Ondo state CDTI annual project technical report submitted to Technical Consultative Committee (TCC): December 2003 to November 2004

,1, r i. ,n OhIDO STATE MIMSTRY OF HEALTH CDTI PROJECT COUNIRVAIOTF.: NIGERIA Proiect Name: ONDO STATE CDTI PROJECT Aonroval vean l9D9 Launching vear: 2fi)0 Reoortins Pcriod: Fnom: December 2fi)3 To: Novcmbcr 2fi)4 Proiectvearofthisreoort (circleone) I 2 3 (4 )S 6 7 E 9 10 Date submitted: December 2004 NGDO partner: Unicef ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHMCAL CONSULTATTVE COMMTTTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) h RffiCT! 0 7 FE\j. ?oos /\t{.)1,./Dtt For To: lcc) For ticn [c:Aj LSD(,oP AUr=(-tr J 3tn BF-i:l )r I..,Tot h" 't ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: DR J.Y. JIYA i..1.:.A.f ...... Zonal Oncho Coordinator Name: MR. A.O. JAIYEOBA. Signatme Date: NGDO Representative Name: LINICEF Signature Date: This report has been prepared by Name : MR E O ADEJAI Designation :ST 4 o RDINATOR. (A\ Signature Date ..1 5 t.ry. \ %ffi+ Date Table of contents ACROI.IYIVIS TIEFINITIONS ............ FOLLOW IJP ON TCC RECOMMENDATIONS EXECI.'TIVE SI,JMMARY ...... SECTION t : BACKGROUND INFORMATION... I.I. GENERALINFOR}{ATION .......... 1.1.1 Description of the project (brieJly) .. 1.1.2. Partnership 1.2. Popt-rt-p^noN SECTION 2: IMPLEMENTATION OF CDTI...... 6-7 62. I.TIMELINE OF ACTTVTflES .....8 .....8 ....92.2. ADvoCAcY _2.3.MostrzATroN, SENSITzATIoN AND HEALTTT EDUCATIoN oF AT RIsK COMMI.'MTIES...... 9- 10 2.4. CotinvrmurrINVoLVEMENT 2.5. CapecrryBr.rrLDING... 2.6. TREATIVffi{TS 2.6.1. Theannentfigures.................... 6 2.6.2 2.6.3 lVhat are the muses of absenteeism?........... What are the reasons for refusa\s?................2.6.4 Briefly describe all louwn andverified serious adtrerse ewnts (SAEI) thot.... l8 2.6.5. Trod of treatmant achievement fmm CDA project in@ption to the arrent War 192.7. Onnrnmg sroRAGEANDDELrvERyoFrvERMEcrIN..........,., ..,.......2o-zl 2.E. Counuuurry sELF-MoMToRING AI.ID STAKEHoI^DER.s MEETING 2.9, ST'PERVISION 2.9.L Provide aflou chart of supervision hierarchy. 2.9.2 Whatwere the main issues idmtified during supervision? .......... 2.9.3. W'as a supervision checklist used?... .v VI t 2 3 3 3 4-5 2.9.4. 2.9.5. lVhatwere the outcomes at mch level of CDTI implementation supervision? Was feedback gt rcn to the person or groups supedsed? t7 l7 22 25 25 25 25 25 25 _l_L ... 12- l 5 l6 SECTION 3: SUPPORT TO CDTI. EeUPI\,DN-I FnvaNcnl CONTRIBUTIONS OF THE PARTNERS AND COMMT]MTIES Orgnn FoRMs oF CoMMUMTY SUPPORT..... E)GENDITI.JRE PER ACTTVITY 3.1. 3.2. 3.3. 3.4. SECTION 4: SUSTAINABILTTY OF CDTI 4.1. hrrm.Nau INDEPENDENT pARTrcrpAToRy MoNIT0RING; EvetuenoN....................29 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any ofthefollowingwhichareappliuble)............ ........29 4.1.2. Whatwere the recommendations? ...........29 4.1.3. How lnve they been implemented? ................ ............29 4,2. SUsTA$IABtr-ITY oF PR.oJECTS: PI.AI.IAND SET TARGETS (UANOATONY AT .......,.. .....29 YR3) 29 4.2.1. Planningatallrelevant levels 4.2.2. Funds........ 4.2.3 Transport (replacement andmaintenance)..... .... ... . 4.2.4. Otherresources... 4.2.5. Towhat extent lns the plan been implemented ............ 4,3. INTEGRATION 4.3.1. Ivermectindeliverymechsnisms 4.3.2. Training.... 4.3.3. Joint supervision and monitoringwith other programs 4.3-4. Release offinds for project activities .......... 4.3.5 Is CDTI included in the PHC budget? SECTION 5 : STRENGTHS, WEAKNESSES, CHALLENGES, ANID OPPORTUMTIES . 