Gombe State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): 1st January 2005 to 31st December 2005

GOMBE STATE C.D.T.I. PROJECT. ORIGINAL: English I t ,i .ftt t1 t \tz For Actcn Tol .. .'t5 ftv .BrH ,'.,i ,10(' ri lr- ,'rrt ti{tl U f 'l a ft 0 I ilj'N 200i for brlormdott To,$R. AO 'AAJIL;i, tt -d.'Are COUNTRYAIOTF: NIGERIA Proiect Name: NOTF/APOC- WHO CDTI PROJECT GOMBE STATE. Approval yeat: December 1999 Launchins vear: March 2000 R.portios P".iod (Morth/Y""r): lsr January - 31't December 2005 Proiectvearofthisreport: (circleone)1 2 3 4 (5) 67 8 9 10 Date Re- submitted: January 2007. NGDO nartner: UNICEF. WT{C)/APOC ?4 Nowemher ?0O4 I I I I I t 1 II ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FO SUBMI SION:S To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) t 2 WHO/APOC, 24 November 2004 aANNUAL 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: P. O PEARCE (MRS). Signatwe: . (-.*: L' Zonal Oncho Coordinator Name: P. O PEARCE (MRS). Signature Date :o tIr.s-la] This report has been prepared by Narne . HARUNA ALI D Designation State Coordinator: Signature Date Date: 3llo c,a- J WHO/APOC, 24 November 2004 aTable of contents ACROI{YMS.......... ........6 DEFrNITrONS......... -......7 FOLLOW UP ON TCC RECOMMENDATIONS.. .........8 EXECUTTVE SUMMARY ............10 SECTION 1: BACKGROUND INFORMATION....... ....'.'.""""""11 l.l. GENsner INFoRMATIoN............. '......'11 1.1.1 Descriptionoftheproiect(briefly) """""""11 1.1.2. Partnership """""""' '1'3 1.2. Poput euoN ..-....14 SECTION 2: IMPLEMENTATION OF CDTI....... ...."16 2.1. TI\GLtr{E oF ACTIvITIES............ .. ..-..16 2.2 Aovocecv . '..".....19 2.3. MOSTLZETION, SENSITIZATION AND FIEALTH EDUCATION OF AT RISK COMMUNITTES 20 2.4. CoIwIm-TITYINVoLVEMENT ..............-..21 2.5. Cepecttv BUILDING .......-.--.-..22 2.6. Tngem,mvrs............... ...-.24 2.6.1. Treatmentfigtffes........... ...-...--..24 2.6.2 What are the causes of absenteeism? ... ......27 2.6.3 What are the reasons.for refusals?................ ...............27 2.6.4 BrieJty describe all htown and verified serious adverse events (SAEI) thot....27 2.6.5. Trend of treatment achievement from CDTI prolect inceplion to the current year 28 2.7. Onopnxc, sToRAGEANDDELIVERYoFIVERMECTIN........ ..--..-....-.--......29 2.8. Corvnvtxtry sELF-MoMToRING auo SrnrrHoLDERS Mssrr{cEnnon! Booroanx NOT DEFINED. 2.9. SrppRvtstoN ..........31 2.9. 1 . Provide a -flow chart of supervision hierarchy. .. - -. .. ... -.. 3 22.9.2. What were the main issues identtfied during supervision?.....--- 33 2.9.3. Was a supentision checklist used? ....... What were the outcomes at each level of CDTI implementation supervision?.33 Wasfeedback given to the person or ttrottps supervised?......................'...'....-3-3 Hov'tt'cts the feedback used to improt'e the overall performance of the project? 34 SECTION 3: SUPPORT TO CDTI... ...35 2.9.1. 2.9.5. 2.9.6. 31 32 J.J 3.4 EQUIP}VffiNT FhIANCIAI CONTRIBUTIONS OF TI]E PARTNERS AND COMMUNITIES Oruer FoRMS oF coMMUMTY SIJPPoRT E>cpNotruRg pER ACTIVITy............. 35 36 36 36 SECTION 4: SUSTAINABILITY OF CDTI........ERROR! BOOKMARK NOT DEFINED 4.1. hmnNnq INDEPENDENTPARTICIPAToRY MoNIToRINc; EvaruerloN...... ...........37 1.1. 1 Was Monitoringievaluation cqrried out during the reporting period? (tick any of the following which are applicable) ........... ............37 4.1.2 Wat were the recommendalions? ........ 37 4.1.3. How have they been implemented? ............. .................38 4.2. SusreNesILITyoFrRoJECTS: PLANANDSETTARGETS(uaNoeroRYAT................38 Yn 3) ...................38 4.2.1. Planning at all relevant 1eve1s......... ............38 4 WHO/APOC, 24 November 2004 4.2.2. Funds. 4.2.3 4.2.4. .................... 38 4.3 1.2.5. To what extent has the plan been implemented-... I]vTEGRATION . Ivermectin delivery mechcmisms Transport (replacement and maintenance) - - Other resources.. 38 38 .......38 ERROR! BOOT<UANX NOT DEFIIYED. ......... Error! Bookmark not deJined. I 1.3.1 4.3.2. 4.3.3. defineil 1.3.4. 1.3.5. 4.s.6. Training Enor! Bookmark not defined Joint npervision and monitoring with other programs Error! Boohmark not Release offundsfor project activities....-............8rror! Bookmark not iletined Is CDTI included in the PHC budget?...........--. -..-...""'39 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievemenlsZ.'.'......... 4.3.7. Describe others issues considered in the integration of CDTL 4.4. OpERATIONAL RESEARCH. 1.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. Enor! Bookmark not deJined 1.1.2. How were the rexilts apptied in the project? .....Enor! Bookmark not deJined SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITMS .......40 SECTION 6: UNIQUE FEATURES OF TI{E PROJECT/OTHER MATT8RS............41 39 10 40 5 WHO/APOC. 24 November 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBD Community Based Distributor CBO Community-Based Organization CDD Community-Directed Distributor CBIT Community - based Ivermectin Treatment CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring GMC Gombe Media Corporation GSWC Gombe State Water Corporation LGA Local Government Area LOCT Local Onchocerciasis Control Team MLCCA Ministry for Local Government and Chieftaincy Affairs. MOA&NR Ministry of Agriculture & Natural Resources. MLGCA Ministry for Local Government and Chieftaincy Affairs. MOH Ministry of Health MWR&E Ministry of Water Resources & Environment NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care PHCC Primary health care Coordinator REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UBRBDA Upper Benue River Basin Development Authority LINICEF United Nations Children's Fund UTG ljltimate Treatment Goal WHO World Health Organization ZOTF Zonal Onchocerciasis Task Force. 