Taraba State CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2007 to December 2007

TARABA CDTI PROJECT I I * Y +? :+ { I ta ORIGINAL : English For To: {eVq'+I BJ Y1r r,rfu CoP A r+6 Bkk FO For lnforrnotlon To,l-r'tR AO. nt. !t4u n.B4l?rt COUNTRY/NOTF NIGERIA Proiect Name: TARABA STATE CDTI PROJECT Approval year: t997 Launching vear: 1997 Reportins Period: January/2007 From: ......To: Decemberl 2007 (MONTH/YEAR) (MONTH/YEAR) Proiectvearofthisreport: (circleone)l 2 3 4 5 6 78 9 (10) NGDO partner: MITOSATH n 7 l{Ati lllllfi WHO/APOC, 24 November 2004 Date submitted: January 2008 'J+ i, n 1 ANNUAL PROJECT TBCHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ll WHO/APOC, 24 November 2004 t t r i T e & r { !t ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE cgMMIrrEE (rcc) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: n.fl racrl rA National Coordinator Name: .?Xf,.t*rei.A. &k^ Signature: @"-*...... Date: Z.lo*.1 '2+:ef,.... --J t4Lir^ Zonal Oncho Coordinator N lo-r NGDO Representative Name: ..F.:.f.*5G..,..C' L*a^ Signature Date '31 i1 lp? Signature: , Date: Ll op i E Tlris report has been prepared by Name , ..W..m.ft&!?.V.S ^/D Designation frrrrl Q>ot-busrr NZcr f ? Signature ,ft,\dffi \P\9t 2 i oA Date a\ WHO/APOC. 24 November 2004lil Table of contents ACROIYYMS ............... ..................vI DEFINITIONS......... ... vII FOLLOW UP ON TCC RECOMMENDATIONS ...........8 EXECUTIVE SUMMARY............ 9 SECTION 1: BACKGROUND INFORMATION ll 1.1.1 Desuiption of the project ftrieJly) 1.1.2. Partnership ,,....,, 1 10 ........ 120 1{ 1.2. Popu1auoN............... ...143 SECTION 2: IMPLEMENTATION OF CDTI........ ..11,6 2.1. Trunr,npoFAcTrvrrrEs............ ....176 2.2. Aovocecy ..176 2.3. MoBILtzATIoN, sENSITIZATIoN AND HEALTH EDUcATToN oF AT RrsK coMMUNITTEs ............. 1872.4. Coul,tuNlry rNvoLvEMENT........ .....1g2.5. CAPACITY BUILDING. 202.6, TRrarunxrs.............. ...ZZl 2.6.1. Treatmentfigures............ .........2212.6.2 What are the causes of absenteeism?.......... .................254 2.6.3 What are the reasonsfor refusals?................ ...............254 2.6.4 BrieJly describe all known and verified serious adverse events (SAEs) that ... 265 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 287 2.7. ORoBRlxc, sroRAGE AND DELIVERy oFIvBRuncuN.............. ............2g2.8. Couuuxrry sELF-MoNrroRrNG AND STAKEHoLDERs Mpntnc. .......2g2.9. SuprRvrsroN ............... ...................... 3l2.91. Provide aflow chart of supervision hierarchy. ............3212.9.2 What were the main issues identified during supervision ?................ 2.9.3 Was a supervision checklist used?......... 2.9.4. Whatwere the outcomes at each level of CDTI implementation supervision? 321 2.9.5. I4ras feedback given to the person or groups supervised? 332 2.9.6.How was the feedback used to improve the overall performance of the project? 32 SECTION 3: SUPPORT TO CDTI ............332 3.1. E9urnunxr............... ....3323.2. FTxIxcu,I CoNTRIBUTIoNS oF THE PARTNERs AND CoMMUNITIES .................... 3433.3. OrHnR FoRMs oF coMMUNrry suppoRT.............. .............3433.4. ExpuNntruRE pER AcTrvrry. .........354 SECTION 4: SUSTAINABILITY OF CDTI........ .......365 4.l.InrrnnAl,; INDEPENDENT PARTICIPAToRY MoNIToRINc; EvaIuaTIoN..................3654.1'l Was Monitoring/evaluation carried out during the reporting period? (Tick any of thefollowingwhich are applicable)............ .........366 4.1.2. What were the recommendations? ............. 3764.1.i. How have they been implemented? ................ .............. 3764.2. SusrenauLITY oF PRoJECTS: PLAN AND sET TARGETS (rvrlxneroRy AT yR 3 .376 lv WHO/APOC, 24 November 2004 = { T .IIil - t. t t r 4.2.1 Planning at all relevant levels 4.2.2 Funds 37 4.2.3 4.2.4 4.2.5 4.3 Transport (replacement and maintenance ).... Other resources. To what extent has the plan been implemented...... INTEGRATION.......... 4.3.1 Ivermectin delivery mechanism.. ....37 ...37 .37 37 .38 ........ 38 38 39 ..........41 4t 4.3.2 Training... 4.3.3 Joint supervision and monitoring with other programs.. 4.4.2 How were the results applied in the project? ........................ SECTION 5: STRENGTHS WEAKNESSES CHALLENGES AI\D OPPORTUNTTIES. 4.3.4 Release of funds for projectactivities 38 4.3.5 Is CDTI included in the PHC budget?............... ............. 38 4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What are the achivements?. 4.3.7 Describe other issues considered in the integration of CDTI 4.4. OPERATIONAL 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. ................... 39 SECTION 6:.............. ..................422 UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS.......... ......422 v WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CBR CDD CDTI CSM FLTIF IIFs LGA LF LID LOCT MOH NGDO NOCP NOTF NPI RBM PHC REMO SAE SHM SOCT TBA TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-B ased Rehabilitation Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Front Line Health Facility Staff Health Facility Staff Local Government Area Lymphatic Filariasis Local Govemment Immunization Days Local Onchocerciasis Control Team Ministry of Health Non-Governmental Development Organization National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme on Immuni zation Roll Back Malaria Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting State Onchocerciasis Control Team Traditional Birth Attendants Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization l. vl WHO/APOC, 24 November 2004 Delinitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 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 heat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project are4 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) Geographical coverage: number of communities treated in a given year over the total number of mesoftiyper-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 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) Comrnunity 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), with 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. vll WHO/APOC, 24 November 2004 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they TCC session have been addressed th Number of Recommendation in the report. TCC RECOMENDATIONS ACTIONS TAKEN BY THE PROJECT Year 8 report(s Rccommendations wcrc givcn,3 of which arc same with ycar 9 rccommendations and addressed below) 5(D Involve communities supervision. ln In year 2007,11 80 community supervisors were selected and trained in the project under the special country initiative. These supervisors are teachers teaching in schools in ttre endemic communities. The hained teachers are involved in data crosschecking and a good number of them are the secretaries ofthe self monitors. s(v) Strengthen ettbrts to carry out community self monitoring and stake holders' meetings. Community self monitoring has been initiated in 72 endemic communities, the recommendations of the community monitors will be implemented in the next distribution exercise. CSM activity will confinue in the communities where it has been initiated as from year 2008, while it will be targeted for implementation in all other endemic communities as of CDTI activities Year 9 report (3 Recommcndations were givcn) 3(i) State and LGA leveis should be encouraged to release funds for CDTL visit were paid to LGA policy makers at the state and LGAs, that of the state did not yield the expected result and arrangement is in place for high level advocacy to the Govemor of the state early January 2008.Advocacy to the LGA yielded result and about 60% have so far released counterpart fund. Advocacy 3(ii) Need to traltr more CDDs at least to attain ICDD: 100 persons. The current level of I CDD: 405 persons is still not adequate. project in year 2007 was able to train 4125 new CDDi This brings the total number of CDDs to 6,831 .The current ratio is I CDD: 200 Community mernbers. The project is mobilizing support to tain additional CDDs to be able to meet the recommended target . The Please add more rows if necessary 8 WHO/APOC, 24 November 2004 t t +I tit t { tt I L t I t EXECUTIVE SUMMARY Prepan tn Executive summary of lhe reporl in nol morc than Wpogal. Background on trcatment and population data - Total communities, communitios treated, total population, LITG, ATO and pcrsons h€ated. 2. Background on population movements. 