2 tt - 29 26 ..26 .....25 .....26 ..........29 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.JNICEF I.JTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective fumual Training Obj ective Communi ty-Based Or ganizalion Community-Direeted Distributor Community-Directed Treatment with Ivermectin Communiw Self-Monitoring Local Govemment Area Ministry of Health Non-Govemmental Development Organrzalion Non-Go vemmental Organization National Onchocerciasis Task Force Pnmary health care Rapid Epidemiologtcal M apping of Onchocerci asi s Severe adverse event Stakeholders meeting Technical C onsultative C ommittee (APOC scientifi c advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Or garuzation Definitions Total population: the total population living in meso/hypo-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84% 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/hyper-endemic areas that a CDTI project intends to ffeat with ivermectin in a given year. (iv) [Iltimate Treatment Goal (UTG): calculated as the maximum number of people to be ueated annuatly in meso/hypcr endcmic areas within thc project area, ultimately to be reached when the project has reached full geographic coverage (ncmally the project should be expected to reach the UTG at the End of the 3'd year ofthe project). (v) Therapeutic coveragp: number of peoplc trcated in a givcn year ovcr thc total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities heated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the pnoject area (this should be expressed as a percentage). (viD Integration: delivering additional health interventions (i.e. vitamin A supplements, albcndazole for LF, sueening for cataract, ctc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and eurpower corrmunities to solve more of their health problems. This does not include activities or interventions carried out bv communitv distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable futurc, with high treatment coveragp, integrated into the available healthcre service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intcrvention programmc), with a view to cnstringthat thc programme is being orecuted in the way intended. It encourages the community to take full responsibility of ivemrcctin distribution and make appropriate modifications when necessary. (i) FOLLOW UP O]I TGG REGOTTE]IDATIOIIS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 18 All the LGA coordinators were invited to a two day training workshop where they were well informed about CDTI activities and the roles of each partner. The workshop was sponsored by the State Government. Also the monthly review meeting of the SOCT and LOCTs were used to sensitize the LGA coordinators. Advocacy visit to the LGA policy makers were also carried out to assist the LGA Coordinators. Numbcr of Rcconnwduton inthe Repoft TCC RECOMMENDATIONS ACTIONS TAKEN BY TTIE PROJECT FOR rcC/APOC MGT ASE ONLY I Detailed in formation on slpervrslon. Detailed infmmation on stryervision have been provided ) All the LGA coordinators have been sensitized to CDTI activities and advocacy with policy maker be intensified. All the LGA coordinator have been sensitized to wards CDTI activities and Advocacy visit to the LGApolicy makers have been carried out WHO/APOC. 24 November 2004t Exeeutlve Summaly Ondo State is one of the States in the South Westem part of the Country and is located in B- Health Zone. It has a projected population of about 3.5 million and covers an area of approximately I 5,600 square kilometers. Mectizan distribution in the State started in 1994 under the auspices of UNICEF in five Local Govemment Areas of the State. Following REMO updates, the programme expanded to cover ten LGAs. Between the periods of 1994 to 1999, CBIT strategy was adopted in project areas. APOC CDTI strategy became operational in the state in June 2000 following APOC approval of ffieen LGAS. Following the review of REMO exercise carried out in the State, the number of endemic communities was reduced to 579 in fourteen LGAs. Okitipupa and Odigbo LGAS have been exempted from endemic LGAs; therefore the new-targeted population is l.2million Population movement in the State is attached to various events and seasons of the year. Such events include religious activities such as Christmas celebration pilgrimage to holy land etc, educatioq farming season, etc. During these periods, there are migration of people from one place to another. Majority of the people engaged in farming migrates from other pafi of the Country to the rural areas while studenb move in and out of the rural Communities during holidays and school periods respectively. Empowerment and capacity building of communities