NGKG annual project technical report submitted to Technical Consultative Committee (TCC): from January 2005 to December 2005

KOGI STATE EIGHTH YEAR AI\NUAL TECHNICAL REPORT COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN COI.TNITRYAIOTF: Proiect Name:NGKG Approval year:1997 Launching year: Reportins Period: From: January 2005 To: December 2005 Proiectvearofthisreport: (circleone) | 2 3 4 5 6 7Qr9 10 Date submitted: L3'n Decemberr2005 NGDO partner: Sight Savers International ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLII\E FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Juty for September meeting t, tir( cs-b cor Alr€ e'Go Fo q9, 3 0 JU|N 2006 lnformtrtto" \in N A{n*{o WHO/APOC, 24 November 2004 Ta: c.! IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: National Coordinator Signature: ,@noro- This report has been prepared by Name ' . .b.,. i , .. .'ft}l. Xpl- , signature' -SN.ASR Date St l r--lcr r WHO/APOC, 24 November 2004 I Table of Contents ACRONYMS...... ...........vDEFINITIONS.... .............vi FOLLOW UP ON TCC RECOMMENDATIONS . . . . . ... I EXECUTIVE SUMMARY... .......,2 SECTIONI: BACKGROTINDINFORMATION. .......31.1. GENERAL INFORMATION. .......3 I .1 .1. Description of the project (briefly). . .. . ....4 1.1.2. Partnership ............5t.2. POPULATTON... ......6 SECTION 2: IMPLEMENTATION OF CDTI. .........82,1, TIMELINE OF ACTTVITIES. .......82.2. ADVOCACY..... ......102.3. MOBILIZATION, SENSITIZATION AND HEALTH EDUCATIONATRISKCOMMI.INITIES. ........102.4. COMMTINITY INVOLVEMENT. ,,.,,...122.5, CAPACITY BUILDING ............142.6. TREATMENTS.... ............15 2.6.1. Treatmentfigures.... .........18 2.6.2. What are the causes of absenteeism? . . .. .. . .. . .. ..22 2.6.3. V[hat are the reasons for refusals? ... ... ... ... ... ....23 2.6.4. Briefly describe all known and verified serious adverse events (SAEI that 23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 23 2.7 . ORDERING, STORAGE AND DELIVERY OF TVERMECTIN. . . ...24 2.8. COMMTINITY SELF-MONITORING AND STAKEHOLDERS MEETING. .. .. ..27 2.9. SUPERVISION.. ...,..29 2.9.1. Provide aflow chart of supervision hierarchy... ..........29 2.9.2. What were the main issues identified during superttision?......... ... ...29 2.9.3. Was a supervision checklist used?... .......30 2.9.4. VVhat were the outcomes at each level of CDTI implementation superttision 30 2.9.5. Was feedback given to the person or groups supervised? ... .....30 2.9.6. How was the feedback used to improve the overall performance of the project? ....30 SECTION 3: SUPPORT TO CDTL ......303.1. EQUrPMENT...... .....303.2. FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMTINITIES.. 3I3.3. OTHERFORMS OF COMMTINITY SUPPORT.... ....,.,.,,..32 EXPENDITURE PER ACTTVITY 3.4. SECTION 4: SUSTAINABILITY OF CDTL .....334.1. INTERNAL; INDEPENDENT PARTICIPATORY MONITORING, EVALUATION....... 33 4.1 .1 . Was monitoring/evaluation carried out during the reporting period? ... ... ... . . 3 3 (tick any of thefollowingwhich are applicable) 4.1.2. Vlhat were the recommendations? . ...... ....33 4.1.3. How have they been implemented? ...... ......33 WHO/APOC, 24 November 2004 4.2. SUSTAINABILIry OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YR 3). .........34 4.2.1. Planning and all relevant levels... ..........34 4.2.2. Funds... ... ... ...34 4.2.3 . Transport (replacement and maintenance) ... ... ... 54 4.2.4. Other resources... ... ... ... ..... j.I 4.2.5. To what extent has the plan been implemented... ........354.3. INTEGRATTON.. ............35 4.3.1 . Ivermectin delivery mechanisms ............35 4.3.2. Training... .....35 4.3.3. Joint supervision and monitoring with other programs... .....36 4.3.4. Release offunds for project activities... ... ... ...36 4.3.5. Is CDTI included in the PHC budget?... ........36 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements? ...........36 4.3.7. Describe others issue considered in the integration of CDTI ......364.4. OPERATIONAL RESEARCH... ....,36 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... ... ....36 4.4.2. How were the results applied in the project?... ... .....36 SECTION 5: STRENGTHS, WEAKNESS, CIIALLENGES, AND OPPORTUNITrES............. ..................37 sECTroN 6: UNTQUE FEATURES oF THE PRoJECT/orrrER MATTERS .....37Problems. ...... .. . ...37Recommendation. ...........39 WHO/APOC, 24 November 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-GovemmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical consultative committee (Apoc scientific advisory group) TOT Trainer of trainers LINICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectinln 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 projict area, ultimately to be reached when the project has reached fulI geographic coverage(normally the project should be expected to reach the UTG at the end of the 3-.d year ofthe project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geopraphical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using it. .u111. systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower corlmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: 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 prograrnme is being executed in the way intended. It encourages the community io tirc nrU responsibility of ivermectin distribution and make appropriate modifications when necessary. 1V WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session Number of Recommendation in the Reoort TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (Please add more rows if necessary) There was no comment to answer from the previous TCC report. EXEGUTIVE SUMMARY Kogi State is made up of twenty- one (21) LGAs with2544 communities all of which are endemic with Onchocerciasis. The projected population for the State is 3.2 million based on the 1991 census. The project was one of the first four (4) projects approved in Nigeria in 1977. During the period of report 1,127 ,965 persons were treated out of population of 1 ,572168 in 2544 communities. This represents 71.7o/o therapeutic coverage. The Annual Treatment objective for the year was 1.2 million . 