,l ir ANNT]AL TECHNICAL RE,PORT OF CDTI ACTIVTTIES ? ilY t ,t ENUGU/ANAMBRA/EBONYI PROJE CT INOTF/APO C/WHO PROJE CT l September 1998 - May 1999 Submitted to AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONCTROL (APOC) MAY 1999 RE9U , 3 I MAt 1999 .i trPOC / PM (, tTE,CHNICAL RE,PORT OF CDTI ACTIVITTES IN ENUGU/ANAMBRA/E B OTI-YI PROJE C T SEPTEMBER 1998 - MAY 1999 SUBMITTED TO AFRICAN PROGRAMME FOR ONCHOCERCIASIS (APOC) MAY, tggg E (
I 2 i EXECUTIVE SUMMARY The implementation of CDTI in Enugu/Anambra/Ebonyi States Project commenced in September, 1998, even though APOC money came in January, 1999. Before this date, Global 2000 was the NGDO providing the necessary fund for all the activities. The project has an estimated population of about 7.5 million persons. CDTI implementation started with macro-level advocacy to the states and local government areas. The objective was to sufficiently educate and mobilize groups to provide the financial, logistic and human resources for CDTI activities. The project undertook a total of 68 advocacy visits to 32 LGAs 192 frainings were conducted at three levels namely: State, LGA and community. A total of 341 rors, lg5 DHS, 1g5 ADHS and 7,025 cDDs, and 184 LOCTs were trained on CDTI. A total of 2,754 villages were mobilized and health educated. Twenty-one [21] Ministry of health staff and one [1] NGDO staffwere involved in the mobilization exercise at LGA level. Treatment has been concluded in only 2,7 54 villages that collected drug. Active treatment was the case in all the villages and a total of 7,256,840 eligible persons were treated out of a total [census] population of 1,887,514 giving a treatment coverage of 66.59yo and cost per treatment of 018US$. From the progress made so far, there are indications that CDTI approach will be successful and sustainable. ( TJ Finally, the prolect is being saddled with some problems which need immediate attention and these include, provision of new field project vehicles, more motorcycles and bicycles. .TYPICAL BREEDING SITE FOR BLACKFLY IN NKANU LGA v -t ,- ,f, it*{i_ -d_ ABOVE ARROI.S SHOl.lS DR FI!L\-K RICHARDS DR E.S. }IIP.I HRH T|I.E TR;.DITION\L RULERS OF OZALLA CO}.i}lUNITY Ii{ I;KANU LCT.I PROJECT AD}IINISTRATOR FoR EN/AN/EBONYI STATE. SPO ENUGU STATE SPO AN.L\IBRA STATE SPO EBO:{YI STATE s0cT :1a).itilr::s iroR ENUGU/ \Nt-llRiiA/t:BOiiy I s |ATL . -ct3 I /- *w 'l 1 l' l- I,Q .'(, ' ('. q-''i*, ( a I (l r r)4, ! 0.Ig' o d, ,: , a}- -l t' ,,!> 1 ,to 't ,r,,) l,) .>0 . !;' ,t .D l, 0>., ( ! I 4 I SECTION I BACKGROUND INTROI)UCTION: Enugu, Anambra and Ebonyi States are among the seven South Eastern States of Nigeria benefiting from the Lions Clubs/Global 2000 River Blindness Programme. The programme started in 1995 with two States, Enugu and Anambra, before Ebonyi State was created later in 1997 . The project area is located between 5"43' and 8.30,N with a combined population of 7.5 million inhabitants [Enugu 2.5 million, Ebonyi 1.8 million and Anambra 3.2 million]. It has a total of 5l LGAs out of which, 3g are hyper/meso endemic for onchocerciasis, [see map 2]. This giant project received APOC funds in January lggg and had long commenced operation with three project officers each directing the operations in each state. {i} The total number of communities in the hyper ond meso-endemic districts/LGAs The total number of villages in the hyper and meso-endemic LGAs is 3,553 [Enugu : 1,331, Ebonyi : 1,160 and Anambra : 1,062]. {ii} How many villages were receiving tvermectin before and how mony are now tncluded in APOC project? AII the 3,553 villages have been receiving Mectizan before the introduction of the Community Directed Treatment with Ivermectin [CDTI] approach, and all are included in APOC project. ( ) IN THE THREE STATES. Z 7F-- wF Li 5 Qr) l- frlZ eff e \ F] wlor)7xTN - q:r4q t=tE - tr+S PIE -'{ 4 -U Ln --OO rH -\7 ZCZ m EAST o C)@ uC WESTt r- AFIKPO S 6 =m C OHAUK}/U c\h .-/-"'- ir Yr.n l---ti-=tr{ 5, {iii} The number of times the communities/villages in the Project urea have received treotment. Any other additionol information will be hetpful. The project commenced in 1995 and all the villages did not start receiving mectizan in the same year. While some villages are currently in their 5ft year, others are either on the 3'd or 4ft year of treatment [see map I1.. {iv} If you are using the term community or village, define what constitute the community or village. This will hetp the TCC reviewer understantt the profile of the project srea A village is a group of houses which forms the smallest unit of Local Government. with this, therefore, a group of villages makes up a community ( 6Administrative Structures in the Project Area: STATE LGALCA COMMUNITY COMMUNITY VILLAGEVILLAGE HOUSEHOLDS o o = =Cz = m9 =nf-,-oxsi zn w7 rn w oz a -l -{ ma ( o **"-' Or(smr<>r =r:> -l-Joni rm m { oOr( =ffF =>r1!Brlirm m oO-(<ffF<>r r!Bdrm m oO-( =frF<>r -i1->f,-.|o ni -Lm m oO-(sfnr3>r =l:> -.1{o ni -rm m .C= .q EI o .:] o :!l CI ,:E! r.i :t ! ,:l-l'' ,'E--'r: )r-r.r i..? i ,-' ,,'1?, " ''t. - -la*'-.t "1 f 1' j le:.. :.:*..' '-i ;:..i, , :,1 i -.--'i i:)'.\ :.i-tr-i: ' ..!),/-- , '.i' { t',,- t oOr(smr <>r =|:>J-to ni rm m
