Bauchi State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2006 -December 2006

RESERVED FOR PROJE CT I,OGO/IIEADING I COUNTRYAIOTFz Nigeria Proi Name: BAUCHI CDTI PROJECT Launchins vearz 2000 JANUARY 2006 _ DECEMBER 2006. Proiectvearofthisreport: (circleone) I 2 3 (4) 5 6 7 8 9 10 Date submittedz JANUARY 2007. NGDO partnerz UNICEF I t 'iat ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 31 JanuarY for March TCC meeting For To APOC Management by 31 Julv for September TCC meeting To I ZTt V(c girr csb .1o+, i,/ I ArlL B{'i) Ii) for fnbrrnotton Tot at T $I AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)ri. f= i-bie ifrr*t* itl,*tHui I a- L t.- L 0 I JU|N 2007 i & t WHO/APOC, 24 November 2004 Approval Yeart 1999 I t{ I d 1- t- t- WHO/APOC, 24 November 2004 I 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 the ort: Country: Nigeria National Coordinator Name: {".,r^;*" &qL."(J Signature: .. .. Date ro Date: .A.tnezlw* Zonal Oncho Coordinator Name: .. This report has been prepared by Name :Abdulkarim Danjeba Designation: , Coordinator Signature Date: ll Table of contents Acronyms v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive Summary 2 SECTION 1: Background information 3 1.1. GnNBner-TNFoRMATIoN 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopurerroN................ SECTION 2: Implementation of CDTI 8 2.1. Tnranr-rNe oF AcTIvITIES .............. 2.2. Aovocecy 2.3. MosTLIzeTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIBS 10 2.4. CovrruuNrry INVoLvEMENT............ .................12 2.5. CepnclTyBUILDING ..t4 2.6. TRrerusurs................ ................. 16 2.6.1. Treatmentfigures............. .....16 2.6.2 V[hat are the causes of absenteeism?............. ............19 2.6.3 Vfhat are the reasons for refusals? ................ ............ 19 2.6.4 Brte/ly describe all known and verified serious adverse events (SAEs) that.... 19 2.6.5. Trend of treatment achievement from CDTI proj ect inception to the current year 2 I 2.7. ORorrrNG, sroRAGE AND DELIVERY oF IVERMECTIN ..........22 2.8. Corrrlatxny sELF-MoNIToRING AND STAKEHoLDERS MnsrrNc ...........24 2.9. SupBRvrsroN............... ..................25 2.9.1. Provide aflow chart of supervision hierarchy. ..........25 2.9.2. What were the main issues identified during supervision? .............................25 2.9.3. Was a supervision checklist used? ...........26 2.9.4. Vlrhat were the outcomes at each level of CDTI implementation supervision? 26 2.9.5. Was feedback given to the person or groups supervised? .............26 2.9.6. How was the feedback used to improve the overall performance of the project? 26 SECTION 3: Support to CDTI 26 3.1. Equnuevr .................26 3.2. FtNeucteL coNTRTBUTIoNS oF THE PARTNERS AND coMMUNITIES.............. ............28 3.3. Orusn FoRMS oF coMMUNITY suPPoRT ...........28 3,4. ExprNoIruRE PER ACTIVITY ....,,...,29 SECTION 4: Sustainability of CDTI 29 4.1. INrenNnl-; INDEIENDENTIARTICInAToRYMoNIToRING;Evn1uertoN....................29 4.1.1 Was Monitoring/evaluation caried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........29 4.1.2. Lfhat were the recommendations? ..... .....30 4.1.3. How have they been implemented? .............. ..............30 4.2. SusreNasrI.rry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT ...............31 3 3 4 6 ..8 l0 Yn 3) 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3. IvrecRanoN.. 4.3.1. Ivermectin delivery mechanisms... Planning at all relevant levels Funds Transport (replacement and maintenance) ...... Other resources... To what extent has the plan been implemented .......3 I .......31 ,.,....3 1 .......3 I .......3 I .......31 .......32 ....... i2 tr t- lu WHO/APOC, 24 November 2004 4.3.2. Training 32 4.3.i. Joint supervision and monitoring with other programs..... ...........32 4.3.4. Release offunds for project activities ......324.3.5. Is CDTI included in the PHC budget? .....32 4.3.6. Describe other health programmes that are using the CDTI stntcture and how this was achieved. What have been the achievements? ............. ..................32 4.3.7. Describe others issues considered in the integration of CDTL .....32 4.4. OpBuuoNAL RESEARCH.. ..................32 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period........ ..................32 4.4.2. How were the results applied in the project? ............. ..................32 SECTION 5: Strengths, weaknesses, challenges, and opportunities 33 SECTION 6: Unique features of the projecVother matters 33 t- { t, lv WHO/APOC, 24 November 2004 t, Acronyms APOC ATO ATrO CBO CDD CDTI CSM FLHF FOMWAN GIS LGA LOCT MDP MOH NGDO NGO NOTF NPI PHC PHC & DC REMO SAE SHM SOCT TCC TV TOT I.INICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Front Line Health Facility Federation of Muslim Women Association in Nigeria Geographic Information System Local Government Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Govemmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force National Programme on Immunization Primary health care Primary health care and disease control Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Television Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization J WHO/APOC, 24 November 2004 t- Definitions Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Elisible pooulation: calculated as 84o/o 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) Ultimate Treatment Goal f[JTG): calculated as the maximum number of people to be treated annually in mesoAryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geopraphical coverage: number of communities treated in a given year over the total number of mesoAtyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower comrnunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the progmmme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (D 1- a- 1- vl WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) lr t- Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BYTHE PROTECT FOR TCAAPOC MGT ASE ONLY WHO/APOC, 24 November 2004 f 1 IExecutive Summary Prepate an Executive sumrnary of the report in not more than one page. Bauchi State is located in the Northeastem part of Nigeria. It shares borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau State border it to the West, and Taraba State to the South. The State has a total population of 4.6 million according to 2006 census, and is made up of 20 LGAs. By the national prevalence survey and the results of rapid epidemiological mapping of Onchocerciasis in the country in 1999 which was refined in 2003, I I out of the 20 LGAs in the State are endemic. These are Tafawa Balewa, Ningi, Warji, Bauchi, Alkaleri, Toro, Bogoro, Misau, Giade, Ganjuwa and Darazo LGAs. Earlier, treatments were carried out in 13 LGAs but with the REMO refine and its integration into the GIS, and subsequent production of a REMO map made available to the State in 2005 in the health mapper software, it was discovered that only I I LGAs fall within the definite CDTI area. Treafinents commenced in the State since 1991 with UNICEF assistance and number of persons treated fluctuated in the initial years, but since 2001 treatments have been on the