100o/o geographic coverage was attained. The ultimate treatment goal (UTG) is 1,207,406 representing 76.7% of the population. Population migrations occur mainly during Christmas festival and more especially in 5 LGAs of the State where they celebrate their festivals thrice in a year. There are also litfle migration of the nomadic fulanis in some LGAs viz; lba1i, Bassa, Kogi and Lokoja during the peak of dry seasons normally January to April. This accounts for poor fluctuation in the census update of the areas. However, poor census update was observed in Lokoja, Kogi, Dekina, Kabba-Bunu, ljumu and Okehi LGAs of the State. 5 SOCTS, 1 Nutrition Officer were re-oriented as TOTs on Vitamin "A" supplementation while 212 LOCTS and 13 Nutrition offers were trained as supervisors of CDDs on vitamin "A" supplement in 13 LGAs. Ofu LGA could not take part in the supplementation this year as a result of some internal problems among the health supervisor, which was lately resolved. There was late release of state counterpart fund and as such, activities like spots checks and supervision of lvermectin distribution at the LGAs were implemented lately. The project was faced with poor commitment of some communities and some LGAs to CDTI as they failed to compensate their CDDs and the non-release of counterpart funds by some LGAs. This was eminent in Kogi, Olamaboro and Ofu LGAs. However, the Hon. Commissioner, the Permanent Secretary visited these LGAs. This yielded positive results as the council members of both LGAs promised a change in CDTI activities in the forth - coming year. 133 new LOCTs were trained on CDTI along side with 351 old trained staff that had orientation on CDTI, totaling 484 health staff trained. Atotal of 3,136 CDDs were trained and orientated on CDTI activities. SECTION 1: Background lnformation 1.1. General lnformation Kogi State is located in the Middle Belt of Nigeria and shares boundaries with Niger, Nassarawa State and the Federal Territory to the north, to the east, the State has boundary with Benue State and to the South with Edo, Enugu, Anambra and Ondo States while to the West it has a boundary with Kwara State. The two largest rivers in Nigeria, rivers Niger and Benue form a Confluence at Lokoja, the State Capital. There are also several other fast flowing rivers namely Ofu, Anambra, Ubele, lnachalo, Okura and Oyi, which transverse the several endemic communities in the State. The main occupation of the people is farming, lumbering, fishing and trading. The vegetation is made up of rain forest in the Western part of the State, wooded savanna and grassland in the east, forest savanna mosaic to the south and guinea savanna in the north. Onchocerciasis was first reported in Nigeria in Kogi State in 1907 at Lokoja. Kogi State is a multilingual State of about eight (8) ethnic tribes but three major languages viz lgala, Yoruba and Ebira are predominant. The topography of the State is highly undulating, while some parts are mountainous, some riverine and as such, 50% of the communities are hard-to-reach areas especially in rainy season, while the remaining 50% have manageable network of roads. However, all the 21 LGA headquarters are well connected with all season roads except one (lbaji). Also the 21 LGAs have mass transit buses that ply their headquarters and the State Headquarters. About 95% of the LGA are directly or indirectly connected with GSM communication. This has made network communication easier and affordable to partners. The administrative structure is a politically elected Executive Governor at the State level and politically elected chairmen in the 21 LGAs of the State. Several hierarchies of traditional institutions are in place to oversee the districts and communities. About 1,027 primary health centers and health post are fairly distributed in CDTI areas of the State. With this arrangement the collection points of mectizan tablets by CDDs is easily accessible and affordable to members of the communities. Table 1: Number of health staff involved in CDTI. Districts/LGAs Number of health staff involved in CDTI activitiesTotal number of health staff in the entire project area B1 Number of health staff involved in CDTI B2 Percentage 81=82/81 *100 Adavi 250 14 5.6 Ajaokuta 146 19 13.0 Ankpa 242 25 10.3 Bassa 611 26 4.2 Dekina 368 41 11.1 lbaji 138 16 4.5 ldah 278 23 8.2 lgalamela/Odolu 235 38 16.1 ljumu 176 27 15.3 Kabba/Bunu 231 26 11.2 Kogi 146 12 8.2 Lokoja 174 14 8.0 Mopamuro 112 14 12.5 Ofu 288 50 17.3 Okene 198 25 12.6 Okehi 146 16 10.9 Ogorimagongo 105 14 13.3 Omala 194 20 10.3 Olamaboro 352 32 9.0 Yagba East 172 18 10.4 Yagba West 210 14 6.6 Total 4,772 484 10.8% Despite the attempts made through advocacy to heads of health Department at the LGAs to involve more health staff in CDTI activities, only few health workers were involved in the activities this year .We hope to intensify our advocacy on the need to involve more health workers for effective CDTI activities in subsequent years. 4 1.1 .2, PARTNERSHIP The partners involved in the project implementation in the State are MOH, SSl, APOC, 21 LGAs and 2,544 communities and the Federal Ministry of Health while the NOCP (Zonal level) supports the ordering of Mectizan from Mectizan donation committee in Paris. The partnership between the State, the NGDO, and the benefiting communities has been very rewarding as a result of useful advices and contributions from NGDO partners. The MOH provides office accommodation, pay salaries and emoluments of SOCTs. The State Government in the 8th year of project implementation in response to various memos to His Excellency released Five hundred thousand naira (N500, 000.00) as counterpart funds. This was rather inadequate and as such only few field trips could be made to the LGAs to oversee the level of implementation of CDTI activities for the year. This has contributed to our late collation of treatment figure and early submission of our technical report. The State project NGDO (SSl) made some visit to the State and to some communities to carry out spot checks activities of the supervisors and the CDDs. The supply of mectizan and other materials like posters, MIS forms and some