Monitoring/evaluating the implementation of CDTI sustainability plans for Enugu CDTI project, Nigeria

I ! a I AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL Monitoring/Evaluating the implementation of CDTI sustainability plans for Enugu CDTI project, Nigeria. Patricia Ogbu-Pearce Adejai Emmanuel Olu For To: 6mP i : il 7 ii i. I .) I so {ition csb CoP ,ti+ i.- BFo tro For lnfornrotlon fl ? AVR 2008 To'SiL I t f' IflM ffi ffi "Q.F. IG a rEn ugu Ez; +o s I , T H\ ,n, {' I Ii E _ i, I TI I IL L t o ,ou Z € H Table of Contents Abbreviations----------- Acknowledgement Executive Summary Introduction Team composition Background to the visit ------- ----- 7 aJ 4 5--6 n ? 7 List of Objectives- -----7 Monitoring itinery 8 The process involved in the monitoring --8 - 9 Findings and Recommendations ------------ -----------10 3.1 State Level 10- 11 11- 13 13 -14 15 -15 3.2Local Government 3.3 Health Centre/Front Line Health Facility 3.4 Community Some qualitative data List of people met ----------'- L7 & * 2 l I{ l I. q d" L t t I APOC CBIT CBO CDD CDTI CHEW CHO DHS LG LGA LOCT MHO NGDO NGO NOCP NOTF PHC PS SOC SOCT UTG Abbreviations African Programme for Onchocerciasis Control Community Based Ivermectin Treatment Community Based Organization Community Directed Distributor (of Ivermectin) Community Directed Treatment with Ivermectin Community Health Extension Worker Community Health Officer District Health Supervisor Local Government Local Government Authority Local Government Onchocerciasis Control Team Ministry of Health Non-Govemment Development Organization Non-Govemment Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force Primary Health Care Permanent Secretary State Onchocerciasis Coordinator State Onchocerciasis Control Team Ultimate Treatment Goal {' ,+r * 3 Acknowledgements We are grateful to Almighty God who has granted all members of the monitoring team a journey mercy throughout the period. We are enormously thankftil to the following for their co-operations and their help I The staff at APOC Headquarters in Ouagadougou; Dr. Amazigo and other members of staff in the provision of the logistic and ftind. r The State Hon. Comrnissioner for Health, Permanent Secretary, Ministry of Health, Director PHC/DC I The Global 2000 - Mrs. C. Maduka and her team for their support to CDTI activities in Enugu I All mernbers of SOCTs, LOCTs and FLHFs tl The chairman of Nsukka, Nkanu West and Udi LGAs Community members andf CDDs visited. EJ I l= t ( 0) EXECUTIVE SUMMARY Enugu State CDTI project is part of the combined Enugu/Anambra/Ebonyi CDTI project which cuune on board with APOC sponsorship in 1998. Other partners are Global 2000, Federal, State and Local Govemments. The State consists of 17 LGAs out of which 15 LGAs are implementing CDTI. The population at risk is 975,l41from 1373 endemic communities. The plan of action for sustainability: Planning process, Supervision and Monitoring, Procure Mectizan, Advocacy and Mobilization at all levels, Training, Finance,Integration, Provision of capital equipment and record keeping. The aim of this report is to review the implementation of sustainability plan put in place after the first five years of APOC assistance. The evaluation monitoring was carried out over a period of ten days. Information was generated by docutnent study. survey (using the instluments developed by APOC for the monitoring of sustainability of CDTI) The following are the major flinding of the monitoring exercise.(1) PLANNING: Planning at the State level is integrated to other health services as shown in the list of activities to be carried out by the department of Disease Control. Detailed work plan that include list of CDTI activities including the dates when they will be carried out is also available. two of the LGAs visited have stistainability plan but work plan with dates Are available. (2) TISAM: Series of advocacy to the stakeholders have been carried out but with little effect since the objective was toward counterpart funding which is yet to be accomplished at all level of CDTI operation in the State. Although the community awareness on CDTI irnplementation is high but the problem of incentive is working against actualization of Community ownership of CDTI. (3) MECTI ISSUE Procurement procedures of mectizan tablets from the State level down to the community level are working well. Adequate and timely supply is ensured at all levels. Although this has not been integrated as a result of non-availability of central store. (4) INTEGRATION : CDTI activities have been integrated into other health Services particularly in the areas of using particular personnel to carry out Two or more health services and using the same logistics during activities such as training, monitoring and supervision. *r * 5 (5) FINANCE Contribution at present is largely in the areas of payment of staff salaries both at State and LGA levels. Budgets are prepared and approved but no release were made except when capital equipments were to be collected with the sum of Nl49,000.00. (6) RECORD KEEPING At the State level, records of CDTI activities are available and well analyzed. (7) TRAINING There is need to carry out training of personnel involved in CDTI activities in all the LGAs, health facilities and at communities. This will improve the skill and knowledge of the personnel who are new on the programme and those who have been previously involved. The use of IEC materials will also be required to facilitate learning. (8) MONITORING AND SUPERVISION: There were monitoring and Supervision of CDTI activities during distribution of mectizan tablets in some corununities. The exercise could not be carried out as required due to probiem of logistics and flreling both at LGA and Health facility levels. In some cases, checklists were not used. (e) HUMAN RESOURCES: Personnel involved in CDTI activities were found to be well informed, cornmitted and stable, especially at the State Ievel. Frequent transfers of health staff at the local and health facility levels are the major problem affecting the implementation of CDTI at these levels. (10) TRANSPOR'I :- Transport facilities available for use in tl-re CDTI activities are provided by APOC and Global 2000. Maintenance and fueling of vehicles at the State level as well as motorcycles at the LGA levels should be the responsibility of the state and LGAs to Ensure sustainability. (11) COVERAGE: The coverage at the state and the reporl from the local goverrunent and FLHF shows that the geographical coverage is 100% while therapeutic coverage is 82.6Yr. h? 6 .i L : t t l ii INTRODUCTION Enugu State CDTI project since its inception in the year 1995 was funded by the Lions Club intemational and Global 2000. APOC funding started in the year 1998 and also known as ENUGU/ANAMBRA/EBONYI CDTI Project. After the five years of APOC assistance, there was a monitoring and evaluation exercise to determine the sustainability of the project. At the end of the exercise there was a sustainable work plan comprises of 17 LGAs are implementing CDTI actively covering 1,373 communities with a population of about 915,141 people. The treatment with mectizan over the past five years has reached over J2Yo, still below the require d 84%. (iii) Background to the visit Having implemented CDTI five years the project was evaluated in 2003 by APOC management. At the end of the evaluation, the State and Local Governments developed sustainability work plans for the next tluee years that is 2004 to 2006. So this current exercise was to monitor 2004 - 2006 work plans and ascertain the sustainability or otherwise of the Enugu CDTI project. TEAM COMPOSITION i Princess Patricia Ogbu- Pearce National Onchocerciasis Control Coordinator, Federal Ministry of Health, OIOCP) Abuja. 