EN uc ,/ANAM BRA/EB"-"& r/NorF/Apoc cD, PROJEGT #I4 AJALI CRESCENT, INDEPENDENCE LAYOUT, P.O. BOX 3027, ENUGU. ENUGU STATE. NIGERIA. 8/FAX: 042-450460; 042-300225, DL: 042-452333 ANNUAL PRO.IECT TECHNICAL REPORT TO TECHNICAL CONSIJLTATIVB COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) COUNTRY/NI]TF: NIGEzuA Proiect Name: ENUGU/ANAMBRA/EBONYI STATES'CDTI PROJECT Year of approval is 1998 SEPTEMBER 2OO2 _ C)CTOBER" 2OO3 DECEMBER.2OO3 Launchins vear: SEPTEMBER, 1998 NGDO Partner GLOBAL 2OOO . THE CARTER CENTER Table of Contents ACRONYMS DEFINITION FOLLOW UP ON TCC RECOMMENDATIONS EXECUTTVE SUMMARY SECTION 1: BACKGROLJND 1.1 General Inforrnation 1.2 Description of the project 1.1.1. Partnership 1.3 POPULATION AND SYSTEM SECTION 2: MPLEMENTA 2.1. Period of Activities 2.2. Ordering, Storage and 2.3. Advocacy And Sensitization 2.4. Mobilization And Health 2.5. Communities' lnvolvem 2.6. Capacity Building 2.6.1 TrainingL.V. t 2.6.2 Equipment and Htrnan Resources CONDITION OF THE EQUIPMENT (Please state) 2.7 Treatments 2.7.1 Treatment Figures 2.7.2 Trend of Treatment to the Current Year Supervision vll 1 2 J J 6 8 l0 10 11 l2 t2 t6 16 l6 i9 19 22 22 Achievement from CDTI Project lnception 2.8 24 25 lll SECTION 3: SUPPORT TO CDTI 3.1 Financial Contributions of the Partners and Communities Other Forms of Community Support 3.2 Expenditure Per Activity SECTION 4: SUSTAINABILITY OF CDTI .. .. 4.1 lnternal; Independent ParticipatoryMonitoring; Evaluation 4.2 Community Self- Monitoring and Stake-Holders Meeting 4.3 Sustainability Of Projects: Plan and set Targets (mandatory at year 3) 4.4 Integration 4.5 OperationalResearch SECTION 5: STRENGTHS, WEAKNESS, AND CHALLENGES 28 28 32 33 37 37 62 65 66 66 67 lv Acronyms African Programme for Onchocerciasis APOC Control ATO Annual 'Ireatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor Community-Directed Treatment with CDTI Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry c,f Health Non-Gov€)rnmental Development NGDO Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary h,:alth care Rapid Epidemiological Mapping of REMO Onchocerr:iasis SAE Severe ad'verse event SHM Stakeholders meeting Technical Consultative Committee (APOC TCC scientific advisory group) TOT Trainer of trainers LTNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organrzation V DEFINITIONS (i) Total populatiou: the total population living in meso/h1per endemic communities within the within the project area (based on REMo and census taking). (ii) Elieible population: calculated as 84oh of the total population in meso/hyper endemic communities in the project area. (iii) Annual Treatment Objective (ATO): the estimated number of persons living in meso/h1per-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper-endemic areas within the project area, ultimately to be reached when the project has reached full geographical coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project. (v) Therapeutic Coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical Coveraee: number of communities treated in a given year over the total numberof meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Village: Immedia,te smaller functional administrative unit of a community larger than a hamlet with village head and made up of many households. .v+f vt FOLLOW UP ON TCC RECOMMENDATIONS The recommendations of TCC l6 on the pro.iect had long been addrbssed. , Statns ol-l'CC l6 Recornurendations; S/N TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT I 1'hc Project to scale r.rp comnrunity self'- nronitoring (CSM Comnrunity self-monitoring villages. has been scaled up to 2.12-5 2 The project to provide clariflcation on the reduction of total population. The internal NOTF evaluation team on census registratir>n for mectizan treatment recomntended revisit of the exercise in thc project because of the high nurnber of absentees in CDD registers. Therefore the project embarked on conrinuous rcvision ol' C DD rcgi stcrs to cl i r:rinatc llantcs ol' rrolt-rcsiclcnts which swell up the population at risk. The latest exercise bronglrt tl-re population to 2.514.986 in 2003. J Pro.iect to give infbrrnation on what lirncls rclcasecl by the state were used on Funds releasecl by the states were used fcrr procurentcnt r.rl' rurotorcycles and other office equiprnent, lirmishirrg the Cl)-l'l ofl'ice. printing of some IEC material; and settlirig the rcnt Iirr office accommodation in the states. 4 Pro.iect to explain who deterrrrines how these litttcls rvcrc' usccl. Furnds are approved arid attached to the recluest. tutilization. released based on thc work ;rlarrr The states tlierelbre cletennine lirtrcl 5 Pro.ject to give the number of ivermectin tablets used in 2002. A total of 5.507,694 tablets were requested lor by tlic projccr. wlrile 4.956.925 tablets were received. A total of 5.544.t371 tablets were utilized 2EXECUTIVE SUMMARY Conrmunity Directcd Treatlnerlt with Ivcrrtrcctin (CDTI) conrttretrced irt Enugu/Anambra/Ebonyi States in October. 1998. The Project cornpleted its f lrst (5years) phase of APOC assistance in September.2003. CDTI activities forthe lllilr ycar collll.nenced in the Proiect with initial advocacy visits to States ar-rd Local Government Policy makers to elicit their respotrse towards supporting various implemerrtation aspects of the programrne. Advocacy visits were simultaneously carried out with targeted Community rrrobilizatiotr at states, LGA and Commur.rity levels. Mobilization was centered on those LGAs that have not been releasing 1r.urd fbr CDTI activities and also for those comrnunities/villages that have not beetr paying their CDDs. A total ol'1.942.356 pcrsons were treartecl li'onr a total population ol'2.513.992. tltLrs givirrg a therapeutic coverage of 77.2o/r. All the 3.408 Hyper/Meso etrdenric villages in the project were treated, thus recording 100% Geographic coverage. The Ultirnate Treatprent Goal and the Ar,nual Treatmeut Objective of the Project were 2.112.582 ald 1.975.013 persons respectively. The coverage rates against the UTG and ATO renrairr 91.9o/o and 98.3%o respectively. A total of 246 out of the targeted 246 LGA stalf (LOCTs and PHC Cortrdinators).981 out of targeted 981 Hr:alth Center staff ancl 7.21 3 out of targeted 8,344 CDDs were trained within the period under review (October. 2OO2 - September 2003). The average population per CDD is 348 pcrsons. A total of 3,408 villages were ntobilized arrd health educated on targetcd areas. All the 3,408 villages selected their CDDs. and as well collected their drr'rgs. wliile all the villages decided on the period of distribution. Allthe 3.408 villages decided on the method of distribution. 'fhe States contributed $2,266, while I-GAs coltributed $10,248 as coLultel'part fiurd lbr the programme. The suur of $10,235 was used by various villages to compensate their CDDs. 1'hc Pro.iect was laced with a lot ol'constraints. which include lirnited number ol motorcycles. Iack of counterpart fr-rnd release by Enugu and Anambra States, and the LGAs. ancl taih"rre ol'many comnrunities to providc colnpellsation to their CDDs. However. the Project was able to overcorre these problerns by the commitrneut ol' the State Team. LOCTs, Health Facility Staff and CDDs. SECTION I: BACKGROUND INFORMATION 1.I GENERALINFORMATION The Enugu lAnantbralEborryi CDTI Project is a conrposition of three sister stqte Pro.iects - Enugu, Anambra and Ebonyi, For the purpose of clarity. the backgrouncl irrlbruratiotr has been separately writtetr according to each State. I.I.I DESCRIPTION OF THE PROJECT A. ENUGU STATE IJpugr-r State is located between 7.10"N and 7.45" N. It is bounded ou theNorth by Kogi ancl Bcnr-rc Statcs. on thc sorrth by Abia Statc: ott thc East by Ebonyi State arrd on tltc West by Anambra State. The topography has two ma'ked zones. hilly or mountaneous and flat zones. The hilly nature gives rise to rapids and water falls that exist in most rivers which fbrnr cotrducive breeclirtg sites for Silltulir'rtrr clantttosttrlt. The bio-climatic zone is rairrforest in nature with annual rainfall betweeu l52and 203 cr-p. f'he cliniate is contparatively eqr"rable arid the temperatul'e ranges betwcen 22.2"C and 36"C. Htulidity is between 78o/o and 95o/o. 'l'he State has l7 LGAs and the State Capital. Enugu, the Coal City, is almost centrally located. The people are of Igbo ethnicity and a predominantly christiatrs with l-ew traces of people with traditional religious leaniugs. The comnlon langtrage is IGBO and ENGLISH. 'fhe chaip of high lands running frorn Awgu, through Udi and Nsul<ka gives rise to llLrmerolls rivers, rivulers and streams which traverse the adjoining lowlands. At lcast Tlohol' the population of Enugu State dwell in the rural areas. Agriculttrrc therelore is the mainstay of their preoccupation. = Communication system: Most parts of the l7 LGAs arr: linked by roads. sotnc ol' which becoure inaccessible during the rairry seasoll. 4= Tlie adrninistrative structure: This confbrms to the State. LGAs, ComuruniLies arlcl villagcs. 'l'hc villages thcrclbrc is thc basic opcrational level and is thc imrrediate smaller functional administrative r.rnit of a community, larger than a hatllet with a village head and nrade up of man households. B: ANAMBRA STATE Apambra State Opchocerciasis Control Programnre came itrto existence in 1989 after the R-EMO assessment sLu.vey conducted in the state showed tliat tlte State was endenric with Onchocerciasis' Treatrnept ip three pilot LGAs took off inJanuary 1995 and was later extended to 16 LGAs in the State. The presept Anagtbra State came into being in l99l when the old Anarnbra State was split into t$'o states. Thc stale sliares boundaries with five other states in Nigeria. nantely. Abia (by the liast). Dclta (by the West), Enugu and Kogi (by the North) and Lno (by the South) States. The state has au area ol- abor"rt 4.416 sq. kn. lt has a semi tropical rain lbrest vegetation. a hur-r-rid cliniate with tenlperatttre ol' g7,'F and rainfall of between 152-203 cm. The Igbo language is the vernacular though English is widely spgken. It has road commrutication networks. The highly fertile area of O.ii and Mantt rivct's are established breeding site for Sitnulium damnosum. Tliere are 2l Local Government Areas in Anambra State with a total popr'rlation of 2.667 .903 accordilg to the l99l population census. lt is estirnated that about 1.4 nrillionpeople living in Anambra Statc ar.e at risk o1'Onclrocerciasis. ttlrMo result conducted in the State in l6 out ol'21 LGAs i1 the state are hyper/meso endemic with onchcerciasis. A total of 1.062 villages in the l(r LGAs have been enunierated ancl needed active treatnrent with Mectizan. Only f-rve LGAs lvere found to be liypo endenic that require clinical treatment. Tl-rere are health centres/health posts in every cornnrunity; there are also hospitals in every Local Government Headquarter. The objective of Onchocerciasis Cor-rtrol Programme in Anambra State is to control River Blindness to a level where it ceases to be a public problem throurgh annual distribution of Mectizan tablets. C: IIIIONYI S'I'A-I'E GEOGRAPHICAL LOCATION Ebonyi State is located between longitucle 7'.45'and 8".30'E and latitude 5".40'and 7".00 N of the equator. It is boundecl on the North by Benue State. on the East by Cross River State. on the South by Abia State and West by Enugu state. flie State has a total of thirteen ( I 3 ) Local Governmettt Areas. It has an approximate populatiqn of 1.8 million based on the l99l National Population Cetlst"ts Estirnate. There are over six different dialectic local languages in the State. However based ou the population update/regislration of CD-fl comtlutrities. there are about 700.000 persons living in onchocerciasis endemic villages in the state' CLIMATIC LANDFORMS AND VEGETATION Ebonyi state consists of rugged and urrdulatir-rg larrdfbrms in South. which tapers to a tablelancl with interprittept cscapement of the Ce:ntral and North Zones. l-he Cross River terrailr is rrrainly atl alluvir.rm tableland. which favours most agricultural activities. T5e vegetatiop arrangement consists o1-mangrove lbrest sparsely distribr.rted around tl-re Cross RiVer basin of the boundary of the State. with a mixture of the deciduous and evergreen type ol' trees. 'l'hc topography consists of undulatinll elevation ol'approxinrately 500m above sea level in the Sottth atrd extends to the rugged terrain of tire central. 'fhe Northern part is charactet'rzedby uni,ibrtrr lattdscape with intermittent escapemetlt. l'he Cross River terrain is r-nainly an allr,rvia tableland. whicli favours rnost agricultural activities. There are l0 CDI-I LCAs in the State consisting of 2 hyper and tl lllcso- cnclcnric. nlroc luncl tbr CDl'l inrplcrncutation in Ebonyi Statc is bcing jointly rcceivcd along u'ith Enugu atrd Anambra States. 1.1.2 PAR'TNERSFIII' A: ENUGU STATE Partners irtvolved in Project iurplenierltzttiotl itrclude: al APOC (External Donor) bl Global 2000 (NGDO) c] Health services at Federal. State and Local Government levels d] Oncho affected conlmunities/villages All the partrlers are harmoniously working togetl-rer to achieve the APOC objective ol' establishing effective and self sustainable. community directed ivertnectitr treatlllellt throughout tl-re endemic areas in the geographic scope of the project. Planning. supervisiott- advocacy apcl mobilizatiolt are carried out by the various partners at specific levels. Furthcrrlore. all partners are in one way or the other responsible fbr the following: I . Procuremerrt and storage of iverniectin 2. Tirnely delivery of iverttrectin to the Central Point 3. Provision of appropriate inlbrmation on CDTI and the need lbr its lotlg-tcrttt sLlstenal'lce 4. Promotiotl of involveureut and ownership of CD'II 5. Mobilization/health educatiorr o1'communities to participants irr CDTI 6. Training personnel involved in ivermectin distribution 7. I)rovisiou of targeted minir.rruru aud regular supervision at all levels. Meapwhile. there are plans to identify credible NGOs (such as WACOL, GHARF). CBO ancl individuals that can assist in CDTI implemer-rtation in the project. Enr.rgu State has cornnlellced discussion with the partnership fbr transforuration of Flealth System (l'A'l'llS). w5ic5 is a subsidiary of the Depalturent lbl Interuational Developntent (DFID) lbr possiblc assistattce in mobilization. Plan to nrobilize Statc/LcA clccisiol prakers. NGDOs. NGOs, CBOs, is irtch.rded in the clcvclopecl sr-rstainability plan of the proiect. B. ANAMI}ITA STATE Partners involved in project implementatiou are: . The State Ministry of Health - the State Governor has been actively involved in CDTI programme. all executives. top firnctionaries and top management staff at Statc arld Ministry level. o Local Government'fop firnctionaries and stafl. Respected and Opinion Leaders in the commturities; I National - National Prograrnme on Onchocerciasiss Control, Zonal Onchocerciasis'l'ask Force: a International - African Program fbr Onchocerciasis Control led by World Health Organization. the Lions Clubs Internatioual. District 404 artd Global 2000 Rivcr Blirldrlcss Prograurme. Ovcr:rll Workinq Relatiqnship Anlonq Pn rtncrs : The Anaprbra State CDTI/fvtinistry of Health staff works through partnership with Local Govegtntent Area staff and iocal communities member in the Planrring, orgatlization. supervision and distribution of lvemrectirr to all endemic communities usitlg inlbrmation. educatiol and comrluutication techniqure to iutprove the prograurme. At tlie National level. tl'rc Zonal Oncho Control Task Force and the National Oncho Control prograrn work closely with Anambra State in rnobilization, sensitization, monitoring and supervision of ender.nic villages to solicit fbr their support and cooperation. C. EBONYI STATE 'l-5e partners ipvolved in CDl-l implemenlation are the Ministry of l-lealth. Local Govcrtltrlcut At'cet and villagcs levels ipclude APOC. Governurcrir. sol11e local NGDOs and the comurunity/village with Global 2000 asthe supportingNGDO. ln Et',,,,iJ,i State, tl-re Project is beingassisted by the Sudatr Ulited Mission of Netherlands in drug distribution and community mobilization. 