rise. Total number of target communities is now 988, out of which 908 communities were treated resulting in a geographical coverage of 92yo. 620,138 persons were treated in CDTI definite zones out of a total population of 1,129,290 giving a therapeutic coverage of 55%o, alad a 67%o achievement of the ATOruTG. However, 166,494 persons were treated passively. Most of the inhabitants of the State are normal settlers, but in recent years there are some movements of immigrants from the neighboring States of Nasarawa and Plateau States due communal clash. These immigrants have settled in Toro, Bogoro and Tafawa Balewa LGAs. Also there are movements of the nomadic Fulani who come to the State during rainy season, and seek greener pastures elsewhere during the dry season. Moreover, after the farming season, youths from the communities tend to migrate to the townships to get involved in commercial motorcycle business popularly called okada, as a means of getting extra income. The project has conducted a series of training in order to build capacity at LGA and Community levels. The training sessions conducted involved 44 LOCTs, 292 Health facility staff, and 2,828 CDDs, who were either newly trained and re-trained. Overall, 176%o and 94%o of ATrOs of health workers and CDDs were achieved for the year reported. Challenges facing the project and how they were overcome are as follows: - Lack of adequate census update. A state level management meeting for SOCT and LOCTs is being planned for early 2007 to address this and other gendarme issues. A data collection exercise supported by APOC Management is being initiated. - Low CDD/population ratio. Communities are being sensitized to select more CDDs. UMCEF intends to complement whatever APOC will provide in 2007 for CDD training to reduce the ratio. - Inadequate logistic support at the LGA level. The APOC donated motorcycles in the six endemic areas are almost gtounded. Only one out of the available six is repairable. Five LGAs newly co-opted in to the programme this year have no motorcycles. Programme officers liaise with other PHC programmes for their supervision and conduct of other CDTI activities. - Inadequate community support for CDDs. They are being sensitized to provide incentives. Some LGAs have taken it upon themselves to give financial incentives to their CDDs. The CDDs on the other hand are being encouraged to do the work willingly despite the apparent lack of incentives. 2{-. L, WHO/APOC, 24 November 2004 ,- SEGTION {: Background information {.{. General lnformation 1.1.1 Description of the project (briefly) - Geographical location, topography, climate Bauchi State is located in the Northern Eastern part of Nigeria. The State is sharing borders in the North with Kano and Jigawa States, to the East by Gombe and Yobe States, while Kaduna and Plateau State borders to the West, and Taraba State to the South. The State lies in Savannah region of Nigeria with variation in ecological conditions. The South and Westem part are Sudan or Guinea Savannah, while the Northem part of the State is Sahel Savannah. Some major Rivers transverse the State, and these are Hadeja, Jama'are, Gongola and Dindima. Most of the Oncho endemic LGAs lie along these rivers. - Population: activities, cultures, language The State is made up of 20 LGAs with the headquarters at Bauchi. The State has a total population of 4.6m people based on 2006 census. There are more than 40 ethnic groups and different cultures in the State. The major ethnic groups include the Hausas, Fulanis, Jarawas, Gerawas, Sayawas, Kanuris, and the Kare-kares. Islam and Christianity are the major two religions of the people of the State. The settlement pattern varies in different parts of the State from nuclear settlements with surrounding farmlands to dispersed settlements. Agriculture is the chief mainstay of the people of the State. Farming season is May to December - Communication systems (roads...) Communication is mostly by road and trunk A roads exist linking the State with the capitals of all neighboring States. Other road networks are available linking the various towns and villages but some of the rural areas are difficult to access during the rainy season. - Administrationstructure The Administrative system in the State is of two folds - the modem administration system and the traditional administration system each of which exert influence on the people at the community level. The traditional system is closer to the people and structured in such a way that large areas are under the authority of a District head, who is responsible to the Emir. Under the district head are village heads, and below them are the ward heads who relate directly to the heads of households in the communities. Under the modern administrative structure the State consists of 20 LGAs. The LGAs are further subdivided into wards, which in tum are made up of communities. The State has an elected Governor as the head of the executive arm while there is a house of assembly made up of elected representatives of the different LGAs. This forms the legislative ann. The same pattem applies at the LGA level where the legislative is made up of councilors from the different political wards. - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). The health system consists of Primary, Secondary and Tertiary levels. The Primary Health Care facilities are at the LGA level where the health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the LGA headquarters and tertiary is the referral hospital located in the State capital. By the national prevalence survey of Onchocerciasis and the results of rapid epidemiological mapping of Onchocerciasis in the country in 1999 which was refined in 2003, 11 out of the 20 LGAs in the State are endemic. These are Tafawa Balewa, Ningi, Warji, Bauchi, Alkaleri, 3 WHO/APOC, 24 November 2004{. t. !i IToro, Bogoro, Misau, Giade, Ganjuwa andDarazo LGAs. Earlier treatments were carried out in 13 LGAs but with the REMO refine and its integration into the GIS, and subsequent production of a REMO map made available to the State in 2005 in the health maPPer software, it was discovered that only I I LGAs fall within the definite CDTI area' - Number of health stalf in project area and number of health staff involved in CDTI activities. Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Numbcr of hcrlth steff involvcd in CDTI activitics. Totel Numbcr of hcelth strff in the cntirc projcct arcl Br Numbcr of herlth strff involvcd in CDTI Bu Percentegc Br=Bzl Br *100 Alkaleri 43 19 44.2 Bauchi 63 30 47.6 Bogoro 24 24 100 Darazo 22 22 100 Ganjuwa 31 19 61.3 Giade 43 23 53.5 Misau 44 39 88.6 Ningi 2l 2t 100 T/ Balewa 4t 22 53.7 Toro 65 36 55.4 Warji 37 37 100 Total 434 292 67.3 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels IMOH, N G D O s (n ati o n aL/int e rn atio n al), c omm un itie s, I o c al o rg a nizatio n s, et c. J Partners involved in CDTI implementation are the National Onchocerciasis Control Programme (NOCP), -LINICEF, Ministry of Health, endemic LGAs and endemic communities. Some local CBOs like the community development associations, zumunta mata (women fellowship groups) of various churches as well as Federation. of Moslem Women Association in Nigeria (FOMWAN) are also involved in some LGAs. - Describe overall working relationship among partners, clearly indicating specifrc areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved Working relationship between these groups has always been cordial. The NOCP through the zonal office in Bauchi supervises control activities, facilitates delivery of mectizan to the State, conduct advocacy visits to policy makers at State and LGA levels, assists in training of State personnel, and gives other forms of technical support. 