6 WHO/APOC, 24 November 2004 Definitions (D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated x 84Yo 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 treat with Ivermectin in a given year. (i") Illtimate Treatment Goal (UTG): calculated as the maximum number of people to be treated arurually rn meso/hper endemic areas within the project are4 ultimately to be reached when the project has reached frrll geographic coverage (normally the project should Ue expiaea to reach the UTG at the end of the 3'd year ofthe project) (") Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("r) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: 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 communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (vur) SustamabrhW: CDTI activlties in an area are sustarnable when they continue to function effectively for the foreseeable future, wtth high ffeatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Communitv self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), *ith a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 7 WHO/APOC, 24 November 2004 FOLLOW UP Oil TGG RECOMTENDATTONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 19 8 Number of Recommenddio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 33 (a) 1. The project reported a geographic coverage of 82o/o, which was rather unsatisfactory for a project in its 4th year. Although the ATO had always been exceeded, therapeutic coverage was 67% for the reporting period, which was a decline from previous years'figures. This has been corrected as the geographical coverage in year 2004 is 100 o/o and therapeutic coverage is 750. (1) It was brought to the attention of TCC that the project had still not resubmitted its sustainability plan since the rejection of the last one Anothcr facilrtator- \\'as scnt (br N0CF) \\'h0 assrslcd us iti nrakrrrg thc necessarl' corrcctlons to the re.lcrrtcd plan bcfore il was resubmrtted. 5 2. TCC requested that the project provide more information on s(a) Clinic-based treatment Clinic-based treatment is only carried out in Gombe metropolis (the State capital) which is the only non- CDTI L.G.A. where diagnosed cases or those on treatment from other States (especially federal civil servants) are referred so) Outcomes of supervision used to improve implementation As a result of the supervision delays in the delivery of mectizan tablets from the L.G.A. fo the health facility and WHO/APOC, 24 November 2004 communitv were reduced to the barest minimum and community leaders are alway's made aw'are of the arrival of mectizan to their communities. s@ Absentees and refusals as these were not noted in table 8 In that year the absentees and refusals ivere left out bv the LOCTs ur their reports but these uere included in the subsequent rcWrt. ). 9 WHO/APOC. 24 November 2004 t Executive Summary Gombe State was carved out of the former Bauchi State on lst October 1996. It is made up of 11 LGAs, 10 of which are onchocerciasis endemic. Mectizan treatment started in the State since 1991 as part of the former Bauchi State. CDTI implementation started in 2000 and all the 10 endemic LGAs are incorporated. The State has a total population of 2,295,032 while the population of endemic communities in the 10 CDTI LGAs is 1,300,215. In the period under review a total of 95 I , I 52 persons were treated in 966 communities in the 10 CDTI LGAs. 568 persons were treated in Gombe LGA (clinic-based treatment). The UTG as well as the ATO for the year is 1,105,160. The performance this year (under review) is 100% geographical coverage, T3 %o Therapeutic coverage andgSYo of the UTG/ATO. Majority of the population of the endemic communities are peasant farmers who are always at home during the rainy season in order to cultivate their fannlands. In the dry season most of the youths in the rural areas move to various urban centers in the State and outside in search of white kola jobs. Similarly indigenes of other States troop into the State capital and down to the endemic communities for petty- trading and in search of white kola jobs and dry season farming. Towards the end of the rainy season, most of the cattle rearers travel down to the Southern part of the country in search of green pastures for their cattle and will not come back until the beginning of the next rainy season when green grass is available up north. Generally there is rural - urban migration where rural dwellers especially the youths, migrate to the urban centers for government employment or private enterprises. In the year under review only 2 types of trainings were carried out for 200 front line health facility staff and 27 Pnmary Health Care Coordinators and Assistant PHC Coordinators on integration of PHC programmes and sustainability of CDTI. 470 CDDs were trained in 6- selected LGAs (Nafada, Funakaye, Kaltungo, Shongom & Billiri) The ratio of CDDs to total population is about 1: 600. Community self-monitoring was virtually not carried out. The challenges faced by the project ranged from lack of approved budget from APOC for most of the year, zero funding from UNICEF and the LGAs and decreased funding from the State. These resulted in decreased commitment from health staff and paying attention to money - backed progranrmes like NPI, HIV AIDS, Roll Back Malaria etc. These challenges were overcome through sacrifice and reorientation of the health staff for change of attitude, and integration of PHC programmes. 10 WHO/APOC, 24 November 2004 t SEGTIOII { : Background information 1.1. General information 1.1.1 Description of the project (briefly) Gombe State was carved from the former Bauchi State on 1st October 1996.It is located in the northeast sub region of the country Nigeria. The State occupies a landmass of 17,048 square kilometers with an estimated population of 2.4 million. Gombe State shares a common boundary with Adamawa, Bauchi, Borno, Taraba and Yobe States. Topographically it consists of a plain land with undulating hills especially to the southern part. The entire State is drained by the Gongola river, which passes through almost the entire State emptying into the river Benue at Numan (Adamawa State). The climate is mostly sudan and sahel savannah with a little of guinea savannah to the south eastern part. The people are predominantly peasant farmers or petty traders and the major religion is Islam followed by Christianity. The major tribes are Hausa, Fulani, Kanuri, Tera, Tangale, Waja, Tula etc. 