1.2 8 There has been a harmonious working relationship between the partners with each tunclerstanding her roles and lier expectatiotrs. Planning. supervisiorr. advocacy ancl nlobilization at all levels are carried or.rt by the various partners. POI'ULATION AND HEALTH SYSTBM A. ENUGU STATE Enugu State. according. to the NationaI Popi,lation Cornrnission (NPC). has an estittlatccl population of 2,680,439. About 7loh of the population of the State dwells in the rural areas where onchocerciasis is prevalent. The number of people registered for iverurectiu treatttretlt in 2003 stood aL 961,940. l-lowever. this lrgr"rre is continuously being reviervccl througlt revision of CDD registers to eliminate registered abroad members. The inclusiott ol'tlott- resiclent members of the communities in CDD registers reuders the nutuber of at-risk population invalid and unreliable hence lias rregative effect on therapeutic coverage. The Health System performance in Nigeria was ranked l87thatnong tlie 191 member states b)' the World Health Organization (WHO) in 2000. In Enugu State. the health systenl is based on Priprary Health Care (PFII)). The State Government urpholds the systenr as the ntaitt loctts ol' governnlent interveption for meeting the health care needs of tl-re majority o1' tlie peolllc without uncler rating the inter-linkages with secondary and tertiary health care levels. l-hc PLIC systern operates a1 state. local governmenl. district and comtrtunity levels. hetrce tlte iptcgration o1'oncliocerciasis control activities into the systeut. At presertt. thc state has 792 hcalth lacilitics. which includcci 207 Pl'lCs. 38 SI-lCs and threc I'}llCs. Thc tron--gt.rvcrtrtltctttal voluntary agerlcy facilities are 12. while private ones are 532. The state CD'fl Pro.iect utilizcs about 335 of these existing healtli facilities ANAMBITA STATB Anambra State has an estimated population of 3.119,880 persons. There are2l LGAs in the State.4 are hyper endemic. l2 rueso ancl 5 are hypo etrdemic. 'l-here arc also 1.062 r'illagcs with a population of 899.136 persons in the l6 LGAs of hyper and ureso endetlic areas. 'l'hc licalth systcnr of Anarnbra State is ,-l on Priurary l{ealth Care (PHC). 'l'hc govcrtllllcrlt upholds the system as the main focu i'government intervention for meeting tlie health neecls B. Iof the people of the state at all levels. hence the integration of onchocerciasis control activitics into thc hcalth systclll. C. BBONYI STATE 'l'here are 13 local governrnent areas in the State. fwo are Hyper endemic. eight are tneso etldenlic. while three are hypo endemic. The total popLrlation of the 973 Meso/Hyper villages irl the ten(10) CDTI LGAs is 653.910 persons. In t[is report. a village means the lowest organized settletrtent structure with deflned leaclersllill structure. lt has households as the lower level to it and community as the next leadership levcl. T 1.2 Population and Health System Table 1: Gommunities and population at risk in the entire project area whether they are treated or not during the reporting period State No. of CDTI Districts/LGAs in the entire Project Area Total Pop. in the entire proj. area Number of communities/villaqes in Population of Ultimate Treatment Goal(UTG) Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proi. area Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proj. area A1 A2 A3=A1 +A2 A4 A5 A6=A4+A5 NUGU 15 961,940 638 735 1.373 484,910 477,030 961,940 808,030 CNAMBRA 16 899,1 36 780 282 1,062 686,1 55 212,981 899,1 36 755,274 BONYI 10 653,910 733 240 973 483,942 169,968 653,910 549,278 TOTAL 41 2,514,986 2,151 1,257 3,408 1,655,007 859,979 2,514,986 2,112,592 Source: National census CDD\/ others, specify Year. 2003 UTG = calculated in the maximum numer of people to be treated annua y in meso/hypet endemb areas within the prcjecl area ultimately to be reachecl project has reached fullgeographic coverage (normally the project should be when expected to reach the UTG at the end ofthe 3rd year ofthe project) lf you are using the term comrnunity or village, define what constitutes the community or village. This will help understand the profile of the Project Area Any other information of interest to programme. 9o. Table 1: COMMUNITIES AND POPULATION AT RISK IN ENUGU STATE S/N CDTI LGAs Total Pop. Number of communities/villages in Population of Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proj. area Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in t-e proj. ari 1 ANINRI 71,728 0 70 70 0 71,728 71.728 2 AWGU 80,207 0 131 131 0 80,207 80,207 3 ENUGU EAST 50,016 31 0 31 50,016 0 50,016 4 EZEAGU 83,430 0 120 120 0 83,430 83,430 5 IGBO-ETITI 60,618 0 100 100 0 60,618 60,618 6 IGBOEZE NORTH 69,506 49 0 49 69,506 0 69,506 7 IGBOEZE SOUTH 54,328 89 0 89 54,328 0 54,328 I ISI-UZO 61,542 41 0 41 61,542 0 61,542 I NKANU EAST 64,1 1 6 136 0 136 64,116 0 64,116 10 NKANU WEST 62,378 142 0 142 62,378 0 62,378 11 NSUKKA 68,690 77 0 77 68,690 0 68,690 12 OJI RIVER 51 116 0 62 62 0 51 ,1 16 51 ,1 16 13 UDENU 54,334 73 0 73 54,334 0 54,334 14 UDI 62,182 0 172 172 0 62,182 62,182 15 UZO.UWANI 67,749 80 80 0 67,749 67,749 67,749 TOTAL 961 940 718 735 1,293 552,659 477,030 961,940 gb. Table 1: COMMUNIT]ES AND POPULATION AT RISK IN ANAMBRA STATE S/N CDTI Districts/LGAs in the entire Project Area Total Pop. in the entire project area Number of communities/villages in Population of Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proj. area Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proj. area 1 NJIKOKA 47,968 45 0 45 47,968 0 47,968 2 IHIALA 70,801 45 0 45 70,801 0 70,801 3 AGUATA 89,217 90 0 90 89,217 0 89,217 4 ORUMBA NORTH 58,572 0 90 90 0 58,572 58,572 5 ORUMBA SOUTH 60,576 0 65 65 0 60,576 60,576 6 AYAMELUM 56,242 0 54 54 0 56,242 56,242 7 AWKA NORTH 37,591 0 73 73 0 37,591 37,591 B AWKA SOUTH 37,060 65 0 65 37,060 0 37,060 I oYr 49,557 50 0 50 49,557 0 49,557 10 IDEMILI NORTH 81,888 115 0 115 81,888 0 81,888 11 IDEMILI SOUTH 38,028 80 0 80 38,028 0 38,028 12 NNEWI SOUTH 70,813 105 0 105 70,813 0 70,813 13 DUNUKOFIA 33,780 43 0 43 33,780 0 33,780 14 ANAOCHA 56,'1 10 76 0 76 56,1 '10 0 56,1 1 0 15 NNEWI NORTH 77,420 35 0 35 77,420 0 77,420 16 EKWUSIGO 33,513 31 0 31 33,513 0 33,513 TOTAL 8991 36 780 282 1,062 686,155 212,981 899,136 9.c Table 1: COMMUNITIES AND POPULATTON AT RISK EBONYI STATE S/N CDTI Districts/LGAs in the entire Project Area Total Pop. in the entire project area Number ojI communities/villages in Population of Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proi. area Meso- endemic zone in the proj. area Hyper endemic zone in the proj. area Total in Meso/Hyper endemic zone in the proi. area 1 IKWO 116,921 89 14 103 95,020 21,901 116,921 2 IZZI 86,802 76 35 111 59,848 26,954 86,802 3 OHAOZARA 57,347 28 68 96 17,778 39,569 57,347 4 ONICHA 72,934 30 76 106 19,693 53,241 72,934 5 EZZA NORTH 59,386 96 0 96 59,386 0 59,386 6 EZZA SOUTH 42,945 81 0 81 42,945 0 42,945 7 ISHIELU 74,183 88 23 111 57,040 17,143 74,183 8 EBONYI STATE 54,813 84 22 106 44,747 10,066 54,8'13 I tvo 38,082 61 0 61 38,082 0 38,082 10 AFIKPO NORTH 50,497 100 2 102 I,Q AN? 1 o'01 50,497 TOTAL 653,910 733 240 973 483,942 169,969 653,910 Source: Natcnal CDD .,/ Others, specify Year: 2003 9,d . r0 SECTION 2 IMPLEMENTATION OF CDTI 2.1 Period of Activities Tl-re period of activities beir-rg reported is between October. 2002 and Septernber. 2003. The actir,'ities implemented include: (a) Mobilization/Health Edurcation ol'commutrities (b) Advocacy visits (c) Training of LOCTs. DHS. HF-S. and CDDs (d) Drug distribution (e) Monitoring and supervisiott (t) Procluctioltol'lECtnaterials The period these activities were implemented is as attached by the various states in Table 2. r0 Table 2: TIMELINE OF ACTIVITIES FOR THE AREAS TREATED lN THE CURRENT YEAR. Comments: 40a, State No. of LGAs Mobilization of communities Traininq Census Update Druo Distribution Supervision Starting month 3ompletior month Starting month 3ompletior month Starting month ompletior month Starting month )ompletior month Starting month Completion month NUGU 16 October Sept. February Auqust January October March Sept. January Sept. ANAMBRA 16 January December January Mav October January January December October Sept BONYI 10 October Sept. January April April Sept. January Sept January Sept. -II Table 2: TIMELINE OF ACTIVITIES FOR THE AREAS TREATED IN THE CURRENT YEAR. ENUGU STATE DistricULGA Mobilization of communities Traininq Census Update Druq Distribution Supervision Starting month Completior month Starting month ompletior month Starting month Sompleti, month or Starting month ompletior month Starting month Completion month ANINRi Oct.02 Sept. 03 Feb. 03 Auq. 03 Jan. 03 Onqoinq Nov. 02 Onqoinq Jan Sept. AWGU Nov. 02 Nov. 03 Sept. 03 =NUGU EAST Jan. 03 Jan. 03 Mar. 03 :ZEAGU GBO-ETITI GBOEZE NORTH IGBOEZE SOUTH SI.UZO Oct.02 Nov. 02 3-Jun 3-Jun Onqoinq Nov. 02 Jul 03 \KANU EAST Nov. 02 Feb. 03 Nov. 02 Seot. 03 Auq. 03 NKANU WEST NSUKKA OJI RIVER Jan. 03 JDENU Auq. 03 Auq. 03 Ongoinq Feb. JDI UZO-UWANI Nov 03 Nov. 02 Jul. 03 Jul. 03 Ongoing Mar. 03 Mar. 03 Sept. 03 Jan. 03 Sept. 03 io b. "loc. Table 2: TIMELINE OF ACTIVITIES FOR THE AREAS TREATED lN THE CURRENT YEAR. ANAMBRA STATE DistricULGA Mobilization of communities Training Census Update Druq Distribution Supervision Starting month 3ompletior month Starting month ompletior month Starting month ompletior month Starting month month Starting month Completion month NJIKOKA JAN DEC. JAN. MAY OCT. APRIL JAN DEC. OCT. Sept. 03 HIALA CGUATA SRUMBA NORTH CRUMBA SOUTH AYAMELUM AWKA NORTH AWKA SOUTH oYr DEMILI NORTH DEMILI SOUTH NNEWI SOUTH I DUNUKOFIA ANAOCHA \NEWI NORTH EKWUSIGO r^--t^a:^- lo d. Table 2: TIMELINE OF ACTIVITIES FOR THE AREAS TREATED lN THE CURRENT YEAR. EBONYI STATE DistricULGA Mobilization of communities Traininq Census Update Druq Distribution Supervision Starting month nmnlafiar Starting month lnm nlafiar Starting month ompletior month Starting month ompletior month Starting month Completion monthmonth rt r r PrsLrvt month KWO OCT. SEPT. JAN. APRIL APRIL SEPT. JAN. SEPT. JAN SEPT. ZZI 3HAOZARA CNICHA EZZA NORTH EZZA SOUTH ISHIELU =BONYI VO qFIKPO NORTH il 2.2 Ordcring, Storagc and dclivcry ol'lvcntrectin Mectizan applied for by: MOH UNICEFwHo i] E NGDO E Mectizan ordered for by: MOH Mectizan delivered by: wHo n uNrcEF E NGDO V wFro [] UNICEF' EMOI-I NGDO The State Project submits mectizan requirenrent to Global 2000, whir:h collates requests fl'onr otlrer' projects under its control. Global 2000 orders fbr mectizan, collects and delivers them to thc Enu-{ur/Anambra/Ebonyi CDTI pro.iect where they are stored temporarily for tl-re states to collect their quota as and when required. The LGAs collect from states based on requests and the FLHFS collect fronr LOCTs from where the corninunities collect their requirernents. The Flealth Care Personnel at Heillth Facility level come to the LGA to collect their drug requcst lbr the commruriLies under their control. while tlre LOCTs collect tl-reir allocation from the state. Besidcs, health service statf at state, LGA and liealth facility undertake advocacy to public ofI-rce liolders ancl conrmunity leaders. Health staff'also organize targeted training and mobilizalion, provide targeted monitoring and supervision. determine annual mectizan requirement and collect requrired nrectizan tablcts fronr higher level. lt V 2.2 Ordering, Storage, and Delivery of lvermectin Table 3: MECTIZAN INVENTORY State Number of Mectizan Tablets Requested Received Used Lost Wasted Expired Returned NUGU 2,262,000 2,262,000 2,240,852 0 0 0 21,148 qNAMBRA '1,904,000 1,904,000 1,903,691 0 309 0 0 BONYI 1,634,000 1,634,000 1,621,776 0 0 0 12,224 TOTAL 5,900,000 5,800,000 5,756,319 0 309 0 33,372 ll d- Table 3: MECTIZAN INVENTORY ENUGU STATE LGAs Number of Mectizan Tablets Requested Received Used Lost Wasted Expired Returned ANINRI '175,000 175,000 174,223 NIL NIL NIL 21,148 \WGU 175,000 175,000 174,958 NIL NIL NIL 0 ENUGU EAST 105,000 105,000 104,007 NIL NIL NIL 0 EZEAGU 175,000 175,000 174,527 NIL NIL NIL 0 IGBOETITI 140,000 140,000 139,639 NIL NIL NIL U IGBOEZE NORTH 170,000 170,000 169,748 NIL NIL NIL 0 IGBOEZE SOUTH 140,000 140,000 139,667 NIL NIL NIL 0 rsr-uzo '165,000 165,000 164,872 NIL NIL NIL 0 NKANU EAST 140,000 14C,000 139,571 NIL NIL NIL 0 NKANU WEST 140,000 140,000 1 38,1 06 NIL NIL NIL 0 NSUKKA 180,000 180,000 179,927 NIL NIL NIL 0 OJI RIVER 105,000 105,000 104,872 NIL NIL NIL 0 UDENU 150,000 150,000 139,960 NIL NIL NIL 0 UDI '145,000 145,000 139,950 NIL NIL NIL 0 UZO-UWANI 157,000 157,000 156,825 NIL NIL NIL 0 TOTAL 2,262,OOO 2.262.OOO 2,240,852 0 0 0 21,148 " A total of 21 ,148 tablets which were returned to the office, were later used in passive treatment in Enugu North and Enugu South LGAs. tl b" Table 3: MECTIZAN ]NVENTORY ANAMBRA STATE LGAs Number of Mectizan Tablets Requested Received Used