4 WHO/APOC, 24 November 2004t- L, { f: UNICEF has been the supportive NGDO partner since 1991 and provides suppod in the areas of capacity building and logistic support. Though for some time now no support has been received from the organization, during the period of reporting the project was informed of the appointment of a consultant to oversee Onchocerciasis control activities in the assisted States. this consultant has visited the project and promised increased visibility and support of UNICEF in the coming years. The Ministry of Health and LGAs provide the supportive staff as well as logistics for the implementation of the programme right down to the community level. They conduct relevant training for field personnel, supervise activities at their levels, manage Mectizan, deliver these tablets through the various established channels to the communities, and keep records of CDTI data and report same to the appropriate levels. The community selects the distributors, plans the distribution schedule, makes decision as to mode and period of distribution, and provides some support for distribution and CDD training. The local CBOs, where involved, assist in the mobilization of communities, particularly women. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project intends to identiff and sensitize more local NGOs and CBOs as well as community development associations and health committees to participate actively in CDTI implementation given the decreasing level of funding from all parhrers. The general elections are expected to take place between March and April 2007, and new administrators are to be in place at all levels by May 29,2007. These new policy makers at State and LGA levels will need to be sensitized and mobilized to support CDTI implementation. 5 t WHO/APOC, 24 November 2004 !- tooN o -o o o z{N (J oA d Jr B "jo)Lr RI F a CJ C' tr rtr o)E C) tr B .,8 v, () F] >' (ll € E(Dlr 0) oot) rt) GI > C)lr(g ,tr o an\q) a-N\l' Bq) .s o tr \r)OO c.l 0) cl a I o () ! cl ct d (D € cl & R! E o E]& cl(t o tro () t oL{ a. (l) =6o rnI (n tr c! a o) o o alL bI) o o €tr cl o rE olr o rqc() B s th o 11 c.) tr (n o € a,) .E G() 0) o B v) trq) tr o lio lr(l, 0) €(D cl o) an q) P' a. a) .s o'\ \)\ a ^s \ q) a) s !5 q) 0)\ o\q) q)$ qJ q) -a\: o V1 Iq) 'o \ q) I B t o q) 60Iq) a .s $ L booq) 00 q) (J B P d "c $\) 'Fl T\ q) "s q) li \3q) "sQ s)L o\ q) E s \ip B !! \) P\ \) .si i tl P o q) 1l q)\q) s. a : \) I Bs B\q) s P q) -o o \) $q) '\b Lq) ^o s s\ a) B p I uh \o la L q)L o t B -jo o)A bo tr E oa c)li o oo tr Lr) € o li o € C) d c)rI C)lid >, C) lr() o B GI 0)L6l (Jq) o a oL q) c) }l .t) 'tr Id tro (o ooa E (! a C' E tr oO oir ol 3I GilFI E o -fl6 -3c oE IN atF B {- Lr tj rr) @(a$ (f)l € o\ 66lg\ c.l o\ f-ra ca( F. +\o o o\irt cair) o\ c- c.t o\o O\at e.l oo c.l t--F-\o @o o\\o €$ $r- N$ c.lt-\o" N\o i-$ ,.I \o$ oFfE= EEE F-@ o^ c.- o\ \r|o r-\o o € oo r- rr| r-$ c.l\o c.lN\r- ca o\ c-t c.) o\$ o o\6l o\GImN \o\o @o$ GI( ca(a\o € o\ $@ U1 \o(rl s\aq @\o ils .(Ditr -oo .= f N E E'3 F: AEEEI Oo o o o 7 , .-g Ei'=vdB.E.E6;>.'r, o o :E E E'T o o \.) F-$ cO\o 6t(\l r- F- eO o\ co c,I o\$ o o\GI o\N@o =l:N\n co\n\o oo o\ $@ rn ..d\n $\atq @\o F-@ o- rr o\ \o o^ F-\o o oo oo r- .9Eei;gE hFito E'=gsi c.t c\ \o\o 66 o\ r-s c.trn o$ c.lo o\ co c.l o$ \oc.l I q) EL .. (:o ctN8.e -tr6a e) oF c.t € c\ @r- o O o o O o O o o o .eE ts9gE A: Eien(l)E >rtlJtsEEo N O $ c.lo o\ c.t c\l os \o6l € €a .9E9U €: rtr.=!n?oUo E'=Isi c.) @N @r- t-.$ co\n cI o L o)E E z g s\at o\ €\o ttr oo F- o\ r.lo o^ F-\o o@ €^ r- (rl r-$^ co\o 6lN\r- c.t o\ ert cO oi$ o o\N o\N 6lES) .egi =EE.EE 3e e-Ha.i:a c.tN \o\o €o n^N(rl co(.l \O^ € o\ $@(a) .d\n b0tr z ((l B() GIo F o oF d B Fl Fr o F,{ q) ((l AZ o)(! ca oL.o o0 o FA oN(ll (B a (o B d L) orJ cl )(!t) Ert .:E.g ti islr(J5 E'A t: o + il Was a census for the project done during the reporting period? Yes If No, what is the source of the data in the table above? * Source:National census CDD Other source, speciry: Year : If you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the project area, A community or village is a clustered settlement of no less than 150 persons and no more than 1500 persons having a head or leader. Is there any other information of interest about the population in the project area? If so, include it here. As a result of communal clashes in neighboring State of Plateau, there was an influx of refugees into the project area most especially in Alkaleri, Tafawa Balewa, Toro and Bogoro. Some of these refugees have taken up residence in these areas, while some are on the verge of goig back to theirformer homes as calm is gradually returning to the troubled spots. As a result of this the population of these areas mentioned above may remain significantly dynamic for the next couple ofyears. t- 7Lr L. I WHO/APOC, 24 November 2004 I aSEGTION 2: lmplementation of GDTI 2.1 . Timellne of actlvlties Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8a- L T ! WHO/APOC, 24 November 2004 tooN o -o o o z sfN O oA d /r B o\ : GIE.Exoq)'F G)ktt o. *c) A.P -x +rO E.9Grtr ^(llElog-b ctE O. v) 0!ict5 6t) ,!9 r.B €p -c{9H 9ii ,h .roo-q o€ cll o) dctE9EEEEEE3:EE =E(). 9L o::9to9+gnE t -:. A 44q) aq) S ? S p \ N \)q q) E l.r(d C) >t 0)lit<)o o 9 .d o(! 0)k a(B 0) l-r(n o H € <n o o(Bqi C) C) F c.ir o.rl -olallFI a l- t- L a o ah Lq) a a o 9: aE U o -o (,) o z 0) -o E c) o z ()p o o z Eq) -o E c) o z C) .o (;) oZ k() -o tro o z q) .o o o z Lo -o q) o z (.) ,ot o o z o -o () o z C) -o E C) o z .E',t +jE 6t=iiE ct >'cl x(, (l x(l z x6l (n d (t >'d E o E L o € o! L n E .9- o9 =tr EE Q (.)! E 0) o z o -o () o z r(.) ,.o q) oz 0) .o E a,) oz () -o o o z 0) -o tro o z (.)3 o o z ko -otr c) o z o tr c) o z C) -otr c) o z () -o Eq) o z .He +JE 6i= aE a(t z ,Eor(! o ct ,tro! Cd o ctl E c) d or(, z ok GI o d o!d o R! q) 6l!a o .Atr c)U e o g: 3E Q c) .o G) o z k3 E 0) o z r0) -o Eo o z ro -o E c) o z C) -o tr C) o z h6) -o Eq) o z Lt tr(.) o z 0) -o o oz c) -otr q) oz ()p tr C) o z 3 E(.) o z Eno 1Ptr 6a= -cC)Ld oL ci o({ o6 2 -co 6! .Eo (l 2 o z oLd 2 o d z o c! 2 o ct OT 6lLF o EL6EEoU >'(g 2 >ld xq, xct z >'(l z x GI x Gt c0 z d xd .E',eiiE 6i=i;E o(t -co GI (J 6 2 o GI () 6, -cI GI o G! oLd or 2 o Gi o fi! -c) E.E s= -otrooIi Ia o o- o.=EEoU L() -o tr c) o.o U) (.) -o C) o(.)(n Eo -o 0) o.oa ! a) -o Eo o.oa o -o E(.) ooo ko -o tro o. C) U) (.) -o o o. 0)a Eo! oq q) c/) Lo .o c) o()(n Eq) ! a) o.o v) ro .o trq) o.