through training of CDDs, Community mobilization and networking were aggressively pursued in the fourteen designated LGfu in the third year. The project trained and rerained 336 LGA staff,100 TOTs, 350 Health Workers and 5973 CDDs, thereby achieving 90o/o overall for its training objectives 579 communities were mobilized to select their CDDs and collect mectizan from designated points. Additionally, 576 policy makers and community leaders were mobilized in various advocacy meetings to support CDTI process in the State. Health Committees have been constituted and made functional in the course of implementing CDTI in some communities. As regards trealment of endemic communities, the project was able to treat 935,406 poople in the communities with 2,807,781-mectizan tablets. The therapeutic coverage rate is 78% while the geographical coverage rate is l00o/o. The projects in the coming months intend to carry out some targeted taining aimed at corecting some lapses identified during monitoring exercise. More advocacy, mobilization and Health education will be carried out in some targeted communities and Local Govemment areas. The frequent transfer of the trained Health workers from one health facility to another is a mqior challenge facing the project. The project during the reportingyear have been able to train and retrain more health workers while the Local Government Service Commission personnel have been involved in various form of mobilizaion and sensitization. This has enable the personnel responsible for fte transfer of Health workers to acquire knowledge about CDTI activities in the State. ) WHOiAPOC. 24 November 2004 tSEGTIOII {: Eaclrground lnformatlon 1.1. Geneal information 1.1.1 Description of the pruject (briefly) GEOGRAPHTGAL LOCATION, TOPOGRAPHY, GLIilATE Ondo State is in the South West of the Courtry and covers anmea of approximately 15.600 square kilometers. It is bounded on the North by Ekiti State, East by Edo State, West by Osun States South West by Ogun State and South by Atlantic Ocean. The Bio-climatic zones of the state range from rain forest to forest savannah mosaic, to guinea savannah and mountainous areas. The rainy season is from April to October while dry season starts from November to end of March. Farming is throughout the year while planting period covers April to October and harvesting period is October to March. POPULATION ACTIVITIES. CULTURES LANGUAGE Ondo State located in the B-HealthZone has a projected population of about 3.5 million. The major ethnic groups are the Akoko, Akure, Owo, Ondo, Ikale, Ilaje, Ijaw Arogbo/Apoi The major language spoken is Yoruba but there are various dialects. The occupation of the State is farming which include growing of Coco4 Yams, Oil palm, Cassav4 Cultivation of Maize, Beans and Pepper etc. Fishing along the riverine areas is very coflrmon, Crafts such as weaving of cloths, using raffra to make baskets, mats, chairs etc. Some people in the State also practice keeping of domestic animals. COMMUNICATION SYSTEM (ROAD):- Transport by road is the major means of communication among the communities some of the roads between major towns or cities are in good condition while access roads to most of the endemic Communities are very bad some are not passable during the rainy season for the communities at the riverine areas, transportation by river or water ways is used. The uses of electronic and print media are also means of communication in the State. Schools. Churches, Mosques are other means of communication in the communities. Town criers are used in some rural areas to announce or communicate within the communities. ADMINISTRATION STRUCTURE:- Ondo State administration is headed by the Executive Govemor. There are the legislative and judicial arms. The Iocal Govemment with the Chief administrative officer being the Chairman supported by the legislative arm made up of elected councilors from different wards. The State consists of 18 LGAs with the State capital located in Akure. T{EALTH SYSTEM AND I{EALTH CARE DELIVERY The health service of the State is sffuctured to provide health care for the people at all