Independent monitoring of Community Directed Treatment with Ivermectin(CDTI) in Edo State, Nigeria: August14-September 4, 2000

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) INDEPENDENT MONITORING OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI} IN EDO STATE, NIGERIA. AUGUST 14 . SEPTEMBER 4, 2OOO REPOP.T RECU I 7 ocT. 2000 APOC/DIR TABLE OF CONTENT A. ACRONYMS B. CERTIFICATION C. OTHER PARTICIPANTS D. EXECUTIVE SUMMARY E. INTRODUCTION F. TERMS OF REFERENCE G. STUDY SITE H. METHODOLOGY I. RESULTS J. DISCUSSION K. STRENGTHSNVEAKNESSES L. RECOMMENDATIONS M. ..WHAT THE PEOPLE SAID,, N. ACKNOWLEDGEMENT O. APPBNDICES t. Time plan for CDTI monitoring in Edo State.2. FGDs in Category A villages. 1. Sample of Village register. ! Sample of Village ,egister. t. Sample of LGA Summary form.6' summary from Edo state Technicar Report June 2000.7' summary from Edo state Technicar Reiort,lrn.2000. !. Sample of Edo SOCU monitoring fo"r.---'9, Instruments used in monitoring fxercise. Page 2 3 4 5 7 8 t0 ll l6 24 33 36 38 43 44 2A. ACRONYMS APOC Afi'rcan prograrnlne fbr' Onchocerciasis Control World Ilealth Organrzatron C'omlnunrty Directed Treatment with [vermectin Cornmunity Based Treatment with Ivermectin National Onchocerciasis Control programme Natronal Onchocerciasis Control Task Force State Onchocerciasis Control Unit State Onchocerciasis Control Team Local Government Onchocerciasis Control Unit Local Government Onchocerciasis Control Team Global 2000 River Bllndness programme Non Governmental Development Organisation Local Government Area Focus Group Discussion Annual Treatment Objective Corn nrunity Directed Distributors Prirnary Health Care Irrfirrrrratiolt. Eclucaticln and Communrcation Rapr d Ep r denr i ological mappin g for Onchocerciasis wHo CDTI CBTI NOCP NOTF SOCU SOCT LOCU LOCT "Cornrnunity' is used rnterchangeably wrth .village,, in this report. GRBP NGDO LGA FGD ATO CDD PHC IE( REMO MONITORING OF CDTI WAS CONDUCTED TN EDO STATE, NIGERIA BY: Ekanem Ikpi Braide (Team Leader) Department of Biological Sciences University of Calabar P. O. Box 3679 Calabar, Nigeria, West Africa Tel:087-230452 Ernail ekab @unical. anoa. net.ng t- Christopher Ogoshi (Team Member) Christoffel BI indenMi ssion (CBM) Onchocerciasis Programme 3,A' Gomwalk Close, P. O. Box 8426 Jos, Nigeria, West Africa Tel. 234-73-454230 Fax 234-73-456578 Email: JeffWatson@maf.org $6m^ -7-- Dr. Y. A. Saka (Team Member) Federal Ministry of Health Nati onal Onchocerciasi s Control Prograrnlne QI{OCP) Federal Secretariat Phase II Room 915 Ikoyi Lagos, Nigeria, West Africa Tel: 0l -2696013 Fax: 0l-2696013 4C. OTHER PARTICIPANTS ASSISTANTS I Mr. (Jwern Ekpo 2. Mr. Obono Marrrn 3 Mr Urna Udurna .1. Mr. Mike Urnoh 5 Miss Ekaette Akpaidiok SOCT FIELD GTIIDES I Mr A. O. Abu 2. Mr,. Salru Kadirr 3. Mrs patrence Irabor 4. Mrs Dora Akpata 5 Mrs Elizabeth Orbih 6 Mrs Dora E. Osoata DRIVERS I Mr. Drrisu Osrtb 2. Mr. Osamudiawawen Edobor 3 Mr. Eko J Eko Data assistant Field assistant Field assistant Field assistant Secretarial assistant 5D EXECUTIVE SLIMMARY A rnonitoring tearn set up by NoCP Nigena comprising prof. E. t. Braide, Mr.c' ogoshi and Dr Y'A Saka' tnouitored CDTI project in Edo state within theperiod of August l4 - septetnber 4 (field work and report writing). The aim ofthe rnonitoring was to assess the extent to which CDTI is being implemented inEdo State' A one day training of members of the monito,ng team and fieldassistants preceded fierd visits. During the monitoring period, briefing andinterview sessrons were held with key officials of NOCp. GRBP, SOCT, EdoState Government, LGA Council and LOCT. After field visits, a .lointdebriefing session was rrerr, with trre programme Assistant (pA) of GRBpEdo/Delta and Edo socT members. A totar of 2g (6 category A and, 23category B) vi,ages' serected through multistage sampring procedure werevisited rn 6 Locar Government Areas. Instruments developed by Apoctemporary advisers in ouagadougou, Burkina Faso and refined in Kabare,uganda were used' Infor:nation was gathered through key informant interviewsand Focus Group Discussions (FGDs) on drugprocuremenilstorage/delivery/distributlon, cornmunity involvement in decisionmaking, community support of distribution, communit satisfaction, troinins rp.nri t.^^-: y perception/expectation/ pHc, counrerparr,ri;,,""ffil:#;;il1ffi -;*j,T-n inro Procedure for procurement, storage and derivery of mectizan was found to be inline wit^ APoc guidelines except fbr the fact that mectizanrs yet to be stored instate and LGA facilities' In spite of lack of information on onchocerciasis and.DTI' a,d inadequate rnobil izationand sensit ization,freated communities weresatisfied with the therapeutic effect of mectizan. They were willing toparttclpate fully in the programrne as stakehorders, if tord what to do. Recordkeeping and reporting was not in accordance with Apoc/NOTF approved 6formats at commurrttl' level and was very poor in quality. Records were not available in l5 of the 29 villages visited and in all 6 LGAs visited. Data in Edo State Jttne 2000 I'eclmrcal Report did not tally with LGA Summary forms obtained from the SOCT office and none of the two sets of data agreed with data in village registers (notebooks). It was impossible to calculate coverage as onlS eligibles were recorded in registers. All CDDs seen had been trained at least ottce but quality of trainrng was found to be very poor. Though all 29 villages claimed to have received health education, there was no evidence of any posrtive effect of the health education as awareness was found to be very low' Strengths of the project were found to include high political commitment on the part of State Govemment and LGAs, commitment of SOCT and LOCT, structttral integratron into PHC, high literacy level of CDDs and willingness of communities to participate, weakness of the pro;ect were found to include poor sensitization and mobilization of State/LGAs/communities, Information gap berween NGDoNocp and the state/LcAs/communities, lack of tEC materials, lack of census data, poor haining, poor record keeping and poor supervision' There was also no arrangement for management and referral of adverse reactiotts and no follow up of refusals, absentees, underage and the sick. The team recommerlds that NOCP/GRBP should correct the structural defect inEdo/Delta prolect by ernpowerng each State to take control of their pro.;ect. These stakeholders should carry out joint advocacy visits to Edo State and fullytnform and sensitize Edo State government and LGA councils about GDTI andthe role of the Stakeholders. GRBP shoulcl take immediate actions to empower the Edo socT to take on thetr prescribed role. Edo state Government shouldpay her counrerpart funds for I 999 and 2000 and fortifi, the SOCT office for safe storage of mect izan and otlrer CDTI equipment and suppries. lntensive comrnunity mobirization, se,srtrzation and education using appropnate IEC tltaterlals should be conducted afresh in all target communities. Thorough 7training and retraining should be conducted for LOCT, health workers and CDDs orr all components of CDTI All Stakeholders should implement accurate distribution and proper reporting procedures and ensure that supervision is intensified, census is conducted and REMO updated. E. INTRODTIC]TION The African Programme for onchocerciasis Control (ApoC) was set up in December 1995 to implement an effective and self-sustaining programme for treatment of poptrlations in hyper and meso endemic areas using lvermectin donated by Merck company Inc. The programme began with communiry Based Treatment with lvermectin (cBTI) approach but in lgg6changed to the community Directed Treatment with Ivermectin (CDTI) approach after a multi- country study showed tlrat communities are capable of directing Ivermectindistribution This approaclt requires that communities own and sustain theprograrnme by taking on full responsibility for selection of distributors, decision making on date' rnode of distribution as well as supporting distribution. The first CDTI project EII'a'lts were awarded in 1997 andat present there are 47projects' 36 of which are specifically devoted to field operations for GDTIPro-;ects are impremented as partnership between Apoc, Government, NGDos and communities. Each project is funded for a period of 5 years over whichtime it is expected that support by partners wiil increase whire Apoc supportwill decrease' and cost of treatment per person will reduce by abou t gooh. It isexpected that GDTI activitres will be sustained for up to 15 years in order toguarantee effectiv,e control of onchocerciasis. o,e of trre key actrvities in the .DTI pran of action is regurar monitoring ofCDTI projects to detennine to what extent the key activities are being carried 8out, to highhght strengths and weaknesses and make recommendations for improvelnent of the plogralnme. Presented here is the repoft of monitoring exercise conducted in Edo State, Nigeria within the period August l4 to Septenrber. 4,2ooo. F. TERMS OF REFERENCE s,ccrnctly docurnent how Ivermectin treatments were undertaken in a number of communities in Edo State 2 Assess comtnunity involvement in drug collection, decision on the time of distribution. rnode of distribution and selection of distributors and the willingness of co,rr,unity to bear the responsibilities as designed in the CDTI projeus Document community perceptions of CDTI processes, especialry the issue of ownership attd expectations for onchocerciasis control, and basedon these perceptrorrs and expectations, determine the degree ofsatisfaction of trre cornrnu,ity with the drfferent programme activities and outcornes. J I Assess the quality of Distributors (CDDs). training received by Community Directed _5 Examrne tlre record books of cDDs and assess the quarity of recordkeep,rg ard therr abiritl, to keep accurate records. The same appries totlre lrealtlr serv,tces staff olt the projects. 96 7 8 Detennine the ntrrnber of Communities and eligible persons treated and compare findings with the records of CDDs and the records at the State and LGA levels. Determine whether health personnel participated in Ivermectin distribution and assess the degree of supervision by hearth staff (and the quality of training and/or orientation of such staffto CDTI). Identrfy constraints in trre distributions and make recommendations to the NorF and management of Apoc on corrective measures necessary before next treatment. Document reasons (e. g constraints) why a project did not comprete treatments (geographic and therapeutic) or achieved g0%o ofthe Annuar Treatmenr Objective (ATO) Examine IEC materials in use in the project. Obtain infonnatron on funding by State Gor,,enrrnent Local Government Area NGDO Discttss the pro;ect's sustainabilify based on the findings above Brief and debrief the national coordinator and the country representative of the NGDO suppor-ting the projects. 9 l0 ll 2 l3 10 t4 Submit data on lrousehold survey rrr category "A" villages and all other quantitatrve and qualrtative data on categories ..A,, and ..B,, villages (hard copy and diskettes). G. STTIDY SITES Nigeria, Africa's rnost popurous country, inspite of her size and immense natural and human resources, is still faced with many health problems one of which is onchocerciasis. It is estimated that Nigeria habours about 60%o of all onchocerciasis cases in west Africa and 30-40 o/o of the cases in the world. Expectedly Nigeria was among the first set of countries to receive grants from the APOC Trust Fund fbr CDTI Edo state and Delta state were carved out of the former Bendel State. EdoState is bounded to the East by Derta State, to the west by ondo State, and tothe North by Kogi State. The state, which is in the B zone of the pHC system,is made up of 18 local government areas of which 12 have been identified aslryper/meso endemic fbr onchocerciasis. As indicated in the June ZO00Technical Report, Edo/Derta proje* was approved in Aprir rggg forcommencetnent in June 1999 The first installment of funds was rereased byAPoc in July lggg' It is indicated in the technical report that atotar of 1,051persons were trained' 381,466 persons in 464 villages in l2LGAs were heated,and a therapeutic coverage of 68. lo/o achieved within the period June I ggg andMay 2000 (Appendix I) I2 3 4 5 6 7 8 8. 9. II 12. I3. 14. I5. 16. 17. t8 19. 