3. Training data - CDDs, hcalth workcrs, Total population (community) per CDD traincd. 4. Challcnges and how they wcrc overcome. In Taraba State, 12 out of the l6 Local Govemment areas have been determined by REMO to be meso and hyper endemic for disease. The LGAS are: - Ardo-Kola, Bali, Donga, Gashaka, Ibi, Karim-Lamido, Kurmi, Sardauna, Takum,IJssa, Yorro andZing. Mass Mectizan distribution started in the State seventeen years ago with the assistance from Africare. In 1996 Christofell Blindemission (CBM) and Mission to Help the Helpless (MITOSATH) joined to support the state with the withdrawal of Africare. The approach then was the CBTI approach with the programme planning and implementation carried at the community level with minimal input from the community. The African Programme for Onchocerciasis Control (APOC) started assisting the State in 1997 and with it came the CDTI approach. With this approach the community is empowered to take on the responsibility of Mectizan distribution while the Health sector oversees and facilitates process. The project had a 5e year evaluation in 2002. The evaluation team reported the Taraba CDTI project al "not far from being sustainable". This made the project become a matured project and only receives very minimal support from APOC. MITOSATH has been the supporting NGO, following CBM's devolution of CDTI activities to MITOSATH in year 2004. The total population of CDTI area of Taraba State in year 2007 is 1,364,119. CDTI activities were carried out in the l2 endemic LGAs of Taraba State. Total number of communities is 1509 out of which 1509 was treated, giving a geographic coverage of 100%. A total of 1,094,185 people were keated giving a therapeutic coverage of 80%. The ATO which was also the UTG for year 2007 was I177809. The project has a good number of trained personnel.l0 trained SOCTs (6 currently active in CDTI while others are involved in other PHC activities) 55LOCTs, 509HFs. In the year 2007, a total of 4125 new CDDs were trained and 2706 were retrained giving a total of 683lCDDs. Out of this number, 5889 are males while 942 are females. The current ratio is ICDD:200 community members .In addition 1180 Community supervisors,l224 representatives of Community Based Organizations were trained The main challenge in2007 was how to reduce the CDD community member ratio which stood at ICDD:778 community members in year 2005 as well as ensuring that community Self monitoring is implemented . This was overcome by encouraging the communities to select CDDs along the kindred family line and with the additional support from APOC tbrough the special Country Initiative they were trained and the ratio dropped to l:200 trained CDDs.CSM training and implementation was successfully carried out using learning by doing approach applied. It was equally phased, enabling the project to use the lessons learnt in the pilot communities to improve performance in the subsequent communities. Release of counterpart funds by the state has remained a challenge and it will get priority attention next year. Nomadic Fulani's continue to affect population figures especially that of their host communities because they move in and out without notice, and their population figures is unpredictable. Effort was made this year to plan them in during Ivermectin distribution and Vit'min A supplementation, even with that shortage of drugs was reported as they came back 9 WHO/APOC, 24 November 2004 much more than planned. In year 2008, effort will be made through HSAM initiative to have dialogue with the Nomads on how to address the issue. APOC sponsored compliance study was completed this year as well as the operational research on sustainability of CDTI using the hamlet/kinship system. The recommendations from both studies will be studied and used to improve CDTI performance in subsequent years l0 WHO/APOC, 24 November 2004 SECTION 1: Background information 7,1. General lnformatlon 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activit6s, cultures, language Communication systems (roads...) Administration structure Health system & health care delivery @rovide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staffinvolved in CDTI activities. Taraba state is located in the northeastern part of Nigeria. It lies roughly between latitude 6o30 and 9o36 north and longitude 9ol0 and I lo50 east with a landmass of approximately 55,000 square kilometers. Taraba has a total population of 1,512,613 according to a projection of the l99l National Census record .It has a total 16 LGAs out of whicb 12 is endemic for Onchocerciasis. The mean temperature of Taraba State ranges from 22 C-35 C. Minimum rainfall in Taraba is 800mm while maximum is l350mm. The topography is made up of undulating hills and mountains interwoven with marshy and swampy land being drained by many tributaries of the Benue River and its two main ffibutaries (Taraba and Donga) provides conducive breeding environment for the black fly (simulium SPP). Much of the state is very much endemic for Onchocerciasis as twelve out of the 16 LGAs of the state have been determined by REMO to be Meso and hyper endemic for the disease. The LGAs are: Ardo Kola, Bali, Donga, Gashaka, Ibi, Karim Lamido, Kurmi, Sardauna, Takum, Ussa, Yorro and Zing. More than 75%o of the over 2 million populations reside in rural areas where the main occupations are farming, fishing and cattle rearing. Taraba State is a multi lingual state comprising of the Jukuns, Mummuye, and Tivs among others. The road network in Taraba State is not a very good one. The major roads that connect to other states are fairly alright but the intra-state terrains are bad and worse during the rainy season. The mountainous areas are not motorable except on foot and makes interventions even more difficult. Taraba State has a Governor who overseas her affairs. The state has 16 LGAs. Each LGA (comprising of several wards and communities) has a chairman while each ward has a councilor. HEALTII CARE SYSTEM AND HEALTH CARE DELIVERY The health service system of Taraba state ministry of Health is structured to provide effective Health care for the people at all levels. The primary Health Care (PHC) system provide Health sevices with support from the state, local govemment and other stake holders like commun ity volunteers. Several catergories ofhealth care structures and services are provided across the state and the entire project area.This include * Federal medical center 1 *State specilaist hospital I *General hospital 6 *Cottage hospital 5 *Referral hospital I *Comprehensive health centers 4 ll WHO/APOC, 24 November 2004 *Health centers \ post PHC 750 There are total of 2563 number health staff in the entire project area out of which 532 are involved in CDTI. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Numbcr of health staffin the entire project arca Br Numbcr of health steffinvolved in CDTI B, Percentage B:=Brl Br *100 Ardo Kola 201 40 20 Bali 368 39 10.5 Donga 166 36 22 Gashaka 140 36 26 rbi 133 37 28 Karim Lamido r98 54 27.2 Kurmi 134 5i 28 Sardauna 297 46 15.4 Takum 274 48 17.5 Ussa 238 54 23 Yorro 259 36 t4 Zing 155 69 44.5 Total 2563 532 2l 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaVinternational), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. - lndicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaVintemational), communities, local organizations, etc]. t2 WHO/APOC, 24 November 2004 - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the state/region/district/LcA decision-makers NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in Onchocerciasis control in Taraba state are MITOSATH, MOH, LGAs, and CBOs and Communities. This year teachers teaching in schools in the endemic communities have been involved as community supervisors. APOC also provides minimal support to the project like fund for advocacy and some capital equipments. The partners have a good working relationship with one another and join hands together (in terms of finance, manpower and logistic support) to ensure the success of the programme. Planning of project activities are done jointly by the project staff (MOH/LGA), MITOSATH provides technical and financial assistance, some logistics, and IEC / MIS materials when required. The MOH/LGAs provide personnel and some logistics. The LGA provide both personnel and financial support. The MOH are actually responsible for the implementation of the programme activities. Some NGOs/CBOs like transport unions support their community with Mectizan collection. CBOs like the religious groups, farmers association volunteer their time for mobilization, monitoring and supervision of CDTI. The communities are responsible for ensuring distribution of the drug within their communities selecting and supporting their CDDs and ensuring that the selected person is trained by health system. With the initiation of CSM iu some comm-unities, the community members selected some CBO members as their community monitors. At the state level, plans have been put in place for high level advocacy (that will involve TCC representative, NOCP and MITOSATH) to the newly elected Govemor of the state who was a one time commissioner for Health. The project continues to use people that Policy makers at all levels can listen to advocate for support for CDTI. The plan to institute a reward system for LGA chairmen supporting CDTI is still being considered, this will be discussed further at the next review meeting scheduled to hold in January 2008. Representatives of CBOs participated in the review meeting of year 2007,they will equally be invited during the year 2008 review along with the newly trained community supervisors, this the project believes will further enhance joint implementation of agreed programme and partnership . The supporting NGDO will continue to mobilize support not only Onchocerciasis but other add-on interventions like Micronutrient Deficiency Control (MNDC), Rehabilitation, Trachoma and Schistosomiasis Conhol. l3 WHO/APOC, 24 November 2004 1.2. Populatlon Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. (Please add more rows if necessary) t4 WHO/APOC, 24 November 2004 sa N L(.) € ts o)I z$cl d o o< i<o B rn ()F D gHdvtr H_ sE3Dij(2 N@oo\\n \o o\\.) lr} Oto oo@ .f,o(.} Nrn co ol$F. \o o\rrt €F-F- € tr-o o\ r t-- $tr-o @ oo oo e7) o\rn o\:fN$\o ooo ca o\o oo tr-t-- (H o Ho (\l)q o O{ \ + sf, I\o I C)a - >,o E 8E q -v=co \oN\f,\o \o rr1 + o\\o o\ c\l C.l$ r-rr \o o\ c\\o @ $ cf)r- o\t-- ool o\ o\ o\ o\ co$ool lr)\o o\ ao \o Ot coN$ car- $rrl$ oo$ H Ot .f\o ca # r. E.s ; st cs sH? \o ra$Ot\o r-r- \o rat r.) o\ ao o\ \o o\\o o\ o\ .+ Ol c?l s€ Hs gsx \oN .+\o o\olol .+ o\ C.l\o oo $ co t-- o\F- o c.lOl o\ o\Ot ca1 .+oN cac!s cor- $ r$@$ oc{ o\Ol\o o\ tr aa ob! C, TA .(D rEo=!ctr= ZE c.l + il L 0)q - >\O d!lo() -'o9EEIiE0)N \o\o $rr) ta)$ rt\o r+ .+ \o(r) ooco c{t'- coco ooo $ € ra$ o\otr1 oilE .E ?i H€ i,5sQHTVdHL rli c) NE O.d $lr} .+\o (r) cr1 @o o\\r}$ o a ts.- OHdo .91:- €E I e e'U<4 (l) NE O.d \o\o la)$ $$ \olrr ooco c{c- $oo rrt$ o\no .9d ., .,8 -rVVr\A)ALV .6 8:E ?EF O<.= o f ad \o c\$\o \o ra} .t o\\o o\ol ct$ c- t-- \o o\ N\o oo $ cAl-. o\ t-- oN o\ o\ o\ o\ co$o c.I (alr) o\ co Ot \o o\\o ca ot$ cor- $r.r$ €$ o\ $\o co o E8>e 'ot F ir.go.9 9'oo a d oVIo € CIE (B b0 tr o a GI Jdds and o p rOCE HE MFI tr M (ll H3 GIE H V) E J1d F" GltA .h o Eo b0tr N cl oF -io H C)q bo H t< oao o bI) li € o H Fio E(l) (B C)k ok cd h() r< C) o =d(l)k((! o c) 'a t<q (.) I C) o H .\1o t{ cl o (B)a oa €d GI (r,() tr) Fa oO Ail ol -ol6tltrl L- i L I b I tt UTG = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reachedfull geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). Was a census for the project done during the reporting period? Ytr-{- No If No, what is the source of the data in the table above? * Source :National census CDD Other source, speciry: Y"^, 'JOO7 - 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 is a group of people living in a given geographical area sharing the same culture and doing things in common. They have a leader, which they called Jauro, Mai unguwa. A typical community will have between 500 - 1000 house holds on the average and a household on the other hand will have an average between 5 -8 persons. Is there any other information of interest about the population in the project area? If so, include it here. l6 WHO/APOC, 24 November 2004 SECTION 2: Implementation of CDTI 2.1. Tlmellne ol acllvltles 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. Table 3: Timeline of activities for the areas treated in the current year (Please add more rows d necessary) Comments 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the cunent year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. 12 care taker committees, who were acting as chairmen of the endemic LGAs, 741 community/opinion leaders, and the Honorable commissioner of Health, Taraba State were advocated to and sensitized during the year under review. The reason for the advocacy was to solicit their support for CDTI activities by releasing counterpart fund and ensuring treatment compliance. As a result of the advocacy and sensitization the sum of $2,400 was released by the state while the LGAs released $3,700 for CDTI activities. L r It t I I t District/L GA Mobilization of communities Training Census/ update Drug distribution Supervision Starting month Completi on month Startin c month Completi on month Startin c month Completi on month Startin E month Completi on month Startin g month Completi on month Ardo- Kola. March March April April Nil Nil April Scptember March Deccrnbcr Bali March March April April Nil Nil April Scptcmbcr March Dcccmbcr Donga March March April April Nil Nil April Scptcmbcr March Dcccmbcr Gashaka March March April April Nil Nit April Scptcmbcr March Dcccmbcr Ibi March March April April Nil Nil April Scptcmbcr March Dcccmbcr Karim- Lamido March March April April Nil Nil Apnl Scptcmbcr March Dcccrrbcr Kurmi March March April April Nil Nil April Scptcmbcr March Dcccmbcr Sardauna March March April April Nit Nil April Septembcr March Dcccmbcr Takum March March April April Nil Nil April Scptcmbcr March Dcccmbcr Ussa March March April April Nil Nil April Scprcmbcr March Dcccmbcr Yorro March March April Apnl Nil Nil April Scptcmbcr March Dcccmbcr Zing March March April April Nil Nil April Scptcmbcr March Dcccmbcr t7 WHO/APOC, 24 November 2003 The main challenge the project have had over the past 8 years up until early part of last year was that of insensitive administration that was unwilling to release counterpart fund at the state level despite the advocacy visits.Leadership changed in the last quarter of last year and there is improvement evidenced by the counterpart contribution totalling $6,100 received from both state and LGA late last year . The project will carry out intensive advocacy and sensitization especially in the first quarter of year 2008 at all levels by partnering with the state media. There is also plan to institute a reward system like an award to the best performing Chairman which might further improve their support and commitment. 