6 months report on Community Directed Treatment with Ivermectin (CDTI): Adamawa State, Nigeria: June, 1999 to November, 1999

AFRICANPROGRAM FOR ONCHOCERCIASIS CONTROL (APoc) 6 MONTHS REPORT ON COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN(cDrr) ADAMAWA STATE, NIGERIA JLrN{E, tggg TO NOVEMBER,tggg. ADAMAWA STATE SECTION 1: BACKGROUND INTROD UCTION : Adamawa state, "..ffi* th" d.funct Gongola State in August, 1991 is located ott the northeastern part of Nigeria. The State..lies between latitude 7o zlr and l0o 55 I and longitude llYz'and l4 3/a" East.. There are 2l Local Government Council areas (LGAs). The State lies within two notable vegetational zones, the sub-Sudan Savannah with short grasses and sparce trees i1 the nJrth".n part and the Guinea Savannah marked with tall grasses in the southern zone. The presence of few dotted mountains along the Cameroonian border where three major rivers and have their sources has given the land undulating landscape. These water courses with their tributaries have traversed and turned almost the entire land area arable for agricultural activities and nice breeding sites for the Similium Damnosum. The State has two main seasons, the dry and the rainy seasons. The rainy season begins in April and ends in mid October with average rainfall of 759 mm in the northern parts and 101lmm in the southern part, particularly around Ganye and Toungo LGAs The wettest months, which signify the period of highest rainfalls, are August and September. The dry season starts from thl end of Octoberlo April, with the driest months being January and February when humidity is as low as l3o/o- The State is multi-ethnics with varied cultures, languages and dialect groups. Their rural settlements are in large and small satellite groups, which are often than not along socio- cultural, and language lineage. Despite this apparent diversity the people are still bound together by their natural hospitality, poliiical/administrative structure o? tti. State and few common languages like Hausa and Fulfude which are widely spoken. This is in addition to English, which has been adopled as the official medium of communication. Onchocerciasis is prevalent in 17 out of the 21 LGAs in the State. There are nine hyper- endemic LGAs and eight Meso endemic LGAs. In some of the Meso-endemic LGAs only few heavy foci have been noticed. Only nine (9) LGAs out of the l7 LGAs are presently enjoying the support of African program for 6nchocerciasis Control. However, the program is in the State of expansion lvith the Mectizan Distribution Program, which has almost reached every endemic area rvith Mectizan drug in this treatment season. Approximately 1,364 communities were receiving N{ectizan treatment before APOC assistance started coming in. The number of communities under Mectizan Treatment has now increased to 1,731 following the APOC support, which became e{Iective from July, 1999 ,4 The Project is in the l$ year of CDTI implementation which came to being with effect from June, 1999 following the presence and supports of HKI and APOC. Before now it had been Community Based Ivermectin Treatment approach where the Governments (State and LGA) in collaboration with their supporting NGDO bring the drug to the doorstep of every recipient without meaningful contributions from the communities (in cash or kind). Now with the CDTI approach, the frontier of partnership has been expanded to four thereby including the benefiting communities and the APOC. A community refers to a group of people who recognized and fall under the leadership of a government recognized traditional leader. The population of communities vary and most often along language and cultural group(s). NTIMBER OF ENDEMIC COMMUNITIES AND TREATMENT ROUNDS. s/tr LGA IIypcr Endcmic Communities Meso Endemic Communities Communities under Treatment beforc APOC Communities includcd in APOC Treatment Round 1 GOMBI t40 t07 107 7 2 MADAGALI 213 213 213 7 J SONG 280 