1t H. METHODOLOGY The Monitoring Exercise began immediatery after a training session was conducted for the monitors and the other assistants in Benin City on the 15ft of August,2000 Using appropriate interview guides/questionnaires the following policy makers and health workers were interviewed and briefed. Dr. Kenneth Korve, Dep. National Coord. GRBP Mr. John Eguagie, project Admin Edo/Delt4 GRBP Mr. A. O. Abu, oncho coordinator Ministry of health Edo State Mrs' C. o. [ru, Deputy Director PHCTDC Ministry of Hearth Edo stateDr. Peter Nosa 8., Director pHC/Dc Mrnistry of Hearth Edo StateDr. E' Irubera, pernranent Secretary Ministry of Hearth Edo StateDr' E' S' Okpaise' Head of Service Edo State Government Dr' odu Bamgbose, Assistant chief Scientific of;ficer, Nocp Mrs. Ruth O. Aigbokham, pHC Coordinator, Etsako East Hon' charres Inwumho, counciror for Hearth, Etsako EastHon. G. A. Eshieshi, Chainnan, Etsako East Mr' F' I' Akindo' Director of personner mgt., Etsako EastMrs. Esther E. Asse, pHC Coordinator, Owan West Hon. Okhiria Andrew, Councillor for Health, Owan WestMrs. T. E. Odiboh, pHC Coordinator, Esan South EastHo,. Iyamu, Councillor for Health, Ovia South West Mrs. C. A. Osazuwa, pHC Coordinator, Ovia South west Mr. S. E. Aghedo, LGA Secretary, Ovia South West Mr. Anselm Lnobige, Secretary of Council , Owan East t2 At the end of field vrsits the team held a Jomt debrrefing session with the following . Mr. John Eguagie . Mr. A. O. Abu . Mrs. D. E. Osata . Mr S A. Kadiri . Mrs. P. Akpata . Mrs. P. Irabor Ogunmola . Mrs. E Orbilr PA GRBP EdoiDelta Coordinator Edo SOCU Mernber Edo SCOT Member Edo SCOT Member Edo SCOT Member Edo SCOT Member Edo SCOT To aid selection of villages, Edo State REMO results, Iists of Local Government Areas (LGAs) and villages as well as the map of the State were examined. careful consideration was given to geographical and administrative spread irr the selection of "A" viilages. A totar of 6 category ..A,, villages were serected frorn six LGAs under the following catego rization. ' Two villages each with Hearth facirity and far from headquarters ' one village with Hearth facirity and near to headquarters ' Two villages each without rrearth facirity and far from headquarters ' one village without rrearth facirity and near to headquarters. In eaclr category "A" village, key irrformant interviews were conducted on cDD' village head and health worker after obtaining permission from the village head to work in the virage. In each category ..A,, v,rage arso, two Focus Group Discussions (IrGDs) were conducted with one female adult group and one male adurt group (FGDs) per virage in 3 A virages and with one female youth and one mare youth goups per vilrage in 3 vilrages (Appendix 2). care was taken to have g-r0 persons per group. The group discussions were 13 tape recorded in labelled cassettes and later transcribed. A sample of l0-15 hotrseholds was selected in each category "A" village for household survey. After obtaining perrnlssron fiom the household head, all members of the household were listed starting with the head of the household. Each household member was asked questions listed in the household survey form. A sample of 5 persons in 3 Category "A" villages were measured to determine the accuracy of number of tablets given. All available registers were collected for inspection. CDDs were requested to submit their measuring tools for inspection. For each category "A" villa ge, 4 category "B" villages were selected. tn each category "B" village, key informant interviews were conducted with CDD and village head' All available treatment registers and measuring tools were inspected. Limitations experienced during the exercise were the fo[owing: ' Settlement pattern in Edo state made it difficult to find ((8,, villages surrounding the "A" villages. Most villages are situated along the marn roads and therefbre are at the same revel of deveropment. ..B,, vilrages selected are therefore not necessarily smaller than ..A,, villages, and in most cases not "around,, ((A', villages. ' Inaccurate REMo results made it difficult for team to determine accurate endemicity of villages. 14 Table l. Profile Of Villages Monitored A En CI Odiguetue Iguonalchr II Eguare Eu'ohrml REMO YO(hlpo) but treatrnent donc *cDD and chief not at Itotne so no Key Informant interviews conducted WOHF Without Healtlr Facility With Health Facrlity Far fiom Headquarters Near Headquarters WHF FHQ NHQ S/N LGA B villages EndemicityAI O-r'ra N.E H)'per H]'per WHF' FHQ WOHC FHQ -U Adichr Hyper82 Orvan Hyper 83 Uhiere HYPer 84 Osasemoba+A2 Ovra SW 85 Obazumamwen Listed but no REMO resutt 86 Ora I Lrsted but no REMO result 87 Ora II Hypo 88 Okokpo I Meso 89 Okoro II Bl0 Aifasoba Hyper A3 Esako East Or.ao H)'pcr WHF FHQ Bll Ekwotsor Not on REMO lisr Bl2Iviukwe close to B14 Othameh Hypo but close to hyper A{ Ouan East Ihievbe H)'per WHF NHQ Bl5 Onarrake Not on REMOlisr 816 Okhuame Not on REMO lisr Bl7 Warrake BIE Osun Meso MesoA.5 Esan West Imulc Mcso WHF NHQ Bt9 Ille B20 Orvene Not on REMO listA6 Esan S, E NHF FHQ B2l Iheken MESO B22 Ewatto Not on REMO list 823 Ogbe Ewohimi B'24 Idumogo Ewohimi Not on REMO list Not on REMOtist Bl3 Agiere Meso EDO $TATE MAP trI0 z c ul Oc ,r" o. \.o AI(OKO.EDO EISAI(O EASI EISAI(OOWA}I EAII EISAIO CENIIAL ottAl't wESr 2 rtl rill EliAN SOUIHWEST UHUNITAU'ODC -alt6L, =(9 OVIA NORTHEAST ORHIONMWON / 'rt l6 I. RESTILTS General Information Table 2: Decis ion-makin rocesses at the commun level Number of LGAs visited Number of "A" villages visited Nurnber of "8" villages visrted Number of key Infbrrnarrt rnterviews: village "A" leaders Number of key Inforrnant lnterviews: village "B" leaders Nurnber of ln-depth Interviews: Village..Ai CDDs Number of In-depth Interviews: Village..B,, CDDs Nurnber of Health Personnel lnterviewed Number of Household rnernbers surveyed Number of Policy makers interviewed Number of FGDs conducted 6 6 23 6 23 7 22 il 37t 8 5 Input Indicators (using response fiorn vlllage head)E-l - 9 (31 0%) of the 2giommuniti"s ,nonitored-rlecidedln period of treatment,l0 (34 4Yo) of the 29 communities monrtored decided o, ,oa. of treatmentE-2 - 12 (4t 49/o) of 29 comrnunities ,nonito.ea ,"t""i"JCoo at village meeting. Information frotn the FGDs revealed that decisions were made mainly by thehealth workers and village elders. Vrllage Village Elders Village Health Worker Vrllage H, Village Others Total . Who decides on tl.rc month of Distributron . Mode of Drstnbutron Village Resporues on *'ho decides [,eader -.rAt'and ..Brt lon CDDa L2 .1L.r e (31 0) l0 (3.1 .1) 8 27.6 2 ((t B) 7 (21.t) J t7 3 (10.3) 0 (0.0) 3.+ 5 (t7.2) e (31.0) 2 r0 (34.4) 0 (0.0) (0. (3. 0 I 0) 4) 0 0 0 (0.0) 2 (6.8) 29 29 (100) 2e (100) Village r4r *4 rifn . Trme of Distnbutlon . Mode of DrstnbuUon CDD Selection of (ri5 7) I (t 9 (r.r 3) 121 t2 42. 0 (0.0) r (t4 3) s (7t.4)0 (0.0) 2 0 (0.0) 0 (0.0) 1 l (14.3) 0 (0.0) 0 (0.0) 0 (0.0) 28 7 (100) 7 (100) . Mode of drslnbutron G t *A ,,roup viDiscussion age ofTuue d.rstnbu lron a of 0 0 I 2 2 2 I I 0 2 0 (0.0) 0 (0.0) 2 2 2 0 0 0 0 0 0 o 0 0 5 5 5 l7 Table 3: Absentees and Refusals (Treatment Registers) LGA v Absentees Refusels TOTAL Output lndicators 9-]- Proportion and number of refusals two months after distribution : No records. o-2 - Proportion and number of absentees later treated : No records FGDs revealed that there were many absentees and refusals that were not followed up and also that not all eligibles had been treated. LGA summaries obtained from the SoCT has data for refusals, absentees, sick and underage. The meanirrg of these data is not clear as no such records exist in the village registers. Table 4: Proportion of villages treated and in which cDDs where changed after the firsitreatment (Key Informant interviews cDDs and vilrage Heads). LGA Village (B & A) Treated CDD Cha Yes No Yes NoEsan South East 4+ I 5 J ., 0 5Esan West 0 5 3 I 2Etsako East 4+ 1 5 0 I 4Ovia North East 3+ I 4 0 4 I 3Ovia South West 6+l 7 4+ I 5 5 2 I 6Owan East I 4 2 3Total 2s + 6 (29) t4 15 6 23 6 o-3 - l1 (48 3o/o) of zg villages monitored had been treated under CDTI9-1 99rat o.r person treated was not addressed au.ing tt e monitoring.o-5 - cDDs were changed after first treatment in 6 ed 7%)of 29 villiges monitored LOCT Record GRBP State Village Register LOCT Record Village Register GRBP State Esan South East Esan West Etsako East Ovia North East Ovia South West Owan East Equare Ewohimr Imule Ovao Odiguetue Iguoriakhi II Ihievbe A A A A A A NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR A NR NR NR 2+t(3) l8 Table 5: Proportion of villages which received health education and in which CDDs where srrpervised by henlth care personnel. (Data pooled from interview with CDD and Village head). LGA Esan South East CDD supervised by health system (o/ol 1L100) 4 (80) Esan West ., 3 (r00) 2 (66.7) Etsako East 5 s (100) 3 (60) Ovia North East 4 7 3 (7s) 1IJs)Ovia South West 7 I s (71 4)Owan East 5 4 80 3 60 Total 29 27 (93.1) 20 (6r.e6) 5 Nrrmber of Villnges Received health education (%o) tsako 0-6 - CDDS were supervised by Health care system in 20 (68.9 6%o) of zgvillages monitoredo-7 - Health Educatton about importance olivermectin treatment had been givenin2T(93 19%) of 29 communitiis monitored Table 6: Treatment summary (Data only from ,.A,, villages) No summary data were available in all the."A" vitlages visited Data below were calculatedfi'om registers (notebooks) where available una "oirpu;; u, indicated with data obtainedfrom household survey n S/E, Esun Wtrt IUi(' lts RI'(' 32 NA NI NI l8t () NA NA t? N/E uso o il 28 0 NI 0 5 lot r\bscntecs -lreated l1 NA 55 54 Fis .- ilousehokl S u:vct'. ltcc - I(ci,ords lrorn :VTlagc '- Not*-l otal retlrs to tolal rrunrbur ol'1rcoplc rn thc housc survc'v,sample, an<J total nurnbcr of pcopte rn thc villagc rcgisters. -NotAvarlablc Total population of villages was rtot available in village treatment notebooks asonly eligible persons were listed. o-lJ - Proportion and nttmber of persons 5 years and above whom received ivermectin. coverage of totar population in 6 catego ry "A" vi[ages computed from househordsurvey is 59 6 9/o None of r I persons measured in ovao.(4), Ihievebe (2), Imure llreh (r) and Eguare(3) was given correct dose of ivermectin IIS Owen Eart ITS REC ITSl-ota.lr 55 HS1 006 REC RI.:C 557 IIS 58 I0t 78 47 NA NA NA t, 78 NA NA l' 2 47 INA I NA NA t- Ovir SrV REC -to FD s.p a { { A) rfl FD ln U) s)i, U) E frj(t, e {(!(n rn v) FlF o r., o) F |iJ N)\o 5{lJl latLlr 3 S.ZZ = = '= E6 + N) -J Ao\5 (,(+.)(^ OEIFl-x9.0i a tzo \o 6\ \oP O@l{^ @O Oooo A oh.) oo u) t-EBErq' I b.) z o sh.)OUJ oo Ol-.J6 o\ OoN)o N)tJ oA i 20i.) dE aoQ D CEo z o sNJo(}JA(/r tJ@ o\ t\)o@o zz zz zzz I!FEE 3Bta I(r)(D(r, zo zz zz zzz NJ€ Ot\) N) ig38 =38-E+ o za \oo\5oN)\to\ o\ l-.)a 5o(,Jl'.)a oN) oN) ii?FF s. :. d6' s. FF =$ zo o\ \o 5Ooo \o6\oo *J+ A .t+ iJr* .t+ zo *(JJ*O stFi FFB$ rl I o\ N)oAoo oo o{ A \o 6\o\oo ON) (3 z o 9FE'g E'8..i. i *.J E .{l I -I oI\o tJooo stJoo O zoo o FFO(DiD='8H"- (!=a- | ig>6 ='< =.8.)=rrg .D oO rO o\o -l EE - tr! J zrE -l zU o r.i oF(t) 1, F9 z fr, TTT iii772 !CO{C\UrJ-!)N- qr ! 'p'v'o 1r'tr rc "c) 7 --lEEEEEEEE X ]:1::1:1:r:1:11:_r P =aa9g-ei=ai EE)sJtJ$$$oo(Jl-aaaeaaaB,d 63==,=====\E= EtE,C,E-,- 4 3 3 3 3 3 3 C L./q.IEqqqgI Eoooooooo -------- ic858QEE88 2 =F=FEE=T 9 =A=isIEE fi-qlF;=efa E ,E id==*, atT=eE=:sEL 6- ;3 E;:E€ g € arasFaEi g e=; i; U.r3 U =Eg?E'9BFEE'rg 9g€ e5 =9o'7G 6 I -o@ O = ht =: d E o<A =*9.(,=J61 r'DGC)O(E1F a ?i e= n tsts8 F Z<or ilod .)50 .iX=s=. .):l EFl.o+=55.) -F)6 .i=1,8 F EF 8'7!+E; :, 98 : @^ o J hJ 0aa ixrxsr-".!Ssis^' i59*9s- {-'- v ra =. -\ \o 20 Table 8 Treatment Register Data I LGA )r'ia N E Etsako East s.w sanS E mW an East Village Ebese Ivbaro Trcatrrrcnt Regrster scclt Nunrbcr of[anlcs ln rcSlstcr i f-I I I r- Number of psrsons recorded as tre;rtcd ofNumber absentees refusal ineligrbles Nurnber of tablets distributed Summary page in regster No i Orran Uhrere No No No Osasernoba No Ovao Yes I 280 17 Not indlcated l03E NoYes Yes No No El$votsor Iviulove 2t{t I{09 913 160 Not indrcated Not indicated 1906 478Aglere Yes Yes I 187 1t7 359 Not rndlcated Not rndicated Nor indicated 2500 1286 No NoII en I Ora I Ora II No Ycs 196 460 592 I8t -53 3t3 229 6l Not indicaied Not indicatcd Not mdicated Not 524 1028 588 401 No No No 188 54 Not indicated made an attempt mdrcating absentees. CDD sick 543 482 No No NoAifasoba Eguare Err'ohimr Ihckcn Euohrnrr Okoro I Ycs Yes 100(r I It.5 Not indicated An attempt nude by CDD at Not lndlcated No E$atto Ycs 688 Not rndrcatcd Not indrcated Not indicated No No No No No No No hnule Ille Okhuanre Onarrake Or 'be No No Ogbc En'ohrnrr Idumogo Eryohrmr Warrake t9E7 No Yes 802 620 Not indrcated No Ycs Ycs Y I INPUT INDI 0 n q Percentage of Villages 60 80 1m Trained CDDe Late Supply Drug Shortage Collec{irn from a print Meawrirg device Tredment regis{er Summary in Distric-t orffice Side reaction record E Esan South East I Esan West I Etsako East o Ovia North East ts Ovia South West 12 o o (U o €E

0 20 40 Percentage of Villages 60 80 100 120 Esan South East Esan West Etsako East vt (,J Ovia North East Ovia South West Oran East Total r Treated I CDD Changed I Health Education o Supervised I I I

DECISION-MAKING PROCESS- MONTH OF DISTRIBUTION DECISION.MAKING PROCESS- MODE OF HSTRIBUTIoN DECISION.MAKING PROCESS- SELECTION OF (6.si6) (31.0%) (10.3%) (0.0%) (17.M) (34.5%) @Mllaga ll/bcting I Villagc Eldcrs ElMllagc hcalh Com r Vilhg.Comm. r Mlhgc Chiaf trl Hoalh Workars E Oth.E (6.e%) (0.s6%) (3,{.5%) (31.0e/6) (0.0%) (24.1%) a Mllago [lllccting I Vilhg. Eldcrt E Villag. hcalh Com I Mllagc Comm. r Vlllegc Chicf E l{cehh Worklr8 E Ot r6rs tMllega llhcting I Vilhgc Eld6{s E Vilhgc hcalth Com r Villagc Comm. I Mllagc Chicf IO0prr E Hcfllth Work rE (41.4%) 117.2%) (27.6%) (6.9,6) (3.4%) (3 4%) (0.0%) r--J F

