Annual NOTF Secretariat technical report submitted to Technical Consultative Committee (TCC): January to December 2010

+iI ORIGINAL : English TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)'TEE ( )* ;* To APOC Management by 31 January for March TCC To APOC Management by 31 July for September TCC AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) -----HECU LE - - &rrY.zotz APOC/DtR "* i ,l COUNTRY/: Nigeria NOTF: ffigeria Approval vear: 1997 Reportine Period (Month/Year) z Jonuary - December 2010 PToiectyearof thisrepq4: (circle) 12 3 4 56 7 8 910 11 12 (13) 14 Date submitted: fanuary 2012 ANNUAL NOTF SECRETARIAT TECHNICAL REPORT l"oc for t- .N c". J I : -"----tLi I I I I I I I at ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC} ENDORSEMENT Please conlirm you have read this repurt by signing in the appropriate spflce. OFFICERS to sign the reportl Country t NIGERIA National Coordinator Name: Dr. Y. A. Saks ur*r.w.Signat Date:. al lo?/*n/2 NOTF Chair This report has been prepared by Name:. Chukwa Okorunkwo Design ation: Pro gril m me Offic e r Signature,..W* pprq-,*/n f4otn* IVHO/APOC. 3 October 2004 TAtsLE OF GONTENTS ACROITYMS ............,. ............-.II DEFIMTIONS......... SECTION 1 : BACKGROUND INI'ORMATION.......... 1.1. GSITERAL INFoRMATIoN .....................-. 7 1.2. PopulenoNAND[IEALrHsYsrEM..... .................10 SECTION 2: ST]MMARY OF CDTI IMPLEMENTATION ..........-..7 2.1. DrsrRrsurIoNpERIoD ...-.- 11 2.2. Aovocecv AND SENsITIzATIoN.. ...--.12 2.3. INnoRunuoN, Eouca.noNAND CoMMLJNICATION STRATEGY AND MATERLALS DEVELOPMENT............... .....-;.......,-.. ................ 13 2.4. ColltvruNtrrps' IIwoLVEMENT IN DEcIsIoN-MAKING... .......-.14 2.5. CnpecnvBUILDINc.. ......15 2.6. ORpnnrxc, sroRAcE ANDDELTvERYoF IVERMEcTIN ............ 19 2.7. TnrerN{er.ITs.............. ----.-21 2.8. SupenvlsloN ....................28 2.9. COuratnury SELF-MONITORINGeNp SrerenOLDERS MrnrrNC ............-29 SECTION 3: OTIIER ACTIVITIES OF TIm NOTF............. 31 SECTION 4: SUPPORT TO CDTI 4.1. FTNINcIAL coNTRIBUTIoNS oF THE PARTNERs ............... ..-..-.40 4.2. OTHBnFoRMS oFcoMMUMTY sLTPPoRT ..........-...42 4.3. RrsouRce MoBILIZATIoN EFFoRTS................ --..-.42 4.4. E>cruomunn PER AcrIwrY sv fiENOTF sBcnerARIAT........ ....-.-.-..---.42 4.5. EeurprreNt ...................-..43 SECTION 5: EVALUATION T'OR SUSTAINABILITY OF CDTI,IIYDEPENDENT MOMTORING AI\D OTIMR REVIEWS .............. 5.1. INoepeNDExr PARTICIPAToRYMoMTonTNc/BvII,uATIoN..... ..............-..45 5.2. SusrerNreslllTy oF pRoJEcrs: pLAN AND sET TARGETs (MANDAToRYAT YR 3)............47 5.3. INrBcRartoN............ -.---..47 5.4 OpBneTIoNALREsEARcH ...--.-49 SEC-TION 6: STRENGTHS, WEAKI\IESSES, CHALLENGES AI\D OPPORTIINITIES ........_..49 t 6 I 45 Acronyms AFAN Agricultural Farmers Association ofNigeria AIDS Acryired knmme De#eieney Sytldrome ALGON Association of Local Governments ofNigeria APOC African Prograrnme for Onchocerciasis Control ATO Annual Treatuent Objective ATrO Annual Training Objeetive BCC Behavioural Change Communication BSN Bible Society ofNigeria CAN Christian Association of Nigeria CBBI Community Based Bamako Initiative CBO Community-Based Organization CBM Christoffel BlindenMission CC Carter Center CDA Cornmnnity Development Association CDD Conrmunity-Direoted Distributor CDI Community-Directed Intervention CDTI Commrmity-Directed Treatment with Ivermectin CM Community Meeting CRUTECH Cross River State University CSM Community Self-Monitoring CWO Catholic Women Organization DHS DistrictHealth Statr DOTS Directly Observed Treatment Short-course FCT Federal Capital Territory FENAM Federation ofNurses and Midwives FLHF Front Line Health Facility FOMWAN Federation of Moslem Women Association in Nigeria GAELF Global Alliance for Elimination of Lymphatic Filariasis GCR Geographic Coverage Rate GIS Geographic Information System GMC Gombe Media Corporation GPS Global Positioning System GRBP Global2000 River Blindness Programme HFS Health Facility Staff HtV Human Immuno Deficiency Virus HKI Helen Keller Intemational HMM Home Management of Malaria HSAM Health Education, Sensitization, Advocacy & Mobiliz.ation HQs Headquarters IDP Ivermectin Distribution Programme IEC Infomration, Education & Communication IEF International Eye Foundation WHO/APOC, 10 April 2003 IFESH International Foundation for Education & Self Help IT Information Technology ITN Insecticide Treated Net JM Jffia'atu t{ffiilih-klffii IGP Knowledge, Attitude & practice LCIF Lions Club International Foundation LF Lymphatic Filariasis LGA Local GowrnmentArea LOCT Local Government Onohocerciasis Contol Team M&E Monitoring&Evaluation MDA Mass Drug Administration MDP Mectizan DonationProgramme MIS Management Information System MITOSATH Mission to Save the Hclpless MLG&CD Ministry of Local Govenrment & community Deveropment MOH Ministry of Health MSD Merck, Sharpe & Dohme MWR&E Ministy of Water Resources & Environment NAFDAC National Agency for Food, DrugAdministation & contror NAPEP National Poverty Eradication Programme NEEDS NationalEconomicEmpowennentDevelopmentstrategy NFO Nigeria Farmers Organization NGDO Non-Govemmental Development Organization NGO Non Governrnental Organization NHMIS NationalHealthManagementlnformationSystem NIGEP NigeriaGunieawormEradicationprogramme NOCP National Onchocerciasis Control programme NON Newsletter on Onchocerciasis inNigeria NOTF National Onchocerciasis Task Force NPHCDA National Primary Health Care Development Agency NPI National Progranrme on Immunization NTD Neglected Tropical Disease O/R Operational Research PATHS Partrership for Transfonnation of Health Systems PEC Primary Eye Care PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SCH Schistosomiasis SENOES South Eastem Nigeria Outeach Eyecare Services SIZ Special Intervention Zone SHM Stakeholders meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team iii WHO/APOC, 10 April2003 SSI Sight Savers International STI Sexually Transmitted tnfection TRC Technical Review Committee TB Tt$orEu;tosis TBA Traditional Birttr Attendant TCC Technical consultative committee (APoc scientific advisory goup) TCR Therapeutic Coverage Rate TOT Trainer of tainers LJN United Nations UNICEF United Nations Children's Frxrd LINTVA University Village Association UTG VAS Ultimate Treafinent GoaI Vitamin A Supplerneatation WHO World Health Organization WHO/AFROWorld Health Organization African Regional Office ZOTF Tnnal Onchocerciasis Task Force iv WHO/APOC, 10 April2003 I Definitions (i) Totd.Sqpqldion: the total populallO"n living in mesg&.yfer-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated as 84o/o of the total population in meso/h1per- endemic communities in the project arca. (iiD Annqal Treafnent Obieotiye: (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. (iv) Ultimatp Treafinent Goal fUTG): calculated as the marimum number of people to be treated annually in meso/hyper cndemic areas within the project area, ultimatery to be reached when the p,roject has reached full geographic coverage (normally the project should be expocted to reach the UTG at the end of the 3' year of the project). (v) Therapeutic coveragei number of people treated in a given year over the total population (this should be expressed as a percentage)- (vD GeoEraphical coverage: number of communities treated in a given year over the tohf number of meso/h1per-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) tntegation: The bringing together of two or more health progfams, removing barriers bctrreen/among them, in order to maximise cost-effectiveness and permit free and equal association. For example delivering additional health interventions (i.e. vitrmin A supplements, alben&zole for LF, screening for cataract, etc.) ttpough CDTI (using the same systems, training, supervision and personnel) t1 order-to ma:rimise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities br interventions canied 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 treafinent coverage, integrated into the available healthcare service, with strong community ownemhip, . llsing resources mobilised by the community and the government. WHO/APOC, 10 Aprit 2003v FOLLOW UP ON TCC REGOM]UIEHEATIOilS Using the,mblc belpw fillrn frtp recommendatious qf the last TCC on the project and desoribe how they have been addressed. TCC session _32 Namber of Reconutand ation ln the Renort TCC RECOMMENDATION ACT'TONS TAMN BY TIIE NOTF 8EG*ETARIAT FOn TCg APOC MGT USE ONLY 151 Ihe WG should be recalculated so that WG is not below the nufiber treated This ls noted and reflected in the report. 151 Efrorts should be made to ensure th& aA projects reach tlrc 100% GC and a minimum of 80% TC Improverrents vrere recorded in the cunfut year. Nearly two-thirds of all the States achieved 80% therapeutic coverage But more still need to be done to ensure that all projects achieve and sustain 80% therapeutic coverage.. Efforts are being made but these af,e harrpered by inadequate resources at various levels. 152 CDD/Population ratio is still high This is acknowledged. In 2010 there was a slight improvement with the achievement of a Cnnhoprlationratio of I : 191 153 Review of projects in-country should be encouraged The TRC inNigeria is doing an excellent work not only in rwiewing projects but also in building capacity of the zonal coordinators 154 No participatory monitoring took place in arry proiect This was due to inadequate fundine. 155 Little information was provided on integration and co-impl ementation despite evidence from publications that good activities are toking place More ioformation on integration and co-implementation is capttred in the relevant section of this report. 155 HQs is not showing any steps towards elimination Some actions and activities have been undertaken in this respect. A meeting on this was held and three States were assessed in 2009 while four were epidemiolo gically assessed in 2010. Further details are provided inside the report. TRC Nigeria's recommendations u TRC noted that Helen Keller International has support problems in Adamawa, Alcwa/Ibom and Borno CDTI Programmes. A meeting betweenthe regional director and Public Health Director was requested, but there was no response from HKI. even I WHO/APOC, 10 April2003 NOCP / FMOH is requested to intervene and resolve this issue afrer areminder was sent. This will be followed up. Ill The meeting acbtowledged the imgnrtolgq e{Z,9T{ r.t eelinss as a forumfor the Zorul Coordlnators to review Prajects' technical reports beforeforuarding them to TRC / TCC. It urged Zonal Coordinators to qtpraach NGDO partners for financial wtd mat e rial support while States are encouraged to fund attendance of their Coordinators to such meetlngs. The zonal ofrces should be well eauiooed 7-onal Coordinators have followed up 9! this but ol+tg9mps lvilte reflected in the 201I teehnleal report. Request for the equipping of zonal offices with some basic office items such as laptops has been submitted to the Fcderat Mni$try of Health but thore has beenno positive outcome. Sorne NGDO parrrers have also been approached. ry States are enaouraged to devise innovative ways to a&ocatefor c ounte rpart fandins. P r oj e c t personnel slauld be tratned on the appl i c at I on d c o rnmwti c ati o n sffills in adncacy This was passed on to States. Moreover, a special advisor visited selected States to meet with Executive Governors & some LGA Chalrmen to solicit f,or cotrnterpart funding. Advocacy kits were produced for field testing in UNICEF-assisted States. These will be produced later for use in these States and recommended to other States. Training as recommended is yet to be carried out Y NOCP shoulit srrid| monitbr Mectizan m{mogement at project implementation level to avoid over/under stocbing as well as diversion along distribution clunnels ltus wril be glven specBl emphasis in future monitoring activities YI Facilitate conduct of operational research. The rate ofrefusals and obsentees is alarming in some projects e.g.Imo, Niger, Zomfara CDTI Projects. An operational research should therefore be carried out on this The OR issue is expected to be partly addressd as a starting point, at a planning meeting for UNICEF-assisted States in March 2011. There are OR proposals from Imo and Zamfara that may have some bearing on reduction of refusals and absenteeism. These have been submitted to APOC Management vll Carry out monitoring & evaluation of project This will be done once funds are available. Routine monitoring and supervision do take place occasionally. NOCP should advice States to provide functional ofi c es for State coordinators/ SOCTs. TRC noted that some State coordinators don't have functional offices. Visits to the States have been used to advocate for provision of needed logistic and financial assistance to SOCTs. This will be followed up in subsequent visits I WHO/APOC, 10 April 20032 by all parhlers. NOCP should continue to monitor impl e me ntati on of s us tainab il ity plans by all projects Some States were visited both by NOCP HQs, NOCP Zonal &by both - sometimes with the NGDO Baftffier. I$f;fles A ottooffibs are reflected in this report. NOCP should plan and ensure tlat detailed census of communities is carried out in all Projects in order to estabtrish reallsttc ppulatlon fi gures for effe ctive dntg guontlfication NOCP is working with individual State projects and suppoiting parUlers particularly IINICEF to ensurle this is done. In order to boost the morale of the CDDI and reduce dewandfor incentives, bicycles should be provided for all CDDs from resources mobilized by FMOH, States, LGAs andNGDOs This is yet to be done. (Please add more rows if necessary) 3 WHO/APOC, 10 April 2003 a a Executive $ummary Nigeria is made up of 36 States and the Federal Capital Territory with a population of abotrt 156 million persoru. Total poplrlatuon at risk for Onch.ocprpiasis is about 30 - jZ Ei[iaa persons. In 2010 total number of persons fieated was 28,825,117 out of a total population of 35,983,848 persons. This represented a80% therapeutic coverage rate, and achievemeuts of 96% arrd 95% of the ATO and UTG rospeetively. Overall, the national ther.apeutic eovtragp has been >65% sinee 1999. Details of teatueffs show that all the 31 States and FCT (lO0Yr) achieved > 65Yo therapeutic coverage rate, and nearly two-thirds achieved >80%.. 