2.3. Moblllzatlon, sensltlzaflon and health educatlon oJ at rlsk communltles Provide information on: The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Mobilization, sensitization and health education has been going on using face to face contact by the Health workers and CDDs. Posters were mainly used to enhance health education. Recently posters were produced in local languages, the messages were changed from emphasizing disease symptoms to key sustainability messages, this was used to sensitize the endemic communities.The use of electronic and print media in health education and sensitization in the project though effective, have not been implemented because of lack of state counterpart fund . Efforts have been going on at involving women and other members of the community especially the minority groups. The result of the compliance study equally enabled the project to identiff some mobilization and sensitization problems especially amomg the minority groups.In view of that a proposal for support for HSAM was sent to APOC and was approved. It will help address low treatment compliance among the minority group like the nomadic Fulani's . On the improvement of women participation the step taken was to sensitize the communities on the need to select women as CDDs especially with add on interventions like nuhition education. The sensitisation has accomplished the following *Availiability of 942trained female CDDs. *Selection of more CDDs along the kindred system *Improvement in the number of communities providing incentives for their CDDs. Sensitization and mobilization will be improved upon by: *Ensuring that state and LGAs release counterpart funds, some of which can be channeled to holding regular health talks on CDTI, emerging issues and awareness. *Sensitizing opinion leaders at the district level by holding sensitization meetings.Already the project has support from APOC for HSAM activities to revamp CDTI activities in the endemic LGAs in year 2008. l8 WHO/APOC, 24 November 2004 I 2,4. Communlty lnvolvemenf Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? - Other issues - Women participation at community meetings is improving, as their women leaders now participate and give feedback to their various women groups especially the CBOs. Their involvement in discussion at the combined community meetings is minimal because of cultural sentiments. In order to really get the opinion of the women separate community meetings are held. The nutrition education programme using CDTI structure gave the project more access to women as their male folks readily accepted their involvement in community education that involved cooking. Some communities provided monetary incentives for their CDDs while some gave in kind incentives. There is however paucity of data on this support which is the reason the project is making effort to improve data on community support in year 2008. 42 24 iL Number of communities/villages with community members as supervisors Number of CDDs and the communities involvcd Number of communitics /villrgcs with femele CDDr Total no. communities in thc entire project area Br Number with community members as supervisors Bs Percentage Bc= BJ B, *IOO Mele CDDs Bz Female CDDs Br Total Br Br+Br Number of communitics with female CDDs Brn Perccntegc Blr- Bro/B.*100 Ardo-Kola, 66 20 30 285 ll 296 ll t7 Bali t54 105 68 723 60 783 5l 33 Donga 145 44 30 418 47 465 9 6 Gashaka 64 49 77 464 43 507 2t 33 Ibi 144 60 42 546 197 743 60 Karim-Lamido 156 53 34 660 42 702 37 Kurmi 138 127 92 373 57 430 5l 37 Sardauna 172 109 63 653 103 756 70 4l Takum 133 94 7t 54r t45 686 74 56 IJssa 108 108 100 372 ll9 49t 84 78 Yorro 84 64 76 354 72 426 36 43 Ziro.g 145 l8 17 690 56 546 2t 18 Total I 509 851 58 5889 942 683 I 525 35 t9 WHO/APOC, 24 Novemb er 2004 CDD attrition used to be a problem in this project but is reducing because: *More CDDs are selected along the kindred line meaning that CDDs now treat members of their own families. * CDD :Community member ratio is presently 1:200.Plan is in place to further reduce the ratio to at least l:125 in year 2008. *IEC materials emphasizing sustainability and community responsibilities have been produced and distributed to the endemic communities. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meqsures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff is frequently transferred during the course of the campaign). The project has a good number of trained personnel.l0 hained SOCTs (6 currently active in CDTI while others are involved in other PHC activities) 55LOCTs, 509HFs, 6831 CDDs and 1224 CBOs(Some of them ward Heads) and I180 community supervisors. Healthworkers at state and LGAs are involved both in CDTI and other addons like NPI, RBM as well as Nutrition programmes. Frequent hansfer of trained staff was not a problem for the project in the year under review Healthworkers in non endemic LGAs were also trained on CDTI during the Vitamin A training so that when transfers do occur there will be no gap. iL 20 WHO/APOC, 24 November 2004 coo cl h(D -o E 0) oz *cl d op. o c\I s o L\ \s E\\ -o tS !){ L: ,s rs s os E o o\ s UL L * \ s \u \ I 3] 3. o h.,r * L] o' ho tl-tt+9 bo a Q "o:o\ o ${ B "( L $ E t o B o 5oH\ ! * P\o U ${ \ I\ s_ "a B o B s\lb '. F i \l + F aU +{ o o o tr 0)t< . (.)tr E o I (ll a t tI t tt i t t t t \o o\N ao € r-, \o\ot ea$(-- O + =OEgo#FQ r-olrl c{or- o co .f, \o(n F- \o €\o o\.+ \oN$ \os\a co oo\o o\ ,Ji n &t) Cie.lc.l €€ 6r- F- o t-rt- orc e.l(..t \oa-. aaN o\NN \oor- e.l B< OFZt) ail o\o r-r-a^l o\ct or- o\o\ c.tr.l \o+ \ov $ c7)6 r-c.) c.lt .E Iq oo(J l z ?-F- <O \o 01r- \o \o o\r- \o.-- o\ \o ooo r- 00\o o F- o\\o ot-\o 00 € =() 6 (.) EI\o-FQ oN c.lo \o\oN N$N t--o\ rrN r-ca c.l \n € oo cr1(.l (n oi OtN o rc ii: -o-&t) o o o o o o o o o o )o zo oC\ coo \o\o(\I Nrf,N r'-o\ r-N r-co c{ \.) € oo co c.I \o c{ Otc\ o oo EUF ootr ,Ie oo 8.3oE, .99Eb' bb €Eqc oH .troozr) eF 6(-) \o\o N \o\o eil \o\o N \o\o c.l \o\o o.l or-N \o\oN ot-- c.I \o\o ol \o\o C.I \o\oN \o\o ol oo o\N r() + € E?o€ FQ \o cn s co N ca N cO N cO o@ Ncf) $ carf, ora) Nca \n\o o\o\.) arCO oo o co o N @ co o\ N o\N eO o\ @ 0z €U @C.l $N o\ c.lN oN N\o o\ c.lc.I Nc.I ol 6 \o$ $cilco oa o uo€io 6€q5gL o( o t')z eFn <(J \o(n $(r) NeA Nco Ncn ooo c.tca sf, (nsf, o\r} c.lca \n\o o\orn +N -()sil ortFO $ tr} $ * \rt \o (rt la) trl $ $ $ \n(rt &o& o $ \.) lr, s la) $ \.| \n rn .t $ $ $rn ,oz c.lo o o o o o o o o o o o d () cooEE !'e OH c;z o <o $ (n \n $ \n lr) rn rn (o v $ $ \nrr) o Bo .2 o d v o 'ok (, m (, bo troa €lz(, q(t o D rOtr! EHVJ ql v dc ctEI GI U) E J.dF (l6 D o Eo boq N sl oF s ca € tr(l) tr 0) q) o(B s $ soo 9 o) o o) o(\l \o 6\ soo tril) o 0) o Gt 10o\ Trainees Type oftraining CDDs Other community members e.g. community supervisors Health workers (front line health facilities) MOH staffor others Political leaders Others (speciff) Programme management. ,( * How to conduct health education * * * * *CBOs Management of SAEs CSM * * SHM Data collection d( rr * :1. * Data analysis * * * Report writing * Others(speciff) Table 6: Type of training undertaken Qick the boxes where specific trainingwas carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65% Any other comments therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. In the year 2006 the project achieved 85% therapeutic coverage and 99.9% geogaphic coverage. This happened because one corrmunity in Ardokola did not treat because the CDD did not collect drugs. This has been addressed and treatment is going on there but thier report is not contained in this year 2006 report. 22 WHO/APOC, 24 November 2003 $ a c.l L o) - Eo oz !t(.l o o o B G C)L(tl oo 'a a o) € tr o EI& >r -o 'o o) €d(l) ah(\l .A o) Pg FI Eoa() E o) €trq) I l1) o. o at,(,) tr o k()o d RI oF 6q.) L. GI oo 'a Lrr C) tr € B .a o) .E a E o o .E c) -o tro I oax ot Iol o -ldxl : 'l,l .=9l oo 8l.strl.= 6)l - =l tr5t.9 BIE +il 5ot h. r-.1 O3|9. EIE5tAZlt- cOc\ 0.) Rll-. (D b{) GI 0) oo 8a t g-. (!lk u0oo(, C) cBk o@ cl o) oo .96Eo\ 11) o.(rlk o)E F1 u)l 11)l e1 tl:l(Bl ol -cl0ldt sol s trl(oI ol '51 dl al rBlL.l 0:,l -cl $ 5li]l E1 3l €l dl JI EI ol frrl J4(r, k I Gl(,(\t oli GI cd o -l o l-. a o p (n r! (n t GI E q) I(t C)LrF i:l ol =l6rlErl Ii iI r L t t t t r AJ €s E Hi eatt € I I I I I I I I I I I I .tr2z* I I I I I I I I I I I I o _o otr .o Z-a o\N+\o €o++ \o\oN € oo$ eil I\o t-r- o\ e.l \o ci\o \o F-atN t-s\oN r- o\$\o $ o $\o o\ o\ cl *E E E97,o4 E ,EfEsg c\t I o\\oo c.I \o oo\o $\n$ o $ C\l@ t+ + c.l ca\oN N co ca v-) co (n r- .+ o Id A o Pr V)o oo(B an c) H oU o r- H^ @=O* o dg" dl:b 9^ F sE ooo \o€ oo\o o\r- o\r-- cnoo t--t- N00 roo o@ N@ cooo ooo a-o o B"g rGt9O o\ a.l\o c^t c.)r-N$ al\o c.-t-r- F.- o.l\o @sf vr-!t @\o €N at o\t \f, \or\ o\ o6\o o\ o\r- \o tr\ o\ $ a.l € to\o \o o E9 3EE EE€ cil6oo\ \o o\ Oro € oo $ 6l c.lrtr- \o o\ 6r-r- @ r-o o\ t- rf r-F- € O co o\ o\$ a.l$\o €o o\ oor-r- 'E .9d., ' tr EAfEHiEEF Oo trt ii iri \o eil$\o \o $o\\o o\ c.l c.lsf t-F- \o o\ oil\o @ $ t-' o\rr oct o\ o\ o\o\r! .foct 6("l o\ \o o\\o rl6l .t CAr- $ t € * o\ t\o E 93ot-.t oil-<-ro ? .9 .o =oFhoi:dqob3> o oo oo oo oo oo oo oo oo oo oo oo oo o o 'd- , , o jE E PU - c- =v A'- oz 6< b \o\o s|.r) (ns $\o $s \ora} @co olr- coco ooO $ oo rrt$ o\o\n c.l ! -^E ,EOE E.gtg€ \o\o \f,n ral$ t\o $!t \o(n €co c.Itt- cOca €o .