105 280 4 GIREI 6t 6l 6l 2 5 JADA 289 164 289 4 6 SHELLENG 52 l8 52 4 TOTAL 1,03 5 668 1,002 2-7 SECTION 2: YEAR 1. CDTI IMPLEMENTATION (1S1'6 MONTTIS) Note: Some communities have expressed their willinf{ness lo support lheir CDDs, hotvever, v,e ore yet to delermine how many supported them eilher in cash or kind. 7'his tt'ill be determined al lhe end ofon-going A4ectizan lrealment, come end of Decemher,1999. t. s/N DistricULGA #of Commtie s/Villages #of Comms/V' illages which selected their CDDs #of Comms/Y illagcs which Collected Drug #of Comms/Villa ges that deciderl on the method of Distribution #of comms/Village s which decided on the months of Treatment #of Comms/vil lages with trained CDDs #of Comms/Yilla gcs paying CDDs in Cash or kind. I JADA 289 289 289 289 289 289 2 SONG 280 280 280 280 280 280 aJ GIREI 6l 6l 6l 6l 6l 6t 4 GOMBI 80 80 80 80 80 80 5 MADAGALI 161 l6l 161 161 161 l6l 6 SHELLI]NG 52 52 52 52 52 52 TOTAL 923 923 923 923 923 923 4. TRAINING OF DIFFERENT LEVELS OF STAFF INVOLVED IN CDTI IMPLEMENTATION 2.1 The annual training objective was to trained 7,364 programme staff and PHC workers. Out of this , 7,170 were trained for ivermectin distribution )) The materials used were CDD Training Manual, CDD Guide, and Flipchart, provided by Helen Keller Worldwide and APOC Respectively. 2.3 There is need to increase training of trainers, more training materials and better scheduling of time and venues close to treatment communities. Training materials produced by HKI to supplement those already produced by the State S/N DISTRICT/LGA No of Training Undertaken No. of TOT Trained No. of District or LGA Staff Trained in CDTI No of llealth Ccntres/Post Staff Trained in CDTI No of CDDs Trained I JADA I 4 9 Not yet trained 384 2 SONG I 4 8 <a 217 J GIREI I 2 8 65 4 GOMBI I 4 l0 a 155 5 MADAGALI 1 4 8 a< 283 6 SFMLLENG I 2 6 47 TOTAL 1 36 49 1,150 S/N ITEIVI QUAI\TITY PRODUCEI) QUANTITY ISSUED BALANCE I Household Cards 20,000 2 Community Register 1,000 100 900 J Community Summary Treatment Form Big Small 2,000 3,000 500 1 000 I 500 2000 4 Community Treatment Form 2,000 1000 1000 5 Adverse Reaction Form 2,000 s00 I 500 6 LGA Mect izan T reatment Form 1,000 500 500 7 State Mectizan T r eatment Form 1,000 500 500 8 Mectizan Inventory Form 2,000 500 1500 9 Posters 2,000 1000 1000 10 Information Brochure 2,000 900 I 100 1t HKI Training Manual 186 70 116 3 M EDUCA TCO 2.2.1 During community mobilization and education of target communities, personal face- to-face contact as well as town criers were used to mobilize the people. 2.2.2 Mobilization exercise was satisfactory, however, more intensive efforts need to be done to increase awareness and involvement in the CDTI implementation. 2.2.3 Most communities have responded favorably. This was evidenced by the level of community involvement and support to the programme. 2.2.4 More time for mobilization and education needs to be included in our timeline of activities. Emphasis during training of health workers need to be increased in this area to improve the awareness and further increase the community support. LGA staffneed to step up efforts in mobilizing leaders and their subjects on regular basis. SECTION 3: ACHIEVEMDNTS: Even though we have just started CDTI implementation (about six months ago), the following achievements have been recorded. 3 I Have been able to train 36 trainers (LOCT), 49 district health supervisors and 1,150 CDDs in CDTI. 3.2 Mobilized and health educated 923 communities. 