t7 ( SE,CTION 2 The overall strategy for the control of onchocerciasis through chemotherapy revolve around the implementation of community-based sustainable programmes for the distribution of mectizan to all individuals either infected or at the risk of infection. Emphasis is therefore placed on establishing Ivermectin delivery programmes in which the primary responsibility of obtaining the required Mectizan, distributing it to the at-risk population, supervising the activities of the CDDs and keeping relevant records is that of the communities themselves. In addition, the communities are responsible for taking decisions on selection of CDDs, remuneration method of distribution, month[s] of treatment and remuneration of distributors, [see table 7,2,3 &.4f. Training of staff involved in CDTI implementation was conducted at three separate levels. These are: til The state level training for the SOCTs tiil LGA level training for LOCTs and District Health Supervisors [DHS] [iii] Community/Village level training for Community Directed Distributors [CDDs], Village Health Committees [VHCs], Assistant District Health Supervisors [ADHS] arrd local leaders. In other words, whereas the state and LGA level trainings are for TOTs, the community/village level trainings are for CDDs and Assistant District Health supervisors [ADHS]. In all the States, 12 SOCTs were trained [i.e. 4 SOCTs per state]. Table 5,6,7 & 8 show training of different levels of staff involved in CDTI implementation. { wr rn =T'zf, =mh= ;{zO Eq E8rn{TD:O@zrn u, rnil#tsa? o(0113 = (O(O 19 m z. z m P m(D oz z q) I mzC oc N \(,l5 (o @ _\ O)(,^) N) -t Is -1, N \(rt5 (o @ J O) o) 1\) Ju{(Il5 (o @ -\ O)(-^) N) -.r J5 J N -Ol @N (oo(o O)o N) -tb! -L b@{ (rt(o .5 G) @ _\ (,t -1,T\) N \ Ol5 (O @ .-\ o) o) N) J Is I b,{ O) O) O) @ o) --l(o o,l\)(o 1 a 1]ffi luffi @ tffi lh'1ffi FIG. 1 a UJ(,IJ =TL o oz IMPLEM NTATION OF CDTI tsEPT. 1998 - FEB. 1999t tN EN/AN/EB. STATES 3,000 2,500 2,000 1,500 1,000 500o (, 0 ABCDE KEY: A,B,C,D,E,F,G, REFER TO TABLE I FG 1. r- t{o{ r ztzC rn a) --t CNoC € z zx zC =rn@{ co mzC z. o,Cxx oq, o I m -{ -{ mN m G)C C C, oc- T m n € oC oq, o I mN rn z oT{T =m -I -f5I @ N I5 O) -tN _\ (rl(, @{ (o(o --r--rI\) -l5 N) s G) (,rN-l-Ao) (.^)(o -l .ssI @N -.A .r o, --\N -.L (Jl(rt @{ (o(o -l-\N 5G) -1,-r.G) G)(o (Jl1\) I5 N) J ,A5 -L @N -\,sO) -\,\l --1, (rt(Jt @\l (o(o .-.1 -l N) .J,s 1\) 5 G) J. J. G) G)(o (JtN J o{ J @ O)@N -J,\| --\ s(rl @N (o(o -\-\l\) --ls N) 5 o) -AJ G) G)(o (Jt I N 5 G) \l--t O)@ G) -t G) o, s(o (,to, o)N J(,r (,l.r N 5 @N) I 5 O) -\, --l I (,t(rl o{ (o(o III\) 5N sG) -\-\G) o)(o (JlN) (') N(o (rt N (o @ -Lo -\, l\)(n t\)(o s(.r) (rrI @s .-\@ _.1@ -I@ G)1\) -l (Dr m !Y =! rn =rnZ{ { o z- o -Tt o(f{ a rn1'{ m =tD rn? (o(o @ I =5 (O(o 19 =razC oC Ut{ { rn T.s gd llF'* liffi IIF;tslriiii;; ffi ffi (FIG 2 IMPL MENTA NOFCDfl TSEPT. 1 - MAY 1 IN EN GUS TE 1,200 1,000 800 @ UJ() JJ S TL o u ulo E :)z 600 400 200 0 A BCDEF KEY: A,B,C,D,E,F,G, REFER To TABLE 2 G nl q I I-{ w rn !f 1' rn =mz{ { oz o .Tt o o -l a rII1'{ rII =TD m? (o(o @ f =5 (o(o 19 = z =IDv a{ d rn 7.g {o{ r € r @ oC -{I o7c u, a oC{I rnrc oz{aI z o7{ - z u,x m U){ o m r z o7 -{I mx €Ca o o =tr zz m E z ox{I o7C u, z oa{I oc + o) G)N o)(.) N \lo @(rl (Jt5 -1,5 .-l.\l -\-I(.Il N)O) (l)(,r (,O) (oo (oo {o @(Jt (Jt5 J,5 -1,\l -I-A(Jl No) G)(}t G)o) (oo (oo ct)(..) N) {o @(,t (Jls Js .l! J.J(Jl No, G)(,t o)o) (Oo (oo o)N N) {o @(rl (,ts .-\,5 J\l Jo(,t No) o)(Jl G)o, (oo (Oo G) @ -l .s ! 5o l\)s @ -\o @(Jt Jo) l.ol\) -1,@ (Jlo o)--\ ct) G)N {o @(rl (,ts -A5 J{ --.\-\(rl N(D (.^)(rl G)O) (oo (oo (.,{fo s\l s(, o)N) (Jl (.l) @@ @ G)G) No (Jlo s@ I FIG.3 IMPLEMEN TION OF CDTI TSEPT. 1998 . MAY 1999 IN ANAMBRA STATE U) TIJ(, =TL o oz A BCDEF KEY: A,B,C,D,E,F,G, REFER TO TABLE 3 G ).e 700 600 300 100 {t o filrffic lL+,?* ll$ __tffi {o{ mNN a oC -{ - oz oI -n xT' o z ox --.{I mNN z o7{a o :f oN 7 NN x € o I(o -L _\ G)(o (rl _\ I _\ _\ fC, @ -l I I .r @ _\ --loN (o O) (o O) I -A _\@J IoI\) (o o) (oo) _\(o -A .-\. G)(o (Jt -\ (o @ .J -l -\.5 (o O) .-\(o -\ -r.G)(o (Jt -\ tffi tffi J J J (O @ .A .-\ .-t5 @ J ..Lo 1\) (o o, -\(o -\ I o)(o (rl I (oo(0 (ol\) {O) @(o o)s (oo) {S N)@ (rlN)!O) @(o o,s s@ \l-lOr(os (o t\) (O O) (o O) -f(o I -l o)(O (rl I ., ltffir llffi l1''i$i;1 (o co -l .--l5 @ --\ L o 1\) N @ (rl O) tffi {(O { o)5 N(Jl I(o .-.\ o) O) O) CD @ @N { u, rnf =1'r rn =mz{ -.1 =o1Z Se9.; =g@:;frilI rn =TD rn? (o(o @ I =5 (o(O t9 '1,1 ffi iffi llffi _ffi I FIG.4 IMP 1,000 900 800 700 LEMENTATION CDTI ISEPT. 1998 - MAY. 1 9991 rN EBONYI STATE 981 G KEY: A,B,C,D,E,F,G, REFER TABLE 4 a IU o JJ =lJ. o oz 500 400 300 200 100 0 S1 t Y,6 981 1 B 1 A c D E F mf f m F mctof =. fq) 3q) o -!q) mlflc koC .J(o N' (,ls O)o) !N (^)5 ..I (o ! I l\) J --l !.\) CrJ -I@5 (,tio O)o) O)O) (l) -lo (oo -\,_\o -IJ o JoN(Jt Ju N) N)N I \s @ l(, o(Jl(rl { (D rn ST {n z z o o 'Tt -{J. m o -Tl 'n rnv rnz + 1- rn rnr ct) o -Tl @{ 'n 'n z. o mo =o o{ =!t- rn =EIz{ { oz CI' lrn1'J (o(0 @ t = J(o CO ?r w (FIG.5 TRAINING OF THE DI F T LEVELS OF STAFF INVO IN CDTI IMPLE ENTATION IN E B. STATES 8,000 7,000 6,000 o tlJz E5,F J UJz 54, U'E UJ(L tL o J,l oz 000 000 2,000 1,000 0 A B C D E KEY: A,B,C,D,E, REFER TO TABLE 5 B'$E4.H&ae ? lo t { TDt- rnI {v z z o o .Tt { m o 'n .Tt mv rnz{r m rnra o .Tt @{ .Tt .Tt z, or mg z o o{ =1't- rn =rnz{ -{oz =rnzc oc @{ { rn +o+ r CNo IC € z z.x zC € m U) --{ zx zC m @ -t Co mzC z a)Cxx o @o I m -{{ mN m oC Co o(- 7 m7 €oC o ulo mN m zo7{ - z z7 {N O) o) o, o) o, O) o, o, O) o, o) o, .A N(^, (o (o o) J .i J J -\ -\ -1,J -r,.l I .l ..A -.4 -A -\, I ...\ o)(D 5 (rt G) o, o) o) O) o, O) o, o, o) .J .lo o, @ o) Jo -1,o -lo -\,o -.4o -\o Jo -lo Io _(,o Ot(,t l\) G) .-1, _\ @(o G)sN -I(rt .