Lost Wasted Expired Returned NJIKOKA 91,500 91,500 91,431 0 20 0 0 IHIALA 143,500 143,500 143,483 0 10 0 0 AGUATA 196,000 196,000 196,137 0 34 0 0 CRUMBA NORTH 130,000 130,000 130,082 0 18 0 0 CRUMBA SOUTH 116,000 116,000 115,842 0 14 0 0 AYAMELUM 137,500 137,500 1 37,569 0 26 0 U AWKA NORTH 75,000 75,000 74,990 0 12 0 n AWKA SOUTH 76,000 76,000 75,957 0 10 0 0 oYt 105,000 105,000 104,886 0 21 0 0 IDEMILI NORTH 171,500 171,500 171,425 0 29 0 0 IDEMILI SOUTH 78,500 78,500 78,538 0 14 0 0 NNEWI SOUTH 156,000 1{;6,000 156,234 0 29 0 0 DUNUKOFIA 69,500 69,500 69,359 0 13 0 0 ANAOCHA 125,000 1:15,000 124,847 0 1B 0 0 NNEWI NORTH 153,000 1{;3,000 1 53,1 66 0 25 0 0 KWUSIGO 80,000 80,000 79,745 0 16 0 0 TOTAL 1,904,000 1,904,000 1,903,691 0 309 0 0 4l c. Table 3: MECTIZAN INVENTORY EBONYI STATE t Number of Mectizan Tablets LGAs Requested Received Used Lost Wasted Expired Returned KWO 260,000 260,000 259,310 0 0 0 690 ZZI 212,000 212,000 211,866 0 0 0 134 CHAOZARA 140,000 140,000 138,073 0 0 0 1,927 ONICHA 175,000 175,000 171,009 0 0 0 3,991 EZZA NORTH 125,000 125,000 124,280 0 0 0 720 EZZA SOUTH I 10,000 110,000 108,033 0 0 0 1,967 SHIELU 195,000 195,000 194,673 0 0 0 327 EBONYI STATE 105,000 135,000 103,968 0 0 0 1,032 VO 100,000 100,000 99,564 0 0 0 436 AFIKPO NORTH 212,000 212,000 211,000 0 0 0 0 1,000 TOTAL 1,634,000 1,634,000 1,621,776 0 0 12,224 I I I lt d. I2.3 t2 ADVOCACY AND SENSITIZATION Advocacy ald sensitization represents an iurportant activity in CDTI itnplet'ncntation irl Flugu/Alambra/Ebonyi pro.iect. During the period under review, advocacy visits were made to the Permanent Secretaries in the Health Ministries. Also in conjunction with the Directors ol'pLrblic Flealth services, the project made advocacy visits to Flonourable Contmissioners lbr I-lealth. Ip Epugu State, in the colltparl), ol'Global 2000 Progranlllle Administrator, a top lcvcl advocacy visit was made to the State Deputy Governor on the need for the State Government to continue sllpporting the state CDTI activities. especially at this tirne that APOC has ceased their slpport to the state. In Anantbra State. sr,rstainability evah-ratiou teattr visitccl thc Secretary to the State Goven1l11ent. while tlie Execr.ttive Goveruor o1'Ebonyi State was visitccl by similar teaur. At the LGA level. advocacy visits were urade. At the community, sonle tielvly electcd traditior-ral leaders have been sensitized including some inf'luential comntutiity nrctrlbers. social leaders and conrrnunity based organization on the need to continue participating ancl sr-rpporting CDTI activitie's. Tlie high level advocacy and sensitization carried oLrt vl'ithirl tltc period under review has contributed to the state, local and community meurbers agrceittg tt-r support CDTI at these levels. MOBILIZATION AND EDUCATION OF AT-RISK COMMUNITIES Successlul targetecl mobilization and health education were r:t'ucial activities which createcl awurcpcss of t6e problenr of Orrchoccrciasis at the state. conlniunity and village lcvels. as rvcll as solicit sLlpport and patronage of the entire citizens towards eflective iuplementation o[.the coltrol progral-nme. Tlie ultimate ainr was to have a sustained high demand 1br lllectizilll tablets lbr prevention ol'blindness cluc to onchocerciasis. Advocacy visits we rc tttaclc to top State apd LGA governrnent officials to acquaint them with the problent of onchocerciasis and the need for the govenmlent at all levels to support the programme in variolts wa\/s. Coltmulities were mobilizecl with the help of health stafl'. CDDs and membcrs of' VIICs r.rsipg lll available avelllles both lbrnial. inlbrmal and appropriate health eclttcatiott l'llcssagcs cgpvcyccl by use ol- varicty ol culturally-relcvant media. Mobilization sotrtctitncs targctctl women and minority gt'oups so as to sensitize thern for effective participation. 2.4 t2 I. IJ MEDIA/CHANNEL OF COMMUNICATION 'l'[c chapuels usccl lbr clisscmirrating irttbrmation itr tlie project varied h'ot-lr conrrntttritl' l.tr conrmunity and village to village. Tl-re methods r.rsed were: ELECTORNIC MEDIA: (a) Eleclronic Media: Radio jingles. radio discr.tssious/ir-rterviews/broaclcast. Radio jingles were prepared and aired constantly, especially dr-rring thc 'Onchocerciasis Week'wl-rich was observed by the project in Februarl'2003. Radio stations in the State and the National radio stations were involved in the mobilization activities. During this period, messages were relaycd to thc public as news insert or dr-rring in-rportant programmes. The use of radio provecl r'cn' efl'ective b,:cause the project was getting feedback ll'ont a lot ol' peoplc. lrifbrr-r-ratiort released through the radio travels very last and gets into the trooks and cranies ofthe project area. (b) Television: This was also widely used,.but coverage was limited bv lack ol' electricity in tnost o1'the coninrunities and villages. Luckily ettouglt. trtost ol' the commur-rity leaders are rich enough to ovrtr television sets attcl raclios. During training of trainers (1'OT), TV/video fihns were used in some [,GAs that have r:lectricity while some communities provided generatiltg scts to enable the trainers Ltsc the ecluipment durriug tlaining o1' CDDs. Ortchtr nressages u,ere also given try way of slide presentation. prepared clocttmentary and overhead transparency projection PRINT MEDIA 'l'hose used inclLrde posters. brochures. newspapel publicatiorts. pictures ol' photographs. flipcliarts. haudotrts. handbills and calendars. LOCAL SYSTEMS These are the traditior-ral methods applicable to different communities and villagcs. arlcl relate to varied traditions. The local tnethods include: (a) 'l'own Criers - 'l'hese arc pcoplc chosen by thc coururutritl, fbr the ltttrpose trl' moving round the villages or rnarket squares with metal or woodeu gollgs c)r drums disserninating infbrmation to the people. The village or comnlttuitl' II. lIt. rj (b) (c) (d) (e) t4 through their common pLrrse usually compensates them. They move arouncl thc nrarkcts cluring thc clay. but arouncl thc villages a1 rlawn or at night. -l-his rlethod was very effective. Church Announcenlents - -['he nrain religion of the inhabitants of the project area is Clrristianity. There are churches in the entire town and are built thror-rgh comurunal contribution. 1'hey are r.rsually centlally located and inrportant messages disserninated through the churches reach every household. School Announcements - Education is one of the valuable assets recognized irr the project area. Each fanrily. no rnatter how poor makes effort to train its children. Messages passed through schools children get to the householcls vcn' fast. Village/cornnrunity lieads/Bzes -Tlie village head is a good channcl lbr lllessage dissemination. As tlie head of village or commllnity. he is entitlecl to call r-neetings of his cabinet chief-s or other members of the communitv or givc oral directive to his subjects through the village chief-s or sectional heads like ward heacls and heads of householcls. Village Meetings/Group Meetings - These are very effective channcls lbr infbrmatiou dissemination and were very much r"rtilized by the project. 'l-hc project teatns usually collect the dates of village meetings or. launchings. or' group tneetings ancl usually assigrt the health lacility stall'via thc LOC'l's to courrtrunitir:s in ordcr to talk Ltl thcnr at the nreeting sessior-rs. Thc VIICs ancl CDDs who are trow much more in number than before had been verv r-rsefirl in this aspect. l4 I5 MOBILIZATION AND HEALTH EDUCATION OF WOMEN AND MONOIUTIES _ METHOD AND ITESPONSE The methods: used in rnobilization and health eclucation of women and minorities were through gathering. holding talks and discr,rssions with thenr at the end of church services, at village hcad premises. at the village sqLlare and at the August Women's nreeting. These nrethods were used in sorne commurnities in Enugu State. especially at Obinofia Ndiagu, Isu-Awa. etc.. where wonren who returned fbr Ar-rgust meeting were healtll educated. I The above nrethods yielded or produced high respollse f}om women and minorities. Anothcr nrethocl was visiting those who were sick, ancl blincl in their homes to encourage theui to continuc participating in ivermectin treatmelit. Due to the extertsive rlatLlre of the exercise. nlost wonlett rvltcl delivered babies, upou the expiration of exclusion period. turned up lbr treatmenL with nrectizan. Even thosc who were sick upon reoovery canre fbr treatment. The percentage of those who rcsponclccl was very high. This method stirnulated even the blind to come fbrward fbr treatment. DID TARGET VILLAGES RESPOND FAVOURABLY? Target villages/communities responded very favourably. ACCOMPLISHMENT The use of media and other locaL system of disseminating information were very efi-ective ancl -{avc satisfactory results lionr the tarqet villages. The effectiveness is reflected by the increasecl commitrnent ol the commurity leaclership ancl clistributors and the higli degree of involvement ol'the contnrunitics and thcir willingrlesri to conrnrit available local resources to tlie distribution proccss. Furthermore, there was increased response ti'om isolated hamlets, which hitherto were not reachecl in the past. WEAKNESS/CONSTRAINTS il Baci road posed difficulty in reaching villages lor effective mobilization and health education. iil Most of the LOCTs and I{ealth Facility stafl lack transport rneans ol'penetrating or reaching renlote areas lbr health eclr"rcation and mobilizatiorl SUGGEST WAYS TO IMPIi.OVE MOBILIZATION OF TAITGET COMMUNITIES a. increased logistic supporl particularly motorcycles fbr LGA staff parlicipating in CDI'l ittrpleutetttatiorl. t5 2.5 coMrfrunrnes TNVoLVED rN DEctsIoN-MAKTNG Table 4: Communities' participation in the CDTI State No. of health staff involved in CDTI activitir No. of comm/villages with comm. Members as supervisors Number of CDDs and the communities involved Total Number of lvillaSes withI female| "rr. Percen- tage Total No. of health staff in the entire proj. area No. of health staff involved in CDTI Percen- tage Total No. of comm. in the entire proi. area No. of community members as supervisors Percen- tage male CDD female CDD =NUGU 724 483 66.7C% I Caat,JrJ 822 EO ano/- 2,641 791 3,432 772 56.20% \NAMBRA 650 456 70 10% 1,062 758 76.3OYo 1,295 1,525 2,820 825 77.68% =BONYI 419 303 72.30o/o 973 743 72.3OYo 953 444 1,397 35 39.80% TOTAL 1,793 1,242 69.20% 3,408 2,323 68.10% 4,889 2,760 7,649 1,632 s9.10% Comment on: Attendance of female members of the community at health education meetings ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion, etc.)? Other issues i5 u-. .? Table 4: Community participation in the CDTI ENUGU STATE LGAs No. of Villages with selected CDDs No. of villages paying CDDS om cash or kind Total number of CDDs Number of villages with Female CDDs Total No. % Total Male CDDs Female CDDs Total Total ANINRI 70 100 60 86 152 63 215 62 88.57Yo EZEAGU 120 100 23 19 258 42 300 40 33.30% IGBO.ETiTI 100 100 45 45 254 36 290 36 36.00% UDI 172 100 27 16 340 90 430 84 48.80Yo CWGU 131 100 25 19 315 65 380 65 49 60% UDENU 73 100 10 14 146 44 190 44 60.30% f,JI RIVER 62 100 2 3 103 44 147 43 69.30% GBOEZE SOUTH 89 100 10 11 172 55 227 54 60.70o/o NUGU EAST 31 100 2 7 70 28 98 26 83.90% NKANU EAST 136 100 5 4 125 80 205 80 58.90% NKANU WEST 142 100 18 13 250 67 317 64 45.1OYo IGBOEZE NORTH 49 100 28 57 93 32 125 32 65.30% UZO-UWANI 80 100 6 8 126 44 170 43 53.80% sr-uzo 41 100 31 76 99 39 138 38 52.7jyo NSUKKA 77 100 36 47 138 62 200 61 79.20%TOTAL 1,373 100 328 423 2,641 791 3,432 772 s6.20% l5 b. Table 4: Communities' participation in the CDTI ANAMBRA STATE LGAs No. of Villages with selected CDDs . of villages paying CDDs om cash or kind Total number of CDDs Number of villageb with Female GDDs Total No. Total Male CDDs Female CDDs Total Total NJIKOKA 45 100 20 44.44% 60 86 146 30 66.66%IHIALA 45 100 20 44.44% 80 144 2.24 25 55.55%CGUAiA 90 100 80 88.88% 112 I -7.' 284 80 88.88%f,RUMBA NORTH 90 100 48 53.33% 41 66 107 OA 94.44%f,RUMBA SOUTH 65 100 41 63.070/" 69 75 144 55 84.610/oAYAMELUM 54 100 20 37.03o/o 114 92 206 44 81.46%AWKA NORTH 73 100 20 27.39Yo 65 34 99 63 86.30%AWKA SOUTH 65 100 20 30.76y. 83 62 145 52 80.00% cYr 50 100 20 40.00o/o 54 48 1A2 28 76.00%DEMILI NORTH 115 100 30 26.08% 113 162 132 116 275 87 115.00%DEMILISOUTH 80 100 52 65.00% 89 221 64 80.00%NNEWISOUTH 105 100 66 62.85Yo 105 221 76 72.38%DUNUKOFIA 43 100 20 46.51% 53 81 134 25 58.13YoANAOCHA 76 100 20 26.31% 93 88 181 53 69.73o/oNNEWI NORTH 35 100 35 100.00% 89 113 202 28 80.00%KWUSIGO 31 100 10 32.20o/o 75 54 129 20 64.51%TOTAL 1,062 100 552 49.15% 1,295 1,525 2,920 825 77.68% 15 c Table 4: Communities' participation in the CDTI EBONYI STATE LGAs No. of Villages with selected CDDs of villages paying CDDs om cash or kind Total number of CDDs Number of villages with Female CDDs Total No. Total % Male CDDs Female CDDs Total Total IKWO 103 100 69 66.90% 114 69 183 54 52.40o/o IZZI 111 100 73 65.70% 125 48 173 39 35.10% fHAOZARA 96 100 54 56.20o/o 104 41 145 3'r 32.20Yo f,NICHA 106 100 66 62.200h 113 52 165 37 34.90% ZZA NORTH 96 100 AO 5'1.00% 84 E/l 138 43 42.70o/o ZZA SOUTH 81 100 43 53.00% 67 36 103 40 39.50% SHIELU 111 100 58 52.20% 103 39 142 24 24.30o/o EBONYI 106 100 61 57.50% 75 45 120 30 30.1 0% lvo 61 100 41 67.20o/o 58 31 89 38 37.70o/o CFIKPO NORTH 102 100 49 48.00o/o 110 29 139 22 21.50o/o TOTAL 973 100 554 56.90% 953 444 1,397 35 34.70% t5 ,J" II6 b. Provision of bicycles fbr healtli centre staff and CDDs involved in the CD't-l iurplcnicntatiou to cnablc thcnr ct'rvcr the villages more effectively. c. Use of rnobile public address system for better outreach of the population. 2.5 COMMUNITY INVOLVEMENT IN DECISION.MAKING Decision-making is one of the hallmarks ol cornmunities' involvement in CDTI activities. -fhc contmunity decision making determined the level or seriousness oltcommunity participatit-rtr itt CDTI process. ln the Project, communities decided on the number and sex of CDDs to be used fbr' CDTI activities. Decision making sometinres involved a fraction of community members or ke1' functionaries and occasionally sizeable community members which sometintes involved woltlell depending on the needs and circumslauces. Reports of the various supervisors show that the perforrnance of female CDDs was coltlparable to that of niale CDDs. However. male CDDs perfbrmed higherthan the f-emale. This was true because the male CDDs were more in nurnber than f-en-rale CDDs. Many of the f-emale members of the community were in attendance at the health education meetitrgs. At the decision-making meetings at the village' level. or-rly few female members participated. Wonrctt are not always involved in decision making. This is one meeting nlen always dotttirtate as thev decidc liow the community firnctions. 