levels. Primary Health Care (PHC) system provides health services with the community participation and support from the State. Local Government and NGOs. Different levels of health care delivery and services are provided across the State and the project areas. ? WHO/APOC. 24 November 2004 ,State Specialist Hospitals General Hospitals Comprehensive Health Centre Health post- and centers 4 L4 l8 168 Table l: Number ofhealth staffinvolved in CDTI (Please add more rows ifnecessary) District/LGA Nunbor of hcrlth rtrfiinvolved in CDTI ecdddcs. Iotd Nunbcr of hcdth drff h the entlre projoct erer Nrmbcrof hcdth ltrfi hvolvcd ln CDTI Perccntege AkokoN.E. 78 54 69 AkokoN.rt 74 53 72 Akoko S.E. 83 57 69 Akoko S.W. 75 53 7t Akurc North 85 53 62 Akurc Soth 98 50 51 Idanre u 54 il Ifcdore 75 50 67 Ileoluji/Okeigbo 65 44 68 Irele 82 63 77 Ondo E. 69 49 7t Ondo W 75 62 83 Owo 98 62 63 Ose 80 58 73 Tot l l,l2l 762 680/o 1.12. Parlnership Parrrers involved in CDTI project implementation at all level in Ondo State is as listed below. World Health Organization (WHO) African Programme on Onchocerciasis Control (APOC) United Nuion Intemational Children's fund (UNICEF) National Onchocerciasis Control Programme (NOCP) Federal, Stue and Local Crove,ntments Local NGDOs (Progressive Club; Elite Club; Cordat Club; Union of Friends) Communities in the endemic Areas. Unicef has been able to collaborate with the State Ministry of Health by releasing frrnds for training and retraining of Health workers, monitoring and supervision of CDTI activities at the LGAs and community levels. 4 WHO/APOC. 24 November 20O4 The state and the 14 APOC assisted LGAs have been able to approved and release their counterpart funding and provide logistic for CDTI activities. Advocacy and mobilization of the new policy makers community leader,, GDOs, and NGOs and CBOs have been carried out throughout the State. 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G)L 3oI .E R 6) t,(g o) .d aEf{idJa- .lE#'5l,'sG ..tr TE s3 .= .trI-gg LHL:i F'. aot .gl F -Olr a6lNFI -F nU +r Eo e!5 L'(9 to I Hl.i N z o -FUftla 2.2 ADVOCAGY Advocacy mobilization workshop for the state policy makers, LGA policy makers, Top Crovsnment functionaries, Traditional Rulss, Religious Leaders, PHC Coordinatory urd some notable opinion leaders was carried out in the state. The Advocacy mobilization visit, which was carried out by the Top management from Stde Ministry of Healttr, was facilitated by officials from WHO, UNICEF, NOCP Headquarters,B-Zotlr.l official and members of SOCT was very successful. A total of forty-five state Policy makers, one hundred and sixty-eight LGA policy makens, eighty-five Traditional rulers, Seventy religious leaders, One hundred and sixty-five school Teachers and thirty-five opinion leaders in the communities were mobilized. Advocacy and sensitization of these groups were carried out to enable them understand the concept of CDTI and the roles of partrrers in the implementation of CDTI project in the State. As a result of the advocacy and sensitization of the policy makers, State and LGA cour[erpart funding were proposed and released for implementation of CDTI activities. The State Govemment released a total sum of #2.6m while the zum of # I . lm was released by the 14 LGfu where CDTI is in operation 2.1 tobtlLrtion, semtttzetlon and heelth educeton ofi at rlrk cortmunltles The mobilizdion and trcalth education of the endemic communities were supported by the use of posters and radio/television jingles developed in the Local languages. Additional frained trcalth staff and town criers were used as mobilizers . Churches and Mosques w€re also used as places of mobilization The State Ministry of ldealth continued to sponsored a T.V. prcgramme known as "stewardship" and also a radio programme known as "Our Cruest" where CDTI programme is sell to the populace. There was no sepaxde mobilization and Health education of women and minorities in Ottdo State project sirrce there were no segregation in all the CDTI project areas. They all live together in peace urd harmony under one community leadership. As a result of the mobilizuion carried out