2 Mr. E. O. Adejai Ondo State Onchocerciasis Control Coordinator, Ministry of Health, Akure. LIST OF OBJECTIVES To determine the extent to which programme partners, particularly at the district, FLMF and community levels are implementing the proposed activities in their sustainability plans. Check implementation of sustainability plan and verify whether constraints earlier identified are being rectified. s Check if key CDTI activities e.g. training, monitoring and supervision, HSAM and mectizan procurement and distribution are being implemented as planned. To pay advocacy visits to policy makers at State and Local Governments level for more corlmitment to support CDTI implementation financially. I 2. aJ 4 I ? t ]. MONITORING ITINERY (iv) THE PROCESS INVOLVED IN THE MONITOIUNG Meetings with the SOCT members on the first day to explain the objective of the mission, then together we selected three LGAs to be visited based on tlieir coverage either as good (Udi-82.80o%), moderate $ikanu West ) and bad (Nsukka). The various SOCT members responsible for these LGAs were dispatched to go and give notices of the proposed visits on the selected dates. The monitoring team briefed the Global 2000lCarter Centre project offtcer, Dr. (Mrs) Maduka and the State4 Director, Health Services and Primary Health Care, Dr. Eznta Ezeilo. Next three days were the actual field work. At each LGA efforts were made to meet r,vith policy makers especially, the Chairmen, Heads of Health Departments and Director of Finance. Only in Nsukka where we are able to have audience with the Chairman of the Council. The team met with LOCT members in each LGA, reviewed their records, and asked them questions about the process of CDTI implementation. The team then visited two FLHF in each LGA where discussions witl'r Nurses in-charge of mectizan tablets allocated to them are held for distribution to CDDs. We examined their mectizan inventories, which were found on sir-rgle pieces of paper. Visits to one community each within each FLHF were carried next. Here at least one CDD, community leader and community members were interviewed. CDD's registers were examined for census tt .* ancl proper documentation of treatment. Advice was offered whenever as error r,vas observed. Following the end of field work, the team debriefed the State Ministry of Health policy makers. We met the Honourable Commissioner and the Director, Health Services and Primary Health Care, Dr. Chukwunweike and Dr. Ezeilo respectively. At this point, the team called on the Ministry authorities to ensure support through paying counterpart 8 SA{O DATE ACTIVITY I 15th - 16th September 2007 Arrival of the Monitors from their base 2 17th Sept. 2007 Meeting with SOCT,NGDO and State Policy Makers at the MOH / development of plan of action J l Str' September 2OO7 Pre monitoring mobilization of LGAs, FLHFs and the communities 4 19th September 2OO7 Monitoring at Nkanu West LGA / Debriefing. 5 20tn September 2007 Monitoring at Udi LGA / Debriefing 6 21" September 2007 Monitoring at Nskka West/ Debriefing 22"d -2511' September 2OO7 Report Writing /Debriefing of Policy Makers and the NGDO (Global 2000) 8 26"' September 2007 Departure funding for the implementation of CDTI if they are to reach and maintain the minimum coverage for sustenance of the programme. We also asked them to get needed IEC materials for the SOCT as we did not find any posters or any other IEC at FLHFs or communities visited. As little or no training have been carried out lately we asked to try and get funds for SOCT to train LOCT, FLHF staff and CDDs. In his response, the Honourable Commissioner thanked the team, agreed he will sensitize the Executive Governor to get LGA contribution from source. That as for the State contribution, the Governor had already put into motion the payment of all outstanding counterpart funds, so Oncho Control will get hers in the very near future so our earlier request to meet with the Executive Governor was seen by all team rnembers and the Commissioner as no longer necessary. We then started on repoft writing after collating data for the field. The visiting team debriefed the SOCT and NGDO respectively and concluded our report writing. L t t, * I 3.0 FINDINGS AND RECOMMENDATIONS 1 .1 STATE LEVEL: 3 '1'1 PLANNING (Good): CDTI activities is integrated into the overall health serviceplan The detailed list of CDTI activities for the project for the year 2007 including thedates when they will be carried out was available. 3 'i'2.!ElLMiEer0 series of advocacy to the stakeholders have been carried out butwith little or no effect. The state Government is yet to release fund as promisedduring the advocacy visit. Health education matirials were not available due to lackof fund for the production of IEC materials. trnstable policy maker at the state Minisfy of Health is affecting the approval andrelease of budget. 3- 1.3 : Mectizan procuement is timely andsufficient. Also flre procedure/channel of distribution is effective and reliable. Thepro;ect has not experienced any shotage or inadequate supply of Mectizan. 3' 1'4INTEGRATION (Good): cDTI activities have been integrated into other healthservices particularly in the aleas of Health personnel. performing other healthactivities such as Guinea wonn control, Nirtrition, Ner. uling the same Iogisticsduring implementation of health activities such urirul.rirs monitoring, supervisionand collection of data. 3'^1:5 NNcElPgq0: CDTI budgets were given approval but there was no releaseof fund except when the capital equlpments were to be collected at Lagos with thesurn of Nl49,000. The Honourabll iommissioner promi."i to work out thepossibility with the State coordinator to ensure the reiease of counterpart fund for the ilHrl?:' He also promised to involve the LGAs to "o.rt ib,rte their bourrt.rpurt 3.1.6 data on CDTI activities were madeavailable. They were properly recorded and stored in the project office. The data arereliable but it has not been analyzed and utilized for panning CDTI activities in theState. The project shales data with the State Ministry of Health planning Unit. 3 '1 '7 covERAGE (G-oo0: the geographical coverage according to record over thepast two years shows that the p.oi..t has achieve a tloyrcoverage and 7517otherapeutic coverage. # t- j t f i l0 L, i t I RECOMMENDATIONS: 2.L.0 LOCAI, GOVERNMENT LEVEL 2.1.1 PLANNING: In all the LGAs visited, CDTI is integrated into the overall health service plan since Oncho Control Unit is under the department of PHC. Out of the three LGAs visited, only one of thern has a detailed list of key CDTI Activities. 