(,) a S-e PE d= aE (! cd XLdJ 6l x d rg tr Gt L d trd x d Rt d)tr >r L(l c, ! d) Ct .O 6l 6t (J Fl () L (r, o Lo d l( oado o o d0 oa oN(t d o (, B 6() o! €() 6l o0 z 6 ,o ll la F o oF .trr d B 1- a2.2. Advocacy State the number of policy/decision makerc mobilized at each relevant level during the curreilt yeary the reason(s) for undertaking the advocacy and the outcoma Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. At the State level the project sensitized the Honourable Commissioner of Health, Permanent Secretary and Director Public Health. These then mobilized the Deputy Governor, Commissioner of Finance and the Permanent Secretary Deparknent for Local Govemment Area. The Honourable Commissioner, the Permanent Secretary and the Director PHC paid advocacy visits to all the l1 CDTI Chairmen in order to solicit support to the programme. The trip was a success as the Chairmen pledged to support the programme as best as possible. In Ningi LGA the Chairman assembled the Council and the traditional rulers and they were sensitized on the programme. Already the LGA is supporting the CDTI programme by giving the CDDs some token incentives and involving them in money-paying exercises like NPI. At the community level the SOCT have paid advocacy visits to traditional rulers and religious leaders. The health facility staff has been trained to carry out advocacy visits to traditional rulers and religious leader which most of them complied. The State team has paid advocacy visits to the media houses in the State, which include the State television, the State Radio and the National television. These media houses have shown commifinent towards supporting the programme by allocating slots for onchocerciasis control activities when the need arises. 2.!. Moblllzatlon, sensitizatlon and health educatlon of at risk communitles Provide information on : The use of media and/or other local systerns to disseminate information As effective means of disseminating information the State CDTI project is using electronic media like the State Radio and Television through jingles and TV spots to pass information on CDTI to the populace. The media have been used to cover some key CDTI activities particularly at the State level with the help of the information officer of the Ministry of Health. Information officers of the LGAs also assist in ensuring coverage of some CDTI activities, and reports of these are sent directly to the State Radio for broadcast. This is as a result of continuous advocacy and mobilization to the media houses. Other local strategies used in Community mobilization include: t Use of traditional and religious leaders i Face to face discussion with community members .) Town announcers mobilizing community members Frontline Health Facility staff helped the CDDs to mobilize the Communities. They also mobilize women during ante-natal care services. Types of IEC materials used Posters, hand bills, pocket and table calendars, t-shirts, where available, were used during mobilization Mobilization and health education of communities including h)omen and minorities The CDDs and health facility staff mobilize communities through traditional and religious leaders, face-to-face meetings with community members and the town announcers. Due tol- I I t" i- 10 WHO/APOC, 24 November 2004 treligious and cultural reasons females are rarely mobilized along with the men. Women are mobilized at clinics for those who attended health talks during pre natal visits. Some got CDTI messages through listening to the public address systems or reading the posters made available at community level. There are efforts to involve traditional birth attendants and women religious leaders on mobilization and distribution of Mectizan. Some women religious groups in some LGAs like Federation of Muslim Women Association in Nigeria (FOMWAN) and,zumunta mata' (women fellowship groups) in churches now assist mobilize women on CDTI activities and to allow their members to participate during mobilization and distribution of mectizan. Response of target communities/villages The various communities have responded by keeping faith as far as intake of Mectizan is concemed. Accomplishntents The project has been able to reach out to some women goups who are now involved in CDTI implementation. The project also tried in mobilizing the endemic communities and getting them to comply to Mectizan treatment. lle a kn e s s/C o n s tr aint s o The nomadic Fulani herdsmen make mobilizationdifficult due to their highly mobile nature in search of pasture for their animals. r Language barrier has also been an obstacle to effective mobilization in some areas. o Culture and traditions which restrict contact with women (purdah). Suggest ways to improve mobilization und sensitization of the target communities. Purdah. give the women and minorities opportunity to express their views and the way forward to solve the problems. This is due to the facet that the two groups are in direct contact with women and the communities have trust in them. communities. Therefore, these religious leaders need special attention and need to be fully mobilized and involved in the CDTI programme. t. t* I E l1 WHO/APOC, 24 November 2004 q() BO6l 8e5H EY ,9trd OE qt L}oa z ooilr le (D bD6t a C)q o) E \o o\\O O o o o \o o\\ sn6t sr- o E r.g * i EEEzg, ol O o o o st c.) o\ o oa(.) o oE z le + F te ll6 m 6t F. \n coN \o (n c.| F-o\ o$ r-\o o$ c{ r-€ o(.}$ \o \oN\n €N € N EE 9o EE .9U N O o o $ co o\ re a a aQ Q) 6l 2 ca c.l6l \o ( ca, F- o\ .t F-\o .+N F.oo tr)$ r* \o co c-l(n o\ € N a oO oo O 6 6l o (D E c oI ! 0o ot) 6l 0q) o l.) o o! z oo ll * IQla le o E&6l Q)o q) Er o O O O o o O o O o le #aEr i EE HEtr:!A 23Ea o o o le sfi.E H -Etr:'lI z 3.ii E€ E cA @ N @ F- r-t cnlr) <f cO o\ ca N $ \oN 6€o\ I rl a 'tr o G,v o)cl pa o li o bI) o ca oN(r, L.fil c0 B a (rl(, () € CI o G,t) a bo z (d Bo 6 FA oHoF :E, cl 6l F (Oooci Lo -o o o zt .l o o B c{ -:. B4 uq) -S V) oLp s \ q) V2 q) 0*v FaO (D r!€Lo.=EtrLa)o'E -*o'6 -HLfil a.o ..'n --= -, =4,EH -eEXo-(, :. +sl$i fll.t-i L : L f' {- Comment on: - Attendance offemale members of the communigt at health education meetings: Female members of communities in the state do not attend meetings when their male counterparts are in attendance due to cultural and haditional barriers. - In general, how do you rate the participation offemale members of the community meetings when CDTI isszes are being discusses (attendance, participation in the discussion etc). The attendance of female members is poor due to reason given above. - Incentives provided by communities for the CDDs. Incentive provided by the communities is very low. The Health facility staff have mobilized the CDDs to make more sacrifice for CDTI as their reward will come later either from God or the community. Most of the community leaders were sensitized not rely on this but to motivate the CDDs either in cash or in kind. - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Yes attrition is a problem in the project but selection and training of additional CDDs and sensitization of communities to support the CDDs is expected to address CDD athition. Other isszes f. L r" l3 WHO/APOC, 24 November 2003 {- 2.5. Gapacityl building - Describe the adequacy of available knowledgeable manpob'er at all levels. There is availability of knowledgeable manpower at all levels of the project. The project has conducted the series of training and re-training as follows: - Training of 44 LOCTs, four from each LGA, 292 Health Facility Staffs, and 2,828 CDDs. However, more CDDs need to be fiained in order to reduce the CDD/population ratio and curb attrition. - lVhere frequent transfers oftrained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough lorcwledgeable manpower was available or if staff arefrequently transfened during the course of the campaign). The project intends to train all the health facility staff in the entire CDTI LGAs so that when ever transfer is made a CDTI knowledgeable personnel will take over. i; t- tr t- ' .