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 in the wet season. Motor boats and canoes are used for transportation in the 4 L,G.As where communities are bordering the Dadinkowa dam upstream. The health system consists of Primary, Secondary and Tertiary levels. The Primary Health Care facilities are at the L.G.A level where the maternity health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the L.G.A headquarters and tertiary is the referral hospital (Federal Medical Centre located in the State capital. The number of health staffin the L.G.As varies depending on the literacy level of the L.G.A. and some other factors. The number of health staffas well as the number of health facilities in the 10 CDTI L.G.As are as shown in the tables below :- a 11 \[run/APn/. ?/. ]rlnvam]rpr ,)OOd Table l: Number of health staffinvolved in CDTI (Please add more rows iJ necessary) LGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staffinvolved in CDTI B, Percentrge BrBzl B1 tl(X) Akko 118 40 34% Balanga 74 40 s4% Billiri 158 53 34% Dukku 119 35 29% Funakaye 50 29 s8% Kaltungo 53 37 70% Kwami 49 3l 63% Nafada 29 20 69% Shongom 75 32 43% YamaltuDeba 146 52 36% Total 871 369 42o/" Table 1a : showing the number of health facilities by L.G.A. in the CDTI area in Gombe State. SAIO. L.G.A. NO. OF HEALTII FACILITTES. 1 Akko 51 2 Balanga 28 J Billiri 64 4 Dukku 44 5 Funakaye 3l 6 Kaltungo 37 7 Kwami 35 8 Nafada 23 9 Shongom 29 10 YamaltuDeba 62 TOTAL 404 Does is it mean that some of the health facilities do not have trained personnel Yes becuuse some of the health.fircilities ilre not located in oncltocerciasis enclenic communities. 12 WHO/APOC, 24 November 2004 1.1.2. Partnership The partners involved in CDTI implementation include APOC, LINICEF, Federal Ministry of Health (NOCP), the State Ministry of HealtlU the l0 focal L.G.As and the endemic communities. UNICEF is the NGDO supporting the programme even before the advent of APOC. Other partners are the Ministry for Local Government and Chieftaincy Affairs (MLG&CA) the major link between the project and the 10 focal L.G.As. It is also involved in advocacy and mobilization of the L.G.A. policy makers as well as planning They play a very vital role in the release of counterpart funds by the 10 L.G.As. The media houses in the state are always ready to help whenever they are called upon. They are actively involved in mobilization as well as coverage of all our activities. The management of the Upper Benue River Basin Development Authority, Dadinkowa Area office, is a partner in vector control as well as mobilization and education of their staff on CDTI implementation. In the 10 CDTI L.G.As all the PHC Coordinators and the health facility staff are involved in all activities - supervision and monitoring, advocacy and mobilization. The policy makers are involved in advocacy and planning meetings. The community members are involved in all the activities carried out at the community level. Eftorts are being made by the Zonal Coordinator and the Ministry of Health to mobilize local NGOs and CBOs to assist in the implementation of the programme in the State. The table below summarizes the communities and populations covered by the programme. 13 WHO/APOC. 24 November 2004 lF.l tlo) .lgNlo. lr..r ^!() otEp- I3rtrsP.i =' -!6'o(o3 E) o. oio ED o O) r-t V) ,f o CD rt o rt o r! t,) p rt (D { (D (DFt (D g) r_t(D tst CDp (D or-t o- rt 0q o r.t (D oFt 0a o .t o + F.l o D tr !r U(D d t9 a o oco z D B p X{p XF9 oeo 19 D o U Ed E! EE Dp oe 19 o l^I r,U+Ad -. Y)'. )I E€ f sD==3 v?'+ *.a)aa+(+ '- E .\ (, ooN (rr o\\o -IoUi € UI o\5\0 o\ €{ €Ut b,J o hJ h,J(.) o\\o hJ -Ia UI o\o5 o\ b'J b,J \o()) 6 [.Jo{(/) \o hJ €\o E, eE Fl e d€ 3 -ts3.i= P;6' tD)P=. o\ b,J o\ s ())tJ u o\N) o\o A\) o\(j) o \o ='9+ap E'9 3 .6E ='iiD'.3 T ? r!=3d z (D n o .lo (D aa, p oa tD a, (}) UtI @ t.) u) \o N)(/t N)N) N)5 1..)5 5 Ulo\ N){ NOr!, lt6(< !l(!F:*it :E'd)!!oE -E B9.=g6' \o o\ o\ At.) {5 (j \)o\ @5 @5 { U5 (rro\ oo Fl r! B? d'a NQ. =<(! 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'3(,i @v +) Z. -V1 pDiS oo ; ttl6-o ^.o p- o- .5 o lr)o @ =' l-{AO, tsiitaS rE P PdE a)eE. 6J+ Ats.9. *@ =tf o- 0coiD -*-H.9 ='5 tD*<! +o'o (D3a Eol"F.> UHo E;9- 3 t(D H ,a- A3 I@.o 9r H:o o):1tr oaHE JD i+5B-g 6' - O- ;r'va9o-(! 'OEj 8. 1 E;^ O)'53 8 -. E.i nirx' 6 +aij.ds trEF g UH+ Qo d ;9 IE$ = --ruJ -(D l-r rt !Jto ='U-etDU 5'o' )c-€ *CFDfBA E +(D -A:=lSiL =.aq , ==s)5oq ia .@ E. (Dt- Do=o- o- '(D Ft(h + B o- + J(D 'd ,.1 oA 5- ot+ J(D ro ,.t €.(D o+ (,l E FU o ,o N)5 zo (D d tD ,.t tJ 5 o tSEGTION 2: lmplementation of GDTI 2.1. Timeline of activities The timeline for activities carried out during the reporting period is as shown in table 3 below: t6 WHO/APOC. 24 November 2004 !0 E tr t (! rg XI D' X te oq rTl o}(g) o *F E! tDI HI tt 7<o U Q" E! a F o ? AJH c) rk 54 0e ?6=oo ,NtrD o,tA^ 16 E o EI EI iE o oo od(} o C) od(D o r) o6ot ? D9H .) 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Y =.CDgj ^.ut ld 3-ud ,rE EE+5i;+)ta-N' -(D -Pis =.= o ='--t \-, A j = (ax tDx(D a A)o4J7,1 \u! >= \ D9+ ^ (9 aD ; r) -.-J^<V/-. v^lDEt =' 5: *= Ar -' ? € =-gL- = 6 L .aE)Vv-;.-(?; 4! 