2.1.2 TRAINING There was no formal training in all the LGAs visited. The LGA Coordinators were new on the job and there was no ftind to carry out the training exercise. Some of the LOCT inform the monitoring team that they were given informal training by the SOCT during visits to their LGAs. 2.1.3 HSAM: The three LGAs visited informed the rnonitoring team that advocacy and sensitization were carried out but due to unstable situation of the LGA policy rnaker there was no positive response. Aparl from the payment of salary of LOCT and Health workers there was no counterpart fund to carry out the activities of CDTI. There was little attempt on the mobilization of the comrnunities which is ineffective for CDTI implementation. 2.1.4 MONITO RING AND SUPERVISION 4jThe LOCTs reported that they canied * out minimal monitoring and supervision due to absence of logistic support and fund. There were no writing report of the few monitoring and supervisions carried out. Checklist was not used. Reporls of the monitoring and supervision canied out were given verbally without any feedback. RECOMMENDATIONS ACTION BY WHOM a Ensure approval and release ofcounterpart funding advo to the Po maker NGO/SOCT a Production of IEC materials and Community treatment ster SOCT a Community mobilization and sensitization to reduce the rate of refusals, and absenteeism SOCT a Recomposition of LOCTs to make is more functional. T of first line health facili staff and CDDs SOCT AND LOCT a Monitoring and supervision of CDTI activities to ensure Effective implementation. SOCT AND LOCT it 2.1.5 MECTIZAN SUPPLY: Mectizan supply in all the LGA visited was sufficient for previous distribution cycle. Supply was timely and record of distribution to FLHF was available. 2.1.6 IIUMAN RESOURCE: In all the 3 LGAs visited, there were officers responsible for Onchocerciasis control. Some of the LOCTs were new and required training to be able to perform adequately. They are also involved in other health programmes such as NPI, AIDs Control Malaria Control etc. 2.I.7 INTEGRATED: Integration if CDTI activities into other health activities in all the LGAs visited is fair. Logistic such as motorcycles, bicycles are used for other health services. LOCTs involved in other health services use the same period to carry out some of the CDTI activities. 2.1.8 FINANCE: In all the LGAs visited, there was no release of fund fol CDTI activities except the payment of salary and allowances of the personnel involved. There was an advocacy meeting with the chairman and supervisor for Health in Nsukka LGA where he promised to effect the release of fund but advised tlie LOCT to put up a memo to remind him. The problem of unstable political leaders at the LGA level was responsible for non-release of counterpart ftiird for CDTI. 2.1.9 RECORD KEEPING : Trvo out of three LGA visited were unable to present their CDTI records. They said the former LGA coordinator did not handover any record on CDTI to him. When they prepare their repofis, they did not keep copies of the reports for future reference. Data that are available were not reliable and could not be analysed and used for planning. 2.1.10 TRANSPORT: The available rnotorcycles in allthe three LGA visited were old, but serviceable. One motorcycle in each of the LGA is not adequate to carry out CDTI activities. Fueling of the motorcycles by the LOCT to implement CDTI activities is another problem facing CDTI implementation. 2.I.II COVERAGE The geographical coverage for the past two years in the 3 LGAs visited was 100% while the therapeutic coverage for: Nkanu West LGA was79%o in 2005 and84Yoin2006 Nsukka LGA was 7lo/o in 2005 and 75o/o in2006 UDI LGA was 690/o in 2005 andTSYo in 2006 The percentage of FLHFs that reached the minimum 65'Yo therapeutic coverage during the two last distributions was 100%o in all the 3 LGAs visited. g tz RECOMMENDATION 3.3.0 tIF LEVEL 3.3.1 PLANNING: - There was a list of CDTI activities carried ottt in two FLHFs out of six FLHFs visited. The two FLHFs are Nachi Health Centre and Eke Health Centre in Udi LGA. At the remaining four FLHFs visited, list of CDTI activities carried out was not seen. The LOCT planned for the FLHFs. 3.3.2 TRAINING: Only few of the FLHF staffs trained CDDs on their own. The LOCT carried out the training activities with the FLHFs in some areas; This was because they are new and had little experience on the implementation of CDTI. It was reported that formal training was carried out last in the year 2005 q v t 3.3.3 HSAM Most of the FLHF visited did not cary out sensitization of community and opinion leaders about Onchocerciasis. Where it was carried out, it was done alongside with other activities such as data collection. The FLHF staff also cornplaint of lack of fund and logistic to move to all the communities under their areas. t3t I RECOMMENDATIONS ACTION BY WHOM Detailed work plans should be developed by the LOCT To ensure sustainability of CDTI a LOCT The LOCTs should be reconstituted and trained since most of them are new on the job. This will improve Their skill and knowledge on CDTI Implementation a SOCT Monitoring tools should be developed and use during monitoring and supervision exercise. Reports should be provided with feedbacks a SOCT & LOCT Record of mectizan inventory should be kept* LOCT The LOCTs should be given more orientation on the benefits of integration in order to ensure effective utilization of the available resources a a More advocacy visit should be carried out to the LGAs to appeal to the policy makers on the importance of counterpart fund for the implementation of CDT activities SOCTAIGO/LOCT a Reports on CDTI activities should be written and documented. Transferred LOCT should submit all CDTI documents to the new officers LOCT a Request for additional motocycles should be made to the Appropriate quarters while the old ones should be properly maintained SOCT/LOCT 3.3.4 AND SU V Monitoring and supervision was not carried out regularly in most of the FLHFs visited. Where it was carried out occasionally, checklist was not used and there was no feedback and reports. Some of the FLHF staff which were also engaged in other Health services use the opportunity to carry out monitorir-rg and supervision. 3.3.5 MECTIZAN Mectizan supply in all the FLHF visited was timely and adequate There was no report of late supply or inadequacy in all the FLHF visited 3.3.6 HUMAN RESOURCES: There were designated person for Onchocerciasis control although they are also involved in other health services such as EPI, AIDS Control, Rollback malaria, etc. Some of the designated persons were not given formal training on CDTI thus making them to lack sorne skills and knowledge about CDTI. 3.3.1 INTEGRATION: Some of the FLHF staff combined training, nionitoring, supervision and collection of data from field with other health programme , such as EPI and malaria. They also share office spaces and logistics 3.3.8 COVERAGE Treatment data at the FLHF visited were not processed to determined the geographical coverage and therapeutic coverage. RECOMMENDATIONS RECOMMENDATION ACTION BY WHOM Detailed workplan with list of activities scheduled for Implementation should be developed a FLHFs a {< FLHF should keep records of CDTI activities FLHFs should make efforts to train CDDs in their Communities FLHF FLHFS a Health Education, sensitization and rnobilization of Endemic communities should be carried out with emphasis on CDD incentives and effect of absentees/reftisal FLHFS a Monitoring and supervision of CDTI activities should be Carried out by the FLHFs to ensure proper implementation of all the activities FLHFS {r * a Integration which has been put in place should be Strengthen throughout the project area FLHFs a Records of activities should be analysed and copies should be retained at the FLHF level for reference. Endemic Communities should be treated to ensure 100% Geo graphical coverage. FLHFS I t ,ll d I t !