'fhe mode of'treatmeut decided for female community nrentbcrs wars house-to-holrse. especially to track those who delivered baby newly and who are at earll' or latc pregnancy. The nature of the work of females also calls fbr hor.rse-to-house treatmeut. They ltave tlte tendency of leaving home early and retuming late, especially during farmiug or nrarket. Therefbre. the convenicut tinte for the treatment was usually early tlorning time or late evetritrg. 2.6 CAPACITY BUILDING 2.6.1 TRAINING Targeted trainirrg based on clearly identifled needs were conducted at zrlI levels. There wcrc perioclic retraining of onchocerciasis workers and training of new personnel. During the period under revier.l'. training/retrair-ring were carried out at three levels. (a) State Level - 15 SOCTs (TOT) were retrained in order to r,rpdate thcir l<nowleclgc. attitude and skill to carry out their uranagement and irnplernentation of tasks. (b) LGA Level - 246 LGA staff (PHC, LOCTs) and 981 Health center/Post staff (DHS and HFS) and wele trained/retrained to update their skills in relevant areas. (c) Community level - 7,213 CDDs were trained or retrained on CDTI. l6 tt Materials developed and used for lraining inch"rde: * Training uranuals lbr SOCTs/LOCTs. DHS and HFS * Brochure on CDTI for CDDs .l Flipchart and posters * Measuring sticks and village treatllletlt registers * Mectizan treatment sLllllllary slteets. reactiou guides and duty/tasks for each cadre of health staff and CDDs. * Mectizan transf-er forms * Instruction for Health workers and CDDs Contents o1' training were based on identiflcd treeds of each cadre and include efl-ectivc data management. management of advt:rse reactions, effective rnonitoring and supervision, etc. The reason fbr training is to r.rpdrtte the knowledge. attitude and skill to carry out CDTI activities at specified levels. The irrtroductiorr of CSM and SHM called fbr liesh training in tl-rat area hence botlt new and old staflTworkers were tritined. Perfbrnrancc of the CDDs contiuue to inrprove indicating that they received atrd utrderstoocl vital information about their roles. Fronr the above. the arrnual training targets or ob.iectives were ltlct except for the CDDs where only ll7.32o% o1'the target was achieved. l'he project plar-rs to incrcetsc its mobilization effort to improve the level of participation and ownership of the progralllllc b1' the community. t7 TABLE 5: Training at the different levels of CDTI implementation State No. of Districts/LGA Staff trained No. of health center/post staff trained No. of other trainers of trainees (TOTs) Number of CDDs trained ATrO New Refr. Total ATrO New Refr. Total ATrO New Refr. Total ATrO New Refr. Total NUGU 90 15 75 90 363 25 363 388 5 0 5 5 3432 349 2647 2996 ANAMBRA 96 10 86 96 252 103 252 355 5 0 5 5 2966 774 2046 2820 EBONYI 60 0 60 60 238 0 238 238 5 0 5 5 1 946 301 1 096 1397 TOTAL 246 25 221 246 853 128 8s3 981 15 0 15 15 8344 1424 5789 7213 % Achievement 100.00% % Achievement 100.00% % Achievement 100.00% % Achievement 86.40% l1 ,.t . TABLE 5: Training at the different levels of CDTI implementation ENUGU STATE LGA Number of Districts/LGA Staff trained No. of health center/post staff trained Number of other trainers of trainees (TOTs) Number of CDDs trained ATrO (F) New (F) Refr. (F) Total (F-F) ATrO (F) New (F) Refr. (F) Total (F-F) ATrO (F) New (F) Refr. (F) Total F10 - F11 ATrO (F) New (F) Refr. (F1s) Total (F-F) ANINRI 6 1 5 6 13 0 13 13 1 0 1 1 215 15 147 162 AWGU 6 0 6 6 27 0 27 27 I 0 1 1 380 54 250 304 =NUGU STATE 6 1 5 6 20 0 20 20 1 0 1 1 98 37 56 93 ZEAGU 6 3 3 6 33 4 29 33 0 0 0 0 300 13 209 222 GBO-ETITI 6 0 6 6 17 0 17 17 0 0 0 0 290 B 220 228 IGBOEZE NORTI- 6 1 5 6 34 3 31 34 1 0 1 1 125 3 150 153 IGBOEZE SOUTF 6 1 5 6 20 2 18 20 0 0 0 0 227 5 187 192 ISIUZO 6 2 4 6 20 2 16 20 0 0 0 0 138 20 121 141 \KANU EAST 6 0 6 6 21 0 30 30 0 0 1 1 205 5 191 196 \KANU WEST 6 0 b 6 30 0 21 21 1 0 0 0 317 49 215 264 \SUKKA 6 1 5 6 27 0 27 27 0 0 0 0 200 29 201 230 3JI RIVER 6 1 5 6 28 0 28 28 0 0 0 0 147 18 124 142 JDENU 6 0 6 6 29 6 23 29 0 0 0 0 190 24 141 165 UDI 6 0 b o 35 J cz 35 0 0 0 0 430 35 285 320 UZO-UWANI 6 4 2 6 36 5 31 36 0 0 0 0 170 34 150 184 TOTAL 90 15 75 90 390 25 363 388 5 0 5 5 3432 349 2647 2996 % Achievement 100.00% % Achievement 100.00% % Achievement 100.00% % Achievement 87.29% t+ b. -'e TABLE 5: Training at the different levels of CDTI implementation ANAMBRA STATE LGA Number of Districts/LGA Staff trained No. of health center/post staff trained Number of other trainers of trainees (TOTs) Number of CDDs trained ATrO G1 New G2 Refr. G3 Total G3+G2 ATrO G5 New G6 Refr. G7 Total G8 ATrO G9 New G10 Refr. G11 Total G10+11 ATrO G13 New G14 Refr. G15 Total ll 14+G15 NJIKOKA b 1 5 6 20 8 12 20 5 0 5 5 148 46 100 146 IHIALA 6 1 5 6 20 6 14 20 0 0 0 0 226 69 155 224 AGUATA 6 0 6 6 25 10 15 25 0 0 0 0 286 80 204 284 )RUMBA NORTI. 6 1 5 6 25 7 18 25 0 0 0 0 109 45 62 107 3RUMBA SOUTI 6 1 5 6 25 6 19 25 0 0 0 0 147 51 93 144 qYAMELUM 6 0 b 6 25 5 20 25 0 0 0 0 208 68 138 206 {WKA NORTH 6 1 5 6 20 6 14 20 0 0 0 0 101 20 79 99 \WKA SOUTH 6 0 6 6 25 4 21 25 0 0 0 0 147 42 103 145 cYt 6 1 5 6 20 5 '15 20 0 0 0 0 104 21 81 102 DEMILI NORTH 6 0 6 6 25 4 21 25 0 0 0 0 344 75 200 275 IDEMILI SOUTH 6 0 6 6 20 6 14 20 0 0 0 0 222 43 178 221 NNEWI SOUTH 6 1 5 6 20 5 15 20 0 0 0 0 233 52 169 221 DUNUKOFIA 6 0 6 6 20 6 14 20 0 0 0 0 137 37 97 134 ANAOCHA 6 1 5 6 25 8 17 25 0 0 0 0 218 49 132 181 NNEWI NORTH o I 5 o ZV at IJ zv 0 0 0 0 204 53 149 202 KWUSIGO 6 1 5 b 20 10 10 20 0 0 0 0 132 23 106 129 TOTAL 96 10 86 96 355 103 252 355 5 0 5 5 2966 774 2046 2820 % Achievement 100.00% % Achievement 100% % Achievement 100.00% % Achievement 95.07% lVc, TABLE 5: Training at the different levels of CDTI implementation * These are the S-member State Onchocerciasis Control Team (SOCTs) EBONYI STATE LGA Number of Districts/LGA Staff trained No. of health center/post staff trained Number of other trainers of trainees (TOTs) Number of CDDs trained ATrO G1 New G2 Refr. G3 Total G3+G2 ATrO G5 New G6 Refr. G7 Total G6+G7 ATrO G9 New G10 Refr. Gl1 Total G10+G11 ATrO Gl3 New G14 Refr. G15 Total 5 KWO 6 0 6 6 35 0 35 35 5 0 5 5 206 47 136 183 ZZI 6 0 6 6 30 0 30 30 5 0 5 5 222 39 134 173 f,HAOZARA 6 0 6 6 25 0 25 25 5 0 5 5 192 40 105 145 SNICHA 6 0 6 6 25 0 25 25 5 0 5 5 212 51 114 '165 EZZA NORTH 6 0 6 6 20 0 20 20 5 0 5 5 192 28 110 138 EZZA SOUTH 6 0 6 6 18 0 18 18 5 0 5 5 162 21 82 103 SHIELU 6 0 6 6 20 0 20 20 5 0 5 5 222 26 116 142 EBONYI 6 0 6 6 21 0 21 21 5 6 5 212 10 110 120 tvo 6 0 6 6 24 0 24 24 5 0 5 5 122 16 73 89 AFIKPO NORTH 6 0 6 6 20 0 20 20 5 0 5 5 204 23 116 139 TOTAL 60 0 60 60 238 0 238 238 5* 0 5* 5* 1 946 301 1397 1297 % Achievement 100.00% % Achievement 100% % Achievement 100.00% .% Achievement 71.70% t7 d. l8 Table 6: Type of training undertaken 'l'rainees Type Of training CDDs Other Community Members e.g Community Su nervisors I lealtlr Workers ( frontl ine health facilities) MOH Staff or other Political Leaders Others (specify) Progran-r Managenrent Good good Ilow to Conduct Health Education Manggenrent eZiaes CSM SHM Data Colleotion Data analysis Report Writing (Othcrs) Planning b r8 l9 2.6.2 EQUIPMENT AND HUMAN nESOUITCES Table 7: Status of equipment WHO/APOC. 26 SI]PTEMBER 2OO3 . IlclLriputent provided by Ebonyi State Govertrnlent' A. ENUGU S'TATE SOUITCB TYPE OF EQUIPMENT APOC MOH DISTITICT /LGA NGDO OTHEIIS Condition of he equipurenlt p ease state l. Vehicle 2 Fr"u'rctional Nil Nil 1 Functional Nir l. motorcycle ll functional & 7 Non- funclional 3 frurctional* I Non liurctional Nil 2 Functional 5 not Functioning Nil 3. Coniputers 3 Fr-urctional 1 Functional* N N N 4. printcrs 3 Furtctional 1 Func ottal+ N N N 5. Fax Machine Nil I Func onal* N N N 6. Generator 3 Functional N I N I N N 7 Photocopier 2 Functional N I N I N N 8 Air condition 3 functional I Functional* N I N N 9]'V/Viclco N Nil N I 3 Fr-urctional N 10 Refiigerator N I functional* N I Nil N I l ceilingFan N Nil N I 3 Functional Nil SOURCE TYPE OF EQUIPMENT APOC MOH DISTRICT/LG A NGDO OTHERS Condition of the uipment* please state 1. Vehicle Stolen Nil Nil f unctior-ral Nir 2. motorcycles 7 fturctional Nil Nil 2 functional Nit 3. Computers 1 Functional Ni N I N Nil 4. printers 1 Functional N N I N N 5. F-ax Machine NiI N N I N N 6. Generator I Functional Ni N I N I N 7. Photocopier I Fr.u-rctional N N I N I N 8. TV/Video Nil N Nil 1 Functional N t9 I I I I I I I 2.0 B. ANAMBIIA STATE C. EBONYI STATE SOURCIi TYPE OF EQUIPMENT APOC MOI.I DISTRICT/LGA NGDO OTTIIiITS Cor-rdition of the eq uipment* please state 1. Vehicle Fr.urctional Nil Nil Nil Nil 2. motorcycles 3 Non functional 3 lunctional Nil Nil 2 non functional Nil 3. Computers Functional N N N I N 4. printers Functional N N N I N 5. Fax Machine Nil N N N I N 6. others A/C Functional N N N I Nil a) Photocopicr Irunctiottal N N N I NiI b) Gen Set Functional N N N I Nil c) TV/Video Nir N N Functional Nil Standir-rg lran Nil N N 2 functional Nil SOUR.CE TYPE OF EQUIPMI]NT APOC MOH DISTITICT/ LCA NGDO OTHEITS Condition of e e<luiptlent* pleasr state I. Vehicle I Functional Nit Nit Nil Nil 2. nrotorcycle lFunctional 4 Non furtctional 5 functional I )Jon functiortal Nil 2 Functional 4 not Functiotring Nil 3. Computers I Functional I Functional N N Nil 4. printers Nil I Funct onal N N Nit 5. Fax Machine N I Functional N N Nil 6. Generator I Functional Nir N N Nil a) Photocopier I Norr Functional Nil Nil Nil Nil b) Air condition I functional I Functional Nil Nit Nil c) TV/Video Nil Nil Nit I Functional I Non functional Nil Refiiserator Nil I functional Nit Nil Nit 20 s I I I 2t MAINTENANCE AND REPLACEMENT OF EXISTING EOUIPMENT AND OTHER MATERIALS. The project has provided fbr maintenance and replacement of existing equipment in 3- year post - APOCBUDGET/WORKPLAN. APOC is expected to replace some basic equipment that have either beel stolep/ gope bad or were uot supplied during the flrst phase. Also firlld has bcctl budgeted fbr state ar-rd LGAs to be releasecl fbr vehicle. motorcycle and other equipmer-rt/ nlaterial maintenance in the post APoc budget/workplan already submitted. There is esougli apd adeciuate manpower in the three states project as health workers involvcd irl t5c pregrlpllc arc not only,skillccl but clcclicatccl ancl willing to cotttitrr,re to vrtlrk irl tlrc programllle O, the issue of fi.equer-rttralsf'erof stafl. The project is expanding the scope of training to ittvolve all healtli staff irr all the LGAs both HYPER and MESO endemic and even hypo-endemic LGAs to takc carc of this problem. 2t TABLE 9: CASES OF SERIOUS ADVERSE EVENTS (SAEs)THAT OCCURRED DURING THE REPoRTING PERIoD States Age Sex Village of origir Date Mectizan was taken Date first symptoms appeared Symptoms Health Status befor taking mectizan Date of admission in health facility Date of dismissal from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involvement or not ENUGU 0 0 0 0 0 0 0 0 0 0 0 0 0 ANAMBRA 0 0 0 0 0 0 Qrnr \DtrO IN Rl p 0 0 0 0 EBONYI 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 2'l a 22 2.7 TREATMENT 2.7.1 TITEATMENT FIGURES The nurnber of people treated in tlie project witl-rir-r the period i.s 1,942,356, The project's tlrerapetrtic coverage rate (TCR) against the total population of (2,514.992) is 77.23Yo while all tlie 3.408 CDTI villages were treated thus attaining 100% Geograpltical Coverage Ratc (GCf{). T. TABLE 8: TREATMENT AND SAEs BY DISTRICT/LGA IN ALL AREAS AT-RISK STATE Communities/Villages Population Number of pers. who refused the treatment Number of absentees Number of SAEs No. of Serious Adverse Events (SAEs) referred to the health posUhosp. Total No. of Com/ Vill. ln the meso/hyper endemic Areas Annual Treatment Objective Number of communities/ villages treated Geogra- phical coverage (%) Total Popn. of the meso/hyper endemic areas Annual Treatment Objective Objective No. of Persons Treated Therapeutic coverage (%) NUGU 1,373 1,373 I a1at,JrJ ,|n^ .l^o/ rla1 rrAAvv r,9av 4tr.) /Ei 752,581 78.24% 975 1,098 0 0 ANAMBRA 1,062 1,062 1,062 100.00% 899,1 36 706,987 668,998 74 40% 3,214 8,997 0 0 EBONYI 973 973 973 100.00% 653,916 514,576 520,777 79.64% 2,476 8,782 0 0 TOTAL 3,408 3,408 3,408 100.00% 2,514,992 1,975,013 1,942,356 77.23% 6,665 18,877 0 0 22a TABLE 8: TREATMENT AND SAEs BY DISTRICT/LGA IN ALL AREAS AT-RISK ENUGU STATE LGA Communities/Villaqes Population Number of pers. who refused the treatment Number of absentees Number of SAEs No. of Serious Adverse Events (SAEs) referred to the health posUhosp. Total No. of Com/ Vill. ln the meso/hyper endemic Areas Annual Treatment Objective Number of communities/ villages treated Geogra- phical coverage t%l Total Popn. of the meso/hyper endemic areas Annual Treatment Objective Objective No. of Persons Treated Therapeutic coverage t%) ANINRI 70 70 70 100 00% 71.728 59,700 61,659 85.96% 62 45 0 0 AWGU 131 131 131 100.00% 80,207 58,300 67,179 83.76% 71 62 0 0 NUGU EAST 31 31 31 100.00% 50,016 35,235 33,032 66.04% 82 125 0 0 ZEAGU 120 120 120 100.00% 83,490 50,000 57,035 68.31% 28 40 0 0 GBO-ETITI 100 100 100 100.00% 60,618 45,200 48,918 80.70% 90 100 0 0 GBOEZE N 49 49 49 '100.00% 69,506 59,000 53,722 77.29% 50 43 0 0 GBOEZE S. 89 89 89 100.00% 54,328 46,450 44,430 81 78o/o 80 97 0 0 ISI-UZO 41 41 41 100.00% 61,542 45,000 52,722 85.67Yo 63 101 0 0 NKANU E. 136 136 136 100 00% 64,1 1 6 47,920 54,456 84.93% 85 67 0 0 NKANU W 142 142 142 100.00% 62,378 46,500 48,516 77.78% 67 54 0 0 NSUKKA 77 77 77 '100.00% 68,692 40,000 59,062 85.98% 58 43 0 0 OJI RIVER 62 62 62 '100.00% 51 ,1 16 45,000 33,671 65.87% 70 50 0 0 UDENU 73 73 73 100.00% 54,334 48,000 43,371 79.82% 63 66 0 0 JDI 172 172 172 100.00% 62,182 47,000 45,357 72.94% 51 69 0 0 JZO UWANI 80 80 80 100.00% 67,749 58,345 49,291 72.76% 55 '136 0 0 rOTAL 1,373 1,373 1,373 100.00% 962,002 731,650 752,421 78.21% 975 1,099 0 0 22 b. .? TABLE 8: TREATMENT AND SAEs BY DISTRIGT/LGA IN ALL AREAS AT-RISK ANAMBRA STATE LGA CommunitiesA/illages Population Number of pers. who refused the treatment Number of Absentees Number of SAEs No. of Serious Adverse Events (SAEs) referred to the health posUhosp. Total No. of Gom/ Vill. ln the meso/hyper endemic Areas Annual Treatment Objective Number of communities/ villages treated Geogra- phical coverage (%) Total Popn. of the meso/hyper endemic areas Annual Treatment Objective Objective No. of Persons Treated Therapeutic coverage (%) \iikoka 45 45 45 100.00% 47,968 34,396 32,651 68.07o/o 246 58l 0 0 lhiala 45 45 AA l nn nno/- 7i a^.4 53,556 51,206 72.32% 221 542 0 0 Aquata 90 90 90 100.00% 89,217 70,288 67,588 75.760/o 246 536 0 0 Orumba North 90 90 90 100.00% 58,572 49,1 56 46,420 79.25o/o 234 499 0 0 Orumba South 65 65 65 100.00% 60,576 43,820 40,995 67.680/o 200 600 0 0 Avamelum 54 54 54 100.00% 56,242 49,963 49,053 87.22% 153 324 0 0 Awka North 73 73 73 100.00% 37,591 29,141 26,386 70.19% 224 532 0 0 Awka South 65 65 65 100.00% 37,060 29,743 27,087 73.09% 215 616 0 0 Ovi 50 50 50 100.00% 49,557 40,124 37,124 74.91% 234 623 0 0 demili North 115 115 115 100.00% 81,888 61,569 58,1 94 71.07% 223 532 0 0 demiliSouth 80 80 80 100.00% 38,028 30,632 27,536 72.41o/o 215 614 0 0 Nnewi South 105 105 105 100.00% 70,813 58,417 54,490 76.95% 235 576 0 0 Dunukofia 43 43 43 1 00 00% 33,780 26,233 24,189 71.61% 145 522 0 0 \naocha 76 76 76 100.00% 56,1 1 0 44,158 43,700 77.88Yo 153 567 0 0 ),lnewi North 35 35 35 100.00% 77,420 56,455 54,152 69.95% 136 613 0 0 kwusiqo 31 31 31 100.00% 33,513 29,326 28,227 84.23o/o 134 648 0 0 IOTAL 1,062 1,062 1,062 100.00% 899,136 706,987 668,ggg 74.40% 3,214 8,925 0 0 22 c. TABLE 8: TREATMENT AND SAES BY DISTRICT/LGA IN ALL AREAS AT-RISK EBONYI STATE LGA Communities/Villages Population Number of pers. who refused the treatment Nurnber of absentees Number of SAEs No. of Serious Adverse Events (SAEs) referred to the health posUhosp. Total No. of Com/ Vill. ln the meso/hyper endemic Areas D1 Annual Treatment Objective D2 Number of communities/ villages treated D3 Geogra- phical coverage (%) D4 3/ D1.100 Total Popn. of the meso/hyper endemic areas D5 Annual Treatment Objective Objective D6 No. of Persons Treated D7 Therapeutic coverage %t D8= D7lD58100 kwo 103 103 I \J.) 4e ia4turJa I AA 1AA 6a e,l, 79.21o/o 983 2,111 0 0 lzzi 111 111 111 100.00% 86,802 67,708 68,344 78.74% 109 562 0 0 Jhaozara 96 96 96 100.00% 57,347 48,744 49,312 85.99% 49 123 0 0 Jnicha 106 106 106 100 00% 72,934 58,347 57,003 78.16% 361 983 0 0 zza North 96 96 96 100.00% 59,386 46,320 47,800 80.49% 10 136 0 0 Ezza South 81 B1 81 100.00% 42,945 35,644 37,253 86 75% 70 607 0 0 lvo 61 61 61 100.00% 38,082 28,238 31,114 81.70% 99 432 0 0 Ebonyi 106 106 106 100.00% 54,813 44,442 39,988 72.95% 36 211 0 0 shielu 111 111 111 100.00% 74,183 58,604 58,992 73.00o/o 134 1,623 0 0 Afikpo North 102 102 102 100.00% 50 4o.7 31,824 38,360 75.96% 615 1,994 0 0 TOTAL 973 973 973 100.00% 653,910 514,577 520,777 79.640/o 2,475 8,782 0 0 22d. :) 2.7.2 CAUSES OF ABSENTEEISM l. Migratiol: an individural who took utcctizatt itr a particular yeat', lcavcs thc arcit tltc lilllou'ilrg year probably in search of employrnent. 2. Death : an individual who took mectizan iu a particular year dies. 3. Child delivery: a woman delivers and keeps away from taking the drug for some period. 24 2.7 .3 There has not been any case of serious adverse events (SAEs) resultir-rg frorn rnectizan in-take since project inception. No case of serious adverse reaction 2.7.4 No case to report 2.7.5 Trend of treatrnent achievement from CDTI project inception to the current year. 24 25 2.8 SUPERVISIOI{ 2.8.I SUPERVISION FLOWCHART Supervision of CDTI activities is being carried out at LGA, First line health facility and cornmunity levels. Supervision at all these levels are not only targeted, but on specific areas identifled. The state team sr-rpervises the imurediate lower level, i.e., the LGA while the LOCTs supervises activities of the FLHFS who in turn supervises the CDDs. ' Cornrnunities also provided internal supervision of the distribution rnechanisur of the drug and thus act as check to Llnexpected deficiencies. NG NOCP '1" MOH LOCT <-_ LGA PHC DEPARTMENT DO \ ,/ \ l./lr/V .,'X F'LHFS I Ii CDDS {-_ COMMUNITY SIMPLE SUPEI?VISION IVIE('IIAN|,\M OI; L'DTI A('1'1VIT'IE,S IN E N I.]G U/.4 N A A4 B RA / E B O Nl/' I STA T E S' P Ro,I E(- T 2.5 26 2.8.2 Main Issues Identified During Supervision The main issues identified during supervision include:- a. Inaccurate population registration b. Poor record keeping/data rnanagement c. Complaints of non cornpensation of CDDS d. Cornplaints of non-release of counterpaft fund by LGAs for LOCTs and HFS e. Inability of LOCTs and HFS to make workplans and budgets for CDTI activities f. Failure to use already prepared supervisory checklist g. Complaints of ina'Cequate/or absence of transport facilities h. Failure to use appropriate IEC materials supplied 2.8.3 USE OF SUPER'YISORY CHECKLIST Supervisory checl:list developed by NOCP was fine-tuned and r-rsed at LGA. The LGAs and health facilities though have checklist, rarely use it. 2.8.4 OUTCOME OF CDTI SI.IPERVISION The supervision afforded the supervisors opportr.rnity to address the issues highlighted on 2.8.2 above. On the spot corrections were made and better clr"rality CDTI activities were put into place. Overall treatment coverage was improved. Specificalll,. issues that border on the community and CDDs were addressed b1, Iiolding meeting with community members where outcome of supervision are discussecl. Targeted training on record keeping and data management. including population update were organized at CDD level. Training on budget preparatiot-r and development of workplans were- lrelcl 26 27 with LGA olllcials and was fbllowed by advocacy to LGA policy tnakers for full implementatiort of tlie workplan particularly release of budgetecl amounts. 2.8.5 FEED.BACK INFORMATION TO THE SUPERVISORS Supervision is carried out in the presence of the supervised. The supervised was always I communicated both orally and writin[ on the finclings and necessary measures to undertaken with a view to improvement. 27 28 SECTION 3: SUPPORT TO CDTI 3. 1 . Financial contributions of the partners and communities Table 1 1 : Finar-rcial contributions by all partners forthe last three years Contributor Year I 2001) Year 2 (2002\ Year 3 2003 TOTAL I}UDGET (r,s$) TOTAL ITELEASEI) (uss) TOTAL I}UDGET (US$) TOTAL RELEASET) (US$) TOTAL I]UDCET (USS) TOTAL ITELEAS II) (USS) Ministry ol' Health (MOH) 65,500 31,950 49,443.8 37,500 67,701 2,265.62 Local NGDO (SXIF ANY) 5,000 5,000 2,800 2,800 5,500 5,500 NGDO partners (s) 219.492 279,492 144,205 144,205 29,125 29l.2ll LGA 10,900 1 1 ,3 80.5 15,900 8,276.6 15,170 0.248 88 Others a) b) c) Cornrnunities 8,849 8,268"4 r0,235 APOC Trust Fund 1 62,1 08 I 62,1 08 I 62,1 08 I 62,1 08 I 18,973 I 18,973 TOTAL 523,000 4,,987,775 374,456.8 363,158 236,469 438,439.5 28 29 Table 1lA: Financial contributions by all parlners for the last three years in Enugu State Contributor Year I (2001) Year 2 (20021 Year 3 (2003) TOTAL BUDGET (US$) TOTAL RELEASED (USS) TOTAL BUDGET (US$) TOTAL RELEASED (US$) TOTAL BUDGET (US$) TOTAL RELEASED (US$) Ministry of I{ealth MOH 19,500 1,950 1,1943.8 NIL 31,201 NIL Local NGDO (sxrF ANY) NGDO paftners (s) N/A N/A N/A N/A N/A N/A District/LGA N/A 4,430.5 N/A 1,316.6 N/A s 16.38 Comrnunities 1,872.0 N/A 1,310.4 NIL 1,884 APOC Trust Fund 33,695.8 33,695.8 41,237 .40 41,237 .40 33,519.5 33,579.5 TOTAL 53,195.8 41,948.3 95,165.5 43,864.4 36,580.5 35,979.88 29 30 Table 1l b: Financial contributions by all partners for the last three years in Anambra State I I I -t I I I I I I l Contributor Year I (2001) Year 2 (20021 Year 3 (2003 TOTAL BI.JDGET (us$) TOTAL RELEASED (us$) TOTAL BUDGET (us$) TOTAL RELEASED (us$) TOTAL BUDGET (us$) TOTAL ITELEASEI (USS) Ministry of Health MOH l 6000 NIL r 6000 NIL 8000 765.62 Local NGDO (sxrF ANY) NIL NIL NIL NIL NIL NIL NGDO partners (s) 11,193.40 1rr93.44 13440 11340 7109.37 7 109.37 District/LGA 6400 4000 6800 4500 7000 1562.5 Cornrnunities 4000 NIL 4998 NIL 5832 APOC Tn-rst Fund 431953.40 31953 41273.4 4t273.4 34348 34348 TOTAL 465547 51146 77513 642t1 56457 5r35s 30 3l Table 1 lc: Financial contributions by all partners fbr the last three years in Ebonyi State COMMENT Table I I contains a breakdow.n of the contribution by the various parlners (in US Dollars) lol the years 3- 5. An interesting issue here is that communities and LGAs rnake contribution to CDTI. It is also necessary to note the following:- (a) APOC contribution as reported are the total contribution to Enugu/Anarnbra/Ebonyi States' Project as one block (b) The NGDO contribution as reflected is fbr the states of Enugu, Anambra and Ebonyi en bloc. The actual amount allocate to each state could not be obtained. (c) There were delays in the release of fund fiorn APOC, Ministry of Health and Local Governments. These problems particularly the ones frotn state and LGA s were address by repeated advocacy tiom the NCDO and state teatn. Contributor YEAR 3 2OOI YEAR 4 2OO2 YEAR 5 2OO3 TOTAL BUDCET ( US$) TOTAL RELEASED (US$) TOTAI- BUDGI]I' (us$) TOTAL RELEASED (USS) TOTAL BUDGET (US$) TOTAL BUDGE-I (US$) Ministry o1' Health MOH 30,000 30,000 37s00 3 7s00 28s00 I 500 Local NGDO (sxrF ANY) 5000 5000 2800 2800 5500 5500 NGDO partners (s) 279492* 279492* t44205x t44205* 29t25* 291217 District/LGA 4500 2950 9r00 2460 8170 8170 Cornrnunities 2977 r 950 2519 APOC Trust Fund 162108 162r08 29484 29484 26644 26644 3t ):- 3.2 OTHER FORMS OF COMMUNITY SUPPORT INCLUDE. (a) Food to CDDs during distribution (b) Free land allocation for cultivation (c) Yams rice and other food iterns (d) Exernption fiorn comtnunity levies (e) Nornination for appointrnents as councillors or LGA Chainnan (0 Sewing of uniform to CDDs (g) Assistance during farming season. 32 33 3.3 EXPENDITURE PER ACTIVITY Table l2: lndicate how rnuch the project spent for each activity listed belorv during the reporting period EN U G U/ANAMBRA/EBONYI PROJECT Activity Expenditure ($ US) Source(s) of fundine Drug delivering frorn NOTF HQ area to central collection point of community t291.05 APOC Mobilization and health education of communities 4340 APOC Training of CDDs t2600 APOC Training of health staff at all levels 6338 APOC Supervising CDDs and distribution 2525 APOC lnternal monitoring of CDTI activities 3300 APOC Advocacy visits to health and political authoritics r 088 APOC IEC rnaterials 35t'..z APOC Surnrnary(reporting) forms for treatment 2901) APOC/MOH Vehicles/Motorcycles/b icycles nraintenance 890() APOC Office Equipment(e.g cornputers printers etc) r 3000 MOH Others 21191.16 MOH/APOC TOTAL 8098s.2I AI'OC/MOH Total number of persons treated 1,942,356 JJ 34 Tablc l2a: Inclicate how much the project spent for each activity listed below during the reporting period ENUGU STATE Activity Expenditure ($US) Source(s) of funding Drug delivering fi'orn NOTF HQ area to central collection point of comrnunity 430.35 APOC Mobilization and health education of communities 550 APOC Training of CDD 4700 APOC Training of health staff at all levels 2544 APOC/LGA Supervising CDDs and distritrution 925 APOC lnternal monitoring of CDTI!{tyIlg! 800 APOC Advocacy visits to health and political authorities 544 APOC IEC Materials r 056 APOC/STAT E Summary(reporting) fonns for treattnent 450 APOC Vehicle/Motorcycles/bicycles, maintenance 3500 APOC Of fi ce equiprnent(e. g Cornputers, printers etc) 300 APOC Others fuel, meetings telephone 9821.16 APOC Total 25,620.51 Total number of lrersons treated 752,581 Other activities not specified above include fuel, meetings, CSM, SHM, Supplies, Telephone and rnaintenance of air conditioner and photocopier supplied by APOC 34 i5 Table l2b: Indicate how much the project spent for each activity listed below during the reporting period ANAMBRA STATE Activity Expenditure ($US) Source(s) of Funding Drug delivering fiom NOTF HQ Area to central collection point of community 430.35 APOC Mobilization and Health education of communities ss0 APOC Training of CDDs 4000 APOC Training o1'Health staff at all levels 2544 APOC/LGA Supervising CDDs and distritrution 92s APOC Internal Monitoring of CDTI activities 800 ,{POC Advocacy visits to health and pqlt4qul authorities 544 APOC IEC rnaterials l 056 APOC/State Summary (reporting) forms for treatment 450 APOC/State Vehicle/Motorcycle/B icycle s 3r00 APOC Office equiprnent (eg Cornputers printer etc Others (fuel, Meeting, GSM Calls) 9070 APOC TOTAL 23,491.35 Total number of persons Treated 699,136 35 t36 Table 12c: Indicate how much the project spent for each activity listed below during the reporting period EBONYI STATE Activity Expenditure ($ US) Source (s) of fundine Drug delivering from NOTF HQ area to central col lection point of community Mobilization and health education of comrnunities 3240 APOC Training of CDDs 3900 APOC 'l'raining ol' health stalf at all levels r250 APOC Supervising CDDs and distribr"rtior-r 675 APOC lnternal rnonitoring of CDTI activities by Proiect 1 700 APOC Advocacy visits to health and political authorities 0 IEC rnaterials l 400 APOC Surnmary (reporling) forms fbr treatrnent 2000 MOH Vehicles/Motorcycles/B icycles rnaintenance 2300 APOCI Office Equiprnent (e.g computers, printers etc) I 3000 MOH Others 2000 MOH TOTAL 3146s APOC/MOH Total number of persons treated 520,777 I T 36 37 SECTION 4 SUSTAINNABILITY OF CDTI 4.1 INTERNAL; INDEPENDENT, PARTICIPATORY MONITORING EVALUATION Year I participatory independent rnonitoring Mid-terrn sustainability evaluation 5 years sustainability evaluation lnternal monitoring by NOTF 4.t.1 *,/ Other cvaluatior-r by other partners Global 2C00 monitored the three states in May 2003 and later, 5 year sustainability evaluation was carried out by APOC-WHO team. 4.1 .2 EVALUATION RECOMMENDATIONS The recomrnendations fiorn Global 2000 and APOC - WHO officials are exactly the sarne. Below are the recommendations ar-rd action already taken. 