-l -t(o t\) o)(Jl(o G)(os s\l (,^) N)o! @5 -l. @ O) ?,, tr ?FIG.6 TR.AI ING OF THE DIFFERENT LEVELS OF STAFF INVO VED IN CDTI IMPLEM TATION IN ENUGU ATE o tuz d UJzz o U)g. lt(L lr o oz 2500 2000 1 1 ABCD KEY: A,B,C,D,E, REFER To TABLE 6 E ( 't. rL 500 oTC @ z o7I - oC + =Fr z.z m =zo7+I z @v rn U) -{ m(f m r z o7+ - mx =C9. oo ovC @ cl)oC -{ - mrC oz = (t) - zov{T -lo -.| r €x (n oC -t - o) O)O) o)o) o) o)o, o, o,o)o) O) -l .A -1, -l -\ I J .-r J I _T J .-\ -\ J, ,J NJ o)o) o)o) o, O)o, o,O) O) o,o)CD -t,o-to -ro-\o -\.o_\o Jo ..1o-\,o Io J Jo --to (os N)@(o f\)(,t @ (o o -LI\)AO)@ G) _\ O) _\ O) N) -r.l\) o, N) @ A {5(.r, _\ @ @ { TDr rfl : { n Ez z o o -Tt { I rn o .Tt .Tt mv mz{r rn mr @ o 'n CN + .Tt -Tt z or rng =o oJ =1'r rr| =mlzl-t I oz z z =TD n U,{ { rn '1.,s 3a IFIG. 7 TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOL IN CDTI ENTATION IN ANAMBRA STATE 1 800 1 1400 {'-j Z: ,!i 1 1 000 800 400 200 A B C D E Y:A ER TO TAB *rl I ia i* ::: 1Jq -7. ,q ' '':- a' ..-, : -,. -i:,-., -1 I{ IDr rn P {n z z o o .Tt {r m(f .Tt .Tt rnv mz{r m mr @ o ,TI U, -{ 'n .Tt z or rno =o o{ =1'r m =mz{ { oz z rfl tD oz CN{ { rn lmlr{ -a(o(0 @ I = (o(o(o s {o -l r oz o :f mNN @oC -l - 'n x1' o z ov{ J mNN z ov{ - o - oN v NN = €o o 6 - mrC OI5 O) o) o, O) o) o) o) o) o) (o{ J (o -\ -\ .A...\ -\-A -T -\ -1, .l -I -.1 CtrN O) 5 o) o, O) o) O) o, o, (0o Jo -J,o -Io -J,o -1,o -Io -Io Io .J,o NN N)N' J N! --.\ _\ @ -LI\) .s .-l .so (r) N) @ (rl(rt (,^) 5 G)o -A -1,o Nfi T t! (.? FIG,8 IN CDTI STATE 2500 2000 o UJz uFJ IUzz o a) E, u, o. tt o oz 1 500 1 A B C D E B, C,D,E REFER TO TABLE 8 ! ( '1, t5 t 0 -.t -. .: '. .:: TABLE 9: DETAILED BREAKDOWN OF TRAINING ACTtVtTtES (SEPT. 1998 - MAY 1999) SOCT 4 4 LOCT/PHC COORDINATOR 102 66 DHS 85 72 ADHS 85 74 ENUGU CDDS 2,154 3,055 SUB.TOTAL 2,430 3,271 SOCT 4 4 LOCT/PHC COORDINATOR 114 65 DHS 95 65 ADHS 95 66 ANAMBRA CDDS 2,286 1,748 SUB.TOTAL 2,594 1,950 SOCT 4 4 LOCT/PHC COORDINATOR 72 52 DHS 60 45 ADHS 60 45 EBONYI CDDS 2,667 2,222 SUB.TOTAL 2,963 2,369 SOCT 12 12 LOCT 288 184 DHS 240 183 ADHS 240 185 EN/AN/EB CDDS 7,107 7,O25 \ 1 00% 64.7% 84.7% 87.1% 141.83o/. 134.6% lOOo/o 57.9Yo 69.47o/o 69.47% 76.47% 75.2% 100% 41.66% 72.23o/o 75% 75% 82.71% lOOo/o 50% 64% 76% 98.85% T. ,z FIG. 9 DETAILED BREAKDOWN OF TRAINING ACTIVITIES tsEPT. 1998 - MAY 1999I 8,000 7,000 6 000 o tUz4tr.tr!' J uJz64 @ E, tu o- tLao\'] oz 000 000 000 ETarget IActual E% Achievement 2, 1,000 Enugu Anambra Ebonyi En/Ab/Eb. PROJECT t ?, rd \ i-r. _: :;,.- +i i::-: r:-a ii:,j riijt +_E { =u, >mgi @ -ez6 rnE z-F E} >oZ.- =;6=vrt>r EEoizi<; @o{C >c){>m{2doz -og i; al!* 'o AnI 19 -l@o 'o ==D=5c ->zto If(o -.:@m -Q ?, ,1 rnz z m P m(p o z. z. @7 m z.C 6)C Ju{(Jt 5 (o @ -1, o,(r, l\) --r Is -I J.,{(rl5 (o @ I o) o)!\) -I -I5 J o) @ J @ N)s l\)O) { { !\| -L J J, lc I i FIGl O i t: c ru NJ fr o =U) IU(5 i J o -, MOBILIZATION AND HEALTH EDUCATION OF TARGET COMMUNITIESruILLAGES IN EN/AN/EB. STATES' IDP BCD KEY: A,B,C,D,E, REFER TO TABLE 1O Ht,to 2,OOO 1,000 3,000 2 1 500 o A E -{o{ r cNIC € z zx zC € ma{ z rzC m o{ C(f mzC z u)Cx r o u, o I m{ = mN m oC Co oC- a ma €oC o u, o mN m z. on{ - z zx -l 5 @N -Is o) .J.\t ...\ (Jl(rt @\t (o(o --\Il\) -J,s N) 5 o) -1, -A G) G)(o (JtI\) .J 5 @N .Js o) -\{ (Jl(,l @N (o(o IN) -tsN) 5CD .AG) (r,(o (JtN) N o) N) N N 19 l\) t9 G) G) l\) 19 N) N \t { N {{ N \l { { { \t ! { J -A -1, -t -L -L J I A J -\ I -1, -.1 7o rn 8esr3rnc.rz) ==rnx 3Ezr rnNz>g{ooCZ(,n> 17P6t- -^. [Tlcn>rnr r=gs TDC s9 .-r {3ooZi9 (o CO t3 t4t,t r !u J: r,3 FtG. 11 MoBlLlz.A AND HEALTH EDU ON OF TARGET COMMUNITIES I ENUGU STATE 1200 1000 oluN J E o =a UI o =TL o dz 800 600 400 200 0 A BCD KEY: A,B,C,D,E, REFER. TAtsLE 1,i E I i. 'l ,tt E r19OE{+ o1C TD a oc{I mrC oz{aI z ou{ - z u,7 m U'{ o m - z ovJr mx €CI o o =tr .> zz m =zox{ - oTC q, z oa -{I oC{ O)(r) N) N c) @(rl (Jts .-Ls I! -\-\(rl N)O) G)(rl (ooG)o, (oo o) CJl\) No @(,t (,ls .J,5 -I! -L-1,(,l NO) G)(}l q) o, (oo N)s G) I\) co l\) N) I\) t\) I\) N) l\) t\) { { ! N ! ! ! { \t \l N { I J _\ -L J _\ -t -A I J -T { (Dr{mi$o_rn<{o otDOF =N =>?1zo1zfr>U,Z =9!-Prr1;? ={[DJvmDo E5 {{m6 z o .Tt 4r, L3 I rm IFtG.12 :.1 ii [i ; L. iZ.Ji'i-i i-] i'i,& it lr ii :: i,, i."': ii f il U i. ;.;r. i- ' " 1 ' \!- 1_ -:- t:1!-t ''-'r! !./ i .j 1_-., :" ; .i), i\r i..: -:: : COMMUNITIES IN ANAMBR,A STATE 700 600 o UJN J E o =o trt o 5J 5 TL o oz 500 400 300 200 100 0 ABCD KEY: A,B,C,D,E, REFEER TO TABLE 12 E -l Ih {o{ r oz oI mN H a oC --{I t>ITI l=t1llo z. ov{I mN H z on+ - oI o Nfl x €o NN o U, - rnrC (o @ -A -\, -J,5 @ -L JoN (o o, (o o) .-\ G)(o -1,(o -\ (Jl .l -A -I -\ (o @ -\ -A5 @ -I -tol\) (o o) (oO) G)(o (o (Jl.1. .1, .-\, -\, J. @ l\) N I\) t\) N N) N N N ! \ { { ! ! ! N { \l J J I J -L -\ _\ I -A ..1, { IDr rn st' =o tD r N { oz z o - rn t-{r rn oCo { oz o 'Tt -t 7o m{ o o = =Cz{ ffia z m(! oz @{ { rn U, rn1'{ rrl =tr m7 (o @ @ I = (o(o(o 1,tr - -- IFlG. 13 MOBILIZA D HEAL F G COMMUNITIES I EBONYI STATE o IUNJ (D oE o IU(9 JJ =LLo oz A B C ar: ,.i- -: i ,-r ' , D E s c 1, ,-6 1 000 800 600 500 300 200 1 0 i !