5'A L.l'st1 ?1o r 5i (Dx/ J' - rEa+C(D- :. ='lo !! = +)'/v).5(D-.D + o-6 -r J I . *1 6e ;(D - V Fx.ri^5o -X o-a, 1-at, +vl,= A ts J YC):ir] = 6; gY- ro eo 'iiA@ oi. = -^) -<' ;U;V ^(rt l+ U W ?P d '- d.i" q9 /l^o)ai A) ,..i + H IJF de- Ea tsa {T.J^?:tY=^<a)(E g-,, f 'J+:.iJ = +x- (D)riliCl s@;:(DL O) =-: (r) f;+fa 6P B tD o- ,,+ o { {H a to "c) N)5 zo (D d(D r-t N) 5 t a o E ,qo E z 19 D'd tc :x A=. ;4 +E!. 0r+ ad -3L2 OQ O ti-/ +)rla ,+< a!9 =,0 '6Jl- >r , -.1 C)o trb ad 6 a lD 6 @ I a Eo J) t..J5 zo(l do{ tJ 5 2.2. Advocacy At the beginning of the year there were advocacy visits by high-ranking officers of the Ministry of Health and the Ministry of Local Government to the policy makers of all the l0 CDTI L.G.As in order to solicit for their continuous support for the sustainability of the progranrme. At the community level, members of the State team together with LOCTs and health facility staff visited most of the communities in order to mobilize them for their continuous support and participation for the sustainability of the prograflrme. The number and category of policy makers and leaders mobilized is hereby summarized in the table below: - Table 4.Showing the number of policy makers and leaders mobilized by L.G.A. During the period under review a total of 494 policy / decision makers in the l0 CDTI LGAs have been mobilized. The objective for the mobilizations is to ensure continuous support to CDTI implementation through the timely release of counterpart funds and moral support. Nthough moral and material support are being rendered none of the L.G.As was able to release the usual one hundred and fifty-thousand naira counterpart contribution for the year. The major constraints in advocacy and mobilization are lack of funds for logistics and preparation and airing of radio and television discussions and jingles. Other problems are the frequent change of policy makers in the L.G.As; and the Chairmen / Secretaries are not easy to meet on seat. Proper timing of advocacy / mobilizations to be carried out through the Ministry for Local Government as soon as policy makers are changed and budgeting / release of enough funds to carter for mobilization activities are the proffered solutions. SAI L.G.A Communit y leaders PHC Superuiso ry Councilor PHC Coordinato r L.GA Chairman Secretary Treasurer 1 Akko 40 I I I I 0 2 Balanga 68 I 1 I 1 0 J Billiri 55 I I 1 1 0 4 Dukku 70 1 I 1 1 0 5 Funakaye JJ 1 1 I I 0 6 Kaltungo 62 I I I 1 0 7 Kwami 51 I I 1 I 0 8 Nafada 32 1 t 1 1 0 9 Shongom 3l 1 I 1 1 0 10 YamaltuD eba 52 I I I 1 0 Total 494 10 10 l0 10 0 t9 WHO/APOC, 24 November 2004 2.g. Mobilization, sensitization and health education of at risk communities The media houses in the State are always ready to cover all functions on CDTI implementation in the State. In the State capital their reporters are present while in the L.G.As information officers of the various L.G.As cover the functions/ actMties and send reports to the media houses for airing. The use of town criers and other local means is now reduced to local announcements in the villages as a result of the wide coverage of the State media houses. No IEC materials were produced due to lack of funds. Only a few samples of the old ones are posted at the venues of trainings or functions on CDTI. Mobilization, education and advocacy are carried out simultaneously at the beginning of the year at the L.G.A and community levels. At times mectizan consignments for the communities are also delivered. Due to the nature of the society where women groups are very rare and not easy to access in some parts of the State, efforts will be made to trace local NGOs and CBOs to access the womenfolk and mobilize them. (So in the meantime how are women in the communities mobilized?). They are mobilized when ever the opportunity exists as during training of health workers and advocacy visits to community leaders by outlining the important role of women in all PHC prorammes. The response of target communities is encouraging as they show their willingness to continue taking mectizan as long as it is available to them. They also narrate their wonderfi.rl experiences after taking mectizan. The major shortcoming is that most communities are still not able to compensate their CDDs. (The issue is - what are the constraints with regards to mobilization of the communities?) The major constraint is inadequate logistics because some of the motorcycles donated by APOC since year 2000 are broken down beyond repairs and availability of funds on time to enable the conduct of mobilisation and education early befor e commencing treatment. Mobilization and sensitization could be improved through the provision of new IEC materials and the involvement of CBOs and local NGOs in the programme. 20 WHO/APOC, 24 November 2004 a 2.4. Gommunity involvement Community involvement in CDTI activities is mainly through their selection of CDDs to distribute mectizan, stakeholders meeting and community self- monitoring. Some community leaders and few individuals try to supervise the CDDs during mectizan distribution and some even attend CDD trainings, Involvement of the communities in CDTI is hereby summarized in the table below. Table 4: Communities participation in the CDTI Akko alanga COMMENTS Attendance of females at community health education meetings is very rare particularly now that community self-monitoring is carried out only in a very few places in the entire CDTI area. The participation of females in most health activities is generally very low particularly in the northern part of the State. But now that other programmes like UNFPA, filV AIDS and Roll Back malaria are scouting for Local NGOs so that they can be empowered to assist, the participation of females in all health programmes including CDTI will improve. Provision of incentives to CDDs is rare and very negligible. Mectizan distribution is continuing because the CDDs are willing to continue in spite of their request for incentives CDD attrition is a serious problem because most of the CDDs are still young school leavers that have the ambition of leaving their communities to other places in quest of employment or studies. Young girls are married away from the village or to husbands that may not allow them to continue mectizan distribution. Efforts are being made in the selection of more elderly