @5@ EsF (D6I a -. Ii te -F E E'[ .d.E g:r r o (D o..< ,r3;'gE l! * B.'! 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G s fG- $\ 0oGI \ G o d d 0a G a s Y $\ .ci o \ a.G G{ a \s $ a: N lr) ?HH $ g€g ."zf E+ii=,E[ra e;H$ fr gilHg ita$ t af*E FTFR E Eg$i3i1$ 3 ==Eqg :qE$ E s'xes [isF g $f$sqE'Hs H $d"EBEHs s A5 t EgE i i rB ; IHFx r rla i+$i f EH3Ei* € ;lEd;ga x 113iait 3 €l$[[sN r rlg r+it [ *EgsEf E :;E3*p i rHirEi E [r* --S.!'3 O EA8-6-rd ts 6 ErgE q E B EgE 5#aa; *\o *t \6Q.r$daG o*QAG !,- iri e(F *$ xs rioS! s.\G5G G *(\ s$Fetlo N@ "(^ o 5(/r "5 @ @ o\ o t,t, N (, t\) o (, {O{o A I T f, *-& ri oFi F Nt = O o,FA,tt$) z oqolu ,f El A)F G' uo !o- PB*laoc Edp oat o.o \J a{ It e.F o 4(D cr r-t e E(Dd e s) a? tl (D6 e o) .: E(Dd e E) a? E(DC e s)q t,(D cr'r-tt D' a? 3EB3 ii# ? D'I ? s)t e) 7 F'E C, ? A)t a) ?rt OJH C) ? F'Ht) ooEtsEg 59. oIt z855r =$1. 3.(Droo Etst rdtr EE q Et f6E EK6PE+ rrE ? D) ? o, ? A) .q 7 A) E E o F oo E (! o HFI t9 xl o) s) A' o) p) 0) a? o) O) a !) a? A' F' a? d9!a tD lt .+ +T'oo o5 E F' a? (D 5Ft A) a? FTJ (D c' e A) .{ rd (DCHd o)q EJ odFt 80q E(DC' ?J F'rt E oa o (! o oo o ra E' le G a(DE o d(D oo o5(Dn ? A: oo o(, oEt ? E Bo EI E (a E a u 0e () oC(D H o od(DFt Uo C)(D J -(DFt Uoo(D tso'(D)-t o BE9'o ES. o UEl ,ar (a s.g o 7 a, o ll)Ho ? F9Eo ? A)lf o A o,Ho A A)t e) !r3 =sE* =i5CE z o o 5q oFt zo (D doFt zo @ 5or-t zo (D do >1 zo (D 6(D r-t zo (D doFt oEg aEIr s'.oI 0 t,o J u, o A 5 I.f (r,BS+MII-Os$J{Ni\ I I *"x" E g - Ixs='-i[o NsS'O ir $$t is *. ='EN-S. =. = "$t I:o\5Rl}u!,+-(\ rrRO\fioHrrto .s. EE{ \I *. E Oa a s (\ F .i a^ :i(\q a\ I,S\ s (\ .s = (\ is .(\ = rt o tD ot o, c) (D @ aFt (D tJ)f(D lgth r-t(D o0H(Do E. (D o .{(D V2(\ $ R\o *h s(\ a(\ !a EP E X8LIE H BH=H& E. EE* -.- + pgE 3 gBEp = i5 id.E ?+H 6 qEi:3? + BH'sH=: :9- 3 *Ev,8 ; d;* , <, (,) c ia:+< + -v rJHE Z' :1?5'a9 a +i8 +H I E'3s'liE # &Hx+= a =G 66 o o I e.dr d-(rQ.ra i EiE'Ee I r,5id5g $ 36=Sg F +9Fs.6 5 c vc93 D qEXJi; i, 6=E rL s s[err ,1 E5g3f D e. B?DFB i gEEAbE.9=:YrAVF)+)$ - '-3.3A F rg: EH E ES8 - ..) -l-OX - (D o'Vcr :F q EE :rg E. 6 r?! =. <Ff,s . &g@<g5 ='S " oB B rI ' a) gd' aS)FO ErO; E{e gs '? a:8- N6 =. HE5 trrF' 16a, o=a ><,; u)ai, 86J iT.)pE!) elH ,tE aD 'J.H. 5(DE. 60-s 8-3 EO) oN) *- ia i T f E 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertadng the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy, 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 actual commencement of CDTI activities and subsequently during implementation of CDTI activities. This was done to ensure that the project gets the needed support toward sustainability. As a result of this govemment support to the prograrnme 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 governments 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 r.GAs. Based on the traditionaVreligion structure, both traditional and religion leaders had a big role to play in ensuring that women in purdatr are reached, get their communities to provide incentives for the CDDs and the selection of female CDDs. Advocacy was made to poliddecision makers in the Ministry for Local Govemment and Chieftaincy Affairs, the Ministry of Heatth and six endemic local govemment areas. A total of 37 persons were mobilised to support CDn implementation and they include Hon. Commissioners of Health and Local Govemment and Chieftaincy Affairs, Permanent Secretaries in both Ministries, relevant Directors, Information Officer at 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 advocacy lvere; all the policy'decision maliers at the state/LGA Ievels and most oi the community/traditional rulers promised to ensure that counterparl funds and incentives are prolrded 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, commitnent to CDDs compensation is also an issue to the project. These are challenges to the project that we would continue to advocate for.