Kano State CDTI annual project technical report submitted to Technical Consultative Committe (TCC): January to December 2006

II I I RESERVED FOR PROTECT LOGO/HEADIIYG ORIGINAL: English COUNTRY/NOTF: Nrgerra Proi Na e: Kano State CDTI Project Approval yeaf: 1999 Launching year: 1999 Reporting Period: From: January To December, 2006 (Month/Yr4{ ( Month/Year) Proiectyearofthis report: (circle one) I 2 3 4 5 6 7 ( 8) 9 10 Date submitted: December 2006 NGDO partner: CBM ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) For Action lliM(oP 44tE8rc l- for $onAonTo, br( tu DEADLINE FO SUBMISSION: To APOC Management by 3l Januarv for March TCC meeting To APOC Management by 31 Julv fbr September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) fuvft --1-- 2 0 JU|L. 2007 WHO/APOC, 24 November 2006 H 1 1 l 1 ,1 I 1 { r -q rl tl ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Tcta-:; ,// !,i- t L IT L rrr NIGERIA Country National Coordinator Name:[hf f.1.9.t.ft....O.C i I r>l &{,t-[E*,tACe Signature Date: .. / ?- ('_Q_ Zonal Oncho Coordinator Nurn., S .l:.t.t= H .U . . .Y.r .8. fu, N r-\! .J-a' --M. )i Signature: ..ff.+1, . f ,-lzl_r-V \ v- Date: f ) .:..C'n.=.[,.7. This report has been prepared by Name : Shehu Musa Ishaq Designation ('<s.iry ,,\ Signature : ... Date .O 7- o + '-t'V il .ltli'j AiiA COP- f.T$ 2 U JUIL 2tl07 For lnfcrrnoilon ro. 5'r R AO khlnt#, \1- ddh;LL ll WHO/APOC, 24 November 2006 I I I I I I I I I I I I I Table of contents Acronyms Error! Bookmark not defined. Definitions Enor! Bookmark not defined. FOLLOW UP ON TCC RECOMMEI\DATIONS Error! BooKmark not definEd. Executive Summary Error! Bookmark not defined. SECTION 1: Background information Error! Bookmark not defined. 1.I. GgNpRaI-INFORMATION... ....Ennon! Booruanx Nor DEFINED. ............ Error ! Bookmark not defined. ............ Error ! Boo kmurk not deJined. .... Ennon! Booxuanx Nor DEFINED. L 1.1 Description of the project (briefly) SECTION 2: Implementation of CDTI Error! Bookmark not defined 2.1. TtvtplrNs oF ACTIVITIES ....... EnnOn! BOOXM,q.RK NOT DEFINED. 1.1.2. Partnership....... 1.2. PopulartoN 2.2. 2.3. 2.4. 2.5. ADvoCACY ..ENNON!BOOTTTANX NOT DEFINED. Mog[tzarloN, SENSITIZATIoN AND HEALTH EDUCATION oF AT RISK CoMMUNITIES Ennon! Booxuanx Nor DEFINED. CouuuNrry INVoLVEMENT............ . Ennon! Booxlranx Nor DEFINED. Ca,pacnv BUTLDING ......ERnon! Booxuenx Nor DEFINED. 2.6. TneerupNrs............... 2.6.1. Treatmentfigures ........ Ennon! BoornrlRK Nor DEFINED. ................ Error ! Bookmark not deJined 2.6.2 What are the causes of absenteeism?.................Eruor! Bookmark not deftned. 2.6. j What are the reasons for refusals? ....................Error! Bookmark not deiined.2.6.4 Briefly describe all known cndverified serious adverse events (SAEs) that Error! Bookmark not defined. 2.6.5. Trend of treatment ochievement from CDTI project inception to the current year ................ Eruor! Bookmark not deftned. 2.7. OnoeRrNc, SToRAGE AND DELIVERY oF IVERMECTIN......... ENNON! BOOXUENX XOT DEFINED. 2.8. CorvruuNrry sELF-MoNrroRrNG aNo SrareHoLDERS Mrerwc Ennon! Boox*ram NOT DEFINED. 2.9. SuppRvrstoN............... ..Ennon! BOOxuanx NoT DEFINED. 2.9. 1 . Provide a Jlow chart of supervision hierarchy. .. Error! Bookmark not deJined.2.9.2. What were the main issues identified during supervision? .....Error! Bookmark not deJined. 2.9.3. Wss a supervision checklist used? .....................Error! Bookmork not deJined 2.9.4. What were the outcomes at each level of CDTI intplementation supervision? Eruor! Bookmark not deJined. 2.9.5. Was feedback given to the person or groups supervised? Error! Bookmark not defined. 2.9.6. How was the feedback used to improve the overall performance of the project? Error! Bookmark not defined. SECTION 3: Support to CDTI Error! Bookmark not defined. 3.1. EeutpvpNr... Ennon! BoOxuaRX NOT DEFINED. 3.2. FTNaNcTaI CoNTRIBUTIoNS oF THE PARTNERS AND COMMUNITIES................. ENNON! BooxuaRX NOT DEFINED. 3.3. OrHpRFoRMSoFCoMMTINITYSUPPoRT.............ERNOR!BOOKMARKNOTDEFINED. 3.4. ExppNorruREpERAcTrvrry.......... ..Ennon!BoornntmNorDEFINED. SECTION 4: Sustainability of CDTI Error! Bookmark not defined. 4.1. INTBRNaT-; INDEPENDENT PARTICIPAToRY MoNIToRING; EvelueloN...........ERR0R! Booxulnx NOT DEFINED. 4.1. t Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) ............ Error! Bookmark not defined. 4.1.2. What were the recommendations? ..Error! Bookmark not delined. a ;t 1{ WHO/APOC, 24 November 2006rlt l' 4.1.3. How have they been implemented?....................Etor! Bookmark not deftned 4.2. Susrail{asrt.rry oF IRoJECTS: nLAN AND sET TARGETS (MANDAToRY AT ......Ennon! Booxuanx NoT DEFINED. Yn 3) ......... Ennon! Booxtuanx Nor DEFINED. 4.2.1. Planning at all relevant levels .........Ertor! Bookmatk not deftned. 4.2.2. Funds........ ..Error! Bookmark not defined 4.2.3 Transport (replacement and maintenance) ........Error! Bookmark not detined 4.2.4. Other resources... .........Eruor! Bookmark not deftned 4.2.5. To what extent has the plan been implemented..Etor! Bookmark not dejined. 4.3. INrecRanoN Ennon! Boorulnx Nor DEFINED. 4.3.1. Ivermectin delivery mechanisms .....Etor! Bookmark not deftned 4. j.2. Training.... ..Error! Bookmark not defined. 4.3.i. Joint supervision and monitoringwith other programs... Error! Bookmork not deJined. 4.3.4. Release offunds for project activities ................Enor! Bookmark not deJined. 4.3.5. Is CDTI included in the PHC budget? ...............Enor! Bookmark not delined. 4.3.6. Describe other health programmes thot are using lhe CDTI structure and how this was achieved. lYhat hwe been the achievements? .....Etor! Bookmark not defined 4.3.7. Describe others issues considered in the integration of CDTI................. Error! Bookmark not deJined 4.4. OpsnarroNAl RESEARCH.. ..Ennon! Booxrrlanx Nor DEFINED. 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project areawithin the reporting period............. Etor! Bookmurk nol delined 4.4.2. How were the results applied in the project? .....Error! Bookmark not defined. SECTION 5: Strengths, weaknesses, challenges, and opportunities Error! Bookmark not defined. SECTION 6: Unique features of the project/other matters Error! Bookmark not defined. ,L *lF b IF ir ?r "I lv WHO/APOC, 24 November 2006 ! Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM FLHF FMOH HFS IDP LGA LOCT MDP MOH NGDO NGO NID NOCP NOTF NPI PHC REMO SAE SHM SMOH SOCT TCC TOT UNICEF UTG wHo ZOTF CAPA MFU PLACO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Cristofell Blindenmission Community Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring First Line Health Facility Federal Ministry of Health Health Facility Staff Ivermectin Distribution Programme Local Government Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Governmental Devel opment Organ ization Non- Governmental Organization National Immunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force National Programme On Immunization Primary Health Care Rapid Epidemiological Mapping of Onchocerciasis Severe Adverse Event Stakeholders meeting State Ministry of Health State Onchocerciasis Control Team Technical Consultative Committee (APOC scientific advisory group) Trainer of Trainers United Nations Children's Fund Ultimate Treatment Goad World Health Organization Zonal Onchocerciasis Task Force Catchment Area Planning and Action Medical Field Unit Participatory Learning and Action Committee , lL l*. , tl rL fF!' WHO/APOC, 24 November 2006 Definitions (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84%o of the total population in mesolhyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoeraphical coverage: number of communities treated in a given year over the total number of mesolhyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. ]E laF ** t b tFL t*i' vl WHO/APOC, 24 November 2006 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session}DlZ3 TCC accepted the report and recommended the project to: 1r. I ** t al lFtL 10 Number of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCAAPOC MGT USE ONLY vlll. The Executive summary and challenges indicate that there is a lack of support for CDDs; however, in other places (page l5 and 'Strengths'), it is indicated that the CDDs are happy with "prevailing conditions" as they are and that the CDDs are committed. These statements seem contradictory and require clarification. The figures in Table 5 indicate that 100% of all training objectives were achieved, but on the page prior to the table (pages 16), it is stated that "training for various categories of CDTI personnel envisaged for the reporting period couldn't hold due to the delay in the release of funds". This is contradictory, and thus the is asked to clari o Diminished support to CDDs as one of the challenges to proper implementation of CDTI programme earlier on indicated in our reports is in comparison to the incentives given to volunteers by LGAs for other programmes such as Roll back malaria, National Programme on Immunization and Guinea worrn eradication. Even though happy with the prevailing situation, a one time incentive that is tied to the work and will be valued by the CDDs should be provided to ensure a workable solution to sustainability of volunteer input. o It is actually an error on the part of the project, however, training was held belated though. This was as a result of the too much delay in the release of the counterpart funds for the activity. The project should explain what evidence exists to show that the messages regarding CDTI received by women in purdah are incorrect. If there is evidence for this, the project should continue to development strategies to reach these women directly with CDTI messages. No impact noticed yet, and if there are the project intends to carryout house to house awareness campaign using female students from health institution and other women volunteers. WHO/APOC, 24 November 2006 .E Executive Summary Kano State is situated in the northern part of Nigeria and falls in the Sudan, and sahel zones. However, the endemic areas are generally located in the Sudan Savannah. The terrain in these areas is generally flat or slightly undulating with sandy soil. The State has 44 Local Government Areas with a population of about 8 million people based on the 2006-population census. The people of the area are mainly Hausa/Fulani with few other tribes usually found in urban areas who serve as the minorities in the State. The vast majority of the populations of the communities are settled agriculturists, keeping herds of cattle, sheep and goats. There are numbers of pastoral Fulani some of who move according to the seasons. CDTI is however being implemented in 18 LGAs in the State with a total population of 609,711 person living in 810 endemic communities. The training objectives for year 2006 were 572 for health workers and 1267 for CDDs. By the close of the year the project was able to train 572 health workers and 1267 CDDs thus achieving 100% respectively of the ATrOs. The ratio of CDDs to community population stand at l:475. Treatment was conducted in all the 810 endemic communities of the 18 CDTI LGAs. This represents 100% geographic coverage. A total number of536,160 persons were treated out of the total population of 609711. This gives an overall therapeutic coverage of 87% and an ATO coverage rate of 95%o for the State. The major challenges that faced the project include inadequate support to CDDs by the communities and the payment of incentives to village workers by some programmes such as NPI, which has affected the CDTI implementation negatively. Participation of women groups in the CDTI process within the project is still not encouraging. There is also low participation by local CBOs and NGOs. The challenges encountered were addressed in the following ways (but they still remained current challenges): support CDDs. This is still being pursued. The project intends to continue in the coming years to o Use Islamic scholars and use them as mobilizers and health educators of women. o Use of women vaccinators/guides used during NIDs (generally accepted) in reaching women in purdah. o Use of government and non governmental organisations and community based organisations such as CAPA, PLACO and MFU, HISBA. (5 ** Ta j t: te 2 3 WHO/APOC, 24 November 2006 I tll SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Kano State is situated in the northern