} r- t4 WHO/APOC, 24 November 2003 osN (.) co F-oN r- € r-6 O st o s \oo ca \o .:. \or-N \o N ra o ra GT € ol €N \o ?n\o N\o hd tnd E,j8 tr *o o rat(O N c.l O\o o :, o $ : r- F- o\ Nrr N o\t o$ : o t--\o cO o{ $\f o$ O$ o*(q oos O .+ ca otc(.) oootr) a() o (D C,) s !c o\Eq) 6t 0 e oQ o c)E E z Q ?F o$ cO os $(.l o$ c.t o$ Uo< ?ilQ6-=+ I. ev q) q) q) I \c o 0 q) .=cdFrL_^ lFr €): .oE rtr(l)H z o? o\ o\ o cO : o(O *(\.l $ot C..l al c'.lN o o\ o\ aa} c.t ao(\l o o\ co o\ a.t N a.l o o \o co \o .o c.l(\l c.l C.t o r- c{) r- I GI o\cl F. ra ra(.) OI o d oF +U U*.( t q) 8ts l5 .rEES 4C q)(J QF ra) ra\o \oF. Eo o q) s .if $ o $ * t o $ t s <f s $ $ $ s s s O $$ s e.t c{ (; U EJ3 rS q * * s O $ s .f $ s $ s $ $ t $ s $ $ $s tr c o0 I Fl3zo() l, '= o 0)! z (JF s o)6 la o o@o la oNd(, o dti d o o!d() 6 bo z 6 Bo do F. o F L'6 F Fl F oF oo q) €) o I \c J g q a o 6J c-) o c..l (') -o c) oz lf c.l o o- sIJ Ji = l-l Fr () (h() oL L q) 6l C)tr 6l q) o B 6lq Xq) c)(n 6lo e e) clL o q) (h()q) GI o ta)L o) GI Lr Lq) o bo .s oq t 3 t s i. t E o bo E dl. { s\ 6s o \ E 4V) qJ() q) \- % =p \)L q)4 \3q) U o cd o Eo o. F oU (H o a C) c) c)}{ -(.)I € C) (o o0tr ftlLF .iir orl -ol(Bt FI il Table 6: Tlpe of training undertaken (Tick the boxes where specific trainingwas carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1. Treetmentfigures - If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Full geographic coverage and a minimum of 650/o therapeutic coverage were not achieved due to: t Inadequate mobilization by health workers a Poor supervision of the distribution process due to inadequate funding o Inadequate censes update, and late reporting of insufficiency of Mectizan tablets. Census update has been done in all the 11 CDTI LGAs and arrangement has been made to order enough mectizan tablets to cover the eligible population in the State by 2007 . There are plans to conduct management training for SOCTs and LOCTs that will address roles and responsibilities, supervision and Mectizan management. More health workers are intended to be trained and involved in the CDTI process. Already UNICEF has expressed willingness to support these management training, and the involvement of more health workers. Major focus will be paid to Tafawa Balewa, Ningi and Bogoro LGAs. d- 1" f- Trainees Type of taining CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Managemurt ofSAEs CSM SHM Data collection Data analysis Report writing Others (specifu) 16 WHO/APOC, 24 November 2003 ! a€E EH€gIEgz tE & o o o O a o O o o a o 9r!t<to AO o a O o a o o o o a oEbc3trEB)9zd O \o o ooco c.) o a co o rr F-N rr1oN Ee'Eg o o o a o o a o o o o il a o '5o , bI) O da *bs ooIi oF o --EIE EBE z iEB ,=.rdH E9 = o tr(, *f €:o-:oE = ct -oF t-- \l\o @N t--\o r-\r) st-- o\t'- (\l$ cncn r- c-\o raro c.t ''I\o$ \o\o c.l ra c.) cO .+ \o\n \o$ o^ 6 c.) N o\ co N oo o. Nt'r cO o\ oi \n(\lq o\ c.l F-t- $\a t--N r- o\ o\ o\ct oo € ?a oN\o o\\o €t $t- (.ils o.l t-r\o- (..l\o r- * ,.I \o$ (-.l t-- rt} \o$ cA\n\$\o o o\t,I c.) ra) o\F-dI a\o l,.) C.l @ co r.- c-\o oo rn oo- t t?)@6 6N o\ c.t c{ \o\o €o n^ crl\n c.tlat\o € o\ $ €VI \o(r) $ q oo\o rr oo o. r- o\ rat o r*\o o oo 0a r- \ r- .f, a.t\o N c.lt-- F- co o\ o\ ca o\t o o\N o\ al oo I >9,3q o= x d EEFEE E '= Eo Ebsbba-83(, tsE.-s.ts U! .8 E SH 5 E'5 rrzd o =oEHE EE5 o o o oo o oo o oa m cO ao oo t\o\ c.l co c{ @ t-- r-$ cO ot co o\ c.) $ .f, \oN 6 o\ c.l € o.l @r- t--$ co(.) $ caa o\ cO c\ o$ \o(.l €€ o\ t) €N 00r- r-t to o\t CNo o\ co N $ \ool €€o\ .9<fivA< L 0) G!}1 () d cq oHo oo o FA oNdr cl o (B B) () c)6(o(, )(l o bo z d B c) GI ca t- oIoF :a cl F rl H oF soo N H(l) -o E 6.) oz$ c..t t,op< o :E B {q)\B!\t\ sI \) $'\ ${ s 3 ,\ S €\$' .s U)\t\t q) B, q q)\) €\B{i q) aq)\ U) u) a t) \) .tti q d{ q) la aB\\ a) B\)\ q) I 14 S 3t)\\g\\\s\o -\ $h\aq)$q) .S q)L o t B U2 q)g JIA Lr d an cl C)lr cl cl tr n o L o .o >.p U)H a (o 0) tr (, C)H t< :t -olGllFI r\ yQ ra) ra) il o x oo co ooi\o q.) dl< C) bI) GIl.r(.) o(.) o) o)& GIk C) H t ( + ( I ( + t ( ( I ,l ( I( IJ l- { t- t- lt .+oO(\.l C) .o C:) oz$cl oA. d 'J-;> oo \ i .ti 'ts 53\s$s .tr{ ool It1 .ss .s3E :RI .'il s\ EEi E riQ lt!; lra\jQqrt !CTSBE\Xt :iN SEs 'i9v .F a tt!E s*l .S.r E {! .9 ?sE \\t ,s ntF r$$ Es E Ei .s EEP s'$E sE u S{$$s E ES _$ sg s :Y ,$:lsE .S:s l{BE E,!o ol+s sIl.r t\ Eo rr ttSP FS\ .qi olol E'a aKc\ o\\o €o o o(! oF D rO 6\ -o6\ t-* \O \o6\ 6\ c..l t-rO\ \O ilil olol HI at 5lgYl co o\ #IE 3K o v'6I o\O\ \Ooo\ct o\N (.) (dE (D oo G,bsaGlOlOq ho !! ^ cd'^ ':s.bsE-6-i:o bD (I)F o\ l- L. l.r r- 2.6.2 What are the causes of absenteeism? The causes of absenteeism are because of the following reasons: r The nomadic Fulanis are not always available for teatrnent as they migrate in search of greener pastures for their flocks I Some of the Community members especially the youth move to the towns for Okada (commercial motorcycling) during treatnent. I Some of the eligible girls and women got married and relocate to other communities. o Inadequate mobilization of communities Solutions: t Arrangement is on to treat the nomads during the rainy season, when they are around. o The LGAs have been urged to make proper arrangement with the traditional rulers and the cDDs of communities to ensure adequate mobilization of members. 2.6.3 What are the reasons for refusals? No case of refusals was reported 2.6.4 Briefly describe all known and verilied serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ i- 19 WHO/APOC, 24 November 2004 D $ooN C) -o o oz$N Oop. o 6l q) Bs. q) *s o' L\) -a B\$) a-a * 1\t^l q taq)() q) S ? oLp o N q) V') q) E Eo l.or o0 }rog o l-< C) bI) L{ € € o) E)ooo (!I (A rq U) 6 (D o q)(h lro €(!t t) o liq) rr)(H cr)o an ctO ciir 0)l -ol(dt FI L a 66EE"o= olliq <.E b Aa PHg .EES6roi,a:E c E 3:x 6.=ILIoo o a oc h0 o o.o c) troo ao I t o On €T o,O^ +Ja =d.9 uOE tr&9d ! Eq6 o.2 ECo E tr== E#,EgE - ( .A -D r.a O-E! 6= >,voGle o = ()= H -E s'5O H.E,E Lt- a\ € - 9 4! EEEEg ! YH A , \ Eo o (n \lt d ( ) , D s\ ! (.) 6loo o.(! q tr ;o oI dts l)a \ ) C) .Y(, o(!i (l N (){)()d a I C) ) o oo0c 6'F =o0>b 1I xoa b0(c> z(t) * a) uo P Es -o U \o € t\a € \oro v1 (r) r $\o o\\o r-\o lt ti II ri ts *H - E EH EE€€E' d. Eso Ex o. o 'Eo 3DOO 6^ * b.s ooEoF EE$ opH. F O6\ -o o qB o6 .o ot,9_aHI zB a @ N nN m N\ o\ N\o t-.- c.l .j o 00 n c.l (a ol 6lN Nq t-- o t--\o ctl € \o9rrN q ol oo N $q $ ra) q \o(-- .t\ CA € c.l o\\ \o (--\o \a c.l ra € o rn ao\a oo\o oo 6 o\t oovI cor- cO@ \O^ $ cO c.t rr t--\o^ oo\o$ r-o o ( o t- o\ ra r* cO -1: c.t$\o @ c.) N\o o\ocl r- s o\ c{ r* $ Olo .l r- $ o\aN t-- s o\ C\l c- $ o\o c{ r- s o\o c\l r- s \n\o("I \o @ c- \o\.)