35,750 communities were teated out of a total of 36,1 I 7 communities targeted, representing a D o/o geographic coverage rate. For the reporting period States with unsatisfactory (<99%) geographic coverage were Niger, Abia, Osun & Kebbi. Reasons muged from change in leadership (Kebbi), insectrity in some areas (Abia), to inadequate managerial abilities (Kwara and Osun). During the reporting period a total of 31,810 health workers (project and health staff) and 187,855 CDDs were tained ot re-trained, representing achievements of 760/o and 80% oftbir ATrOs respectively. Of these 10,228 health workers (32Yr) and A,044 CDDs (337o) were newly tained. The CDD/population ratio has improved to I CDD: 191 persons. Extent of integration of CDTI into PHC varies from one project to another, and from State level to the FLHF level. Generally, Mectizan processes and funding are within the goverffnent system. Joint monitoring/supervision and joint utilization of logistics/transport occur more at the peripheral level than at the project or national levels. CDTI has been used as a vehicle for VAS, PEC, schistosomiasis, Malaria and LF contol prograrnmes to the benefit of all the progranimmes. In abouf 17 SEtes, LF is Fein$ cb-imptemefiE-d anal dvef6iifrmon persons have been reached. In 6 and 4 States VAS and schistosomiasis are being coimplemented respectively. Total population covered were 1.5 million for VAS and 0.7 million for schistosomiasis. About half a million persons were reached for both home management of malaria and ITN disnibution in 5 States. In the course of the year, the NOTF conducted advocacy campaigns, participated in targeted training of programme staff, coordinated procurement of Mectizan and capital itms, organized supervisory, monitoring and epidemiological assessments in selected projects, and ensured transfers of APOC funds to projects while monitoring that expenditures are in line with approved budgets. The NOTF has also conducted routine prograrnme review meetings and sensitizationl mobilization of target populations. Outcomes of epidemiological suryeys indicated that elimination of onchocerciasis tansmission has probably been achieved in 4 foci in Kaduna (2), Ebonyi, ffid Z,arnfara States while 2 sites in Cross Criver may be close to achieving elimination. Taraba foci was on tuack but still had some way to go while the results from the Ondo/Edo sites were unsatisfactory. High level of community awareness, availability of a huge workforce at the community level and health system level, improved CDD/population ratio, greater reach in co-implementing programmes, probable elimination of onchocerciasis transmission in selected foci constitute some of the strengths of the progftllnme. Other strengths include good working relationship of the project officers with NGDO parfrrers and ef,fective coordination of CDTI impleme,ntation at national level. Mectizan processes, apart from the procurement, are well established within the govemment system, and are working perfectly. Poor supervision at all levels, inadequate WHO/APOC, 10 April2003 logistic support, growing tiredness with intake of Mectizan, ffid poor record keeplng at various levels remain the major weaknesses being experienced. Opportunities for strengthening the CDTI process include increasing intemational focrs on integrated cohtoril of He$tectedTrbpical Dtseases (NlUg), dixaileHfiry offltlffian fElioiifirs frir CDTI implementation at all levels, increasing recognition by stakeholders of CDTI as a vehicle for the effective delivery of varied health interventions at the commtrnity level, and increasing involvement of local NGOs, CBOs and associations in the CDTI process. Late releases of aglroved funds by all partrers, poor countorlrart fimding by govemment at all levels; weak levels of community oumership in some of ths projects; demands by CDDs for monetary incentives, and frequent tansfers of health workers still constitute the penasive thneats to effective programme implementation inthe country. To address the challenges the NOTF embarked on monitoring and supervisory visits to make on-the-spot corrections, participated in the development of a stategrc plan for NIDs, conducted advocacy visits targeted at some States, hained and retrained programme managers on areas of deficiency during review meetings, and participated in and encouraged re-mobilization of commtmities in selected States. WHO/APOC, 10 April2003 SECTION { : Background inforination 1.1. General information 1.1.1. Description of the country program-CDTI and vector elimination @riofiy) Status of Nationol plan iruplenuntotion, populotion at risk, nantber of projeca being funplcmented, other rclevant ocfwities, infrastuAwre (eg. Adequate healthfacilitb, is systern decenbattzpd or nol, dc), logfulia, aifrntatsnffitve sfriietilne. Nigeria is made up of 36 States and the Federal Capital Territory with a population of about 160 million persons (projection from 2006 census). It operates a federal system. There is a central goveflunent with the president at the top, supported by execlrtive, legislative and judicial apparatus. Each State has its own govemrnent with the Governor as the chief executive. He is complemented by the sam€ qrpe of stuctures at the fed€ral level but on a State basis. The State cousists of a nrrmber of LGAs with each LGAbeing administered by the Executive Chainnan supported by its miniature legislatine and executive structures. The country is divided into six geo-political zones. There are however 4 health zones for the onchocerciasis control progrzunme and the neglected topical diseases. Each health zone comprises eight to ten States and has a Coordinator for the Onchocerciais Confrol Programme as well as fot a Coordinator for Neglected Tropical Diseases. There are over 23,000 PHC facilities (primary, secondary and tertiary) in the country. Most are public health facilities (about 62%r) while others are privately owned. The total number of health care facilities is still considered grossly inadequate and accessibility (physical and economic access) is a big problem. A majority of the rural populrce is emasculated from adequate health care. Presently Nigeria has 28 projects (27 CD'il projects covering 3l States and the Fderal Capital Territory, as well as the National Headquarters Support Project. About 36 million persons are at risk of the disease. Health system & healrh care delivery $tate any problems related to health system that imp e de p r o g r an imp le mentatio n). The Nigerian govemment has developed a national health policy which targets the reduction of morbidity and mortality rates due to communicable diseases to the barest minimum, reverces the increasing prevalence of non-commuricable diseases, meets global targets on the elimination and eradication of diseases, and significantly increases the life expectancy and quality of life of Nigerians. To achieve this, the health sector has undergone reforms and systems are being stengthened at every level of governme,lrt. [n addition, poverty eradication and alleviation programmes have been established. The National Health Insurance Scheme has been set up. Primary Health Care @HC) is the strategic policS cental function and focus of Nigeria's national health system, and to this is tied the overall social and economic development of the communities. Health Care Delivery is the responsibility of all three tiers of govemment, with each tiertaking care of its level. The Primary Health Care facility is the first level of contact of the community members with the health service, and referrals are made upwards from that level. WHO/APOC, 10 April20037 Provide map locating all projects (CDTI and Yector Control, if any) within coanfry. Sha&d teas tnfuue the comblnedproJeds 1.1.2. Partnerchip Indicote the partn*s lnvolved in project inElementafion at all levels (MoH, NGDh - CDTI Proiect Partners Adamawa MOH, APOC,WHO, HKI, CBBI, LGAs,Communities Ahm Ibom NIOIL APOC,\YI{O, [IKI, L-GAs,eomruniti,es Bauchi APOC. UNICEF, State Government, LGAs, Communities Beirue UMCEF, NOCP, SMOH, LGAs, Federation ofNurses and Midwives (FENAM), Catholic Women Organization (CWO), Benue State Agricultural Development Fund, Agricultural Farmers Association ofNigeria (AFAN), Nigerian Farmers Oreanization (NFO), various community & development associations, Communities Borno MOH. APOC,WHO, filil, LGAs,Commuuities Cross River APOC,WHO, SMOH, LGA, UMCEF, , South Eas0ern Nigeria Ouheach Eyecare Services (SENOES), Ogoja Catholic Eyecarc Services, Cross RiverNational Parlq Cross River Forestry CommissiorU Ttrlsi Chanrai Foundation, Great Friends of Obudu, Pacesetters Klub Exclusive of Calabar, Calabar Leo Club, Catholic Nurses Guild, Youth Care, Opthalmology Dept of University of Calabar, Cross River State Universi8 (CRUTEC[[), Communities klo WHO,APOC, NOTF, LCIF, Carter Center, MOH, LGAs, Communities Delta WHO.APOC.NOTF. LCIF. Carter Center. MOH. LGAs, Communities Ekiti MOH, APOC, WHO, NOCP, UMCEF, LGAs, NGOs/CBOs [Kids & Teens, Boys Brigade, Girls Guide, Boys Scout, Centre for Society reconditioning and Development,Lrfe & Peace Development Commission, Farmers Congress, New Initiative for Social Initiative, Busy Bees and Life Centre Foundation], communities Enuzu WHO, APOC, Carter Center, NOCP, SMOH, LGAs, Communities Anambra WHO, APOC, Carter Center, NOCP, SMOH, LGAs, Communities Ebonvi APOC, WHO, Carter Center, SMOH, Communities FCT APOC, NOCP, CBM, State Govemment, LGAs, Commr.mities Gombe WHO, APOC, UNICEF, FMOH,SMOH, LGAs, Communities 8 WHO/APOC, l0 April2003 Irno APOC, NOCP, LCIF, TCq, SMOH, LGAs, Communities Abia APoc, NocP, LCI, GRBP, sMoH, LGA, ABHSDP lI, communitiespirts cuidq Girls Erigade, Boys Scout, Boys Brigade. Jigawa {lylpH, CBM, SI\,[OH, PHCA, WHO, APOC, LGAs, Healt@Cffis, erii iuli trs Kaduna SS*L N"OCP, State MQII, e.ndemic LGAs. Comurunifircs Kano Kebbi SS.I, NOCP, State MOH, endemii LG-4,s, Communitiei Kosi q $L .Npf.-P- $Ie$p MQ"trI e&foip LGAs, C o-nsu0mitu6 Kwara $stN@H, s@Mo_tt, Niger APOC, WHO, LINICEF, FMOE SMOH, LGAs, "larna'atu Nasril-Islam (JND, Nigeria Red Cross Society, National Union of Road Transport Workgrs, endemic LGAs, Agric. cooperative Q.roups, Trade unions, Age Grades, Communities Ogun UNrcEF, NOCP, State MOH, Christian A society of Nigeria (BsN), NASFAT, DAWAH, NAWA-RU-DEEN, cluistian Corpers' Fellowship (CCF), Market Associations, Commercial Motorcycle Riders Associatiog endernic LGAs, Communities Ondo WHO, APOC, LINICEF, MITOSAJII, FMOH, SMOH, LGAs, Communifies Osun APOC, UNICEF, NOCP, SMOTi, LGAs, Commffies oyo UNrcEF, WHO, APOC, NOCP, MOH, TOES Girls Guilds, Lydia Groups, Man o war Groups, community Development Associations, comtnercial Motorcycle Riders Association, communities Plateau NOCP, MSD, TCC, APOC, LGAs, Communities Nassarawa MDP, APOC, WHO, FMOH, Carter Center, SMOH, LGAs, Communities, NURTW, Women in Health, Jamaatul Nasinrl Islam, Women Fellowship Groups Taraba MITOSATH, MOH, LGAs, CBOs, Communitie.s Yobe MOH, CBM, NOCP, LGAs, MLG &CA,Communi (CDAs), Communities 7-amfara SSI, NOCP, State MOH, MLG & CA, endemic LGAs, Communities Describe overall worklng relatiottship omong pattnerc, clearly indicating specific areas of proiect adivtlies where all partnerc are involved (plonning, supervision, advocaqt, tesources mobilization, endemici$r mapping / assessment, development of IEC mderials, studies or survqts etc). Overall working relationship among partners is good. All parhrers are involved in planning, advocacy, supervision, resource mobilization and sensitization. State plans if any to solve any issues arising as regards CDTI implementation The NOTF is concemed that leadership changes and inadequacy of resources have affected CDTI implementation in the States b"i"g supported by HKI viz: Adarnawa, Borno and Akwa lbom. There are consultations with the organization and among parhrers on the way forward. 9 WHO/APOC, l0 April2003 Nrme of CD'TI PiolC€t TotffituttrmffiIffics hW,h!"er- endemic zone TdCI pop.ulttffffi tf, rueo&ype r-er.daumio zotre T]ffiffitc Tinrillfisilt Goel (UTG) by?,010 Adamawa 2i{4 rc67A64 t316334 Akura Ibom 13 2E6?8 ,2*lN Bauchi 99S tffi6770 '[3ffi5+ Benue 4382 33t0405 2$3*541 Bomo 1660 1257632 1056411 Cross River gss Ln$w rczfize Edo 530 951945 7W634 Delta 4to 617438 5I.8648 Ekiti 422 1208887 t0t5'[64 Enugu 1373 984245 82676;6 Anambra 1062 731537 61449r Ebonyi w3 6l3ls3 315&e FCT 559 492645 413822 Gombe rca+ 1903804 1599195 Imo t647 817180 686431 Abia 564 476228 400033 Jigawa lll 337539 283533 Kaduna 2677 2995506 2516225 Kano 810 727280 610909 Kebbi 2M -1909s3 +610400 Kogi 2544 1672641 140s018 Kwara 1069 1364200 tt45928 Niger 3028 2391412 20f,8;X86 ogtut 952 336082 282309 Ondo 579 r338036 t123946 0sun 1582 1577213 1324859 oyo 2385 t075733 903616 Plateau 296 456965 38385r Nassarawa 589 1060797 891070 Tamba 1509 t708320 1434989 Yobe 247 621536 522090 7amfaru 116 231947 194835 TOTAL 36.117 35'983,848 30235,962 Source: From Oncho Project neports: snecifw Year r ''/ National census: l- Other source, 1.2. Population and llealth system Table 1: Projects and population at risk inthe entire country whether they are treated or not pecify UTG: Calculated as the maximum number of people to be tneated annually in meso/hlper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year ofthe project). t0 WHO/APOC, l0 April 2003 SEGTION 2r Summary of GDTI lmplementation 2,t1. E]e,ttfhrffGffi ffffitrt Chart the actual distribution period for each CDTI Project in the country in the table below. Briefly note any problems/issues (one paragraph). Late receipt of drugs and inadequate mobilization of communities due to late release of funds as well as inadequate funding tend to cause extended periods of distribution.. l1 : Overview of distibution turdertaken by proi rows cts WHO/APOC, 26 September 2003 2.2. Advocacy and Sensltizatlon a) State tke nwqbw snd W ef pofuy / @i{{on mq*aw noM at Ghe nffiiowt sad lower (state and district leve\ during the current yeary the reasons tor the sensifrzttion and outcome. b) State progress made towards internal resource mobillzation. A lot of emphasis is placed on advocacy to policy makers at all levels which in some places has ensured sustenance of government counterpart funding and in some others brought about release of firnds. During this year, a forrrer Minister of State for Heatth with support from APOC, started visiting States with history of non-release of counterpart funding. In a few States like Abia the Health Systems Development Fund has been approached to support some CDTI activities. At the national level, an NTD Plan of Action and policy document have been developed to be utilized in advocating for resources at national and international levels. c) Describe any policy-related consfiaints being faced by any particulor project ond descrtbe what was done to assist the project (outcomc). Explain any plans on how to improve advocacy. No policy-related