other logistics/technical supports by the NGDO helped to encourage further commitment of the SOCTs and LOCTs to CDTI activities. To solicit for further and commitment to CDTI activities at the grassroot, a high power advocacy visit to two LGAs was made by the Hon. Commissioner. There is also a plan to remobilize some communities on CDDs incentives, and acceptance of mectizan therapy in some selected communities in Olamaboro, Kogi, Lokoja LGAS. 1.2. Population Table 2: Communities and population at risk in the entire prolect area whether they are treated or not during the reporting period. CDTI Districts/LGAs in the entire project area Total population in the entire project area Number of communities villases in Population Meso-endemic zone in the project area A Hyper- endemic zone in the project area A Total in meso hyper endemic zone A=A-A Meso-endemic zone in the project area A Hyper- endemic zone in the project area A Total in meso hyper- endemic zone A1=A1+A2 Ultimate treatment Goal (UTG) Adavi 55,489 56 2 58 54,010 1,479 55,489 42615 Ajaokuta 57,574 60 60 57,574 57,574 44216 Ankpa 104,269 129 84 213 69,540 34,728 104,269 80077 Bassa 1 19,933 123 62 185 87,592 31,336 1 19,933 91 340 Dekina 121471 162 80 242 103,250 18,221 121,471 93288 lbaji 87,699 117 45 162 57,561 30,128 87,689 67,344 ldah 65,103 39 39 78 33,207 31,896 63,103 49998 lgalamela/O 107,631 116 64 180 75,054 32,577 107,631 7881 9 ljumu 75,661 21 73 94 12,548 63,113 75,661 58106 Kabba Bunu 75,429 10 97 107 18,709 55,123 75,429 57929 Kogi 53,264 30 89 119 16,539 36,725 53,264 40906 Lokoja 46,000 84 7 91 6,996 38,004 45,000 35328 Mopamuro 31,069 4 15 19 3,471 27,596 31,069 23,860 Ofu 14,2363 192 76 268 84,969 55,814 142,363 1 09334 Okene 98,284 50 10 60 79,253 19,031 98,284 75482 Okehi 65,348 63 9 72 50,254 15,094 65,349 50,187 6 Ogorimagongo 34,232 47 13 87 60 25,769 8,462 34,232 26,299 Omala 48,147 73 160 11,034 37,113 48,147 36976 Olamaboro 107,916 47 198 245 45,537 62,379 107,916 82878 Yagba East 45,439 21 31 52 13,725 31,713 45,439 34895 Yagba West 35,859 11 8 19 8,216 22,643 35,859 27539 Total 1,552,017 1,455 1,099 2,544 917,990 654,179 1,572169 1,207406 UTG = calculated as the maximum number of people to be treated annually in meso hyper endemic areas within the projectarea, ultimately reached when the proiect has're.ached ru geograpiic @verage (normally the project should be expected toreach the UTG at the end of f yeai oithe prcjecl). A census fotthe projoct done duing the repofting period yesSf No ln some LGA3 proper census update was not carrled out. What is the source of the data in the table above? Source: National census other source, specify Year uPp You are using the term communitv ot village; define what constitutes the communw or village. This wilt help understand theprofile of the project area. ?##i:ili:;r: communU in the contert of this proiect is deftned as a srcup of peopte that setled in a tocation shains Thorc any other information of interest about the popurarion in the project area? rf so, inctude it here. SEGTION 2: lmplementation of CDTI Timeline of activities Districts/LGA Mobilization of communities Training on vitamin A supplementation Census/update Drug distribution Superuision Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion monthAdavi April April Aug April April Mry Mry May May Oct July Oct Ajaokuta April April Aug at June Sept June Aug. Ankpa April April ta June July Sept July Aug. Bassa April April lt l May June Sept Aug Aug Dekina April April Aug Aug May May May Sept Jun Aug & Sept lbaji April April Aug Aug May May Mry June Sept ldah April April Aug Aug May May Oct July Sept lgalamela/O April April at April May June Oct July Aug ljumu April April $ tt May May Oct June Sept Kabba/Bunu April April ta 4 Oct June Oct July Sept Kogi tl tt May Sept Nov Lokoja May May il ta June June Nov Mopamuro March March Aug Aug May Mry Arg May July Sept Aug Sept Ofu July July la May Sept Nov Oct Oct Okene April April Aug Aug June June Oct Aug Sept Okehi April April Aug Aug Oct Oct Oct Oct Ogorimagongo April April Aug Aug May Mry May June Sept July Sept Omala April April Aug Aug June June Oct Sept Sept Olamaboro April April May May June Oct Aug Aug Yagba East April April Aug Aug June Mry June June Sept June Aug Yagba West April April May July Sept Aug Aug NOTE: ' Training of SOcTs/LocTs/cDDs on vitamin supplementing using cDTl structures along with mectizan distribution was witnessed in '13 LGAS. ' Non-lncentives for CDDS in most communities were observed which eventually led to late collation of treatment ligure and reports from the LGAS. . spots supervision was canied out by socrs and some Locrs in few LGAS and communities. ' lt was observed that some communities were merged for treatment as a result of failure of some CDDS to accept the responsibility of distribution due to inadequate or lack of incentives by their communities. However, some large communities were splinted for efficacy in distribution. ' ln Kogi LGA it was sad to note that some mmmunities did not commence treatment as a result of non incentives for the CDDS and nonchalant attitude of some supervisors to work. 9 2.2. Advocacy The need for LGA Chairman, Supervisory Councillors for health and HODs health from the 21 LGAs for CDTI support was emphasized during the State Council on health held in May and October, 2005. More so the LGAs that seem performing below expectation were made to see to the need to improve on their performance. However, visit to policy makers and decision makers in their respective domain are being considered for implementation next year. 2.3. Mobilization, Sensitization and Health Education of at risk communities Community mobilization and health education of few communities were carried out by the CDDs in collaboration with town announcer. Posters were also used to explain some conditions in local dialect to some community members especially the women who cannot read nor write. This yielded positive results in those communities as eagerness to take the tablets was reported. lssues on CDDs remuneration were addressed and promises by community members to see to the CDDs incentives were received but most communities failed to respond to the CDDs need as such most CDDs were frustrated. This has continued to pose problem in treatment report collation. I strongly suggest that community mobilization and health education of community members on the need to remunerate their CDDs for the purpose of CDTI sustainability be looked into. There is also therefore, the need to put up a high powered advocacy meeting with Traditional Rulers, Chairmen in collaboration with Ministry for Local Government and Chieftaincy Affairs to agree on how best the non compensation of CDDs incentives by their various communities could be best solved. Furthermore, it may be beneficial if the Federal Government could issue a policy to be adopted by the State on CDDs incentives and subsequently be given wider awareness creation by the National Orientation Agency for the purpose of uniformity. 