\o. r- ca\o cn oo o\ €N o\ r- o\ o" o\o\o a- 01o o\o\o r- 01 o\o\o t- o\ o\o\o cr o\a o\ \o t-- o\ o- o\o\o \os \i\o o\ rat q t--@ o\ \o$ \o\o o\ o o\c\ o\ c.l 0) o0(l () c a EoU oo I El e il He$s< e- o ao o o o oo o a oo No\ EOy ool)= FE EE'5tOoli o o o oo oo oo oo a Oo No\ rd o5q? EEE"Et E= II EQ J: >Oo ca c.)\o c.t c.l\o co co\o co rr)\o ca cO\o ro CO\o c.) cn\o cO cn\o co ao\o ooo o\ f.lEEB c.) c.l\o c.) c.)\o c.) cO\o cn co\o c.l ca\o co cO\o c.) cn\o cO CN\o co cO\o 6@ o\ Dt)d =q _r6q>xo f B€ *H =.E c €.E rJ:5 c'- O t: T E 6 E€ EO oo cA CO\o cO(.)\o co cO\o cO co\o c.) cO\o co cO\o c.) c.t\o cO cO\o cr) cn\o 00 € o\ & ral c- o\ o\ @ o\ o\ o\ o\ o\ o aN N c\l oN cOooC\ -fooN \n 6l \o c{ t-- oN oo o c{ o\ c\ O oC\ sOON G) -o E G) oz +N U o- o = -ah H o .lI s '-o -clI Q) a0 6lkq) aoI Itrp - -RI S^'EB €:\E .\ .= sE\Efr A\ 6)8SIi.s EEB3Y:sr, .glFIErj t! u, .l I.T €9 =90)EH3A+)6)9le.9Il .=o'lEil .gelo.=t5E qx-qooI.I 9NQXq\Et I L0)l : al :'i6,51 gE.EI ; 6)ol .-E>l g()sl O. +.O0:HSE :(.)L H8:EEE!HdDO6 vt,cEtro+.otro)iEH '0)q)dts.eSdr :ol t, =l GlH.eFl t( 6l I {- a q 2.7. Ordering, storage and delivery of ivermectln Mectizan@ MOII Other Mectizan@ de MOH for by WH - Qtlease otr tick the appropriate answer) t]NICEil NGDC] NGDC specifu): by - Qtlease tick the appropriate answer)WHOI T]NICEil t Other speciff): Please describe how Mectizaz@ rb ordered and how it gets to the communities The State applies and submits its request to the National Onchocerciasis Control Programme (NOCP) through the Zonal Oncho Control Office at Bauchi. When the drugs are ready the State collect their consignment from the National Headquarters in Lagos' Sometimes, theZonal office assists in collecting the drug. When the drugs arrive formal notification is made to the Honourable Commissioner for Health who gives the final approval for the drugs to be distributed. When approval is obtained from the Ministry the LGAs (endemic) are informed through the department for LGA and Chieftaincy affairs. The LGA Coordinators collect their consignments from the State office and make their distribution to the health facilities after getting approval from the LGA Chairmen. The community directed distributors (CDDs) collect their drugs from the health facilities down to the community leaders who gave final approval for the distribution of mectizan tablets to the community. Table l0: Mectizan@ Inventory (Please add more rows if necessary) al t- l' tr t! 22 WHO/APOC, 24 November 2004 ILGA Number of Mectizanre tablets Numbe rin stock Requeste d Received Used Used/ Person treated Lost Wasted Expire d Remainin c ALKALERI 200,000 150,000 149,989 +6;5t5 0 ll 0 BAUCHI 100,000 70,000 69,994 33,366 0 6 0 BOGORO 200,000 160,000 159,544 s*{18 0 0 0 DARAZO 200,000 100,000 99,813 3i$046 0 8 0 DASS * 40,000 40,000 39,650 3o;3So 0 l0 0 GANruWA 250,000 I10,000 109,826 3eJfl 0 4 0 GAMAWA * 50,000 50,000 49,914 20;255 0 t2 0 GIADE 250,000 200,000 196,022 7id82 0 0 0 ITAS/GADAU * 50,000 50,000 50,000 18,397 0 0 0 +_ JAI4A'AITF * 40,000 40,000 50,000 t7sst 0 0 0 KIRFI * 40,000 40,000 39,986 4.,rJ98 0 24 0 MISAU 250,000 200,000 198,876 sz;e13 0 1l 0 NINGI 200,000 150,000 I15,783 29;925 0 l0 0 SHIRA * 50,000 50,000 49,998 19,178 0 2 0 T/BALEWA 250,000 120,000 I19,984 54,177 0 l6 0 TORO 300,000 263,000 262,929 97,271 0 20 0 WARII 250,000 203,000 202,901 100,299 0 2l 0 ZAKI* 50,000 50,000 49,999 19,065 0 I 0 TOTAL 2,690,000 2,046,000 2,045,844 786,632 0 1s6 0 * LGAs where passive treatments are on. - How are the remaining ivermectin tablets collected and where are they kept? If there are any remaining tablets, they are retrieved by FLHF staff and handed over to LGA Coordinators for onward transmission to the State. List and briefly describe the activities under ivermectin delivery that are being cunied out by health care personnel in the proiect area r Request for Mectizan . Collection of Mectizan . Delivery of Mectizan to lower levels . Storage & management of Mectizan {- t- Any other comments 23 WHO/APOC, 24 November 2004 2.8. Gommunityl self-monltoring and Stakeholdens Meetlng Has any training (of trainers) for community self-monitoring had been done in the project area? Non has been done. lf so, When? Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) CSM and SHM not conducted during period of reporting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. N/A l- i- District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSfvD No of Communities that conducted stakeholders meeting (SIIM) TOTAL !' 24 WHO/APOC, 24 November 2004 { 2.9. Supervlslon 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? The main problems identified during the supervision exercise include the following : a. Improper record keeping at the LG, Health facility and Community levels. Some Health facility staff were not keeping the copy of reports they send to the LGA. b. Inadequate counterpart funding by LGAs. Only a few LGAs pay minimal counterpart funding to take care of fueling of the motorcycles and allowances for the LOCTs. c. Most communities do not compensate their CDDs either in cash or in kind but the CDDs have managed to continue with the job. l- NOCP Zonal Ollice Coordinator SOCTs LOCTS Health Facility Stalf CDDs/Communities 1: 25 WHO/APOC, 24 November 2004 {- t+ t- d. Some health facility in-charges are not committed to supervision of CDDs during distribution. As a result many minor problems which occur during distribufion are left unattended to. These health staffs complain of lack of logistic support. 2.9.3. Was a supervision checklist used? Normal supervisory checklist is used at the State level, but at the LGAs level some LOCTs are not using the checklist. The State have simplified another checklist and distributed it to all the endemic LGAs and asked the LGAs to reproduce them for further use. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? r The LGA Chairman have pledge their support to the programme, but the issue now is that most of the LGAs are facing financial crunch. However, plans are in place for the department for LGA administration to deduct from source LGAs contribution for CDTI activities. o 29Zhealth facility staff have been trained on various CDTI activities and an additional 527 are to be trained by 2007. o Most of the communities have been mobilized on the issue of CDD incentives. The LGAs of Ningi and Warji have been giving minimal incentives to CDDs during distribution. 2.9.4. Was feedback given to the person or groups supervised? Feed back was given to persons supervised and their attention drawn to areas where action need be taken by them. 2.9.6. How was the feedback used to improve the overall performance of the project? o Assurances given by Chairmen of LGAs on support of CDTI activities in their areas have boosted the moral of LOCTs and FLHFs leading to improved performance. r Many communities have promised to look into the issue of incentives to their CDDs during distribution. Some LGAs have even begun minimal support to CDDs during distribution. o LOCTs have been able to follow up on health facility staff that appear not to be committed to the programme. SEGTION 3: Support to GDTI 3.