persons for training as CDDs because they have lower tendencies of leaving the community and demanding for incentives. Number of communities/villages with community members as supervisors Number of CDDs Number of communities /villages with female CDDs Total no. communities in the entire project area Ba Number with community members as supervisors Bs Percentage Be= Bs/ Br *100 Male CDDs B7 Female CDDs Bs Total Rf B/Bs Number of communities with female CDDs Bro Percentage Btt= Blo/B{.100 118 l7 140 321 48 389 20 17 r56 40 26Yo 352 63 4t5 43 40 Billiri 104 24 23% 307 57 364 25 24 Dukku 71 27 38% 224 23 247 l9 27 Funakaye 84 26 3r% 260 13 273 2t 26 Kaltungo 84 t5 lg06 238 92 330 43 15 Kwami 76 28 37Yo 226 22 248 t7 28 Nafada 5l t0 20o/o 202 l7 219 13 25 Shongom 74 2t 28% 201 76 277 22 2l YamaltuDeba 142 22 23% 299 67 366 4t 22 Total 966 230 24Yo 2650 478 3128 249 26 2l WHO/APOC, 24 November 2003 5. Gapacity building Manpower at the State level is quiet adequate. In most L.G.As the number of health staff involved in CDTI implementation is inadequate because most of those trained over the years are not actually participating in CDTI implementation. However, plans are being made for recruitment of more staffin those L.G.As lacking and the training of more health staffin all the L.G.As to guard against transfer of health staff The proposed number of CDDs could not be trained due to lack of funds. However the trainings carried out within the reporting period are hereby summarized in the table below: 22 WHO/APOC, 24 November 2004 UFx ,f Ed !o ID oa TD f ,(o a .) F o a o ,eo z !9 B l0 7{ ID !3 n FD d oao g !D ,( o) a! Ho 19 5 (J) o rl ts F 5 F s 5 5 5 (,J\o 5 ir ,! 6 8pd ^ll ti z - d(D Et o -:a ='H(Dar r{ o ar, o F';q (, (,) + 5 (.) 5 (, l..J t'.) +: F 5 (, 5 UJ (,) s a ET(! o t! -I [.JbJ (,J\o A o rlo\ o\ o\ o\ o\ o\ o\ o\ o\ -)o\ { () t.J o o II 'l sr o + o 6- o a4 <5 A@ t40 hc +Ep= oo \v (.) (! o o (.) o\ t\) o\ tr) (}J o\ 5 f'J 5 NJ (^) UJ o\ 5 tJ 5 N.J o\ 5 t.) o\ o\ 5 N.J O O O z to a, rtE'o?D ET(Do iq FlE o'i' (D 0 o rl 3 ilE .a : s ! \i\ s ag (D o (! o O O o o O O O O O O O'li36 (, Ut L.,I Ur (Jr (Jr Ur { (]) a (l) (rt O O o + o I H o Do ah *' *' SFr€ z r(D c o U U(a D oE \U a t! (! (D \J -l\o NJ 5{ O t, ca b-) f.J 5i 'l l ---.1 ;' lJr -I -T -_I -t(l) (Jl lFll!)ld ltDl* d, o{ 0a o +Ft F) !] oa o ts+) N) o (D o) or'o + t) D9 *1 t-ooFl(r) +{o o o r-1 o- c) o>t(o -o 0a(D (D r-1 N)p v)t) U) to cr) +o l o F)o r- o o) p- o Ft FD 0a ot 5{o o U U(a o\ v)q (D o (D o- l- o ? (\-{ sltl : o a d:-sB s\ a o : o\ N a $ 0a >l s G a a o s_ oi I 0a N)t, { ts oI t-)+ zo (D N)O UJ w 5 5 5 5 o Table 6: Stro*ing the various aspects of CDTI implementation on which the trainings was conducted 2.6. Treatments 2.6.1. Treatment figures For the year under review, therapeutic coverage is well above T4Yowltrle geographical coverage up to 100%.. Trainees Type of trainine CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders PHC Coordinators and 2 Assistant PHC Coordinators. Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing lntegration of PHC progftrmmes. 24 WHO/APOC 24 Novemtrer 200i {Ugr.d#g; H.O .+(D ^: ra E9 (Do-Bg5iJ '-t(D(D:]< -.oV'< p)ol :l+5'9O- 9r o= =F+:H3oor ES Hx ouD *9od61 So .D; 8el- o) i(D '+ o-(D-. (D+V1 IE(D =_(n^o:-(D;j 6- dL '<o o.'E> -l u) 11 c5e. N0a&s -.d ,(Dd+ ol(,Y-o(Dt -ll+(D5gd['iB (iJ o (D 5p (D F.t o g q) l-l Is)Id l(D l-I (r) o{ oa (D() + N o, + ,-t (D OD+ (D Et(D(A u) d l- o P gao uF* Fi o l! U<(DE'('59'H ct) o 0ao z E' Et', o. E' X P X 0, d 0a o Fd o) ,f b, (D U )t >i TE .t EU c) 0a lD * o F;' PA \o o\ o\ 5tJ -l5 (/t { o\ 00s @s \)\t O5 (rlo\ oo "E ts-gE *6'E ='I q oo oa l!e 0a t(Dlo \o €\ o\ At) \)5 (,t {o\ oo5 oo5 \)\) Os (Jro\ @ EgH \o o\ o\ st.) -I5 (,r -Io\ @s @s -I{ O5 (,ro\ oo On *<lg' 65 =E Ble19 d ,30q =t 6Lg E::(! =. \U oo 1Oq\ oo\oo\ o -o o\ oos oo s o 1O o\ oO 1O o\ ooyO o\ oO\oo\ o \oo\ 6 ^ab ^u0esE 3:,dic ao Ito;. ID '* ll (r)oo b,J (,I o\\o{o(,t @qrr o\5\o o\@{a(rl t)o O N) t.)(.) o\\o NJ \)@ LA o\os o\ N) N) \o(JJ @ N)O{(r) o\o N) oo\o =(! G' ;.E F 8.3qH t -gi q Eo s, o ott o\o A N)( @^tJ \t \o5(,rl (,.r{{(, @ O ooO N) -l{t.) o\ o\ tJtJ\o\o @ N) oo5 -J5 (Jr \o { 5 t.)(,J @@ €dr eElr!3 UI o\ € \o UI UI},J 5F -t5(rt {NO(,l @ (,| h.J o \oP5 o\ O@ "t.r s o\ @ "ro (rr o\ (JJ -!o \o \o\) O @ o\\o \o )ot)A o\ z +El:acE!9r;ErFO6:r5r -{(r) s oo(,r \oo\ 00(,,l -o5\ { o\\o o\ { o\ s @(, -o o\ o\@\o 6\ @A\oo\ @ o\ -oo\ oo \o 6\ \o oo\o o\ :3 aH IX.i le:,38 0qg -v.Y*ll O (J o o o -: z,:g. rcrcd.t'{qEHisEI5i+o^;6 :i o\ b,J\o N) u)(rl o\5 @{ O\o {o\ (,rU) Ou) t) UJN)o\ N)5 cZ oC or o o o O o o o o o oZ(ta Er o O O o o o O o o o o EgAe*r;r N) Llt Jr t \Jp NJ5 zo tD ot f.J 5 oo v7 V) fd a. o) o oo oog oP rl (D r-tIt (D{trt]) 9. ,^c)\o.)o-A tD r-t A' clE)o r-t o,a(D oo o 0e S) '6 ><o -o-o\ovo (D r-t 0, 0ao Ft o,ao -l o ooo<O\(D -o !, o- 0Qv(D |-t S) o 1Oo\ H ,o c)3, C)co (D (D o- a A) l o .l o o 3 *tz ts rE00 -l=!o=15tr I-t3lod l-)(D lc,rt(D alO +19rd l(D(Dlr €le = lg)(D16 8ladlxol- .+ lOalo D' -o a- (D(a o otIta oo o tl,Ft(D e)ta (D r.i €.(D o p, to lD -t o 35 \Eo oEtt l $H Na:t =1GG G{: IBE $\E Rss s.ST E ES. TsN qsa e. *H \E.t" EFC- GiiF r sLt-iT fr sE s' i$ Eii s .:PdE Et.s { lE$e,s i$: cGB. E <el r =*E iSE E\t .s i' iJ\Si Yss' RGRt ,iF I r'8. c.9^ S'{;}eiRE ,q sv E' iS ^hGEsEi*Si.rqTI r1 i3. Gr3s'S.asE. R: =l:G.i i= €.eG' Q. =r tS > G .\ Oe 3 Oe EF E. $ El\ N) o\ {H L,' p tJ5 zo (D d ta N.J 5 ll at2olc '6 |taolr!6 lotr lFb EIBx'loY tct -lo?tqE.I'D;J to) oa ld 5'lo- -lx(D t'^ 815 'dor-t I(D o-o o ooT oa ,j. *- (D Ft9(D o A)Hop) il t'j r- 1 6 lr.,olxOI\i l5;ro tz IElpIPIC l(Dl*t lo l3lo IE Its IE ltDlbt\ ls. H ltT l@l+ tFtI'D IDD lt-Dlo- lx loIO io A) t d(D tst oFb !1 (D(A o t-f (DFt t(D a.o o C)o J (D IA A) ?J) o lft(D o. d F rn? o o Et&. @o p) o t0 il l\O lo,to\ lxl-\oo\o\ >tz E.Ig. '{ l^a lx,p tc,g18 (D ltrl Bl(D eledl.lD) s lg. <lx(Dt lolo I (^ o\ Iil 2.6.2 What are the causes of absenteeism? The major cause of absenteeism being reported is the failure of the CDDs to carry out mop up treatment and the inability of the persons either absent or in eligible at the time of treatment to contact the CDD for their mectizan. 