+ b * I l E 22 2.3. Hobilization, sensitisation and health education of at risk communities Provide information on : The use of media and/or other local systems to disseminnte illformation Types of IEC materials used Mobilization and health educotion of communities includingwomen and m,tnorities Res p onse of tar ge t communiti e s /vi lla ge s Accomplishments Suggestways to improve mobilization and sensfiisation of the target cam;nuniiies Information on CDTI was disseminated to the endemic communities through the use of distributors (CDDs) in collaboration with community leaders during comrnunity 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 occasions 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 (huru, Danko 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 identify other forms of communication within the communities to sensitise, health educate and mobilise communities wzrs 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 sensitlsation and health education: this r.vas to ersure that women rn purdah got adequate information and to fully comply with CDTI. rA -i3 I l E 23 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Anendance offemale members of the communit.v at health education meetings - In general, how do you rate the participation offemale members of the community meetings when CDTI issues are being discusses (attendance, Wrticirytion in the discussion etc). - Incentives provided by communities.for the CDDs - Attrition o.f CDDs. Is attition a problemfor the project? I.f yes, how is it addressed? - Other issues 4 a Female attendance to community health education has not improved, This is due to the Islamic norrns and culture that prevents women from freely mixiiig rvith males, though few old women and young girls attended meetings. Loudhailers were used to ensure that the females in purdah are informed about the programme during mobilisation and sensitisation sessions. Attendance and partrcipation of women in the discussion and implementation of CDTI continue to be poor due to the Islamic way of life that does not allow at free mixing of males and females. Compensation to disributors 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 trying to make communities see the need for the provision of incentives, through encouraging them to provide incentive in kind instead oi cash. CDD attrition was an issue of concemed too; this was :rs a result of non- incentives to the selected distributors. However there are CDDs who have been in the programme for quite a number of years and have continued to o a C- I T rL Nwnber of communities/vilhges with commrurity rnembers es supervisors Numbcr of CDDs Nurnber of comrnrmlties /villeges with fcmrlc CDDs Totd no. commrmities in tlrc entire projcct erea B. Nwrber with community mcmbcrs es supervisors & Percentrge B; B/ Br *llx) MrlD CDDSI B7 Female CDDs Bs Totel Be= BTtBg Nurnbcr of csnmrmities with female CDDs Btn Pcrccntrgc Brr- Bt,/Br'1(X) Bagudo 32 15 47Y" 210 6 216 6 l8o/o Danko Wasagu 83 26 3lo 330 t2 342 t2 l4o/o Fakai 1l 7 64% 99 2 l0l 2 l8o/o Ngaski 36 22 6t% 240 J 243 3 8% Sakaba 30 20 67% 110 8 118 80 8 4 2',70/o Zuru t0 6 60|, 