- 8ti) Project's annual training objective and the percentage of the objective achieved The project's annual training objective is 7,887 persons. A total of 7,589 persons representing 96.2% of the targeted persons were actually trained. Table 9 shows the detailed breakdown of the training activities of each of the three states that make up the project. Similarly, the cumulative haining targets and percentage achievement is also included in the table. The low level of percentage coverage as compared with the project's annual training objective is as a result of series of industrial dispute between labour and government in respect of minimum wage which in some states lasted for months. The industrial dispute disrupted trainings, especially at the LGA, district and village levels. It is hoped that with the strike action now over, there will be improved coverage of the project's training targets. {ii} Types of materials developed and used for training healtlt staff and CDDs. The project also used the APOC approved CDTI training materials such as: 1. CDD training guide 2. Flip chart 3. CDTI Video tape 4. Informationbrochure In addition, the project in collaboration with NOTF, developed and used the following materials: 9a lal Post and Pre-test: These are used to assess the effectiveness of communication of trainers on the course of training, and also an instrument for evaluating the knowledge of the trainees before and after training sessions. Pocket Treatment Guide: This is used as a reference material for LOCTs, DHS, ADHS and CDDs with a view to understanding: til What onchocerciasis is tiil Their roles in oncho control [iii] The CDTI concept [irr] The difference between (iii) above and the system formerly in place ["] Communitymobilizattonstrategies ["i] The new 3mg Mectizan formulation [vii] Treatment techniques and management of side reactions Samples of measuring stick and village treatment registers. Hand bills in local languages MIS forms Blind walk goggles (to illustrate the challenges to being blind) tbl Ic] tdl lel tfl ,t ( {iii} The performance of the CDDs, does the performance of the CDDs indicate they received and understood. important information about their roles? At the start of the trainit1, a pre test was administered to assess the level of understanding of the CDDs. After the hainirr5, a post test was administered to assess the level of assimilation of the training content. The general observation showed a significant level of improvement. l0 The CDDs performance on the field was also encouraging, as there were few erors ln: t Health Education messages I Dosing i Record keeping o Eligibility criteria o Monitoring and management of side effects I Mectizan inventory control In the light of the above, it is clear that the CDDs received and understood important information about their roles and responsibilities The CDDs chosen in most communities appreciated the work required of them and were quite zealous in carrying out their tasks. 2.1. MOBIL TION AND EDUCATION: Successful mobilization and health education are crucial activities, which create awareness of the problem of onchocerciasis at the State, LGA, community and village levels as well as solicit support and patronage of the entire citizens towards effective implementation of the control programme. The ultimate aim is to have a sustained high demand for Mectizan tablets to prevent blindness due to onchocerciasis. Advocacy visits were made to top state and LGA government officials to acquaint them with the problem of onchocerciasis and the need for the government at all levels to support the programme in various (, ll ways. Communities were mobilized with the help of District Health Supervisors and their assistants, the CDDs and members of VHCs. The formal and informal avenues were used to convey appropriate health education messages. Unfortunately, state participation has not been impressive. High level advocacy visit to MOH management (Commissioner, Director General, Director PHC etc.) is required to educate the States on their role in the implementation of CDTI. Some local govemment areas have been quite responsive and most have principally agreed to support the programme and release funds for the project. ti] Provide information on the use of media and/or other local systems to diss eminate info r matio n? Information is said to be effectively disseminated when the message relayed or transmitted has been coded [heard, accepted] and the receptor [villager] elicits a positive response. The channels used for disseminating information in the project varied from community to community and village to village. The methods used were: {a} Electronic media: til Radio: Radio jingles, radio discussions/interviews/broadcast were prepared and aired constantly, especially, during the Onchocerciasis Week observed by the project from lzn 22"d February 1999. Radio stations in all the states and the National radio stations were involved in the mobilization activities. During this period, radio messages were relayed to the public as news inserts or durin g important pro grammes. {. l2 tii] Television- The television was also used, but coverage was limited by lack of electricity in most of the communities and villages. lbl Print Media: Newspapers and magazines were used for mobilization. [cl Local Systems: These are the haditional methods applcable to different communities and villages and relate to varied traditions The local methods include: {i} Town criers: These are persons chosen by the community for the purpose of moving around the villages or market squares with metal or wooden gongs or drums disseminating information to the people. The village or community through their common purse usually compensates them. They move around the markets during the day, but around the villages at dawn or at night. {ii} Churches: The main religion of the inhabitants of the project area is Christianity. There are