24 J. DISCUSSION Procedure for drug procurement, delivery and distrihution Procedure for drug proourernent and delivery in Edo State conforms with APoc g*idehrres ,p to trre stage of collection fiom Nocp by GRBp. GRBP and NOCP apply for rnecti zan, L)nicef clears the consignment and infbrrns Nocp and GRBp, GRBP collects and stores in GRBp office in Benin fbrrn where it is released on requisition to Edo state socr State officials inform the team that the State Ministry of health does not yet have a safe store' GRBP project Administratcr stated that it is safest to store rnectizarr fbr Edo State irr GRBP office because ..mectizan is money,,. Ideally, the consigrrtnent of the drug for Edo State should be stored by Edo socT and delrvered throtrgh the LocT to collections points (health clinics)frorn where ffained cDDs pick up for distribution. All Edo state Goventment officials interviewed expressed the State willingness to take onthe resporrsibility of proviclirrg a safe store for the drug. The team found noinvelrtories for mectizan at community, LGA and state levers, a rapse, whilh arises frorn the fact trrat the drug is never stored at these revers. f)ecision on month and mode of distribution is taken at village meeting in9 (31'0o,'o) of virages rrorritored. Expectedry, therefore, cDDs pick up rnectizarr fbnn LcA i, onry g of the 2g v,rages monitored. The remaining21 villages ltave tnectizan delivered by health officials who decide on thettltte of dellvery'. l'he Focus Group Discussions revealed that decisions on month and mode of distribution were taken mainry by the village elders andhealth workers lrt most of'the villages, the vilragers were called without notice to gathe. at the hearth centre fbr treatment. Measuring stick was 25 found in only 2 ot'the 29 vrllages vrsrted, It was evident that CDDs were not aware of the importance of using Ineasuring sticks. They therefore freely used "maturity", "marital status" and "gender" as criteria for dosage. communify Perception, Expectations and satisfaction communities, including those last treated in l ggg, are satisfied with the therapeutic effect of mectizan and are prepared to do anything to continue getting the drug. Most indicate that mectizan is good for the eyes but do know much about onchocerciasis. Most communities believe that some philanthropist who came in "a particurar type of vehicle,, bring mectizan free of charge to them and they expect that the .. the drug free of charge to them. donor" will continue to provide It is evident that mobilization and sensitzation of the communities have been very poor and inadequate for a community directed programme. It is only after the communities have been given all available information aboutCDTI tha*hey wiil effectivery participate fulry as stakeholders. Training Though cDDs interviewed craimed to have been Fained, there is no evidence that adequate training was given. pooring together informationfiom interviews and Focus Group Discussions, it was clear that the quality of training (content and duratior) as weli as suitability of resource persons were inadequate. Most of the trainings were left to poorry trained LocT tohandle whereas the ideal situation wourd have been for training to behandled bv a rearn of Nocp, GRB., socr and LocT officiars. The cDDs are not aware that they need to compulsorily use measuring sticks for 26 tneasurlng persons in order to determine dosage. Most CDDs could not remember any toprc outsrde the actual distribution process. Obviously, they were not trained on community mobilization, dosage determination, record keeping' lnanagement and referral of adverse reactions, as well as follow up of absentees and refirsals. Record Keeping The team found record keeping at community and LGA levels to be very poor The only LGA treatment records seen were obtained from the State socT office and these were not complete for all LGAs. It was not clear where the data in the records seen at the Socr originated from as there were no corresponding records in the villages. Records in all t4 (44.g%) of the 29 villages (where they exrsred) wero not kept on Apocalocp approved format' Notebooks marnry purchased by the communities were used. only Name' Age, Sex, Tabs/Herght, and years of treatment were entered in the notebooks (Appendix 3)' In most notebooks number of tabrets were Lot indicated and fearment was indicated by a tick (J), onry erigibres were recorded in tlre rrotebooks making it impossible to calculated Eeatment coverage, determirre nurnber of underage, sick, absentees and refusals. None of the notebooks had surnmary forms. with such poor records, it w,r bedifficult for the cDDs t, krtow the number of tabrets distributed in any round of treatment and the number of tablets needed for next round oflreatment It will also be inrpossible fbr them to follow up treatment of the srck' pregnant, absentees, refusars and underage as these were not specifiedin the notebooks' These sh,rtcoming will resurt in inaccurate requisitrng, which wrll in turn lead to either short suppry or wastage. some cDDs made requests fbr nrore tablets through the monitoring teams as follows: 27 Village Ekwotsor Agiere Okokpon I Eguare lkeken Ogbokpa Ewatto Num of additi al tablets I,000 2,500 1,000 1,500 I,000 2,000 The cDDs were fotrnd to be literate and capable of keeping accurate recordsif properly trained. one cDD in Ikeken Ewohimi made commendable attempt to record absentees, sick and refusals beside the names in her notebook (Appendix 4). An unsolvedpuzzle in the Edo State CDTI data is t,at while there were no records of absentees, refusals, sick, pregnant and underage in the viilage registers (Appendix 5), LGA records had figures entered for these categories. Most worrisome is the discrepancy between data contained in June 2000 Technical report and information in registers at community level and in the LGA summaries. For example Technical report has it that 433 or 464 target viilages treated had summary forms, whereas no summary fbnns were seen rn any of the 29 vilages vrsited (Appendi x 6 &7)' Tecllnical report has rt tlrat no severe reactions were experienced in all 'rllages rreated' whereas LtiA reoords had a total of 152 adverse reactions in Etsako East alone as at June 2000. these were indeed adverse reactions. Focus Group Discussions revealed that 28 Coverage It is rmpossible to accurately calculate tlrerapeutic coverage from the information available in records in the villages. Only 14 of 29 villages visited had been treated withrn the perrod 1999 - 2000 giving a geo$aphical coverage (under CDTI) of 48.27oto. This does not agree with geographical coverage of 464 (99.59o) out of 466 at risk villages indicated in the technical report. The Teclrnical report also gives therapeutic coverage as 68.1%o for Edo State Thrs calculation was probably done using eligible population as denominator since no census of the communities had been carried out and village registers only had names of eligibles. The team could not effectively compare number treated from household survey in 6 ..A,, villages with number recorded as trealed in registers because most (4 of 6) of the regrsters did not have enough rnformation to allow for such comparison. Supervision Supervision was found to be grossly inadequate. The State officials citetl inadequate logistics proviston as reason for poor supervision. Lack of vehtcle and funds fbr per diem were principal constraints given, Supervision checkhst was not found at any level. The only supervision document found ts the time sheet (Appendix 8) obtained from the state coordinator. It is important that the SOCT and LOCT have access to funds and transportation for supervision. It rs also necessary for NOCP ZonalCoordinator and GRBp Programme Admrnrstrator to accompany the socr and LocT during some supervisory,visits. 29 Integration into PHC Potentral for future ttttegratron rnto PHC is high. Admrnrsffative framework for structural integratrorr exists in that SOCT and LOCT members are health officials with other functions. Drug delivery and storage can easily be integsated into the already existing drug storage system in the State and LGAs. Practical inte[ration will be achieved when the state and LGAs are made to understand that CDTI rs another health programme, which should fall into the "health programme basket" of the state. At present the State and LGAs are not fully aware of their responsibilities as they still view the programme as belonging to GRBP and Lions. Counterpart Funding So far' the state has approved the sum of N797, 000. 00 which is, yet to be released for CDTI for 1999 The State officials do not yet fully understand the role of the State Government in CDTI and seen not to be familiar with the APocNocp organogram The team was told of a document, which was submitted by a GRBP official to ttre Ministry within the week of monitoring. Had the document arrived earlier, they said, the State Ministry of Health would rrave applied for more firnding for 2000. It is very necessary for the National Coordinator, the Zonal Coordinator and the NGDO to.lointly pay an aclvocacy visit to Edo State and provide exhaustive information about CDTI to the state Government. If this is not immediately possible' the National Coordinator should send a letter with all supportirrg documents to Edo state Government giving all necessary information. In all six LGAs visited, Council officials have asked that the State project should send official letters to thern indicating the amount of counterpart 30 funding required and how ofien rt should be paid. Again, there is an indication that the LGAs ltave not been pr:operly briefed as to theu roles as stakeholders in CDTI The Technical report has it that funding has been received from four of the srx I-GAs monitored as follows: Ovia South East Ovia North East Etsako East Owan East Esan South East Esan West 35,000.00 20,000.00 0 0 50,000.00 20,000.00 The fact that these were "ad hoc" donations to the project is a pointer to the willingness and capability of the LGAs to give more sustained support if told exactly what to do. IEC Materials Apart fiom one stngle poster. placed three days before monitoring in ovao village' no other IEC nraterials were found in the villages monitored. However. the fbllowing IIIC and training materials were found in the GRB' office ' A practical gulde fbr trainers of community Directed Dishibutors ' Information brochure fierd guide for river brindness control ' Preventive health education for river blindness flip chart for Village Based Health Workers (VBHW). 31 Ten important questiotts and answers on onchocerciasis otherwise called river blindness Hand bills - rne ctizan dose by height cm onchocerciasis river blindness disease Calendar on health education messages. These materials need to get into the hands of SOCT, LOCT, health workers and CDDs Sustainability Two mandatory actions have a ripple effect on the elements of CDTI and therefore on sustainability of CDTI. The first is the ability and willingness of the NGDO and health workers at State and LGA levels to adequately mobilize and sensitize the communities on ther roles in CDTI the second is the willingness of the cornmunities to accept ther responsibilities. Fortunately the communities are willing to participate fully in GDTI inspite of the fact that CDTI philosophy is yet to be made clear to them and they are not empowered to take on their roles. Unfortunately the socT and LocT are themserves not empowered to faciritate the empowerment of the communities' The situation will remain unchanged until the NGD9 makes conscious effort to allow the State, LGAs, and communities play their roles as stakeholders. constraints observed in Edo state project, which w1r impact negatively on sustainability of CDTI, are: structural set up of the programme is not conducive for sustainability. Two State projects Edo and Delta are lumped into one proJect under a a rl 32 the ctmtrol ol- ths (;ltBP LJrrder this set up, it is difficult for individual states to take <;ontrol of their projects. Inadequate logistic support fbr effective supervision by SoCT and LOCT Paucity of accurate rnfbrmation about CDTI at State, LGA and communitles levels. Communication gap between NOCP and the State as the role of the NOCP zonal Coordinator seems to have been overshadowed by the strong control of the programme by GRBp. Lack of IEC materials at [,GA and community levels. Poor planning fbr implernentation and supervision. Sconng of Edo State CDTI with respect to performance in the basic elements of GDTI necessary for sustainability is as follows: Procedure for procurement, storage and delivery Community rnvolvernent Community perception Commtur ity expectat lolts Community satisfacti on Comrnunity wrllingness to be fully involved Politrcal wrll of State Political will of LGAs Level of adherence to disfibution regulations Record keeping and reporling Accuracy rn dosage Coverage of eligible populatron 2 3 4 5 6 C D D D B B B B D D D C 33 Quality of trainrng Quality of supervrsiorr Orientation of healtlr staff to CDTI Integration into PHC Facilitating role of NGDO STRENGTHS AND WEAKNESSES Strengths ' There ls evidence of politrcal commitment on the part of the State Government and LGA Councils. The State Government approved the sum of N797, 000.00 fbr CDTI for 1999 and is willing to continue to support the programme rf properly bnefed. Some LGA councils have financially supported the programme and