76 4 40o/o Total 202 96 48o/" 1,(m5 35 I,100 35 l7o/o o 24 "+ serve their communities without asking 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 prograrrmes in the communifies. For example they should be use as guides during National Immunization Dals so that they get some incentive. The provision of incentives for other community based health programme like the National Immunization Programme has not helped in resolving the incentive issue. Et I T f E 25 2.5. Gapacity building - Describe the adequacy of available - Where frequent transfers oftrained staffoccur, intends to do, to remedy the situation: (The most measures were taken to ensure adequate CDTI lcnowledgeable manpower was available or if ihe course of the campaign). Since the inception of APOC support for resources had been developed and prograrnme Onchocerciasis. A total of One of the Local Onchocerciasis Team and health seven (777) community distributors were only : 1,1 10 respectively during the year under review principle. Trarsfer of tained staff was experienced by the LGAs. Some were within the endemic area and found very fair unlike the previous years were the endemic areas. Decision is still on to addres staff at each of the endemic LGAs on experiences in fufure. t" l t F & manpower at all levels. what the project is doing. or issue to describe is whet where not enough are frequently transferred during activities in Kebbi State, human to the success of the control and eighty-eighty (188) members seven hundred and seventy- out of the target of 196 and manage the project based on CDTI particularly in all the endemic staff outside, which the project of the staff were transferred from such issue by training all the health implementation to address such 26 H oFl F Nt e a Ei! ,+Ed cr z oap otr Ff, 6 ,fD €P$Ei H5'tr Edts oatoo U q F o o O o .l6 s o (! E(D I s O O O o O O O O O o O O Ir z * b +l,E a ll ir- z E ata- tio!lrr P.353.t! a)adi F O \o o\ tJtJ { t-J -.t N o\ o H6 s o (! Et(! I o\5 s a6 B O t.JF F.J m o -l { tJ NJ O A5 ss O [.J l.J S) z o h +q.rg z ot 3sltEEjr! .tP E. E! r! a:g(! art I a O O o O s G G E' ot, O O O O o O O O o * z :!E Eq ox ^!t 'r9oi rE. Ert a - s n F tu .t 6 = ^Fi ong - @ @ N5r! t/)I N) b..) o\ NEt6s lrJ ts .c<o\oJ(D I \J5 : t,[J : -I{ -t i-J o\\t t-JtJ (I t-J -IA 5 \o o\ (,{ Ot \o t-JO \] o\ N) s o\ s U t.J o jl F * >1$ ooo, .+lt E ,i t z H= =. t! 8sol, t) l-llo,IC Ita lur, rl :l E. E oq B B o iho'Ft taE (D @ oFn o UJ = 3Eq o E, A)+ E(\ A (\ R\ = \(\\ a 14 Go : \ o oI s o0 s E o 'i ! * t 3 : o \.* c'sSqQs *atE =' (\ NUdU .o%\=s'd SN xtsE€ xil(\R a-ss:xsN*EsRG(\= t\: NS Ei8 da SRO1 *.G .$B aR'NF. SS \,\$u'}J\I\ t-i ^s' UG SS -S <c si oS rr F( tr (\ .% o s\ qo N{iL l t * & o (aEt @ Ug, D tD € Fod o3{ 5 @ UE O) to o: 0 @ UB tr 8 .Do o a rJa oV' v)z>F FB o(I(D E(D oF+, ooLI -sE EEgE Ttsts eci 6q9oo o5gE .D H to F666 OJ d(D t, E 0e oo * (a a (] o oUU EEc6{r O ,.\ -li ioEE'i' a(< (Dt!E ;46 r!il edGt0 rlEoolp E! 0.e o E tr Eq o0 (Do oa oo oa t (D O (D0 393I E'* EroE* td E3 rlO5E FEllo o.r(D;' ag XF 9.6 r?7 l-l lo)t(' l(D lce' a5 *(DqO (\6 QT F) 6ts'%0Q 3a (!O :(D\! Fl\+(\ i.rio5 o h A' q B\ (\ 6 $ -r :$0! G\\ o\ Oa\(\\ e -t N rI: s S T o s $ ci$(\ =. $ a -q srt ts. (s r< o (D r_t r) o J(D tn BE G o o $ o- GJ d r{ ri a\ ci G s i)\ a1 t 1 \\\ d. aGs .dt: .l = o G& l l F tE N\o 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. in the period under review the project attained l00o/o geographic coverage with a therapeutic coverage of 87%. The project in the past reported