churches in all the towns and are built through communal contribution. They are usually centrally located and important messages disseminated through the churches reach every household. {iii} schools: Health Education messages are provided through schools during health lessons or drama. Education is one of the valuable assets recognized in the project area. {i"} village/community Heads/Ezes - The head of the village or community, convenes meetings of his cabinet chiefs or other members of the community at regular intervals. Health Education messages are being passed at these meetings. tl3 {u} Village SociaVGroup Meetings:- The project team used social meetings such as Youth Development Associations to disserninate Health Education messages. Tables 10,11 ,12,13, show mobilization and Health education target communities/villages in the project area. {ii} Are you satistiedwith the results of the mobilization efforts? The use of media and other local system of disseminating information were very effective and gave satisfactory results from the target villages. The effectiveness is reflected by the increased commitment of the community leaders and distributors and the high degree of involvement of the communities and their willingness to commit available local resources to the distribution process [see pix I, II, ilI]. {iii} Did target communities/villages respond favourably? The target villages are responding very well to the CDTI approach as a result of mobilization, all the villages have: o Selected one or more CDDs in each village t Paid CDDs transport fare to collect Mectizan from the district centres I Made cash or in-kind compensations to CDDs t Plans to conduct mop-up treatment for absentees i Formed Village Health Committees Some villages also developed workplans for training and Mectizan distribution. {i,r} Suggest ways to improve mobilizafion of target communities. l4 ways to Improve Mobilization of Target communities include: {u} Increased logistic support @articularly motorcycles) for LGA staff participating in CDTI implementation. {b} Provision of bicycles for health centre staff involved in the CDTI implementation to enable them cover the villages more effectiyely. {"} Use of mobile public address system for better outreach of the population. !PIX r CROSS SECTION OF PARTICIPANTS IN AN ORIENTATION MEETING ON CDTI FOR WOMEN LEADERS FROM FIVE COMMTINITIES OF ONTCF{A LGA OF EBONYI STATE ORGANI ZEDBY ONICHA WOMEN DEVELOPKMENT ASSOCIATION.o 4 '-'r C$ I t\ . -< ,'- .r( '-tI ..r\ i r I , -, ! j $ :fl Irt \ | -- -' (i \.;, ... j> 7) IL\ -'i 't' I ;si .: t -$,.2', t!f a tt t'i);- I _i t' I I f .- \ ,n;'d I)IX 2 A CROSS St:C.'l'tON OI; l,n l( Il('tl,n N IS tN A I rrNI) ttAISIN(; CLrl{t:MONY I;OIi Stlt,t,OIt'l Ot, C_DTI tX OLO COMMtJNf|Y, l;,/.|:ACti t- (i /\ t , r\. 'r"& \ \ 4Ll ,L {- q4a. f,; 'Dt t t t 1 .+r[ ,t 'I ,t .\.ri t? I t l.'t F ir ,,\ '1 t t' ?:\. ( It I lPIX3-_-..- COMMUNTTY AND OPIMON LEADERS PRESIDING IN A FT]ND RAISING CEREMONY FOR SUPPORT OF CDTI IN OLO COMMLTNITY $ I 1. t\ j 9'L-',ft T: i\ t i \?..1 (.. I l r r ,1 1- .l ,t t' fn: tr fi- -af $.. t ; t'r 'ir : [' \ I \- ti ti /, t r'- {P\' j\[ *t\\r t il I t{ Y s :li lr t'I .j& 4.rir 'l . \, .f ,+".dt {--.3 . F'{1\I,J .:,, ilo t. D 2 i.ir i 4 I ,3p e. I 1 llll Ii llt,3 't t \,i , *J ?,
(l5 SECTION 3: ACHIEVEMENTS: The project total [census] population is 1,887,514 persons. The number of persons treated is 1,256,840. This gives a treatment coverage rate of 66.59%. out of the total population, 1,475,629 persons were eligible. Based on that the coverage rate (eligible) is 85 -2o/o' {ir} Describe brielly whether the proportion of village/community members who were absent during treatment is higher than upected The proportion of absentees and refusals is lower than expected in all the project areas. This situation is attributed to the aggressive mobilization of the communities, perceived benefits of ivermectin and the high demand for it in all the endemic villages. In addition, the ability of the communities to recognize problems with distribution methods and modifu the methods accordingly contributed to low absenteeism recorded so far. {"} State the most common reasons for absenteeism For those that are absent dunng treatment, the most common reason glven by them is "farming activity" which keeps them away from the community during distribution period. {"i} Suggest what actions need to be taken by the proiect to reaclt absentees and defaulters during the next treatment and if any constratnts might prevent their tnclusion- There is need for the villages to adjust the distribution period in line with their tradition to avoid clashing with the farming season. Where this is not l6 possible, iurangement should be made to treat absentees/defaulters in the farm settlements. There are also some people who refuse the drugs for some reasons. For this group of persons, continuous education and mobilization is suggested z@7 mzC oC {o{ t- m w oz --r .-\5 -\ Jr,{ Ots (o @ J o,(.^) N) o)5 -(Jlo)NN (,ls -(,lNs N) ..1 N OTI @5o o) o, -(Jl(o{ o, P -A o) I .J @ I -\\l I N)q) N)N) zF zF !.,{(Jts C') o@(o NN t\) N) .-\ -o, J. l9 -o)o(,l(rt (O @ J, o,(-() N) -\ Is _\ O) N)(o .l C'){ o) o, o, @ G)!(o { TDr rn z* m- =BorCEI D#<< 2,ryE=g2 Efr o-Yzfir<= EH>v{-rIlI to4.0 .G' E: (o(.o .o ( '16. a ll E r)-: L:.= . r-.J _ F-1n ':'1 i:- :i-iil, {o{ CNIC € z z rzc € ma{ z r z.C m a{ C c, mz z. a)Cxx o TD o a m{{ m oC Cg oC- v ma €oC oq, o I mN m z on{ - z 2v 5 @1\) -\5o) -1,{ J (rl(rt @N (o(o -\-1,T\) .