are prepared to pay counterpart funding if officially told to do so. ' The members of the SOCT and LoCT are willing to work hard to effect the success of CDTI if the constraints that have hindered their perfbrmance are addressed. There is cornmendable level of structural integration of CDTI into existing PHC system at afi revels as most socr and LocT members perform other functions In the health sector. They are in turn under the supervision of the Director Public Ilealth Services who is in charge of all PHC health programmes D D C C D a 34 + The LGAs have good drug storage facilities, which provide opportunity for integrating mectizan delivery and storage into the LGA drug supply system ' The CDDs are literate and capable of keeping acctrate records if properly trained and adequately supervised The communities are willing to be fully involved in GDTI and take on their responsibilities fully if appropriately briefed. o Weaknesses . The State, LGAs and communrties are not fully aware of their responsibilities. Information sharing between Nocp/NGDo and the State, LGAs and communities is not optimum. e communities are not adequatery invorved in decision making. e Accruate census data of communities are not avairable. e Record keeping is poor particularry in the communities e cDDs are not adequatery trained on community mobiluatron, dosing byheight and record keeprng. As a result, they do not have acceptable records and do not measure rreight before dosing. Accuracy of dosing based on "maturity", "maritar status,, and ..gender,,, is questionabre. ' supervision at a, Ievers is inadequate. period approved by NGDO forsocr and LocT to spend in the communities is too short for effective supervision. +35 Short supply of mectizan was experienced in most communities Allocatio, was not based on census tigures. Rationing was adopted ' Geographical coverage of some endemic villages was not achieved ' Edo State Ministry of health does not have a secure facility for storage of mectizan as welr as for keeping Apoc donated equipment such as computers, printers etc ' Edo state CDTI project does not have CDTI account as required. . Information, Education and Communication State, LGA and Community levels. materials are not available at 36 RECOMMENDATIONS The projec- intensive com should embark on munrty m obilization, sensrtization and CDTI S/N Recommendation taken Action to be Recommendation will im on ect OTN F and RG PB ;hs tdou correct the entpres structural whichdefect, has Edo/De Ita rhS an eth sameng hiveproposal Iescbudget etc Edo State ulsho d run one separate cte andproJ the SOCT and LOCT shou d make rntornput the nplan and eng mentationlmp of the NOCP GRBP . State support 2 Jr[r POC and GRBP S hould outcarry orntJ vocad ac to thev Edo StateGovernment brief the StateGovernm ten full aboutv TICD and Soli tct for S NOCP GRBP o State support 3 GR <aPB should let a bitgo aplayfaci itati lero ang nd theempower SOCT and LOC T to take on their escn bed ro le GRBP ustainabilityos 4 fort S tate Mi ISn oftry health hs ou d thefy TSOC o ffice and take custod of Edoty S tate s toupp ly me ctizan and ul ment Ministry of Health e Edo State ustainabilityo S 5 OCP/APOC fo The veh cle mean t for Edo State sho u d be appro lapriately bel ed.N, wHo-cDTI Edo S tate cThe llLIITC t labe Edo/De ta thegrves thrmpresston at Edo State does not fuI ownv the ect.proJThis ma affecv t the Edo S tateGovernm ten S reactron to any uest r fo CDTI GRBP o Sustainability . State Support 6 SOCT LOCT Community involvement Community a aeducation on ,) 37 Adequate time should b; allowedfor SOCT and LOC'[' members toproperly supervlse and monitorCDTI activities ln the communi tres Supervisory checklist should badeveloped for use by NOCP,GRBP, LOCT and SOCT A plan(schedule) for supervision should exrst at all Ievels State should write ofTicially toLGA councils and gtve adequateinforrnation otr tlrerr roles andresponsibilities ro enable thembud trfq r CDTI REMO foi Edo State shouidbe Exchange visits should be arranged such that Edo State SOCT andLOCT' can visit srrccessful projects outside Edo State should be used approved fbr reporting format 7 d be conducted afresh for SOCT, LOCT, health workers and CDDs. The training should cover information on onchocerciasis, concept of CDTI, Training shoul lnco unlIN blno trtzaty recordofl, keepl (,ts,r dosaccurate exc lus onrg, cr teria and adverse loreact sn CDTI off,rcials . Proper implementation of CDTI . Sustainability . Commitment of 9 proJ distriburio eTh tcc should uceprod throu cgh partl methorpatory ds IEC materials for s tate- dewl n. NOCP GRBP SOCT LOCT Communities SOCT . Awareness on CDTI . Proper implementation of CDIIl0 NOCP GRBP SOCU LOCT implementation of CDTI a koper ll Supervision a Effective t2 t3 NOCP MState ln ofstry Health NOCP GRBP SOCT LOCT a ) a LGA Sustai support inability Accurate recordst4 NOCP Edo Governrnent state CDTI officials a of t5 NOCP GRBP SOCT LOC CDDs Accurate recording a 38 WHA'[ TIIE PIiOPI,E Sr\tD Procurement, dclivery an(l tlistribution "The medicine gets to thrs village through the people they send i.e. thehealth officer from trre LcA rn t6qs. T#; ,u,n. twice in l99g but sincethen they've not come again',.["GD, Adurt rv{are, Iguoirakht rr'tiloge. ovia south l4e.gt LGA. "Some rnemb_ers of tlre vrllage were involved,,.I;GD, lvlale youth lhrevbe ,iitrg, Owan l:a.ct I.GA. "We doll't know". F-GD, Atlurt rvfure, otrrgue tua l,'tilage ovia North East LGA. community perception, expectations and satisfaction ;.ffi#'J:j:':,i:x';1j::1JJ}r take the medicine vc,u wilr not suffer from eye l;GD Aclult l;amale t)clrgua:trtc, Ovrct N. li. L(;A. "T'e first tirne yo., peopre came, they announced that everybody shouldcome and have their 'eig't.s measured and we all *"ri . ;; after theygave 's littre tabrets' . rh:I tord us it ui-tt " medicine works soeveryolle took it. Tlris was in l9gg,,. ----- ,l;GD Adulr l;cntale tgr,,,r,)iii vrllage Ovru South l,l/e.st LGA. "Help us talk to the white rrrcn make them still help_ us to send the medicine,,l;(il) Adutt l;cntqlt, tgr,,r,r,A.i, vtttage rii,i i""ii Iltest LGA. "About the persorrs *'rr. lrr,rrgrrt trre prolpamme to us, I cannot reary givedates, bur I kroy ,1,u1 about +'v.u^ ig"^ i saw peopre moving about with astick. They take heigrrt measure,nent before giving you medicine,,l;GD Aclutt lv,lulc lldt vrilag, t,iro, We,yt L(iA. Decision on month and mrde of distribution and serection of cDn "Meetings are rnafters fbr trre erders. we are not aware,,.l;GD l;cntale l'outh, tttrn l;,itri, li,ran East LGA. 39 "They (the onclro people) elected 2 people here that will represent thecommunity". I'-GD, Adult lvfale tlharkpcn liguarr Ewohirui Esqn south Eost LGA. "They just announced that everyone srrourd gather here,,.r'(;D [;entare Acrurt rgttrr.rakht r,1ilage. oriz iuth we';t LGA. Training ,il!'tili:ii5:ffiff,j:3'r,I)s rhe rast time we went ror training it was F'GD, Adult Mqle. tguoiiakhr L/rllage Ovia South LGA. "The health officers have been trained change processes are beingffi"::qff'xil;?;;1iiffi1llJ:tr ;"# time ror ;;; put thesi A.s's r.rtan I Nqt r on ql I ) r rcct o rl,-, ; ii n p Performance of CDDs "The cDDs are friendry because they are from this virage,,[.-GD, Malc youth, lhtivhe i,iiog", Owan liast. iilli,,Jifi'li,;i,;itiff:l ilH Ji:i:l,r nght' thev don't rorce, thev givel;(;D lvlata litu/lr, ttich t,,ttr,lJ,'r)*an l'ta,si t,(iA. *The rnan did hrslob happrl-1,. I;GD, Adurt rienturc rgrit)tt*ttt L,rilage ovta south we.rt LuA "He is trying his best. It arso depends on getting the tabrets.get the tablets he will not do tt,,joU,,I''(iD' '4dutt rrarc (/hrukpen it:i,io, r:'wohrnti, E^van south t,GA. Ifhe dces not 40 f)istribution - Dosage "He (cDD) had o,e stick r,easuring 5ft. He said anybody under that stickshould take the rnedicine" ITGD Adult rv{qra rgrutriukrtr ,rrage ovru south wesr. "Age was used,'. l;GD Adurt rvtara ( /hatkp,t r:guari riwohimr E.sqn south Eq'ir LGA -*m;tr:ytooody in rnv house - even those that were not there, they F-GD F-emale youth ttteh t,i,oge Li'an llrest LGA Record Keeping "we keep records very wer. As_they are doing it they record it down. The ;:ffil,,llSl;li;,'::J;:n''d' age evervthine iir,", r saw i, ir," ?Lro every PH('('oorrl. Ii.s.on ,\ortlh litr,tt l,(iA. "Yes we have records ... the cornmunities, we suppry them with this bignote. They record a, the no,r", ortrr" p*"pr"'rir* have treated, we in turnretrieve that one from them, pf,liortut and ,"tu_,,. lPHC: C)oord. l:tsako t;ast t.ii,a. Coverage ;:il[y,.mrly onrv mv morrrer rook. I refused because of the reaction I had I,-GD Youth l;cmalc llleh llllage, E,san West t,GA. Supervision "Despite mv busy schedure, I find time to go to the fierd to supervise,,.supervrso,y t'ou'nrrilor./or ttrrii owan Lve.vt LGA, Edo srarc. '-'-we do not go out as sucrr. 'r'rre time limit is very smalr,,.State Coordinator SO('.1' t :do Srare. "Transport fare is a probrern. They telr us there is no transportthey say there is no rnoney _ that is why,,.SOCT olficer lldo g1u1n. IEC Materials During normal routine 4t At ti.nes ""'give us posters showing people that have this Rrver blindness so thatother peopre wilr see it. AiJ;;-phrets ,rrourJ-L. circulated to those thatare educated so that they can rn iur, ,nlighten others,,.FGD yourh Mate, threrlii,tilii owan East LGA. Integration into pH(l "The oncho progralnlne ltas been incorporated into other pHc actrvitres. ttrs one of the work plan we ,nude fo. th;;;;;;s *,iPHC Coorcfinator li.s,an So,rti,iurt, lt.do Sitate. "Yes the programrne is r'tegrated into the pHc programme in the state. #';:X: huu. meeting uti om."r, ,il.;;'Lo brief others on their [.)irector pH(. D(,, titto Stott, "Yes, into Schistosorniasis and Npl programsimrnunization we ao *au"ri.,fr'ri"ople orr it,,.PHC Coord. Owa Sourh wr:rt t1ie, Edo State. Counterpart Funtling "This year, N30,000 lvas appr.v-ed but has not been released. Maybe bynext week or thereabout trrev'ir rerease th"-;;;,rSecrelary, Ovra ,s,6uth ll/c,st'1.( j,i.' "Four point somethi,g lnillr'rr has been approved by the Governor, but as Itold you, the money iiyet to b. ,Jl.ur.d,,.Deputy Drrec.tor ql Heitrh t|riu iiorr. 42 "If the Clrainnan is arvare he rs always ready to help,,PHC ()oord. li,yatt South l:a,st LGA. Sustainability "Personalry we wi, co.tribute. If th.: erders give us the opportunity asyouths to contribute, we will conhibute,,.FGD Mare youth thievbe o*ai'Eart LGA Edo stare. "we'll be willing-t,o,pay his transport to go and collect,,.FGD Mate Actut/ t)ctryicri;';,;;;sr, Ovia North Eost LGA "we'll do ail in our power to ensure sustainability of the programme,,.I ;G D I ;e m a I e .4 d u I t,' t ),1, g,,, t,,-"'ii t t ri"- iir,^r"i ri n, E o, t LGA. *&H:,[:1Xr:Tl#: o^'* has come, we win make iuransement to goI"-GD Adurt Mqre, Igu,rrukhr vrrage ovia sourh ,vest LGA. "It is going to take time because they ggn't realry want to hear that they erestill going to take care of *hoere. is giving tt e#tnese^services. Everything;ii?,:,i;f ,:;{i;f il:;,,_ntsrourEd;;"oreverythins,, 43 '.I ACKNOWLEDGEN,{ENT The team is gratefirl to ' Staff of National onolrocerciasis Control Programme office in Lagos and Abulat staff of GRBP Edo State . Staff of Edo State Mirristry of Health+ Edo State Goventment ' Edo LOCTs . Contrntrnities nronrlt>r.edfor their assorted contnbutions to monitoring. the successful completion of the 44 C-\ APPENDICES TIME PLAN F'OR I}IONI'I'ORING, OF CDTI PROJECT IN EDO STATE ACl'TVITIES Arrrval ln Benrn Debnefing o? Submrssion of NOCP Report of DATE NO. OF DAYS EXPECTEI) OUTCOME t4 I memTeam ,bers alTrve BeninrnTuesday August i5 ew NOCP officials lntervrew GRBP officialsInterview Edo SOCU officials Tramrng Monitors Adrninistration and financial lssues Intervr Selection of Vi Date of debriefing fixed Trarnrng Briefing complced Field materials prepared Date for debriefing fixed Villages selected Briefing on Mission Wednesday August l6 Al and B8 Review Data col lnlection vrllages B I -84 andta B5 Data entered into computer Review of day's work Data collected Plan for nextThursday August 17 Data col A389_ in villagesA4 Bl3 _ lection Bt2, Bl6 Revlew Data entered urto computer Revrew of day's work Plan for next Data collected Friday August 18 Iv August ection in villases B2O and ,{6 B2l - Debrrefing of GRBP andSOCU Data coll A5 BI7 - 824 Rer,,rew Data entry 20 Data entered rnto computer Review of day's work Plan for next day GRBP and SOCU;orntly debnefed Data collected Data entered D lscusslott of ResuAMonday 2ugust R"p ort Writmg Report produced Monda y Septem ber 4 I Report submrtod NOCP debriefed I I I I I Lt5 ODIGTIETTIE VILLAGE OVIA NORTH EAST LGA,FOCUS GROUP DISCTISSION TION ADULT _ MALE T- ktrou' about onchocerciasrs lreauncrrI Pleasc tell us rrhat )'ou llre rui*c us to sce well and cure other drscascs, Even the frn frme the,y can)c sonreone fronr the village rvas hclplng them. He's over there. Wc *crc told Llrat the nredicine will s .' iJrrn eyc ,t prOblem and other diseases. , drd not rcll us about the ol, -rship of the We were rold that if takeyou the me,l .il(mecitizan) 'twon Please descrr conmrunitl' took dccision ontime and mode of distribution he hory Thc Health u'orker at the health ccntrc decided the time and place. Thel