having 2ro communities, during monitoring and supervision some places were found to be one community but have sections, which were classified as communities. This was found to be as a result of trying to have more recognition to such places, but clarity was made which they accepted, as such this brought about the present 202 as total number of endemic communities within the project area- But it has to be noted that such places have same community household treatment register, though with list of households accordingly and based on which section of the community a household falls. It should be noted that there is a drop in totat population and population trEated compared to the last year's (2005) treatment, this accounted to migration by nomads and some few indigenes from Ngaski LGA, this happened before treatrnent commenced. icr + JI t t t 3l l-l lo)td tc l-r ; >.1(Ds (D o, g O E it^t 6 g (n H o -ori FO esH(D 5)lh O) El.(t,tr E a (\ 6 a(\\o s (\ C)(\ Ez:q Ft oH F N a e o A)FF'd SD z tra B d: Eb,Fp) 30 A'- Effirt EO Ot(I0 co.o H bB >d' t9o N) (, O t,)o\ - @t, (, N -aB -O "H +g.tE g- E !.S " I E.* " + = [q o o )t5 (D o, 0aoIA b') I\) tJ) (]) o\ @t, t, N Y e'> *ee Nct\) (, (j) a @t, ()) N 6 o XzR5gQ E: I =alQ qH Ooo oo s 5\ O rO o\ s 10 s o ^dxo >o0 di'o aE iro6' A) o\ t UU rll o \o hJ 5 t\)6 5 @ @ Ur 9o{{5 5 -N@{ o\ @lfJ\o 5 9o @E@ tf) tJ L,I 3- ao X ro I K of *r; h'=?ao' ts B._€ tB.Eox o FU o rc o: o E -lh) \o Lrr o\5 Lrr5 "N{ UJ t, -J t]) 5{ (Jr "@ \o\o 55 o\ NI lf) t.)N oJ- .trr.d P oEC 9aad= o\{ ts € A o\N (,l 5 N (^ (, o\ (,l u) o\ y, o\ tJ) tJ) 5 J.)NUr N N5 N Efr8g q 6 -l s a(, o\ \o t.) o\ @(^ ^\ @ N -o5\ @ o\ -o6\ @ -o o\ ,tofOo EEE60Qcoi' o -9,v -v t\){ N{ t) t.J(+) l+.)5 (, 5O N)\o t.) C * $ tE "1H " 6 5 g *+3sq\ (r) \ott C) o\s o\ Ur6 @ N UJ t\) (,L,I {(/t z r o sttaa oo o o o z, r o v) It o o O E e.; 28.6 H,ae &E EgilE.F*$Er il+a"-' " - S -t oHq! 't(D ^C -oh :io oo (D xs oa(D nB: o o6o oct o)tt ro ts. .o-- o e)o .D E@(D BA' o H o oo ro (tio\tsvF) 0a .D Eq) o 8 EE d EE [ il :.-{ISS E Ol'tr A 3 arq:s q"A Eg[ ;.E s!$ E &\SF E S n$ gIs: o $$E H El$tgf, t E. E'16" F$B B IH E 3 $ 5.t; tE I $lE i*s s i$t EFTI B\ ss [B €.e * a AS s H - FF E s'B[= .t l. SdF]:3 Bs :F -. \S$r. sN \- \<GG\e ri. B. s s\ N Oa N E Et sI il 412. 1tZ.3lE 3lE -ld5to '6totsl- oFtslo Elo!:- l+, C lt E 18 EIB silE E lEg' lE -- lo E IE E:IilSIU oo 16 .2 F ='lsdt= :tx;I lio 5 lts *E 818O. l* >gIE EE'6 I8F iiEE FE19 !l ir.jH8(AE AP e o- iJoB' =aD a o.='{z 5'F3!JLlt aD o.a E'(Dp6 +5!)AH (D 9S .d.I A'H(D$ >12,5lcEt3 E.H +E .li l+)pt lEtrr l(DBto(Dltr :+l(D elH ,:. lot slE <lx aDl lolo *+ * '& ci d IL I ts ri il oa a a 2.6.2 What are the causes of absenteeism? There is always a high migration of male youth and some heads of households to urban settlements during the dry season to engage in petty rading and other unshlled professions to earn a living. They however retum to their communities in the rainy season for agricultural activities. The nomads around endemic communities do move southwards annually for pasfure for ttreir animals during the dry season and return in the rairry 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 norns 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the rcporting period and prcvide (in table 8) the required information when available. ln case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE was reported t* i: t & t rII 33 - lFl !D)IE l(Dl* oE U2 o ra o l,o o rr2 :ea otU(D (D a! aa a F](t) t) oaa rl .6I OQ o Ft ID o! t. OQ o 6a .Yl!A V, G S \ = R d