10 ldentification and training of Local NGDOs on CDTI activities within the communities as change agents could not be effected due to lack of funds. We hope that in the coming year, the project financial situation would be better. 11 2.4. Gommunity Involvement Table 4: Communities participation in the CDTI (please add more rows if necessary) DistricilLGA Number of communities/villages with community members as superyisors Number of CDDs and the communities involved N u m ber of com m u nities/vi I I a ge s with female CDDs Total Number of communities in the entire project B1 Number with community members as supervisors B2 Percentage 82= 81/82 *100 Male CDDs B2 Female CDDs B3 Total 84=82+ B2 Number of communities with female CDDs 814 Percentage 811 = 814/84 * 100 Adavi 58 104 3 107 3 2.8o/o Ajaokuta 60 93 2 95 2 2.1o/o Ankpa 213 234 I 243 4 1.60/0 Bassa 185 192 6 198 6 3.0% Dekina 242 276 19 295 15 5.0% lbaji 162 354 11 365 7 1.9o/o ldah 78 123 3 126 3 2.38% lgalamela/O 180 175 22 197 58 29.44% ljumu 94 70 61 131 58 42.27% Kabba/Bunu 107 84 31 115 31 26.95% Kogi 119 122 122 0% Lokoja 91 52 52 0% Mopamuro 19 75 9 84 5 5.95% Ofu 268 272 29 301 21 6.97Yo Okene 60 50 50 0% t2 Okehi 72 30 14 44 5 11.360/0 Ogorimagongo 60 23 11 34 6 17.64% Omala 160 109 3 112 2 1.78% Olamaboro 245 183 65 248 31 12.SYo Yagba East 52 137 18 155 11 7.09% Yagba West 19 55 7 62 3 4.83Yo Total 2,544 2813 323 3,136 230 8.84% Gomment on: - Attendance of female members ofthe community at health education meeting. - ln general, how do you rate the panicipation of female members of the community meeting when CDTI issues are being discussed (attendance, participation in the discussion etc). - lncentives provided by communities forthe CDDS. - Attrition ofCDDs. ls attrition a problem forthe project? lfyes, how is it addressed? - Other issues. Female attendance at mmmunity health education meeting is mmpetitive to that of man, but their participation on decision making is still shallow. The number of female cDDs icontinue to depreciated. we hope to give more enlightenment on the need forfullfemale participation in CDTI activities. The CDD'S incentive is posing a big problem in most communities and the few communities that give incentives are either not regular or inadequate. The nature of the incentives is mainly in kind and words of appreciation. Attrition_oJ CDDs is still a problem in some mmmunities especially in lgbira speaking LGAs and some tgala speaking communities. This issue is being addressed through lobbing the immunization managers to recruit some of these CDDs as local guide for National lmmunizations days and we have over the years called on the community leaders and influential personalities in the mmmunities to see to their CDDS welfare. However, some CDDS are now being reCruited as NID local guide which has helped to minimize attrition rate in few LGAS. We hope to continue in Advocacy and sensitization of communitt leaders on the welfare of the CDDs. 13 2.5. Gapacity Building 5 SOCTs have been trained and retrained as faciliators on vitamin A supplementation. 1 nutritionist was also trained to facilitate vitamin A supplementation under CDTI strategy. 484 LOCTs from the 21 LGAs were trained while 3,136 CDDs were trained in2,544 communities. On transfers of trained staff, the project rarely witness such, since the advocacy visit to the Local Government Service Commission to revert the transfer of Ajaokuta Coordinator where poor staff commitment to CDTI activities were observed to be poor, as witnessed in Ofu, Lokoja, Okehi and Yagba East LGAs the replacement of such staff were effected. t4 Table 5: Training at the different levels of cDTr implementation DistricVLGA Number of Diskicts/LGAS staff Number of health centre/post staff trained Number of other trainers of trainees (TOTs) Number of CDDs kained ATrO c1 New c2 Ref. c3 Total C4= C2+62 ATrO c5 New c6 Ref. c7 Total C8= C6+C7 ATIO c9 New c10 Ref cl1 Total C12 =C10 + c'1 ATrO cl3 New cl4 Ref. cl5 Total C16 =C14 + c'5Adavi 250 0 14 14 20 0 14 14 2 0 2 2 120 0 104 104 Ajaokuta 146 7 12 19 25 7 12 19 2 0 2 2 20 0 56 56 Ankpa 242 7 18 25 35 7 18 25 2 0 1 1 300 0 233 233 Bassa 611 12 14 26 30 12 14 26 2 0 2 2 200 0 162 162 Dekina 368 19 22 41 60 19 22 41 2 0 2 2 400 0 307 307 lbaji 138 2 14 16 25 2 14 16 2 0 2 2 300 0 290 290 ldah 278 11 12 23 25 11 12 23 2 0 2 2 200 0 189 189 lgalamela/O 235 22 16 33 45 22 16 38 2 0 2 2 350 0 169 169 ljumu 176 13 14 27 35 13 14 27 2 0 2 2 250 0 166 166 Kabba/Bunu 321 12 14 26 35 12 14 26 2 0 2 2 300 0 202 202 Kogi 146 0 14 12 25 0 12 12 2 0 2 2 160 0 115 115 Lokoja 174 0 15 14 30 0 14 14 2 0 2 2 250 0 122 122 Mopamuro 112 2 12 14 20 2 12 14 2 0 2 2 150 0 120 120 Ofu 288 14 36 50 60 14 36 50 2 0 2 1 400 0 108 201 Okene 198 6 19 25 30 6 19 25 2 0 2 2 150 0 31 120 Okehi 146 2 14 16 30 2 14 16 2 0 2 2 160 0 120 108 Ogorimagongo 105 2 12 14 20 2 12 14 2 0 2 2 50 0 248 31 Omala 194 2 18 20 30 2 18 20 2 0 2 2 220 0 82 120 15 Olamaboro 352 0 32 32 60 0 32 32 2 0 2 2 350 0 62 248 Yagba East 172 0 18 18 25 0 18 18 2 0 2 2 100 0 82 82 Yagba West 210 0 14 14 25 0 14 14 2 0 2 2 80 0 62 62 Tota! 4,862 133 351 484 660 133 351 484 42 0 40 40 4,680 0 3136 3,136 t6 Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the repofting period) Any other comments 2.6. Treatments 