part of Nigeria and falls in the Sudan, and sahel zones. However, the endemic areas are generally located in the Sudan Savannah. The terrain in these areas is generally flat or slightly undulating with sandy soil. There are occasional rocky out crops and granite inselbergs. The rainy season begins in May and ends in mid October while the dry season lasts from early October to late April. Pop ulation: activities, c ult ures, and language The State has 44local government areas with a population of about 8 million people based on the 2006-population census. The people of the arca are mainly Hausa/Fulani with few other tribes usually found in urban areas who serve as the minorities in the State. At the community level these ethnic groups (both from within the country and from neighboring countries such as Niger Republic) are more or less assimilated into the local populations. Hausa is the major language of communication. Islam is the religion that dominates the State with a little percentage of Christians, who are mainly found in the cities. The vast majorities of the population of the communities are settled agriculturists, keeping herds of cattle, sheep and goats. There are numbers of pastoral Fulani some of who move according to the seasons. There are fishermen along the river valleys. Craftsmen of various descriptions exist and traders abound. Some of the traders are itinerants seeking markets for their goods and services. Communication system (road....) The road connecting the towns and major cities are in relatively good condition, but the roads to the communities are in varying shapes. While a few are in good condition, some others are full of potholes. Others still are laterite roads and can be impassable during the rainy season. Communication channels are many and varied. Some follow the traditional authority structure (from the Emir to the district heads, to villages heads, then to ward heads and lastly to household heads). At the community level, town criers, local musicians and drama groups are veritable means of communication. Radio is a medium that is widely listened to as Hausa is the major language of communication and used for most programmes. Newspapers especially those in Hausa are also read and television is a medium that some listen to. Administrative system The Administrative system in Kano State is of two folds - the modem administration system and the traditional administration system each of which exert some level of influence on the people at community level. The traditional structure is closer to the people and therefore well nature, large areas are under the authority of a District head, who is responsible to the Emir. Under the district head are village heads, and under them, the ward heads, who relate directly to the heads of households in the communities. Under the modem administrative structure the State consists of 44 LGAs. The LGAs are further subdivided into wards, which in turn are made up of communities. The state has an elected Governor as the head of the executive arm while there is ahouse of assembly made up of elected representatives of the different LGAs. This forms the legislative arm. The same pattern applies at the LGA level where the legislative is made up of councilors from the different political wards. J WHO/APOC, 24 November 2006 Health system & heatth care delivery @rovide the number of health posts/centers in the project areas if the information is available). The state operated two forms of health care system. The first is the primary health care services which takes care of the health of the people at the grass root through health education, environmental sanitation, provision of essential drugs and control of communicable diseases. The services are provided to the community through health posts, health clinics and comprehensive health centers. This level of care is operated by local governments and communities throughout the State. Professional health staff such as community health extension workers mainly staff these facilities. Further still, out side the health institution there are other health professionals who are found in the communities as environmental health workers. These groups are engaged in health education/mobilization, water and basic sanitation in the communities. The other system of health services is the secondary health care, which is more specialized that serves as a referral to the lower level of health care. Secondary health service is only available in cottage hospitals and general hospitals that are mostly located in towns and cities. This level is largely the responsibility of the State. There are about 300 health facilities spread across the 810 endemic communities of the l8 effected LGAs in the state. 4 WHO/APOC, 24 November 2006 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of hcelth staff involved in CDTI activitics. Totrl Number of hcrlth steff in the entirc project arcl Bl Number of herlth staff involved in CDTI Br Perccnlage Br=Bzl Br *100 Doguwa 36 36 l00Yo Tudun Wada 45 41 9t% Bebeji 40 34 85% Kura 35 25 71% Garun Malam 36 JJ 9t% Madobi 38 29 76% Kiru 40 36 90% Karaye 39 3l 79% Rogo 40 3l 77% Gwarzo 38 34 89% Kabo 52 43 82% Dawakin Tofa JJ 29 87% Dambatta 39 30 76% Makoda 30 27 90% Takai 40 38 95% Gaya 39 29 74% Sumaila 38 34 89% Aiingi 30 28 93% Total 683 588 86% 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MOH, NGDOs - national, international) The partners involved in the implementation of CDTI project in the state include 1. Communities (endemic) 2. The endemic local government (LGAs) 3. The State Ministry of Health (SMOH) 4. The FederalMinistry of Health (FMOH) 5. Christofell Blinden Mission (CBM) 6. WHO/APOC 5 WHO/APOC, 24 November 2006 6:i ie t* qr -tj IrL t! The Federal Ministry of Health (NOCP) provides policies, operational guidelines, and trains the state level workers. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs, monitoring and supervision of mectizan distribution, formulation of operational guidelines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re-training of health facility staff and CDDs, mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of mectizan distribution. The assisting NGDO, CBM, supports in the production of IEC materials, provision of technical support to the project, advocacy for financial support and supervision of CDTI activities in the State. The endemic communities collect their yearly mectizan supply from the health facilities, ensures distribution of mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The partners enjoy cordial working relationships. State plans tf ony to mobilize the State/region/district/LcA decision-makers, NGDOs, NGOs, CBMs, to assist in CDTI implementation. The project intends to mobilize other local NGOs and stakeholders especially those from the problem areas during stakeholders meeting to support CDTI implementation in the State as reflected in the State sustainability plan of 2007 . The newly appointed LGA Caretaker Chairman will be mobilized on the CDTI process with the aim of knowing their roles. Also in the current year more advocacy activities will be organized for local NGOs and CBOs members. 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SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in cunent year, indicating when the key activities were implemented by the month they began and the month they ended. Periods of Activities: 2006 The timeline varied because of: 1. Delayed approvals, release of fund or both at State and LGA levels 2. Other integrated PHC activities involving oncho control staff at both LGA and State level. Activities Month Implemented Mectizan procurement January Advocacyisensitization activities in all endemic LGAs March Training/retraining of LOCTs, FLHFs and CDDs March Mectizan distribution April - October Training of FLHF staff on CSM August Wrap up of treatment activities November NOTF review meetings WHO/APOC, 24 November 2006 \o ol o .o E 0) o z r+ c.l \J Or t (t o ()E' E()E9oo.a1 i l-. *a d'l,Oo 'E t) o" lflo 'EB{e >E .\ 9Y6(B rr >=trBOE902.i>96F -o-ESt5 JV 'c,qc!;i 0)xo La Lrtrq .9oe u)8E6g -o'58 Eor -^ rhYc)9F -tdl-?";Ya)J.- o.r !F!V q=o Q.E <L =aii9 ,to$ aa(d; thC <9qE -o)95oH(sa0 chE .Eo !I a''(B= U).4LV()= -a 993itrEo= d)trotro ^6X4 6 ed3!v).- a BI.=P<.YPE .qE Htr .ZSaF EE96 doEo qgd , dt o. q %pU q: \ q)\ o tN q) % q) 5 9 () oL o 0) Ic() Cd() L (r',(! oL(o 0) t< U)o F o (H o C) (.) 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C)a \oO io z \o bb \oa \o +jo o \o o \oo C) o \o Pp.()a ht)EE ritr \o (,) tr l- \oO C) \oo Lq \oo d 2 \o (! z \oo (0 \oO o \oo() \o d \o (B \o \o (0 z \o z \o (d \o ci \o cO 2 \oo (B q) 6l p .t) u, q)() o EEo Q \o (h OI \ooi o z \o \o U) bl \oo on \o bt \oo >o z \oo io z \o h \o +jo \o o. 0) V) \o to z \o ub \o \o +jo o \o to \o Ioo \o Po c)a bt)CE ?E c!= \o (6 z \o C) \o t<o \o (B \c)o d \o d \o d h \o o \o (o \c) (d 2, \o \o 2 \o z \o z \o (6 Z \o d \o cc 2 \o (0 a ot c\lL t'r a6EE o U \o -:Lo \o d =z \o oL z \oo (B z \o d z \o -:Lq \o cO z \o cE z \o ; r<o \o -:l<a \o -:ko \o -iLro \o (d \o -iL \o (d \o O d \o -.iko \o cn z ht)trt riE CE: a- \o oLr CB \o -:Lro \o ok(B a \o -.:rro \o -.iLg \o oL(B z \o -.:Lo \o -;Lo \o -.:Lq \o oL(n 2 \o oL.(! z \o c)L CB \o -.:trq \o J Lo \o -iLo \o J L o. \o -iLo \o -i YUD r(D !E Nr !EooFT(Ja o o! =EBOEE o U \o .c;o Er \o oL(s z \o J 0)tr \o o lid z \o oLr(n z \o j o tJ. \o olr(d 2 \o o d \o oL cri 2 \o oIri \o o a odo tu \o o (0 A \oo o z \o o (6 z \o o(! 2 \oo oL(d z \o olr(d z 60EE !E 6r: \o ; (d \o (d \o j ofri \o -do trr \o lj c) trr \o ; d \o J c)fr \oq (.) fJi \o oL(B z \o (! \o dorr \o \o oLr(o z \oo oL cd z \o ; d \o j C) E< \oo oLd \oo oL cS z Fl c) L U) d =b0 o o (n!(d tr := -o(.) o (! d Eo d v 5 oro(l L v o rd d v ox o& oNL B o o -o(d v ,s o o d (d (d o rd! o -vd a d -5z(dF (t dt a (n cl b0 ? Fl F oF 2.2. Advocacy Several visits to all the 18 endemic LGAs aimed at sensitizing/mobilizing the policy makers at that level were carried out during the period uder review. Both the Chairmen and councillors as well as the Director Personnel Management and the LGA treasurers were sensitized on the need for continued support to CDTI during the visit. I I LGA Chairmen, 18 councilors for health and 5 newly appointed traditional leaders were sensitized, also 2 NGO members. The aim of the visit was to sensitize the LGAs to release their counter part funds to facilitate the implementation of the planned activities. Advocacy and sensitization activities has yielded fruitful results in about 60% of the LGAs visited as fueling and maintenance allowance are being provided together with monthly salaries of the coordinators. At the State level, the Government is taking care for maintenance of the project vehicle from the MOH central pool. Already the State Govemment has released its counterpart fund for 2006. Some of the difficulties faced are: o Frequent change of council especially at LGA level. o Too much commitment of the policy makers makes it difficult to pin them down for advocacy. Some suggestion to improve advocacy: o { high level advocacy comprising the NOCP, our supporting NGDO, Ministry for Local Govt. and that of Health should be carried out to all endemic LGAs . The project should organize a media forum to further mobilize the communities and policy makers. o Involvement of community based organizations. 2.3. Mobilization, sensitization and health education of at risk communities The use of media in mobilization The services of Mass Media were utilized during distribution activities in the community and LGAs. Kano conducted a press conference on oncho and other blindness control issues, some endemic LGAs involved Radio Kano to cover their control activities. Other local strategies used in Community mobilization include: -Use of traditional and religious leaders -Face to face discussion with community members -Town announcers mobilizing community members Mobilization and Health Education of Women and Minorities Communities were fully mobilized using traditional and religious leaders, meeting face to face with the community members and the use of town criers. These brought about increased acceptance of CDTI. Women were also mobilized at clinics for those who attended health talks during pre natal visits. Some got CDTI messages through listening to the public address systems or reading the posters made available at community level. Response of target