sIG I u) .f * lrl(\'\r t S ail\ (\ G I 5'>e5[ x/5x(to 4i I t Fg. E (A 2t o0(D a .D x o? EO .;'do ";. oi, IUBl0q6 0)? ,( s.oo5o N lq s@HE:5 VtE 6'E!69-s q a J ,o o o <rF8 EE. Eo5' B SH db B,FP U '4Jq ^ o i I i L l I I l l I l B, 3 V ,2Jqa -EB- ; E-fr d HE - d.b x*rX+Hta ?a rr^ BF aa;'o o ooH :EXEE O A F'E EE:u)Lri tJ <> o l.Joo\o l.Joo6 NJoo -l t.) o o\ !.) (, I,Joo5 N.) o(, l.Joo hJ h.)oo tJo o \o\o\o \o\o @ \o\o -I rd F N.J l..J l-.J tJ N.J t-.) @ € t) @ o\u) (,(, tJru) 89a E ,$gggE Hi f 3i 0) oa N.) tJ N) N) [.J N) @@ tj@ o\ (, Ur ET 5E g oo o Fl ta A, o l.J i.) N) UJ l..J \o\o I.J oo oo ur 00 o\tJ) lJJ t,u) ao4 6EE 1gfiEI or+ -o6\ \o -Is \o o\ UI o\ yO OqO -oo\ 10o\ yCo\ 14oOc-o(D t,IlQ6 s€! ll g.!d !d =daljx(D= o\ \o -ts \o o\ 1O (Jr o\ o\ o\ \o oo\e @o\ @\oo\ tt,qr * ll oo-G6 ae-# o o oo !l !a .D c. s ol 0Qoo \otJ "5 t.J& N)O L \o -tP @ \tP t.J 595 )oNJ t) 5 \t 5 \o{ -tl.J o\ 6(I ie o\ { ,hJ o\ H: E .+srEt Si I HhY5gH q -l -r"\o o\ @ -l OO N) .,u.O O ,-I(,OO o\ O @ ;-I -tN) o\ oo F.) -I!.J o\ UJ -Fl .d.d P 6AEo l.{ rl ,'6 E_d=* o\ .J(, 0a o\yc \o t-J F u) m i @5Ur @5\o 5 o\N(Jr (,r 5\o N.) \oI (j) o\ 6 ,s \o -I -t -I ttl o OE a3_qE o'oro A @{ s 00(, o\ 00 u) s @\o o\ 6 N.J s 00 NJ s € i..J s \o\o o\ \o\o s \o{\o6\ E' lt,r ll FlC)t]i oh s6Evp) (! oado tr'.o \o -ts s \o(, s N)5 s t'.J s \o\o s o\oo\ \o\o rO ^\ \o\o s \o\t s t_ =t! all E oo- roO i ,9- E .i o FU oE A) o \o -Is s \ot, s \o @ s { L'i g\ \o @ 6\ 00 -J 6\ \o\o s \o\o s \o -I\oo\ 5\ cHo oo 6 A' oa .D l=l t\) l$h 16- lrrlp'.1 _rlH(D d=0r-qo =,r!O* ag EG5ErEOEo+(cs o= ai !too ='(Di ldokEl lo aDlP5li! +15 ri ls3lil(<- ta/iHU ,s Fl I 5r(Do 6=' =t ii dIE8El rr (!o Q= Hsg9 r'D GE $E :h; =dr. !9 s G ils G f.g (D BOO a atr (D (D Fl o eFl (D (D .l DEl (Dp {e O(D O E e2 (D a(D o tr on F9 H o (,) D .) p F} o -ta, t, -I i- ; $ l l C 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qilease tick the apgopriate answer) MoH ! wHfl TINICEF I] - NGDO E / other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH f] WHil UNICEFD NGDO t] / Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The LGA Coordinators compiled the Onchocerciasis treatment report and Mectizan@ used in their various endemic communities and submit it to the State Onchocerciasis Office. The quantity of Mectizan@ tablet required by each community 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 by three (x 3). This is then collated at the local government level and sent to the state level thm 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, UNICEF thereafter takes 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 community level the first line 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 acfivities have been concluded. c. I T $ 38 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 community treatrnent reports to the front line health staff (supervisors) at the first line health facility. These are then passed on to the LGA Coordinator from all FLHF staff along with treafinent data, he/she collates all the reports and drug for all first line healtr 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 U Llllu. List and brieJly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Front Line Health Staff at the first line health facilities calculate the amount of Mectizan@ required from the updated census done by the CDDs, this is done b-n-' each of the endemic communities under their supervisions, 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 allocatioru after notification of the availability of the drugs. a - Any other comments None r* d, I t E LGA Number of Mectizan' tablets Number in stock Requested Total Received Used Used/?ercon treeted Lost Wasted Erpired Remalnlng Bagudo 3,O20 I10,000 105.980 73,921 24,620 2 0 0 35.077 Danko Wasagu 11,299 140,000 130.000 150,746 42,252 I 6 I 0 0 -9,608 Fakai 5,166 15,000 12,000 16,496 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 Ztxu |,774 17,000 15.000 10,700 4,062 0 0 0 6,074 TOTAL 22gee 512,000 482980 4571726 167,308 8t9 0 0 47,364 39 .