Technical report on Kadunna State CDTI project (year five): January-December, 2002

1B Jfl E rl ,s )ra!oCe Corp.1 TECHNICAL REPORT ON KADUNA STATE CDTI PROJECT (YEAR FIVE) JANUARY _ DECEMBER, 2OO2 BY: MR. PHILIP D. SANKWAI STATE ONCHOCERCIASIS COORDINATOR €Jr* For lnformollon Tor *br ( Ito For Actiou Tol TCc,,l-( C'Jn a6 csI C"s-pCd 81m 8fic RECU 2 7 FE\,. 2003 APOC/DIR L4 u, u5 tl ,l .t ',fllil c 'i .:f; t ,I Ct .T -- i6 )o 4" o" t ' 3cr' ADMI NIST r c'o o' I(A DUNA STATE Sl v' It^ Jo' RATI V E MAP OF fxarstr.ra I(ANO STATE (rl Q-, 5TA TE UrU2a l- +f- t- 7 LE HE KAURU +t-/- Sominoko A y-* -/r * a -t_*/^t r-tt-r* Ou AUnA. Kolonchon * N ++ ! I./ q ',J a j J r'1 r,j lk * 'Jl-4 -o /- r'- f- /-r- a j- o *- *'* ;+ *r 7 -i- 1) I I/-tl r> t* 1-* t- * * r' * * S-* f * * JEnA'a f)f *-on*+/ S w D I _i okorl i Sobo o SO BA +f- v>< ]K * x- ,-lt\ * IG A B >L Kr- *r'- r'- ,-*- aK- -a- v-* T U /lU k Ul-J- /- f/f-v- /-t-K/NONI KAJUR U )A -* O f+*t + >-,t- >--/-t- l' )-* Kojuru l- >- t-t ** t-t- f/-* *Az N t-GON r(-TKA FA** 7a-xt t-cf ** f-to n kt- 1 Pt * i.l 6 3o ,]0 0' 'l o 3n' go o' Bo'so _iD 'tt) 'l) ** XUDAN n o t L )*4 * /- r->t(aAu * /-r'+ A D Y-rtt'-* /-t'-f- y-f- r-/-*4 *-.* * f * *{ AIF 3OUN0Any . -._ _ - ry-. rqr. I G.1IOUNOARy .. . .,.- L/^\_./ t,r X6 [,Rdeau.c,n's _ ._...___.-_ o i. I il t ["';l L] il l EXECUTIVE SUMMARY The implementation of Community Directed Treatment with Ivermectin (CDTI) under the African Prograrnme for Onchocerciasis Control, (APOC) entered its Fifth year. All the 16 endemic LGAs are fully implementing CDTI. The project was evaluated in January 2002 by a team of extemal evaluators. The result showed that the State is doing fairly well, thus, heading towards sustainability. The Hon. Commissioner of Health gave a press briefing as part of activities commemorating Oncho week. He reiterated that APOC supports ends this year.However,SSl will continue to provide Mectizan and other logistics to sustain the programme,The 16 endemic LGAs Corporate organizations and individuals will also have to sustain the programme. He showered appreciations to Sight Savers International (SSD and APOC for their immense contribution in terms of logistics and financial support. He said the State would not forget the support and advice of the National Onchocerciasis Control Programme. There is a sffong partnership in the programme.SSl and NOCP Zonal office have continued to train SOCT and LOCTs and provided minimal supervision. 8 SOCT members were re trained on CDTI strategy, while 305 LOCTs were trained/re-trained in l6 LGAs on the control strategy of CDTI, community roles and responsibilities, monitoring and supervision, Health Education and Community mobilization.5,55l CDDs were trained/re-trained. In our self- sustainability bid, all the Health workers in Birnin Gwari,Chikun, Jema'a and Kaura LGAs were trained. During the year, there has been increased Government involvement and commitment to CDTI programme in the State. The Hon. Commissioner, Permanent Secretary and all Directors in the Ministry of Health were involved in advocacy visits/Social mobilization to endemic LGAs. The LGAs Hon. Chairmen, Traditional and Religious leaders and Community members were re-sensitized on their roles and responsibility in CDTI implementation. l I l-i l1 t.l 2 ti I ,'l Community mobilization/Health Education was carrieil out in all the 16 endemic LGAs, 1,215 Communities were mobilized. Distribution of Mectizanhas been completed; reports collated with 16 LGAs reporting 960,558 people treated. TECHNICAL REPORT ON KADUNA STATE CDTI PROJECT Section I BACKGROUND INFORMATION Kaduna State is located in the north central part of Nigeria. The State shares boundaries with Plateau State to the east, Nasarawa to the southeast, Niger to the west, Federal Capital Territory