on CDTI implementation, the positive response of the communities were recognized on these areas. Communities selested their CDDs withoutdelay Non-functional village health commiffees were reactivated. More Communities decided on mode/period of distribution Communities collected their mectizan from the collection points. Communities give incentives to their CDDs, Communities moniter CDTI intheir domains. Despite poorterain and inadequate fund for fueling of project vehicles, most of the endemic communities we,re visited for mobilization, sensitization and health education The leaders urd members of the communities promised to ensure the g WHO/APOC. 24 November 20M a e o a a o success of CDTI activities in their domains. This has also resulted into increase treafinent coverages and reduction in refusal rate. More time should be devoted to communit-v mobilization, sensitization and Heatth education. This should be supported with adequate logistics i.e. good project vehicle, adequate fund for fueling to take care of unstable fuel prices and vehicle parts. ro WHO/APOC. 24 November 2004 t 8N 0)! EIIo z rtN R 0.\ o|i > b B ti oO I o 8. o hD G) d) ,ti oo 0)() A o d9a2ll) E:g €.9 EBHFHt< 9pO .HOht 6-B oDv -E clEFHN ooi SEHE,O68N rE .e .E PE 89 E.g 8eEc!HU}t>,!ll) c, -Cgo -oid5 FS Eor E6 EEOrC9E bE EE3€ E-e HOO s.E9E ,86 Oe !rEYAHE!EgB <B 8A '!r H 'Ev E* EE :lt r!{$,E.tE tott E o 5 t t t I t :t I - t t t x - t ='E dL OFI iEE - Ee € 6 6I ot \o \o t F (nt \ota €ta sfN c-+ €ca o\ c-!A 0 .i I Et, a) €=iire Q o 3 E ,z a aF @t\(f) t-.(n sol ooo+ $ o\o$ @€ s6 cflo\(fi $\o CO c\ CA\o o\t-in (a o\s tnF o\ r tao tiEv @t 6@ t- sf o \o ol o 6l ol r* o\ 66 rf,€ m!a \o A U o I a @ (.) € ot (7) ol o\ C.l r.. F.- o\ l'- \oF-(\ \o€c.t \orrcl ra\o cl o\+$ ln o\ Cq $ CA ta\o ett^ + €r,'rt 8'FE0xax !;nir 'Elr 'Eb l-aEE tro OE3a rl .rEEI z?) o EO !a E E 5& -c a\ N tt- t-.\o \o t\$ t o\t (.I Nr- o\ca o\ rn$ \oN 1Oo\ !+ f rr r !Erl N <t ct 6t ol 6 i.) \o c.l l,.) t oI o{ r-(fl N I!t ti I tI a I Et- o6troEr ;E 00 00 oN N \o \o(o ? (- u1s \ocat €ca t+N r-$ €(a o\ c-in oJI .J a .-i z o '1.o .l E z o ,rloI trj U' osol< E rh olzo -t E z o =g a o U) o a -v o E cl o €g 3 oo o ,vo oo (u E Ei oE o F oE o o 6 o) 6 r oF tr a L) 6) tJ -Ea-19H Y* eEE3>t .H o. - 6 .B:BEE EE E-ao9U+r orl{El6r Fl Majority of CDTI communities provided incentives to their CDDs. It may be in form of castq materials or in kind. The rate of attrition of CDDs is not a problem to the project because large number of CDDs have been trained within the community and this give room for easy replacement. 2.5. Gapacit1r buitding TRAINING This is a continuous exercise. All officers involved in the distribution of Mectizan in the State have received one form of training or the other since the inception of Onchocerciasis Control in the State. Howwer for the purpose of CDTI Implementation in the fourth year, monbers of the SOCT and LOCT were retrained. The BZoml Coordinator Mr. A. O. Jayeoba and other facilitators from NOCP facilitated these. The training of the Local Government Oncho. Control Team for CDTI implementation was carried out in fourten Local Crovernment areas simultaneously in the State. Training of CDDs at various LGAs was done by the trained LOCTs and supenrised by the SOCTs. They were trained on disease identificatiorq registration of Community monbers, measurement for dosage and mestizan disribution. AIso management of mild reactions and the referral of swere reactions were discussed. Stake Holders meeting as well as community s€lf monitoring (SHIWCSM) were thoroughly explained. During the treining cours€, attention was given to some targ*ed areas where lapses were detected during monitoring exercise at different levels of CDTI implementation. The training materials used include the following:- Flipcharts, Posters, CDD field guide, SOCT/LOCT field guide, training manuals, tape measures, community reglster book and a projector. As a result of the training carried out the number of trained CDDs increased This resulted in increased coverage. ln the process of supervision the CDDs demonsffated greater understanding of their responsibilities, this explained the ingrease in coverage. 