-/- 4.1 COMMUNITY LEVEL 4.1 HSAM: In most of the endemic communities visited, health education, Sensitisation and mobilization was carried out; but it has not been effectively Canied out due to financial constraint especially at the FLHF level. Most of the HSAM carried out was done through contracts with community Community participation. Members. There was increase in treatment coverage and irnprovement in 4.2 MECTIZAN SUPPLY: There was sufficient supply of mectizan tablet in all the communities visited. The CDDs collected their mectizan tablets at the appropriate time from the FLHFs 4.3 HUNMAN RESOURCES In most of the communities visited, they have an average of 8 CDDs. In some communities, they use kindred to serve as CDDs. Both r-nale and female CDDs are available in the CDTI communities. The workload for each CDD is very light since they operate the kindred system. Most of the communities pay their CDDs after distribution of mectizan tablets while sorne community did not motivate their CDDs .As a result of non motivation of the CDDs, the attrition rate was about 4%. Most of the CDDs required more training to improve their knowledge and skill. 4.5 RECORD KEEPING :- Treatrrent register used by the CDDs are available and properly recorded . The treatr-nent register are kept with the community leaders in some cases or with the appointed leaders of the CDDs. The community treatment register are well recorded and reliable but not integrated into other health services. 4.6 COVERAGE:- In most of the communities visited, all the households were not treated and reasonable numbers of the eligible persons were not treated in the last distribution cycle. Although the community members are aware of the benefit of the drug and want to take it, the therapeutic coverage is still below 84% due to CDD attrition and poor commurity sensitization. S.3 IS Recornmendation Action by whom Health education, sensitization and mobilization of the community members should be canied out to update their awareness and participation. FLHF, CDDs and community leaders. Selection and training of more CDDs to reduce the workload and make them more effective. Community leaders Incentives should be given to the CDDs to encourage them to distribute mectizan tablets effectivel Community leaders. RECOMMENDATION CONCLUS ON AND RECO ONS In conclusion having examined the sustainability indicator so far CDTI at the state and LGA level as contained in their plans, it is obvious that not much was achieved due to '-ck of firnds released to the project. However their supporting NGDO, Global 2000, arter Center kept her promise of making available Mectizan supply both timely and adequate. They even supporl the Socr with funds for distribution. o There has not been much formal training which is very much needed especially since the introduction of "IJmun-na Kindred" system. Even the Memorandum of underitanding signed between Cartel Center and APOC for assistance in training more CDDs was not fulfitled. APoc is yet to remit any money to the state on the issue. o There has been a lot of transfers within the system so the need for training and retraining of as many as health workers and CDDs cannot be over emphasizid. ApOC management should corle to the aid of Enugu State CDTI by providing some funds for the required trainings to correct mistakes noted and empower more wiling health workers and CDDs if the achieved,T5Yo therapeutic.orerug" is to be maiitained and improved upon. o The communities are very aware of the benefits of Mectizan and are willing to continue taking it. e The shortage of IEC materiais at all levels require the attention of the stakeholders due to its importance in mobilizing and health educating the endemic communities. l'i * t' t I r f6 1. 2. LIST OF PEOPI,E MET AND INTERVIEWEI} IN ENUGU Dr. Martins Chukrvunweike - Hon. Cornmissioner of Health Dr. Ezenta Ezeilo - State Director Health Services and Primary Health Care Mrs. Rita Ojide -- Deputy Team leader (SOCT) Mr. Augustine Nuamani ] Mrs. Joy Nwagwu ] Mr. Ikechukwu Nwangwu ] SOCT members Mr. Lazarus Onuigbo ] Mr. Levi Idoko l Mr. Lazarus Nweke - Team ieader'(in Adamawa) Dr'.(Mrs) Maduka - Zonal Coordinator Carter Centre (Talked with hel over the phone) Pastor Sunday Ede - LOCT leader of Nkanu West Friday Onovo - FLIIF staff in-charge, CDTI in Ozalla Flealth Centre, Nkanu West Mrs. Cecilia Nweke - CDD in Anigbo, OzalLa Mrs. Blessing Aneke - Nurse in charge FLHF in Obr-rofia Primary Health Centre, Nkanu West Joy Atu - Obuofia Mls. Chinasa - Volunteer CDD Mrs. Eucharia Ujan-r - Courtnunitl' member Elder Chinweike Agbo - CDD for urnuogbu * UmuagvvrLl coulmlurities of Obuofia Mrs. Ben Onyia - LOCT leader, Udi LGA HRH Igwe Onuigbo - Community leader, Nachi. Udi LGA Nze S. U. Onyia l Nze Ezedagu Igbokwe ] Cornurunity members Dom Eze l Mr-s. Virginia Ezechi - Oldest CDD in Atneke, Nachi. Udi I-GA itzlrs. Cosmas Onyeama - Oldest CDD in Amanku,o. Eke Ichie Alexis Ukeje - Chairman, Oma, Eke. Udi LGA Juliana Nwafor - CDD Eunice Ashuke - i/c FLHF.Oma. Eke Mr. Prince Omeje - LOCT, Nsukka LGA Mls. Victoria Ezido - i/c Eha Ndiagu I{ealth Centre Mr. Dennis Agbo - CDD Mrs. Gloria Aro ] Mrs. Joseph Odo ] Community members # Mr. Abugu.u Nebuwa - CDD ] HRH Igu'e D.E. Eze - Commr-urity leadet', Eha Ndiagu Mrs. Blessing Ikwueze-tlc FLHF Opi Health Centre 3. 4 5 6 l 8 9 I 0 ll t2 13 14 15. r6. t7. 18. 19. 24. 2t. 22. 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IJoE (-,l {o\\o o\ t\) CO hJ -l 'uJ -lUJ@ o\ Ur (n co t-) o\\) @ !.) o\ ooIJ icl co I.J oo @ UJ L, oo(}J io \) + cot\)L ca @(r) b. @U) 6, oo i'J @I @ @t\) io ea UJ L^ oo!, oo\ { UJ t-J O O O t.J O O o O o O UJ t\) Ab -xii3,+a+ e a6: g =1 q^ .,o @ O + +-UJ UJ+ \o{ J-J> t.JUJ o\UJ L,lr U)rJ L'Io\ {+r -t- UJ\o (,rrUJ oZ-C=@= =9 o- a- O O o O O O O O OO O o O z7 >+ ri)G O O O O O O O O O r5 Ago 7,6 z-?tiaV4ZE=?aizrY.- a 2 o a ^ t.J o 'E "r) l.J .t- z o o- at t.JooJ: L t OOO 2OO5 SUMMARY REPORT OF OBUOFIA PRIM. H/CARE AND OZALLA H/CENTER IN NKANU WEST OBUOFIA PRIM. H/ CARE VILLAGE POPULATION NO.TREATED o/o COVERAGE 1 Obuofia Amechi 245 172 70.2 2 lt Amupata 578 s00 86.5 3 Enugu Agu 309 242 78.3 4 TT lsiofor 381 294 77.2 5 I Mgboko 448 379 M.6 6 lr Umuagwu 241 184 76.3 7 I Umuchingwu 637 541 84.9 8 Umuiba 399 300 75.2 o Umuogbu 321 241 75.1 TOTAL 3559 2853 80.2 €* i L t 23 OZALLA H/CENTER VILLAGE POPULATION NO.TREATED % COVERAGE 1 Ozalla Amaechi 299 178 59.5 2 I Amiqbo 253 160 63.2 3 Enuguagu 283 177 62.5 4 Ezi 350 224 64.O 5 I Obeaqwu 970 670 69.1 6 Umuokorouba 438 324 74.O TOTAL 2s93 1733 66.8 l- 4 * t t r 2+ REPORT OF NTER AND NTER IN2005 LGA EKE H/ CENTER VILLAGE POPULATION NO. TREATED % COVERAGE 1 EKE Amankwo 400 370 92.s 2 il Ogui 360 312 86.7 3 Ogui agu 60s 299 49.6 4 Oma 350 314 89.7 5 I Umuovu 592 303 51.2 TOTAL 2305 I 598 69.3 NACHIH/CENTER VILLAGE POPULATION NO. TREATED %COVERAGE 1 Nachi Amagu 610 555 91.0 2 Ameke 401 333 83.0 3 Okpubeze 205 167 81.5 4 Umumbo 335 32',| 9s.8 TOTAL 1 551 I 376 88.7 I *J!F -LS 2OO5 SUMMARY REPORT OF EHA NDIAGU