to the south, Katsina and Kano State to the north. The State has 23 I-Ges and a projected population of 4.7 million. The major rivers are river Kaduna, Galma and Gurara. The vegetation is mainly savannah grassland with pockets of forest mosaic. The climate consists of the dry season (November to March) and the wet season (April to October). The main occupation of the people is farming, fishing and trading. The people are mostly indigenes living in permanent settlements. Community leaders in consultation with their elders and community members take decisions. Mectizan distribution started in Kaduna State in 1988 in Lere and Kauru LGAs. Distribution was expanded to Bimin Gwari LGA in 1990 and Kachia and Zango Kataf LGA in 1993. Six thousand two hundred and seventy (6,270) people were treated in Lere LGA in 1988 and 6,149 in 1993. 5,694 in Lere, Birnin Gwari and Kauru LGAs in 1990, 5,015 in 1991 and 10,032 in 1992. From 1993 to 1997,37,464, 145,342,234,730, 283,642 and 285,845 persons were treated respectively in the five LGAs of Kauru, Lere, Bimin Gwari, Zangon Kataf and Kachia. The APOC project proposal was approved in May 1997 and funds received in October 1997. The first year (1998) of CDTI implementation 333,935 people were treated in the aforementioned LGAs. In the second year (1999) of CDTI implementation funds were received in April and September 1999 respectively. The State Ministry of Health contributed US$2,438.43 to' the project as counterpart funds in year one. US$5320 was approved for year two but was not released. In the second year of implementation, 146,225 persons were treated in 10 LGAs. In the third year (2000) of implementation, 833,172 persons were treated in 13 LGAs. APOC released US$68,007, for CDTI activities in the State, while US$9,200 was approved, and released as State counterpart funds. In the fourth year (2001), US$42,395'was approved by APOC while the State approved and released US$19,504 as counterpart funds; a total of 958,061 people were treated for the year. The State has approved the sum of US$19,410 as counterpart fund for year 2002. APOC has approved US$35,556 for CDTI implementation for the fifth year activities,'uvhile the State has approved US$19,410 as counterpart funds. I I I I il I i-J l t.i tl I l _l I 1 J _l i,] 1TABLE I THE TOTAL NUMBER OF COMMUNITIES IN HYPER AND MESO ENDEMIC LGAS 1 197 communities received IVermectin in 1998, 2,075 comm.unities in 1999 2,423 communities received Ivermectin for year 2000,2,515 Communities were issued with Ivermectin in the year 2001. 2,417 communities were issued with Ivermectin in the year 2002. In the second year, the 5 additional APOC LGAs (Jema'a, Kaura, Kajuru, Kagarko and Sanga) with 872 communities received treatment for the third time, using the CDTI strategy. 1,203 communities (in Bimin Gwari, Lere, Kauru and Zangon-Kataf LGAs) are on their fifth round of treatment under the project. Treatment is on going in Chikun, Jaba and Kubau with 348 Communities, using the CDTI strategy for the third time. The last three LGAs (Giwa, Igabi, Ikara) with 109 communities commenced the CDTI strategy for the second time this year. :r tl il i-tii I i.J il 13 (i) U ,} J -] 4 s/l\o LGAs HYPER MESO TOTAL COMM. UN TREATMENT I BIRI\IN GWARI 40 180 220) KACHIA 85 24 109 3 KAURU 84 85 169 4 LERE 100 115 2ts 5 Z/KATAF 180 224 404 6 JEMA'A 133 133 7 KAGARI(O 113 113 8 KAJURU 11 118 129 9 KAURA 185 185 10 SANGA 218 218 11 CHIKUN 196 196 t2 JABA 86 86 13 KUBAU 131 131 t4 GI\vA 2t 2t l5 IGABI 62 62 16 IKARA 26 26 TOTAL 500 1,917 2,417 ;u ,:-l 1 -.1 .=1 a;:l at '-..j :..1 I I l,,l IJ I ) a-'I ,.r1 --'t I I I -l I :l .'