+oo lal!f, o\o\n SEtss{ c- \o\o $rr) (.l.+ $\o I \ora €co c\F- catfl 00o $oo r.)$ o\o\ o do ,9 o ci oVIo .o 6 c0 (l hod oo clJ(l ! cl o o rOEP EE14J tr av dtrad € CI a) ti aLdF (l op o o hoc i.i EoF il $ a.t Hop A ru oz$ a.l d A ts $ c\l t) bo T\) o(J ltq -llt st) bo ,i\q)tq \r \t .s o a) S'(tr-!u'x*Ss!,\) boiB\ .s$ .!€EP!q,s'a!s 's \' ':: ESXs OE{tSEX $ii q \'\$ *i :-$ .s .sR stR'i:' E Ss)SFL a'-\)Ei t'.ris tBq 9\ suq)ts*tu ^\rI ;a * EXS' s5 3 trSI SiSE s.s eSJ(t .= i\tEo oP .S {o >Qr\ :\ * tt :4. O' a)N ts :r o'u : L'aI tsE s= E \ta\ EE!iiaiE E'i\ .s'B\ ii S.s$ $]{ {o n ilso ultt F.9\ as F (d ok(B oo 'a l-. a. (.) I B at,d C)kd o otd () Il-. C)r oao d () cd ot 9ol s *l o.r xl D *l o 9l o>8lEirl Iql a ol (HoloOl polo <*l I ol ELl i3l trtrlE 3t 6Zlt- olOI:l l0)xl > EI E El8 el Eol 0) 8I Egl iirElt sl=Et c =l dzt< !(D (D o cl()F) s o slt< o) bo!tra6S oo o t-. I 3. I Ii ". I i t t I t i: I {2.6.2 What are the causes of absenteeism? The causes of absenteeism in the project have been traced to culture and practice of some tribes. - Some community members move house shortly before farming season and do not return until after the farming season. This therefore makes them unavailable for fieatrnent. Efforts are currently on to ensure that heatment commences early in January to further reduce absenteeism amongst these groups.CDD workload makes it difficult for a revisit to households where eligible people are absent at the time of distribution. With increase in the number of CDDs and selection along kindred we are hopeful that absenteeism will greatly reduce. The Nomadic Fulanis are another group that are quite mobile and unstable and are found around different communities of Taraba state 2.6.3 What are the reasons for refusals? Some religious sects in the state do not take any form of drug including Mectizan. They conhibute to the refusal figure. A few community members also refuse because of an earlier side effect especially itching when Mectizan distribution started some yeaxs back. This view was confirmed by the compliance study. The CBO members are playing an important role in sensitizing these groups and there is improvement from what it was last year. The project will work with the compliance group in order to implement some of their recommendations on improving compliance amongst the minority groups. 25 WHO/APOC, 24 November 2004 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 of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report rl. , , 26 WHO/APOC, 24 November 2004 $ao c.l L() ! Eo oz !t cl pi B t-- C\.l a) U\ \) -e\- o'\q) .a t S u\ "B* :.n v) Vjq) Uq) S V) =L p \\ B a) V2 Bq) 5 € o trO O. b0d li oook o u0 litE €(l) kk oo o (g .t) rrl a t,9 H C) (.) C)q,ko € CI U)) o kot)(ri o a,(u an GIU #r ol -olcIFt ; 1 '] 7 I I i. l L It tt I I IE0e 3E a <.E E B E'E EEEt o.3E8 EF.E9(J A. q q C)nEE la ! ,.. ET E()-d trd9d =d(Hiio-o.2e o 0) c C=(6oO()O€&,.8 ob'7-ao'=E=H.E R'OO H i,.E tr GI € .a g SP'E EEEEg Eo A E a a3 or Cd c)A o.d ;5 or*dt 11 q EC) N.= 9!2- o> X o o)b0c(g '- =o0>5 xo u) o bI) * 4a () bo H EsFa > <-/ -O O \o$ o\tr) @\o r-\o lr)tr- cnc- oor- tr*t-- o@ o\ cno\ tro d) O. oA ll r dri Id o ^ hI)9 EGF O6\d >v -o o \o$ o\\ oo\o c'-\o \nt-- cal.- oot-- r-t-- aoo o\ (no\ ll r Hri f.l o\ () '5o 560o(t FE()oEoF (nlr) \o\o ooIr* ootr- Noo $€ .+oo (n o oo ,ri oo \ v1 € ol o € ti 'o<- .go6g9) o5 Ee ,oz8 o. r-s m €$ o\ o\\o €6 $ € @ oao € F- 00 oo € o\$ o\o @ c- at o\ o\ tF- o\ $ €t.-\o o\ r,-O,F- o\\o € $o\o rq tso d o.=2Ets5=of utrFU oo oo- \o Oo o r- o € oo 6l € € o o o € or- c-@v o\ oF-tf\or- Or \o a-6t 6o6rr L6;.rd -oy - x o.ES'E o )o.o 6-c:<'=El ' a EgE EE c.l ei(\O C\(\\a(\o \o$\o ciO F.. \ooo o\ \or\o co cil c.l c.l r-(\\r) @o o\ oot o\cl $ct €- o\o\ -i $o\6 €sf a.l o\ *\o q o b0 Gt q C) E (.) ll * f.1 f.f rd o ^boL) !s- F Oo\ o lr) @ r 6 o\ +o\ \? o\ o\ oq @ o\ r- + o\ oOt ,a? @ oo oo q o\ o\ oo to= $r $s.s(7orrl lr)@ trloo Ol+o\ 9o\o\ oqooo\ r-+o\ o6 .,?@oo oo qo\o\ oo 14 qc)o.= 8- E E PE c ts= u ,ll< 5>z Oq € !-) rat oo(n tr) € co C\N ral \or-rrl co (r) $\t tr-\o co ca co(r) o\r)( o\otn l-l Eo? b.z:E6E H.S < 9€FC) $ra)\o $rf)\o @ o\ @N\n c- o\lr) r-O' u1 r- o\lr) c.}$lrl co catr, tr}lr) o\on s :=6:* g t E rt.9= XI(i tr'--> dE E E $"EgE ts8o $\o\o $(r)\o oo o\ @(\l(.| r- o\(.| F- o\\n F- o\(rl ca$(.) coca\n trlrn * o\o\n d rq r,- o\Or € o\ o\ o\ o\ o\ oooN oo c.l c\looN coooN $ooC\ rooo c{ \ooo(\t c-ooc{ cooaol o\oocl o ct $aoN k() -o H() oz v c.l L,o Ar o *{ B (g o k(l) -otr cl d o o .E oo t o) li(a F _: (u bok 0) E (DLq) B q Q) tr E Eoo !) Eoo r{F \Jz -oE C)q € CI od E E ruq ok 0)xq) o0 cl 6l 'r10.a €d CI tro (, o rE 'tr 9F- -O(lo tN!tr o €8 Es)16 98c c'.1 ocd(!()B>' eg o.iOH trrno{- EE r- Gl Rg HE>,tr ctr rE -U' s ^9G,o Q) a0 clLo o0I Fr SttB- \r.PS trl E TELa'O$* E r-.-€ E'i crFN€i\- 3HT f;* a O(EI a.p5 gEE; g(l)()= c) (D\i/ .='a I -! ICJ Lar I .9p I e.E IqEo,l - oOl E{ q ooJRtFI : € -':lEl s-lOctlL0)If he' EEI H E -EIr> (ol o)C) Ol .-E >lg9PlqI9og E B:tr >.o 6t 5,.8:E! 6p;83E oe9troliEE . !2.=raErtG'-- E6i o,l';(1)l a) =l GtHeFlFi L i. I lr f L I t t ooN 2.7. Orderlng, storage and dellvery ol lvermectln - Qtlease tick the appropriate answer) ofl UNICEfl NG Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH D wHoN UNICEil Other (please specifu) Please describe how Mectizan@ is ordered and how it gets to the communities Usually, the NGDO partner orders for and collect the drug on behalf of the project, which is then handed over to the state for delivery to the various LGAs. In most cases the drugs are collected by the LGAs and delivered to the collection centers. The communities collect the drugs from the collection centers. However, as a result of lack of funds some LGAs could not come to carry the drug from the state and deliver to the collection centers,In that case the SOCTs carried it along to them during field activities. Table 10: Mectizan inventory. How are the remaining ivermectin tablets collected and where are they kept? - The remaining ivermectin tablets were retumed by the LOCTS to the SOCTS in charge of a particular LGA .The remaining tablets are kept in the state onchocerciasis control offrce's store and later carried over for year 2008 treatment. List and briefly describe the activities under Ivermectin delivery that are being carried out by health care personnel in the project area Health care personnel are involved in planning, community mobilization, taining, supervision and data collection. State/Disnict/LGA Number of Mectizan tablets Requested Received Used Lost Wasted Expired Remaining Ardo-Ko1a,2007 135000 I 35000 I 33000 2000 Bali 200'l 275000 275000 275000 Donga 2007 200000 200000 198871 36 1093 Gashaka 2OO7 130000 130000 130000 Ibi 200'7 r70595 I 70595 169617 1l 967 Karim-Lamido 2007 446324 446324 373757 337 72230 Kurmi 2007 188000 l 88000 t829tt 89 5000 Sardauna 2007 380000 380000 380000 Takum 2C/)7 200000 200000 I 6825 I 72 31677 Ussa 2007 210000 210000 209660 340 Yorro ZW7 190000 190000 190000 Zing 2W7 300000 300000 299893 107 Total 282t9t9 28249t9 27t0960 72 580 I I 3307 29 WHO/APOC, 24 November 2004 . E L ra L t r I { i PLANNING. Health workers are involved in the planning, implementation and monitoring of Ivermectin delivery programmes at the state, LGA and dishict and ward levels. As the year 2007 ends plans are in place for review and joint planning meeting for year 2008 ivermectin distribution by healthcare personnel, especially in the face of add on interventions, COMMI.JNITY MOBILIZATION The health care personnel will use available IEC materials and face to face contact to mobilize the communities under their supervision. The CDD guides them on issue of concem which becomes the main focus during the mobilization with the aim of solving problems where they arise or commending the community for their support. Under the HSAM initiative, specific plan will be made on improving compliance amongst the minority groups. TRAINING Training is usually carried out in a cascaded manner. SOCTs trains LOCTs, LOCTs fains HFs who in turn trains the CDDs. In year 2008 more CDDs and Health workers will be trained to further reduce workload. In order to have