aunourced that we should see althertr soSO rinle. was a village we were told to meetlng ar assemble at the maternity to tal(e the dnrg. There which Pleasc dcscribc comnrunitl. took decisron on the persons responslblc for drstrrbution of thc dnrg ro comnrunih- nrernbcrs hou thc inforrrrat Tlrc hca lh ccntre tunonilnated tn, tlrc nlconl Itee. thc chairman theof hcal h conunil tec of the village nlno lta hrnrtcd ald onpassed the ton to andus rl was to us selection. We have no contribution t this process. It is the village head who does rhE herc abcen lnchange Iltc pcrson forresponslble distnbu tion no change in CDDThere has been WInt rvere l.ou told aboulthe need trcamrent w. for conlrnunrt\ ith Ivcrmcctrn It rs still the rcprcscnt';rtivc T'ho' lalked about lold us u.e'll take rs the the eyes They drugs for l0 same person, thc Yes we were measured and(heignt) on the thatbasis adults were grven two tablets childrenand one.Hog' is drug no*rallrl brought into thJ conrnrunrtt, and distribtrtc Pleasc tell us lhosc u,ho should not be trcaled wrth ivermectin Pregnant sickwomen, cannotpeople be treated. How' \r'as thc dosagc determine CDDby durrng Iastthe tondistnbut ccnlrc nas given. But not sick Wc don't know, COINC Ercn'bodv that came lo the health Thcv rycigh hcrglrt. Thev on a scale say our name with our lhen you and women. mcasuredThey our height using stick.measunng What problenrs havc had 1I','irh respcct drstnbutrorr of the _1',Or.r to None! conttilurilh' to take control What problerns have )'ou alierlud takmg drug Hon tsprepared of ivermedrn drstributron drc prcfer house to housG nl\\ -Crit\\. raSheS, what c.xpcrrcnccd. I c,xcreted tapcworm, rrlrrch nhcn I tirke other drugs I do not c\crclc ll Wc C Wc'll be ullhng to go and collecl, to pay lus transport our power to ensure sustainability of the programme We'lI do all in Wc'r 'c not paid an)'thing. Wc'G nol cn8r\ Thc:uy'thrng. man drstr rbu s frorn thrstrng fromplacc, the hcalth centre. He ls forworking hi S conr We do not knowcommurun, g,lvcn to CDD thc thc lurs Pleasc tcll us hou ]ou mcasurc thc succcss What support The atncd thc rcaction. If thcrc ls nran sard thc rcaction, hc Wc arc unablc to answcr thc I +b Oi CDTI -lrr\ ollrcr rcJcllon $c'll lulo$. lt ls r)rlr lx)d\ As soon as the nrcdtclne uc'll ltno* thc tlung is l,e4' good Irnd uc'll tcll lunr to coututuc r,lrstrrbtrt Horv uell has thc CDD I{c's good. lrc's domg a good job. Suggestion I bcg tlrc Gorcrnment to give more hclp to us br providrng the medrcine nrore and trtorc. Let the conte and cheuk us to sce rf the medicure is IHIEVBE VILLAGE, OWAN I]AST LGA FOCUS GROTIP DISCTISSION lon l\{alc Youth I I Plcasc tcll us ulurt rou krrorr, about the onchocercrasrs treatment Please descnbc horr comnturutl' took dccrsron on tirne and mode of drstflbutron Please descnbc horr thc commuruh' took dccrsron on the persons responsrblc for distnbutron of the drug ro communt rrrcrtrberu Has there been a changc rrr the person resprnsrblc lor dstnbutron What rrerc lou told atxut thc necd for coluruunlh treatment $rth IVermectrn Please tell us thosc rr ho should not be trcatcd trrth ivermectin Thc pr ogramme was brought by Unicef They said they want to help the community by giving them medicine against River Blindness which they have been doing And since that time especially during the rainy season they help the community and those that have sickness inteinally to solve their problems. -f here was a representative of the local government. He was the one who came to inform the Community then. Then they now slarted doing their operation. This was about 5 years () I can't remember the exact od came. 'l'hev had a meeting with the elders and told them about the <lrug They told us that each time they bring the drug we should take it [t is free of Sorne ntembers of the village were involved. The reason why they chose them is because they are educated. They are educationally viable. 'I'lrey are still the same people fhev did not lvlaybe they d iscussed that one with the elders betrr c they now announced that we should go to the maternity and take, I'rn not aware of that They only tell us that we,ll take tlre medicine (4 tablets) this year and after that they'll conrc back next ]'he d rug is passed to the local government and from the lccal gover ililrent to the community. It is the community that will now call those people that have been distributing the medicine who would now be distributi the medicine. Ther, said that anybody that is We'r'e not taken the drug tlus year We are unable to answer Hou ts drug nonuallr brought urto thc cornnttulltv and drstnbute wontan to mtscarry pregnant it would make the Hou' \\as thc closrgc determine bv CDD during the last distnbution What problcrns havc r ou lrad u'ith respcct to drstnbution of drc What problerrrs havc vou had afler taking drug Hou' prcparcd rs thc comnrunih' to taltc control of it'ermectrn distribut ron What support has Lhe communitl'grven to the CDD Personally we will contribute. If the elders give us the opportunity as youth to contribute, we will contribute. The fact is that there is no forum to address youth like this in this village When the people come they only go and inform the eldcrs who are not so much educated and so we don't see No infbrrnation. The elders will know that one what they can really tell us Please tell us holl't'ou u'ould measure the success of CDTI If the condition of the people improve like the woman who has swollen legs and the medicine cured her then I know the qrylicine is working. How rvell has thc CDD performcd The CDDs are friendly because they are from this community Suggestion I'll suggest that they give us posters showing this River Blindness so that other people will see it. AIso pamphlets should be circulated to those that are educated so that tlrey can in turn enlighten others- people that have lrl 81'age No problems that period The time they will give, they will only come Sonre of my friends w'hen they took the medicine some part of their body swelled up. Some of them were even complaining that ttrey will not take again. Some of them some part of the eye swell up as if they now have double face. After the thing go down again. Me I slept for 2 days without waking up. t also has rashes and I made a decision that I won't take this dru a n Another friend was worns *According to the male youths, their female counterparts had all either gone to the farm or the market and whatever ones remained would not heed to their cal[ because if they called the girls, the girls would be in "thinking of some purpose,'. We however tried to assernble them girls together but to no avail. ILLEH VILLAGE ESAN WES LGA FOCUS GROUP DISCUSSION Youth MaleQuestion Youth Female Please tell us rhat you knou' about thc onchocercrasls trealnlenl This are the programme established to carry out some certain processes so that these processes will get to the masses by taking care of people like the River blindness, they enlighten the people about the River I don't really know much about the programme. But I know some people have been coming to treat River Blindness. They take names of families'and share drugs The last time they came most people did not take the tablets because of the reactions it gave them (1997). In my family only my mother took. I refused because of the reaction I had before. Please descnbe hotr conrmuritv took decision on time and nrode of distribution Discussions were held with the elders and not with us and decisions made by elders and torvn crier informed the people no to go to f'arm that someone is coming to give the drugs Meetings are matters for the elders. We are not aware. Please descnbc horv the comnruniq' took dccisron on the persons responsrble for dstnbuUon of thc dnrg lo communih'membcrs I told you though they were doing it, it is not with the youths. It's '"vith the elders Those people that will carry out the operation, those people that will give otrt the drurgs those are the people that they enlightened. Thc clc'lers decided who and who would be chosen for the assigrrrnent After the meeting they sent the town crier to tell the town what had taken place and decisions reached Don't know Has there been a change in the person responsible for dmg drstnbution Don't know Wltat rvere 1-ou told about the need for conrmunitr treafment $ith Ivernreclin Hou' ls drug nonnalll brought rnto the commumh'and drstnbute Don't know Don't know Please tell us thosc \r ho should not be treatcd utth il'ermectur Don't know Horv u'as the dosagc determine by' CDD durrng thc last drstributron They gave everybody in my house even those that were not there, they kept for them +8 blirtdrt"'st s() that they'll know horv thc sickness, i e the symptonrs and the remedy for the sickness about the persons who brouglrt the programme to us I cannot really give dates, but I know that about 4 years ago I saw people moving about with a stick They take height measurernent before giving you ttredrcinc Yes We don't know. As we said belbre the elders make such decisiorrs It rs house by house(distribution) The medicine is brought liorn the local govt. Dru u,as swallowed on the('hildren under age People rvith high blood pressure. L)sing N{easuring stick Wtat problcnrs lrar e vou had rvith rcspcct to drstributron of thc drue. Don't know What problents lure lou had after takrng drue Swollen body and sickness Horv preparcd is thc commuflrb to take conLrol of ir-ermectin distribu tion Don't know Wlut support lus conuuunitl' given to CDD the thc The conrrnunity is giving them assistance but we cannot specific on it Don't know Please tell us horv 1,ou would measurc the success ofCDTI If the people that have bad sight now are cured within the next few years then I'll know that this lplegl4ru![q LS very effective They are doing it in a cool way. The1, don't fight, they don't fbrce, they give you if you are yllting if not rhey leave you. Don't know Hou u'ell has the CDD performed Don't know Suggestion More education, somebody like me I refused to take it berlause I did not even know where the drugs were coming from. There are many that don't even know what you are coming to do. +q After taking it I had rashes Yes we are prepared. If you look at the Nigerian Situation every hunran being they are willing to work l,ike me at any time this type ol'thing comes to our side['ll make sure I will be the first person to carry out this ASSI nnlcnt Come down whenever you arefiee You enlarge the campaign to all the youth and you assemble thenr together and talk to them in this manner I believe it would prornote the prclgramme UHAIKPEN EGUARI EWOHIMI VILLAGE, ESAN SOUTH EAST LGA FOCUS GROUP DISCUSSION Male Adult The first people that came here carne to our father to give a notice, so our f,ather called us then told us how they're coming lo use the medicine How they'r'e going to provide the nredicinc Right from that time Itrr or,er I rvecks we r,r,aited fbr thern, larcr they came back again and told us the day they'll start Question Female Adult Please tell us wtal you knorv about the onchocerciasis trcatnlcn t I understand this programme started about 2 or 3 years ago. But this last time they came the CDD came and said he wants to see the chief that he wants to tell them about this particular drug. The first time they came they said they shared the drugs. That the same drugs they shared\vrr the names Actuall the years ago and last year is what they want to share and they the chief said bring some people for them tolecture. So that was the discussion they had then he now appointed another date that he will be coming, that they should bring those people that day for theIecture. I was not there when they were doing the meeting so I do not know ifthe discussed the community ownership and 2 bidescribe how commturity. took dccision on time and mode of distrrbutron Please The people only h with the chief and chief called us to rally None of us here was present at the meeting Only the chief can explain what happenecl at the meeting. We were not the ones who gave them the date They gave us the date that they were coml ad a meeting after that the communtty rang the summoning werybody e at the chiefls house where we were briefed. The bell tob communi$' took decision on the persons responslble for drstribution of the drug to conrrnunitv menrbers Please describe hou, the Oncho(They people elected 2,) here that .wIpeople represent the The C'community DDs can ex,plain themsel wves hy they them They hel chief and call us and d meeting t"ith elders and they , told us. Has hc re bcen a nchange t.he forperson responslble ; drstnbutlon No, they're the started it first person who u'ere you told about the necd for conmrunrn, treatnlent u ith It.enueclrn What one of the that somebocJy who has blindness cannot taie the tablet and secondly if the tablet fell down you should leave it you cannot take that. A wornan with ex nedThey plai that ca em ate Ithough heard comm nc from cannot take the tablet They said there insect that cause River blindness and by the tlmeyou take this drug if the rnsect bite it would not affect you. is a certain drug nonrrall),Hou. is brought conrnruni tnlo thc and drstribute rug was swallowetJ on theThe d spot Please tell us those