-1,5N s CD J -J, G) (r)(o (,tt\) lor5 J,l N)5{ (Jr o)b5o I I <^ll{t-N @o (,tIo .J. o) lN)N -o, o)(,t S _o .J. N) N) s -(o@{(o o, -(Jt @\l (,t @ \ G)(Jt lsj- N)oI\) (,tJ' @ N) @ NJ'(o @ @ 5J'(oo @ P O) I .-L o) I -t(o P .-L5 I N) o, I -J. @ P Js I -\N) P -1,N s) ..J, ! I --l G) s) OJo N N zF z.F zF z.F z.F z.F zF zF zF zF z (^, lblur OI N) G) --l .l @(o G)sN J(Jt J, -L(o tu G)(Jl(o (..)(o5 sN o) T9oN @s J @ o) Ns{ 5 @l\) .1,s O) .-1,{ -L (,r(Jl @! (O(o -lr-lT\) -LA N) s (.l) -.l -IG) o)(o (Jl1\) o)N(o t-l(rr t\) (o@ -Ao -l 1\)(Jt N)(o sG) (Jl-A @5 -l@ {@ -1,@ G)N) { u,F m sf o I ffi zm m= zflf,czo{ t- A7 cnm{T'D-t{mm= =t!Yrnua _t(o(o @ I s I(0(0(o 16 t- Fffi E E - -.i ilffi 11ffi llb-,# liFj ll ii'i " llFiij {o{ O)(, N) G)(,r -l(o -A (,^)s J', O) !l €x C' oC{I !o o7C @ (n oC{ :E mrC @(Jl (Jls lz --{ar z o7{I -Ls ql x m (n{ -\! E m r- z oa{r J -A(rt mx ECa o o N) o) =t F zz rn E z on{ - (/)(rt o)o, oC -{G) z o7{r (oo (oo l(r) .J. \(o(rt l-l-rI- lc.rlo)o -1, _s G) @ o) .J. -t .J, @ N) 5!(o O) G) .-\ @ N)s @ N)s @ T\) G) .A G) sNl\) s -@o -\N) s(o N)(,^)(Jl P N) o) I N)o z zF (Jt(oo ..t{o o, G) N) !o s) -I5 z.F -\o)N @(,t .o N) N) I5(o zF z. - -\N) o) N@ (rts -Ls I o)s zF s o, -LN I -.J(rt zF N)N@ -L -A(,r s) G)(o zF (oo t\) O) s) N) @ z -J,os G)(Jr IA(o I.-t(}t zF zF (os No,s o) O) (o o P -ls zF l\)N @ (o o (,.) (o s{ 5(,I (,tG)N) G) @@ @ (l)o) N)o (rto A@ { TDt- rn 9.'' oI =mz,< >trzs >rnzz6{{oP6@a{{ >rn{=rn6 =mYr rl(o(o @ I = (o(o J9 16j ti @ I { trr m { ;o =m zm m=tDMoz =d2R4ft rri -=(]E urn v (o(o @ I = (0(l'(o {o{ F oz c) - mN N U) oC{ - -n x1' o z ov --.1I mNN Z oT -{ - o - oN n x =o o a, - mrC NN (o @ -\ -l -l .r @ J .-.toN (o O) (o O) -1,o)(o (Jt -A J -IJ J(o -1, (..) O) J,'(o ! Ct) (Jl J -o, .l N) s -.A \(,l (,t -oG)(-l)(Jl (,t _(,l(J)(,l{ G) -(Jl -l @ N) G)(o s o, I J' Jo N) G) -O)N)(rr -'\ (Jl Ju(o N)(,l I .J ! I J.s I .J{ I .J, G) P -As I N) I J. @ Nl\)(o PNo I J. o) zF zF zF z.r zF = z.F z.r z.F zF Nl\)t\) t\) JNN -IJ. @ J.N5 -A5o o)N @ .s(r)o -L o N5t\) (Jt(Jl G) (o @ -\ I Js @-Jt ..-\o N) (o O) COO) -\,co(o (rt I _\ -\ -L _\(o _\, o) O) @ @N !(o {{ o,s l\)(Jl O)O) N)@ (Jto) -\,(o -1, r6. L1 ll ffi ilffi lih#ri ilffi ACHIEVEMENT TSEPT. '98 - MAY'99I COST PER PERSON TREATED Enugu Anambra STATE Ebonyi t6. 5 mzC G)C N{(}t5 mz z m @ m ul oz (o @ J @7 o, o)N --1, -1,s J @ @{ Or 5 (rtN N) @o N) (Jt I\) N)(o o)N \(o -A !5(rt 5{ Ot o,N(o s G) @ N)(o(,t s(r' N (JtN @ (Jt(o(o \(Jl O) ql o, @5o G) o)(rt (o N o) o)s(rt o) no DO (Jls(,t t\)sl\) o) O) irr(o oe o) l^,(o @\oo\ O)I -\:o cr\ o) 9o @ o) s { u,r m -IzPY{FVxm fr -l\rr zm ={ EEm{tD rno=z(D ,vt-lTEti269= .A(o(o J9 t6. 6 ts3 lW FtG. 18 TITEATMENT ISEPT. 1998 - MAY 1999I IN EN/AN/EB. ATES'IDP 2,000,000 1,800,000 1,600,000 o UJF lut.F oz ootr UI o- lL o c,z 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 ABCDE KEY: A,B,C,D,E, REFER TO TABLE 1S 16, + I !, { tDr m -II {7 m { =mz{ FIa m!{ rn =(D m7 -t(o(s) @ {o = .J(o(o J9 =mzC oC a{ { m g 1' { o{ r CNIC = = z.x zC =ma)+ zx zC rn @{ Co mzC zg) Cxx o(D o m{ -{ mN m 6)C Cq o(_ 7 mn =CIC G, u, o mN m z oa -{ - 1z7 O) @ --.1 @ N) Js O) ...\\l -L (Jlo @-.1 (o(o -tJl\) -\.5N) 5G) -\,-r.G) (-^)(o (rlN) @N5o(Jt (Jt J^) @ O)(rl \t J,)(,l 5 @ S Juq) G)s O) .P O)(o o \to s o) @ (o _(Jl I\)@{ { Jo -J, @ N) o)os! G) N(Jlb o,o G) -(rl(rtS N) O) Ju(o l\) --l (,(, -(o(,(o(, 5 J G)(, O')(o O)p --t(rt O) 5 -oo()ts (Jlsbl\) o) G) -\\(Jl -A 5 :.to N)N (rl _o,(Jt G)s ! o) T\' @N o, -(.^)Io -1, SFo(rt J (rl o) -o,{(o l\) -o,G) G)(Jl ls -o)G) o)o G) --.1 _O) @ .s5 (rl G) -s so lG)\l i$oo (JlIo .l G) l\) :J o) o)(,t SI -\NN s Jo @!s O) J,' .-L @ ! (Jl 9o{ G)(Jt s J. i\)o N) (rt J}) @ N)@ N -G)(o @ @ 5 J.l,(oo @ O)I @5 s Io(Jl s O)(o i\r I s O) 90oo s o, sn G)(}t s O) P -.\ -l s !I @ -\,\o o) @ S ..4 s NI L @s O) 90 -r.O) s ! I -J I s o,{s(o s o,(o \ @ s It.8 E iff FtG. 19 TREATMENT EPT. 1998 - MAY 1999I IN ENUGU STATE IDP 600000 s00000 o UJF UJdF @z o U't UJ(L LL o oz 300000 200000 1 A B CD E KEY: A,B,C,D,E, REFER TO TABLE 19 tc. 3 400000 0 -i I t I I 1 : I : z.z m =zo nr -{I o nC @ z ov{I G)C{ { o{ r = i\ CN oC{T o nC G' C' oC -{I mrC oz{ U)I z oT{ - z ul7 rn U){ o m f z ox{T mx =Ca) G) o =tr G) o) (oo (oo o,(, N) \l c) @(,t (rl5 -L5 J! J J(Jt t9 O) G)(rl N) J -J. o,(Jl I _5 @ .rs { -(o(oS(o l.oF @ @(o G) I -o, N J. N) -@(Jl I I\) o, Ju{ @(rl { @ \N o, (Jl N)N(o O) -{ (rtIs(o O) ! !o t\)(rlo (Jl J -o, @o s (-A) _--l(,{ @ o) Jo N)\t J !J' @o(rl s _@ ! (.l) @ -\ -@J(o @ I Ju @ o) G} o) -A -Crt l\)(o l\) Ju{@ o) N@ ssN N) 9o G'(o(,l (,lI(Jl o) o) (rt Ju(o @ G) N)i @N G) Jq) SNt\) .s @ -o I T\) S Jo t\) G)(rt G)s _(Jr O) N) N) G) -(,lI(o o) (Jl ..L -G' o,o o) I \(o(Jl -.-lF G) @ o, _\ _\ I @N s :.1(o o) C^) J -@l\)s @ { o, S! ;e o) N(Jt s Po(o s o)I!o s o) stt o,s s o) -\, Ln N) s o, :(o ! s N -(Jl o) G) s (JlI(o(o s \t 9^, co t\) s { 90(Jt s s :o{ s { TDr m NI {v m { = =EI1Z 7G =trID -YsgAtrts -lma =(oVi -lo .Tt m tD nC v J(o(0 J9 16,10 gt w FtG.20 TREATMENT ISEPT. 1998 - MAY 1999I IN ANAMBRA STATE IDP 600000 500000 o I'JF UJtF az o U' E. IIJ(L TL o oz 4 300000 200000 A B C D E KEY: A,B,C,D,E, REFER TO TABLE 20 ld, rr 1 { o{ r oz c)r rnN N @ oC{I -n x1l o Z ov{r rnNN z o n -{I oI oN v x =o o @I mrC NN (o @ -l (JI -\.1 N) @ol\) I -\s @I Io N) (o o) (oO) I G)(o (Jl -A J -.1I -\,(o I \.1 Ju O)(o N) O) Jo @(rl I\) @I O) o)(rl (o J'(o @s (rt Ju(Jl .1,o o, _@o G) o, -o)oN @ (Jl Ju o, 19s \.1 o, -s -\ .A 5(, !o N)(o(Jt O)N o, @ .l S Jo(o .-\ ! o, J -@ o) O) o, Jo @(o(Jl G) :o --A G) (,tJ'! @ O) Jrt -AS{ o, :oo(o o) J. -o .l .J. O) o) Jrr(o ! o, (rt --\ -o) -\,I\) 5 -t\(,l --\ (JlI(/)(r)(rt (rl _(Jl(-.)(,t _.1 G) Jrt J @ 1\) G)(o 5 o) I J' IoN G) o, i$(,t I (Jl Ju(o N(Jt O) l^,(o @ s \l -t'o o s (rtI ! --l s o) N) so s (Jl po(o o s O)foo s (Jl 90oo s (,t -\s o) s o) 9o @(O s o)I N) o, s { TDr m Ni {v m -tz= mmP=L.' - z'cn AI :{mZ=IH(fv T'J (o(o @ {o = ..l(o(o J9 t.6 , tL o{ !E ,El; o [rJF tuEF (n z o(t) E, LU o- LL o oz FtG. 21 TREATMENT TS EPT. 1998 . MAY 1999I IN EBONYI STATE 600000 s00000 400000 300000 200000 1 00000 A E KEY: A,B,C,D,E, REFER TO TABLE 21 16, 13 0 DCB