constraints are being experienced. Level No & Type of Policy makers rfuohiticd Reason for Sensitization Outcome of Mobilizetion National 4 (Mnisters &d, Pemmnent Secretary at federal level; Director Public Health) Orientationon CDTI imple,mentation and the needto improve on count€fpart fuirding by Federal govt Creation of more aw.Ireness on CDTI implementation and the roles of Partrers. Solicitation for the release ofcounterpart fimding Improvement in counterpart firnding State 460 (Commissioners for Health & Local Government, Permanent Secretaries, Directors for Healttg other Directors, Members of the House of Assembly, Members of LG Civil Service Commission) knprovement in cormtdrpart funding in some States and imcreased awaxeness of the distribution programme. LGA lsr I(LGA Chairmen, PHC Directors, councilors, otherpolicy makers at this level) Health education and seasitizatiqn on Onchocerciasis disease and mobilization to support the programme. Increased awareness of the Mectizan distribution programme and release of counterpart funding by some Local Government Councils. t2 WHO/APOC, 10 April2003 2.3. lnformation, Education and communication strategy and materials development Brielly describe the IEC strategt being used in the countrltfor CDTI. The State projects develop their own IEC materials based on what have been done before, and some have gone ahead to develop new ones with input from both the NGDO parhrers and the NOCP HQs. With the increasing emphasis on NTDs, a group has been set up within the NTD Steering Committee to look at training and IEC materials but the group has been unable to work due to funding constraints. Note if any new IEC matertals were developed or revised, the type of the material, the message and target audience, and where thqt were distributed - How were the IEC materials developed ? No new material was developed during the reporting period. - Are the materlals reviewed to address upcoming issues Qike decreasing refusals, sustainability, mnintaining compliance to long-term treilment, SAEs) ? - Report dany KAP surveys have been done and how their resulfr were used? No KAP survey was carried out within the reporting period S ummarize information o n : - The use of appropriate and innovative media and/or other strategies to disseminole information amttng the proj e6 ; To disseminate information among the various projects, the following strategies/channels of communication were utilized : o Radio and televison messages/programmes a Posters/Handbills . Bill boards o Community meetings o Announcements in churches and mosques o Health workers sensitization meetings a Local Town criers a Workshops for various target groups at both State and national levels a Identification, sensitization and mobilization of local NGOs and CBOs. To disseminate information to the various projects, the following strategies/channels of communication were utilized: per zone) 13 WHO/APOC, l0 April 2003 Organization of specific NGDO - assisted States review meeting Supervisory visits to the projects ' Mobillzation and health education of women and minortlies - method and response In the southern part of Nigeria (oastern & western), mobilization and hedth education of women are part and parcel of the community mobilization and health education by health workers and CDDs. This is sfiengthened using family support prognunme advocacy grorfps, community women leaders, trade women associations and faith-based wonren societies. Inthe northern part of the cormtry (and some sections of the West) where ryomen seclrrcion is practiced, Muslim teachers. the public-address system, fernale health workers, traditional birttr attendants (TBAs) and family heads constitute means of health educating and mobilizing 9t Conseq-uenfly, while overall there is an increasing level of participation of women in the country, this is more pronounced in the south than in the north. Minorities are usually mobilized along with others, and where there are language differences appropriate persons are utilized to do the mobilization. Maj or accomplis hments ; Increased involvement of women in the CDTI process reflected in the increased number of frmale CDDs available Sustenance of high teatment coveftrge Sustained awareness of the treatment prograrnme lVe akn es s es/Co ns traints ; are sufficiently inviting as in immunizationcampaigns. Suggest ways to improve mobilization of the target communities among projects. logistics groups etc for community mobilization. current nonn is to have one person in a health facility who is the focal point for mectizan distribution - and it is only this person who is involved. 2.4. Gommunities, involvement in decision-making comment on community participation making comparisons among projects Community participation is reasonably good in Cross River, Kaduna, Taraba, Ebonyi, Anambra and Ondo. In most other projects community participation is waning. To inject niw enthusiasm in the implementation process, co-implementation (especially with llnnphatic filariasis) has been introduced and expanded in various projects. The projecis where commtrnity participation has been poor include FCT, Osun, Ogun, Kwara and Benue. t4 WHO/APOC, 10 April2003 - Pafiicipation of female and youth members of the community at health education meetlngs; This varieE,&wn oae part of.thp country to another. In th.p sorrthnrn psxt of thc cortntsy @ost sections) feniales and youth have the freedom to attend health education sessions with other community members. In some of these parts they can be more vooal thqn the men. However, in the south east, the youths do not attend as they see the programme as belonging to the adults. Moreover, the youths believe they will be more rewarded for their time if tbey are engagod in some activity ttlat will generate morcy. In the north, wotaen are usually not allowed to attend any gathering with the men, including heatrth education sessions. In order to reach wotlen, separate heatth education sessions are organized, and their participation in such sessions can be uninhibited. - In general, how fu you rate the participation of ruinority groups andferwle members in commanity meetings, decision-maHng, (attendance, pafiicipation ln the dlscnssion etc") other lssttcs. In most communities women are not part of the decision processes. They can contribfie but final decisions lie with the men. With the expansion of co-implementation (especially with LF) and increased sensitization on the need for female participation, there has been a general improvement although a lot of improvement is still needed particulaily for projects in the northern part. There have been no reports of marginalization of minority groups. In most parts they become assimilated into the host community and play the roles expected of all commrmity members. 2.5. Gapaei$l building Training of national, district level staff in CDTI and general management skills (eo mputer app-licetiot s, p rgj ect pla4n in g' etc.) BricJly describe any training done by the NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow-up needed). No training activity was organized by the NOTF at the national level in the course of the year, but review meetings were used for training in areas of deficiency identified. Moreever, NOTF members participated in various State/project-level training where it was deemed Table 3: Type of taining undertaken at national level by the GTNO/NOTF the boxes where speci, ininswas carried out How to conduct Health education Others (Operational Research) 15 WHO/APOC, l0 April2003 Briefly describe any technieal assistance provided to the CDTI projects. Technical assistance has been extended to projects in the following areas: o Preparation and review of technical reports o Co-implementation o Conduct of Community Self Monitoring o Rendition of accurate financial retums. This is applicable to projects that have new accountants or have problems in usage of the WHO imprest system. Fill in table 4 on the next page. t6 WHO/APOC, l0 April2003 Tabte 4: Summary oftraining done by projects @lease add more rows ifr&cessary). Ensure that 'New' and 'Refresher' fidining qrc rccorded )arately. Make sure there is no double Project name Number of Proiect stafftrained Number of Health center/post stalf tr4ined Number of other training of trainers ( TOTs) Number of CDIb trained ATrO C' New c, PcIt c, Totrl(ir C.+e, ATrO (- New a. W a" Total CF C.+C, ATrO C. New c,^ ReIr c,, Totrl Crf C."+C, ATrO c.. New Cu Relr C,, Total Grr C-* C,. Adamawa 34 0 34 ?4 1345 204 1044 t248 t7 0 t7 t7 '8275 1661 6614 sdps Akwa Ibom 16 6 t2 18 27 9 t3 22 32 19 0 l9 110 25 92 tt7 Bauchi 33 11 22 33 1857 293 592 885 0 0 0 0 16s47 3159 70s6 102rs Benue 88 J 85 88 1523 209 582 791 154 154 0 t54 19057 26t6 s542 8158 Borno 36 0 36 36 2029 515 996 1511 t20 3 tt7 t20 3405 1041 2012 3053 Cross River 789 7 789 789 2187 0 386 386 0 0 0 0 3350 ts37 3282 4819 Edo 96 t4 82 96 654 246 372 618 24 0 24 24 7t24 r626 3725 5351 Delta 135 57 78 135 6s0 224 268 492 9 0 9 9 4016 tt49 2684 3833 Ekiti 80 t2 20 32 1600 453 547 1000 0 0 0 0 1600 589 571 rzffi Enugu 75 15 45 60 704 185 506 704 300 300 0 300 18046 0 4t1,9 4tt9 Anambra 96 32 66 96 747 478 310 788 95 0 96 96 5485 1703 6486 8rE9 Ebonyi 54 7 47 54 1223 2M t0t7 t223 5 0 5 5 8016 6t3 7547 8160 FCT 31 0 31 3l 1459 4t6 692 I 108 l0 0 10 l0 3500 950 1550 2500 Gombe 50 33 l5 48 434 26s 104 369 130 50 m 130 1U899 601 l22W l&e [no 144 7 53 60 1835 323 t392 t7t5 48 9 38 79 10918 94t 8707 9tr$8 Abia 1.04 34 52 86 600 220 353 573 56 20 29 51 s000 1949 2509 4468 Jigawa 32 0 32 32 288 2t5 101 3t6 98 0 0 98 r808 673 952 1@s 17 WHO/APOC, 26 September 2003 I Kaduna 32 t6 t6 32 I 158 330 36r 691 296 t7l 231 402 8803 361 I 4217 7828 Kano 90 52 38 90 414 l6 398 414 36 36 0 36 5580 2873 2707 5580 Kebbi 21 2 t2 l4 184 rs3 70 223 0 0 0 0 3652 r482 1534 301 5 Kogi 63 25 44 69 3971 s60 2658 3218 476 167 213 405 6750 9622 4353 1397s Kwara 194 68 104 172 204 0 503 923 142 6 97 22 47 69 5550 l3l 8 307 8 4396 Niger 147 18 129 147 378s t32t tr52 2473 955 0 0 0 230s0 t24tt 4426 16837 Ogun 870 158 318 476 620 295 260 555 2430 973 929 1902 Ondo 96 4l 32 73 578 288 227 5ls 0 0 0 0 6450 10s0 5075 6125 Osun 280 20 )1'' 242 1607 276 894 lt70 14514 1993 8703 10655 oyo 161 91 70 l6l 600 600 266 866 44 0 44 44 9000 3119 300s 6124 Plateau 85 0 85 85 939 168 445 6t3 35 0 3s 35 3657 s88 r233 t82t Nassatawa 59 l9 40 59 1281 245 1036 l28t 4l 0 4l 4l 36t6 331 2632 2963 Taraba 79 0 79 79 980 110 529 639 144 2 142 t44 9068 1549 6069 7618 Yobe r44 70 70 t40 3ls r44 143 287 t2 1 il t2 2426 291 2t35 2426 Zamfua 5 0 5 5 118 0 118 118 0 0 0 0 361 0 0 0 TOTAL 42L9 818 2763 3572 37752 9470 1875 5 28218 3235 954 1189 2300 235064 62044 1258 52 18t8s5 7o Achievement 85 7o Achievement 75 7o Achievement 7t To.dchievernent 80 * Ensure that 'New' and 'Refresher' training are recorded separutely. fulake suri thep i" "o do"N" "o"nti"g. 18 WHO/APOC, l0 April2003 2.6. Ordering, storage and delivery of ivermeatin Pleue deseFtbe how Mecttzctt@ ts or&rud aril kow tt gel* to the confrnrm#lo* The assisting NGDOs/States completes the re - application forms for Mectizan and albendazole needed based on data/rquests collected and collated from the projectsllGAs, and forwards same to the NOCP HQs/NOTF Secretariat. The National office/HQ reviews aud collates these into a single re-application which is forwarded to t*'HO and lvDP. On approval Mectizan shipments are received through LINICEF while the WHO country office clears the albendazole consignments. From the NOTF store, the drugs are lifted by the assi$ing NGDOs, or Zonal offices or by the States. Where the fonner applies, the States get their supplies from the NGDOs or Zonal offices and make them available to the LGAs. The LGAs in tum send the required quantities to the health facility centres/collection centers fronr where the communities pick up their drugs. In some cases the LGAs make the drugs available to the communities directly. Plesse comment on whether ivermcctin delivery has been integrated into the essential fuugs delivery system at the national and lower levels or nol State activities ander lvermcctin delivery that are integrated into the nationdl health care system in the coun@. Nigeria is yet to have a national integrated essential drugs delivery system. Several agencies responsible for health care delivery such as the MHCDA and the NPI have set up drug supply/delivery channels to cater for the services that they render. Ivermectin and albendazole delivery at the national and zonal level operates independently of these channels. However, ufuen States and LGAs receive their drug supplies, some keep their consignments in the PHC store with vaccines and som.e otlr_el -esgq$id_ drugs. It qrust be emp-hasrzed tLat dl the processes except procurement are within the govemment system. Moreover, there are several instances where LGA personnel utilize the opportunity of vaccine collection at the State level to pick up their drugs (Mectizan/Albendazole), and vice versa. Please state where any remaining Mectizaa@ ir stored after the distribution cycle. In some States the remaining Mectizan (and/or albendazole) after disnibution is retrieved and stored at the State level. In other cases they are left at the LGA level and whatever is left is deducted from the number requested for the next distibution cycle. Attention is however paid to exprry dates to ensure that expired drugs are not distibuted to cornmunity members. Projects also share/exchange tablets when the exprry dates for a particular batch are close, and teatnents have been concluded or about to in the particular project having the drugs. It is the policy of the NOTF that all expired drugs be retrieved and forwarded to the NOTF Secretariat where they are properly disposed of. t9 WHO/APOC, 26 September 2003 : Mectizan@ 'lease add ntotre rows Project Name Number of Mectizan@ Tablets who (MoII,WEO, UNTCEF, N@ the &wingto lHro{izan ?Requested Received Used Lost Waste d Expired Remeinin o Orders Stses Ilelivcls Adamawa 3312s00 3528817 3349614 842 0 0 178361 Iilil IJNICEFIh,IOH ru(Ift{oHAkwa Ibom 61000 51000 76794 t2 32 0 10956 HIU I'NICEFIh{OH Ifl(I /hdoHBauchi 4564000 4000000 4106763 1019 270 0 0 t5t7t9 FMOH IJNICEF/},TOH Zon€ltfiOHBenue 7706000 7728340 7616162 0 0 rt2t78 FMOHffi T]NICEFAfiO,}I MOTIBorno 2985000 2775000 2689826 1033 8 0 UNICEFAilOII TIKI/MOHCross River 3351500 3351500 327t037 620 336 0 73463 0 FMOH TINICEF/MOTI MOI{Edo 2828000 2828000 2827948 0 52 0 0 CC IJNICEr/AdOH CC /lrdOHDelta t770000 1770000 1769844 0 ts6 0 CC {.INICEFI},IOH cc /fircHEkiti 3203000 3163s07 2900748 0 910 0 26t8/i9 FMOH IJNICEF/I\4OH ZoseftdOH _Enug" 2440000 2440000 243993s 0 65 0 0 CC UNICEf,'/Mr}H CC /II{OHAnambra 1872000 1872000 1718798 55 0 0 t53t47 CC IJNICEFA,IOH CC /t/!OHEbonyi 1s27000 1527000 152696t 39 0 0 0 CC T.IN,ICEF&{OH cc llrfioHFCT 1040000 1045181 1020000 0 196 0 24985 CBMffiffi c0- ur-EcEF/[40[I CB*{',&[ODI 4200000 3453500 3793346 0 154 0 0 IlrsIcEF/A4oil{Imo ZmefOHffi2016000 2016000 2011900 0 t26 0 3974 983 IJMCEF/hfiOIIAbia 1086000 1086000 1069071 0 7092 0 cc I]NICEF/}{OH CClIr#OHJigawa 502500 474833 224228 4 0 0 2t407 CBM I.