communities The various communities have demonstrated their commitment to the implementation of CDTI, and are actively participating in the CDTI process. ilq nar 1' L IEl! l& ?! Accomplishment of Target Communities The project succeeded in mobilizing all the endemic communities and this has resulted in overall high treatment coverage. Wealorcss/Constraints The women in purdah sometimes are deprived from getting the correct information on CDTI during mobilization as the messages get to them only through their husbands and grown up children. Participation of women as CDDs remains a challenge but treatment coverage remains high because compliance is adhered to annually by both male and female eligible. Sugge stion to improve mobilization The quality of information that gets down to women in purdah is of serious concern in predominantly Muslim communities. The project will co-opt female PHC workers to be part of the teams both at state and local government levels to open up better and easier ways of interacting with this important group of people. The project will also identify female community based organizations to assist in educating this group people to continue taking their drugs yearly as the CDDs are their children and members of the community. The project also intends to target the men to educate them on the need to have the women to be involved in the programme either as distributors or as mobilizers. Effort is being intensified to use community based groups such as Participatory Learning and Community Ownership (PLACO) and Catchment Area Planning and Action( CAPA) available in many endemic LGAs for increased community members participation. * i* :' ib Flr F i+ ar b {F IL 1T t? { 'ao tD 6t 46 'E c, r-9E6 o 0E z il; ol) 6. o o 6\ e.l \o c.! :'i I o5\' E !t a E-9 N o 0 :r> c9 Q .o z ta + lt EA 6a o3 -f rcl o\o\ r tr- € r € @ o\ -t o€ \o {ol ot .+\oc.l 2-doEA (\ la oP lX zu * r GI o\ o\ r F-- € r-@ 66 <1. \o \o .+ ol 6 \oc.l >o k'i Er. Br Eo EO otr =.= q= ze ll * aa Ea o B! 6a A 6\ cl al o\ o\ o\\o \o 6\ o 6\6 6\c.l\o F- \o o\\o 6\ r- o 6\ N\o 6\\o 6\ o o\ \o o\t 6\\o Eq fr'kr?'i e .Z S EE T 5o== Zecq € \o € $ o\ $$ @N c.l r r \o 6l \o a o{ € G :?u1)Y.: L L il 5 9 XH? c c'i $ cl \o€ o, r rr N + rN € N 6 € Fl (! L v o h0 o& (0 (, cl B bn o (! € J1(d =a -(B o o 0)' o FA (d !(! F o) dL(B M Fi v (B cd E (€ ((, tr a o .od v oNLr CB o so 'o z (6p (o o (0J(BF 60 oF co (\ o -o E 0) o z + e.l A so B =f, :\ B % %q) Uq) S ?): t s. t ! V) AJ s FoQ()s€c,o.= EE o'E>a -*o'5>i=EH }l-flc) E.= -aEtrLKEEL^OrIg) :. .U$bt oi gl 13 ** d1 ! L tE L f? 4l b[ tf Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (affendance, participation in the discussion etc). Females are generally not allowed to attend health education sessions with the men, and communities have refused requests for their women to assemble at a common point to be educated by female health workers. The men have insisted on being conduit of whatever information that needs to be passed on to their women folk. In very few places as could be seen in the above table were females selected as CDDs. Given the background of the community this is a good starting point. Incentives provided by communities for the CDDs Reports of token remuneration to CDDs by community members, in group or as individuals, are being received. We have information that CDDs are assisted on their farms but such contributions are suppressed by the CDDs in anticipation of better gestures from LGAs. Others contribute with prayers and political campaign for CDDs when they indicate their intention to contest for elections. All CDDs are satisfied with prevailing conditions and are happy to serve their communities. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Majority of the CDDs are either primary or secondary school leavers, and there is tendency of leaving the job to further their education, and this warrants targeted training for new CDDs selected by the community members. Attrition by CDDs is of concern but is quite minimal and there are always people to continue when a CDD withdraws or is absent. Other issues The state project is happy with the existing cordial relationship that existed between CDDs, FHLF and community members in their respective areas. l5 WHO/APOC, 24 November 2003 2.5, Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. There's adequate manpower at state and LGA levels, these are adequately trained to perform their roles as SOCTs, LOCTs or FLHFS.. Training and retraining of LOCTS, FLHF staff and CDDs was conducted in good time for the 2006 treatment activities. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are frequently tronsferred during the course of the campaign). Additional PHC staff core equally trained with the key oncho control staff during any training activity, thus when a key operational staff is transferred there is always someone conversant with CDTI process to continue. If the trained "stand by" staff is simultaneously transfered with key staff prompt training will immediately be given to another available PHC staff to continue. t6 WHO/APOC, 24 November 2003 c.) (\ o -o 0) o z .+ N O o o.{ F- t) d U7 o nO (! o 9 'ld (g(+i o bo t< (o o C) C) C)tn E € (d ar't 0.)Eq) H (q ta(J rJr 0r rl tro C)0 o) an o >. c) ,; Lad o!q 2cn o>r()-o )Y() .Y t) €(g =c)o.E '13 g)gH -= (,iaEEq3€ >,! >o-6htrr5 oo ,0(o(d Ftr ^oyo -v1 bo o €S o\ o S B o ho s o * s t oL\ ii a6 E B q :. = o\i o\ o\ t : tf F- ca : c.t F.. oo : oo : co :- c.) :_ F- : r-@ a o\ € o\ $ : + : o\o cr)\o ca\o : .+ t : sl c.l $ \t r-\o6l t--\o N : s.:a<v LlJ: iro rizv $ ot O :. :_ l'- : t'-. : r-(\ o\o\ $Fr F- 00m cnc.l F-00 €o\ st \o \o + \fc.l =t rr\o al q) q) o \o soo q) 6l 0 nU q)E z ?!F(J + s.:qv - .:l rll vl LU = .(J ]s *d : I c.l N N c.l c.l c..l N c{ el : c.t a^l ci c.l e.l \o ?a) € € ..l \o c) so tq) o q) a) v o 0 q) .=c c! t-( (): oq)ll9 r. 6l oh z Q c.l e.l C\ c.l a-t (\ N N e.l N N al c.l C.l e.l N N : N o\N \oN r- o\(.) €\o(.t o\atQ: ", (.) + U N o{ c.l (\ a.l o\ :_ F- I ..r o\ € c.l \l : oo :_ \o l^ o\ + : N o\e.l 6l c.l .I \oI I + at c.l c..l N st(\ N $ -: -: \t : co at O : o\ :. € o\ + c{ NN \o6l \o $e.l st6l *N N N o\c.l F o\ ?r) xoo _l o o q) s ol =cl6 t-I EE!s #itr>- ZE q,)(J QF 6l c.l o\ o\ 6l I LJ _t( fl 9l6 r i tl -l I .lDU + + I I + t 6 + + * * <f .