who should not be treatcd u,ith Pregnant women Pregnant children women and below 5 years, 5c> people but not everybody understood why the ,"ii"irl was being divided to them and this thing caused some little fight between your worker (CDD) ;d others who did not understand why the tablets were beingdistributed Even that boy wai giving a challenge that this is the medicine was being distributed to type of medicine that you people use to deceive people And this our agent here (CDD) was unable to explain the condition of the tablets because majorit.y of us did not receive the tablets 5\ those with asthma cough and How' r!'as the dosagc determrne by CDD dunng the last distribution Age was used Measuring stick was used to measure. What problems have 1'ouhad *ith respcct to distnbuhon of the drug. The man did not go round the village. I went to him to ask why he did not come to my place The rnan told some us the medicine is finished he'll come back later No information What problems have you lud afler taking dmg No problems I took yesterday and it did not do me anything. Horv prepared is the community to take control of irermectrn drstnbution We'll call a meeting here and we'll send a delegate to collect our medicine. The community is ready to sustain the programme and shoulder the responsibility to lcgql the programme going It's okay at least you are helping both the poor rnd the village. By the grace of God we are willing to support and sustain the' programme. Whal suport has the corrrmunit-v given to the CDD We understand you. That the community will be ready to do that. No information Plcase tell us how you n'ould measure the success ofCDTI It depends on the result on what has happened whether it is good or bad. Even the insect that turn to that worm I don't even know it. So far I take I don't know how it works. I know it's working so I cannot really say this is what I am expecting. Hor\' u'ell has the CDD perfonned He is trying his best lt also depends on getting the tablets If he does not get the tablets he will !e! do the job No information Suggestron We want you people to pay visits. To check either with the palace here because this is the head of the whole town. The head will send message and call meeting for everyone to be present. Then ask anybody if they have complains so that we can appreciate your work tf even though you're not still doing it you'll find time to say Iet us go to the palace to know why they want us That's how we want it If you people can continue like that it will be good and we'll be happy ra?t- IGUORTAKHI VILLAGE, OVIA SOUTH WEST LGA, EDO STATE FOCAL GROUP DISCUSSION OUESTION ADULT_MALE ADULT -FEMALE Please tell us what you knou' about the onchocerciasis treatment Wetin we sabi about the programme na him be say thid tlpc of drsease ncver affecl anybody for tlus village some group of people canre to rnspect us. They check us. they naked us, not total nakedness o! But wc rcmove our shirt under that tree. We did that one for a time before they start to bnng all tlus rnedicine for only one year. I think that rvas 1998 when they brought ths thing they gave it to one man hcre. He's no\ry under going a school at Uniben. So when we discovcred he \ras away to University we had to appornt some other people to go for training. About two of them who went for training are there u'ith that man interviewrng them. So they told us what that medicinc rvill do for us if we take the medicine, that rve should be coming rndiridually. He lud one stick measuring 5ft. He said any'body under that stick should take the medicine. If you are above that strck you'll not take the mcdrcine. So hc gpve us onc-onc at first. Then the 2nd tinrc hc gave us 2 only the adults, other people did not go. Mrether the medlcinc is finished or it rs not finrshcd we don't knorv, But later u'c lrcard that he pcked thc medicine to the headquarters. Wlrcther thev brought other rnediciue all this days rve do not knorv. but accordurg to information lve gather from one of our fnends, the!' brought the nredicine. it's at Ikpebazorva. they havc not distributed lt so lvc've have not to collect our olyn The first time you people came, they announced that werybody should come and have their heights measured we all went to our mqNurement and afler that they gave us little tables. That day they told us that the medicine works when we take it. So everybody took rt. This was in 1998. Please descnbe how commuruS' took decision on time and mode of drstnbutron No they (i.e oncho people) d.rd not discuss with us the person who wcnt for training at Ikpcbozarva headquarter. They told him u'hen to take the medicine and how to takc it and the ttpe of peoplc to takc it, He w'as taugllt these things. Hc told us whcn hc camc back hcrc. But rvc drd not hold a group of pcople discuss something like that lrkc th;rt They just announced that weryone should gather there 53 Please describe horv the comrnunih' took decision on the persons responsible for drstnbutron of the drug to conrmunity members The conununity plcked th': p1s5.r1 CDDs No information Has there been a change in the person responsible for drug drstnbution Yes there has becn a cluurge in CDD Because the first pcrson lvent to school so the conlmunrtv picked ncrv pcrsons They never change am. What u'ere I'ou told about the need for commuruty treatrnent rvith Ivermectin No information They no tell us anything How' is drug normally brought rnto the conununity and drstnbute The medicine gets to this ullage through the people they send i.e. the health officer from the LGA in 1998. They came twice in l99E but since then they've not come Medince was teken (swallowed) on the spot) there Please tell us those r.l'ho should not be treated u'ith ivermectin Sick people Breast feedrng women Small children (below 5 years) Pregnent women How was the dosage determine by CDD during the last distnbution Measunng sick. He said any'body under that stick should take the medince lf you are above that stick y'ou will not take the medicine Measuring Sick What problems have you had with respect to distriblrtion of the drug. No Reaction No problem What problems hal'e 1.ou lp4 after taking drug No problem No problem Hor+' preprred is the community to take control of ivermectin drstnbution When we know (that the drug) we will make arrangemenl to go :rnd collect the nredicine. Thc iast unre we hold lhe workshop becausc I u'as there nryselfl The health olhccr in charge send lhc drug to us. Wc waited and we drd not sce thent. Thev didn't tcll us to conrc and collect it ourselves. tf thev strll tell us to corne and collect. w,c llrll come and collect We go send person so far we know where the medrcine dey. What support has the communitl' gt\en to the CDD Sponsored their training No informaoon Please tell us how you l'ould measure the success ofCDTI There's one thing. If I havc this disease if it rmproves I wrll know the medicine is working Or if I knorv any' other person rvho has thrs discase and I ask and hc says that it's improving thcm I'll knorv that thc medicrne lvorks. By thc tutlc we have this informatron rve'll bc able to determine u'hethcr the has succeeded or not If to say we don take the medicine we for krrow actually how the medrcine be. As we just take am once now, we never lnow. How well has Ore CDD performed They are doing well medrcine hrst carne W'hcn tho distnbutcd The rnan didhie job hapfly as it rcaches thcnl Suggestion Help us talk to the white men make denr still help us to send the medrcine. Regular inlonrratron rs I'ery important an\4lnle thc prognunnrc is conring out they should lct us know so tlut rve u'ill all respond to it. When the people in charge came to conrplain thal the nrcdrcrne is finished tho, should rcspond tolhcm. Therc should bc proper trainmg. The last time u,c u.ent for training il u,as .lust a fcrv hour w'orks lar t ("t l:i. l ') r') , ,'r,.,j ,' , i.l '...1 ,, ,,.. , , Lt E=i' 1- f:1:,6.7,e-:- f'{,y t- ',."1.,. i!.,€- i',(.',t-^t_, c/ 'i )-l-+t F. r-;t,..rr.- i.l(etnroi,A Iaa.l- r? G: l) .,L r4,uT4. u ( /:l ryl,-r ,a r fil<t. A*.*^^?n .3{1, ,1r /irr} ,r.wT11) ,\\ :-rI i 'l , ,= /.* .-) r) o ,') 'T, ,_, li ct 7 l:lr-l, .,,.bC. /y' E, is >7"rt-i. t (.irr;.yirSL .1 I(. 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H \)P*o Elr\Jl\e t/i JS dr\ ft-, \)N(n tv 96 n d d.J .ww '\)\}1 (^) u\s 1{d \tk$l -J F n N oet I\ u-{ or. o\ C'Q (t'.\) *, 6. -+\D -e\n \hL't' -+ + N NG' I I sp -c.P 2\A\n O) a\r c'(l I I tlP c\(^r i c\,\J I ,\ C'I F oAl @ \hr. * ItIb S6 D o$ m(, o\ptl t^l & p .lv C$f) o a\.(,t u\.Jlv c I !r{ hul *s -g OtcxJ (h -E !^.j \J \rl-s -r.:'cr(, \N \.l.to Fr\ \)' S, 1 I I I *) LSF rp lwNrs $ \Jdr\n -s) \, {(,{ -rLrl \-l\9 to-,$(\ -Ac\{-) +.* 0\ -t\9 o\\A rh u -tr -JN U.r +r6 \ n o\ o. +S -tsD\ 1., hA\^ rd!{@P, 5 l-Olx P g h,aq ol c. cr o G a f 1,}.q ) ) ) E F;l \5 o. B F9mt -+\c I l,$ P\,i,5 I I \lC -+ a o -l f; fi e fiz a o F m -s t--. I I w\AI \ lod\ th W \n t |.. *, 1s w N 0 th I I I tN xmo (AJ l.A T+, I d.J h l.) I t t EI tn \TJ I 1., u\ 0h ,{ I I I rI @.oA I l l s 5 \S -l ), -lP o ,I r, I 3 O -cw (.). T I I lAf I nmp t4 c,I irJ \"1 1.,, \)-CA cn I +, \ \,5 I I (Jl c,\ c^. --$f $-( \N-f i;\^l JF \^ w - n 5?, I G\ \,,.l (,|.\.o \,o( 4 W ilc, J J) aJ0q -stn I I 1 I = I !Ioi moI i I i I I I I I ,I c{\ +\: \rIc{ ur\ -sl^l t qt6l ;J t\ s \n\tt -ll; ic{ lri H -{o --{ r- l I N (nr A -S -F\J i i iule Y:(}, \4.(ri = o Fsp 3llJ.l - ri I tr lu t T o F I il I I I I I I {og o !,,ts lrlI o o{ { 1rI oz r) + o ooz{F ol. !Fo 6)7 33lil q{ {ca o .rt 3 mo{F{N -^Z -tf-, I t- l1>qrn; ET \o (- '{d5 tJJ Z ml{1z =>{<E lJ rn(JFPK -lilc>t!qo p(.) e-gl{m Ni. (, s6 *-Z tsPNT{3er 6) qt Hz m u o a{ { rn @ o o) z o =o o)a !'{ I O o € o) = m o) @ @ o € o) = = o9 O) CT C =3 €o o_ o A rn o. o o 9) -E5(t Bg s=ii'o 9l 3 ez .+6'9oJ.grr9 uto o)! !A @ o)(.r) J ll(,l-lN) lN) lN) I (, --A urO + Ot A @ J o) CI) .5 N) f\)@ (,(, 5 oo @ (tl O +@ ts(, i-l-tlr lo> l l 5 J f\) Or TU N)(, (o O)(, C^)5 + N) ut\o @ (.^) (J)(,(o() s J s u.) O'tO O) @(, ! CN (, o) (-tJ ur r\c, + 5 O)5 tG) l-crrso @ (rt qtl(o -@ N(Jt i i5loJ i(n l<o(, (.) co 5 o) o) J(rl l_-lololo J o(X) o(Jt -t !5 (noo @ J b o J O l-lo)l\l lcn G)Io o CD @ @(o .-\, (o -I O o J _\(o @(o o) A sco o io(,^) t- lo> lco lo> (Jl! o) O l-tiN) ibio lo (oI(Jl o --.1a ooo o))t(o o (o -N) -t(,t o) @ J o O J O C) -o oo (oI(o o A (.^)(o -rOOoJtrd'f3O.O @ (tt o) O) O (n ! o) 90 s o l6 io)l6 IAlols - O{ f;EriS 3R +g =6-9 o Fo) EgEl Or o(, ico o) -\N) JI N) J (,z o o o) U)oC €o(t (o m @ o)) @oC J o o) @ ,+ m U, o)xo = o(, \l o) (Jt 5 (, -oo(D = m (t, o)xo m O) @ m @q)) = o @+ m(tt o)f, z o =Jo O) CN xoiro m o_o 6) s (Jt @ s(Jt N)(o C^)! s(, { ,+I +i.q, <:aoF=ir.i E ig= =.=o og ='" 9. lcr + J^J \o u) A tO (.^)\o N)gt(, O(, +@ \o @(, f\)+(, Ot Or oo' = rq =qr! = 19 = o.:rG'q I I lru I rr> l-oo N) 5F(o --\, o) o) -(o(oo() (.^)s J o o)(, O) _.1(, N) @ o)! N)5 \.1 @(, N)! O) O)o J. -(l)s @ @ J .A J J(^) s(, @(o J (,t) J,^)(o @o I I r..>lN) t-l(.rrA(, s 5\l N) (Jt @ @ A a-l s=*a & $3xro =rr l-J lB -"9t "-3rct oo3 O o o @ .@ J s)r N)(o @I o) Table 3.4 EDO I DELTA STATES', ONCHO CONTROL PROGRAMME TREATMENT UNDER CDTI IMPLEMENTATION I't JUNE 7999 - 37't MAY 2ooo (Using 3mg tablets) EDO STATE PROJECT. s/N o Esan Noftheast 10. Owan East 34 Ei Owan West 4L IiL2 Uhunmwode 36 EDO TOTAL 464 38t,,466 1 2. I 31 18 36 District / LGAs Akoko Edo No. of Target Villages Treated No. of Eligible Persons Treated 58,814 Cost Per Person Treated$ No. of Villages in which CDD is a health worker No. of Distribu- tion super- vised by health workers No. of Treated Villages with summary forms 45 45 1 45 37 4I,,472 8 1 37 3 Esan Southeast 29 45 22F4s 33,990 6 1 29 4 Esan West 11 1 45 5. 6. Etsako East Etsako West 33 31 13,488 451891 33 1 33 31 1 7 Igueben 42 L4,tL3 18 1 Ovia Southwest Ovia Noftheast 4t 50 24,793 27,660 10 1 4L 5 1 50 28.,937 34 1 34 35,673 34,lto 34 3 1 34 1 238 433 7z irl C -_- -r1 . anF z rD o r- - -l ^9 C) z =o -oo -l z AP .) -IJa -j z = .D r. LJ - -l z (n (- a -l q z Z - a/aZ; 7Z E.r; Ad -/n -l- icel) ruia -rX0v>z aY Fa z* >-1 -l CN U Lrl U) z -t z t- ____l s Oa .0 t>tq 0c 6 5 -F 6A -U<_D qO t-- oq U .D <^ u q -= =a fir I , It': u f\nnc-x + I Key I rr fo rrluull-htcrulrru. vlllnBr.,, A " t,rrr r lcl Iltls inilrurnetil is to be adnittistoretl ott tlt? r,illage ltead or n ,.(ltr."srntttri,t,t, tt[ rlto villalTo ltt,rr,l'lltc ltt'ttl "t't t'rl'.,,tt,lltf, lr.'rr.)r, ttt.t\rirt tt,itlt litt, itlt,t't,i,tt, tttttl lrt t.t,t.,r l,t^, ,, i,r' tlttttrt, r,r,itilen'iew-, I)o ttot refuse' Llosr of'tlto qrtt,.r1i1111g ore stnt(trtr.t,rl. ('irrlt,,,lrl,,t,l,,itttt, 1.11111,1 !t,Prorrrlrt lltt re.r1tott.tes,, mtlr"r olltttt,tlte t.o.sltttttdenl to ..rrstt,er.wltilo,s,1t1l t.irt.l. tltr.rlrlrr(rl,tt,tt,olrtiott lo tlte teslt<ltttlettt'J ilrr.rrr,r,r. l.t,ttt,tt t.) tlre Clrlc! ,ur.t .,lrtr.r:1, ,t,r,t,,tX tlrt, ttt ttr.t l,,.,ttttt,l tllrc says sorttelltirtg dilferem selecl'other'ant! writi rlte actttol respo,t.se,?.