}MCEF/}4OH CBK4/.MOHKaduna 9962000 7530357 74277t4 1306 0 0 101337 SSI UNICEF/I4OH SSI /$,fOHKano 2385000 2523000 2s20688 23t2 0 0 689 0 0 CBM UNICEF/}{OH CBM /IV{OHKebbi 1255500 12s5s00 28484t 1923 0 1046109 ssI UNICEF'/AdOH ssl /t,[oHKogr 4184437 3781541 3723989 745 0 56807 SSI I,JMCEF/}{OH ssr /a#oH Kwara 4246950 3s64492 3067859 2632 0 0 490001 L54t6t ssr LTNICEFA,IOH SSI /AdOI{ Niger 574270t 4895000 493261t 6040 0 0 FMOI{ UNICEF/MOH ZorelItdOHQgrur I 125000 932s00 844894 0 t42 0 85047 T'NIVA UNICEWil#OH lv[OHOndo 8066000 s715500 s135086 0 t9633 0 8407il FIYIOII UNICEFA,IOtr Zomellt{G- rl 20 WHO/APOC, 26 September2003 a! Gombe l al - Any other comments 2.7. Treatments 2.7.1. Treatment figures Please fiIl in table 6 on the following page. .) Osun 3s40000 3998387 3473326 0 r87 0 524874 FMOH TINICEFA{OH ZonelMOH oyo 26t8t56 2608573 2439697 0 2918 0 16s958 FMOH LTNICEFfuTOH ZoneAvIOH Plateau 1534000 155973t 1082684 0 0 0 477047 CC LINICEF/IVTOH CC A{OH Nassarawa 3403448 3 171000 2506638 0 0 0 170522 CC IJNICEF/I\4OH CC /}4OH Taraba 371 1000 371 1000 3675432 459 0 0 3s109 MITOS I.INICEF/I\4OH MITOSATFYMOH Yobe 1374305 1374305 1321908 0 I 550 0 50847 CBM UNICEFA4OH CBM /IVIOH Zamfara 558000 530000 5t37tt 740 0 0 t5539 SSI UNICEFA{OH SSIA4OH TOTALS 2l WHO/APOC, 10 April2003 : Treatnent and SAEs in all areas at risk add more rows Project CommunitiesA/illaees Populatiton Numberof p€[Inns rrto refuscd the treatrn€nt Numbcrof absenEes Nrmbor ofSAEs 'Number of serious adverse wents (SAEs) rdcrred to &e hedtt p,ost/hospial Total # of comrnunitieV villages in the meso/hyper- endemic areas D, fumual Treatnent Objective D, Number of communitieV villages feated D. Geographical covcr4ge ea Dr= D/Drilfi) Total population of the meso/hyper- endemic areas D. Annual Trcatment Objective D, Numberof p€nsons teated IL Therapeutic covcrage ea Dr= rL/ D.*too Adamawa 27U 2784 2784 100 1567064 1422121 t25W94 80 0 913 0 0 Akwa Ibom 13 l3 l3 100 28628 24396 243sO 85 l5 3l 0 0 Bauchi 998 998 998 100 1646770 13900s4 1307143 79 0 360 0 0 Benue 2382 2382 2360 99 3380405 2839541 2631198 78 r0890 18456 0 0 Borno 1660 1660 1660 100 1257632 968100 1045206 83 26 50 0 0 C/ Nver 9s8 9s8 958 100 t220t27 t027329 984653 82 31 26E 0 0 Edo 530 530 530 100 95t945 779395 779300 82 7557 20tu 0 0 Delta 470 470 470 100 617438 487885 487?09 79 13723 13830 0 o Ekiti 422 422 422 100 1208887 t015464 950153 79 t4t4 2508 0 0 Enugu 1373 1373 1373 100 984245 820204 799883 8l 3l 378 0 0 Anambra 1062 1062 1062 100 731537 609613 590407 8l 433 t267 0 t Ebonyi 973 973 973 r00 613 153 491609 507199 83 l14 5491 0 0 FCT 559 559 559 100 49264s 413822 370532 75 0 34468 0 0 Gombe 1024 1024 1024 r00 1903804 1590914 1558377 82 0 t7t 0 0 Imo 1647 1647 1647 100 El7l80 653E44 639499 78 36sl 10840 0 0 Abia 564 564 533 95 476228 400033 3s3506 74 3855 4tzt 0 0 Jigawa ltl llt ll1 100 337s39 265000 247939 73 120 5570 0 0 22 WHO/APOC, l0 April2003 ecessary) Kaduna 2677 2677 2677 100 299s506 2492216 2423050 8t 182 4645 0 0 Kano 810 810 810 100 72t280 629260 6147t5 M 2660 r 1885 0 0 Kebbi 204 204 t64 EO 190953 160400 136457 72 235 2761 0 0 Kogi 2544 2544 2544 100 1672641 1401954 1362570 8l I007 1270 0 0 Kwara 1069 1069 t02t 96 1364200 1145932 1090m0 s0 206.5 18&17 0 0 Niger 3028 3028 2827 93 2391412 l9t3 130 1840983 77 7394 r7759 0 0 Ogun 9s2 952 952 100 336082 282309 287634 84 0 t7 0 G Ondo 579 579 579 100 1338036 1123946 r082990 8l 17074 26855 0 0 Osun 1582 1582 1557 98 1577213 1322303 1250535 79 M7 71321 0 0 oyo 2385 2385 2385 100 1075733 899718 8788/'2 82 703 tt92t 0 0 Plateau 296 296 296 100 456965 365571 360376 79 0 0 0 0 Nassarawa 589 s89 589 100 1060797 87831 l 845493 84 7 t39 0 0 Taraba 1509 1509 1509 100 1708320 1434989 140s973 8l 1091 9975 0 o Yobe 247 247 247 100 621536 522090 522104 84 590 13283 0 0 Zamfara il6 t16 116 100 231947 194835 1878/.7 8l 392 1542 0 o TOTAL 36,117 36,117 35,750 99 35,983,848 29,966?E E 2lBfi25,1 17 80 75,N| 3&lrIffi 0 e 23 WHO/APOC, l0 April2003 Therapeutic coverage rate = (%) Geographical coverage rate = (%) ATO coverage rate (%) % UTG achieved Number of people fieated x 100 Total population living in meso/hyper-endemic communities within the project area Number of communitieVvillages treated, x I00 Total number of meso/hyper-endemic communities as identified by REMO in the project ar€a = Number of people feated x 100 Annual Treafinent Objective : Number of people trcated x 100 Total number of people to be teated in qeso/h1per-endemic areas within the project area (UTG) ATo'71t dtdd &rtu otpdoru bvrra ht @bp*anuc ds dtd.cDfl pccd tfie b taa$fli t a,",&, b. &!ta u. Irll0 - 1L rrrdrrr.n nad., ol pefu ,o b tdd h Mobpaed* ea *Ltn rL pold dto, ttthnc',f b b. e& {k k pqd ,N e.!fl(no,nuly tL.Fq.d dtoluh q.d.db rdt fic are d*.;eqf*.*,e {duFga}' 24 WHO/APOC, l0 April 2003 - If the projects are not achieving 100% geogaphical coverage and minimum of 65% therapeutic coverage rate or if cov*age rute is fluctuating, state reasons and planshaW@,&'m@&h. The foliiwing States were urtrble to aphieve l00o/o geographical coverage: Abia, Kebbi, Osun, Kwara and Niger. Reasons ranged from chaage in leadership (Kebbi), insecurity in some areas (Abia), to inadequate managerial abilities (Kwara and Osun). All projects achieved more than 65% therapeutic coverage but projects have been informed that the new minimum coverage rate to be achieved and sustained is 80% in view of the cbange of emphasis from contol to elimination. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them? The causes of absenteeism have remained as follows: 1. Late arrival of Mectizan to the community and its distribution during the rainy season/ farming period when some. community members are already in their farm settlements. 2. Temporary registation of non-residents/migrants whose names are retained even when they have gone back to their permment abodes. 3. Inadequate mobilization of communities leading to lack of community decision on time/period of treafioent. The CDD distibutes whenever the drugs arrive without recourse to community mobilization. 4. Shortage of Mectizan which was not discovered and rernedied on time. Those uiho could not be treated are recorded as absentees. The major causes of refirsals too have remained the feeling of well being by at - risk populations and teatnent fatigue following years of Mectizan treatnent. Additionally, some have refirsed due to fear of reaCtions *hich tbok place in tlie past after Mectizan healinent. To deal with these, the NOTF continued in: 1. Sensitizing project managers and parhrers on improved community mobilization and participation, 2. Sensitizing projects and partrers to ensure selection and training of additional CDDs and health workers, 3. Encouraging initiation and expansion of co-implementation in order to re-kindle enthusiasm for boththe health system as well as communities 4. Conducting supervisory visits based on available resources while requesting States and zones to improve quality of supervision. 5. Submitting early application for Mectizan to ensure early receipt for timely delivery to endemic communities. 2.7.3. BrieJly describe all known and verified serious adverse events (SAEO and provide in table 7 the required informalion when availabla The NOTF Secretariat has received no information on any known and verified serious adverse events. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box No case to report 25 WHO/APOC, l0 April2003 tr Cases of Serious Adverse Events (SAEs) that occurred during the reporting period add more rows * SAEs should be verilied by project coordinator Sequelea is defined as those cutes that have not recoveredfully from the SAE and are left with lasting neurological or other debilitating elfects. 26 WHO/APOC, 10 April2003 F ^4 !t a. .,1 2.7.5. A summary of the trend of treatment achievement per project from inception of first CDTI proJect to the current year What is the ultimate teafrnent goal for the entire country? 50123!;g62 IgblgS: Tretuents and coverage by csleodar vear for the .ntire prcject ara,. @leosefll in tk requ&ct! furalor tlra @My as o ttholc - combine datafrom all CDTI projects into a nationalJigure) *Figuresarepopulationestimatesofthetreatedareasonly.I\B:Treatmerrtfigures"ptir. YEAR Total # of communities/ villages in the meso/hyper-endemic areas Er Total # of communitieV Villages treated Geographical coverage vt Er- E/ Errloo Total population of the meso/h1per- endemic arcas Ee Annual Trcatncnt Objective Er Toral Eligible Population Treated Therapeutic coverage(w E= EUE6*100 UTG Coverage (vo) t997 10,884,133* 9,966,273 82 36 1998 34,522 31,429 9l 16,815,571* 10.456.411 62 42 t999 19.384.047 13.168.650 68 51 2000 33,251 26.776 81 18.069.272 15,040,915 t5,486295 86 63 2001 32.499 31.363 97 22.586.567 19,176,179 16.6t8.937 74 67. 2002 36.013 33,14A 92 25,414,526 20,027,503 19,07a,291 75 77 2003 34.542 32.1,n 93 25.675.921 19.628.445 20.432.593 80 83 2004 34.555 31.505 91 26,132,319 20,194,352 20,057,594 77 8t 200s 36.233 3 1,883 88 28.156.752 23.470.557 21,166,922 75 86 2006 34.827 33,777 97 28,097,347 23.615.463 2t.624.052 77 88 2007 34.920 34,062 98 29,327,021 24,184,060 22.782.949 78 93 2008 35,747 34.403 96 31,530,942 25.908.140 23,598488 75 9S 2009 35,984 35.451 98 33.192.932 26.952.255 26,700,224 EO 105 2010 36.t17 35,750 99 35,983,848 29.966.288 28"825.t17 80 95 27 WHOiAPOC, l0 April2003 2,8. $up.ervision 2.8.1 Ffoe#Wrffit *d ww Mn @,the N*W.@*rye*,ee$ @ W whom, obJec{we of supemislon misslon, outcottterfollow-np needed) Table 9: Supervision undertaken by te NOTF (Please add more rows if necessary) Projeet Name Superrdsor Dete Oblecttve of stir6Itrision O utcornelfollor-up needed Nassaraw a Ndrs. A. Nyor, Dr. Ogunmola, Mr. E. Ekpenyong, Mr. A. Samande & Assess 2009 CDTI implementation There is evidenoe of triple drug administration in some of the communities. Advocacy to policy maker sis vital for release of counterpart funds at all levels for improvement of prograrnme irnnlementation. oyo Mr. M.Igbe Sept Supervise CDTI implementation Training was being conducted, after which distribution will commence. Health workers express poor commitnent due to inadeuqtae motivation. Ttiore is nood to advocate for improved counterpart fundine atthe LGA level. Akwa Ibom Mr. J. Eluwa Feb Supervise CDTI implementation Good counterpart funding but Sate t@m's technioal capacity needs to bo enhancod Abia IvIr. J. Eluwa Sept Supervise CDTI imolementation Inadequate counterpart funding and number of LOCTs inadequate for supervision Imo Mr. J. Eluwa June Supervise CDTI implementation Perennial lack of counterpart funding. More advocacy visits needed. Borno C. Okoronkwo Nov- Dqc 2010 Assess 2009 CDTI implementation Several communities were yet to be teated, and in some places had not been heated for several yea$. Comprehensive follow up in 2011 treatnent cycle essential. Taraba Mrs. M. Adenigba, C. Okoronkwo & Mr. E. Ekoenvone Marc h 2010 MonitorMDA coverage in the State Relatively good coverage was obsened but shortagos of albendazole were recorded that reduced coverage of co-implementation with LF. There is need to ensure adequate supply of albendazole in future treatmetrt rounds. Ondo Mrs. F. Olam[iu, Dr. U. Ekpo, Mrs M. Adenigba& Ms L. Nwafor April 2010 Assess the status ofyear 2009 MDA implementatio Poor therapeutic coverage observed in &e 3 LGAs sampled though 100% geographic ooverage was attained. There is need fu project to improve on supervision and monitoring as well as in data management. Partrers need to be more involved in monitoring of activities in the proiect. Adamaw a Shehu Jubril secon d half of 2010 Supervise CDTI implementation Early delivery of drugs to be ensured Bomo Shehu Jubril Supervise CDTI implementation Improve community awareness of roles in CDTI Kano Shehu Jubril Supervise CDTI implementation Good counterpart funding. There is need to improve quality of Drogramme implementation Ekiti Mr. A. O. Jaieyoba Supervise CDTI implementation Imptoved commitment by health workers to be worked on Ondo Mr. A. O. Jaievoba Supervise CDTI implementation The LOCT to be reinvigorated 28 WHO/APOC, 10 April2003 2.8. 1. Wb*, awe M"awil, tggge'.. AW @. W*l*fia*l . Inadequate and poor qualfiy of supervision by project manageni and health worters o Poor quality fraining thus creating knowledge gaps . Loglstics in deplorable condition in some places o Poor Commlnfty support to distributors o Latearrival of drugs and consequently, late teahent of community members o Inadequate awareness of roles aad responsibilities of conrraunitics in some areas o Counterpart funding remains a big challenge at both State and LGA levels. 2.8.2. Was a standard supervlsion chechllst wed? In most instanses checklists were tsed but in other cases where some zonal personnel carried out supervision alone such checklists were not used. 2,8.3. What were the o*tc- o*es at each lsvel qf CDTI itryk*qwt*lfum stpervised? A comprehensive TOT was carried out in Ondo State with support from MITOSATH, APOC and LJNICEF. Similar nainine is being planned for Borno if the necessary funds are accessed. Advocacy was carried out with policy makers for improved counterpart funding. Planning and debriefing meetings were held with programme manage$ on the way forward. NOTF members participated in various CDTI activities such as training, community mobilization and sensitization to ensure some of the issues were addressed. 2.8.4. Wasfee&baek given to the supervised and howwas lhqeedback used iu improving the overall pedormance of the proJect? Feedback is usually provided to those supervised furing debriefing meetings or at review meetings as well as circulation of reports of such activities where this was documented. Outcomes of assessments in Ondo and Tarabahave led to improvements in MDA in 2010. There is no doubt that these superrrisory activities have contributed to improving treatuent coverage in the country with project managers making more efforts to address issues that have been raised. 