an effective cascaded training, capacity of health worker will be improved and further enhanced especially on data collection, verification and management. A learning by doing approach will be adopted as was the case during the CSM training and implementation. ST]PERVISION Documentation of findings during supervision is usually carried out by healthcare personnel. Supervisory checklist was used during supervisory visits in 2007.Data generated has equally been analyzed. In 2008 efforts will be made to improve on documentation of findings like support by the communities, identified data management problems( like lower level not keeping a copy of their submitted report for verification )and other important operational issues that might emerge DATA COLLECTION The CDD collates the community treatment data and submits to the HFs in charge of his collection center, the HFs submits to the DHs who then collates for his area and submits to the LOCTs. The LOCTs collates for the LGA, summarizes it in an LGA sufirmary form and submit to the state. With the training/retraining on data retrieval and management it is hoped that there will be improvement in the years ahead. Any other comments 2.8, Communtty self-monllorrng and Stakeholders Meetlng Has any training (of trainers) for community self-monitoring been done in the project area? Yes If so, when? September -October 2007 30 WHO/APOC, 24 November 2004 Dishict\LGA Total no of communities in the entire proiect areas No of communities that carried out CSM No of communities. that conducted SHM* ARDO-KOLA 66 6 6 BALI DONGA 154 145 6 6 6 6 GASHAKA 64 6 6 IBI t44 6 6 K\LAMODO 156 6 6 KI.JRMI 138 6 6 SARDAI'NA 172 6 6 TAKI.JM 133 6 6 USSA 108 6 2 YORRO 84 6 5 ZING 145 6 2 TOTAL 1509 72 63 Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) *This figure represents feedback meetings held in the communities where other courmunity stakeholders were in attendance. 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. - CSM training and implementation was carried in two phases and in a cascaded manner. The learning by doing approach was used. This was facilitated by NOCP, MITOSATH officers and Director PHC. 72 communities from the 12 endemic LGAs have so far implemented CSM. 54 LOCTs,36 FLHFs were trained. 513 community monitors have been appointed by the communities. A total of 2945 community members participated in the community meetings while 906 attended the feedback meetings. - Issues that came up from the community meetings which monitors report were: I Poor revisit plan by CDDs for absent community members U Missed breastfeeding mothers that have breastfed for more than 3 weeks. ! Lack ofannual census update I CDD preferential treatment to households that offered him incentives. D Nomadic Fulanis that just show up in the community after community drug estimate and supply have been done . The CSM was a very good development for the project as it gave insight to CDTI performance in the Communities based on community assessment. It's effect on progralnme implementation will be evident in subsequent distibution as training and implementation started only last year .On using the outcome to improve performance, the recommendations of the community monitors have been received as well as their plan to overcome the identified challenges.Update on this witl be reported as from Year 2008. 3l WHO/APOC, 24 November 2004 2.9. Supervlslon 2.91. Provide a flow chart of supervision hierarchy. SOCTs J LOCTs I DHS I HFS t CDDs <- COMMLINITY MEMBERS 2.9.Z.What were the main issues identified during supervision? The project carried out supervision at the LGA , FLHF and community levels using supervisory checklist. The main issues identified are as follows: *That LGA,IIFs and community training was carried as reported . * Training ,distribution and CSM intervention activities were supervised by LOCTs and [IFs. *Census updating was not done in some of the communities, *Late retrieval of data from some CDDs especially those from hard to reach areas *Some CDD's were treating without measuring sticks claiming they can guess the number of tablets by looking at their height. 2.9.3. Was a supervision checklist used? Supervisory checklist was designed and used for the different supervisory activities. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Issues identified at the community were lack of Census updating,CDD unruly behavior, and treating without measurement , At the HF findings boarded more on late retrieval of data and lack of verification. At the LOCT, level it was clear that some of them have wrong attitude to work and will need to be changed. 32 WHO/APOC, 24 November 2004 iI i2,9,5. Was feedback given to the person or groups supervised? When these issues were identified at the community the attention of the health worker in charge of the area was drawn to it as well as the community leader, who promised to discuss and find solutions. For the Health workers feedback was given to their superior for follow up and appropriate actions. 2.9.6. How was the feedback used to improve the overall performance of the project? Update on action taken in view of the findings, issue of roles and responsibilities of the newly trained CDDs and CBOs and other recommendations from the researches carried out will be disscussed the annual review meeting coming up in January 2008. The recommendations that the review will come up with will help improve progrcrnme performance. SECTION 3: Support to CDTI 3.1. Equlpment Table 12: Status of equipment (Please add more rows if necessary) *Condition of equipment (F :Functional, CNFR:currently non functional but reparable. WO:written off) **6pQC has provided one new additional Hilux for the state which has been received by the project. How does the project intend to maintain and replace existing equipment and other materials? The State has plan in place to replace the old vehicle by asking the Government to buy new project vehicle for the project during the planned advocacy meeting. Source Type of Equipment APOC MOH DISTRICT/LGA NGDO OTHERS No. Condition No. Condition No Condition No. Condition No. Condition l. vehicle 4** F I CNFR I F 2. Motorcycle(s) 28 20F 5WO 3CNFR I CNFR t4 F 3. Computer(s) 3 2F ICNFR I F 4. Printerls; 2 1F ICNFR I F 5 Pholocopier 1L IF ICNFR I F 6. Fax machine (s) I F 7.oth"rs a. Filing cabinet I F b. Bicycle 20 F c 33 WHO/APOC, 24 November 2004 Other important capital equipments needed by the project as well as cost of maintenance of the existing equipments will be budgeted and fund sourced from the State Government counterpart fund. 3.2. Flnanclal contrlbutlons of the partners and communttles 3.2. Financial conhibutions of the partners and communities Financial contribution all for the last three U The state government transported motorcycles from Lagos to the state,Repaired photocopiers and printers,organized world sight day. I CBOs were involved in the mobilization and sensitization of community as well as monitoring of compliance. Efforts are currently on to quantiff their support. ! MITOSATH's contribution is for Ivermectin dishibution, two rounds of vitamin A supplementation, Rehabilitation and Nutrition Education. * If there are problems with release of counterpart funds, how were they addressed? There had been several advocacy visits to the SMOH by the partner NGDO on the subject. Plan is in place for high level advocacy. - Additional comments 3,3, Other Jorms oJ communuy supporl - Describe (indicate forms of in-kind contributions of communities if any) In-kind contributions by the communities are many and varied. They could be foodstuffs, assisting the CDD on his farm, donation of some gift items, nominations to represent community in duties where momentary compensations are given e.g. the National Immunization exercise . i Year 8 (2005) Year 9 (2006) Year l0 (2007) TOTAL cash budgeted (us $) Contributor TOTAL cash budgeted rus $) TOTAL cash released rus $) TOTAL cash released rus $) TOTAL cash budgeted (us $) TOTAL cash released (US $) MOH (central+provitionaUstate) 0.00 0.00 0.00 0.00 17,557 2,399 MOH (dishict/LGA) 13,765 t923 12,500 2,000 I1,450 3,744 Local NGDO (s) (if any) CBO Yet to be quantified Yet to be quantified MITOSATH 963l,l 3 1,196 30,519 25,794 46,976 45,876 Others a) b) Communities Yet to be quantified Yet to be quantified Yet to be quantified APOC trust fund 0.00 6,700 8,228 8,229 35,599 32,689 Total 44,961 39,819 51,247 36,022 lll,472 84,698 34 WHO/APOC, 24 Novernber 2004 ri * TiIf 1 The CBOs also provided support for mobilisation ,supervision and monitoring which is yet to be quantified. 