+ 2.8. Gommunity self-monitoring and Stakeholders lUleeting Has any training (of tainers) for community self-monitoring been done in the proiect area? This was not done in the year under review. This was scheduled but could not be held due to late released of funds. Nevertheless uN 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) Descnbe how the results of the commuruty self- monitoring and stalceholders meetmgs have affected project tmplementatrcn or how they would be utilized during the next treatment cycle. ._ i & T l T District/ LGA Total # of communitiesivillages in t?re entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SUn4 TOTAL 40 2.9. Supervision 29.1. Provide a flow chart of supervision hierarchy. NOCP (ZONAL_OFF'rCE) NGDO (STGHTSAVERS rNT',L) STATE ONCHO TEAM LOCAL ONCHO TEAMS FRONT LINE HEALTH FACILTY SUPE,RVISORS COMMUNruY LEADERS CCMMUNITY MEMBERS COMMUI\-ITY DIRECTED DISTRIBUTORS ri - $, l T G 41 2.9.2. Whatwere the main issues identified during superuision? o Lack of female distributors in most communities o Non-community self-monitoring. Poor health education and mobilization of women in purdah as a religious belief and culture. CDTI records were fairly kept at FLI{F. 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 2.9.5. Was feedback given to the pemon or groups supervised? Feedback was given to both LGAs/FLFIF and communities concemed. a a o a a 2.9.4. What were the outcomes at each level of CDTI implementation supervision? LGA/FLHF: At the LGA level it was noted that some health staff still have the impression that CDTI is not part of their primar), assignment, as such they should be pard. This attitude has affected the implementation of CDTI activities. Follow up was 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 during monitoring and supervision exercise, even though this was provided. Community: Compliance to treatment by community members was errcouraging 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 camed out in affected communities with emphasis was on provision of incentives in kind to motivate CDDs. a a a a a a { I l T 2.9.6. How was the feedback used to improve the overall performance of the project? o The response to parbrers concemed stressed issues and recommendations. They were motivated to firlly continue participating as parbrers through 42 carryrng out their roles and responsibilities; this of course resulted to a success. SEGTTON 3= Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Frmctional, CNFR: Currently non-fimctimal but repairable, WO:Writtenoffl. How does the project intend to mnintain and replace existing equipment and other molerials? The project intends to maintain exrsting equipment through reparrs using the state and LGAs counterpart fimd 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. & I t Ft Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No, C,ondition l. Vehicle I F 2. Motor cyclds) 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 I F b) Video Recorder 1 F c) Air Conditioner I F