2.6.1 . Treatment figures lf the project is not achieving 100o/o geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of trainino CDDs Other community members e.g. community suoerwisors Health workers (frontline health facilitiesl MOH Staff or other Political leaders Other Isoeciful Program manaqement ,V ./ How to conduct health education { ./ { Management of SAEs CSM SHM Data collection { { { { Data analysis { ,v Report writinq ./ { LGA coordinator Other (specifv) I7 2.6. Treatments 2.6.1 Treatment Figures LGA TOTAL POPULATION EL!G. POPULATION PERSONS TREATED DRUGS USED Adavi 55,489 43,950 43,701 119997 Ajaokuta 57,574 45,644 45,499 118,041 Ankpa 104,269 81,450 80,330 231207 Bassa 1 18,933 84,234 83,767 258504 Dekina 121471 95,097 95,074 252912 lbaji 87,699 67,969 67,304 202416 ldah 65,103 50,316 50,219 1 1 6804 lgalamela/Odolu 107,916 72,007 71,972 213485 ljumu 75,661 59,758 56,394 171331 Kabba/Bunu 75429 58,393 58,097 1 58209 Kogi 53264 40,532 40,367 115106 Lokoja 45000 36,329 23,669 73915 Mopamuro 31,069 23,713 23,657 78927 Ofu 142363 1 07831 50,095 151172 Ogorimagongo 34,232 26,832 26,215 95487 Okehi 65,349 50,993 50,631 1 53686 Okene 98,294 76,596 76,569 209,991 Olamaboro 107,916 92,691 82,482 243633 18 Omala 48,147 38,952 38,919 121057 Yagba East 45,438 35,856 35,734 111627 Yagba West 35,859 27,444 27,443 95,845 Total 1,572,169 1,216,475 1,127,965 3,293,342 Treatment and SAEs by DistricULGA in atl areas at risk (please add more rows if necessary) t9 ommunitiesfuillages ,tion Number of percons who tefused the trcatment Number of absenfee s Number ofS/Es Number of seilous activlEs (sAEs) referred to the health post hospital Total no. ol communitias/ villagB in the meso hyper endemic D1 Annuat treatment obJective D2 Number of @mmunt ties/ villages treated lieogtaphtcal &verage (%) D4=D3,Dl= 100 Total population of the mesohyper endemrc affears D5 Annual treatment oblectMe D6 Numbet of persons treated D7 43,707 45,489 80,330 Therapeutic coveage (%) D8= D7/D6 = 1O0 Adavi 58 58 58 100 55,489 34,602 78.7 61 88 Ajaokuta 50 50 50 100 57,574 44,607 79 3 154 Ankpa 214 214 214 100 104,269 74,112 77 200 356 Bassa 156 156 156 100 1 18,933 81,503 83,767 70.4 12 425 Dekina 242 242 242 100 121,471 94,919 95,074 78.2 6 7 lbaji 172 172 172 100 87,699 66,641 67,304 76.7 166 498 ldah 78 78 78 100 65,103 50,1 1 5 50,219 77.1 0 0 lgalamela/O 170 170 170 100 107,916 71,484 71,972 66.8 4 31 ljumu 111 111 111 100 75,661 56,194 56,394 74.5 126 206 Kabba/Bunu 156 156 156 100 75,429 57,978 58,097 77 0 286 Kogi 119 119 119 100 53,264 40,195 40,367 75.7 60 105 Lokoja 91 91 91 100 45,000 34,204 23,669 52.5 111 508 Mopamuro 19 19 19 100 31,069 23,500 23,043 76.1 3 53 Ofu 211 211 211 100 142,363 96,000 26J21 50,095 35 4 124 Ogorimagongo 60 60 60 100 34,232 26,215 76.5 2 165 Okehi 60 60 60 100 88,000 77,000 75,764 76.5 103 259 Okene 60 60 60 100 98,297 75,964 76,569 77.9 0 28 Omala 160 160 160 100 48,147 3?,ggg 38,819 80.6 6 28 Olamaboro 188 188 188 100 107,916 81,959 82,492 76.4 74 463 Yagba East 52 52 52 100 45,438 34,993 35,734 76.5 53 69 Yagba West 18 18 18 100 35,859 24,303 27,443 76.5 0 1 Tota! 2544 254/. 2544 100% 1,572,169 1,157,941 1,127,965 73.1 994 3,854 Formula for computinq therapeutic and qeoqraphica! coveraqes Therapeutic coverage rate = 1.127.96s x 100 = T1.To/o(%) 1,572,169 Geographical coverage rats = 2.544 x 100 = 100%('/,) ATO coverage rate ('/,) % UTG achieved (%) 2,544 = 1.200.000 x 1,572169 = 1.207.400 x 1,572,169 100 = 76.3% 100 = 76.7% ATO = The estimated number of people living in mesohyper-endemic areas that a CDTI prokct intends to treat with ivermectin tn a gMen year- UTG.= !h7 maximum number of people..to be heated in meso/hwer-endemic areas within the projed area, ufimately to be reached when the proiect has reached full geognphical covemge iiormally the project should be bxpectei to reach the uTG atthe end of the { year project) 2.6.2. What are the causes of absenteeism? From our observation, the following are the likely causes of absenteeism. . All persons whether resident or not in some communities were registered. And during distribution these people are counted as being absent. o Distribution is often done at peak of farming season when most people stay on their farms. . The CDDs distribute at their own leisure especially as most of them are not compensated. . Most CDDs do not take extra pains to revisit households for mop-up as a result of poor or no incentives to them. 2.6.3. What are the reasons for refusal? . Coincidental illness at the time of treatment round. . Fear of unknown repercaution which might result from taking the drug. . lnduction of fear by few people who had the knowledge of what severe adverse reason might result. o To prevent them from been committed to CDDs incentives. 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 . ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 22 2.5.6. Trend of treatment achievement from GDTI project inception to the current year Table 9: Treatment ?!d coverage bv calendar year for the entire project area. (ptease fitt in the required data)Please indicate the UTG for the project area: '1,207,40G this figure as the denomination in all UTG coverage calculations) 5 LGAs were used as pilot for CDTI in 19g8. ln 1999 this was extended to 13 LGAs. ln year 2000,the21LGAs of the state came on board till present date. The census update for this year was more realistic than the previous years and as such, the therapeutic coverage calculation is fairly encouraging. Year Communitiestulllage Population Total # of @mmunrlres/vrllages rn the reso-hyper- endemrc areas E1 Annual treatment ob;ective E2 Number of communities/ ullages treated E3 Geographical coverage (%) E1=E3/E1=100 Ato coverage (%) E5 = E3/E2 = 100 Total population of the meso hyper-endemic areas E6 Annual treatment objective E7 Number of persons treated E4 Therapeutic coverage (%) E9 = E8/E6 = 100 ATO coverage (%) E10 EEIET 100 UTG coverage (%) 1 998 926 Was not defined Not defined Not defined Not defined 263,022 200,000 233,559 84.9 111.7 18.4o/o 1 999 1926 1926 1926 100 100 760,901 564,000 622,671 81.8 110.4 51.50/o 2000 2176 2176 2176 100 100 1,200,000 