2.9. GommuniQr self-monitoring and Stakeholders Meeting Table l0: Commrmity self-monitoring and Stakeholders Meeting (Please add more rows if necessary) 29 WHO/APOC, 10 April 2003 Project Name Total # of LGAs or disticjs,intbs sffire oroirct mea No. and % ofLGAs or l|&ffifuf car-riedpl# sdfmonitorins (CSM) No. and % of LGAs ordishicts ft*+m*@MsHffs mpoting (Sffi) Adamawa t7 9(53Y0) e (53%) Akwa Ibom 2 2 (t0ltr/o) 2 (l00%a) Bauchi It 0{V/o) 0 (09/o) Elenue 22 5 (23%) 0 (0?6) Borno 12 12 (lWY,) t?llqti%l Cross River l5 15 (ltrro) 15 (lfllYo) Edo t2 7 (58Yo\ 7 (s8%) Delta 9 9 (10QY,) e (100%) Ekiti l6 t6 (1009/0) 16 (10070) Enugu t5 15 (100%) 3 (33W Anambra l6 l6 (10070 16 (I00%) Ebonyi l0 10 (10070) l0 (100%) FCT 6 6 (tov/o) 6 (l00yo) Gombe 10 l0 (10F/0 10 (10CIY0) Imo l6 t6 (t00,%) 16 (1m7o) Abia 8 I (10070) 8 (100yo) Jigawa I 8 (1009/0) 8 (100Yo) I(aduna l6 16 (r00%) 16 (100%) I(ano l8 l8 (100olo) 0 (0%) Kebbi 6 0 (0%) 0 (0Yr) I(ogi 2t s Q4%) s (24%) Kwara t6 0 (0%) 0 (,0%) Niger 2t 2l (lDo/o) 21(Ja0%) Ogun 8 8 (10070) 8 (100%) Ondo t4 t4 (t0n,%\ t4 (100%) Osun 28 22 (79o/o) t4 (s0yo) oyo 23 23 (100%\ 23 (100o/o) Plateau 5 5 (1009/0) s (100%) Nassarawa 7 7 (100Yo) 7 (100%\ Taraba t2 8 Qsya 0 (Wo) Yobe t2 t2(100%) 12 (100o/o') Zamfara 5 5 (100%) 0 (0%) TOTAL 417 328 Qgo/o) 272 (65%0l Describe how the resuhs of the community seut- rrunitoring and stakeholdcrs meetings have alfected project irnplemcntation or how they would be ufilized during the next treatment cycle. Where CSM and SHM are being implementedthe following have been observed: 2.10 Compliance to long-term treatmentwith Ivermectin 30 WHO/APOC, l0 April2003 Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with longiterm mass trea[nmt with ivsmeclin? (Fat-Nqis$i 4..&ed fuw years old) Table I l: Activities ofNOTF that promote compliance to long-term treatuent with ivermectin SEGTION 3: Other activities of the NOTF 3.1 Desoibe any additional activities undefiaken by the NOTF (REMO' RAPLOA, KAP studies, vector elimination where applicable, etc). As part of efforts to expand co-implementation with LF, RAPLOA surveys were conducted in Ogun State, Cross River State, Benue State, Osun State and Akwa Ibom. A total of 312 communities were surveyed in 21 LGAs. 15 communities (6 in Onna LGA, Akwa Ibom) were having more than 40Yo of the respondents report a history of eye wonn. A meeting on elimination of onchocerciasis infection and intemrption of transmission was organized by Federal Ministry of Health/ National Onchocerciasis Control Programme 3l WHO/APOC, 10 April 2003 Obiecttue Snecific ActMties Proiect tarcGtcd l. Promote Integration of CDTI with other health care services Conducted taining for co- implementation with LF Conducted training for co- implementation with malaria Ondo, Ekid, Plateau" Nassarawa, Osuq Kaduna, Kogi, Kebbi, Kano, Kwara, Taafara, Jigawa, Taraba, Yobe and FCT Cross River, Benue, Bauchi and Anambra 2. Maintain high therapeutic e65%) and geographic(I00%) coverage . Appraisal Meeting Avlanagement Training for SOCTs/LOCTs a All CDTI States 3. Promote strong communi8 ownership o 4. Promote high govemment commitment o Advocacy Visits byNOCP & NGDOs o Special advocacy visits by Special Advocate with support from APOC o Hosted the 166 session of the Joint Action Forum All CDTI States Oswr, Kogi, Benue, Kebbi, Niger, Kwara 5. Support strong partnership Periodic meetings with NGDO partrers both formally and infonnally to address developine issues AII CDTI States 6. Put in place a stong IEC strategy that encourages continued treatnent Other (FMOHAIOCP), in collaboration with WHO/APOC. Participants included representatives from APOC, NGDOs and NOCP. The State Onchocerciasis Cjontrol Coordinators as well as some indepnndent scientiqts affiedd the mcsting. The obj.ectives e,f the mGsting were to: ' Obtain inputs from participants on conceptual and operational issues in onchocerciasis elimination with ivennectin freatment; ' Discuss the principle and operational delineation of Onchocerciasis transmission zones; r Discuss the endpoints when to stop teatuent: indicators, criteria and evaluation procedures; . Delineate areas to stop ivennectin treatrent. At the end of the meeting the following resolutions emerged:I The meeting after due consideration of the curent status of , prograrnme in Nigeria agreed that Onchocerciasis elimination is achievable in some parts of the cowtry. ' The goup reviewed the document on the conceptual and operational Onchocerciasis elimination with ivermectin teatnent and: o Adopted it subject to suggested amendments. o Recommended that a simplified version of the document be produced for the' implementers. ' The maps showing the transmission zones for the entire counbry delineated during the meeting are to be submitted to APOC Management. ' The meeting identified the States to be evaluated in 2011 based on consistent high geographic and therapeutic coverage for at least 10 years. These are Ekiti, Enugu, Gombe and Yobe States ' Further capacrty need to be developed in-country for epidemiological and entomological evaluations ' Budgets should be submitted through NOCP by the for:r Projects selected for epidemiological evaluation commencing 2011. Deadline for submission is 3ls October,2010. As a follow up to this meeting the maps developed have been submiued along with the requested budgets. Earlier in the year elimination studies were caried out n 7amfura, Ondo/Edo, Ebonyi. This was a follow up on earlier studies conducted n 2OO9 in Kaduoa, Cross River and Taraba. Results from the studies indicated that elimination of onchocerciasis transmission has probably been achieved in 4 foci in Kadr:na (2), Ebonyi, arrd,7-amfataStates while 2 sites in Cross Criver may be close to achieving elimination. Taraba foci was on hack but still had some way to go while the results from the Ondo/Edo sites were unsatisfactory. The NOTFA{igeria is considering these results in respect of t}re best way forward for the affected States. There is however no doubt that further investigations are needed in those areas where elimination has been probably achieved. In preparation for the entomological studies that will also be carried out in the sites evaluated epidemiologically, the cotrntry sJnt 8 persons for a 3-week training in medical entomology organized by the African Programme for Onchocerciasis Control (APOC) and the Multi Disease Surveillance Centre (MDSC) in Kara, Togo. A geographic coverage survey was conducted with support from APOC n7 States of Abia, Imo, Osun, Ananmbra, Enugrq Kogi and FCT. Results indicated inadequate teatment coverage in some places and nonJisting of communities that are being treated or supposed to be treated. Onchocerciasis possible and framework of 32 WHO/APOC, l0 April2003 The Nigerian NOTF hosted the 166 session of the Joint Action Forum and this proved to be a huge success. 3.2 What was done to coordtnate CDTI hoiect activities? The following was done as part of efforts to coordinate CDTI Project activities: o Conduct of review meetings for all assisted States where status of implementation was assessed and srrygssioq$ mado. Review of reports, Featnreut and taining dritq and feedback is providod to projects. Visits to some pfojects for on-the-spot assessment of situation of things and provision of corrections wtrere needed. Periodic z.or:rrl rheetings where status of CDTI implementation and issues therefiom are discussed and addressed. Significant issues are brought forward to the NOTF meetings for further deliberation. Feedback is given through the zonal office. Zanal coordinatsrs' visits to projects urithin their areas of oversight. Issues they cannot address or that needed more input are referred to the national office. Correspondence (by email or courier) with projects on salient points One-on-one meetings with project staff at national HQs to resolve technical, managerial or financial issues 3.3 Note meetlngs convenedfor the NOTF. (objective of meeting, issues uddre.ssed, date, participants, otttcomc, constraints faced follow-up needed) l. Two meetings of the NOTF were held to review CDTI implementation in the counfiy. Participants included members of the NGDO Coalition, Zonal Coordinalors and NOCP officers. The meetings were held March 18, 2010 anl October22,20l0. At the first meeting there were deliberations on such issues as Mectizan procurement delivery and management, project performance on CDTI, development of improved IEC materials for projects, conduct of REMO update in Benue State, holding of Zor:ril meetings, submission of financial returns and capital equipment replacement. There v/ere presentations and re,ports from NOCP Headquarterc, 7-onal offices and the NGDO Coalition. A special session with some eminent persons was held prior to the NOTF meeting. At the end of the meeting, the following resolutions and recommendations were made: a. NOCP should revise the budget for the development of nedrevised IEC materials that was initiated in Jos and share the budget with partners for consideration and suPport b. To ensure early receipt of Mectizan shipments for subsequent teafrnent cycles, States and supporting NGDOs are urged to submit by the end of every first quarter the required re-applications to NOCP for processing and transrnission to MDP. c. The NOTF notes the acceptance of the National policy on NTDs and encourages the finalization, production and circulation of the Plan of Action as a means of atEacting support for NTD controVelimination. d. WHOAIigeria should expedite action on the disposal of obsolete capital items and transfer of some to the MOH so that gaps relating to logistics available to projects would be clearly seen and appropriate actions initiated. WHO is also requested to support the APOC Finance Officer to develop in collaboration with the NOCP HQs Accountant a checklist for monitoring use of counterpart funds and share the draft a o a a 33 WHO/APOC, 10 April 2003 d. document as early as practicable to avoid furttrer delay in obtaining information on this. The NOTF fiote$ with appreeiation the d€eisium sf NGDOs.to fue all relwad &a on NTDs with the FMoH by the 17ft of April 2010 in order to improve on the docrrmentation and wider sharing of achievements made in the controUelimindion of NTDs and Vision 2020 n Nigeria. In order to fast track this process, the NTD Coordinator is rcquested to circulate to NGDOs a template by the 24ft of March 2010. The NTD Coordnator is also to buitd an integrated data managemont system and share as appropriat€ with relerrant stakoholders. In view of the poor performance of the HKl-assisted States and the financial constraints the organization has been facing in recent yeaftt, NOCP is requested to convene a meeting with HKI and its suppoit€d States to fashion away forward. Participants note that Sightsavers Intemational will now be known as Sightsavers with a new logo. Moreover, NGDOs are advised to seek legal opinion where there are changes in their mandate, mode of operations, names or logos, and ensure that all relevant govemment agencies and other parhrers are officially notified and conhactual agreements such as MOUs revised where appropriate. Recommendations by a Group of Eminent Persons to the NOTF from a Special Session of the NGDO Coalition Meeting: It was noted that successful implementation of the mass Mectizan@ distibution programme requires adequate funding from all partrers. Therefore NOTF, States, LGAs and communities should mobilize adequate resources in-county to sustain the prograrnme until Onchocerciasis is no longer a public health problem in Nigeria, therefore funds should be mobilized urgently for completion of mapping of NTDs and for printing of NTD related documents including National policy and National plan of action. NOTF should ensure effective coordination of resources and donated commodities for NTD conhol, in the context of CDI. The Primary Health Care policy is stategic and central to the function and focus of Nigeria's national health system. In order to shengthen PHC and promote sustainability, NOTF should ensure that CDI is adopted as the strategy for implementation of community based health intervention (CBHI). NGDOs are encouraged to promote integration in programrne implementation so that those which are not well funded can piggy-back on the better funded ones and also support up-scaling of co-implementation in the contoVelimination of NTDs and Vision 2020. NGDOs are encouraged to intensifu supervision, monitoring and surveillance preferably using acceptable integrated reporting systems. NOTF should ensure that projects implement sustainability plans, and past recommendations (TCC, TRC, monitoring & evaluation). NGDOs are encouraged to expand their partrrership structure beyond Onchocerciasis control to other NTDs and Vision 2020, share experiences and lessons learnt with new entrants. 34 WHO/APOC, 10 April2003 b. g. The NGDO group expressed the need for a more comprehensive coordination by the FMoH which will cover all aspects of Vision 2020 andNTDs. Possible reshuctnring is re$dred and should be aimed at avoiding pregraeme aad meaing comparbnentalization The second meeting deliberated on outstanding issues; and the conclusions and recommendations reached were as follows: a. Following the inability of the Benue State Coordinator to forward a comprehensive report on REMO carried out in Makdi LGA, the A-Zonal Coor,dinator is roquested to sort out the issue with the State and bring a feedback to the next NOTF meeting. b. The meeting reiterate"s the importance of holding regular Zowl meetings to enable 7rtnal Coordinators arisess progress of projects' implementation and to review technical reports in order to develop and present comprehenslve reports at subsequent NOTF and annual review meetings. c. With regards to treafinent with mectizan in areas co-endemic for loa loa, pafiicipnnts note the information from a risk-model map presented at TCC35 thatNigeria may be at low risk for SAEs dtre to loa loa co-endomioity. The meeting however re- emphasizes and reiterates. Its earlier recommendations that:(i) [n areas where ivermectin treafinent has been on-going for several years, MDA for LF elimination can be upscaled after baseline has been conducted.(ii) In non-onchocerciasis endemics or hypo-endemic LGAs that are ivermectin-narVe but are targeted for MDA, there will be need for RAPLOA surveys especially in the South East and South-South regions of the country.