3.3 Drugs have been collected by the communities and treatment is on going, so we cannot determine treatment now until treatment have been retrieved S/N DISTRICT/LGA No. of Comm./ Villages Mobilized No. of Comties/Villages which reccived Hf about Importance of Extended TreaL No. of Advocacy Visit to State or Regional Directors of Health No. of MOH Staff involved in mobilization No of NGDO staff involved in Mobilization 1 JADA 289 289 2 2 2 7 SHELLE,NG 52 52 2 2 2 J GIREI 6l 6l 2 2 2 4 SONG 280 280 2 4 2 5 GOMBI 80 80 2 4 2 6 MADAGALI i6l t61 2 4 2 TOTAL 923 923 ) 18 12 No. of Treaterl Communiti cs/villages with summary forms. Cost per Person treated No. of Comm./Vill ages which CDDs is a health worker No. of Distributio ns supen'ised by health norkers s/N DistricULGA No of Target Communiti es/Villages Treated No. of eligible persons Treated NoneJADA 289I 2 SONG 280 <a J GOMBI 80 4 MADAGALT 161 5 SFIELLENG 52 6 GIREI 6l TOTAL 923 tl 4 1 STRENGTHS/WEAKNESSES/SUGGESTIONS STRENGTHS WEAI(1\IESSES SUGGESTIONS TRAINING: Training was organized and conducted by the NGDO for SOCT and LOCT members who in tum trained the CDDs at designated centres in the LGAs. a Some LGAs and communitics wcre not adequately informed on time about the dates for training. Inadequatc Training Materials Too many trainees at a session. a a a Need for more tratntng materials. More trainers should b€ trained Adequate and early notices should always be scnt to LGAs and communities during any activity. a a a HEALTH EDUCATION/MOBI LIZATION Community participation was quitc encouraging rvith State. LGA and NGDO ofhcials involved. a Inability to reach and fully interact with all the communitics on the concept of CDTI. Some communities rvere in accessible due to rains and flooding rivers. lnadequate IEC Materials o More time is required for community mobilization and health education. Need for adjustment of p€rid of communitY mobilization. Production of IEC and Training materials for the State should be centralized. a a STAFFING: Dedicated and committed programme staff. PHC District Supervisors have been incorporated and trained for CDTI Implementation. a Staff are yet to fullY understand the concePt of CDTI as it has just been introduced in the State. a More Supervisory visits to be made. More PHC Workers to be trainedon CDTI a a LGA PARTICIPATION Have recognized the problems o[ Oncho in their areas Willingncss to support the LOCTs a a Financial Support to the programme is inadequate. a Need to intensiff advocacy visits to the LGA executives. a COMMUNITY PARTICIPATION Most have accepted the programme. Supported the programme financially. Selected their CDDs. No communitY involvement during the planning stage. There should be more cornmunity involvement during planning stage. Frequent visits and mobilization of some of thc communities who are yet to frrlly accept the programme. a LOGISTICS Availability of vehicles from M.O.H., APOC and NGDO. a No motorcycles, which could be used in areas where vehicle could not. reached. Inadequate logistics support by LGCs. a State and LGCs should be encouraged to support the programme lvith vehicles and motorcycles. a SUSTAINABILITY Involvement Community Based Bamako lnitiative Commitlces would ensure sustainability. Emphasis on shifting the ou'nership of the programmc to communities. a Limited time and attention to communities during mobilization. a Adequate time and attention should be given for interaction with the communities when visited. a 5 SECTION 4: r.I .I a rI a :l 4.2 4.3 4.4 4.5 4.6 4.7 4.8 CDDS PERFOR]VIANCE OF TASK: lementation, CDDs were motivated by the community members to carry out distribution activities' IN Most of the communities participated in CpU during the first six months of activities This was demonstrated by their level of support to the CDDs during training and for collection of drugs. The community members, through the CommunitY Based Bamako Initiative Committees (CBBI) found their involvement and roles quite interesting since they could also plan, and participate actively in the implementation of the programme. Some communities, through the CBBI committees even went to the extent of Producing measuring sticks, community registers and some training materials INVOLVEMENT OF THE NOCP: ffiiasisControlProgramme(NoCP)hasbeenverysupporttve in the CDTI Implementation and actively involved in the training of trainers. It facilitated in the release of APOC funds