2.6.3 What are the reasons for refusals? No cases of refusals were recorded in the entire project area 2.6.4 Briefty describe all known and verified 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 ./ 27 WHO/APOC, 24 November 2004 E lF.l .D lH-D l=- .o I(D(D lio FrE' ir\a :l ir, ='di'5 I Flur(D3d FlOSrB3 l'! Se HiHrt *9t NEE + -10ai+rD(DE E'rdt.)It<5a.hH'(Dlorzslg'Egl+i .8lH=lru+ d !:r rrgdE+3urxAlr + i-.io\5\JeoFl ?D l-l'r,' 3. Et0n-o+: E'd'=L =t=.5E a!x9dP3.Bg3 =*)v(D\i cL :S ir(Dll(Di]E.)OGi-3:h= ='N0ES.3 l.f8 ,! B(\ =E i. -\riGo38s aiviD oao .) F F o ? N tJ o\o tJ oo l.Jo{ i.J o\ TJ UI N) 5 N)o (,) N) tJ t.) N) \o\o\o \o oo \o{ ErjF \o o\ o\ \o o\ o\ \o o\o @ € Ot @Ur( @5\o 8s- B *d s E r g,E SE E:E HE TgiE,' = ttDtoa oo E (Da s p oa(a0 \o o\ o\ \o o\ o\ \o o\O -Ioo o\oo 5Oo $dr EE-EotsF E \o o\ o\ \o o\ o\ { m(,l o\55 (Jt o\\o 5(1t @ -Bzr-i<5Eo =E 56'# E E*E E oo- t! oo s oo\o 6\ @N s -l(r) s o\{ s (.r!5 s E BPYf;s$ gE =da'oEo= oos oos *.I(,l 1g o\ \ot) rO o\ \o(,r\o6\ (,rO o\ o ^? >sg 'l "#oo c_ tr, Fl r ll (}J o -9t.) (JI @5 t) @ N) J- o\{ 5(n h.) \oo -5t.)Llr{ { ooI N) N) {{(rl -o -Io\ g* 'o x.(D 'dgq g:J F,HEHB:$HH E -H? q o(/r Oro \o\o "!@ ao 'o s(,r "o. @N o\OPoOo (rtOo oo t) N) "9ooO Etr ?EE(D:+ lr, \o UI (,t hJ \o o @\o -J@I@o UJ o\s L'T ".o o(.ll Ur (rt @ l..J(,) s(, P55o 'dflz9E a/- HHNO o. {u)\oo\ {\rr -o o\ o\{yO o\ { \o o\ o\ o\ -o 6\ Lh5 -6 o\ Fl o5.oo rd ri '9vN o0adtai+ o tn tr, lr, * ll @ o\ -o o\ \oo rO o\ {(,l s o@\o 6\ Ou) -o5\ 5o s oo- ^<.>Sg 'l "fio E' il E q t @ o\\oo\ \oO s {(Jrl s @A\oo\ \){ -oo\ o\@ s oo; d$ d0a(D N@ a Fl o rd o "ot)5 zo (D do l.J 5 ./ ' 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Project Coordinator (MOH)WHOtr UI\I-ICEil]MOH Other (please specrfy) by - Project Coordinator (MOH) WHO[] UN-ICETf] NGD([ Mectizan@ NGDC Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizanneeded for treatment for the particular is applied for by the State Coordinator (based on the census update results or number of persons treated in the previous year. This request is forwarded to NOCP for consideration. When the tablets are available, the Project Coordinator will be invited to Lagos for collection. After collectiorq the tablets are kept in the State medical stores where it is entered in to the ledger. The tablets are allocated to the CDTI L.G.As based on their populations and the number of persons treated in the previous year. The L.G.As are invited to come for drugs. On arrival they sign the mectizan register and collect a note to the Store keeper where they collect and sign for the consignments. At the L.G.As the tablets are stored in the PHC store from where they are given to FLIIFs to deliver to the communities through the CDD and community leader. An inventory is also kept at the health facilities. no WI{O/AP0C ?4 Nnwemher ?004 Mectizan inventory Number of Mectizan tablets @The Treatments figure does not include 568 clinic -based treatment in Gombe L.G.A. The remaining tablets of mectizan in the field are collected by the LOCTs and kept at the L.G.A. headquarters. It is added to the consignment for the subsequent year. Activities carried out by Health Care personnel under ivermectin delivery in the project area. i). Collection of mectizan consignments for the State by the project Coordinator from NOCP Lagos or Zonal office Bauchi. ii). Offloading of mectizan consignment at the PHC store at the Ministry of Health and entering into ledger. iii). Collection of mectizan consignment for each L.G.A. by PHC stafffrom the L.G.A. iv). Delivery of mectizan supplies from L.G.A. headquarters to FLI{F by PHC staff. v). Delivery of mectizan supplies to CDDs / communities by FLIIF staff. Community self-monitoring and stakeholders meeting were not carried out. Remainin 192 192 ? 0 0 0 0 0 0 0 0 0 Wested Erpir ed Used/Perso n treated LostReceived Used /LGA Numberin stock Requested 158 0119,246 0352,000 351,842Akko 0 352,000 0 r809 0488,191 169,9100 490,000 490,000Balanga 0 97 0265,0r3 97,0800 266,999 266,000Billiri t064 0134,019 0370,000 368,936Dukku 0 370,000 081,956 0 158250,000 240,842Funakaye 0 250,000 0 362 0319,639 108,246Kaltungo 0 320,000 320000 151 090,460 0260,000 260,000 259,649Kwami 0 052,110 0 603150,000 149,397Nafada 17563 150,000 0 369 0209,000 72,058 Shongom 0 210,000 210,000 0 t29 0394,871 144,745YamaltuD eba 0 395,000.0 0 395,000 8 0r600 568 0Gombe runiO. 808 1000 1000 4,908 03,048-9E0 @951,152 0Total 183,71 3,0641999 3,064,000 30 WHO/APOC, 24 November 2004 Table 1 l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Gommunity self-monitoring and SHM were not carried out. DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) Akko Balanga Billd Drkku Funakaye Kaltungo Kwami Nafadal Shongom Yamaltul)eba TOTAL il WHO/APOC, 24 November 2004 2.9. Supervision 2.9.1. Flow chart of supervision hierarchy. The NOCP zonal Office Bauchi and UMCEF supervise the state team (SOCTs), while the SOCTs supervise the LOCTs and the LOCTs supervise the IIFS. The I{FS and some commurity members supervise the CDDs. This arrangement is not very rigd as the zonal office and UNICEF as well as the state team can go to the community level in order to ascertain the situation in the field. NOCP Zonal office / UNICEF SOCT FIFS FtrS/Community Members CDD I I I 32 WHO/APOC, 24 November 2004 2.g.2. What were the main issues identifred during supewision? The main issues identified during supervision include:- i). Delay in the disbursement of mectizan tablets to the Front line health facilities for delivery to the endemic communities. ii). Lack of comprehensive records at the L.G.A. level iii). There is no defined channel of delivering mectizan to the communities. iv).It appears the LOCT leader is doing the job alone in most L.G.As. v).The spirit of integration is not really imbibed in most of the L.G.A. staff. vi). Most FLtIFs are not participating in CDTI either because they are not committed or they have been sidelined. vii). Records on CDTI are scarce in most health facilities. viii). Most communities have forgotten about CSM and SHM. ix). Most CDDs are not receMng incentives. x). CDD attrition is still very high. xi). The ratio of CDD to total population is still very high. xii).Many communities do not have good registers and census update was not carried out. 2.9.3. Was a supervision checklist used? Supervisory checklists were occasionally used by SOCTs and LOCTs. 