12 ! 8ci k 0) € !) b zt .l R t B r,(u E GItr attrtrU Lo E z av o -. F< - -l \.tr i * 00$ :_ OO @$ t'- .: o \o $(\I s\o6t I .:. t\oN o\t O ao .: o e.l$ \o vs O : (o o\o : : EI co& $ _:. F.$ 00 @ : cl : \o (o o\(n $ o\ $\ 6lo (..l r F- \o a r-\ o\t-. otn o\$ o\i €$$ r$ ?ar\ o\ vt rrr\oN V' F. s e tr a) Eo 0) -g s? II !it 8\t OC.l Ilrt a I fis $ t 8$ It- o\o 6 \a\o \o o O q) .=oGlIr!b r. f-r9- -ao9 E.ELG6)L Jz = --E'---t{- : i. e q ? 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L)00EJ E8i\# SE H o op.E =oo>5 x 0)(h o) h0 + z a s 8(\l h a) Io zt GI Et o Ae\i c s t g!9; -spe6l O-+. e) a6) .9e EELgs .= 'E' oEQ(l) .geeFr5 l-Lh8uhE(,t E6l r (tllEolg5 96) .ESE6 Gl i) .r()EE EG'Eea)ELO) *.ttsE rtgEI-9 , v'l(l)l ut =l €El .l Fl i) 6D E E8 U z z z s t sa o\ o\o o\ s\o o\ sF. o, o cl q oA o$.t- Oo\<av o z z z s+ s\o o\ Io\ c\\oo\ sF..o\ 3r50.I FESb 6-toH z z z s c..l scl\o \o At'. $ st'. ET EA \o\o t- t s $ e.l s (-l $(\l\a tr fa \oN 6+ 1..6lr- fq r-ai o\ r- o\ Qal o\ Iq r o, EE$ z z z e5d \o a5 rat rr 8 $p 6 co i s o\ F.oN$\o o\ E iE sEuft = E tsE z z z 8 \o I O6 o 8 oc\ fit'- o e.t t'.$N o(\l 8 0()d E !t E o O o _009 EG^ta oa\ -8 z z z so soo sI s(f E to=o. EoE= da l-bOX Oo\ - --A->V;- ao z z z 10 -o6\ l'- tr- \o G\\o OD ^\6O 6\ GOi6'E A i E$E EES" z z z O O rt Oo o\F o\F tso? E.a E €,-L< g*'F\J z z z 6 Iv 8 o\r-.\a o\1..\n 00 G, lEe IH EE;85'c=E -5 oo z z z o,t-. r o\tr rn Olt.. v1 Olt- r Oll"( t 14 r-o\ o\ cp o\ o\ eo\ 8o(\ oa.t el ot\t (.iooc\ I N o(\ p ts a.l tr N cooo6l o\ 6l O O6t 2.7. Ordering, stolage and deliveqy of ivermectin Mectizan@ orderrcd/applied for by- MOH nr wno il IINICEFll n NGDO Mectizan@ delivercd by - MOII/NOC[ v ilno uftrr NcDoD Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan ordering and delivery in Ondo State CDTI prqect originated from the Community through tre CDDs. The Community Directod Distributors requested for their yeady needed Mectizan tablets using their Mectizan treatrnent census register. Their request is forwarded to the LGA Oncho Control team (LOCT) through the Health facility statrGIFS). The LOCT compiles the reques* from the various Communities in the LGA and forwarded it to the State Oncho Control Team (SOCT) who submit to Zonal office for onward transmission to the NOCP Headquarter. The National Onchocerciasis Control Programme Headquarter collates all requests for Mectizan. and makes application to MSD. On approval MSD ships the drup which are cleared by LJNICEF and storod in their storage facilities on behalf of NOTF. Drug delivery follows the ordering process but in revised order. MSD TJ NOCP UNICEF . .j, ZONAL OFFICEtJ STATE AItv LGA TJ HFLf .1. (cDD) COMMUNITY o .fr WHO/APOC. 24 November 2003 tr Table l0: Mectizan@ Inventory In some communities, the remaining tablets are kept with the Health workers at the health facilities nearest to them while some communitios kept their remaining mectizan tablets with their supervisors which may be a CDDs, community leaders or a1y appointed members of the community. STATE/DISTRICT /LGA NUMBER OF MECTIZAN TABLETS REQUESTED RECEIVED USED LOST WASTE ONFMLD EXPIRED Akoko N.E. 212,000 ztt,250 208,454 2,796 Akoko N.W 2t4,000 213,460 211,364 2.096 Akoko S.E. 182,000 l8l,5l0 179,213 2,297 Akoko S.W 205.000 204,420 201,920 2.500 Akure North 214.000 2t3,720 2ll,8l9 1.901 Akure South 210,500 210,060 208,214 1,856 Idanre 200,000 189,900 187,206 2.694 Ifedore 204,000 203,670 200,923 2,747 Ileoluii/Okeiebo 152,000 151,820 149,668 2.152 Irele 210,000 207,020 204,524 ?,496 Ondo E. 190,000 170,500 168,427 2,073 Ondo W 235.000 232,820 231,120 1.700 Owo 2r3,000 211,270 210,419 851 Ose 250,000 235,490 234,510 980 TOTAL 2.891.s00 2,836,910 2,807,781 29,129 20 WHOiAPOC. 24 November 2004 oN 3 Ei) z 'fN x o * EJ $tI ts G) o0 cd 0) tso clt) EEdi)t t() ot o ob d troE }l 6 o oU € E oo =tr 0)q a) J, EI RH h 66 d IDk aI (!) 3(, lt 0) d o E c.i cl (l L (D E (Bq) tll EF3. .=Xfl*EE -.E9E €E pE FET [EoEEi6 s! t-9rotr EtoEoEiE|!;iLiLd)kl .E ggE EEEE'ErlEotsbEE?*F8g?KE -alrrEtE,F ET B,?,trHl .'Eclq E€N F. f-l $ N ta \o (\l el o\ (aN \n $t\ N(.I 6\OF(?i C)r-?