d) Calculators 0 25 wo e) Bicycles 30 CNFR 2l wo f) Overhead proiector I F g) Generator I wo 43 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Exchange rate: Year 5 - 81 - Nl38, Year 6 - $1 - N127, Year 7 - $1 - Nl29 If there are problems with release of counterpart funds, how were they addressed? Effiort 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 take up it's responsibilities towards sustaining the programme nothing was done. fr 3.3. Other forms of community support Descrube (indtcate forms o-f m-kind contnbutions of commuruties i.f an| The forms of support to community distributors were in cash and in-kind (food items), though this was from few members within the communities. a a : * I I t E 3.4. Expenditure per activityr Indicote in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current \Jnited Nations exchange rate to local currency. Indicate exchange rate used here - $1 = NI27 Contributor Year 5 (2004) Year 6 (2005) YearT (2006) TOTAL AMOUNT (cAsH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsH) Budgeted rus$) TOTAL CASH Rcleased (us$) TOTAL AMOI]NT (cASH) Budgeted (us$) TOTAL CASH Releascd (us$) MOH (Central + ProvinciaVState) 28,985.5 7,246.3 78,740 7,874 38,759 0 MOH (District/LGA) 18,260.86 13,913 23,763.7 1l ,8 ll 38,759 13,953 I ocal NGDO(s) ( if any) 0 0 0 0 0 0 NGDO parrrer(s) 10,265.83 9,470.43 9,251.9 I 1,186 6,157.49 6,156.14 Others 0 0 0 0 0 0 APOC Trust Fund 8,750.00 8,750.00 142,030 0 7,920 0 TOTAL 66,262 39,380 111,898.6 30r871 91,595.4E 20,109.14 44 nF Table l4: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? ; { I T I Activity Expenditurrc ($ US) Sourc{s) of funding Drug delivery from NOTF HQ areato central collection pqtrLg[qglqnr4y_ Mobilization and health education of communities Iteqr4gpf QP_Ds staffat all levels Supervising CDDs and distribution Intemal of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance OEce Equipment (e.g. computers, printers etc) Others 562 3,713 3,291 l,Tie i6, 2,213 Dta 412 4rz 6,003 220 0 20,108 SSI LGAs/SSI LGAS/SSI LGAsiSSI SSI LGAs LGAs _qSI SSI LGAs/SSI SSI TOTAL Total number gf persons treated 288,151 45 SEGTTON 4: SustainabiliQr of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which arc appticable) Year I Participatory Independent monitoring: NONE Mid Term Sustainability Evaluation: NONE 5 year Sustainability Evaluation: NONE Intemal Monitoring by APOC: NONE Other Evaluation by other parmers: NONE 4.1.2. What were the rrccommendations? 4.1.3. How have they been implemented? 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'/ No When u'as the sustainability plan submitted'] NA What arrangements have been made to sustain CDTI after APOC funding ceases rn 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 government and community levels to support the sustainability plan. Each LGA will meet with stakeholders including religious and community leaders to discuss and implement decisions taken on sustaining the project Communities will be health educated and sensitised on their roles as parErer toward sustaining the project. a o a a .rI I T t 46 4.2.2. Funds Advocary as continuous process since the inception of the project will be intensified to relevant partrers to release counterpart funds to support the CDTI project. 4.2.3 Transport(rrcplacementandmaintenance) 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 capita! equipment. The project would however approach parllers for a one off donation to support the programme. 