37 38 RECOMMENDATIONS _ ENUGU STATE OVERALL RECOMMENDATION FOLLOW-UP ACTION BY THE PROJECT 1 State, LGAs and FLHF/ Districts planning syslems to fully involve all stakeholders in CDTI, and draw up a detail integrated sustainability health plan, which includes CDTI activities basing on existing situation judgement; The ministry of health in October 2003 held meetings of the state council on health, which involved all stakeholders not only in Oncho but other programmes. Detailed integrated State Ministry of Health action plan for all programmes consequently were developed. This was followed by setting up a budget monitoring & review committee, which has the responsibility of screening detailed activity plan of all the programmes in the Ministry. Detailed CDTI activity plan including post APOC sustainability plan for 2004 has been submitted to the Review committee to enable her prepares memo to His Excellency. Similar health plan of actions are being carried out a t LGA level includinq FLHF/District ') lnvolve FLHFs/Districts, CDDs and Traditional rulersr in the mobilization of the communities for the CDTI activities, and the comrnunities in the decision-making process e.g appropriate time for mectizan distribution. Letters had been written to each group specifying their roles with regards to mobilization of the communities for Oncho activities especially promotion of drug in-take. Physical visits had been made to some traditional rulers in the LGAs where drug distribution is on going. Through letters and meetings, communities are now being given chance to decide on the period and mode of distribution 3. lntensify advocacy to all stakeholders in CDTI especially the top-level management and policy- makers in the States and LGAs. Held Advocacy meetings with directors of planning and public health and permanent secretary as well as New commissioner for health, Dr. Festus Uzo and other stakeholders such as the Carter center, NOCP 38 39 Advocacy visit to His Excellency has been planned by the NOCP Zonal coordinator, through his letter to His Excellency. Advocacy meetings with some LGA Chairmen to solicit for CDTI suPPort. 4. Government suPPort, especially financing should be regular and increasing Government is yet to. release fund to the project. But there is hope that His Excellency will approve the state-integrated plan of action submitted to him. The State Government budgeted 15 million Naira for 2004 - 2006 to the project and out of this, 5 million Naira was for 2004. Also some LGAs have shown positive indication to support the CDTI at LGA level. For instance, Uzo-Uwani approved the sum of NB0, 000.00 for mectizan distribution /training for 2004. 5. Management of CDTI project especially at the State level should be revamped and fully work equitably iand transparently with all partners with a stake in CDTI activities. The CDTI Management at the State level has been changed. The former State Oncho coordinator, Mr. E.T. Alo withdrew at the end of Dec. 2003. He was replaced by L.N. Nweke in January 2004. The New leadership has good working relationship with NOCP Enugu Office, Global 2000 and other stakeholders RECOMMENDATION IMPLEMENTATION AT STATE LEVEL - ENUGU STATE 39 40 ACTION TAKENRECOMMBNDATIONS All stakeholders are now involved in the participatory planning process for the project' For instance, the CDTI plan for 2004 was jointly developed by all stakeholders at the ministry of health policy meeting in October 2003 - Jan2004. All stakeholders were informed of their input into the final plan. Global 2000 and state govemment received feedback of their inputs into the plan The plan clearly specified the roles of key partners especially the State and Global 2000 The CDTI programme is owned by the State' I I N....tury conducive environment is provided by the state to the project. For better linkage and CDTI support, the State has changed the CDTI management to ensure better outPut. Planning: Prioritv: High 1. Entire Planning Process should involve all stakeholder in totality (i'e plans must be developed jointly or in active ParticiPation bY all stakeholders) at his level. All stakeholders should receive a feedback on their inputs before the final plan is produced. The roles of all key partners at this level (State and GRBP) should be explicitly clear. State should own the CDTI programme and provide a conducive environrnent to the NGDO partner to contribute to the CDTI activities significantly and without hindrances The project was visited by the Acting Direcior, SE programmes, Dr. Emmanuel Emeka in APril 2004. SPO and SOCTs are to embark on supervision in Sept. Mon ito rin glS u D ervis iqE!. Priority: Medium 1. One routine supervision visit to each project should be conducted every year' 40 4t 2. Supervision should use checklist Checklist used by the Acting director. SOCTs and SPO, to use checklist during their supervision. 3. Resource ror supervision shourd be in an I 3:;: :T ffi?T:?,1|::,:JHH:'?lJlXi efficient and effective manner I plan' 4t 42 Mectizan SuPPIY: PrioritY: Medium l. Improve the existing Process of mectizan orderin g, Procurement, storage and distribution. Mectizan has been ordered, procured, stored and distributed appropriately based on the last treatment figure as well as census uPdate. There is no report on Mectizan shortage since SPO and SOCTs insist on allocation of drugs based on 3x census (population) from LOCTs. Training and HSAM: ] Priority: Medium & High 1. LOCTs (not SOCTs) should train FLHF staff 2. Adequate amounts of appropriate training materials should be made availairle. 3. Planned mobilization to brief policy maker (about CDTI) specifically for the new ones to be carried out regularly. lmprove record keePing and management. LOCTs are now training the FLHF staff. Adequate materials for training have been provided. Meetings have been held with the policy makers on CDTI (Commissioner for health, Permanent Secretary, Director of finance and planning etc. | rut the available data well kept and I managed using newly introduced format. Integration of Support activities Priority: Medium 1. All trips must be authorized in writing and submit triPs to the SPIC SPO now authorizes all field trips of SOCT in writing. Finance : PrioritY: High 1. A cost reduction / contairunent strategy should be embedded in the CDTI and comprehensive health budgets. 2. The SOCTs should be involved in the budgeting in totalitY. Cost reduction/containment strategy has been introduced in tlre project as well as in integrated health estimated budget. SOCTs are involved in every budget and also aware of any fund available to the project including the source. 42 I 3. The government should release the funds budgets for CDTI' 43 This is a problem. The State budgeted N15 million for-2004 2006 and N5 million for 2004 but no release 43 44 2. 3. 4. Transport: PrioritY: Medium 1. The current replaced and vehicles are insured. Use of the vehicles (four wheeled and motorcycles) must authorized in writing. Each trip must be recorded in the logbook, and logbook and service schedules be checked regularlY. There must be a maintenance schedule for the vehicles, which are checked regularly. vehicle should be ensure that new comprehensive APOC has agreed to purchase one vehicle for the project as contained in her letter of Agreement 2004. The new vehicle will be comprehensively insured. SPO authorizes in writing the use of vehicles by SOCTS. Drivers now properly record each trip in the logbook and SPO regularly checks the logbook Vehicle is not Yet being serviced I maintained m onthly a nd c hecking is not done regularly as it is not readilY available. Human R.esources: Priority: Medium r. Human resources should be motivated (not necessary financial motivation) to enhance their commitment to CDTI activities. SPO now praised and encouraged SOCT and he is open to them in all CDTI matters. Coverage: PrioritY: High 1. Increase both geograPhical and therapeutic coverage 2. Update census correc;tlY and regularly All CDTI communities are receiving Mectizan treatment and the therapeutic coverage is steadily on increase of above 65%. The current census update is not yet available but the project is making effort to get it ready. 44 45 LOCAL GOVERNMENT AREA LEVEL . ENUGU STATE Plannine: Priority: Higli 1. CDTI should be integrated in the overall / comprehensive health plan. The planning process should be participatory and take into account communi Most LGAs included CDTI in their health plan for 2004. Community n eeds a re now included in the health plan of the LGAs.Leadership: Prioritv: Medium l. Staffs at the LGA should be fully empowered to initiate CDTI activities. SPO and SOCTs wrote letter, which empowered both the pHC and LOCTs to initiate CDTI activities this Supervisory visits should be focused to ensure problematic areas/aspects are addressed appropriately. 2. Checklists are available but not used. Only the recommended supervisory visits should be done. PHC coordinators held meeting withLOCTs on the importance of supervision. And problematic areas 319 _now being supervised for e.g.AMOLI in Awgu LGA. LOCTs arc directed to be using checklist during supervision. PHC now limited LOCT only to recommended / planned supervision visits Mectizan: Priorit]': Hiqh FLFH staff and CDDs trained to determine the quantity of mectizan tablets needed their areas. Accurate census updates. Mectizan orders to originate from the lower levels. 4. Ensure that all eligible persons swallows mectizan. LOCTs trained FLHF and CDDs onhow to determine the quantity of mectizan tablets needed by their communities. LOCTs are finalizing the conduct of census update in their LGAs. Accurate census updates are not yet available in all the LGAs. Requests/ orders for Mectizan are now from FLHF to LOCTs. LOCT/PHC now mobilize and heatth 9!y9_ate community members throughFLHFs to ensure that all eligible ale treated. 45 1. 'rioritv: Hieh I 46 1. Targeted identificati train staff on needs on and target. LOCTs and pHC have trainedthrough letters on needs identification. LOCTs/PHC coordinators had paid advocacy visits to the newly elected LGA policy makers to solicit for their supports. 2. lntensify advocacy to policy makers andpotential NGDOs / Organisations. 46 47 A proper CDTI budget to be developed basing on the market prices and resources available with full participation of all stakeholders. CDTI budget should be a component in the overall health budget of the lbns. Strategies for cost reduction / containment should be developed with the involvement of all stakeholders. Government funding must be regular and I LOCTs with pHC coordinators and LGA finance officer had developedproper CDTI budget using the market prices and resdurces available involving alt stakeholders. The CDTI budget is now integrated into overall health budget 6f tne LGAs. Review committee involving stakeholders set up by LGAs has reduced all cost only to the carrying ] capacity of the LGA. See the overall recommendation, No.4 _ryn+','Prioritv.- Medium 1. At least one motorcycle for CDTI activities should be made, available at all LGAs. 1. Continue improving the existing situation 2. Develop realistic plans and budgets for the maintenance and replacernent of logistics for CDTI activities. Each LGA wilt receive one motorcycle as soon as the donation from the APOC is received. Memorandum of understanding on the maintenance and replacerient will be signed between the State CDTI project and LGA officials or by at source deduction SOCTs a re yet to train LOCTs on plgqng. New ones trained by the LOCT leader have replaced t-hose IOCTs transferred. l. All eligible communities should receive Mectizan. lntensive community mobilization on the need for all eligible communities to receive treatment has been carried out by LOCTs 47 Finances: prio.it, Coverage: Prioritv: Hieh 48 2. A minimum of 65% of the eligible population should be treated. through announcemeit--- in churches, schools, markets etc. LOCTs are aware that at least 65%of the eligible should receive treatment with ivermectin. 48 49 3. FIRST LINE HEALTH FACILITY (F'LHF) LEVEL - ENUGU STATE Plannine: Prioritv: Medium 1. All plans or schedules for CDTI and other programmes should be written. 2. FLHF should be empowered to carry out CDTI activities without having to be directed by the LOCTs. 3. FLHF staffs should be trained, encouraged and given opportunities to plan. FLHF staff have started writing all plans or schedules for CDTI and other programmes through the instruction of LOCTs LOCTs had empowered FLHF staff to carry out CDTI activities on their own. Encouragement is being given to FLHF staff by LOCTs to enabte them plan CDTI activities. Leadership: Priority: Medium & Hieh 1. FLHF management should initiate the CDTI activities. 2. Political leadership shoukl play significant roles CDTI activities. lntensify advocacy to polltical and traditional leaders. FLHF are allowed to initiate CDTI activities Politicians are now being contacted to assist in CDTI activities especially influential ones. The traditional rulers and councilors are now getting involved in CDTI activities. Mectizan: Priority:_ Medium 1. Communities to be fully involved in decision making regarding the time for Mectizan di stributi on. 2. Mectizan tablets should be collected from the LOCTs and delivered to the CDDs using goverTrment resources. Communities are involved in the deciding time of distribution of mectizan This channel of drug distribution from LOCT to CDDs by FLHF is utilized / maintained. Monitoring / Supervision : Prioritv: Hieh & Medium l. Transmission of CDTI datalinformation Through budgetary provision, 49 50 should not depend on APOC or NGDO but government resources. 2. Supervisory checklist should be used 2. Record keeping must be revamped. 4. The FLHF staff should do only necessary supervision of CDDs. 5. FLHF staffs should tre involved in addressing the problems rcf CDDs and the communities. A1l successes should be noted and always acknowledeed. FLHF are using government resources to transmit CDTI data /information. FLHFs use the checklist provided to them. More checklists are still needed. LOCTs are still orientating F LHF on data management. Files have been provided to them for documentation. FLHF keep to only targeted supervision. FLHF staff are involved in tackling the problems of CDDs and communities particularly in CDDs' compensation as well as issue of adverse reaction. Commendation letters are now to be issued to the deserved staff. 50 5l Trainine / HSAM: Prioritv: Hieh l. Training must be carried out in a cost efficient manner. 2. lncrease the sufficient number of trained CDDs. Targettrainingof CDDs is being done by FLHFs Efforts are being made to increase the number of CDDs for training through mobilization and meetings with community members. Finances: Prioritv: Medium 1. FLHF staffs should be involved in the planning and budgeting for CDTI activities. FLHF staffs should be conversant with the costinq of CDTI activities. They are LGA staff hence involved in planning and budgeting for CDTI activities by sending their inputs through LOCTs or othenruise. They are also involved in costing since it is part of budget. Transport/other material resources: Priori8: Mediugl 1. Avail at least one motorcycl,e or any other means of transport to FLHFs. Make a maintenance and service schedule for the means of transport to be made available. Consideration will be given to this whenever resources are available. The transport is not a big deal, as LOCT motorcycle will be called up for use. Maintenance and service schedules are to be provided. Human Resources: Prioritv: Medium 1. FLHF staffs must be knovyledgeable and skilled in data management and planning. Knowledgeable FLHFs arc now used for data management and planning through induction traininq bv LOCTS. Coverage: Prioritv: High l. Ensure and maintain all (100%) eligible communities on treatment. 