3.4. Expendlture per actlvtty 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 Nr 3l to $1 35 WHO/APOC, 24 November 2004 a Table 14: Indicate how much the project spent for each activity listed below during the reporting period. SECTION 4: Sustainability of CDTI 4.1. lnternal; lndependent partlcipatory monltorlngi Evatuafion 4.t.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) NA Year 1 Participatory Independent monitoring NA Mid Term Sustainability Evaluation NA 5 year Sustainability Evaluation Internal Monitoring by NOTF Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs/CBOs staffat all levels Supervising CDDs and distribution 420 MITOSATH 10,000 23,786 MITOSATH II-GA APOC/]vIIT OSAT}YLG A l0 533 25,618 APOC/SCI LGA,APOC, MITOSATH Intemal monitoring of CDTI activities Advocacy visits to health and authorities IEC materials Summary (reporting forms for treatment VehicleV Motorcyc les/ bicycles maintenance Office Equipment (e.9. cgElulers, printers etc) Others**** *(BANK CHARGES) 4,542 APOCA{IT OSATH 3,753 3,800 APOCAdIT OSATH APOCiIvIIT OSATH 1,984 STATE,LGA MITOSATH 262 MITOSATH TOTAL 84,698 Total number of persons treated o 36 WHO/APOC, 24 November 2004 I t No Other Evaluation by other partners 4.1,2. What were the recommendations? NA 4.1.3. How have they been implemented? NA 4.2. Susfalnablllty oJ prqectst 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?_2003_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1 planning at all relevant levels Partners at all levels -State, LGA, CBOs, Community and MITOSATH-are involved in planning of CDTI activities. 4.2.2. Funds Release of counterpart fund by the State has been difficult but after the advocacy visit to the MOH this year, the State government has promised to contribute her part in the control of Onchocerciasis in the State. 4.2.3. Transport(replacement and maintenance) The State hansported eight motorcycles donated by APOC from Lagos to Jalingo this year. The State and MITOSATH jointly support in the maintenance of vehicles. Motorcycles were maintained by the LGAs. Bicycles are to be maintained by the benefiting community. APOC has procured a new Toyota Hilux for the State. 4.2.4. Other resources The project plans to mobilize resources at the LGAs by instituting a reward system for performing LGA Chairman with respect to the release of counterpart fund for CDTI activities. 4.2.5. To what extend has the plan implemented To a large extent sustainability Plan developed for year 2007 has been implemented but source of fund is different from the source proposed in the plan due to non release of counterpart fund by the state. Indicators of success seen in implementation of plan includes fund release by the LGAS following advocacy visits, procurements of Mectizan, delivery to LGA stores, retrieval of heahent data, production and dissemination of IEC materials, maintenance of vehicle, field visits to the field, etc 4.3. Integration 37 WHO/APOC, 24 November 2004 I I It Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3. L lvermectin delivery mechanisms CDTI has been integrated into PHC structure in respect to Ivermectin delivery mechanisms for example, Calculation of mectizan need is from bottom up. From HF to LGAs, LGAs to state and then to NOCP through the NGDO. The storage of ivermectin as well as the release to the LGA is carried out by the state. HF are also collection cenhe/lnventory centres for ivermectin delivery. Vitamin A supplementation and NPI programmes field activities are used sometimes to deliver Mectizan as well as to get information on stock balances.Ml vehicles is used for Ivermectin delivery activities when APOC vehicle is unavailiable.ln the same vien APOC vehicles are allowed to be used for other PHC activities like RBM,MI and VAS. 4.3.2. Training Training involves both the Onchocerciasis and Nutrition unit of the PHC. A list of all the LGAs Health workers (both those presently involved and those not involved) has been complied this is to enhance their involvement in the CDTI programme.Nutrition prograrnmes like VAS is used to educate participants at all levels on CDTI. 4.3.3. Joint supervision and monitoring with other programs Supervisory visit for other PHC activities like RBM, NPI and Vitamin A dishibution was also used to supervise CDTI activities in the year under review.Other offtcers involved in PHC activites do help with CDTI data collection if duely informed.Similarly Health Staff involved in CDTI equally help them in data collection on their Programmes. 4.3.4. Release of funds for project activities Release of counterpart fund by the state has been very difficult because the little they get is said to be for all PHC activities and priority is given to disease like HIV, Polio, and RBM. Effort was made in2007 to seek additional support specifically from Chairmen at the LGA through the PHC coordinator. This yielded good result as about 60%o of the LGA released counterpart fund to support CDTI activities. The project will continue with its advocacy to policy makers at state level for release of funds for CDTI program. 4.3.5. Is CDTI included in the PHC budget? fes. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Vitamin A supplementation The first round Vitamin A supplementation took place around Apnl /Ivlay using CDTI structure alongside Ivermectin Distribution . 93,960 children 6- I I months and 444,981 children l2-59 months received Vitamin A .The overall coverage was79%o. The second round dose has been given as well using IPD, between November 24'h -27th. Coverage for children 6-59 months is 94%o while that of 12 - 59 months is 9lYo. Community based Rehabilitation : Agric rehabilitation covering home gardening and blind farmers cooperatives have fully commenced in pilot communities, In rehabilitation programme, the CDDs were used to identify the land to be used by the farmers, guide against theft in their farms and also help in marketing their produce. 38 WHO/APOC, 24 November 2004 t In using CDTI shucture to carry out other health interventions, there has been appreciable success like increase in community awareness, increase in coverage and early retrieval of reports. vIsIoN 2020 The state Government has constituted the state Vision 2020 committee. Vision 2020 committee has been inaugurated .The inauguration took place alonsgside world sight day celebration.Awareness on Riverblindness and other blindening diseases was created. Plans are in place to commence meeting. World sight day was also observed in Taraba state with joint support of the state government and MITOSATH. 4.3.7 :Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: CDTI is already integrated into PHC structure at the State and community level.Complete integration at the HF level is yet to be achieved.This year under the Special counky initiative additional Health centre staffs were trained and more collection centres created. The plan is to train all HFs and ensure that every Health facility is a collection cente,that way is easier for the CDDs to collect Ivermection. HFs supervision of CDD activity is equally more effective. 