1,000,000 1,01 1,361 84.2 101.1 83.6 2001 2403 2403 2403 99.3 100 1,221,010 1,000,000 1,051,125 86 105.1 86.9% 2002 2403 2403 2403 100 100 1,263,200 1,000,000 1,101,197 87.1 110.1 91o/o 2003 2403 2403 2403 100 100 1,294,375 1,172,554 1,151,709 89.6 98.2 95.2 2004 2403 2403 2403 100 100 1,294,237 1,200,000 1,153,753 89.3 96.1 94.4 2005 294+ 2gq+ 2842 100 100 1,572,169 1,200,000 1,127,965 71.7 76.3 76.7 2006 2007 2008 2009 2010 23 2.7. Ordering, Storage and Delivery of lvermectin Mectizan@ ordered applied for by (p/ease tick the appropriate answer) MOHI] WHO[] UN|CEF[] NGDOTI Other (please specify) Mectizan@ delivered by (p/ease tick the appropriate answer) MoH[] wHoil uNtcEF[] NGDOtI Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities. Reports of Mectizan treatment are complied by LGA coordinators and submitted to the State Coordinator. The quantity of Mectizan required by each community for the succeeding year is based on total population XB. This is collated at State level and sent to the State NGDO. Sight Savers lnternational (SSl) who places order through NOCP to Mectizan Donation Programme. The clearance of the drugs from the Lagos upon and its storage before collection is the responsibility of UNICEF. The state receives her consignments from the NGDO and informs the LGAs for collection of their requirements. The first line health facilities receive and store the requirements for communities in their jurisdiction. Communities are informed to send their CDDs for the collection of their drugs. ryP COMMUNITY 24 SOCT LOCT FLHF Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (p/ease add more rows if any) S/IVo. Age Sex Village of origin Date Mectizan yyas taken Date 7" symptoms appeared Symptoms Health stafus before taking Mectizan Date of admission in health facility Date of dismissal from health facilitu Resu/fs of tesf (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involvement or not * Serial number of the patient There was no serious adverse event reported during the reporting period. 25 Table 10: Mectizan@ lnventory (p/ease add more rows if necessary) State/District LGA Number of Mectizan@ tablet Reguested by LGAs Received Used Losf Wasted Expired Adavi 120,000 120,000 1 19,997 3 0 Ajaokuta 120,000 120,000 119,041 0 0 0 Ankpa 250,000 250,000 231,207 0 0 0 Bassa 260,000 260,000 258,504 0 0 0 Dekina 320,000 315,000 252,912 0 101 0 lbaji 205,000 205,000 202,416 0 34 0 ldah 122,000 122,000 1 16,904 0 0 0 lgalamela/Odolu 220,000 215,000 213,495 0 0 0 ljumu 172,000 172,000 171,331 0 0 0 Kabba/Bunu 160,000 160,000 158,209 0 19 0 Kogi 120,000 120,000 1 15,106 0 0 0 Lokoja 120,000 120,000 73,915 0 39 0 Mopamuro 80,500 80,500 78,929 0 0 0 Ofu 270,000 270,000 151,172 0 0 0 Okene 210,000 210,000 20g,gg1 3 0 0 Okehi 160,000 160,000 153,696 0 29 0 Ogorimagongo 95,500 95,000 95,487 0 0 0 Omala 130,000 123,000 121,O57 0 0 0 Olamaboro 245,000 245,000 243,633 0 0 0 Yagba East 1 15,000 1 15,000 111,627 0 33 0 Yagba West 100,000 100,000 95,845 0 0 0 Total 3,595,000 3,579,000 3,293,362 6 225 0 26 How are the remaining ivermectin tablets collected and where are they kept? The remaining lvermectin tablets are usually returned to the front health facility staff who make the submission to district supervisors and are handed over to the LGA Coordinator who finally returned them to the State for safe keep at the medical store in the headquarters. List and briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area: - Placement of mectizan order at state level and LGA. (FLHF--+ LGA+ state). - Collection of mectizan to frontline facility. - lssuance of lvermectin to frontline health facility staff. - Notification of community to come for the collection of their drug from FLHF. Any other comments: 2.8. Gommunity Self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes It is frustrating to express that all the communities trained on self-monitoring and stakeholders meetings are not implementing as expected. lf so, when? The training was conducted in November,2004 and 63 participants were trained. Due to limited funds reorientation and training on community self-monitoring and stakeholders meeting could not hold as planned. 27 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) DistricilLGA Total # of communitiesfuillages in the entire proiect area No of communities that carried out self monitorins (CSM) No of communities that conducted stakeholders meetino $HM) Adavi 58 Ajaokuta 60 Ankpa 213 Bassa 185 Dekina 242 lbaji 172 ldah 78 lgalamela/Odolu 170 ljumu 111 Kabba/Bunu 156 Kogi 119 Lokoja 91 Mopamuro 19 Ofu 211 Okene 60 Okehi 79 Ogorimagongo 39 Omala 120 Olamaboro 188 Yagba East 52 Yagba West 18 Total 2,445 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. 1. lt is unfortunate that the 4 pilot LGAs we trained to implement CSM/SHM failed to implement as a result of poor supervision and unwillingness of members of the community to implement. 2. However, we intend to select more LGAs and communities for training and implementation if our financial status improves by next year. 28 NOCP ZONAL COMMUNITIES 2.e. Supervision 2.9.1. Provide a flow chart of supervision hierarchy: 2.9.2. what were the main issues identified during supervision: * Poor record keeping (only eligible persons were registered in some places). * Lack of counterpart fund in some LGAs. * Very poor CDD incentives. * Few Registers not well kept and not kept with the community heads but with CDDs. * Complaint of mild reactions such as swelling of limbs, itching and skin rashes which make some persons unwilling to take the drug. * lnadequate supervision and monitoring by LOCTs due to lack of logistics like broken down motorcycles, non release of funds for maintenance and fuelling of motorcycles and bicycles spare parts. * Proper census update was not carried out in most communities. 29 \ * Broken down motorcycles in some LGAs. * Delay in collation of treatment figures due to non-compensation of CDDs. 2.9.3. Was a supervision checklist used? Not in all places 2.9.4. What were the outcomes at each level of CDTI implementation supervision? It was observed that most communities combined census update and lvermectin distribution. Lack of incentives makes the CDDs to distribute at their convenience. Most LOCTs did not carryout supervision during distribution as a result of lack of funds to fuel their motorcycles. 