2. At least 650/o of the total population are treated. FLHFS, traditional rules and LOCTs have fully mobilized all communities for treatment with ivermectin FLHF have now realized the task before them in treating at least 65% of the total population 5l 52 4. COMMUNITY LEVEL _ ENUGU STATE Plannine: Priority: High 1. Allow CDDs to make decisions on the visiting times and routes that are convenient to them 2. lnvolve leadership in the management of problems Decision on the visiting times and convenient routes are now being allowed for CDDs by FLHFS. Village leaders and traditional rulers are being assigned some management problems: such as refusal, CDD drop out and CDD not collecting drugs from FLHFS. Leadership: Prioritv: High Intensify HSAM to village leaders. Community to select CDDs and not their leaders and FLHF staffs. lncrease compliance to the consumption of mectizan by the eligible population. Leadership to ensure that eligible population consumes mectizan for the recommended period. FLHF and CDDs are being told to intensify HSAM to village leaders. Communities have being directed to take responsibility of selecting their CDDs by FLHFs Through health education /mobilization, eligible persons are now complied to mectizan treatment Persuasion by village leadership has helped to convince eligible person to receive treatment especially the refusals. Supervision/lVlonitoring: Priority: Medium 1. Transport arrangements to facilitate the delivery of reports to the LGA should be made. No action has been taken Mectizan Procurement and Manaqement: Priority: High 1. The process should be community directed. Community is being informed through mobilization meeting with traditional rulers of their roles in mectizan procurement. 52 53 2. All CDDs should be knowledgeable aboutthe calculating of the quantity of Mectizan required. FLHFs have started teaching CDDs on how to calculate the quantity of mectizan required. 53 54 Trainine / HSAM: Priority: Hish l. Management of refusals to swallow mectizan through adequate HSAM. 2. Empower the CDDs and community leaders to play more roles in managing refusals. Meeting of community members with community leaders is addressing this problem in some communities and this is continuous. FLHFs are contacting with influential persons through letters. Also during feedback meeting, the community support for CDDs is addressed. ru 1. Increase community contribution to CDTI activities. 2. Encourage community support for CDDs. 1 & 2 are being addressed through the letters to traditional rulers and involvement of influential persons l. Recruitment of more CDDs to reduce ratio of CDDs: households ('hence, reduce the pressure on the present number of CDDs). 2. Promote CDDs willingness tr: continue playing their roles. All FLHF are instructed through written letters to adhere to appropriate number of CDDs I household ratio. Similar letters to traditional leaders through FLHFs from the State requesting them to support CDDs Coverage: Prioritv: _ Hieh l. All eligible communities should receive mectizan. 2. All eligible persons should swailow mectizan. CDDs and FLHF directed to ensure that all eligible village received treatment Similar effort through CDDs and encouraging/mobilizing villagers to receive treatment 54 55 I ANAMBRA STATE RECOMMEDAI'OruS AT STATE LEVEL ACTION o Human Resources There should be a bookkeeper for Onchocerciasis control activities within the State Ministry of Health The Ministry has designated the Director Finance and Supply as the project bookkeeper. The State Ministry of Health should provide Drivers for the APOC vehicle in the State. A Driver has been assigned to the project. . Financial Funding Government should make financial contribution for the implementation of the CDTI programme. No fund has been released yet. Some funds were conserved and this has helped in the implementation of CDTI activities. A written report has been fonruarded through the Director PHC to the Commissioner emphasising the need for government to release counterpart contribution. I have met and discussed with the Coordinator Anambra Health System Fund on the need to support the programme. I have been directed to make proposal through the Director PHC and he will collaborate the entire finance package for 2005 budget estimate, since there is provision for Onchocerciasis in the Health system lmplementation plan. The Governor has shown much commitment in health programmes. There was a clear demonstration of this during APOC evaluators advocacy visit to the Secretary to the State Government. Fund was released. I also suggest high-powered advocacy from APOC/NGDO to the Governor to solicit for financial support. Government should release approved fund. The commissioner for Health has written to the Governor stating the contribution of APOC and more expectation from APOC The commission has also been intimated that a criterion for the replacement of capital equipment is on the release of counterpart fund and they are working toward that direction. I am optimistic they will respond Positively 55 56 Project Manager should have a clear estimate of the fund available to the proiect. The Project Manager has a clear estimate of the fund available to the project. There should be a financial control system within the Ministry to keep the books for Onchocerciasis control activities in the State. The Finance Director keeps and maintains dayto-day controlling system in CDTI activities. CDTI Project Accountant s hould be trained to handle the funding of CDTI project. Director though knowledgeable in bookkeeping but an update in CDTI accounting procedure will enhance his performance. Jhis will be done by ApOC.o Transportation and other material resources: State Government should put in place fundfor meeting the running costs and maintenance of project vehicle and other capital equipment Fund conserved was used to maintain all the capital equipment available in the project and also some maintenance has been effected from the Director's PHC/DC impress account. The Advocacy visit from APOC/NGDO when implemented will attract fund to the proiect. . Coverage Only permanent residents of communities should be included in the community registers tbr annual treatment. PHC Coordinators and LOCTS have been directed to pass on the information from the lower level to the CDDs. This information has been adhered to by the CDDS. . Mectizan, Ordering, Procurement and Supply Mectizan should be collected in one batch from Enugu and Stored within the State. Mectizan allocation for 2004 was collected in one batch and stored in a store provided by the Ministry and SPO has regular access to the Store. RECOMMEDATION AT LGA LEVEL ACTION . Monitoring and Supervision The monitoring and supervision of CDTI should be included in the routine M & E in PHC System. Supervisory checklist was redesigned by SPO, SOCTS LOCTS PHC Coordinators and other programmes officers to integrate CDTI with other programmes. . Training and HSAM Training for CDTI should be integrated into training for other health proqramme. This has been fully integrated in pHC system. Same LGA staff implement all health programme at LGA levels, 56 57 . Coverage Only permanent residents of communities should be included in the community registers for treatment. CDDs have complied with this directive and names of all non-residents in the community members have been deleted in CDD Transport and other materialo I Resources Replacement o f vehicle should be included in the overall 5 years plan of action of the LGA. Replacements included in the 1't year post APOC sustainability workplan at State level. This issue will be better addressed when there ispermanent Local Government Chairman atthe LGA Level. Vehicles and motorcycles are jointly utilized since same staff oi the LGA performs all these programmes. Government should release the approved counterpart The advo Chairmen. Majority was lamenting of poor revenue which was restricted to thepayment of salary only Advocacy by APOC/NGDO will stress on the need for th;Governor to make policy statement mandating the LGA chairmen, to release some money for the programme which will be deducted at source.Onchocercias have a clear estimate of the fund available to RECOMMEDATION AT THE FLHF The State fras released to LGA for CDTI. Managers have clear estimate of fund released to various units. Monitorinqy and Superuision. atorin$ CDTI reporting should be included in M & E structure with other health Supervisory cne CDTI inM&ESystem. Mectizan Procurement anao u d Distribution LGA should put in place a mechanism to ensure that drugs are collected once. PHC CoorOin have been directed to estimate the required quantity of drugs needed for LGA based on the eligible population in the CDDs register. Drugs required for each LGA this 2004 were supplied once for cost effectiveness. The cost implication for CDTI activities should be clear to staff at this level and stated in the budget plan of action. . Financing/Funding The workptafiAiorffi drawn with the FLHF staff and is aware o f the amount proposed. 57 58 . Transport and other material Resources Log books should be provided for vehicle as well as written authorisation for use. There is neither vehicle nor rnot,orcyctes supplied at this level. There is inter programme utilisation of motorcycles or bicycle supplied. Provision should be made for replacernent of vehicle by the LGA. The Chairmen of LGAs ffi assume office will be mobilized on the need to provide either motorcycles or bicycles at this level. RECOMMENDATION AT COMMUNITY LEVEL - AIYAMBRA STATE RECOMMENDATION ACTION. LEADERSHIP Communities should be empowered to decide for themselves the best turn for the distributions of mectizan Communities have been taken decisions on the time, method and mode of distribution MECTIZAN ORDERING Training of CDDS should include the proper way of calculating and request the quantity of tables required for their community The CDDs have been taught on how to calculate and request for the quantity of tables required for their communities based on the eligible population. HUMAN RESOURCE Communities should ensure that they keep to the recommended ratio of 1.20 householders or 2 CDDs per population Community leaders have been advised to select CDDs on kindred to treat 250 persons or less. Community leaders have strictlv adhered to . 58 59 Recommendation imPlementations State Level Recommendations - Ebonyi State Recommendation Action Planning Planning process for CDTI should begin with development of LGA plans. These should include activities at communities. FLHF & LGA levels. Cost & sources funds should be clearly indicated. The state should evolve from and be supportive to the LGA plans. Planning workshop has been organised for LOCTS & FLHFS & PHC Co- ordinators and LGA leadership. Plans have been generated from these levels to build Monitoring & Supervision Monitoring & Supervision by SOCTs should not be routine. It should be targeted and coordinated. Review of checklist. Supervision by SOCTS is now targeted and specific and supervising checklist reversed by updating and providing areas for comments, action taken, etc. There is need to develop a process and mechanism for recognizing and rewarding for good performance, which is essential for sustainability. These rewards could be financial or non-financial. Unsustainable rewards should be avoided. A process of rewarding hard work is now in place. Annual performance award to best performing LGA, FLHF, community and CDD is now institutionahzed at state, LGA and community levels. Financing There should be coordination between the accounting and auditing of fun<ls provided by APOC and MOH for the CDTI project There is effort to bring coordination b/ the accounting & auditing of APOC funds & that of Ministry of Health. Arrangement is to train MOH Accountant on APOC Accounting A system aimed at ensuring accountability should be put in place at state level Expenditure by line items). Action has been taken to ensure expenditure accountability at the Ministry of Health line item by line item. This is done by opening necessaqi ledgers and entering expenditure details, also line item by line item. Human Resources The roles and size of the SOCTs should be reviewed in view of the project's policy to increase skills and empowered LOCTs to manage their LGAs. The size of SOCTs has been reduced to three for cost effectiveness and empowerrnent to LOCTs for effective proj ect implementation. V 59 60 Leadership SOCTs should empower LOCTs to initiate and carry out CDTI activities LOCTS have been fully empowered to initiate CDTI activities by dictating the pace of the project implementation at that level. Recommendation for Local Government Area level Ebonyi State Recommendation Action taken Planning LOCT skill should be developed in planning workshops Planning workshops have been organized for LOCTS and LGA leadership. Also LOCTs have been empowered to organise training on planning for staff of the PHC system. LOCTs with other LGA staff (PHC Coordinator, Councillor for Health, etc) should in a participatory way draw up intergrated plans and budgets for the health programmes to be implemented at this level. LOCTs with other LGA staff (PHC Coordinator, Councillor for Health, etc) have in participatory way drawn up integrated plans and budgets for the health progralnmes to be implemented at this level. Monitoring and supervision Reporting procedures should be developed: LOCTs should routinely use a checklist for targeted supervision Supervision calenders should btl drawn up and distributed to CDTI implententers All supervisory visits should rer;ult in written reports which should be given to PHC Coordinators, SOCTs, and feedback provided to FLHF LOCTs have introduced the routine use of supervisory checklist Supervision calendars are being drawn up with a view to distributing it to CDTI implementers The attitude