\l)(,,,.r(, irt the.sltrttt,1tr'tttitlal. tr $,i Vlllnge Nnrrre: __ Villnge Corte: $,r Subcourrty/LGA ('(nltlr r':Dlstrlct/Stnte:, Morrlh etrd year of lost rllstrlbrrtlon l'lease tell us about atty l)loS,ralrltlle cottcentitrg (Itcttocercinsis tr(iirtiil(.rrt irr tlris villirgr..l(r'*o^n 1'iln r:or r,()wrNa ts.st,E.s ARE ni)t)RE.S.S'ir)) tvlto brottgltr trte itroa o.r trte oncrrccet.'ciasis 1tt'ogronr,,,e ro rrti.t t,.iyrtge? ' ryltetr did tlrc l)?t',r(),t(s) (ot,,? ro ttttk rvitlt.yott (rbout ttttrltrtcett.itt.ris? ' Did rhe person(s) ttteet u'itrt 1'611 and orrtcr viiluge reailers.rit.tti, ' Did tlrcy askfor.you to ilttdt,ge a r,,eeting? ' rvlnt did tlrcy tell 1'ott ttlrortt <.ottrrtttutitl, re.sltott.siltilirs, 2. llow rvas (he rirrre (rrr.rrrrr/sens,rr) [.r rrisrributiolr tlccirretr.r I 2 3 .l 5. 6 7. at a villaqe nreetinll villagc cldcr s tnccturg village chief/leatler lrcrrlllt \\,rrri.r.l village lrealrlr corrrrrriuie vlllnpa rolrrrri6r,n rrres.lilsp other (specily) ',I 3. What rrrode of distributiorr rvas rjccitletl? l. house-to-lrorrse .) r r.nlt:,1 Il.r.,. /rlrr.r.ily) , ,'rrrl ccnltirl pl;rr;r_. rr,!y.I't , lt.ll,r 'tr] T{ I I I4 I 2 3 4 llow wnr ttre rrrtxto of rtlatrlltutkrr rtecltlerl?l. at I .vlllnge lneeli,tp2. vlllage eltlers ,r"oti,,,3. villnge chief/lentter4. health rvorker5 vlll[ge llentrtr cotrlIrltteC6. villag6 cotnrrrittee,n,..iifg ,7. olher (rpcclfy) -""1 ,ll I , tlr l^ J 6 lluw rrrlrry l,erso,,s (CDDs) r .',rl,t (ft(lln thls vlllage glve out the drug for onchoeerclask? .t | 'll tiI lorv rrrrrrry rrrrrle Cl)l)s?.....-.-- ,t torv rr1n11y ferrrnle Cll)l)s? llorv rvuc tlle pcrsorrs (Ct)l)s).sclectetl lo rju ttle rvork,/ rrt u vllllgc rrreellrrg village eltlers rrrietirrg vlllnge clrlef/teadeh I lealth rvorket " . , 2 3 4. 5 6. 7. Irealth corrrrrrlttee corrirliiliee rrreetirrg'' rpec lfy). Wlry tlitl 1,ou clrouse these per.sorr(s)? (l,robg,fgr crirerla) Vlllage villtsi' orherr.(s 8 9. l-lave the CDDs received nrry lrnirrirrg? l, yer l0' tf yes ro Qg, rvrrerr riltt rrrey recelv. r.n'rrrr,rgz 2. No 3., Dorr't ktrqw Ir S lle[<rre tlre first tlistributiorr Durirrg dlsrrlbutlorr Soon nfter ltre l'irst tlislributlotr Dorr't krrorv/Carr,t renrerrrber II l.lorv rvell trave ttre CDDs done the work? I 2 3 4 -$ 1t) t,. l111 I 2. fair 3. pdor t2. f lnve you chntrged arry of your CDDs? l. yes 2. No 3. Dorr,t klrorv l. rvell (Exptnlrr) t' .l- trr Mrrrltrrr lrr3 rn!l? r,nrc?tlr r(ttxrrttr, May I ggg I OF (; ,,A" C[) 'l?t ltc orltttittistered ottb, itt group tltrttt ottt, CDDs. At c'tul oI tlte ittte "A" yilhges. lnlen,i(1, 2 CDDs n,it,tt, rtsk tlrc tli,s,tr.ilttttor to lct pcr villul4c if there 0K tnot.t tl c y i.t t,, t.t' g i.t t c rs, rettuttttittl4 rlntg i/.it i.s thc crt.re \'0tt ,sec lti.r tools,; tttctturinllUltetr a questiott requtrcs utttltiple re.tponses, do tutt./itrget ro pul u circle arotttttl eoclrtltltltt.rtltlc re'sl)()ns( t'ttrle. Irntltc wlte'ra ttJtltnrytriutt, Nrrrrrc ol'Vill:rgc I) isrrict/.Slate Vill;rgc crxlc: _.Srrbcourrty/l -(iA Nalne <lf CDD Sex: l. Irelnale 2. Male Main Occupation Mrrrrlr,,tr year o'r'irst cDl'r rristrirrution i. trre virag e _/_ M'rrrlr :rrrd year .r'rasl cD'r'r rristrirrrrli., ilr rrrc vir.g e r IIow was the tinre (lnolrth/.scasorr) Ibr distrihuli on decidcd ? at a villagc r)lceting village elders' meeting villagc chicf/leader health workcr village health cornrrrittee I 2 3 4. 5. 6. 7. vill:rgc conllll ollrcr (spccily 2. Wlrat rnode of distribution was decided,/ house-to-horrse ccntral place (spccily) lJolh lrouse-to-lrorr other (specify) sc antl cerrlral placc Ilorv rvas llrc rrrotlc ol'tlistribuli<lrr tlccirlctl,/ l. at a villagc lrrcctirrg 2. villagc cklcrs' nrcclirrg 3. villagc clricl/leatler 4. hcalth rvorker -5. villlgc lrc:rltlr corrrrrriilcc(t. villirgc colrrrrriltcc lucctilrg 7. olhcr (spccily) _ illcc lnccliltg ) I 2 1 -) 4 I\lorrrlor trrlt lil\lt Ulnct)l\ Kirril;lrl,r , lrlay ;r;,1,,1 t4 l'il1 4 Ilorv rvcrc you sclectctl to tkl lhe wrlrk,/ al a villagc rneeting village elders' rnceting vill:rgc chicl/leader lrealth wurker villuge hcalth cournriftcc village cornrnittec nreetirrg olhcr (specify) 5. II.s ^,y cDD bce, clra.ged after thc firsr tlistrirruti.,,/ l. Yes Z. No 3. Don't know (r. Il'YES to Q5, Why was the CDD changed,l 7. I lave you ever hcen supcrvised ? l. Yes 2. No 3. Don'tknow 8a. If yes to Q7, who supervised you ? (lF NAME wAs MENTIoNED, PLEASE ASK FoR I DENTTTy/posrTION/STATUS OF TrrD PERSON) I . Ilealth staff 2. Village health comlnittee member 3. NGO partner 4. Culnrrnrnity lncltrlrcr/chicf 5. Other (specity)_ tlb. WIrat tlid tlre supervisor do'/ I. Checked thc ivennectin inventory 2. Checked thc records/treatnlent rcgister 3. Cullltctl thc rcporls 4. Advised on the treatnlent of, abscntces 5. otlrer (spccify) t). n t rvllar occusiorrs wcrc you supcrvisctr'/ (('lltCl.l: AI-l.l'llA'l- At,l)1.\,) I 2 3 4 5 6. 7. l. Belirre distribution 2. During tlistribution 3. Soon after rlistribution l. Yes l. \'cs2 l Yes2 2. Ntr No No lOir. llavc ytlu reccived cdttcalion on thc inrporlancc ol'takirrg ivcnrrcctirr tablcls arutually frrr several years'/ 2. No l. Can't rertrcrnbcr ls Yes I\lontlr)t ur[,, lrrslr rrrrrttls K :rtrtp.rl,r, N l.ry l t)()() l0b. Il'ycs, rvhat wcrc you told'/ I I. Did yotr llrovidc tltc colttrtturrity lvitlr cdtrc:rtiolr on ivcrrrrcctirr trca(rncrrt'/ l. Ycs 2. No 12. ll'ycs (rl Qll, wlrcrr tlid yotr llrovitlc tlrc ctlucution (o tlrc corrrrrrrrrritl,'l (('ll{('l.lr Al,l 'l'llA'f n I,l,l.Y) L l)urirrg thc fir'st rrrcctirrg I . )'cs 2. Ilelbre tlrc llrst distribution l. \'cs 3. During rlistribution I. Ycs 4. Soort aftcr tlistribution l. Ycs 5. Otlrer (spc.ify) 2. No 2. No '2. No 2. No 13. lf ycs ro Ql l, wlrat did you rcll lhc corrrnruniry'l (Cll{CLIa AL.t. 'l'llA'l'n l,l,l-\,) 'l'akirrg ivcnncc(in anlrually lor scvcr:rl ycars Bcttclits of trcatrncnt Cornrnunity rcsponsibility Sidc c[[ccts Othcr (spccily) 14. Ditl you rcccivc atty training on how (o trcatcornluunity rucurtrcrs? l. Yes 2. N<r 15. If Ycs to Q14, whcn did you rcceivc training? l(r. Wlro traincd you? l. Ilcalth pcrsonucl/Onclro courdinator 2. NGDO staff (spccily)_ 3. Artothcr CDD 4. Othcr (spccify)_ 17. llorv long did tlrc trainirrg l:rst'l l" traiuing_ 2"d trainilrg_ Last tr:rirrilrg 18. llorv rnany CDDs wcre traincd togclhcr (sizc ol'tlrc group)'l l'' trairring_ I-ast training I 2 3 4 6 Ycs Ycs 'l'cs Ycs 2. Nrr 2. No 2. No 2. No Nlotrloutrll lnslnrrcnls Krrrrprlir , Nl:ry lt)()() l6 19. Wlrcrc u,as tltc vcllttc ol'tltc last lraittirrg'l Witlrirr lltc cottttttttttilY Outside [ltc cotttttlttltitY I.lealthcare faci I ity/lrospital Othcr (spccilY) 20. Was lhc vcrruc o['tritittittg llcilr l() yotll c()llllllttttitl") l. Ycs 2. Ntt 2t Whilt rvcrc you t:ruglrt duriltg traitrirrg abtlut ottclltrccrciasis (Cll{(ll-11 Al'l 'l'llA'l' n l,l.,l-\') I Z 3 tl I 2 3 4 5 (r Cause Syurptouts Socio-ecotttltttic itltllortaltcc Cortttnuttity nrobilisatiolt attd ctlucatitltt lvenncctitt as trcatlllcllt lirr a loltg tirlrc l. Duration ol' trcatttlcltt 2. Coverage o[ distribution 3. Dosage tlctcrtninatiott by ttlcasurilrg hciglrt 4. Expiratiolr of drug aftcr reltloviltg cotttailtcr scal -5.'l'rcatlttcttt tll' allsctttccs alttl rcfttsals(r. Sidc efl'ccts (coulrscling alrd rc[crral) 7. Exclusion critcria 8. Ilecord kecPing(). Ccltsus 10. Othcr (spccilY)_- Nurnber o[ Pcrsolts trcated I Nunttrcr of rclusals I Nutttber tll'attsctttccs I Nutttlrcr ol'cxcltttlctl 1)cl'solls I Nuurlrcr rvitlt scvcrc sitlc clll'cts I Othcr (spccilY)- Ycs Ycs YCS Ycs Ycs Ycs Ycs Ycs Ycs 2. No 2. Nrr 2. Ntr 2. Ntr 2. Ntr 2. No 2. Ntr 2. Ntr 2. No 2. Ntr 2. Nrr 2. No 2. Ntt 7. No Othcr (specify) 22. What werc you taught about tltc drug? (CII{CLE ALI-'IIIAl'APPLY) 23. What wcre you rflught about rcprtt'rirrg'/ (Clltcl-li n I-L'l'lln'l'n l'l'LY) I 2 J \ -5 6 Ycs Ycs Ycs Ycs Ycs 2. No 2. No 2. No 2. Ntr 2. Ntr 2,1 I)irl :r.y rrrclr5cr ol'tlrc corrrrrrrurily collcct (lrc tlrtrg ll.ttltt it crtllccttotl ltoittl tlurtttg tlrc litst tlistrilttrtitlrt'/ Ycs 2. No 3. Dtltt't kltorv 25. ll "tto" to Q24. 'uvllY'l I . \'cs L Ycs I . \'cs I . \',cs I . \'cs 26. Wlrcrc is thc collcctiorr poirrt,l )1 l)itl -yrltr cxltctictlcc lrrlc supply ol tllugs tluring thc last clistriSuti,.,/ Ycs ). No I)lc:rsc cxplailt 28 Ilrtrv tltt ytltt lttlrrttltlly tlctcrtttiltc tltc tltralrlity ol'rllrrgs rcrlrrilcrl by tlrc c11lrrrrurrrtv,/ Ccnsus/regislration rccrlrtl I)rcvi0rrs lrcatnlent recttr.rls Ily coultting the nurnber ol'lrouselrolds Other (specify) 29a' l)id yotr expericttcc sltortage ol'tlrugs tluring lhe l:rsr rlistrilruti6rr'/ l. Ycs Z. No 29b. ll'ycs, pleasc explairr 30' IIorv do you (letertnittc thc lturnller of tablets to givc to arr irrtlividuill? (CIttCLIl n I-L .I'I IN'I' AI'I't-Y) I 2 3 4 l. 'l'ake heiglrt ntcasurr:nlcllt 2. Use weight 3. Visual observatiorr 4. Agc 5. Othcr (spccily) l. Yes l. Yes l. Ycs l. Yes 2. No 2. No 2. No 2. No 3l Wlrat tlo yott do aboul indivitluals who are absent tlurirrg norlnal tlistrillution peliod'/ 32. whul do you tkl alxlrrt irrtlivitlrrars rvrro rclirsc trc:rrrrrcrrr'/ 33. Wlticlr catcgorics 0l'peoplc $,()rrlcl you lx)l givc tlrc tablets (l,l-llASIj clltcLlr AI-L T'llAl- API)LY) lnrlividrrals lrclorv -5 ye:rrs ol'agc/ lrclow 90cltr l)rcgttattt w()lllcn wonren wlro tlclivercd less than onc rvcck lrclirrc tlistrillrrliorr .Sick irrtlivithrlls Visitors Olhcr (spccily) ___ -l-l llotv tlo y()tt cnsurc tltitt tlrcse c:rlcgorics ol'pcolllc cvcrrlrrirlly rcccivc I 2 3 tl .5 (, l. Ycs 2. l. Yes 2. l. Ycs 2 l. \'cs 2 l. Yes 2. Nrl No Nrt No No Ir cirlrtrcnl') Nlorrrlor rrrl, ln\lnrn( nl\ K.rtttp,tlrt . Nlay I()'.)() Iti --< 35u' IIorv r,,g d. y.u rr,rlrrary kccp trrc rarrlcts ilr (rrc c,,,rrrrrrrr-y/ --15,' '.rv lru,ry rr;ry.s tritr yrlrr rrrkc r, c,rrrllrcrc rrrc r:rs1 tristl irrrrri,rr,/3(r. Wlrcrc tkl y<lu lrontrally kccp lhc lirlllctsT 37. I)r I you havc drugs lo takc car.c ol.rrrinor sirlc cflL,cls,/ l. Ycs l. Ycs 39 4t PLEASE INI;ORM 38 What kilrd of .supporr 'li'ir rr.sllorta I iolr hrcelrtives (.spccify) Othcl.(.spcc No dt.r you rcccivc liolrr llrc corlrrrrurily? for tlnrg ctrllccliorr I 2 1 -1 2 ilv) Do you havc problcnrs rvith rccortl kccltirrgZ [#.""ft 'llr, * ::r. mi, '#- 'i.r! . ":l)-'; - . 2. No 4l . lrlease tell ASK FOR REGISTIA]'ION 1lt AND MItASi(llUN(; 44a. I.s rrrca.surilrg device for hcight prcscrrt/ 40. If yes to e39, pleasc cxplairr us horv you lbcl aboul thc l)lr)granlllc rvitlr rcsl)cct to a) sustailring dre progralrune t ) cornrnunity resporr.se c) constrairrts ' what 'o you rrrirk srrourd rrc crrxrc t, irr,rovc rrrc ,rrgrarrrrre i) 43. Are you will Ing lo corrtinuc fls a CI)l)? l. Yes 2. No Please explain l)liVISitr't() t,t{OVIt)t: I;OI_t_O\VIN(; l() I\lorrrkrr llrg lnslt Untcllls Karrrp:r l.r, I\ 1.r1, ; r;r,)9 >,16 l. Yes, scelr 2 Ycs, llrrl lrol sccrr (lixpllrirr) :1. No, lixPlrrirr .l.llr Ilorv rkr y()u usc tt./ .l-5 ls trcitttncnt rcgislcr prcscrrl,/ l. Yes, scerr 7. \'cs, lrrrt lrot scclt (lixJllairr) l. No, cxplailr ll'Q45 is "Ycs, sccn" lixAMINIi'fltEn 'fMIiN't' IUicts'ilit( AND OI]1.AtN ,iltEITOLLOWING INIIORMAI'ION ON: Total poprrlalion__ Agc c<lrugrositiolr ol'pco;rlc: lle low 5 ycars 5 years and above .Scx ct'rrnpositiolr oI llre populatiolr: Male I?eltrale Nrrnrlrcr oI pcrsorrs trcirlctl M:rlc I;cnrale Nulrrlrcr ol' grcrsolrs tuulcr --5 yc:rrs rvlrrl rcccivctl lrcalrrrcrrt Nurnber of relusals Nurnber abscnt during last treatnrent Nuntber witlr severe side effects Nunrber of tablets received Nrrrrrlrcr ol' l:rblcts uscrt Nuntlrcr ol'lahlcts le li ilr r hc tlrug kit I 2 1 -t 4 5 6. 7. 8. 9. I0 II I\lorrrlotrrrl' ln\ltlrn(.nl\ K.rrrrJr,rl.r . Nl.ry lr)r)r) ^)0 I\ l(cv lrrlbrrrt:tttl Iltlt't'r'it'rr': \/illirgt"' ll" l't'irrlt'r's I lttt tttrtl t.t t() lr(, tttlttttttttlr,tr,tl ttt tltr, r'tllrt,t;r' ltt'rrrl tlt tt tt'1ttr'.lt'ttlttti|t' rtl tltt' t'tlltt!:t' ltttttl ttt ttll (.ttl(,,q()t\, "l|" r.t//rt11r,.r ltt tltr' t tt.\t, tlt(tl tltt' t'tlltt,rir' lrt'ttrl r|rtttl.t '\ottt('ott(' t'l.tt ttt (l'\'\lsl rt'ltll llt(' ,tl(,t,t(,,,, tltt n,tt tt,ftttr, l'ut tt tu(l('(tttttutrl tllt'(tl)l),t)l)tt(ttt',c.\l)()tl.\( r'tttlt,t' l)(' t'()t l],lt)tltl)l tt,.\l)()tt.\(,.\ tttttl ttllrtry tt,tltttrtrlt,ttt lrttrt'frtt uil\\t't'tut,ri lltt'tltt(',\tlotl. lJ.sc tltt'()l)tiotl "()ll'(r" wltett' tltt, t t,.t1tttil,t(' t.\ il(tl 1,.r1,,,1 ltrtt t (,nt(,ilt1)('t lt) \l)('( tlt' fltr' t(.\l)t,ll.\(' ttl tll( .sltttt't' 1tt'ttt'ttltrl. ll tt rtll(lX( ltCrtrl t.s il()l (tr,(ttl(tlrl(. ttlt('t t'tt'tt' /,t.t tt,\.\t,\lttttl t)t t ('l)1."\('ltlttllr'('. \/illlrgc Nirtttc Strr I c/ l)istr ic t \/illrrgc (lorlt':, stll)c(,lttlt.l'11,1)t\: Corrrrtr..1,: Nlorrllr lrrrrl '\t':rl ol l:tsl rlislrilru(iort I I Ilirye 1tcl1llc 1t llls ( ()l11ll1tly lrt't'lr lrt':rlt'rl r,,,tllr r\,(-'ntlL'e Iltt lll lllc l)ilsl ()llc ]'c;ll'1 I Yes ,l No .\ l)ott'l httort' II; NO 'l'O Q l lrNl) IN'l'l1l{Vll,\\/ II; YLS'l'O Ql (:ON'l'lNtll,'l'lll1 lN'l'l:l{VIlrW 2. llorv was (llc tintc (rttott(lr/scltsott) lot tltslt tl)lt(l()ll tlccitlcrl'/ irt ir villirAc nlcc(iilA vrllrrltc t:ltlct s' rr('('l urll vrl lrrgc c:lr rc [/lr',rtlt r Ircirlllr rvolkrl V tlllgt' lrc:rltlt c()nunltt(i(' vrIlrrltt' c( )rIillrlll(-'(' rIl('('l IItli otltcr (spct:rlv) 3. What tn(xlc ol rlrslr rlrult()n \virs tlt.t:rtlcrl'/ llottsc lo llott.r' cclllr ill l)litLr' (sl)('('t I \' ) llollt lttrrrst' to-llol.,r ,lrrl r t.rtlr:rl pl,rr t olltcr (spcr'rlt') 4. Ilcrw tvas lltc ntorlc ol rlrslr rlrrrtrrrt rlccrrlcrl') l . rt( ;r vrll;rgc nt('('lltJl 2. villirgc cltlcrs' lu('r'lltli 3 vrllirgc clricl/lclrtk'r ,l lrcirl(lt \\/( rr kur -5 Vill;rgc lrcltllir c()nuutil(.c f) vtll;lgcr()nutltll('('tucclllll 7 ollrcr (spccrlt') ti iii x .