+ : s + I I $ =t m $ + <l * c.t sf ca r-\o q a J 9.o(.) q) Eo o (u z Q o F o -o v oNL(! B(, oE(d (c U C€s d o (Bj1 (oF F] F F o (,) a) v s I o a (d l< v ob{ o& >.(o o o0 '.7' o J4 cd z .E oF o c)' o FA s(! F C) L v L M (d (, (d a -\ r\ BV) v1q) uq) S U) 1 r. .: ! q) l.i q) 5 o o c) o tr F t-lU(H o a o C) oL ,C) E G) (! bo (c LF .tr o,l -oldlFI +i] t= fr & w .T& f a.l _l l'-\o r-\o d B bI n Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci&) Program management J How to conduct Health education ,l Management ofSAEs ,l CSM J J ,l SHM Data collection ,l Data analysis J Report writing Others (specify) l8 WHO/APOC, 24 November 2003 2.6. Treatments 2.6.1. Treatmentfigures il* t9 WHO/APOC, 24 November 2006 . GP =Ic9(a='d c E€?lESz tE e o oZ E?Eu) Ao o o z be3cE9A.Dzd \o \o + c.t c.l sf o\ a^tst c..l a- o\ co o\ c.l oor- cA oo F-\o o\ oo\o F- oo oor-N \o e.l+ en F- o\ co\o F- Fr oo ;B-!8 .3 9;E E EilEE co oo oo c.) co a.) o\ ooco o\ oo o\ I \o N cl \o \o .+ € + o\\o o\ € €$ o d o oA H lt o 'Eo , hI)O cda3bs ooEOF s at o\ s o\ \o o\ o\ \o \o € \oo\ € o\ 6\o o\ .66\$ o\ .o ^\F- F- o\ o\ € ^\ o\ F-oo \oo\ =to\ o\ oo \oo\6@ 6\ @ o\ r- \o o\ @ co 6\ Fr € 6Xe -o;EEb9 z oo c! c.l oa a o\ c.l .+ co\o c.l $ o\ a{ \o o\\o F- €\o F- F-@ c.t F- o\o+ N a-N o\ a.l $ c! a.l +t oo \o\o(\ F- c.)$(\ \o <t \o a- o\ c.l c.t \o H Po 6 o.= !=o ; @5' F9 v oo mt+ c.)\o F- o\ $ o\o\ \o o\ oo F- o\ \o N\o o\ \o o\ o\ <t c-l oo o\+ oo\o F-N o\rr =t o\ co + oo o\ e..l $+F- oo c.l\o c.l c.l N o\s <f c-l c.) € c.l\o\o H .9 .,3E E9 = o Pd5-.q i o o=ots E et aF oo C{(\l r-. rat c.) ta) r- c.r I-t o\N oo\o!+\oN ca oo $ oo oo aa la) c.) c.l oo t-- F- ca N$ aa t-- \o c.t \o .\l aa \o N $ o\ cO co$ It- C. c..l o\ co\o c.l oo+$(t.l otr- ral oo c..t N$(\ N \o a.l I*r co F- o\ \o t/) c) b,0d o(,) o O ll r ri ri d9o o:! -e 0xbo4- Ue ^\ o\ ^\ o\ o\ \o o\ O \o ^\ o\ \o ^\ o\ o\ o\ o\ o\ o\ o\ H E.9 .-q = ii!3 5 S# =E>!AO o $ <f, N oo $ o, F- N o N t F-o.l \o+ \o N o. oo =o'ie 6.2 =E-!=o 2aoo' FIJ $ v c.tcl \o€ * m oFr c.l c.) cl + Frc.l \o$ \o o\ 6l o\ O 00 >9,3q o= X o '.= tr aAI E I.i.g x E EgEE-5itrE st $ cac.l \oco \t o\c.) F- N ca c.l N <t F-N \o+ \o o\ca N o\ O € .9< av H (g ti M bI) & x ctl o bo ? (6 T bI) o o d!ojz(o a _(B o o 't ,.o c) FA d (0 F o (€ (d M L v Es(B E(, (o d a o -o cdV oNL o so (! z (o U -o o d JZ(sF F] F o Fr \o N o -o o o z + e.l o Pr o > C\t \ .' S v)q q) q) q) 45 o\ q)\ \ \)q \) e1 v rh L ct) oL c0 .FJ J o H (n ! >. -o(A E] a CB C) (6 C) F n-1 C)l =lJIdlFI -o o\ t-- oo II X rol - -l nr\ot o\ r.ll o rr)l \o o r() bodLo oo o- J.v C)o(! H 0) F (( cI ! ( ( 1 C II ( ( t '1 ( + ( I I( + r + I t ( i& t-Lt b TI IL F li, {Flr ..J i I( I I o(D o 0q A) ^Y-\o =. -98 ; o ot o, oa(D I o) o 'l oo ,a<XEva) oa(D I D' o s -lo Foo 5' o a. 6l@ -l-olo x o il \o o\ () l(i o. luJO\ lO\ l..J l- oo lo\ -lox O II \o \o UJ Iq\o h,o lo\ol-o lo\olo x oo il UJ -) o\ lt sq \SB tss[ [ .Sr \ ==. :. =G GEt I!F S.:E- SE.X R{t \ $r EEs St* F -G .idt .d €s iG$ 6 RE. R\G : \s=(\G OOis s'sR XG\ =\: sc\s EJ8 q :S. ,it.lJ I:E *sq s :{ E':F. SST :G:. q .{.F ExdHB : e.=. uss rG: ! iF *.E'r s >s- =REd=sts SS +$R& SEFS;RGi.l'F=. *s'\F €oos=. sG FXr= .S (1 + E F s Oq G OO Es oF G E Oa G N) 4 ri (., o Ns z oI cto N o o\ LI lt 2.6.2 What are the causes of absenteeism? Inadequate mobilization of women Communities are preoccupied with other activities during distribution (i.e farming) Rural-urban drift. 2.6.3 What are the reasons for refusals? a In adequate mobilization a a a EE r$ 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report I 22 WHO/APOC, 24 November 2006 \o (.l Lo -otr q) o z + o.t o o c.lc\ q) o' Lq) -a B\ _q)q t( L' q hq) Q\) .\ q: \ q) L .x ! q B \ E o Loa bo t- oao o bo L 'o(.) !L) C)o d ln trl U) 6 () o C)(h lr 0) E t/) o L o(t +r o U'o TA(! U ciir rl -oldlFI ;; !t ,{*, 1',i' ar E fF *f -EOo.otr -6aLo= oJl>9 <.9 b Aa - ilc) H€H96J6oo)= d E 3: ,x 6.hIIJOO o bo a () oo) o I Oa l+- ! 13!a =t 7i cdo.= ()o-q tr&9d ! t- c? 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(ll >' ho L o () '1, C) o . (.) !l 0) o(! (h o do rE o E () C) C) ,r; c.l (n(,) bo cd N (H o E(o C) (n r- r-. co oo t- oao L< oJ d F tr o .L G) d() L 0) (h o o o bo !<o 0)L L C) o o o U)(n €o L o.oL bo o -o tho oo F- r-- o\ c) F @ o .h c) tr o c)(H o L C) ) C) bI) d 0. !o oo Lo L a o (6 t<bo C) U) (.) N CO c.l c.i N o O O(\ (, 0) oo ra) r-r- E 0) d c) oh tt) F <io o C) o(A U) oAU I,,(^h C) oo an L(0 o '13 C) (g L bnLo C, oLo G) (t Lbo oLa C) o bo boo ,.o 0) (n 0) ood oo o\ C) F -U) - I 9 ctl -c) 6lI q) u0 cl,t-q) a. (3\(.)EO\ t-r .\? Sr r:Q).)L =trousH t'tB'jl :.=.=6NEFq.: iql6)63'o o)qJq)t\ !!\! AO5d =Pi --E:.9Po()rFroo0 d e!eI llr 0)q)0 '-:-ie€-- l-l Ot)(J nte rU\JE.S ,-9 -SHra .rr o !|Cl,trEl I9EI E6-el Ea€t c)ootE>i eI -ol e.Gl!5o9 H!v9EA!i-u :oriu<)()L9!cl- =dD96Ei tr(D3gtr0) L-slr id 6l 'c)q) rnaE (^.i o\l '; G)l u) tl eFl F{ - {* i* 1i5 Fli !E IF $ c.l 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)MoHJ wno tr uNrcEF tr NGDo Other (please specift): Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH tr wHotr rrNrcEF tr NGDo J Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities The State compiles population figures and determines total number of tablets that will be required for the next treatment cycle. It provides this information to CBM who fills the re application forms and submits through the NOTF to MDP. On receipt of the drugs, the State collects the mectizan from CBM headquarters in Jos. The LGA Coordinators pick the consignments from the State while the health facility staff fetch their mectizan from the local government headquarters. These then inform the CDDs of the availability of mectizan. The CDDs pick their consignments and distribute to the community members. Table l0: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining lvermectin tablets collected and where are they kept? The remaining not used by CDDs is retrieved by FLHF staff and handed over to LGAs for onward transmission to the state. If the quantity is much CBM collects for reallocation to other states in need, but if the quantity is not much they are left to conduct mop-up treatment activities. State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Kura 108000 108000 107098 902 Rogo 25000 25000 24104 346 550 Gaya 69000 69000 6883 I 169 Aiinei 56000 56000 55880 120 Doguwa 162000 162000 161788 212 Makoda 26000 26000 26000 D/Tofa 72000 72000 71842 158 Bebeji 72000 72000 70980 1020 T/Wada 148000 148000 142661 339 5000 Karaye 57000 57000 57000 Kiru 60000 60000 s9927 73 G/Malam t I 0000 I 10000 97500 12500 Sumaila 57000 57000 57000 Kabo 44000 44000 44000 Gwarzo 5s000 55000 5493 8 62 Madobi 58500 s8500 58269 231 Dambaffa 40000 40000 40000 Takai 82000 82000 81998 2 TOTAL 1301s00 1301s00 1279816 t7t2 19972 25 WHO/APOC, 24 November 2006 EE tr - List and brieJly describe the activities under lvermectin delivery that are being carried out by heahh care personnel in the project area.