of making reports of each CD'II supervision is being cultivated among health workers so as to provide feedback to FLHF Efforts should be made to carry out integrated supervision Workshop on integration and integrated supervision has been organized at the State level where this deficiency is discussed Training/HSAM LOCTs should only train FLHF staff in CDTI LOCTs have been training FLHFs who in turn train CCDs and other community members Training of FLHFs should targeted needed skills and knowledge A11 trainings in the project now is targeted on specific areas of need HSAM should be properly planned to address issues relating to programme implementation and most importantly fund raising A schedule of HSAM has been drawn to attend to the problem of LGA poor funding to CDTI activities Finances New strategy of advocacy to State official 60 61 LOCTs should intensify advocacy towards LGA authorities with regard to funding CDTI activities have been developed so as to obtain directive from the Executive Governor for LGAs to be releasing fund for CDTI activities Recommendations at the Front Li Ith F Leveline tleat I'ac Recommendation Action taken 1. The project should organise management training for FLHF staff involved in CDTI with emphasis on integrated planning, targeted supervision, record keeping, & metizan ordering (especiall y mectizan inventory 2. AII trained FLHF staff need to be trained on CDTI and encouraged to see it as part of their routine duties The project has planned to organise management training for FLHFs during the first quarter of next year 2OO4 There has been a general orientation of FLHF staff on CDTI, while LGA pHC Directors have also been trained to ensure that FLHF staff see CDTI as part of their duties. Leadership Higher levels should empower and encourage staff at this level to initiate particularly with respect to planning and conducting CDD training with little or no input from the LGA FLHF staff now initiate CDTI activities by asking and going for their drugs. They also plan for training, monitorin and supervision. Training/HSAM l.Training of CDDs should focus on identified needs (lack of skills in certain areas or newly selected CDDs). 2. LOCTs should empower and allow FLHF staff to plan and conduct CDD training Training of CDDs is now targeted in specific areas. Also FLHFs now plan and conduct CDD training. Transport and other materials costs: Project should supply adequate quantities of IEC materials to this level or mobilizeLGA authorities to pro4uce needed quantities Adequate quantity of IEC materials are now being supplied to LOCTs and FLHFs Human Resources See recommendation under planning Plan should be made to provide immediate orientation on CDTI to new staff See action taken on planning 6t t, 62 f-monitoring and stakeheirlers meeti Table 13a: COMMUNITY SELF MONITORING AND STAKEHOLDERS MEETING IN ENUGU STATE 4.2 Community Setf-monitoring and Stakeholders' Meeting Table 13: Comm n seI c d State Total # of villages in the entire project area No.of communities that carried out self monitoring (CSM) No. of communities that conducted stakeholders meetins (SHM) ENUGU 1373 835 767 ANAMBRA 1062 804 301 EBONYI 973 486 111 TOTAL 3408 2125 tt79 LGA TOTAL NO.OF' VILLAGE IN THE ENTIRE PROJECT ARIIlt NO.OFVILLAGES THAT CARRIED OUT SELF MONITORING (CSM) NO. OF VILLAGES THAT CONDUCTED STAKEHOLDER, MEETING (SHM) Nsukka 77 53 51 Isi-Uzo 4t 28 24 Igbo-Eze North 49 40 37 Uzo-Uwani 80 4t 40 Ezeagu r20 67 62 Aninri 70 59 50 Iebo-Etiti 100 43 42 Nkanu west 142 80 73 Nkanu East 136 85 78 Oii River 62 43 40 Enugu East 31 25 2t Igbo-Eze South 89 54 50 Awgu 131 77 72 Udenu 73 51 47 udi 172 89 80 Total 1373 83s 767 T 62 63 Table 13b: COMMUNITY SELF MONITORING AND STAKEHOLDERS MEETING IN ANAMBRA STATE District/LGA Total of Communities/villages in the meso/Hyper Endemic No. communities/villagr', carried out self monitoring No. of communities that conduct stakeholders nrceting NJIKOKA 45 25 10 IHIALA 45 23 8 AGUATA 90 66 2t ORUMBA NORTH 90 73 28 ORUMBA SOUTH 65 48 T9 AYAMELI.IM 54 32 10 AWKA NORTH 73 65 29 AWKA SOUTH 65 50 2t OYI 50 47 t9 IDEMILI NORTH 115 89 32 IDEMILI SOUTH 80 72 27 NNEWI SOUTH 105 73 24 DLINUKOFI,A 43 31 11 ANAOCHA 76 54 20 NNEWI NORTH 35 35 15 EKWUSIGO 31 2t 7 TOTAL 1062 804 301 63 s64 Table 13c: COMMUNITY SELF MONITORING AND STAKEHOLDERS MEETING IN EBONYI STATE LGA NO OF VILLAGES IN PROJECT AREA NO OF VILLAGES THAT CARRIED CSM NO CONDUCTING CSM NOW NO OF VILLAGES THAT CONDUCTED SHM IKWO 103 30 39 2l VZI 96 r6 2l 15 OHAOZARA 106 5 46 22 ONICHA 96 t2 36 8 EZZA NORTH 81 9 4l 9 EZZA SOUTH 6t t4 2l 8 NO 106 t6 34 J EBONYi 111 t7 20 2 ISHIELU t02 2l 27 4 AFIKPO NORTFI t02 2l 27 4 TOTAL 973 175 311 111 Comment: The result from the community self-monitoring and stake-holders meeting have positively affected the project,s implementation in ttre state. This is because findings during evaluations provided the state of things with regard to the programme. These situation results are often discussed during stakeholdersmeetingand the main concems raised addressed. The final outcome is better quality CDTI implementation. 64 65 4.3 SUSTAINABII,ITY OF PRO.IECTS: PLAN AND SET TARGETS 4.3.1 PLANNING AT ALL LEVELS: Sustainable CDTI plans for post APOC period have been developed at state, LGA and facility levels. Communities have organised structure and system that has plans to continue Mectizan intake after APOC period. 4.3.2 FUNDS: The plan referred to on 4.3.1 has budgetary provision for the various partners/levels. Also there are scheduled advocacy visits to state and LGA policy makers. This is complimented with follow-up budgetary provisions for ease of release. Equally, there has been deliberate policy for deduction of LGA annual contributions at source at state/LGA joint account for the next five year 4.3.3 TRANSPORT REPLACEMENT: Ebonyi State project has commended replacement and maintenanceoftransportfacilitieswithfundfromthestate and LGAs. More so, adequate provision has been made with other projects like Health System Development Project (HSDP) - a World Bank Assisted Project to povide some capital equipment. Enugu State project has written to His Excellency through the Ministry of Health for one Hilux Toyota vehicle to support the APOC donated vehicle. LGAs in the state have been requested to provide and mainrationtain motorcycles for use by LOCTs. Also Anambra State has written a memo through the Honourable Commissioner for Health to supply the project with vehicle. Though health system project has agreed to assist the project during some of their field trips. In the same vain, LGAs have been advised to provide motorcycles for CDTI implementation. 4.3.4 OTHER RESOURCES: Adequate arrangements have been made for other resources for the programmes sustainability. This involves integration with sectors within and outside health, involvement of CBOs and inter/intra pro gram cooperation. 4.3,5 WRITTEN PLANS: Written Plans for Post-APOC era have been completed and forwarded to APOC via NOCP. 4.3,6 LEVEL OF PLAN IMFLEMENTATION: The 5tl' year of APOC support just ended. Necessary structures and imputes are being put in place to ensure full implementation of plan. 65 66 4.4. INTEGRATION: There is integration of CDTI into the PHC structure in the states. Directors of PHC are the of PHC Department 4,4.1 IVERMECTIN DELIVERY MECHANISM: Distribution of mectizan within the Health service follows the PHC structure of the states to LGA PHC to FLHF to community. 4,4.2 TRAINING: Training are sometimes integrated as two or programme officers plan for joint of LGA and Health facility levels to minimize cost. 4,4.3 JOINT SUPERVISION AND MONITORING: There is inter-programme supervision and monitoring. This is effected through the joint use of vehicle and other logistics. This ensures effective communication and message delivery. 4.4.4 FUND RELEASE: Fund release has been a difticult area in integration. Each project has budgetary provisions in the state but not all (in fact few of the) programmes eventually receive fund. It will indeed be difficult to integrate fund usage because of accountability problem. Rather, resources like staff and eequipment/facilities are inter used. 4.4.5 CDTI PHC BUDGET: CDTI is appropriately accommodated into PHC budget. 4.4.6 OTiIER PROGRAMME USING CDTI STRUCTURE: Other programmes using CDTI structures include Guinea Worm Eradication, National Programme on Immunization, and Nutrition Prograrnmes. Since onchocerciasis programme officer at LGA and Health facility co-ordinates two or three of these programmes, the issue of programme integration appear easy. There is inter project equipment usage. Also at the village level, one CDD uses bicycle provided by onchocerciasis programme to carry out guinea worTn surveillance, while the same CDD uses his bicycle as a guide during immunization campaigns. The achievements have been that it has made the project coordinaonr easier and less costly. 4.4.7 No other issue 4.5 OPERATIONAL RESEARCH 4.5.1 No operational research has been undertaken in the project since inception. 66 67 I SECTION 5 STRENGTHS, WEAKNESS AND CHALLENGES A. ENUGU STATE 5.1 STRENGTHS I 1. Commitment and dedication of some LGA and Health center staff to the programme despite continued non-paylnent of salaries for months by their LGAs. 2. Stability of Health staff involved in CDTI. 5.2 WEAKNESSES 1. Low levels of community parlicipation and ownership of CDTI. 2. Inadequatemotorcycles 3. Lack of adequate financial support from state and LGAs. 4. Inability of government at state and LGA level to provide counterpart fund. 5.3 CHALLENGES ADDRESSED 1. To obtain reliable census figures. The project embarked on revision of CDD regisi';rs. CDDs were asked to come to the health facilities with their registers, the health facility staff had to sit down with the CDDs and go through the registers in order to eliminate non-residents and abroad members of households. The exercise will be a continuous one until reliable census figures are finally obtained. 67 68 B. ANAMBRA STATE Strensths * Adequate sensitization of endemic communities on GDTI. .1. Commitments of SOCTS,LOCTS, and HFS in CDTI activities, despite non- payments of arrears of salaries owed by the state and LGAs. t' Major decisions now being taken by communities. * Prompt and regular data submission by some CDDs because area of submission is within their doorsteps. t' Some communities support and motivate their CDDs. Weaknesses , o Inadequate motorcycles for all the LGAs to enable the health workers identify problem area and deal with the problem immediately. o Participation fatique spreading into the communities leading to some communities not providing support to CDDs. o Non-challant attitude of some LGA policy makers in the release of funds. o Lack of financial commitment by State Government l Incessant cabinet re-shul'flement leading to increase advocacy. t LGA complaint over poor revenue allocation and restriction to payment of salary only military agatnst release of fund by LGA. Challenges: - Getting communily support for CDDs. - Continuos mobilization and sensitization of communities, opinion leaders and appeal to prominent philanthropists and public spirited individuals in the communities to support the programme that CDDs will be benefactors I 68 69 and benefactress in health system i nsurance s cheme e mbarked u pon b y r communities. - Getting the state and LGA to budget and release cash counterpart fund. Advocacy visits by NGDO, APOC, NOCP and zonal onchocerciasis , task force will be of immense benefit. Increase in the federation allocation and reduction in turnover rate of policy makers to give room for continuity. Integration of PHC especially at grassroots level. Programme that is quite lucrative and offer incentive to their health workers at community level for level for example NPI, Baby Friendly initiative etc can use CDDs in their programmes. C. EBONYI STATE STRENGTHS t The State's continuous release of counterpart fund on yearly basis' O Ccmmitment of weli lettered state and LGA Oncho team members' o Availability of literate CDDs o Use of CDTI as a vehicle for delivery of other Health Services at Community level e.g. Guinea woffn eradication, polio campaign etc' t Availability of basic office equipment/facilities i Commitment of sofiie communities in supporting their CDDs. C WEAKNESS e Non- effectiveness of primary Flealth Care System at State and levels e Inability of some LG.As to release counterpart fund for the Programme o Non- Provision of support to CDDs by many villages 69 70 c Absence of travel logistics for LOCTs and HFS to take care of large and scattered settlement. CHANLLENGES o The creation of LGAs and consequent transfer of Health staff from endemic to non-endemic areas constitute a problem in continuity and man power development. o Absence of bicycles for District Flealth staff and Health staff and some CDDs who live in areas of scattered settlement. o tr Villages now have added responsibility because of increased CDDs. Inability of some LGAs and communities to provide counterpart contribution at each of the levels towards Onchocerciasis control. Late release of approved fund for CDTI activities by APOC. Scattered pattern of settlement in some communities. Poor road network throughout the state. tr tr tr * * * b * Increased provision on training to take care of transfer and re-posting of .lealth staff due to LGA creation. * APOC to supply equipment including motorcycles, bicycles, etc. to compliment the one already supplied by Global 2000. APOC and NOTF to continue re-examining the entire APOC philosophy with a view to re-adjusting its application as peculiar to varying local communities APOC to be more realistic by releasing fund for CDTI activities on time. APOCATOTFAIGO and state to continue mounting aggressive advocacyl mobilization to ensure that LGAs and benefiting communities provide their counterpart contribution. IMPLEMENTATION IN EBONYI STATE 7A 7t * District Health staff Health Facility staff and CDDs to be provided with motorcycles and bicycles respectively, in those areas with poor road network and scattered settlement. 7t
Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents
Enugu/Anambra/Ebonyi states’ CDTI annual project technical report submitted to Technical Consultative Committee (TCC): September 2002-October 2003
Открыть оригинал документа
Полный текст размещён на сайте публикующей организации. lawenc.com индексирует метаданные и ведёт на официальный источник.
Полный текст