(iil) All parerers should incorporate management of S.AEs in their trainiug agenda for health workers and CDDs and ensure active phamaco-vigilance where MDA is being initiated. d. The meeting agrees that obsolete and non-firnctional equipment be auctioned The NOCP HQs is requested to liaise with APOC Management to fast-track this process. e. Members sfiessed the need for all parErers to intensiff supervision of projects in order to enhance project technical and financial performance. f. The meeting views with concem the lackadaisical attitude of some State projects in the collection of capital equipment donated by APOC. Consequenfly, NOCP HQs should give a dead-line to the affected States to pick up their items or risk them being re- allocated to States that will need them. g. The meeting notes the admission of two new NGDOs, Amen Health Foundation and Netherland Leprosy Relief (NLR) to the NGDO Coalition Group and encourages.them to improve on their support especially to the States they are reported to be assisting. h. All expired Mectizan tablets at the NGDO and State levels should be documented and retumed to NOCP through the Central Medical Store, Oshodi, Lagos for destruction- i. The meeting calls for the revitalization of the process commenced at the Jos meeting in 2008 for the development of revised IEC materials. It notes that the budget circularcd by the sub-committee to continue this. process will be reviewed by members and a feedback grven to NOCP by the 30m of November,2Ol0. The sub-committee is requested to incorporate, where feasible, IEC materials that address SCH and STH issuesj. Meanwhile, NOCP is urged to provide guidance on production of new IEC materials especially posters by State projects to ensure correctness of information and message. 35 WHO/APOC, 10 April2003 l. In view of recent findings from inventory assessment visits to selected States and NGDO offices that Mectizan are being sold in the open market, N0CP HQs is requested to discuss with NAFDAC HQs the possibilrsr.of.fh€ State NAFDAC offisps.gning on raid for sale of Mectizan in Plateau, Kadutra arrd Bauchi States. Souces of Metizsn tablets purchased in Plateau and Kaduna States should be fraced through thc batoh nurrbers. Members recommend that funds e4pected from the Federal Government for LF map1xng should be utilized also for bascline surveys especially inthe UMCEF- assisted Statos. m. The meeting reiterarcs the need for effective monitoring of utilization of State counterpart contributions by projects. NOCP HQs is requested to liaise with the Chair of the NGDO Coalition to produce the template for reporting utilization of such contibutions. Additiotrally, participants call on all partners to share information" annually on financial contributions to CDTI implementation. n. The meeting notes the issues relating to HKI support to assisted States in Nigeria and requests the organiz,ation to respond urgently to the Federal Ministry of Health's invitation to discuss the way forward. o. Members received an update on preparation for hosting of JAF 16 and note the request by the Chair of LOC sub-committee on resource mobilization firc NOTF notes the pledge made by the NGDO Coalition to support hosting of the JAF as well as the promise to gtve a feedback on the extent of its support by the ls of November, 2010 p. The meeting reminds parfrrers that the NOTF is the highest decision-making body regarding Onchocerciasis control in Nigeri4 and therefore its guidelines and decisions are to be implemented at all levels. q. Participants received the report of the meeting of Community Based Organizations and local NGOs that held on the 20h of October 20l0.Members are advised to encourage and work with these parhers. Meanwhile the meeting notes the proposed review of the expansion of the mandate of the I.IGDO Coalition to cover NTDs and Vision 2020 activities and looks fuward to receiving its report. 2. A review meetings for APOC - assisted States wtrich was combined with tafuing on the new APOC financial reporting guidelines was held October l6m - 19ft,2010. The major objectives wer€: o Review 2009 and 2010 CDTI & co-imple,mentation . Provide orientation on the newmethod of financial reporting o Finalize 2011 PABs for submission to APOC o Discuss on the way forward with regards to elimination Key recommendations from the meeting were: a. Participants notes the reports presented by 7-onal Coordinators but observes that there were significant gaps due to lack of information from some States. In view of this, it was resolved that any State that did not submit report to the Trlrmrl Coordinator ahead of review meetings will not be allowed to present his report. Additional, the State Coordinator or his representative at such meetings risk not being paid his/her entitlements, where applicable. b. The meeting views with concem the non-utilization of 2009 and 2010 Albendazole consignments by the Adamawa State CDTI project for mass drug adminishation (I!DA) because baseline survey for LF had not been carried out. The State Coordinator is advised to ensure that the baseline survey is completed by the 30ft 36 WHO/APOC, 10 April2ffi3 i. of October 2010 or have its albendazole drugs retrieved and re-allocated to other States. The NOTF should meot with Coordinators sf Osun, Edo aod o&er Ststes (Abia Kwara, Anambra, Ogun, Borno, Yobe and Plateau) with problems of lack of counterpart firnding to develop a plan of action for advocacy to the State policy makers to address this issue. APOC/NOCPAIGDO should liaise with the Edo state Project to address the poor troaffient compliance observed during the just concluded epidemiological evaluation. In view of this Edo State Coordinator was roquested to submit to NOCP HQs, by November ending, an updated report on how the issues that came up from the evaluation were addressed and relate it to their project need for possible fimding through the Special Country Initiative. Concerns were raised on lack of information on the use of counterpart contribution provided by the States. Projects are advised to ensure judicious use of this fund, and ensure improved coverage, data management, CDD/population ratio and census update. Projects are encouraged to involve NOCP and NGDO partners in monitoring of their activities as this will improve project perfornance. They are further requested to make adequate provision for this in their annual Plans of Action & Budget (PAB) under the appropriate line item. States that have implemented Community Self monitoring (CSM) and Stakeholders Meeting (Sfilvl) and still have compliance and other programmatic challenges are advised to consider developing an operational research in those areas for further investigation. The meeting emphasizes the need for intensive supervision by State coordinators especially at the community level for early detection and management of constaints. In line with the above: o hojects are advised to carry out household heatnent coverage sunrey at the end of each tneatnent cycle. NOTF should build capaclty of States to conduct this exercise effectively. o NOTF should review current monitoring and supervisory checklists and update them. NOCP should disaggregate data from the joint projects in future presentations to allow for better understanding of individual State's performance. Participants expressed concern on the non availability/poor quallty of report presented by some Zones and projects and advised that Zonal meetings be held atread of National meetings as this will allow for dataharmonisation and improved reporting. NOCP is requested to conduct taining of data managers, which will be cascaded to lower levels, for improved data entry and management.. Additionally, State coordinators are urged to involve data managers in monitoring of field activities to enable them identiff and manage some of data inconsistencies where they arise. j. 37 WHO/APOC, l0 April2003 d. (}E' h. k' N0CP should clariff by 3l't December 2010 the support of Helen Keller Intemational (HKD to Akwa-Ibom and other supported States in line with TCC34 roeorlrffi&tiofl. l' To improve the involvement of female CDDs in various CDTI project, NOCp is urged to share with parftrers the recornmendations of an earlier operational research on female involveme,nt conducted by Dr Badaki. Further recolntrrendetions reaGhed during the conbined session with project Accountants: m. Projects are urged to finalize their Plans of Action and Budgets (pABs) and zubmit to the BFo/APocw 22"d ocbber zoto. n' The meeting notes that therc is the need to build capacity at NOCP headquhrters on the new accounting procedwes as well as provide appropriate soanners and laptops for effective implementation of the new APOC retirementprocodgres. o' Following reported cas@s of missing returns sent to NOCp, thc meeting recommends that NOCP acknowledge in uriting any financial report submitted to it by the projects. p' Participants note, from the presentation on the status of returns, that some projects have outstanding rotirpments qp to 12 months, ffid urge projects to submit all outstanding returns by Thursday 2l't october 2010 to the BFo/Apoc.q' NOCP in collaboration with WHO should develop a comprehensive list of all the projects that will need scanners and internet modems for the implementation of the new retirement procedures. WHOA,ligeria is requested to provide estimates for the procurement of these items, and to submit to APOC management for approval and purchrtse. As a follow up on the resolutions of the meetings, Nocp did the following:o In collaboration with States and NGDO partrrers conducted napfOn surveys and baseline surveys for expansion ofMass nrug Administration for LF elimination TheRAPLOA surveys were with emphasis on ivirmectin-naive LGAs.o Ensured leadership changes in Bauchi and Kebbi Stateso Encouraged r}tegrated delivery ofprogrammes especially with respect to mass chemotherapies o Commenced household treatnent coverage surveys to validate reported coverage rates, thus showing the direction for future supervisory visits.o organization of a data management workshop for selected stateso Participated in taining of project personnel in order to improve their skills 3.4 Note meetings attended to provide technical input to other projects, other or other sectors. Meeting/lVlission Place/Project/ Country Responsible Person Development ofNTD Master plan Nigeria Dr. Y. A. Saka,lv[r. E. Davies & C. Okoronkwo Child Health Week CampAgnJin nZone Edo State, Nieeria Otunba A. O. Jaiyeoba Meeting on NTD Mapping Ouagadougou, Burkina Faso Dr. Y. A. Saka & C. Okoronkd 38 WHO/APOC, l0 April2003 3.5 Briefly state any administtative duties undertaken - Number and type of reports reviewed (technical, financial), Technical reports and financial returns from all projects were reviewed, and forwarded to APOC Management/Technical Review Committee. - Reportsforworded to APOC management, All reports for review either by TRC or TCC are forwarded to APOC Management. In the year being reported reports from all projects (though for different years) were forwarded to APOC management. - Administrative assistance or trouble shootingfor projects. Following concems on the extent of support of HKI to its assisted States a visit was paid to Bomo. The outcome showed that CDTI implementation was sub-optimal and comprehensive shake-up was needed. Further meetings were held with HKI but changes in leadership and a lacuna created delayed follow up. 3.6 Insert the Plnn of Actbn for the NOTF activities for the current year indicating activities by month, which were implemented. This is included. The activities done are clearly marked >>. See Annex I 3.7 Insert the Plon of Action for next year. This is attached as Annex I 39 WHO/APOC, 10 April 2003 SEGTION 4: Support to GDTI 4.1. Financia! contributions of the partnerc of financial contibutions by all parfrers to aII CDTI for the year under Name of project Contribution (money or items in kind released) in US $ Ministry of Health NGDO Parher Local CBO/ communities Distict/LGA Others APOC Adamawa 10,560 4,599 134,639 504.27 8,621.27 Akwa Ibom Bauchi 44,gtg.g6 10,721.75 93,099.1 32,671.55 Benue 35,519.52 1639s.47 186,477.79 62,536.57 Borno 33,961 123,357 Cross River 7,579.29 t5,007.25 6t,796.47 37,509.93 Edo 6,057.33 33,590.35 t94,926.67 3L,920.17 Delta 51,669.65 38,446.t5 240,276.93 46,259.62 Ekiti 24,201 3,693 29,199.67 Enugu 49,316.63 7,961 33,794.77 3,502.00 15,364 Anambra 1,024 12,172.50 2,035.71 l6,4g9 11,513 20,743.90 Ebonyi 5,200 5,813 11,933 41,7M FCT 12,779 2,000 35,937 Gombe 19,660 4,667.99 168,546 10,000 lmo 748.3 6,577.93 10,962.1 3,0gg.l 39,942.7 40 '' WHO/APOC, l0 April2003 l Abia 7,564.5 )ry 14.87 57,004 21,594,14 e"a_6,o- Jlgawa tzsr/D z)rv5u g1,9g6 13,000Kaduna t56,730 38,655.92 143,071 14,449.70 47,069.39Kano^ l31,gg0 J,IUI 135,500 38,903Kebbi Kog 74,341 luruu /.4I 66,407 2,407.41 65,954.2Kwara 54,lgg zu,l55 47,A59 Niger 58,966.67 L)J56.O7 7t2J8A 51,265.73Ogurt 13,9m 54,976 Ondo 128,982 IU,OO I 17l,35g 18,706.5Osrm 1,347.99 72.73 32,272.95 oyo 69,433 /,u05 1,25,L71 2,500.91 45,947 Plateau 31,529 l3,l4u.l5 605,394 14,760 Nassarawa 17,795 16,566.67 20,900 23,061.33 Taraba 80,090 1s3209 Yobe 47,726 296,471 7-anfaru 2,997 16,695 Total lr3g4,7gl 332"339 21035"71. 4,0,r,,ln s0,976.29 745,636.41 fuiosof fuW rrrrqnsof 4l WHO/APOC, l0 April2003 t lf there are problems with release of counterpartfunds, how were they addressed? - Comments . Routine advocacy visits were paid to policy makers o A special advocate, the former Minister of State for Health, paid top-level advocacy visits to 6 States o IntegBted approaches were encouraged State the number of projects that had nofundingfromAPoc Trust Fund? Nil State the number of projects that had nofundingfrom any outside source? Nil All projects had some funding from their assisting NGDOs, but the degree varies. State the number of projects that are late in submbsion of theJinancial reports to APOA 4.2. Other forms of community support Describe (indicateforms otin-kfnd contrlbutlons of communities if any) Communities made 'in-kind' contributions inthe following ways: i. Community members volunteer to help the CDDs on their farms. ii. Recomme,ndation for inclusion of CDDs for other incentive grving social services like Polio Eradication and Guineaworm surveillance. iii. Exemption of CDDs from some community levies or dues. iv. Provision of food to CDDs during distribution v. Provision of venue for CDD taining. vi. The purchase of hard cover note books for the registration of the population. vii. Prayers for dishibuton viii. Special recognition during celebrations or festivals in the community. ix. Provision of refreshment during CDD training or visits by health workers/ monitors x. Provision of foodstufffann produce to supervising health workers 4.9. Resource mobllization efforts Desstbe actlvltlcs underta*cn by the NOTF to raise funds or mobilize in-hind resotoces aad the outanw of those efiofis. A Special advocate with APOC support went to 6 States where she met with the Chief Executives or/and other top polioy makers to solicit for cormterpart funding. The States targeted were Osun, Kogi, Kebbi, Kwara, Niger, and Benue that had contibuted very little to CDTI implementatation since project inception. So .far only Kogi State had responded with a late release of about N3.5 million which will be used in 2011. . The NOTF organized a meeting with local NGOs but affendance was poor. But those that ' came from Imo, Kwara, and Delta States will be followed up. We have received information that the NGO from Imo has started providing some fimding to the project. 