H/CENTER AND OPI H/CENTER IN NSUKKA EHA NDIAGU H/CENTER VILI.AGE POPULATION NO.TREATED % COVERAGE 1 Eha Ndiaqu Agbugwu 994 880 88.5 2 il Amaechemu 839 716 85.3 3 Ndiugwu 915 810 88.5 4 Breme 817 717 87.8 5 I Okpulo 1288 998 77.5 6 Onuinyioku 't022 792 77.5 7 Ugwuatu 904 724 80.1 8 tl Ugwuefi 948 774 81.6 TOTAL 6733 6411 95.2 tu * 26 OPIH/CENTER VILLAGE POPULATION NO.TREATED % COVERAGE 1 opi lbeku 1221 1064 87.12 opi Ogbozalla 968 852 88.03 o 1008 888 88.1 87.7AL 3197 2804 4ttr 27 2006 SUMMARY REPORT FOR OBUOFIA PRIM.H/CARE AND OZALLA H/CENTER IN NIGNU WEST LGA OBUOFIA PRIM.H/CARE VILI.AGE POPULATION NO. TREATED % COVERAGE 1 OBUOFIA Umuagwu 461 390 84.60 2 I Umuchingwu 513 405 78.95 3 Umuiba 361 296 81.99 4 I Umuogbu 401 326 81.30 5 Amechi 560 499 89.11 6 AmrJpata 439 384 87,47 7 lr Enuguagu 491 422 85.95 8 lr lsiofor 415 354 85.30 I r Mgboko 228 168 73.68 TOTAL 3869 3244 83.85 * 2g OZALLA H/GENTER VILLAGE POPULATION NO. TREATED %COVERAGE 1 OZALLA Obeagwu 406 258 63.55 2 Amechi 490 3',14 64.08 3 lr Ezi 595 375 63.03 4 Enuquaqu 661 383 57.94 5 Amiqbo 890 045 72.47 o Umuokoro-Uba 695 4U 62.45 TOTAL 3737 2409 64.46 OBUOFIA COMMUNITY 8 CDDS OZALLL COMMUNIW 14 CDDS g * 21 t- 2006 SUMMARY REPORT FOR NACHI H/CENTER AND EKE H/CENTER EKE HEALTH FACILITY VILLAGE POPULATION NO.TREATED % COVERAGE 1 EKE Ogui 442 363 82.13 2 Enuqu 424 325 76.65 3 Amankwo 1800 935 51.94 4 Oma 1015 863 85.02 5 Ogui Agu 393 310 78.88 TOTAL 4074 2796 68.63 NACHIH/CENTER VILLAGE POPULATION NO.TREATED % COVERAGE 1 NACHI Okpubeze 371 321 86.52 2 Ameke 543 530 97.61 3 Amaqu 380 310 81.58 4 Umumbo 457 387 84.68 TOTAL 1751 1 548 88.41 EKE COMMUNIry 12 CDDS NACHICOMMUNITY 12 CDDS 4r * 7D I 2006 SUMMARY REPORT OF EHA NDIAGU H'CENTER AND OPI H/GENTER IN NSUKKA LGA EHA NDIAGU H/CENTER VILI.AGE POPULATION NO.TREATED % COVERAGE 1 EHA NDIAGU Okpulo 1397 851 60.92 2 I Ugwuatu 1034 874 84.53 3 Breme 1',!48 870 75.78 4 Nkworeha 291 190 65.29 5 Ugwuefi 1484 904 60.92 6 Aqbuqwu 1296 911 70.29 7 fl Amaechenu 1493 908 60.82 I Ndiuqwu 't274 837 65.70 TOTAL 9417 6345 67.38 4a!* 7l OPIH/CENTER VILLAGE POPULATION NO. TREATED % COVERAGE 1 oPt Ogbozalla 473 393 83.09 2 Amaechu 1606 982 61.15 3 lbeku 1 075 s81 91 26 4 Opi Agu 800 473 59.13 TOTAL 3954 2829 71.55 EHA NDIAGU 15 CDDS oPr 7 CDDS U I Ij b+ ,;2 MONITORING IMPLEMENTATION OF CDTTI SUSTAINABILITY PLAI\S INSTRUMENT I (State/Regio nlProvince) # COUNTRY PROIECT NAME NAME OF THE STATE/REGION/PROVINCE DATE OF COMMENCEMENTOF CDTI DATE OF EVALUATION DATE OF COMMENCEMENT OF SUSTAINABILITY PLAN IMPLEMENTATION DATE OF ASSESSMENT OF SUSTAINABILITY PLAN IMPLEMENTATION NAME OF MONITOR Z7 TOOL FOR MONITORING OF CDTI SUSTAINABILITY PLANS Instruction: Check implementation of sustainability plan and veify whether constraints earlier ittentifiert are being rectified. Also check if key CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement and dktribution) are being implementetl as plannecl. STATE/ REGION/PROVINCE 1.1 PLAI\NING 1.2 HSAM (Advocacy) Characteristics of the indicator Sources of information tr Is CDTI integrated into the overall health service o plan? Does a detailed list of CDTI activities exist including the dates when they will be carried out? a Interviews with policy makers and managers at this level Inspection of CDTI plans.a Findings: Describe the situation (*comment on leadership at this level) If planning was not done give reasons why Suggest steps to be taken to improve sihration Characteristics of the indicator Sources oI information What was the objective? Who was targeted for this advocacy? What approach was used? What was the outcome? Interviews with officials responsible for onchocerciasis at this level (managers etc.) Inspection ofthe technical activity reports a a Findiugs: Describe situation 4) +r If advocacy was not done give reasons why Suggest steps to be taken to improve situation Z+ 1.3 MECTIZAN I.4INTEGRATION Characteristics of the indicator Sources of information Is the delivery of ivermectin timely (for distribution)? Is it integrated into drug delivery system? Is ivermectin supply suffi cient (adequacy)? Iaterviews with officials responsible for onchocerciasis at this level (managers etc.) Inspection of technical reports/recordsa Findings Describe the situation If ivermectin is not available (suffrcien! timely, integrated) give reasons why Suggest steps to be taken to improve situation Characteristics of the indicator Sources of information Resources Mention the resources (e.g. kansport staff) that are shared between CDTI and other health programme activiries (e.g. EPI, malaria, HIV/AIDS) Activities List the activities (e.g. Mectizan procuremeut and supply, supervision and monitoring and taining of lower level staff) carried out in an integrated manner with CDTI Inspection ofreports, plans, budgets etc tr tr Interview of staff at this level Findings: Describe situation is no evidence ofintegration give reasoniIf there Suggest steps to be taken to improve 75 a 1.5 FINANCE 1.6 RECORD KEEPING Characteristics of the indicator Sources of information O Are resoutces allocated at this level for the continuation of CDTI? o Are resources released for CDTI activities? A What proportion of allocated fi,rnds was released? a Interviews with officials at this level Inspection of the plans, budgets, documents showing disbursement, for year of reference a Findings: Describe the situation If furances are budgeted but not released give reasons why Suggest steps to be taken to improve situation Characteristics of the indicator Sources of information r Is data on CDTI available? . Are they properly recorded and stored? . Are they analysed and uhlized for planning CDTI activities? o Are they reliable? Are they integrated into the normal health record system at this level? o Interviews with officials at this level o Inspection ofrecords and records system Findings : Describe situation Ifrecord keeping is poor give reasons why Suggest steps to be taken to improve situatiou * L. ,L 1.7 COVERAGE Characteristics of the indicator Sources of information What is the geographic coverage ? What is the therapeutic coverage for the last teatrnent cycle? a a r lnterviews with ofEcials responsible for Onchocerciasis at this level lnspection of records for previous year coverage rates are below 100% and therapeutic coverage rates less tban 65yo, give reasons why Ifgeographical Findings : Describe situation taken to improve situationSuggest steps to be # 3-r MOMTORING IMPLEMENTATION OF CDTI SUSTAINABILITY PLAIIS INSTRUMENT 2 (Districtll,GA) s COTJNTRY PROJECTNAME NAME OF TIIE DISTRICT/LGA DATE OF COMMENCEMENT OF CDTI DATE OF EVALUATION DATE OF COMMENCEMENT OF SUSTAINABILITY PLAN IMPLEMENTATION DATE OF ASSESSMENT OF SUSTAINABILITY PLAN I1!IPLEMENTATION NAME OFMONITOR )'t TOOL FOR MONITORING OF'CDTI SUSTAINABILITY PLANS (DistricI/LGA) Instruction: Check implementation of sustainabitity ptan and verify whether constraints earlier identitied are being rectiJied- Also check if key CDTI activities (Training, Monitoring and Supervision, HSAM and Mectizan procurement and distribution) are being implemented as planned. 