2.9.5. Was feedback given to the person or groups supervised? Yes. but not all communities had opportunity for feed back 2.9.6. How was the feedback used to improve the overall performance of the project? The feedback stressed the area that the project was failing and the consequences. This creates fear in them. Most supervisors were encouraged to use integration strategy to carry out CDTI activities. These yielded positive results as they were able to detect and correct their areas of weakness.However, in few LGAs, some supervisors view Onchocerciasis activity as an adhoc work and as such not enthusiastic about treatment collation more especially as there is no enumeration tied as in NlDs. SECTIN 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (p/ease add more rows if necessary) Condition of the equipment (F = Functional, CNFR = Currently non-functional but repairable, WO = Witten of| Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others 1. Vehicle 3 F 2. Motorcvcle 3. Comouter(s) 2 F 1 F 4. Printer(s) 2 F 5. Photocooier(s) 2 One F 6. Fax Machine(s) 1 F 7. Others a) A/C 1 F b) Fridqe 1 F c) Generator 1 F 30 How does the proiect intend to maintain and replace existing equipment and other materials? The project hopes to maintain the existing equipment and other materials with the judicious use of counterpart funds from the state Government and LGAs. 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years. lf there are problems with release of counterpart funds, how were they addre.ssed? The release of funds for CDTI activities was not easy but through persistent and repeated memos and lobbing including Advocacy visits, the Government released{b00,000 for the year. This was grossly inadequate as most activities planned for the year could not be fully implemented. Additional Comments: 3.3. Other Forms of Gommunaty Support Describe/indicate forms or kindof contributions by the communities (it any) Some opinion leaders in few communities compensated their CDDs in kind such as group farming etc. This was witnessed in lgalamela/Odolu, Omala, Yagba East LGAs. Contributor Year b (provide the period) 2003 Year$ (provide the period) 2004 Year % (provide the period) 2005 TOTAL cash budgeted (us$) TOTAL cash budgeted rus$) TOTAL cash budgeted 1us$) TOTAL cash released (us$) TOTAL cash budgeted rus$) TOTAL cash released rus$) MOH (Central + Provincial/State 71,429 71,429 20,992 37,037 3,703.70 MOH (DistricU LGA) 160,645 160,645 11,094 821 7,777.7 3,303.7 Local NGDO(s) (if any) NGDO partner(s) 19,402.96 19,402.96 19,609.61 19,609.61 Others a) b) Communities APOC Trust Fund 90,151 70,096 TOTAL 251,475.96 20,830.96 192,292.61 111,519.61 31 3.4. Expenditure per activities: Table 14: lndicate how much the project spent for each activity listed below during the reporting period. Any comments or explanations? The counterpart funds released for the project this year was grossly inadequate. Other funds spent on the project were made possible through mutual integration with other pHC activities. Activity Expenditure /$sud Source(s) offunding Drug delivery from NOTF HQ area to central coltection point of community Mobilization and health education of communities LGAs Training of CDDs LGAs Training of health staff at all levels 2,077 APOC/MOH Supervising CDDs and distribution LGA lnternal monitoring of CDTI activities 120,000 State Counterpart Advocacy visits to health and political authorities 120,000 MOH IEC materials Veh icles/motorcycles/bicycles maintenance 240,000 State counterpartOffice equipment (e.g. maintenance computers, printers, etc) 60,000 State counterpart Review meeting 50,000 State counterpart TOTAL + 610,000 APO€#Sitate Total number of persons treated 1,127,965 32 SECTION 4: Sustainability of GDT| 4.1. lnternal; independent participatory monitoring, Evaluation 4.1.1. Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 participatory independent monitoring Mid term sustainability evaluation 5 year sustainability evaluation lnternal monitoring by NOTF Repeat impact assessment & evaluation of sustainability work plan was sponsored by APoc. 0ther evaluations by the NGDO partner. 4.1.2. What were the recommendations? a) That the State with the LGAs should jointly develop a comprehensive work plan on community mobilization and health education in some communities in Olamaboro LGA. b) That the LGAs project staff should endeavour to carry out serious follow-up to bring about full community participation. c) That there should be a forum for LGAs and the State to cross fertilize ideas on how best the project could be sustained. d) That advocacy visit targeting LGA new council members and other sources to give financial support to CDTI activities at this level be carried out. e) That the State team should endeavour to become computer literate for effective data management. 0 That a data clerk be employed to manage treatment data generated from the field for effective progra mme sustainabil ity. 4.1.3. How have they been implemented? a) There had been a follow-up for the implementation of these plans by LGA, but these has not yielded the desired results as there had been weak political will at the LGAs level and other administrative bottlenecks. b) There had be an organized forum for the LGA and the State to cross fertilize ideas in an integrated manner on how best CDTI could be sustained . c) Most LOCTs are actively involved in other PHC activities e.g. NPl, Roll back Malaria ect. This has help to bring the LOCTs closer to some community Members. 33 c) Although unwillingness on the side of the LOCTs to work has been observed as a result of untold stipends received during NID rounds,this has been addressed and it is hoped that the LOCTs would become fully committed to CDTI activities. 