{ ti cttrJl sE9 .E6E EEEEiaopTlE tr6 a)'E BE goEza a cl EI EHEE;9E5E Ets E -Q'tr gi, H.EE',9 o z 6 o\ rf, (n N r- fo r\ roCA \o (f) g\r ra ItJ .- CE oQ ts sE ^-5 U; a.v EE gO'gl oF.EE EE bo 00 a oOI r,alN \oin \otfl t r-trl \n$ \o(f) €(f) r-t 6m$c{ oE at o&o I o6) rd o! o a o) > oE o o Bo oU'o rl F o Er () .l E! ID E Ei z oJ4oJ( B z oi!oJ( rri a oJoJ4 Ea oJoJ o z c)rl & o U)(l) J o) GI € o) o E I 2.9. Supervision 2.9.1. Provide a flow chart of supenision hierarchy. SOCT .t LOCT J DHS J HFL J CSM T CDD L92. Whatwere the main issues identified during supervision? Issues identified during Supervision depends on activities at hand and varies from one Community to another some of the issues include:-(l) lnadequate lnowledge on reporting(2) Recording problems by CDDs(3) Lack of incentives from the Community. 2,93. Was a supervision checklist used? Yes 2.9.4. Whatwerc the outcomes at each levcl of CDTI implementation supervlsion? Through the supervision of CDTI artivities at each level, the health facility staffwere able to provide reports and data wittr conect figures. The CDDs were able to carry out proper recording and update their treatment register. Treatnent coverage at the community level improved 2,95. Was fccdback given to the person or groupt supervlsed? Feed back was given immediately and this has assist the project to have increase in therapeutic coverage 7,9.6. How was the fcedback used to improve the overall petformance of the prcjcct? Every member of Oncho. Control team including the CDDs and the Community members rvere able to identifu their roles and where performmce are below average. As suctr, all personnel involved in CDTI activities improved their performances thereby increase total teatment coverage and reporting. 22) WHO/APOC. 24 November 2004 SEGTIOII 3: Suppoil to GDTI 3,1. Equipment Status of +Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WGWritten off1. How does flre project intend to maintain and replace existing equipment and other materials? The State Ministry of Health has put in place a plan to erisure that project equipments and materials were adequately maintained. The plan include adequate budgeting and release of fund, integration into other PHC activities and periodical servicing and replacement of materials. The project has requested for some capital equipments such as Motor vehicle photocopier, Computer set and laptop from APOC in the fifth year budget while other materials will be replaced by the State Project office. I llrUlr Source Type of equipmcnt APOC MOH DISTRICT/ LGA NGDO 0thers No. Condition No. Cordition No. Conditim No. Conditioo No. Coodition l. Vdricle 1 F 1 wo 2. Motor cvclds) 15 F 5 wo 3. Computer(s) I CNFR 4, Printer(s) I CNFR 5. Photocopier (s) I CNFR 6. Fax Machin(s) 1 F 7. Otlrers a) NC I F b) TV I F c) Bicycles 150 wo 2? WHO/APOC. 24 November 2004 SEGTIOII 3 $upport b GDTI !.2.Flntnctrel contrlbutlons of, thc peilncns and communltles Table 13: Financial contributions by all parrrers for the last three years Release of countcrpart furds are alwap proc€ssed md disbursed forthe project activities withoutproblem 33, Otlrer ftnnr of communlty rtmort Some of the endemic communities provide incertive to their CDD, such incentive include transportation, allowarrce, food items recognition of CDDs dunng celebrdions in the community Contributor Yorr I Juac 2000-Mry, 2001 Ycrr 2 Juoc. 2001-lvleu 2002 Ycer 3 Jrne. 2002-lvley, 2003 Ycrr 4 Nov 2003 -Doc 2m4 TOTAL Budget d russ) TOTAL RGlo.rd russ) TOTAL Budgatcd rus$) TOTAL Rdarlcd 6rs$) TOTAL BudSctd rus$) TOTAL Rclcrsod russ) TOTAL Budg€td rus$) TOTAL Rclceacd russ) Ministry of Hc.lft (MO[D 1E750 l:sfi) 10,000 lt.