(i) FLHF staff put up requisition to the LGA(ii) FLHF collect the supplies and informs the community members/CDDs of mectizan availability in his facility.(iiD CDD put up requisition to FLHF staff and collect supplies signing mectizan inventory.(iv) CDD distributes to all eligibles under supervision of FLHF staff, LOCT and community members.(v) After completing the distribution CDDs return all remaining drugs to FLHF staff. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes, Community self monitoring and stakeholders meetings are yet to be conducted although LGAs have been trained on it in 2003. Also FLHF staff in some of the LGAs were trained this year. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting (SHM) Kura 45 None None Rogo 10 (( (( Gaya t4 aa (( Aiingi 23 aa (a Doguwa 86 (( aa Makoda 4 (( 3( D/Tofa 39 6a (( Bebeii 70 (( (( T/Wada 5tt (( (( Karaye JJ (( aa Kiru 23 a( (( G/\4alam 41 6( (( Sumaila 27 aa (a Kabo 46 (( (a Gwarzo 36 (a a( Madobi 39 (a (5 Dambatta 25 aa 6( Takai 39 (( (a Total 810 aa (( 26 WHO/APOC, 24 November 2006 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. What were the main issues identified during supervision? The main issues identified during supervisory visits include: o Inadequate contribution by some LGAs . Poor participation of CBOs o Most community leaders appear committed to the implementation process. o No drug shortages recorded or reported. . Incorrect registration and poor entries of dosages given by new CDDs with low literacy levels. o Determination of dosage by use of calibrated corn sticks by some old CDDs where wooden sticks aren't adequate. . Low level of participation of women in the CDTI process. Was a supervision checklist used? SOCTs used supervisory checklist but such is rarely the case with LOCTs What were the outcomes at each level of CDTI implementation supervision? o Health facility staff are being encouraged to supervise more thoroughly, although there are complaints of inadequate logistics. o Policy makers at LGA level are routinely visited to solicit support for CDTI . The LOCTs were requested to organize retraining for CDDs on record keeping and entries into the community log books 2.9.2. 2.9.3. 2.9.4. Coordinator SOCTs LOCTS Health Facility Staff CDDsiCommunities 27 WHOiAPOC, 24 November 2006 a During supervision some efforts were made to correct CDDs on poor entries made . 2.9.5. Was feedback given to the person or groups supervised? Effons have been made to give feedback to both health workers at the LGA and Health Facility levels as well as the communities. The major emphasis was on the health workers for those issues seen at the community level, as they are expected to follow up on them. 2.9.6 How was the feedback used to improve the overall performance of the project? Training was organized at state level for local government oncho teams. While at the LGAs level a similar training was organized for FLHF staff which apparently transcends down to community levels. 28 WHO/APOC, 24 November 2006 - If there are problems with release of counterpart funds, how were they addressed? - Additional comments - Advocacy on the policy makers at all levels 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The communities support the CDDs in kind by giving them some measures (mudu) of maizelmillet/guinea corn/beans, or give them other farm products in appreciation of their work. During farming some communities assist their CDDs by mobilizing some members to work on their farms. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here IIl00/$ US Table 14: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Irg,_tfng_ of CDDs tu.4rqs",f!-q1lt!Er{q!ell levels Supervising CDDs and distribution Iqlepa! t1o1tltg1ilg,qt CDTI activities lAlyq"gqy _u isits to health and Iitical authorities IEC materials Summary (reporting) forms for treatment Vehicles/ s/ maintenance Office e 'inters etc Others(communications) 250.00 r2Joo.oo io,ooo.bo To,Sbo.oo - SMOH CgM/LGAsl SMOH LGAs SMO}YLGA S SMOH/LGA S SMOIVLGA SMOH SMOII/LGA SMOH SMOH 16,000.00 9,500.00 16,087.00 I,000.00 5,000.00 1,500.00 1000.00 TOTAL 89,987.00 Total number of persons treated 536160 Any comments or explanations? 30 WHO/APOC, 24 November 2006 SECTION 3: Support to CDTI 3.'1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? State Ministry of Health and LGAs will continue to maintain the existing equipment (i.e. motorcycle and motor vehicles) by providing funds for routine maintenance. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Source Type of Equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condrtion No. Condltlon No Condrtion No Conditron l. Vehicle I Functional I functio nal 2. Motor cycle(s) 19 Functional 4 Func. 3. Computer(s) I Functional 4. Printer(s) 1 Not func. 1 New 5. Photocopier (s) I Not functional 6. Fax Machine(s) I Functional 7. others a) (TV & VCR) I Functional b) Generator I Functional c) Contributor Year 6 Jan - Dec, 2004 Yeer 7 Jan - Dcc. 2005 Ycar E Jan - Dcc. 06 TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) Budget Release Budget Release MOH (Central + Provincial/State) 28.950 28,950 l 0,833 t0,600 t2,248 7,751 MOH (District/I-GA) 48,235 38,087 44,296 20,800 3 5,968 22,968 LocalNGDO(s) ( if any) NGDO partner(s) 40.000 20,450 3333 2500 70,000 64,441 Others a) b) Communities APOC Trust Fund 67,808 59,1 t6 TOTAL I 17,185 8'.1,48',1 58,462 33,900 186,024 154,276 29 WHO/APOC, 24 November 2006 a SECTION 4: Sustainability of CDTI 4.1. Internall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) N/A 4.1.2. What were the recommendations? N/A 4.1.3. How have they been implemented? N/A 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? December, 2006 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1, Planning at all relevant levels The 3 year post APOC plans developed in 2003 on the recommendation of the evaluators have been exhausted, sustainability plans for 2007 for both State and LGA has also been prepared as per attached. 