{. Equlpment Table 12: Status of equipment (Please add more rows if necessary) Lr t- tr Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle 1 Functi onal I functio nal 2. Motor cycle(s) 13 Non functio nal I functio nal 3. Computer(s) 1 functio !! 26 WHO/APOC, 24 November 2004 nal 4. Printer(s) I Non functio nal 5. Photocopier (s) I functio nal 6. Fax Machine(s) I functio nal 7. Others a) Tv I functio nal b) vcR I Non functio nal c) Video camera 1 Non functio nal *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? It is the expectation of the project, and this is contained in the plan submiued and incorporated in the health budget, that funds will be made available by the State to maintain existing equipment and other materials. Though not much was released in the year reported, efforts will be intensified to convince government to release counterpart funds for maintenance of project equipment and purchase of various materials. At the LGA level, some LGAs are releasing minimal funds to the Oncho Coordinator for the maintenance and fueling of their motorcycles. In the meantime, the project has requested APOC to provide replacements for most of the old equipments supplied. i- L {r -f 27 WHO/APOC, 24 November 2004 !.2. Financlal contrlbutions of the partners and communitles Table 13: Financial contributions by all partners for the last three years - If there are problems with release of counterpart funds, how were they addressed? Continuous advocacy is on at policy makers to ensure release of counterpart funds Additional comments a. There are some LGAs that are paying their CDDs and these include Ningi, Warji and Kirfi LGAs but they didn't reflect the exact amount paid by their respective LGAs to the CDDs. Also the State Government have made some little contribution for repairing the Unicef donated vehicle and fueling. b. Most of the communities compensate their CDDs in kind but the problem is that it is not regular. Some of the CDDs who got special admission into School of Health Technology were given special consideration by their LGAs. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any)! Farm cultivation for the CDDs. r CDD exemption from community tax. . Provision of CDD training venue. . Donation of foodstuff to CDDs . Prayers & well-wishes for CDDs t. t- J? Contributor Yerr 2 ('provide the period') Yeer 3 ('Januarv - December 2005) Yeer 4 ('January - December 2006) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted (us$) TOTAL CASH Released (us$) MOH (Central + ProvinciaUState) 40,000 0 40,000 2,000 40,000 800 MOH (District/LGA) 40,000 3,000 40,000 8,757.89 Local NGDO(s) ( if any) NGDO partner(s) Others a) b) APOC Trust Fund 82,640 30,000 '74,454 39,849.8 0 TOTAL 162,640 35,000 154,454 49,407.6 9 28 WHO/APOC, 24 November 2004 !.4. Expenditure per actlviQl Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here Table 14: Indicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; lndependent partlcipatory monitoringl Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners i L L I= Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central community collection point of 800 State Mobilization and health education of communities of CDDs of health staff at all levels 7486.16 APOC Supervising CDDs and distribution 8,757.89 LGA Internal monitoring of CDTI activities visits to health and authorities 5739.t3 3,747.03 APOC APOC IEC materials forms for treatment v_e_lrjctesl\{qt_ol9y_cl_9{_!,ig"y_qlgq"}ei11!q"f l_"q Office Equipment (e.g computers, printers etc) 3788.66 APOC Others TOTAL 30,318.87 Total number of persons treated 620,138 { 29 WHO/APOC, 24 November 2004 4.1.2. What were the recommendations? i. Increase advocacy for the release of counterpart funds at State and LGA levels. The National Coordinator need to attend the meeting of LGA Chairmen in October to sensitize then on CDTI. ln addition, NOCP should forward a corespondence to the Ministry of Local Government & Chieftaincy Affairs on the need for counterpart contributions by the LGAs and the role of NGDOs in the treatment programme. ii. The LGAs plans of action are to be forwarded to the Ministry of Local Govemment & Chieftaincy Affairs for endorsement and possible distribution to the LGAs. iii. State should conclude and validate its census update and forward results to NOCP latestby 30n of November 2006. iv. To enhance community mobilization the State is to identifu and forward list of credible CBOs to UNICEF by 30th October 2006. v. NOCP should assist the State develop a supervisory checklist for use at LGA level. vi. NOCP should make available standardizedMectizan inventory formats to the State. vii. Quarterly progress reports are to be prepared and submitted by every level. viii. Communities are to be sensitizedto select more CDDs. ix. Project should retrain CDTI personnel at all levels on record keeping/data management and census update. In addition, FLtm staff are to be retrained on proper management of side reactions. To ensure quality of training, the zonal office is to be involved in the training sessions. x. New CDTI LGAs are to be provided with motorcycles. xi. Toro LGA should make request for and collect remaining number of tablets needed before end of October to ensure adequate coverage of the area. If Mectizan tablets at the State level prove to be insufficient the State should make arrangements to collect additional from NOCP. xii. NOCP should step up action to ensure quick recovery of the project vehicle. 4.1.3. How have they been implemented? o Work plan for 2007 has been drawn and submitted by the Project. a FLHFS and CDDs were re-trained on proper record keeping, mectizan distribution and management of adverse reaction r The UNICEF Consultant and National Coordinator NOCP did advocacy to the State policy makers for support for the programme and there was assurance from the government representative that provision for direct oncho support will be made in the 2007 budget. A similar visit was made to the Permanent Secretary, departrnent for local government administration, who gave assurance that LGA Chairmen will be made to commit certain amounts towards support of CDTI to be deducted at source. o Communities have been sensitizpd to select more CDDs and support them. t Some CBOs were identified'and mobilized to support CDTI activities in the State and have shown their willingness to participate in the progmmme o The Hon. Commissioner, Permanent Secretary, Director PHC/DC and State Project Coordinator conducted advocacy visit to the CDTI LGAs. I The project vehicle used by the security men has been retrieved o 64,000 additional tablets were given to Toro LGA to complete treatrnent o A standardized Mectizan inventory format has been provided to the State. r Other issues such as quality and targeted training of health workers as well as improved census update and mobilization of more NGOs are expected to be taken on by 2007 with support from IJNICEF. t- !' L +E 30 WHO/APOC, 24 November 2004 {, 4.2. Sustalnabllity of profects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Na Was a sustainability plan written?_ Yes When was the sustainability plan submitted? 