-,'l ,l :-) I :i :-1 'l -j -) I : (ii) A community is defined as a group of people living in one place, considered as a whole, sharing the same race and having the same leader. TABLE 2 IMPLEMENTATTON OF CDTT (YEAR s) With the expansion of the project to 5 additional LGAs,2075 communities received Mectizan at the end of the second year (1999) compared to ll97 inthe first year (1998). 2,423 communities received Ivermectin for the third year (2000). 2,515 communities received Ivermectin for the forth year 2001.2417 communities received ivermectin in the fifth year. The short fall in the number of communities issued with ivermectin was due to sectarian crisis in 2002. Although the last batch of LGAs, viz. Giwa, Igabi and Ikara have been implementing CDTI strategy, they were not supported by APOC. APOC support was extended to them this year. The State Government bought 3 Suzuki motorcycles and donated them to each of the LGAs. Sight Savers International have all along been supporting Mectizan disrribution in these LGAs With the expansion of the project to 5 additional LGAs,2075 communities received Mectizan at the end of the second year (1999) compared to 1 I 97 in the first year ( 1 998). 2,423 communities received Ivermectin for the third year (2000). 2,515 communities rec:ived Ivermectin for the forth year 2001. 2,417 were issued with Ivermectin for the year 2002. I a-t 't -t il l _l J i,i I I 5 District/ LGA No. of Cornmunities No. of Communitics /Vilhges which selected CDDs No. of communities/ Villages which coilected drug No. of communities /villages that decided on method of distribution No. of communities /villeges which decided on month(s) of treatment No. of communities /villeges with trained CDDs No. of communitieVvi llages paying CDDs in cesh or in kind B/Grvari 220 220 220 220 172 220 196 Kachia 109 109 109 109 95 109 86 Kauru 169 169 169 169 141 169 r45 Lere 215 215 215 215 152 2t5 189 ZlKataf 404 404 404 404 287 404 329 Jenra'a 133 133 133 133 106 133 122 Kagarko 113 ll3 ll3 l13 84 113 102 Kajuru r29 129 129 129 93 129 92 Kaura 185 185 185 185 136 185 151 Sanga 2r8 218 2t8 218 173 218 159 Chikun t96 196 196 196 142 196 154 Jaba 86 86 86 86 82 86 72 Kubau r3l l3l l3l l3l tt2 l3l 96 Giwa 2t 2t 2t 2l 14 2t l8 Igabi 62 62 62 62 47 62 46 Ikara 26 26 26 26 l9 26 20 TOTAL 2,417 2,417 2,417 2,417 1,861 2417 1,983 JI l :-l :,l 'l l t:-:l EB TABLE 3 TRAINING OF THE DIFFERENT LEVEL OF STAFF INVOLVED IN CDTI IMPLEMENTATION The performance of the CDDs has continued to improve and there is minimal attrition. CDDs have now learnt and accepted their roles even with little or no incentives. This indicates that they understood the important role they play in CDTI. This can also be seen in the community registers where recording and reporting have improved. They have also been found to use measuring sticks and marked walls to give community members their annual doses. The project annual training objective for CDDs in year 5 was 3,500 - 4,600. In the 16 LGAs 5,551 CDDs were trained. The percentage objective abhieved was l2lYo. The project's annual training objective for LGA staff in year 5 was 220-241. 305 LGA staff were trained. The percentage objective achieved wasl2To/o. The self-sustainability training has started with the training of all the Health workers in Jema'a and Kaura LGAs. 45 Health workers were trained. The two l I l l trt l l l j ; 2. 6 Dist/LGAs No. Of training undertaken No. OfTOTs trained (SOCT) I No. Of District No LGA staff trained on cDTr (LOCT) No. OfCDDS trained B/GWARI I 36 483 KACHIA I 2t 439 KAURTI I t9 420 LERE I t7 558 Z/KATAF I 18 652 JEMA'A ,, 43 415 KAGARKO I t6 341 KAJURII I 15 346 KAURA ) 35 419 SANGA I 15 466 CHIKUN 1 l5 328 JABA I 16 230 KUBATT 1 l4 194 GIWA 1 7 47 IGABI I 8 t4t IKARA I 10 72 Total l8 8 305 5,551 mrl q I I T il it U n U il ll n t L] l LGA Oncho Coordinators did the training while SSI and SOCT assisted only. The aim of the training was to ensure that CDTI implementation does not suffer in any endemic LGA as a result of health workers transfer. MATERIALS PRODUCED FOR YEAR 4: The following materials were developed by NOTF and purchased with APOC funds, SSI, and MOH for training of Health staff and CDDs and for community mobilization and Health Education. Also some IEC materials like posters are placed in community leaders houses and Health facilities. 