4.2. sustainability of projects: plan and set targets(mandatory at Yr 3) Was the project evaluated during the reporting period? yes Was a sustainability plan written? No When was the sustainability plan submitted? No What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:- 4.2.1. Planning at all relevant levels: At the APOC sponsored sustainability planning meeting held in February, 2004, it was resolved that, at the beginning of each year, Onchocerciasis team members should meet to plan and draw plan of activities for the year. This is being implemented at the State level. The LGAs have been encouraged to hold planning meeting at the beginning of each year to give room for efficiency. 4.2.2. Funds The inclusion of yearly budget for CDTI activities has been instituted. At the State level, provision has been made to include Onchocerciasis control in the annual budget. This has paved way for writing of memos for release of funds though, political bottleneck is often experience. 34 4.2.3. Transport (replacement and maintenance): APOC promised the donation of another 4 wheel drive Toyota Hilux. 120 motorcycles, 120 Raleigh, bicycle, 1 desktop computer, sharp photocopier, 1 LaserJet printer and 1 overhead projector. These were redeemed and conveyed into the State in December last year. lt is hoped that other replacement and maintenance of capital equipment would be carried out from the counterpart funds as they are released. The State has been responsible for the maintenance of the capital equipment. lt is gratifying to express that, all this equipment are in good functioning condition. 4.2.4. Other Resources: It is our sincere hope that other philanthropist would contribute to CDTI sustainability and when this happens, the funds; materials would be judiciously committed to CDTI activities in the State. 4.2.5. To what extent has the plan implemented: The inclusion of yearly budget for CDTI activities in the overall Ministry budget has since been instituted. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 4.3.1. lvermectin delivery mechanism: Letters to LGAs informing them of availability of mectizan tablet at the State for collection are normally set through other PHC staff going to the LGAs for programmes and LGAs staff that comes to the headquarters. The vehicle that comes for collection of vaccines helps in the delivery of mectizan to the LGAs. Also the LOCTs/DHS are PHC staff in their various LGAs. 4.3.2. Training: Some M & E officers at the LGAs are also trained at the LGAs to help monitor lvermectin distribution. ln the same vein, some nutrition officers were trained on vitamin A supplementation using CDTI strategy both at the State and LGA levels. 35 4.3.3. Joint supervision and monitoring with other programme: Formal organization for this is yet to be put in place, however, few incidences of joint supervision exist during NlDs but its implementation is been awaited when this is in place, they would be empowered to monitor all aspects of health care delivery in PHC. 4.3.3. Release of funds for project activities: Funds for activities are stringently released at the State level more especially as not all approved funds are often released. 4.3.5. ls GDTI included in the PHG budget? Yes 4.3.6. Describe other health programme that is using the GDT! structure and how this was achieved. what have been the achievements? NPI in Polio Eradication and Vitamin A supplementation in 14 LGAs of State. 4.3.7. Describe other issues considered in the integration of GDTI: The government stands to achieve programme cost effectiveness in terms of man power, money, material and other logistics, if other programme are integrated into CDTI or vise versa. More coordination of activities would be achieved if proper implementation Plan is put in place. 4.4. Operational Research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period? No operational research was conducted during this reporting period. However, we wish that an operational research on CDDs attrition be conducted in our State as to address issues affecting CDTI sustainability in some LGAs. N/A SEGTION 5: Strength, WeE$ness, Challenges and Opportunities STRENGTH - Most CDDs still distribute Mectizan@ despite their demands for incentives - Adequately staffed health facilities in the communities. - Availability of project vehicles (motor vehicre and motorcycles). - Availability of skilled CDT| manpower (SOCTs & LOCTs). WEAKNESS (political will) - lnadequate support for project plans at LGA level. - Lack of provision of incentives for CDDs. - lnadequate logistic support for LOCTs which is affecting supervision and monitoring. SEcrloN 6: Unique features of the project/other matters - To ensure community commitment to providing incentives to CDDs, and mass acceptance of mectizan, visit to some communities in Olamaboro and Kogi LGAs by the Honourable Commissioner was inevitable. - To ensure provision of incentives for CDDs, SOCTs made few visits to the communities to advocate with community leaders and other influential political leaders on the need for community participation towards CDTI sustainability. Problems: 1. Funding of NlDs by WHO and other agency has affected CDTI in the State. This has led to refusal of some community to compensate their CDDs and as such, treatment with lvermectin in such communities was actually very difficult. The LGA mostly affected are Kogi, Lokoja, ofu, okehi and some part of Olamaboro. 2. ln some LGA like Ofu, Kogi, Olamaboro and Lokoja the health supervisors who should oversee the activities of CDDs. were very unwilling to accept responsibilities. 3. lnaccurate data on distrfibution to the setback we had in Ofu and Kogi Lokoja . LGAs. 37 Though advocacy visits to these LGAs were made but I wish to strongly recommend the following :- Recommendations ' High powered advocacy to traditional leaders and LGA council members' for sustainability of CDTI , to be sponsored by APOC and the NGDO assisting the State. ' Re community mobilization and health education of some communities in these LGA to get them refocused on their roles and responsibilities in CDTI implementation, to be sponsored by ApOC. ' Retraining of CDDs in some communities to equip them with skills needed for filling of MIS forms and proper record keeping. ' Orientation training of LOCTs on data management in CDTI implementation. 38