4.2.4. Other resources Other resources for the successfirl implementation of a sustainabilit-y progrirmme will be discussed and explored during the planning meeting. 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 rt is expected that stakeholders would accept the idea. 4.3. lntegration Outline the extent oJ-integration of (IDTI into the PH(' structure and the plan.s.for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery has been integrated into the PHC system from the state to the front line health facilrty. 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 supemsors from the front line health facilities collect for the communities they supervise. 4.3.2. Training Training of personnel for CDTI activities is yet to be integrated into the PHC system as all programmes hold their trainings separately. Attempts have been made to train some Traditional Birttr Attendants on CDTI stratery when they are being trained on matemal and child 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 47 o 1l a : a t t o)'t )i f n a a ri r( nr a n, 'T a supervise National Immunization Progranmes in their areas. It is expected that this would be discussed and agreed as a statery for the sustainability of the prograrnme. 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 prograrnmes 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, identificahon 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 a 4.3.7. Describe other issues considered in the integration of CDTI. The state and local govemments stands the chance to reach people at the grassroots with the necessary awareness related to public health services and to incorporate members of the community to take orvnership of most primar), issues regarding their health. It is cost effective for all partners that may be involved in implementing CDTI principle. 4.4. Operationa! research 4.4.1. Summarize in not more than one half of a page the operational rrcsearch undertaken in the project arrca within the r.eporting period. o No operational research was undertaken during the reporting period. 4.4.2. How were the results applied in the project? o NA. a {} t t_ l * lI 4f I T l 48 a SEGTIOII 5: Strengths, weaknesses, challengcsr and opportunities List the strengths and wealmesses of CDTI implementation process. List the challenges and indicate how theywere addressed. Strengths: Continuous compliance to treatment by communities a o o a Commitment by some health staffto 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 logistic supports from Sightsavers lntemational. a a Weakness: Poor involvement and participation of women in CDTI activities due to religious and traditional believes. Lack of female distributors in most commumties. Poor motivation and incentive for CDDs by some communities leading to CDD attrition every year. In adequate monitoring and supervision by some supervisors. Lack of counterpart fundrng for the year from the state govemment. Ghallenges: Non-release of fund by the State Ministry of Health during the year. Most health workers see CDTI not part of their primary' assignment. The project has continued to advocate for sustainability of CDTI activities post APOC support. As such advocacy was carried out to the state and local govemments. Health workers at the health facility level were at all times made to know it is their responsibility to handle CDTI issues even as they do for other health programmes. a a a a a * + fj L -1 l, t I I T a 49 ! D SEGTIOII 6: Unique features of the proiecUother matters a I r+ . ,- s i & I T TL E 50