s(Iqf,Jo requnu eql ur eseercul ogJ 's8nrp neql lcelloc pue uzld ,{pddeq serJrunuuoc eqJ 'ssocord IJCS eql ol socrnoser Iucol elqulrs^? J[uruoc o] sa8ellrnTsellluntuuroc oqlJo lueuonlo^ur prre sseu8urlp/v\ peseeJcur sr ererlJ ttorctuadns st! puD uognqt4np lo a&nqc alo, o, puD 8nq aq, paflD ot - ssatotd IJO) u1 a1ndtcnnd o, saglunuutoc fo tou ro ssau&u111rr14 {U} eldoed aq] ol se8esseur uor]ucnpg glleeg ]cerroc ene8 sCCJ tsohtr uotlecnpg glpeg (e 'pre8er srq] ul ecueleduoc pelu4suotuep oslu e ?q s(ICIJ yo ,(lHoteur v - slceJJe eprs Jo lueureSeuetu pue BuFolruoyq (p ']ou ro polue4 eq ol segrlenb oq \ Jo Surpuels:epun reelc pole4suouep e^eq lceford eq] q sOCJ 'ecueuodxe rno urorC - €ua]lrc uorsnlcxg (c 'Sursop ^\eu eq] o1 pe1snlpe e^Bq sCICIJ <s]olqe] 8ul E o1 3ru9 ruo{ e8ueqc eq} q}}^r uelo }eq} snonqo s} }I - Bursop tcexo3 (q 'eroJeq ueql papJocer Sureq ,,\{ou eJe sJoxe Jo Jaqunu sso-I - Surdea4 pJoce5 (u :/Y\er^er repun poFed eql Surrnp s€oJe aseql ur sIsBl Jreql lno perxBc scICS ,(uin eql ur uoes eq u?c sseccns srrl] Jo suor]scrpul 'aroJeq perldde ,{3e1e4s uor}nqrrlsrp reqlo ,{ue ueql elqeure}sns puu InJsseccns eJoru eg of punoq sl qceo:dde IJCC eq] lerl] suorlecrpul ore eJeql 're; os oper.u sse_6ord eql uoJC ietsot rlaryt utoltad satltuntauto) ?rfi [q uasorl) nOOJ plp fiioH {f } :NOIIYINSWS'IdIAII II(IJ dO SgSSgN)IVg1!\ ONY SHICNSUIS } NOIIJflS LI 'sJHn oql {q pouuoJuodsrsur eql Suo.u, er, srarsrSer e3e11rn3ro 'urro1ruotr41 .uorleluoueldu, auruer8ord ur polJolur slueur8es [e o] repnUoddo,{roledlcl}red sepl'rord qcuordde IJaf, oql ocms lueuoduo, ..rqr m Jsrss, seellrumrocIllleeq e3e114 erll Sels {l1eoq ew r(q euop sr uorsr^redns q'noqlJy seqsalc {lrunururocJo setur} ur parnsw eq lorru?c eurcrpa4l oq]go ,fiegus eql lnq .s8n:p JIeq]go ,(po6n, .{q o1 ,(ddeq a,n sorlrunuuroc eqJ's.,clJ egl 0l rosorc ore slurod orJr ecurs slurod uorlcorloc urlceuue^r aqror )ceq sprocerysroder Surpuos u sarlrncgJlp ou ore^\ ereqJ .uorl?cr,ue^roJ sprcq e1dr11nru qSnorw ssed o1 ,A?q ,nou,(eqr osnsceq .*?pJo uoruolsppes,ercul sI eraql 'rene"lro11 'uoqnqrrsrpJo poqre{x oql ouruuorep osre {eqJ'so^Ios.,ow,(q rtroqt ]coJJoc p,e s'rup u^\o neqr3lo,,{1rluunb "q, euruuerop'ttou z(aq1 'sseco:d uollnqr4srp eqrJo uorlncoxe pue Buruueld eq1 ur ,{1sa4ceeroru aledrcrped mou {.q1 * lueuJJuJrgJo osuos erou JaoJ sarlrunuruocarrr puu le^e[ pJoqosnoq aqr ol u,*10p.(:olueaur uezr]ce,Al el,rncce puealeudorddu roJ seprlord {3e1e4s IJQJ 'luerueSuu eat rrw\centrJo srrrr3l u, 'e8e11rared pasn Sureq ,&\ou scc3 e1dr11nu eqr Suorue uelqord drqsrepeer pu, '{r1u"rrr Burmor' r(pue:Je sr oreqr .;eaemo11 .ssecord oqr q pe^Jo^ur sc.,JJoJequnu oqr ur osuoJC.rJO rJnseJ e se,,(lrunruruoc e{que orrr uo uorlesuedurocJo uopmq pawercur ]noq, slure;duroc or, erefl 1e,rezno11 .pecueque st eSerenoc pue uorlnqrrlsrpJo oruq arJl solerolocce {lal1ugep sCIOO oro(uJO osn oqJ 'uos:ed euo,(q paro^Oc uorlelndod pue eor, oql pecnpor wq 8I I il9 {iii} Describe the level of involvement of the regional/state and district/LGA governments in the activities tncluding involvement of Sectors outside healtlt in facttitating distribufion If any tevet if government provided funds factual cashJ ond/or materiak towards Implementation of CDTI. It is tmportant to state so and how muclr. Mobilization of states, LGAs and benefiting villages for acceptance, ownership and involvement in onchocerciasis control has been an integral part of the project's routine activities and has yielded useful fruits. The States, LGAs and villages have contributed a total of N816,17O. Details of the breakdown are in table 23. The states and Local Governments apart from approving and releasing fund for CDTI activities, also release their personnel whom they pay salaries and other benefits. Similarly, benefiting communities nominate their indigenes as CDDs and also provide fund for their transportation and stipend for distribution activities. Also, other community-based NGDOs like the Sudan United Mission tStIM] of the Netherlands and local,radio stations at state level support CDTI in training, community mobilization and monitoring of disfiibution activities. l- {i"} {1} wtat do you consider the major achievemen* of the projecL Treatment. The project heated 1,256,840 persons within the period under review. Training: During the period 184 Locrs, 195 DHS, lg5 ADHS were trained. In the same period, 7,025 CDDs and 341 Tors were also trained to lay a shong foundation for CDTI take off in the project. Mobilization: 2,754 villages were mobilized during the period Evered by this report. {ii } {iii} { o ogt o-'I s\EE orS;.+<6E taoE-63 oo !tI iI -(!BT5b iciESoQ.so '4. c': a- Ut E' o tr o ot,I, 0, S a. o r o o\6 .A ot ot a.(A 3! ol o3 o of o ooI th ro ,cn ID mzr m lTl 'n< =m6s Stt-zi=a*, m!Ja> ,-=0<gO -tt+<tmdfi ./\ Zalte -t uDr{E}ord .a =' J(o @ I3 {o{ r r- Fo m r c) (n-l i m zNG' boo z J(rlo ooo ZN -9ooo lzlll-. LOoo l= (o olboo z I @ -9ooo z J lllo oOo z _9)ooo z(^, -l .5 o)(,to z I o,(rl(Oo c) z I G) @!