2.1PLAI\NING 2.2 TRAINING Chrracteristics of the indicator Sources of information Is CDTI integrated into the overall health service plan Is there a detailed list of the key CDTI activities (monitoring, haining, etc.) including their timing? a a Interviews with policy makers and managers at this level Inspection of the written plans a a Findings : Describe situation If there is no plan give reasons why Suggest steps to be taken to improve situation Characteristics of the indicator Sources of information a What was the objective of the training? What was the content of the training? How was the need for karning determined? Who conducted the training? Where was the fraining done? Were training resources efficiently used? a a a a a o Interviews with policy makers and managers o Inspection of haining programme ev Findings: Describe situation If training is not done give reasons why Suggest steps to be taken to improve situation 31 2.3 HSAM (Sensitisation and Advocacy) 2.4 MONITORING A}[D SUPERVISION Sources of information Characteristics of the indicator Sources of information 'Was there sensitization of officials, opinion leaders about Onchocerciasis at this level? How was it done (approach)? What was the result? How many people were sensitized? a a a Interviews with oflicials responsible for onchocerciasis at this level . Inspection of activity/technical reportsa Findings: Describe situation If sensitization was not done give reasons why Suggest steps to be taken to improve sifiration Characteristics of the indicator Was there supervision and monitoring? When were CDTI supervisions and monitoring activities carrieci out? How frequently? (at least once a year) Is there a checklist on oncho. activities? Is it integrated into other health care supervisory forms' checklist? 'Were strengths and weaknesses identified? Were weaknesses redressed? Were there reward systems? Was there feedback to those supewised? a f a a a a Interviews with officials responsible for onchocerciasis at this level Inspection of activity and technical reports as well as monitoring and supervision reports a a Findings : Describe situation s supervision and monitoring were not doneIf give reasons why Suggest steps to be taken to improve situation 40 a a I a a 2.5 MECTIZAN SUPPLY 2.6 IIIJMAII RESOT]RCE Characteristics of the indicator Sources of information drstribution cycle? Was ivermectin delivered in a timely manner from the state to ttre Distict/ LGA? Is ivermectin supply integrated into the nornral drug management component of the health system? a a Was ivermectin suflicient for last onchocerciasis and drug supplies at this level o lnspectionofactivity/technisslreports o Inspection of drug delivery inventory records a lnterviews with officials responsible for Findings Describe the situation was not sufficient, timely and its delivery not integrated give reasons why If ivermectin Suggest steps to be taken to improve sihration Characteristics of the indicator Sources of information Is there an officer responsible for onchocerciasis Is s/he trained./knowledgeable in CDTI? Is s/he responsible for other health projects or activifies? a a onchocerciasis at this level Inspection of activity records a a Interviews with officials responsible for Findings: Describe the situation knowledgeable, give reasons why If responsible oflicer is uot available or 4. , Suggest steps to be taken to improve situation +t o 2.7 INTEGRATION 2.8 FINANCE Characteristics of the indicator Sources of information a Which activities (e.g. taining, monitoring) are carried out jointly with other health progarnme activities? Which resources (e.g. staff, transport) are shared between CDTI and other health a malaria o Interview of staff r lnspection ofreports, Iog-books etc Finding: Described the situation If CDTI activities and resources are not well integrated with other health programmes give r9asorui Suggest steps to be taken to irrprove the situation Characteristics of the indicator Sources of information a Are resources allocated at this level for the continuation of CDTI? Are resources released for CDTI activities rn time? What proporlion of allocated resources is released a a a Interviews with officials at this level Inspection of the plans, budgets, documents showing disbursement, for year of reference a Findings: Describe the situation If proportion of resources budgeted, allocated aud released is iaadequate give reasons why Suggest steps to be taken to improve situation q* l' +2 2.9 RECORD KEEPING 2.l()TRANSPORT Characteristics of the indicator Sources of information o Ale data on CDTI available? . Are they properly recorded, stored and easy to retieve? . Are they analysed and used for planning,? r Are they reliable? . Are they integrated into record system at this level? o lnspection records, records system o Interviews with officials at this |sys1 Fiadings: Describe situation Ifrecord keeping is poor give reasons why Suggest steps to be taken to inprove situation Characteristics of the indicator Sources of information a Is hansport available for CDTI activities? Is it functional, adequate, and used in an integrated way with other health care activities? a a Interviews with officials responsible for onchocerciasis transport at this level Inspection of records, reports, vehicles log-booksa Findings: Describe situation If transport is not available (as stated above) give reasons why Suggest steps to be taken to improve situation g * *s 2.11COVERAGE Characteristics of the indicator Sources of information What is the Geographic coverage for past two years? o What is the therapeutic coverage for last two years? What percentage of FLHFs reached the minimum 65oh therapeutic coverage during the two last distributions? How many cases of serious adverse events rvere referred to a health post/centre during the tn'o last distributions? a a Interviews with offrcials responsible for onchocerciasis at this level Inspection of surnrnary records for ivermectin treatnent and reports. a Findings: Describe situation Ifcoverage rates are below expected (-100% geographical and 65% therapeutic-) give reasons why Suggest steps to be taken to improve situation s j t++ a MONITORING IMPLEMENTATION OF CDTI SUSTAINABILITY PLAI\S (rrrrF) INSTRUMENT 3 Instruction : check implementation of sustainability plan and verify whether constratints earlier identifted are being rectiJied. Also check if key GDTI activities (Training, Monitoring and supemision, HSAM and Mectizan ptocurement and distribution) are being implemented as planned. 