4.4. Expenditure per activity by the NOTF secretariat Indicate the *penditure on activities below in US dollors using the current United Nations uchange rate lo local curren? (=N=150 to 1$) 42 WHO/APOC, l0 April2003 Activitv of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to proiects, districts, etc 3,384.27 Monitoring & supervision of CDTI Proiects+ 2,453.30 14,004.55 Training of Project officers, TOT, NOTF staff, etc. 17,841.90 5,505.20 Advocacy visits to health and political authorities at national level 13,093.10 500,000* IEC KAP studies, materials develop4qg4! 4,603.38 Annual review workshops 8,195.70 Bi annual NOTF meetings 8,722.37 32,535.76 Fuel and maintenance of Vehicles, Maintenance of office equipment Stationery Others (Top-Ups/Bank Charees) 4,542.59 TOTAL 62,836.61 500,000 52,045.51 Total number of persons treated 281825,117 *Used for the hostins of the l6* sessicrn of the Joint Action Forulln rn Table 13: tndicate how much the NOTF secretariat project spent for each activity listed below during the reporting period Abuja - Comments 4,5. Equipment Table l4: Status of equipment of NOTF Secretariat Project (Please add more rows if *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). All the equipment are functional 43 WHO/APOC, l0 April2003 g Source T5pe of Equioment APOC MOH Other donors NGDO Private Condition of the equipment * Please state 1. Vehicle lG) 2. Motor cycle 3. Computers (Desk top) 1(F) 2 (F) 1 (NF) 4. Computers (Lap top) 1G) t(F) 5. Printers I (F) 2 (F) 2 TNF) 6. Fax Machines 7. Others a) LCD l CNF) b) Copier I (F) rNF)I c) Generator How does the project intend to maintain and replace existing equipment and other materialsT The NOCP HQs Support Project has been maintaining and replacing existing equipment by:l. Requesting furttrer support from APOC before devolution. Other partners, especially with the increasing emphasis on co-implementation and collaboration, have been approached for logistic support. 2. Seeking the central government increased support for the maintenance of tle equipment and replacement of computers and printers. This approach will continue. Describe the adequacy of available knowledgeable manpower at all levels. The country is blessed with sufficient manpower, though tlere are concerns on how knowledgeable some are. The problem, particularly at the health facility level, has been the under - utilization of the manpower available for CDTI implementation. Affected projects are however being encouraged to ensure that staff at this level are well utilized. In an increasing number of States the number of SOCTs managing prograrnme implementation is dwindling due to transfers and retirements coupled with non-recruitment of new health workers. . Where frequent tronsfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementationwhere not enough lmowledgeable manpower wos available or staffoften transferred during the course of the campaign). Projects are advised to either train as many of the available health staff present so that transfers will not hinder project implementation or reach agreement with the policy makers in charge to ensure that trained staff are not arbitrarily transferred. Where transfers result in the removal of trained personnel and emergence of those outside the CDTI cycle, the replacements are usually trained by the assisiting NGDO personnel in collaboration with the Zonal office or the national office persorunel, particularly if this is at the State level. Some times the SOCT/State Coordinator provides the needed orientation. At lower levels the immediate higher level ensures a quick orientation or training. 44 WHOiAPOC, 10 April 2003 SECTION 5: Evaluation for sustainability of GDTI, lndependent monitoring and other reviews 5.{. lndependent participatory monitoring/evaluation 5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? None Table 15: Overview of when monitoring and evaluation undertaken (Please addmore rows if Project Name (After Year 1) participatory independent monitoring Mid-term sustainability evaluation (3d year) Independent monitoring after 4h year Evaluation For sustainability (56 year if necessary) Internal monitoring byNOTF Other evaluation by parhers & monitoring implementation of sust. Plans Adamawa Akwa Ibom Bauchi Benue Borno Cross River Edo Delta Ekiti Enuzu Anambra Ebonvi FCT Gombe Imo Abia Jieawa Kaduna Kano Kebbi Koei Kwara Nieer Ozun Ondo Osun ovo Plateau Nassarawa Taraba Yobe Zamfaru 45 WHOiAPOC, l0 April2003 5.1.2 fn general, what were the recommendations? N/A 5.1.3 fn general, how have they been applied/ implemcnted? N/A 5.1.4 Any other comments? 46 WHO/APOC, l0 April2003 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of : 5.2.1. Planning at all relevant levels. AII the projects in the country have developed sustainability plans. The work plans are revised annually by the projects. At the federal level there is an annual planning of activities. A 5-year strategic plan has been developed with input from all partners. An NTD Plan of Action which incorporates onchocerciasis control has also been developed but yet to be finalized. The weakest level as far as planning is concerned is the first line health facility level. The reason is 3 - fold: lack of adequate empowerment, low levels of commitrnent, and inadequate educational background of staff. 5.2.2. Funds Parhrers have paid several advocacy visits at all levels. States with history of poor or no counterpart funding such as Niger, Benue, Cross River, and Kogi have been targeted and visited. To ensure availability of funds for the LGAs, there have also been advocacy visits to the LGAs and in some projects advocacy workshops have been held. These will be followed up especially with changes in administration. 5.2.3. Transport and equipment (replacement and maintenance) In several projects, maintenance of existing hansport and equipment is gradually being sourced from Govemment funds, but APOC Management has been requested to replace and have replaced logistics where necessary. Most States have benefited from replacement of motorcycles and bicycles by the supporting NGDO. 5.2.4. Human resources There are enough human resources at all levels. In fact several projects have had to rationalize their State and LGA teams to make for more cohesion and efEectiveness in programme implementation. However, in recent times State teams are getting smaller in number due to retirements and transfers, and non-replacement of such officers due to inadequate recruitnent. In some projects, staff at the FLHF level are yet to be adequately mobilized and utilized. 5.2.5. lVhich projects have submifred sustainability plan? All have submitted sustainability plans. 5.2.6. To what extent have theplans been implemented? In most of the States implementation of plans is reasonably on course. Generally it is being hampered by inadequate funding and late releases of approved funds. 5.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. fvermectin delivery mechanisms In several projects, LGAs take the opportunity of picking their vaccines for immunization or official as well as private engagements by its officers, who may not even be LOCT members, at the State capital to collect their Mectizan tablets. With cunent co-implementation with lymphatic filariasis in a number of projects, albendazole is usually picked with Mectizan both 47 WHO/APOC, l0April2003 of which are used for mass drug administration. At State and national levels, ivermectin/ albendazole delivery stands separate, but all the processes are within the government system. Where praziquantel is also being distributed, sometimes the same rnechanisms have been used for collection and delivery. 5.3.2. Training In several States (Ondo, Ekiti, Plateau, Nassaraw4 Osun, Kaduna, Kogi, Kebbi, Kano, Kwara, Zarnfara, Jigawa, Taraba, Yobe and FCT) CDTI training is carried out with that for Lymphatic Filariasis. [n such States such as Taraba, Ondo, Plateau, Nassarawa, Zarnfaru, and Kebbi training sessions focus on integrated delivery of drugs targeted at LF, trachoma, schistosomiasis and VAS. Over 19,000 CDDs were trained and involved in various co- implemented efforts during the reporting year. 5.J.3. Joint supervision and monitoring with other programs In many States, project personnel take opportunity of involvement in other programmes such as VAS, immunization, sanitation, to monitor and supervise CDTI activities. What is more common is the sharing of transport in programme monitoring and supervision. [n some instances other prograrnme staff request CDTI personnel to collect important data for them when they are out on field activities, and this is vice versa. With co-implementation there is now, in the States applicable, monitoring of both MDA for LF elirnination as well as Mectizan distribution for onchocerciasis control during one supervisory visit. 5.3.4. Release offunds Fund releases at all levels follow normal channels within the Primary Health CarelPublic Health department. 5.3.5. Is CDTI included in the PHC budget? At national and State levels, CDTVOnchocerciasis control is reflected in annual budget estimates. At the LGA level, some LGAs reflect CDTI in budgets but in majority of cases CDTI is subsumed under a general health line item. 5.i.6. Describe other health programmes that are using the CDTI structure and how this was achieved What have been the achievements? The Lymphatic Filariasis Elimination Prograrnme is utilizing the CDTI structure for MDA wherever this is ongoing. There have been discussions for the National Malaria Control Programme to use CDTI in its World Bank-assisted booster States for home management of malaria and a strategic document is being developed in this regard. Earlier CDTI was accepted as one of the strategies for delivery of VAS nationwide but there are issues, and it is now left with individual CDTI partners to push their way through. 5.3.7. Describe other issues considered in the integration of CDTI A major consideration is the similarity of the progmrnme being integrated to the Onchocerciasis control programme. The intervention measure must be relatively simple e.g. administration of annual dosage of tablets or distibution of a cornmodrty or health education/ mobilization of community members to take preventive measures for improved health. 5.3.8. Describe the integration of other programs into CDTI in your country ond the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the resalts, is screening for cataract of primary eye care interventions integrated in all or some projects, d no integrafion has taken place, are there plans to pilot test a strateglt, etc?) 48 WHO/APOC, 10 April2003 In about 17 States, LF is being co-implemented and over 6 million persons have been reached. In 6 and 4 States VAS and schistosomiasis are being coimplemented respectively. Total population covered were 1.5 miltion for VAS and 0.7 million for schistosomiasis. About half a million persons were reached for both home management of malaria and ITN distribution in 5 States. In 2 States trachoma is being controlled through health education and zithromax distribution using CDTI structures. 5.4 Operational research 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. We are not aware of any OR that was carried out in the course of the year. 5.4.2. How were the results applied in the project? NA 5.4.3 Note the issaes that have been identifted by the NOTF for future operational research. The issues have remained as follows: o Causes of CDD attrition o Best ways for CDDs Compensation . EnhancingCommunityparticipation . Reasons for poor sensitization of communities . The role of CBOs in sustaining CDTI o Causes of poor participation of females in CDTI o The role of add-ons as a form of motivation of CDDs SEGTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunifies and threats of CDTI implementation process. Streneths a Improved CDD/population ratio I Probable achievement of elimination of onchocerciasis in some foci I Community awareness and acceptance of the Mectizan drug rernains high a Good working relationship of the project officers with NGDO partners a Increased reach by prohrammes that are being co-implemented, particularly LF o Huge workforce at the community level and health system level for CDTI implementation as well as for other add-on interventions. a Mectizan processes, apart from the procurement, are well established within the govemment system, and are working perfectly. a Effective coordination of CDTI implementation at national level. Weaknesses a Poor supervision at all levels, partly due to inadequacy of funds 49 WHO/APOC, l0 April 2003 t Inadequate logistic support at LGA and FLHF levels a Growing tiredness with intake of Mectizan after several years of compliance by community members. a Late submission/retrieval of treatment & training reports at all levels. a Poor record keeping at various levels Opportunities a Increasing recognition by stakeholders of CDTI as a vehicle for the effective delivery of varied health interventions at the community level a Increasing international focus on integrated control of Neglected Tropical Diseases(NTDs) t Availability of abundant human resources for CDTI implementtion at all levels. a Increasing involvement of local NGOs, CBOs and associations in the CDTI process.I Involvement of CDTI personnel in other PHC and social service activities. Threats a Inadequate counterpart funding of cDTI activities at all levels. o Frequent transfers of health workers experienced by projects a Demand for incentives by Mectizan distributors leading to atkition of CDDs. a Late release of approved frrnds by all parhlers o Weak levels of community ownership especially with regards to self-monitoring List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicable ). N/A Indicate how challenges were addressed. o Improved supervisory visits to make on the spot corrections in targeted States o Development of a strategic plan for NTDs o Training and