4.2.2 Funds The State and LGAs were made to realize that support from external sponsors (APOC) ceases after expiration of 5 years period which terminated in Dec.'03. They have been requested to contribute increasingly to the implementation of the series of activities. The State and majority of the LGAs have responded by releasing funds for this year's CDTI implementation. Efforts will be made to continue sensitization of the policy makers at these levels to increase support and eventually fully fund the programme. In the meantime the project has been assured of continued support by the assisting NGDO, CBM, although the level of support and its terminal end have been given. 4.2. 3 Transport (replacement and maintenance) There are no written plans to replace existing transport by State, however, approval was given by APOC for new vehicle for the project in sixth year. Meanwhile the State has continued giving maintenance to existing transport. At the LGA level, most LGAs are giving maintenance and fueling allowance with the salaries of LOCTs. 3l WHO/APOC, 24 November 2006 tE a4.2.4 other resources Some LGAs have been providing training and mobilization materials. The project will continue sensitization and mobilization of the endemic LGAs and the State to ensure that materials needed are procured when required. The project also expects in the short-term assistance from the supporting NGDO. This area is the traditional area of support. 4.2.5 Please provide a written plan with set targets and achievements for so far. The 2007 sustainability plan is attached. 4.2.6 To what extent has the plan been implemented. 3 year post APOC plans were exhausted in2004,2005 and 2006 respectively. Some of the achievements with the plans includes :- o Release of State/LGAs counterpart funds for 7th & 8th years sustainability budget o Strenghening advocacy among leaders and local NGO/CBO groups, l1 LGA chairmen, l8 councilors for Health, 5 traditional leaders and 2 NGO members. . Procurement of additional capital equipment I printer and 4 motorcycles. o Capacity building on data management, community self monitoring and mobilizaton 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4. 3. 1 Ivermectin collection The LGA focal persons who are part of PHC department normally come to collect the Ivermectin whenever they come to collect NPI vaccine or other PHC logistics for their LGAs. Also at LGA level Mectizan collection is with PHC structure because LOCTs, first line health facilities and staff are all with PHC department. 4.3.2 Training There has been an instance where training on CDTI was infused into the programme of training for the immunization campaigns. There were also occasions where Onchocerciasis Coordinators have been invited to give lectures/presentations on CDTI during training workshops for other programmes. 433 foint supervision An integrated checklist for supervision of PHC activities has been developed by the Ministry and is being used for supervision of all PHC activities including Onchocerciasis control. 4.3.4 Release offunds. All the PHC programme have a common account where PHC funds are lodged and release follows routine procedure. However, there is a State Oncho account where state counterpart funds are lodged ! 32 WHO/APOC, 24 November 2006 4.3.5.1s CDTI included in the PHC budget? At the State level CDTI is included in the PHC budget. At the LGA level it is subsumed in most cases in general line items. 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. lYhat have been the achievements? National Programme On Immunization (NPI) has started using CDTI structures through involvement of community members as local guides and community supervision in their respective polio campaign. 4.4.7. Describe other issues considered in the integration of CDTI. With the assistance of CBM the first line health facility are being used to serve as primary eye care centres following an intensive training on blindness prevention in some pilot LGAs. However, there is a plan to integrate vitamin 'A' supplementation into existing CDTI structure. 4.5. 0perational research 4.4.1 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None was carried out during the reporting period. 4.4.2. How were the results applied in the project? N/A t J ii :L 33 WHO/APOC, 24 November 2006 aSECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths i. High commitment by community leaders and CDDs ii. Training of CDDs at a location close to them is a good strategy as other community members watch training event and this boost the knowledge of community members regard to CDTI. iii, Committed staff at both State and LGA levels. iv. High treatment coverage. v. CDTI strategy will be an inroad to other PHC programmes. Weaknesses i. Delay in the release of counter part funds by State and Local Governments hampers the smooth implementation of CDTI. ii. Payment of monetary rewards by other programme i.e. polio eradication campaign lower the morale of CDDs. Challenges . Payment of incentives to village workers by some programmes such as NPI has affected the CDTI implementation negatively o participation of women and community based groups in the CDTI process is still not encouraging. List how the challenges were addressed. The challenges encountered were addressed in the following ways (but they still remained current challenges). o Intensified targeted mobilization of community members, influential persons and interest groups to support CDDs.. o Advocacy visits to State and LGAs functionaries. These is still being pursued I a :,'* *.ts 34 WHO/APOC, 24 November 2006 SECTION 6: Unique features of the project/other matters It J a :_-lt *, tto l.r a F & 'F+F 35 WHO/APOC, 24 November 2006