2004 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4,2.1. Planning at all relevant levels Sustainability plans have been prepared jointly with all stakeholders from all the LGAs and the State. This plan is being followed up to ensure annual incorporation into the yearly approved estimates. The most buming problem is not the planning but the execution of the planned activities, with little or no funding available. With the coming of new policy makers next year alrangement have been make to mobilize and sensitize them over the ownership of the programme. 4.2.2. Funds The State Ministry of Health and LGAs are expected to be the financer of the programme through the payment of staff salaries, logistic support, training and other CDTI components like advocacy and mobilization of the affected LGAs and communities. This is yet to take place. Advocacy is on and a high-level advocacy is being planned after the 2OO7 general elections. In the meantime UNICEF has indicated that it will be more supportive in the next two years. 4.2.3 Transport(replacementandmaintenance) The State Government is fully aware of the capital equipment donated to itby APOC, which includes vehicles, motorcycles and other logistic support. The State Ministry of Health is expected to take over the equipment and maintain them from counterpart funds. same is expected at the LGA level. Unfortunately the level of support for maintenance of motorcycles has been very low. With the proposed deduction of counterpart funds at source the situation will improve. In the meantime, APOC is being requested to replace the equipment given earlier and to provide motorcycles to the five new CDTI LGAs for effective running of the programme. 4.2.4. Other resources There are now 22 CBOs and NGOs identified across the State. There is now an effort to mobilize and sensitize these organizations to support CDTI in their respective domain. 4.2.5, To what extent has the plan been implemented The sustainability plan is being integrated into the State primary health care development plan. l_ I L f- L F{ 31 WHO/APOC, 24 November 2004 4.3. lntegratlon Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms All of the Health facility staff involved in the CDTI programme are PHC staff and apart from CDTI programme they are running other PHC components like immunizatton, health education and antenatal care. When they are collecting other materials/vaccines, they also collect Mectizan if available. At the LGA level other programme officers like the malaria Conhol Officer, Leprosy Conhol Officers and other staff take mectizan with them during their supervision to the health facility at the community level. 4.3.2. Training At the state level the SOCTs were trained on various components of PHC and are participating in the NPI exercise some as consultants, supervisors and other as; independent monitors. At the LGA and health facility levels LOCTs and FLHFS are involved in all training activities for the various PHC programmes. Likewise CDDs are hained as guides or vaccinators during most of the immunization campaigns in many LGAs. 4.3.3. Joint supervision and monitoring with other programs Presently there is no joint supervision with other programmes, and there are no plans for this at the State level. At the LGA level, occasionally when LOCTs are on other PHC assignments like routine immunization they check on CDTI matters. The conscientious health workers at the FLHF level integrate a lot of their activities in visits to the communities. 4.3.4. Release of funds for project activities CDTI support funds are being released along with other PHC support funds. Another way of fund release envisaged is through the department for Local Government and Chieftaincy Affairs, whereby the department mandate all the LGA to pay for the counterpart fund or carry out some activities when requested by the State CDTI project. The Deparftnent for LGA is vested with the responsibility of supervising the LGAs activities. 4.3.5. Is CDTI included in the PHC budget? CDTI or Oncho control programme is included in the PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Presently there is no prograrnme that is using the CDTI structure, but plans are underway to use the CDTI structure for some components of the Malaria Control Programme. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operatlonal research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period None was carried out during the reporting period 4.4.2. How were the results applied in the project? t- {. {.' t- E* ti. !* 32 WHO/APOC, 24 November 2004 E ISEGTION 5: Strengths, weaknesses, challengGsr and opportunities STRENGTHS: o Wide acceptance of the Mectizan tablets by community members. The only problem faced is the fact that the LGAs apply for the Mectizan without properly taking the census of the endemic communities and what they received failed short of their needs. o Availability of tained personnel. The project has trained more than 68%o of the health facilities at the l1 endemic LGAs, the remaining32% will be trained next year in order to solve the issue of frequent transfer of health facility staff from one area to another. All the 44 local oncho team members from the I I endemic LGAs have been hained at the state level. . Increased number of CDDs which has helped reduce the workload per CDD. Though CDD/population ratio is still low there has been a dramatic increase in number of CDDs for this year. t Increasing involvement of the frontline health facility staff in the CDTI process. r Participation of some female NGOs in mobilization of communities. r CDDs are committed to CDTI activities even in the face of lack of incentives WEAKNESSES: i Poor counterpart funding by all tiers of government o Delay in report submission by the LGAs r Inadequate mobilization of communities t Inadequate supervision particulatly atthe lower levels r Inadequate understanding of communities of their roles under CDTI, particularly in the newly added LGAs. CHALLENGES AND HOW TIIEY ARE OVERCOME: - Lack of adequate census update. A state level management meeting for SOCT and LOCTs is being planned for early 2007 to address this and other gendarme issues. A data collection exercise supported by APoc Management is being initiated. - Low CDD/population ratio. Communities are being sensitized to select more CDDs. LINICEF intends to complement whatever APOC will provide in 2007 for CDD haining to reduce the ratio. - The programme is facing a serious problem of logistic support at the LGA level. The APOC donated motorcycles in the six endemic areas are almost grounded. Only one out of the available six is repairable. Five LGAs newly co-opted in to the programme this year have no motorcycles. Programme officers liaise with other PHC programmes for their supervision and conduct of other CDTI activities. - Inadequate community support for CDDs. They are being sensitized to provide incentives. Some LGAs have taken it upon themselves to give financial incentives to their CDDs. The CDDs on the other hand are being encouraged to do the work willingly despite the apparent lack of incentives. a SEGTION 6: matters Unique features of the proiecUother r I 1 L L I tE 33 WHO/APOC, 24 November 2004