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. Operational research on the use of hamlet kinship system in the sustainability of CDTI in Taraba CDTI was concluded this year. This study have shown that hamlet system exist in Taraba State, North cenkal Nigeria. It is called Zuiya and can be utilized in improving CDTI performance. This is in agreernent with the findings of its existence and effectiveness for CDTI found in the Eastem part of Nigeria by Dr E. Emuka where it is commonly called Umunna. Outside Nigeria, in Uganda where it was first used and reported by Dr M. Katabawa, his research findings has been corroborated by the findings ofthis study. The additional input that this study added to the hamlet system research is the fact that the more the communities are subdivided, the better their performance. There were statistical significant differences between perforrnance in terms of coverage between homogenous and heterogeneous communities. Coverage was higher in homogenous than in the heterogeneous communities. Strengths Acceptability: The communities were able to identi$ with the hamlet sructure and were very willing to use it. It reflected in ttreir commitrnent in the selection of CDDs that were hained. Commonality of results: In both heterogeneous and homogenousi communities acceptability of the system was evident. The result seen in both were similar. IL I L D. ii). 39 WHO/APOC, 24 November 2004 iii). iv). v). Reduction in workload: It was clear that it is a system that can drastically reduce workload of the CDD within a year in both heterogeneous and homogenous communities, which has a direct bearing to improving both therapeutic and geographic coverages. CDD structure: Some of the CDDs on their own selected their leader. This is a sign of commitment and willingness of the CDDs to be part of the programme for a long time since ttrey believe they might one day become CDD leader. Extension to other LGAs: Other LGAs currently supported by APOC special initiative are currently using the experiences inZing and Karim to encourage community leaders to select more CDDs along their Zuriya system. Weaknesses i). There shouldn't have been additional selection and haining of CDDs in the passive LGA of Ardo Kola. However, since this was done in error by the supervisor, the result was accepted as it is. In some communities there was conflict on who should be the leader since their community now has more than 2 or 3 CDDs against l. There was no prior discussion and logistic arrangement made to provide additional communify registers. The intervention phase did not contain a gender sensitization workshop which could have worked on changing community attitudes towards female leadership. Some CDDs thought that the old registers were no longer useful. Recommendations Efforts should be made to ensure that roles and responsibilities of all the CDDs (old and new) are clearly defined and explained to them. Supervisors should ensure that each CDD operates within ttre defined roles and responsibilities. The project should provide additional community registers to make the work easier for the CDDs. The use of Zuriya system should be encouraged and utilized not only in other LGAs in Taraba state but other CDTI projects. Gender sensitization workshop should be carried out for community leaders and other opinion leaders in the community so us to change cultural attitude towards female participation and leadership in community programmes. The selection of new CDDs on the lineage (zuriya) system should be immediately followed by training and provision of required field materials. ii). iiD iv) v). Another study on compliance with Ivermectin in Taraba CDTI funded by APOC was concluded in the year under review .The study concluded the following: E For individual, 78.5 comply 5 or more times D There were generally positive perceptions that both individuals and communities as a whole would take Ivermectin annually and continue to do so into the foreseeable future. n Previous enlightment \ information about a possible l0 or to l5 years duration of treatment may create a barrier. D Enlightment ,awareness and information stategies topped the list of suggestion. ! Program management suggestions were also important for enhancing acess to Ivermectin. I i). ii). iii). iv). v). E -r- 40 WHO/APOC, 24 Novemb er 2004 t iir t {I f ! Enlightment alone may not overcome some deep seated beliefs such as avoidance of medicine, religious injunctions and perception of what suits one's own body imply that simple information, compaigns will not be adequate. Recommendations from the compliance study : D Health workers and CDD's also need to be hained in counselling skills as traditional mass IEC\BCC materials may not be enough to overcome deep seated personal belief. I Health education material should be geared to specific low compliance groups and their perceptions and beliefs ! Programs must continue to provide adequate and timely supplies of drugs to enable villagers to comply annually. 4.4.2 :How were the results applied in the project? The recommendations of the studies will be discussed further at the at the review meeting and applied as apprioprate.Meanwhile APOC is supporting a HSAM initiative to address some of the compliance study recommendations. SECTION 5: Shengths weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. STRENGIITS l. Ability to use CDTI structure for Add-on interventions. 2. Ability to select and train more female CDDs and CBOs to improve the involvement of female CDDs and promote gender balance. 3. The take-off of the community based Rehabilitation was an open door for donor investment in areas of education, provision of pipe borne water and social amenities. It was also a means of encouraging other interventions. 4. Ability to showcase impact of ivermectin diskibution using CDTI stucture which is improving donor's confidence. WEAKNESSES l. Frequent change of key policy makers at the state and LGA levels last year 2. Inability of the project to repair some of the grounded vehicles and carry out awareness campaigns due to non release of counterpart funds by the state. CHALLENGES. l.The nelv MIS forms: *Enough time was not given for adequate training on the use the new MIS forms. *Different information was captured by the form at different levels ,thereby requiring that Community/IlF forms are collected without proper arrangement on how they can keep their copies. *The project is yet to develop an MIS form to capture vital information on Community Base Organisation (CBO's) activities. 2.Nomadic fulani's non compliance *Shortage of drugs was reported in some host communities of the fulanis. a n 4t WHO/APOC, 24 November 2004 E ! r a; 3. Counterpart funding: - Despite the high level advocacy , the state gevernment is yet to release reasonable fund in support of CDTI activities. How challenges were addressed: I.MIS Forms: *The concerns on the MIS forms were raised at the NOTF meeting. *The project made effort to go back and recopy the forms inorder to get the needed information which expensive and cumbersome. *It has also approached the NGDO to support them in producing the forms in duplicate forms.The NGDO is awaiting the decision of NOTF on whether or not there will be further amendment on the form before a decision can be made. *MIS is currently been designed to capture the contribution of the cBos. 2.Nomadic Fulanis The project is hopeful that the HSAM initiative will address some of the compliance issues among the fulani nomads. 3.Counterpart Funding:Release of counterpart fund is on the high priority list of the project for year 2008.There will be high level advocacy and follow up to ensure release of fund and vehicle.This was not possible last year due to insensitive administration at the state level. OPPORTUNITIES l.Additional add-on Intervention:The project will have the opportunity to add-on other interventions like Lymphatic Filariasis and Schistosomiasis control at a large scale level when mapping that is currently on-going is concluded. 2.Awareness on CDTI activities:With State Govemment renewed zeal for the release of counterpart fund, fund will be available for CDTI awarenes creation using both print and Electronic media in the state . This has been in the plan for some y"u.r ro* but was not executed due to non -release of state counterpart fund. SECTION 6: Unique features of the projecUother matters Special country initiative fund has enabled us reduce CDD community member ratio, enabled the involvement of new partners that is the teachers who are communitysupervisors and increased health workers numbers involved in CDTI. Showcasing community potentials ,strength and ideas through other interventions is the projects unique feature and will be consolidated the more in subsequent years. t' ,- Lr !l 42 WHO/APOC, 24 Novemb er 2004