3.l PLANNING # Characteristics of the indicator Sources of information a list of the key CDTI acfivities (monitoring, training, etc) including dates? Where and when were they conducted?a Is there onchocerciasis at this level Inspection of charts on walls, work plan, list of things to do. a a lnterviews rvith officials responsible for Findings Describe situation If planning was not done give reasons why taken to improve situat'ronSuggest steps to be ?s rt 3.2 TRAINING 3.3 HSAM (Sensitization) Characteristics of the indicator Sources of information tr What were the objectives/ justif,rcation for the taining? D What was the content of the training tr How many CDDs were traiaed? tr Were training resources efficiently used? O lu average, how many people at risk are taken care by I CDD ? lnterview with officials in charge, of onchocerciasis at this level Inspection of training manuals, training reports, notes etc. a a Findings : Describe situation If tr-aining was not done give reasons why steps to be taken to improve situationSuggest Characteristics of the indicator Sources of information a Was there sensitrzation of commuruty and opinion leaders about oncho. at this level? What was the objecrrve of the HSAM? How was it done (approach) What was the result? How rnany people were sensitized? Who were sensitized? a a a a a lnterviews with offrcials resporsible for onchocerciasis at this level Irspection of activity/technical reportsa Findings: Describe situation If sensitization was not done give reasons why # Suggest steps to be taken to improve sihration 1€ 3.4 MOMTORING AND SUPERVISION 3.5 MECTIZAN Characteristics of the indicator Sources of information I Was monitoring and supervision (IWS) carried out for CDTI regularly (how many times in a year)? Is there a IWS checklist? Were M&S activities integrated with M&S activities of other health programmes? What were the strengths and weaknesses idenhfied? Was there feedback to those supewised? a a a a tr Interviews with persons in charge at this o level Inspection of documented reports and supervisory checklist etc. Findings: Describe the sihration Ifmonitoring or supervision was not done as planned give reasons why Suggest steps to be taken to improve the situation Characteristics of the indicator Sources of information with regard to the supply of ivermectin: O Are the supplies adequate? E Is it delivered on time for dates of planned distribution? O Is it ordered and distributed to the FLItr and the communities within the regular health care system? tr o Records control of ivermectin ordering and stock Interview with nurse or health staffin charge # Findings: Describe the situation If ivermectin supply and delivery was inadequate or untimely, give reasons why Suggest steps to be taken to improve the situation 17 3.6 III]MA}[ RESOI]RCE Characteristics of the indicator Sources of information a Is there a designated person for onchocerciasis contol? Is the designated person hained and knowledgeable in CDTI? Is the person able to effectively combine CDTI with his other community-based health responsibilities? a a Interview with the Head of the Health Departrnent lnspection of documentsa Findings: Describe the situation If the use of human resources is inappropriate or unsatisfactory, identifiT the weak points and give reasons Suggest steps to be taken to improve the situation L L t r * t8 3.TINTEGRATION 3.8 COVERAGE Char'acteristics of the indicator Sources of information a Which activities (e.g. training, monitoring) are carried out jointly with other health prograrnme activities? Which resources (e.g. staff, transport, space, time etc.) are shared between CDTI and other health programme activities (e.g. malaria etc. o Interview ofproject staff o Inspection ofreports, log-books etc Findings: Describe the sihration If integration is not effective give reasons why Suggest steps to be taken to improve the situation Characteristics of the indicator Sources of information a What was the Geographic coverage for past two years? r What was the therapeutic coverage for the last treatnent cycle? What percentage of FLHFs reached the nrininrum 61oh therapeutic coverage during the trvo Iast distributions? a Interviews with offrcials responsible for onchocerciasis control at this level Inspection of summary records for ivermectin treatnent and reports for previous years. a Findings: Describe situation If coverage rates are below expected (-100% geographical and 65Yo therapeutic-) give reasons why Suggest steps to be taken to improve situation * ffi a a r'! MONIToRINGIMPLEMENTATIoNoFCDTTISUSTAINABILITYPLANS INSTRTJMENT 4 (Communily) * * COUNTRY NIGERIA PROJECTNAME rNuculnNaNASRA/EBONYI NAME CF DISTRICT/LGA UDI NAME OF SL|PF,PJ ISORY FLHF {=NACHI HEAI,TI{ CENTER *EKE TIEALTH CENTER NAIUE OF THE COMMUN ITY *AMEI(E NACHI *OMA EKE DATE OF COMIVIENCEME NT OF CDTI 1999 DATE OF EV,C.LUATION 2003 OF or susreiuani1itv PLAN NIPLEN{ENTATION 2001 DATE OF ASSESS]VIENT OF SUSTAINABILITY PLAN IIVIPLEMENTATION 11 -25 SEPTENIBER.2OOT NAME OF MONITOR PATRICTA OGBU- PEARCE ADEJAI ENII\IANUEL 50 MONIT ORING IMPLEMENTATION OF SUSTAINABILTTY PLA-NIS (Community) INSTRUMENT 4 Instruction: Check implementation of sustainability ptan andverifu v,hether cowtraints eatlier identified are being recti/ied. Also check if key CDTI acti'rtities (Training, Monitoring and Supentision, HSAA4 ald l,Iecti:an procurement and distribution) are being implemented as planned 4.I PLANNING NOT CRUCIAI AT THIS LE\TEL 4.2 TRAINING NOT CRUCIAL AT TI{IS LEYEL 4.3 HSAM (Health Education and Mobilisation) Characteristics of the indicator Sources of information o Was thcre health education aud mobilisation of the community? *Yes. . How was it done (approach)? *Through contacts with community members r What was the result? *Increase in treatment coverage. o How many pcople received health educatiou? *20 people a Interviews with CDDs and community leaders and members. Inspection of village-kept recordsa Findings: Describe situation *People are aware of taking Mectizan every year 4. * If seusitization was not done give reasous why Suggest steps to be taken to improve situation *Continuous mobilization and health education 5t 4.4. MONITORING AND SUPERVISION NOT CRUCIAL AT THIS LEVEL 4.5 MECTIZAN SUPPLY 4.6 HUIvLAN RESOURCES Characteristics of the indicator Sources of information . Was ivermectin supply sufficient for last distribution cycle? *Yes. . Was ivermectin made ayailable at the FLHF when needed? *Yes. . Was ivermectin collected in a timely manDer from the FLHF? *Yes. Interviews with CDDs and communiQr members. I Inspection of drug delivery inventory records a a Findings: Describe the situation *The communities appreciate the supply of free Mectizan treatment and promised to take it every year due to its usefulness to them. If ivermectin was not sufficient, timely and its mode of distribution not determined by community give reasons why Suggest steps to be taken to improve situation Characteristics of the indicator Sources of information O How many trained CDDs are there in the community? *27 CDDs in the two communities. tr Is there a fair mix of both seres among the CDDs? *Yes. O Is the workload for each CDD compatible with efficient distribution of ivermectin? *No, they need more hands. O Are the CDDs well motivated? *No O What is the attrition rate among CDDs? ," 50 Interyiew with CDDs and community members & * 5J Findings: Describe the situation If CDDs are not available or are not trained, give reasons why Suggest stcps to be taken to improve situation *Training and retraining of more CDDs. 4.7 INTEGRATION NOT CRUCIAI AT THIS LEVEL 4.8 FINANCE NOT CRUCIAL AT THIS LEVEL 4.9 RECORD KEEPING Characteristics of the indicator Sources of information e Are data on CDTI available? *Yes o Are they properly rccorded, properly stored and casy to access? +Yes . Are they analysed and used for planning,? +No . Arc they reliable? *Fairly reliable. o Are thcy integrated into record system at this level? +No. a Inspectiou records, records system lnterricws with officials at this levela Findings: Describe situation *The CDDs require more training and re-training on registration of persons in their communities. -?If record keeping is poor give reasons why Suggest steps to bc taken to improve situation *Training and retraining. I L- (' 57 4.IO TRANSPORT NOT CRUCIAL AT THIS LEVEL 