(Jt o z JloFlooo z @ G,{ (D OIo lz.5(o _(rl(ooo z G) J _sN(llo lz N) -{ !ooo A9, -a 20 {i"} All communities also provided notebooks for their CDDs and took care of transportation for collection of Mectizan tablets. {"} Increased awareness about Oncho and its treatment was achieved. {"i} Increased level of participation of host villages in CDTI. {vii} Decentralization of the issuance of Mectizan tablets from LGA headquarters to the district. {"} {u} {b} The constraints and the challenges for the next treatment cycle. villages have added responsibilities by involving more than one CDD and the burden of compensation is increased. with more than one CDD, there is the tendency for contention for leadership among the CDDs, resulting in negative consequences for the work. Frequent changes in government leadership, requiring more advocacy visits. {c} ( {"i} Clearly state what types of help you need from: [aJ the government[bl APOC Management [cJ other parties to be able to improve the CDTI process nqt yeor. A From State Government: {i} Non-diversion of project vehicles and equipment should be strictly enforced. {ii} States should demonstrate commitment to CDTI by releasing counterpart funds on time. {iii} -Advocacy visits to the LGAs are required. {i"} State Government should solicit for support from electronic and print media for enlightenment on Oncho activities. 2t {"} They should restrict frequent and disruptive transfers of Oncho personnel at LGA level. B {i} {ii} {iii} From Local Government Area Exclusive use of project motorcycles should be enforced. LGAs should be committed to CDTI by timely release of budgeted funds. Advocacy visits to traditional rulers should be embarked upon. From APOC Management: APOC management should release its counterpart funds on time to the project. Release of project annual funds in two installments will be appreciated. Three new vehicles will be required to run the project. This is because the vehicles earlier provided by Lions Club International are too old and therefore, breakdown very frequently. 120 ADHS will require a bicycle each for effective supervision in their respective districts. For effective supervision, motorcycles will be needed in 5l LGAs covered by the CDTI project. Other Parties: Advocacy visits by the Federal Government to the States will be -necessary. C. {i} {ii} {iii } {i"} {"} D. ti) 22 (ii) Compensation for CDDs by the communities is a major concern. We therefore, expect District and village Health Committees to play a major role in this respect. ( t tAppendix 1ORGANIZATIONAL SETUP organizational structure of comnrunity-Directecl Treatment wiflr lvermectin c orn *r tr. ity-oi.cctect rrcatnre nt wi th lvsrnrccti,(Comntunity Leader(s) Viiiagc Health Conrrnittee, Comnrurrity rncrlbers, CDDs) Collection of l.,lectizirrr fronr LGA ljeacjquartr:rs | ..,t: rrner:tin [Jistri l-lu trcn S u pcn,rsron c I Oonirrru rr rty Drs tribu tron Actl,ritrc:-. It4anaqenten. ()r Arjver':;e Rcaction and re{c:rral FunCs for transl:ort ;rnrj clistribution actrvrties to CDD:; NOCP NOCP Steering Committe . NOTF Procurenrent of Mectizan Policy formulation Fornrulation of National plan Of Action, ivlonitoring, Supervisron ancj Evahtation NGDO Non-Governnrental organization (Country Representative - Global 2000)(Asst. National Director, IVectizan Manager) Collectron of [t/ectizan from Lagos Supervision of State Project Officers and SOCTs [t/onitoring and Ei,aluation of lvermectin Distribution Advocacv arrrl fVot.rihzartion of policv lrlakcrs State Onchocerciasis Controt Team(sfafe coordinator, socr, Director pHC, pHC coordinator) Collection of Drug from NGDO Training of SOCTs, & Operation Research Supervision of SOCTs and LOCTs Monrtoring & Evaluation of ivermectin Distributron Advocacy and Mobilization of poricy Makers, and private sector Local Government onchocerciasis control reanr(LOCTs Leader, LOCT, PHC Coord., Healtlr supervisor. District Strpervisor) Collec.iron of Drug frorn the State Advocacy and l,4oLrrlizatron ol'LGA policy N/akcrs Trarning of cDDs, & ivlobilization of endemic conrmur.rrtres [\rlonitorinq & tvaluation of ivermectin DrstribLrtion Appendix 2 MACRO FLOW-CHART FOR SUPERVISION AND MONITORING OF CDTI ACTIVITIES IN STATE PROJECT NOCP a t t GLOBAL 2OOO GRBP QUARTERLY MONITORING ZONE, STATE, LGAs, AND COMfUUNITIES PROJECT OFFICE MONITORING AND SUPERVISION OF STATE, LGAs AND COMMUNITIES ROUTINE MONITORING AND SUPERVISION OF LGAs AND SPOT CHECK ON COMIMUNITIES VHCS AND COMMUNITY LEADERS AND CDDS GRBP OFFICE, ENUGU STATE ONCHOCERCIASIS CONTROL TEAM (SOCTS) .OCAL GOVERNMENT ONCHO.{ coNTRoL TEA,MS (Locrs) I I Appendik . - FINANCIAL FLOW-CHART OF APOC FUNDS IN EN U GU/ANAMBRA/EBONYI STATES NOCP HEADQUARTERS \l NOTF ACCOU NT SIGNATORIES : WR NGDO CHAIRIUAN NATIONAL ONCHO COORDI NATOR GRBP OFFICE ENUGU PROJ ECT ACCOUNT SIGNATORIES: PROJ ECT ADIV I N ISTRATOR ZONAL COORDINATOR NOCP STATE ONCHO COORDINATOR ENUGU/ANAIMBRfuEBONYI STATE ONCHOCERCIASIS CONTROL UNIT ENUGU/ANAM BRA/EBONYI PROJECT SITES ACCOUNT SIGNATORIES: DIR.ECTORS OF PHC/DC STATE PROJECT OFFICER ENUGU, ANAIMBRA & EBONYI I e T PPendix r COMBINED MAP SHOWINC TREATMENT ROUNDS IN THE THREE SIATES. z ?t\ wfr frlZ C n C ( m EEEUl+vr --r -.i .\)J-J-O7nooA. \J1- \-633 TFI o z zm { 91 mNm oC o(- p F CI z(./rCx7\t z ov -JrZ 6?o C R zC zC 6i-CN o mNN z mNN a x o n! t { !I z { i t.la' .3 .-l