2.9.4. 2.9.5. what were the outcomes at each level of CDTI implementation supervision? D.. At the L.G.A.level there was some improvement reducing the over stay of mectizan tablets at the L.G.A. headquarters.. iD. At the frontline health facility level more health facility staffare involved in CDTI activities. ii). At the community level elderly people were selected as CDDs in some communities to reduce CDD attrition. Was feedback given to the person or groups supervised? Yes feedback was given to the CDDs, LOCTs, ELtIFs and the PHC Coordinators 33 WHO/APOC, 24 November 2004 2.9.6. How was the feedback used to improve the overall performance of the project? i). Mectizan supplies are disbursed to the FLIIFs for distribution to the endemic communities without long delays while an inventory is kept at the L.G.A. headquarters. I). Delay in mectizan delivery to endemic communities drastically reduced. ii). Records on CDTI actMties now available in some health facilities located in endemic communities. ii). Many FLFIFs are now involved and keep records at their levels iii). More PHC staffare now involved in CDTI activities through integration. iv). Communities have been reminded of their roles in CDTI including CSM, SHM and grving incentives to CDDs. v). Communities were enlightened on the need to select more CDDs including females and elderly people who are not likely to leave the community. vi). Communities were urged to provide the correct registers or the L.G.A / State should do so. 34 WHO/APOC, 24 November 2004 SEGTION 3: Support to GDTI 3.{. Equipment Table l2: Status of equipment (Please addmore rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Writtenoff). How does the project intend to maintain and replace eristing equipment and other materials? Maintenance of the present capital equipment will not be difficult because these equipments are utilized in an integrated manner with other prograrnmes in the Ministry of Health. Therefore in the absence of counterpart funds, resources from the mother Ministry or any of the programmes benefiting from these equipments can be used for maintenance. Replacement of these equipments is expected to be done by APOC after the fifth year. Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condit 10n No. Cordition No. Coodition No. Conditioo No. Condition l. Vehicle 1 F 0 0 0 0 2. Motor cycle(s) l4 6F8 CNFR 0 0 0 0l 3. Computer(s) I F 0 0 0 0 4. Printe(s) 2 F 0 0 0 0 5. Photocopier (s) ,) IF lwo 0 0 0 0 6. Fax Machine(s) I F 0 0 o 0 7. Bicycles 60 wo 0 0 0 0 8. Slide projector I F 0 0 0 0 9. Standby generator I F 0 0 0 0 10. Air conditioner 1 CNFR 0 0 0 0 11. Electric type writer. 1 F 0 0 0 0 12. UPS I CNFR 0 0 0 0 13. Coloured Television 1 F 0 0 0 0 14. VCR. I CNFR 0 0 0 0 15 PAS 5 F 0 0 0 0 16. Photo camera I F 0 0 0 0 17. Filing cabinet I F I F 0 0 0 18. Safe I F 0 0 0 0 19. Writing board I F 0 0 0 0 20. Laptop (computer). I FI 0 0 0 0 35 WHO/APOC, 24 November 2004 3.2. financial contributions of the partners and communities Table 13: Financial contributions by all pa.rtners for the last three years (2003 - 2005) There is a serious problem with the release of counterpart funds because throughout the year. Nothing was released as counterpart funds by either the State or any of the 10 focal L.G.As. This was because we have come to the end of the 5 years agreement for the release of a specific amount by the State government and each of the 10 CDTI L.G.As. The process of making another agreement for releasing a specific amount by the L.G.As and the State govemment is yet to succeed. Efforts are being made by the NGDO partner and the national office to ensure that the funds are released. 3.3. Other forms of community support Other forms of community support to the CDDs are in terms of honour, dignity and respect in a such a way that the CDD is recognized as an important personality in his community. He is given an upper hand in case of elections or seeking for marriage. 3.4 Expenditure per activi$r Table 14, showing the amount expended during the reporting period for each activity listed. Contributor (March 2004) 2003-Feb (March 2OO4 - DeC. 2004 (JAN 200s - DEC2005) Total budgeted $ Total released $ $ Total budgeted $ Total released $ Total budgeted $ Total released Ministry of Health 20,000 0.0 20,000.00 20,000 20.000.00 9,200.00 L.G.As 12,500 t.666.66 12,500.00 12,500.00 12,500.00 3.575 Communities 1,584 2,000.00 0.0 1,800.00 UNICEF 23,100 1,584 2,461.00 2,461.00 0.0 0.0 APOC 69 ) I 56 40,000 Not available 00.00 24,043 10,000.00 Total 127,756 44834 34,961 36,961 52,543.00 24,575.00 36 WHO/APOC, 24 November 2004 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Tqaining o_f CDDs pTpini4g of h9al1! staffat all ley-elq I Supgrvising CDD-s and distqbUllqn Internal of CDTI activities Advoc4cy lrisits to health and political authorities IEC materials _Summary (lgportipg) forms for treatment V ghiqlg V Mglo1cyc!_eV Q! cy_clgs mqintenance Officq Equrpmgnt (g,g qompUters, printers etc) Others 1000.00 3,000 2,500.00 q,s00.oo l-817.00 a 0.00 957.00 0.0 500-00 2091.00 750.00 NOH/LGAs MOII/L.G.A MoH& GA MO}I/L.G A ,-MOH& GA MOTIIL.G.A MOH/L.G.A IAPOC/A{qH MOWAPOC TOTAL 24,575.00 Total number of persons treated 1,083,364 Table 14: Indicate how much the project spent for each actMty listed below during the reporting period. Exchange rate is I dollar to NI30.00 Any cornments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lntcrnal; 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 I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None of the above was carried out within the period of report. 