1000 Oncho Posters supplied by the State. 2000 Posters for SOCT, LOCTs and CDDs to place in community Heads housesAlealth facilities; supplied using APOC funds. 2,000 Posters supplied by SSL 3,000 MIS summary Forms supplied by SSI. 12,000 MIS summary forms supplied by the SSI TABLE 4 NIOBILIZATION AIID EDUCATION OF TARGET COMMUNITIES t l:J ii Disti LGAs No of Comm/Villages mobrlized No of Target Comm/Vlllages, which received H/Ed about the importance of extended treatment. No of Advocacy vtstt to State or regional directors of Health No of MOH staff involved rn mobilization No of NCDO staff involved rn mobilizatron B/GWARI 82 82 I 2 I KACHIA 73 73 I 3 I KAURU 120 120 I 1 1 LERE 129 129 I 3 2 Z{KATAF 150 150 I 2 2 JEMA'A 85 85 I 2 2 KAGARKO 66 66 I 2 I KAruRU 62 62 I I I KAURA 86 86 I 2 1 SANGA 99 99 I a I CHIKLIN 84 84 I 2 I JABA JJ 33 I I I KUBAU 4l 47 I 2 I GIWA 2t 2t I I I IGABI 54 54 I I I IKARA 24 24 I I I TOTAL I,215 1,215 16 28 r-2 Communrty mobilization and Health Education activities have been completed, only poorly performing communities were mobilized. The Hon. Commissioner, Permanent Secretary and all Directors in the Ministry of Health paid advocacy visits to Hon. Chairmen and their Councils in the endemic LGAs, Traditional, Religious leaders and Community members to re-sensitize and mobilize them on their roles and responsibilities in CDTI implementation. In our self-sustainability bid the officer'in charge of Kamuku National Park in Birnin Gwari LGA was approached. The project solicited with the Parks Management on areas of co-operation, like delivery of Mectizan to health facilities or collecting points, delivery of IEC Materials or any other way the Park could assist the project in reaching endemic communities with difficult terrains. The officer in charge bssured the project of the parks assistance at any time The following are the various organizations/systems used to disseminate information for the implementation of CDTI. Kaduna State Ministry of Information Local Government Commission Local Government Information Departments Radio Television Religious leaders Town criers Community leaders ll Health education was provided by the following methods: Health education talks at Community levels Community leaders Community elders Community members Community Directed Distributors Religious leaders Women group Meeting community members at home during community mobilization and health education makes sensitization on CDTI easier and acceptable by them. Each community has various posters in the community leader's house to further create awareness to those who may refuse to take Mectizan. Copies are also left r,vith the CDDs. lll. 8 f,i-Iel i --:) .:i I 3 l I I ---r ,l -, -T il nLr L) 62 il tJ il t] n il TABLE 5 ACHIEVEMENTS THE MAJOR ACHIEVEMENTS OF THE PROJECT SO FAR HAVE BEEN: High-powered advocacy visits to policy makers in endemic LGAs by Hon. Commissioner, Perrnanent Secretary and all Directors of the Ministry of Health. No of treated . Commun ities/Vill ages wrth summary forms 220 109 6v 215 404 3 113 218 86 2,417 9 I '----l IT DrsI/LGA No. Of target Communiti ES Total Populatio nof Comm. No. of Eligible persons heated No. of Tablets used LGA Cover age Cost per persons treated No. Of Commu nities/V illages in which CDD is a worker No. Of CDTI distribut ions supervis ed by Health workers B/GWAzu 220 83,848 16,945 228,658 9t% 5 84% 5KACHIA 109 