and advocacy visits to policy makers to enhance political will and supports to the programme' TIIE STATE MINISTRY OF HEALTH: TheStateMini,tryffifa.beencommittedtoherrolesand responsibilities. They have a dedicated team who has been working relentlessly at ensuring the success of tn. programme. The SOCT members have demostrated their commitment to the programme by agreeing to receive half of their travel allowances, thus, doubling their field visits to ensure proper programme implementation from the onset. CONTRIBUTION OF STATE GOVERNMENT: fne Stute Government has made the following contributions: l. I Toyota Hilux 2. I Peugeot 504 Station Wagon 3. 2 Motor Cycles 4. Approval of N3 million counterpart funding during launching of 3mg Mictizan distribution to the programme which is yet to be released. LOCAL GOVERNMENT AREAS: Asintheprogrammeprovidedfundsandlogisticsfor community activities. They were also involved in the mobilization of some communities. With more advocacy visits in future, we are sure of their better commitment to the programme. THE DISTRICTS: The various communities are directly under the districts. This makes their roles in CDTI implementation very crucial. The paramount chiefs meet frequently with various viilage and ward heads to discuss how they could assist in the implementation of CDTI activities in their areas. The community leaders met with their subjects, selected CDDs and mobilized members to support the programme, 6 4.9 EXTERNAL INVOLVEMENT:, Reli giou s urd ro*"?o *- eve lop men t or ganizations have contributed greatly in the implementation efforts. They wfre involved in community mobilization' and supported CDDs training It is envisaged that more community organizations would bs involved in the n"ri futr.". Release of APOC funds and logistics supports enhanced the programme implementation' The roles of the facilitating NGDO, Helen Keller International in providing, technical' materials, logistics, manlgerial and injection of Yd: into the CDTI activities imp.orei tnJ establishme-nt of the p.og.urn*". This is courtesy of the Nippon Foundation for sponsoring HK[',s presence and operations in the State. SECTION 5 5.I MAJOR ACHIEVEMENT OF THE PROJEC-T: u1 iruining of CDDs in Centres within the districts b) lnvolvement of senior MOH and LGA Officials in CDTI mobilization and suPervision. c)CommunitymobilizationwithinthecontextofCDTI. d) Community supports to their CDDs' e) The presence of some community leaders and LGA officials during CDDs training. 52 CONSTRAINTS AND CIIALLENGES OF THE FUTURE a) lnadequate number of trainers b) Lack of adequate support to LOCT members by the council officials during CDTI activities There is the need to meet with the LGA authorities regularly to encourage them to be more committed to the programme. c) Some communities are yet to embrace and accept the programme as their own and support their CDDs. d) Frequent strikes by LGA staff. Inadequate availability of Logistics support such as motorcycles and bicycles for adequate programme coverage. e) n 5.3 ASSISTANCE REOUIRED FROM a) GOVER]T{MENT: . Incr.are level of involvement of senior government officials in advocacy visits to LGAs. o Release of counterpart funds for the programme to augment HKI and APOC financial assistance. o Increase the number of State workers involved in the programmes' o lncrease the number of motorcycles required for adequate supervision at the community level. b) APOC MANAGEMENT: o More training and education materials . SupplY of more motorcycles for field activities' . N; for bicycles for easy access to areas where motorcycles cannot reach, and for easy maintenance. I { v o\ I UI I A I (, I b,J I li I - B\o\o t,J tnots-lON U -'l BT cnz -l -l )-l frl OCF tn cr) lr\o\o bJ FI FaG o\?E5 ? - -vt,Y -HZ\o 5E z - 3rr\-- \Or\O ao\tl F, ta, lr\o\o{ -r\o\oa 3 -. rIrz EEa-l -v(i Elt3[t-VE' i :Jg ?Drt PGH' \oE' \.'!9 ire€ CA -I -t r5 -lonFl r\tzs P"" *(+ t?rl * -'t.(? !erl tD I I j!d.-rtttl