4.1.2. What were the recommendations? 7,',l WHO/APOC 2.4 Novemtrr ?004 99_ryr,r!niry 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?-No Was a sustainability plan written? Yes- When was the sustainability plan submitted?-September 2004- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:- 4.2.1. Planning at all relevant levels In august 20q6 4 consultants were sent to the State to enable us prepare a 5 year post APOC sustainability plan. All stake holders (pricipally policy makers from the State and all the CDTI L.G.As met and drew up the first sustainability plan. From that time the plan is reviewed annually. 4.2.2. Funds The release of funds budgeted / allocated in the annual plans will be pursued and used for sustaining the programme. 4.2.3 Transport(replacementandmaintenance) Maintenance of vehicles is incorporated in to the annual plans / budgets prepared while APOC will be approached for replacement of vehicle and motorcycles at the end of the initial 5 years. 4.2.3. other resources Similarly APOC will be approached for replacement of all other necessary capital equipments, while IEC materials and office supplies and training / retraining of needed personnel will be included in the annual budget at the L.G.A. and State levels. 4.2.5. To what extent has the plan been implemented The sustainability plan was implemented to cover key CDTI activities to the extend that available resources (funds) could accomplish. Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 38 WHO/APOC, 24 November 2004 4.3.1. Ivermectin delivery mechanisms At the state level mectizan is collected by the State Coordinator from Lagos and down loaded at the PHC store where all PHC supplies and vaccines are kept. L.G.As. collect their mectizan supplies directly from the store as they collect other PHC materials. Any designated officer can collect mectizan for his L.G.A. 4.3.2. Training At the L.G.A. and health facility levels LOCTs and FLIIFS are involved in all training activities for the various PHC prograrnmes. Likewise CDDs are trained as guides or vaccinators during most of the immunization campaigns in many L.G.As. At State level SOCTs attended trainings on measles campaign. 4.3.3. Joint supervision and monitoring with other programs At the State level there is integration in the use of vehicles and delivery of information to and from the L.G.As. 4.3.4. Release of funds for project activities During the period of report funds were not released for the year for activities but counterpart contributions released by the State and L.G.AS towards the end of year 2004. The funds were released on request after following the usual procedure. 4.3.5. Is CDTI included in the PHC budget? Yes, CDTI is included in the PHC budget 4.3.6. Is CDTI included in the PHC budget? Yes, CDTI is included in the PHC budget 4.3.7. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Presently it is only NPI that is using the CDTI structure for house to house immunization using CDDs as guides or vaccinators. This has improved coverage by reducing the rate of rejection and improving the percentage coverage. 3q WHO/APOC. 24 November 2004 4.3.8. Describe others issues considered in the integration of CDTI. The most important issue in integration is the behavior of the personnel involved which will change faster with the organization of programmes in an integrated manner. 4.4. Operational research No operational research was canied out during the reporting period SEGTIOII 5: Strengths, weaknessesr challenges' and opportunities Strengths l. Willingness of all the endemic communities to continue taking mectizan as long as it is available to them. 2. Continuation of CDDs to distribute mectizan to their communities regardless of their demand for incentives. 3. Easy integration of CDTI into other PHC programmes at the L.G.A. and community levels. 4. Willingness of MSD to continue supplyrng mectizan to all those countries needing it. WEAKNESSES. 1 Lack of commitment from most health staffas a result of decreased funding and the appearance of other donor- driven programmes such as NPI, HIV/AIDS etc. 2. Lack of credible NGOs / NGDOs to support the implementation of CDTI in the State. 3. Inadequate monitoring and supervision at the L.G.A. and community levels due to lack of funds. 40 WHO/APOC, 24 November 2004 4. Unwillingness of most PHC stafftrained on CDTI implementation to practice the integration of PHC prograrnmes at their levels. CHALLENGES. 1. Existence of other heavily donor -supported PHC progranrmes such as HMAIDS, UNFPA NPI undermines the commitment of most PHC staffto CDTI. 2. Inadequacy and delay in the release of funds from most sources. OPPORTUNITIES 1. The availability of an established CDTI structure at the State, L.G.A. and community levels for use as a vehicle for other PHC prograrnmes. 2. The existence of a permanent breeding site of black flies could be used for various operational researches. SEGTION 6: Unique features of the proiecUother matters The unique feature of this project is the existence of identffied permanent breeding sites for the black flies in one of the L.G.As. The populations of the flies tend to grow excessively and the persistent bites of the flies constitute a serious nuisance to the surrounding communities. This is the basis of vector control activities through the spray of insecticides i larvicides at the breeding and resting sites of the flies in order to reduce their population and biting menace. The breeding sites provide an opportunity for operational research and evaluation of the effects of mectizan treatment on transmission rate. 4t WHO/APOC, 24 November 2004