4.I ICOVERAGE Characteristics of the indicator Sources of information o Were all households treated in the last distribution cycle? *Yes. o Were all eligible persons treated in the last distribution cycle? *Yes a Interviews with CDD and community members.. Inspection of summary records for ivermectin treatment and reports. a Fiudings: Describc situation *Treatment coverage is encouraging. lf household coverage and therapeutic coverage rates are below erpected give reasons why Suggest steps to be takeu to improve situation g * 5+ 't itL. CAXr-]'r R ('r-I:T'ERfr i\ IGI,RiA NA'I'IONAI, OF } ICE I , Jck-a Katjir:u Srcct, OtI Tutlun Wada Ring Rrud, P.0, Ii<,x 777 2. J<ts Tcl. 2i4'- 73 - 4$l 86 I, 46:1870, t:at LA-j i460097 The Director, APOCf/1HO, OUAGADOUGOU, Burkina Faso. 20'h April,2006 LE R OF UhIDERTAKI We, Lhe collaborating Partners (The Carler Center and the NOCP Zone A), have undertaken to monitor and supervise the Effective implementation and utiLzatlon of funds for training rnore CDDs using kinship (Umunna) strategy to enhance CDTI actrvilres in Enugu, Anambi-a and Deita States and any other State under The Carter Center as wculd be fundecj cy APCC. -\fvs funhei' reiterate our total comrnrtn'lent to the decrsion i.eacled in F.buja at the NOTF/APOC-A'ssistecl Siates meetinr and the te ephcne convei'saticn ber-vr+en you and Dr'. E.s. Miri, Tra'Jountry F,epi-esen,Eiive oi The Cai-ter Center of l{rge.ia We therefoie rrEe you lo release a:ry lunC approved fci'the siaies menironed amve Sincerely, ,l i'']r..'- " I li; ti.. ... . .. '\ t' I 1 t: t_ r, Emmanuel C Ernukah Directoi', Southeast Programs for': Ccunry Representative The Carter Center Nicei-ra Mr John Eluwa Zcnal Coordrnator NOCP Zone A g * CC The Country Rep., The Carter Cenier, Nioeria Ag National Coordinator, NOCp, FMOH Abura Hon. commrssroners fcr Health. Enugu. Anambi-a & Delta stales E5 ENUGU STATE ONCHOCERCIASIS CONTI{OL PROGRAMME = Mirristrv of health. 15? 7,i1< Avenrre F.rrrrqtl 24Lt' Ju\,2006 Responsibililies of LGA oncho coortlinators are hereunder. stated; ,. Develop annual plan of action 9... Advocacy to LGA policy trral<ers on financjal support -'' Seusitization meeting u,ith conuriunity leadels/traditional leadels . Advocacy to influential persons in tiie conulturities r' It4obilization/health education of conrmunily rnembels on the issue o.[ou,nership, drug availability, conrpensation of commuuitl, direcled distribr-ilors (CDDs) and drug intake . Co.llectioir of Mectizan tablets fi'oni Enugu Oncho offrce o Etrsutittg Mectizan distribution at all levels (fronr Health facility to village) . Number of liealth facility staff involved in oncho activities ' Supelvision of Census update and drug distribution fulease provicle schedule of supervisory visits) . Keeping accurate records of all distributions r lvlaintaining iist of all villages rurder the LGA ' Writing and submitting montirly tleatment sumrlraries based on the iist of the villages uttder your area and lelevant inforuration peltaining 1o the irrogramme to the state (This is not, cornpulsoryl,) " Eusuriug that all villages collected drug and reported treatment at tlie end of the year " Fill motorcycle log book each tiile it is used ( sample provided) o Attend rneeting in Enugu as required. r Collect relevant reporting fonls (fi.om the State office) Lazarus N. Nweke Enugu state onclto coordinator 0803347471 0 I t t I ,l I S6 t DNUGU STATE CDTI TS RS ON 2 3 4 5 6 7 8 I 10 11 12 13 14 15 16 17 1B 19 20 21 t1 2 i3 \4 J5 36 \7 -J8 24 z3 25 6 27 28 z9 30 Checklist L c Yes No Oncho?Do Commu members know eth am ifestationn of th owkn awh ca sesU Oncho? Do th kn OW eth benefits rvermof eetin Do have of Duration of treatment? Do have e of exclus ion criteria? Do VEha owled,kn e Dof osage IAre EC materia SI ava ilab ?le were ECI m ateri Ia Us sed? wAS health ktal fordone eth entire com Um n S Mob ization edon an NU d Do all partners Activities? participate in annual mobilization Are the comm un ES iaenthus astic dn in te rest d thn l,{e DP? Was there train Cof DDs OCL aT dn S OCT? eriod of trainiWas the con uate? Retain done annualWas the Train Were IEC m the traininuse retrainin ? G H S the Sta te coll ected m ectizan thfrom zone/Ne LJ DO edbas on mcom UN e mectizan for this ar been collected?Has th et the anti uestedDid ar?Has treatm nte enbe done this adequate?'as the an collected ls there an a uate sto e facil Was used?facilthe stora treatedWas eli ible Was dos determined? thWere re6 refu sal a Sb oS, nte etcES ? Were refusa I bat tresentees d?ate there cases adverse reaction? Were cas Se of adverse rea Ict ons mana ed? of Mectizan?labilthWas informere onation the a R coR D I N EPORTINGE EKE P availableI s treatment re ister in good ysical condition?ls the ister accordinlse in treatment to NOCP at?ls measurin devise available? r accurate?Are reco inrds 6th treatm ent treatment summals form records in summaAre form accurate? ls there inven of mectizan? 57 LEVEL: Level S H ./ ./ -,i ./ ./ ./ ./ ./{ .V .i ./ { ./ .1 ./ ./ ./ i/ .J ^/ ./ ./ { { .i .i { { ./ ./ ./ r/ ./ ./ ./ ^/ v J ,v .i ./ ./{ I { ./{ ./ {{ .1 { ./ & ./ .i ./ ./ ^/ -t ^i .i I ./{ ./ ./ .i -t ./ ./{ -l -v { s there reco rd com mun S melfity dn coonitoring mtTt unitytio inn m eeti -/ ./ .i ./ ./ ./ I ./ J ./ ./ i/ ./ V .i ./ ./ { .v V I ./ v{ ./ ./ ./ ./ {{ .i ./ V ./ ls th ere inven of UI ment? ls there state wor k ? S there rec ord of cou fu ds/fi I there n nancia I con tribUt tonS?S record of dVETSe reac ri, ? M n AN NVENTORY See P n tedReco rds of rece ip ts d nd scru of nVEntory icatio n for Mectizan?of d in the store an d ?Determin at ion of d u, rement for extRe cord of n treatm ent?r'etu rned Mect iza n ? n UM ber of t bS received ?lnv of dru flow? lnve of tot I tabs used? lnven of number of tabs ired wa S ted ost or coun ofMectizan? U I S there work an Are end itu res tied to activiti I e S OUfl inAd tn th e work p an ?S there bud d roved ? s there b eta proved ls the bud ad U te I 5 rhere an Oncho accoun t? Are fundS released and cred itedAre to th IS CC oun t?there coun rt contrib UtAre there on S AS a ?o th e f cou art con tributio in k ds ?Are NS tnrt con tribu tionS expected from NGDOsU met? Sele ction of CDDs - Are they adequate? - Were criteria for sel ection fo low? WAS there request for trai n tn lretrai com mu ? g n n g of th o CD D S n then t a Ucomm n census done ./D d th o COMMU deci ed t[mon ane d e o ofd d ? ./ and stor ? W thre afran ement fo r col Iect ofion Mid commun decid onp om ofde istrid utb nio ?D id comm UN m on itor C DD S, dru d istr b outi, ann A record ke ilI ? ./dDi commun eid cenin tives ca insh/k ?d ./D id G om nMU pity rovide a teadequ toarrangements rnretu lancebard U ofand o rt on m e? 39 0 3 44 +o t7 ) 41 a2 =GEND S- Sfafq L- LGA, H - Heatilt Factitity, C - Community J ;0 5 3) !F 58 GInoL' ^-' (il,Otli\l' 2(X)0 l{tVl1l{ l}l'lNl):':lrls)' l'l(( x il{'\Nl rjNLrc*r/^N,r'r'ttrn)r)i'l'i iit'i t 1:) l,l't' I'li( )rl1(' I lvll:('ll/AN i'iir'i I ltr\NSlrl:l{ l:ol(\1 R TIISI ,l () St clirr ll .'\: Rctlucst front Stnte 0 6( 03- [ 16" [)atc ntit Statc Pro [)atc Q-" D-\t\ Scclion ll: ( Si F.O's Veri ficationl qo +, t\) Statc I]alancc o rutstandin Ilalancc in thc it !it!,t-I rrc Si irtu rc ttl'lr.() Datc A ft)\' nattlrc t) f l'.A lr3 E D 6-U*-t- q,2 c _o ,1 . 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