(x){) r2,t00 8, rx)0 16,000 16,000 Locrl NGDO(r) ( if rny) NGDO perttc(r) Fivc Motacyclcr Fine Motocyclca 6,rmo 6"10o Didrict/L,GA t,750 3,750 t,000 5,m0 8,000 5,600 t,gx) E,t00 Communitics APOC Trurt Fund l7l,6g) l()4,lm 135,t50 109,t60 73932 61,534 4\622 4\622 TOTAL 199,1E0 120,430 153,8@ 12e8fi 93,832 75,t34 73,822 73,822 4l WHO/APOC. 24 November 2004 I 34. Expendltulu Per *tfvntY Exchange rate used = $1 : Nl36 Table {4: Indicare how muchthe project spent for each activity listed below during the reporting period Activity Erpenditurc ($ US) Sourrce(s) of funding Drug delivery from NOTF HQ area to central collection point of a4lqqmry_ Mobilization and health education of communities CDDs Tr_aini4g gf hedlh qtq$ qt plt [eve]s Supeq4sing CDDs and distribution , Intgmal mgr_utqring oJ_CDlt apqulqqq [{vocqcy vrqltg to health and IEC materials f- lluqqry for treatnent I Vehicle_s/ Motorrycles/_ bicycles maintenance IOmce Equipqq! (e_,ggq4pqtgr!,1,nqtqrq 9!O _ lotn o _lIq! _ _10,100 5,600 8,895 14,900 16,780 6,000 6,650 600 600 2,000 597 MOH UNICEFA,TOH APOCA,IOH APOCA,IOH MOFYLGA IJNICEFA,IOH APOCruNICEF APOC /IVIOH APOCA{OH APOCA,IOH APOCA{OH TOTAL 73fi22 Total number of persons trcated 9ss406 {5 WHO/AFOC. 24 November 2004 authorities APOCAdOH aSEGTIOil 4: Sustalnabllttyr of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation ./ lntemal Monitoring by NOTF Other Evaluation by other partners 1.1.2. Whatwere the recommendations? Recommendations have not been sent to the project although feedback meetings were held after the exercise 4.13. How have they been implernented? Some of the issue discussed during the feedback meetings such as inadequate reporting, supervision and Health education have been implemented. 4.2. Sustalnabllity of proiects: plan and set targerts (mandatory at Yr 3! Was the project evaluated during the reporting period?-\ A Was a sustainability plan wriuen?__N A When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 1.2.1. Planning at all relevant levels 4.22. Funds 4.23 Transport (replacement and maintenance) 4.2.4. Other nesources 4.25. To what extent has the plan been implemented .?5 WHO/APOC. 24 November 2004 Iai { 4.3. lrtegration Oufline the srtent of integration of CDTI into the PHC structure and the plans for complete integtation: 4.3.1. Ivermectin delivera mechanisms Health workers at the health facility level who are also engaged in other PHC activities are involved in the process of mectizan procurement and delivery, 4.32. Training Health workers at various health facilities who are also engaged in PHC activities are used for CDTI training. 4.33. Joint superuision and monitoring with other programs Supervision and monitoring of CDTI activities are carried out at different levels by Health workers during PHC activities such as home visiting, immunizations and Health education. 4,3.4. Release of funds for project activities Release of funds for CDTI activitim always accompanied PHC programmes especially during routine immunization programme and other activities. 4.35. Is CDTI included in tlre PHC budgett The State and Local Government Areas have been able to include CDTI budget plan as part of the overall budget of PHC. SEGTIOII 5: Strengths, weaknesses, challenges, and oppotrunities STRENGTHS I Most of the communities so far treated and where distribution is currently going on have taken on the responsibility of collecting the drug from the nearest Health facility. Generally, the CDDs exhibited a high sense of responsibility and understanding ofthe CDTI concept. 2 \\enumbers of CDDs selected by the communities and trained for CDTI has increased thereby improving the freafinent coverage. 3 All the LGAs have also followed it up by either larding moral support with the physical presence of Policy Makers at relevant occasions or/and by giving financial assistance to the implernentation process. The 14 APOC assisted LGAS provided N80.000 each as counterpart funding during the period under review. WEAKI\ESSESL During the spot checks by the SOCTs, it was discovered that some CDDs had problems in record keeping. Inadequate supervision of CDDs by LOCTs,/IIFS Inability of some communities to give incentive to CDDs , 3 {t WHO/APOC. 24 November 2004 I if CHALLENGES:- Late approval of proposals and fund by Unicef. tncreased operational costs particularly the cost of fueling tho prqect vehicle and maintenance. Latell.{on submission of reports from some of the Onchocerciasis Control Team LESSONS LEARNT Need for timely and adequate funding by parhers Appropriate budgeting for CDTI activities Early submission of reports I e,8 WHO/APOC. 24 November 2004