retraining of prograrnme managers on areas of deficiency during review meetings . Re-mobilization of communities in selected States. . Advocacy visits targeted at some States were conducted. o Promoted integration of GDTI with other community - based progmmmes Indicate how opportunities can be utilizedto improve CDTI. Increased involvement of human resources available particularly at the FLHF level and delineation of areas of oversight for each FLHF trained will improve quality supervision. Increased involvement of NGOs will result in better community mobilization, improved support for cDDs, and increased level of communityJevel supervision. Recognition of CDTI as a vehicle for the delivery of other interventions will improve integration and leverage resources to sustain CDTI operations in the face of dwindling external funding. Increasing international focus on NTDs will result in improved funding and streamlining of implementation efforts for NTDs that will impact positively on GDTI. 50 WHO/APOC, 10 April2003 Annex 1 NOCP/LF WORKPLAN FOR 2O1O S/N Specific Objective Activitles Action By TimeScheduled Expected Out Come lndicator us DoLlrRs ($) 2009 FMOH APOC,YI'HO NGDO'UNICEF 1 To elicit increased commitment and financial support to CDT|from 31 States' Government and FCT Marking of the National Onchocerciasis Day Nat. Coord, Zonal Coord Feb Release of counterpart funds by the 31 states and FCT for CDTI implementation. Commitmentof govemment secured Awareness created, attendance list, Report ofthe event 5,000 1,000 2,000 r/High level advocacy visits to States Nat. Coord, & APOCMHO management Feb - July Release of counterpart funds by States 10,000 1,000 {Conduct follow-up actions on the advocacy visits Nat. Coord, NGDOs May - Oct Attendance list, Report ofthe event 4,000 1,000 1,000 {Produce reports on advocacy activities Admin Officer May - Oct Report exists Sub Total 11,000 12,000 5,000 s/N Speciflc Objectlve Activities Action By TimeScheduled Expected Out Come lndlcator FMOH APOCMHO NGDO/UNICEF 51 WHO/APOC, l0 April2003 I 2To build capacity of National staff on prcglilmme management, monitoring and evaluation r/training of SOCTs on Lymphatic filariasis prcgramme Nat, Coord, APOC mgUGAELF Jan - Oct lncreased knowledge and better performance of staff on programme management No. of technical staff/prog officers trained 8,000 \,Training of new prcgramme officers on onchocerciasis control Drooramme Nat. Coord, UNICEF Jan - Oct No. of technical staff/prog officers hained 4,000 Tnaining of the NOCP/LFEPS on database manaoement APOC Jan - July No. of technical staff/prog officers trained 3,000 2,000 Sub Total 11,000 6,000 S'N ffime ilhffi Actlon By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO/UNICEF 3 To provide support for effective functbning of logistics at the Headquatens office and CDTIprcjecb nationwide {Procurcmentof office supplies. Computers (3), Lapbps (3), Prinbrs (2) & computer accessories Project Acct, Secretaries Feb - Oct Availability of logistics & supplies for monitodng aclivities No. of office equ{pmenUsupplies procured 20,000 ./Handing over of approved capihl items to Droiecb Logistic officer, WHO proc. Officer March - Oct List of capital items released to project {Maintenance and repair of computers and otherequioment Lo$stic officer, WHO proc. Officer March - Nov List of equipment from projects repaired/maintained 5,000 {Supervisory spot checks on projects Logistic officer, WHO proc. Officer March - Nov Checklist used 2,000 {Maintenance and repairs of vehicles Secretaries Jan - Dec Uninterupted use of equipment for routine Signed certilication exists, receipb for 2,000 2,400 4,400 52 WHO/APOC, l0 April2003 I 0 S/N Specific Objective Activlties Action By TimeScheduled Expected Out Gome lndicator FMOH APOC/WHO NGDO/UNICEF 4 To ensure increase in level of sustainability of CDTI activities lntemalMonitoring of implemention of CDTI Sustainability Plans in 6 UNICEF assisted states NOCP, UNICEF consultanF July - Sept Sustainability of project activities Monitoring reports available 10,000 3,000 SpecialCountry lnitiative - Tnaining of CDDs other states NOCP, UNICEF consultanb Feb - May No. of CDDs trained 30,000 Sub Total 40,000 3,ooo 5 6 To create more awareness with a feedback mechanism, and ensure long term compliance to Mectizan and Albendazole treatment in all shtes Production of newsletter Data Manger Feb lncrease compliance to mectizan and albendazole treatment by endemic communities 1,000 copies oroduced 1,000 Review of the existing & development of standardized new prototype posters for long term compliance to treatment NOTF/NOCP 0ct No. of prototypes made available to projects 6,000 Production of T shirts, caps, pens, jotters for awareness creation NOCP Feb 50,000 Tshirb, caps, e.t.c produced 10,000 5,000 To identify and mobilize resources for onchocerciasis control and LF elimination activities Support for identification and mobilization of other sources of funding from private sector, MDG, e.t.d especially NaUZonalCoords, NGDOS, APOC mgt Feb - Sept Mobilization of resources from the private sector, MDG/govt for CDTI/LF activities & NOTF oversight Funds/commitment of pdvate sector, MD secure 53 WHOiAPOC, 10 April2003 forawaeness crcation & sustainability of CDTI functions Sub Total 17,000 5,000 s/N Speclfic Objective Ac'tivities Action By TimeScheduled Expected Out Come lndicator FMOH APOCfWH0 NGDO/UNICEF 7 To sttengthen integration of all Neglected Tropical Disease (NTDs) proglilmmes {Hold NTDs steering committee meetino NTDs coordinators Mar, July, Nov Availability of the NTDs integrated training manualwhich will be circulated to all states. Way fonrad on integrating NTDs atthe primary level will be identified Meeting repoil 8,000 2,000 Review and harmonization of the training matedals on NTDs AllNTDs coordinators Mar/April Availabilig of integrated training materials 10,000 Finalize integrated training manual Partners/NTD coords/WH0 (afro) April Training manual available 3,000 Development & the integrated NTD prcduction of baining manual NTD coordinatons June Copy of tnaining manualavailable 20,000 Advocacy workshop in the dissemination of he developed inegrated NTD training manual NTD coordinators July Funds allocated for NTDs 20,000 10,000 10,000 Sub Total 61,000 12,000 10,000 S/N Speclfic Objective Activities Action By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO/UNICEF I To imprcve capacity of project staff on lntegnated contmlof NTDs implernentation {Training of SOCTs on Integrated conffol of NTDs ZonalCoords, Tech officers Mar - July Enhanced capacity built on managing CDTI and NTDs actiMties No. of staff traAttendance list report of traininq 15,000 5,000 5,000 -# I l-- lt-. A l---^ l:-a 54 WHOiAPOC, 10 Apri12003 "i and other identified areas retraining of SOCTs on new technical reportinq format NGDOs report of tnaining {Reorientation of projecb' coordinators and accountants on WHO imprest system Prcject Acct, WHO finance assistant Feb - Oct Attendance list, report of training 5,000 Sub Total 30,000 9,000 7,000 I To promote and increase usage of CDI for other community based health programmes Planning meeting on distribution of lTNs usino CDTI RBM, Nat coord/NOCP Jan Modalities put in place for |TNs/LLN distribution using CDDs. lncreased usage of Community Directed lnitiative in several states for other health interventions at communig level Report of planning meeting 3,000 r/Training for integrated measles campaign and ITN distribution using CDDs RBM, Nat coord, Technical officers Jan - Oct No, of people trained 10,000 5,000 2,000 {Produce report on training and execution of distribution activities Tech. officers 0ct Copies of report Sub Total 13,000 5,000 2,000 S/N Specific Objective Activities Action By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO/UNICEF 10 To collect baseline information in Lympahtic Filariasis {LF Baseline Surveys in 30 states mapped for LF Nat, Coord, Tech officers Jan - Nov Available baseline data for MDA and LF No. of baseline survey conducted 50,000 50,000 20,000 {Commencement of Nat. Cood, Tech Jan - Nov No. of states 20,000 20,000 3,000 LF elimination and 55 WHO/APOC, l0 April2003 and Multiple Drug Administration mectizan treatment Training of healthworkers on rnonitoring and evaluation for LF elimination Tech, tnaining officens Jan - Nov No. of HWs trained onM&E 50,000 Sub Total 120,000 70,000 23,000 11 To ensule availability of drugs at he shte level for treatment of LF and onchocerciasis in a timely and regular manner .,/Request partrers to submit Mectizan reapplications br 2010 beatmenb to Merck, Sharpe and Dhome Mectizan lnventory Manager(MlM) May Availability of Mectizan & Albendgzole for endemic communities throughout the year. Safe disposalof Mectizan/Albendazole Copies of letters of rcquest exist in the files {Submission af mectizan and albendazole reapplication forms Mectizan lnventory Manager (MlM) July - August Copy of fonrarding letter available, DHL receipt exists 200 ./Detivery of Mectizan and Albendazole to NGDOs/States/Zones (Copies of lefters to NAFDAC) Mectizan lnventory Manager (MlM), Store keeper Oct- Dec tablets. Proper rccod keeping of Mectizan distribution Signed letters of collection, updated inventory 2,000 1,000 1,000 Sub Total 2,000 1,200 1,000 S/N Specific Oblectlve Activities Action By TimeScheduled Expec'ted Out Come lndicator FMOH APOCIWHO NGDO/UNICEF 12 To carry out operational research on priority areas that will address the prcject implementation Training of the NOCP staff and prciect managers on orcoosalt'witino Consultanb, IrlOCP, Prog. Managens Mar Challenges of CDTI addressed No. hined 8,000 9,000 Publication of adverts Admin Asst Mar No. of advert 5,000 onoperdiond 56 WHO/APOC, 10 April2003 placemenh challenges research Undetaking research on priority areas Consultants, NOCP, Prog. Manaqers April- June Reports of research canied out 20,000 5,000 Dissemination of research results NOCP June Copy of foruarding letter available Publication of research findings in per view joumals Consultants, NOCP, Prog. Managers Dec Copies of researchpublications 500 Sub Total 33,000 5,000 9,500 13 To encourage increased involvement in and ownership of CDTI by endemic communities and localpartners Strengthening of CSM and SHM in 24 states I n itiation/lnaug uration of CSM & SHM in at least 15 communities in 14 states; Expansion of CSM & SHM in at least 100 communities in 10 states 20,000 30,000 Provide feedback on CSM and SHM to APOC Sub Total 20,000 30,000 S/N Specific Objective Activities Action By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO'UNICEF 14 To monitor extent of CDTULF implementation in all target states and provide relevant information to all partners for planning and decision making {Collection and collation of CDTULF statistics frcm states and NGDO partners Data Manager Feb - Dec ldentification of constraints, institution of interventbn measurcs leading ti improved quality of CDTI/LF implementation Summaryof report exisb {Collation of budgets, technical reports/retums on CDTI Tech officens, Project acccountant Jan - Dec No. of projects hat made submissions {Submission by Admin Asst Jan - Dec Copy of forwarding 500 courier of CDTI 57 WHO/APOC, 10 April2003 letter available, DHL budgets, technical and financid reporb toAPOC d receipt exists {Forwarding of 2009 & 2010 technical rcporb tothe TRC Admin Asst Jan Receipt exists {tUeeting by TRC to rcview technical rcporF/proposals & caoital eoiuoment Commiftee membens, Nat coord Jan Report of meeting 20,000 Sub Total 20,500 S/N Specific Objective Activities Action By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO/UNICEF 15 To obtain realistic hryet population and strengthen management information systems at HQs and state levels Setting of national database at NOCP HQs APOC mgt March Coverage of all endemic communities. lmproved data management and usage of CDI statistics for programme planning and implementation Report of the exercise, data base set up and functional 2,000 5,000 Census update in selected $ates Validatons June - July List of endemic communities with taruet population 5,000 2,000 4,000 Production of rcport on data collection nationwide Validators july Report prcduced and shared with partners Sub Total 7,000 7,000 4,000 16 To review and assess CDTI activities in orderto identifr constraintschallenges and chart way fonrad r/Holding of ZOTF/sub committee meetinos ZonalCoords April, Nov Holding of 2 meetingsperzone in the year Attendance list, minutes of meeting 10,000 Plan and hold cmss boder meeting with Benin Nat Coord July lmprcved ooss border implementation of CDT|activities, reduction in the number of infective Report of meeting available 5,000 2,000 2,500 Follow up on rcsolutions rcached at meetings Tech ofiicers Aug No. of border states that have implemented 58 WHO/APOC, l0 Apri12003 fa blackflies resolutions Sub Total .l5.000 2,000 2,500 S/N Specific Objective Activities Actlon By TimeScheduled Expected Out Come lndicator FMOH APOCMHO NGDO/UNICEF 17 To review and assess CDT|and LF activities in oder to identify constraints/challenges and chart the way forward {Conduct of review meetings forAPOC assisted states Nat. Coord, ZonalCoord, NGDO chair May lmproved CDTI implementation in all projects Attendance list, report of meeting 3,000 {Conduct 2 review meetings for UNICEF assisted states Nat Coord, UNICEF consultant June and Dec Atbndance list, report of meeting 1,500 {Attendance of review meetings for NGDO assisted states Nat. Coord, zonal coords Oct- Dec Report of meeting 3,000 2,000 {Conduct NOTF/Sub committee meetinos Nat. Coord, NGDO chair May,Oct Attendance list, reoort 1,000 2,000 1,000 {Conduct steering commiftee/sub committee meetinqs Nat. Coord, Chair May, Nov Attendance list, report 3,000 {Attendance of JAF meetings & scientific seminars on onchocercaisis & LF Nat, coord, Minister of Health Dec ReporUCommunique 20,000 Attendance of GAELFS meetinq Nat. cood April ReporUCommunique 20,000 12,500 Sub Total 47,000 5,000 17,000 S/N Specific Objective Activities Action By TimeScheduled Expected Out Come lndicator FMOH APOCTWHO NGDO/UNICEF 18 To strengthen and maintain effective {Maintenance of Nat. coord, zonal Jan - Dec Uninterrupted communication flow Receipt of 5,000 5,000 email 59 WHO/APOC, 10 April 2003 1.- communication links with all partnens servicedtelephone lines between the NOTF sec. and partners voucher present r/Maintenance of/payment of courier/postal services in-counW Nat. coord, Zonal coords, prcject acct Jan - Dec Receipt of payments/Signed voucher present 2,000 1,000 Sub Total 7.000 6,000 60 WHO/APOC, 10 April2003