56,904 47,970 144,1 80 169 79,628 60,826 171,782 76% 5KAURU 76,989 221,843 85% 5LERE 215 90,460 404 143,514 1r6,697 348,1 66 8t% 5ZIKATAF JEMA'A r33 1 54,1 19 136,51I 347,914 89% 4 144,987 81% 4KAruRU 129 63,663 51,31 I 4KAGARKO I 13 59,536 41,993 137,827 82% 42,564 127,441 82% 4KAURA 185 51,687 92% 4SANGA 218 94,332 86,620 265,746 8r,269 71,012 204,331 88% 3CHIKLIN 196 80% JJABA 86 51,023 4l,089 120,637 78% JKUBAU 131 49,740 38,721 107,429 15,933 13,8 I 5 33,r01 87% 2GIWA 2l 80Y" 2IGABI 62 46,823 37,347 93,229 16,628 14,148 38,078 85% 2IKARA 26 84tJhTOTAL 2.417 l,l3g,167 960,558 2,741,3498 ,l 1Training of 8 SOCT members Training of 305 LOCTs. Training of 5,551 CDDs. Tl-re most common reasons for absenteeism as mentioned earlier are migration to farming areas. Students after completion of their education leave the communities to look forjobs in urban areas. Some community members have temporary settlements in their farms, and move there during the rainy season. Treatment should be carried out in the dry season so those community members who move to their farms during the. rainy season will not miss their annual treatment. it rl 2. 3il fl il il n it il il I il il Ij tl I --t I] Section 4 The State Government has been actively involved in the implementation of CDTI. The SOCT is actively involved in implementation of CDTI project through training and supervision. One SOCT member is assigned to take responsibility of CDTI implementation in an LGA. This ensures improved monitoring and supervision and also reduces the workload on the State coordinator and his assistant. This division of labour has also been extended to the LGAs. LGA coordinators have assistants.'The Ministry of Information is using its Media, (Radio and Television) to disseminate information arrd to create awareness on the concept of CDTI. Sight Savers are involved in training, monitoring and supervision of the programme together with the SOCT/LOCT. Sight Savers provide vehicles to assist the project during community mobilization, monitoring and supervision. The LGA staff (LOCTs) participates in the training of CDDs and provides supervision. Some LGAs provide vehicles and motorcycles during mobilization/llealth Education, monitoring /supervision ,Ind accommodation for SOCT when the need arose. l0 1 I:J C) I l .:l I I I -l I 'l i iT :1:l .) .-l 'I :--i 1.1ilLJ Strengths: CONSTRAINTS: CHALLENGES: APOC Financial and Logistic support Formidable State Onchocerciasis Control Team (SOCT) Formidable Local Onchocerciasis Control Teams (LOCTs) Community members willing to implement CDTI activities CCDs willing to distribute Mectizan Availability of Mectizan Corporation of some LGAs in accommodating SOCT, Logistic support like motor vehicles and motorcycles during mobilization[Iealth education Strong partnership between NOCP Zonal office and SSI SSI support in-terms of assisting the project . with vehicles during mobilization/Health Education, Monitoring and supervision and other logistics like motorcycles and Bicycles spares. Greater involvement of policy makers at the State MOH in CDTI implementation. Socio-cultural belief in some LGAs, which make it difficult for women to attend education and mobilization sessions. Arbitrary transfer of trained Mectizan supervisors to non endemic LGAs Access to women in purdah Community ownership in communities with strong socio-cultural beliefs Identification of Local NGOs interested in Oncho. Control. ] LJ :l J il il .J J _l I ,i L] ll I ) .ngl; t.r.t ,! F] :r t il ll HELP REQUIRED: I, GOVERNMENTI - Irrcreased advocacy to LGAs - Early release of counterpart funds by State and Local Govemment APOC MANAGEMENT: Advocacy visit to State, Ministry of Health and LGAs Early release of funds as and when due. iii. 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