+,. *iit :t ..rJr#.ii{'t 'at' . itr I ) 3 4 5 6 7 I I 1 3 4 rr ' ' urt,, rr I r,rl',rl.r NI.t\ l')'r', )t I 5 llorr l)l(11\, l)('tr(rlls ll) tllls vtllitllt: (( l)l.r ; P,lvc ()tl{ tltc tlrtrg lot'ottclttlCcrClitsis'/ 'i llo\v \\,clc tlle l)('ll'()llr, (('l)l))sc'lt'tlt:tl lo tlo tltc: rvork'l ,rl il vlll,lll(' lll('(.'lllll', vlllirgc cltlct's' lll('cllllll v tll;tllc clrit' l/lr'irtlt'r' lre rrltlr tvtltl.ct v rll,rlit' lrt'lrl(lt ( ()llrtlllll('(' v tlllttit: ( ()nurltll{.'L' Iltucl llll', ()tllct I ) I -t s () T. ll,rvt-' llrc (it)l)s tcc:ctt't'tl ,lll\/ {l'lllllllll'/ l Ycs .l l',,1o .1 , l)orr't ktttlrv/ Clttt t t'ctttctttllcr lllr. llitvc yott cltlttgetl illlv (rl )/()rll'('l)l)'') l ycs ) No J I)ott'l kttorv tllr ll yt's, t',,1t1,'/ t) l)rtl lul),nt(.nll)ct ol lllu c()nlllruntty collccl llrc clrttg ll'ottr it crlllcctiott llrlittt'l l. Ycs I No l. l)ort'tknorv lO, l)rtl yort ('\l)('lcnc(: l:rtt'srrpply ol tlrrrli rlurttrll tltc lirsl (listnl)lltl()n'/ l. \'c's f. No 'l l)orr'l ktrorv II I)ltl ;'ou cxllt:ticlrcc slrrtirgc ol tlrrr13r; rlrrrrrrg tlrc lirst rlistritlutiorr'l | \'cs 2 No .i l)on'{ lirrorv II I)ocs tlrc c()ntulunty lurvt. lr ttciltnt(.nl rc.lirste r'l l, \'t:s^l Nrli l)()n't l,rrorv l\lililjrr,rltl, lrr',lrtrrrrt rrt', l,.tr[1l,tl,l , Nl.l\ l'r'/'l t.l 4Nxe*e r1 District/Stete -:T:---__ Narrre of CDD Sex: l. Fernale 2. Male Maln occupatiolt: - . ---- Molrlh arrd year o[ ]ast <tistrilrrrtiorr t To be adrttittistered o1ily itt gr<ttt1t "tl" t'illoges. lrtterviettt 2 Cl)D.s lter village i! tltere Q,? ,,t(rr? tltttrt ttttecDDs' At tlrc at<I ctf tlic trttirviirv tt.rk rhe rii.stribtttir i'to, yoi,r.ree ril.r tttrtrs'; ttieosrrittg crevi.re, registers,t'ettnittittg clntg if owiloble, lv,ert a tltte.rtirttt ,'eq,rir.c.r ,,,,iriitrtn ,?:trr(r,,,r".t, rr, tt,t {rttpet to t,,t, ., ?;..(.,r.t'ot,ttd olrlt qqtlicaltlt ra3nn11r, t.otln, lrtnl,p ttrlir*g Nltltr.Wttlt,n. ll- c-., l. l.low were you setecterl lo do tlre rvork./ I . at a village nteelingZ. village elders' rrreetilrg3. village chfef/leader 4. healtjr worker 5. village health corrrrlriiler:(t. village conrrrriilcc nrec(irrg6. <lther (specil,y) 2. I las .rry CDD beerr clrarrgecl after tlte lir st dislribuli,rr,/ , l. Yes 2. No i. Dorr.l krrow/carr,l rerrrerrrller 3. llave you ever beerr superviserl ,l L yes Z. No -]. I)orr,t klrorv 4' If yes roQ3, *r,o::q:,riserJyru ? (*; Nn ME wns MEN,r.r,NuD, r,r_Ensu nsK r;.,r{IDENTtTy/postTtoNls.rnrits or .il tE pErrsoN) I lialrh statf Village healtlt colrrrrriltec rrrenrltc.r NGO partrrer Corrrrrrunily,rr rerrrber/clr ie I Other (specify) 5. l{ave you receivetl e<lucg:vernl years? nliotr orr rrre irrrporrnrrce oI rnkirrg ivernr<-.clin rnrrtt:ls irrrrru;rily ror I 2 3 4 5. -1 . Cnrr'l rcrrrolrrlrcr(t Did y,u receive alty trai,irrg o, rr,rv r(, trear co,rrrrurriry rrrc,rrrcr.s./ L Yes l. Yes 2. No 2. No Morritorln6 lnltrunE,tt, Krrrpoh ,Mny 199\) ', ."r, ,l'"r, bu(;rrut seerr (l!.rpl;rirr) or1r,: r) lrirr (rl ,,,,,',:,i',"1,'',li,r;=, ;--_' 8. ls lrealtneIl register preserrt/ ls rrrcrrsurirrg tJevice Ior trciglrl prr,.sr.rr(,/ I . Yes, scr:rr Yes, seerr 7 "r'l r$r't.r,t.,, I 2 3 Yes, but nt-ll seen (lixlrlirirr) No, (explnirr) lfl'.3-l,it:ffi:rfiil,iT_I; rRrn rMr:Nf r.,(;rs,ir( AN, r)rru\r{ ,r I .'lbtfl I populaliorr-1 2,Age corrrllosiliorr of jreoplr:. 11.t,,., .s ycnrs 9 -l .5ex ct-rruposiliorr ol tlrr.. 1ro;.ul;rtiorr ] yc;u.s;rrrtl altovc Male Ivl;r le 4 l.lurrrlxtr oI lretsr_rtrs lt(:ill.,rl 5 Nullbcr o[ lrersurrs agctl 5 6 Nurrrber oI re[u.sals yr';rts lttttl nlr0ve rviro r,,,.,,ivr:rl llenrrrrr.,rrt I;t't r rr lr. l 'r.r r rr lt. 7 Nurrrlrcr abserrt t.tulirrg lasl trellrrrerrl I Nurrrber.tvitlr severe sirle ellr:t.ts 9 Nurlrber oI tabtets receivetl l0 NurrrLler of rablets ,,r",i'" I I Nurrrber oI tablets 12. UlrrJa(e of recortJs lelr irr tlre tlrug kit_ ',lt; t I t,'l 'rlll,r,,t, .,t,1.r , .,1 Allrrrl,,ri,: lltltr,,r,r.rrrr.,,,rlI tt ')5. X' :x :i' 'n 13 t'' y't(_ij ;r ii ii 'i =Jzcg() ;1 (! il p z x ,i\ t{r r,lo i. rrq ID 2. N :-1 aY7. rgEoo lr o vt r1r ri [-1 t "' olrl v1 "' iJ v\ r!H6(D--{;,r?4--l ,- .' I 'J Iii !j ,i i, ,LJtl q -.= 7F!l:,,ea E s";f a 3<Ei.-f-'6 a>dcr ii-g '- {Ei A H dJ * ',.:'g ;' :;,tr ,"=;'zcE i1 nE6; 3sfr 56 Eo@E q E ;9 ^ 'DJ ' ;- (D6 ii ut-'2 * (, !CJ6i- 8[!ii1[ ,-r, < gli^.d!!6 r(D 5 E '; I 3'a *3 i; cr = 6 aD -.5 -'.>'h- J= r 5'=t 99E'.I ii ;5rr i^ cr'll < l.'- H #dq,3'ii P i o.h .)(D} E f Fd8;+ "93!l- to. g.u ?-.rpJ6:j J .D I o't h.E.9A)ocac,v1 o: gUfi ou,o o E63:r a->l =59rod'bA-'- -filrnJ5a)d t E s[- 58:o- ?3 2=l3'o xd<E -rD oo-I tro ;3'arlD= =5o!.>a rlo.X \l?vt ,il 'ri l? lrcft O c- c >J - lo) L t a ct </. E'It? .l () & ID I < o iJ =o il'2 (D DJi(D = I ocq(D 9. c!. U z.I Io(, U 5 OJ 3 ID r ! 1t f e dI ti tIIi I g :) F'S' TTE.ggE F fl ? E,Egs,rru : -'q d F' Irfi[:3$,f,F FEr 5 grE f fl#€5 $FJ!I [[Pr3fxl^o .J{ ?E F$ 3 * t ' o. lr{a'g 1*r$EE r=[[F Ff f Fkoc x ='EXrlo13!I{ * B'o. o. 7i* rE Psu - p' [ ] gEc. llr(D Eg. H 3g HrD -r, tr, l^ *,(-) /) u -l o : T zO *l C) o tr, 3 -. a tu 3o z IJ *'() CtI' 3o 7- EE>(r= r)?TrJ A "EFo\<*" g, I I : I I t[: , ? I '/ t. I- a, ,:. L O O tl o oTJ i-l lt:3E .- 'o o (,EHL'OI .tIr a ..; ll ,rr '/1 llV .\, HIU .= ..) r= .:;ll trLr ::1,'Ell €-lla, :: 5| it .:i tt ['] EfiEt'Eal"E r Q E-g d..t ')ro ., 'i' ilLitu';.: i_i'H 'Egll trS.f one X ll EEEH a, 'rJ c, l)I T \oOr-ll o c,i u\ onll C) c-n - .E 9'll rtr.= 5l: ;',[5 r Eq A; ri;gr ii} E E,i)E'a ()_q) cril il .33 UEHIIIiggHs'gE 3 6;r.N Hr c c.Br:i Ii: I t: tn I: I t \l , I ,, l It t: L'(t a I ,i t ! - t)I r< +- , ll' L) ;t :- l-' r(t(-\ Ft ll l't il) t, '_ r: o 5 I t:t, lt:: \, \ !, l: I ) I .l '! t .!, t:: 'I 'l (, I t. ,l I 7\ f: t , I J I t- L a t' al :1 I I lrf ) L't t,ril{ , tll il r ,litl'l ;ii,!,I rllll t 4 tl IN'I'EI{VIIIW C (,II)ll IfoIl I,()LINIANAGIIITS/. ooItI)rNn 7.o It.s '/ /tts ttttct.vtctv t,t rt cl t t t t t t t,t t a rctl o t t Co-ot dtttrttot.s.r.tt CDfl, ilitti.rrty t[ ltutltlt polrr-y111s11g,..r. ,utd tlte, ,, l.(l \'-A I /\ I( til(S/ ryiX,,] f I Ut,It usuN't.A,t,r v t,l/ t,It () G It A l\{ t\,t I' N:i t t t t c 1.vi st y1t rlf t t <,a t ti:/t 1tt'r.rottttcl f)ttt tttttcttt.t s ttc'lt u,t t:;o t/ tttt t t t /b nt til I i,ou cen be 7,y1, ttt'tt'tl for tltt il b L-lc-ntcrrts of c oIl:rlror.utiorrSPI]CIFIC RO r.E.s) bcrrvccl; Qe11 '!lulli ) 1, I "4 ; ; !,: 6,i : :ii,i i,ii i,;, a t, r c r (,,, (,,,,, c s ",ti1tyqrr,'r:tio,;;;i;;ir':;,,!:;;;,';:;r"i; 'tt,it.i, tl'NGDOs irt t,ct I t'ctlIt i,r sitttilttr to tltetlte.fontml itilr,tt'iew .S'llCT'tON A: ptt OGItz\f\,lN,l, NtAN z\CUl(S/ ONC 'l I,rogr:unlnc-, IIO s lrc ng llt l{DtNA1-Or{.s tlrlcrtrclltcrJ tI y()ur itl.cit I)lcasc rlcscrillc lrorv llrc C'I).II'I(OIJI: I.'Ott 'l'lrc a111,lroaclr uscrJ lor rrtrroclucittl.l Cqtl:jt,i Iillc corurrrrrrrit rc.s I 'r i Ucncral re-oflcnl:tliorr <ll_ lrc,rltlr l)cr.s()nl lrlobilrs.rtrou ()l (ilc cotnlll[rntttcs ty,, I{calth .systcnl :rrrcl NGDOs (IDEN.I.lI..y rrl f':t{tls CD'l'l f)rogr.ltrlntc !|1r ]'rlIt L Il 't(.) rl c l)lcasc cx I'ITOUU I ,1 :l g l)ilfcr;tqc S{or:rgc l)is(r rlrrrtlon (o corttrnunitic.s Colr.str.r rlr (.s ( s(()r.lgc, (r arl,\l)(rr( J'r';rirrrrrg ol lruairlr s(alll as (rillucrs Irlaltt JrrclccsS .l'r.r,r.r,i,i,,.. " , ','il'JUI<. (('rvillg rv(:l.nlce(lrr., ;', I)cl.rys rrr .ru1.rply o;rt rvlr,;rt lcvcl irrrtJ wlry/ Adcr;tr;rcy ol. llrc rlrlrnrlty t,ccclvcd/$,tor | ',' t, ' / ' *r 1 , ,,t l, I' L' I I rrll; / urgl.::, I f ,,t',ilj'f ili I 11,, r r.,i i ',: i i,l:1 1,,[ : ,,r i d (itc) I [.,NDINC,: /)/c;rs<.. Irrolrr, /,r ' : , ljci,r,l," ,l .rr,.lrorscrttcll ol. Icltcr * ,rl .;,gr ""rrtc!tt\l'11r"' ,r -" lr I)r'l;rr,.s lll lcccrylt,g lulld.\ . ,tl \\,lt,t( l(,\ (,1 iltrl rr i 11, r ., ; ! 1, i tl Dcl;rys lrr rlrslrrrrscrrrcrtr o/ /urttJs At w/r;rt lcycl ;trrtl tvlty'! l I I I ^lrltllot tlg ltr!t urrr,rrlr k.,,,,1,.,1., Nl,r.1 , /,Jr.7'1 a c .5 (l . trtuclctltrtrcy ol ;lrevrt.lus lrrr11g", c Iiurt<l :rcltrrilristnrlir.rrr. <lcllrys irr r rrl crr.slrrrr.scrrrcrrr .rrrr ;,,,;;;.;;'',:1,:':.' rrrtrl,\riro'r ot l'irrrrrrciar rcr)or r.s, ,r,,r;r1,s,,,,uJ:,;l:l:'*';l:l:l'il[ir rsgi/1,1",, I'rcirsc rlc.scr.rllc (rrr " citdtltt'll tcl s oll ltttattcial reporls : I)rogtililltIlc's g)l,ir,r,, l()r lrIrltr()virtg sustainallility Wlrrclr otlrcr hc:rltll ilctivitics rlo the ( r ,,.1 .ctrvrrlcs.., . ,,ro suJ.rcrvisrlr.s cor.rrbirrc witlr tltcir Orrclto Corrtrol lrrogralnrne Wotrl<l you plcasc t ax,r nr r'r.r rj il;il il'l&jii 3':'.1 1 ;.. l*f.I rcc. r, r kcc;, i ng l,^,ccrr rr rcs () 7 .Srrrnrturry slrcets I A vir ilrrt,l, 2 No( lvlilaLllcliX'I'It/tC,I' I NI,'Olt lll A,I,I ON ONst:llc iul(l LCjA) il. liltll I)<lltulrrtrorr Nurrtltcr ol vrllagc.s tn lllu ir,, ;l Nurrrbcr ol' villagcs wilh srrr,.,,,,,ry lbrnt., Nrrrntrcr of' vill:rAcs trcarcii Ntrrrtlrcr rvrllr scvcrc "ttj".,r Uvrdcrrcc ol rcp<lrt updatc ( I I Jp<ta rc,< I -, .sllcl'loN Il; At()II lr()l rr ,\, ^ . . .. _.-I IIOLIC}' I\{AI(IJI(S ( 8lr Do yott ltlrvc ;r r):rr;,r,,.,r r,, ,,,'"1,,,"".i.,,,-,-'..,r,,1,,t,'lrtion:rl l'rrrrr ror (lrc * kUrtl rll .sUI)l)()r{ rl0 ytr11 pfoVt, 'l'l ui, I,'OLLOWING (rclatc to lltc tcvcl of opcr.atiotr c.g. lr c. cl . t,\ ,'ck, irrrlrual r.ctrlrns alicr <tistriblrtion) ')t rJi)da(cd Slr \\,lr.rr INPI /T) . r nluncnl Scclctary/Dircc(or Diseasc Control) lrol t)t orrclroccrcta.st s ( I)robe. for lhe irnporlancc attaclrccJ t<l ,lor Onclro, Conlr()l . ,,:,iviric.s (PROBE FOIi ITINANCIAL I0 ls rhc t,Icg, itt l;:,1,1" you pcrcervc r,)c cr).r.1 srrarc,r ,l'AJrOC (tritr,," Ibr 1>crsorral <.rlrirri<rrr auc! oilicia! poticy onOncho l)rograrrrnrt, r()rr .r,(i,,*;r.;j;;;;;,,ijl;:J';l::jl;, sys(cnr ( I,r.otrc lbr actjviries whjc,h indicate A lr rlrlr l ra' ,,r,tlrc lrculth r r r;rllilily __r_h.!.i,rrr i,rnlont\ Kurrrll;11 , MJy l()(){l 32 .) )t 'i I j('-l'l()N (- : \\/l I () C( )t,N.l,tt' It I,it,It t,.it,iN.l,A,t.I;i,f ,,' ,I l'\\/lrirt is y.trr licrceJltirllt rtlrrrrrr (lrc n I)()(' srr:rtcgy lr,rr rr,t:rlrcc(i, tlrstri[lutrorr( l)r.trc lirr tL'ri'sibiliry .t'the cD'l'l aPPrt,,,"t, irlrlrtui,i,',',,,r,". rrcirrrrr pr.rrrcr,.s) ll' wlr:rt i's tltc rclatitlttsltiP bclrvscrt tlrc Wllo.l'l'icc,,,,,r rl," Natirl':rl orrcltoccrciasis,rask Force (NoTF))il:l'l;:ffi.,t to CD'll itrtplcr.crtririinn"'il""i* ,.,;'i.;,;ir.",',r1ii,,,, r() (r'.rr.src*r.rurrtrs, sur)r)o* ro No.r.r..anr, a !r lrlil|rlilr trrl lrrrlr rrrr,e|llt X,rr,, Al.r1, I r,1r1r1 tl I 'rl Axr-rexe ? GIIOUI' i, Itt oaclt cat, cottttttetcd, ltttttole youths_att For tttottitorittg TARGET GROUPS FEMALES ?ysION G L,I DE r\tr I ()N( J ( t()Ail\t UNI.I,1, At IiAf tllitt.S: V t Lt,A< ; t., A ' villago' otto A10ra atrd otto Fetttttre arrtrlt 2trtttlt tritt tt.r.rirttr ,rrr,rt rr?rt/ tlta slt t ilten.rr t, /..r,illngo.t, ,trot;p"riltt.tt,t.rltttt.t ttttt,tt lta e ttttrlttt:tod tvltltrltc rettmittittg tr't?" viilttgei. )&'r)t:tirrt,t ,.,,,_.rt be rterd rvirlt /etrmte vortr,s.'projects, T,otttlt.r ote defitted u ir,r,iir,-ia),rrtl.r ltetx,eort lS rtrttl 24 yvn,..r. i;:rf:,?:;:".tL|i',i,i'lt'fur o cort{onottte lttace tt'rt olrers sottte privocy ilt,(, (,t,),stt iii'),i,i,Z,i'' ,,,iii,'i"li'i"fj::.i':' :i:7;: :l',',{,,i:: i:;:;:::;"u,ii;;;,::',:,:l,rii,,j,,,r',,jr,,ji,:,iiii:,,speoklh'eely' otte of rlte ittlcrttal ,,,o,riirr,r.tltr>ttrd tc tttelociTit)tor ,,ltite tt rrr-ttr gttitre.takes ttotes (recot.cler). 7-lte gt.ottlt,li,rr.,,r.rr,),,, rttttst be tttlte-rcccttdetl. At tltc ettd oJ tlte se'tsiott'.1tla1' bock !lto tttlte fttr tt /ctv tttitttttes r(, r)" ,J,tre tltrtt trte dt,tt.ttssitttt tva,rprolterly rccordcd' Lobct thi cassette/N'ios (Natie rtiir"-riit)ge, trte grottp itrcrttit-1,, tlatc), ADULT tvtAL.E.Sl n t)(rL.r FEMn LES; yOtrN(j Mn t-E.S ()ll 2 Please lell us \\'llat you lltl()\v at)r)ur rlre ()nctr()cerciasis rrcilrll]cnl J,r(,.grnrnrrc (rrr-EAsI;PROBE FOR 'iltr -rot-t_<lrvtN(; l.s.sL,ES.) llle ,ers.tt(s) rvlt<l lrt.ttgllt tlre i<l.a .f tlre,rtclr.<:r.rci:rsis r,,()glirrrr(. r() rrris virage . trre (irrre r'rrerr rrre,ersorr(s) carre ro tark witrr y,rr arr.rrr,lrcrr.cerci;rsis rvltetlrer tlrere rvas a villagc rrrcetirrg at llral tinle Issues (lrat,,vere rliscusse<J at rlte rrreelilrg . orvltersltip of the llrogran.une . expectatiorr frOrrr llre prograrrrnte , respolrsibility of llre corrrrnrrrriry Please <Jescribe lrow (lre conlnruntty rocrk <Jrof disrriburiorr. pLEASE pROIIE FOR. sctstolr ou rlrc rirrre (rrrolrtlr/.seasolr) and rtrode I)ersorrs irrvolvecl irr rJecisiorr-rnakirrg Tirne of <Jistributiorr \Vlry tlre lirne was clrosen lr4erlrod of <Jistribut iolr WJry tlre ntelltocj of drstr rlrut ron \vas clrcrsclr Please <Je.scrilre ltorv. tlre corrrrnurrity took <Jecision on llre ;rersorr.sdistributing the drugs lo c.rrrrrrrrrri,, ,,1.,,,iirr. pLE SII t,lf flili fOn. 3 resrronsjble f<lr a a Persolrs irrvolved irt r.leci.siorr-rrrakirrg lVho wiil be resporrsibt. n,r- ,lirrrii,ulio,r Monrtoilng ,nrtru,trDll Ktnrprh ,Mty tg)g 4a 4b t1 o How lhe Det ' wl,y,t;;[:::l'weresereererl . rr,r.rr,o; #:r_::tJ;:..;:,;.,., if ilffi *:t:l lfl ;iil:;,11,1,", iffii!r.#il:,,f.r1il?,f r, isr r i,,,, r i,,,, (( )D r,) si,rcc llas trrere beerr any crrarrge i, the pi,grarnrre? -' "" tt It r, . Who brr . !Vr,a,;lrflffilJ'. Wltat rvere yorr lrllrl alrout rlrr. ttr.,,tl ftt a,. ffi .Hs'iy^ iTii il,, iT, i; ii ; i#$li'i', : ; ; ;'Ji: ", ;; i l, I ;;i [] ;ilr:", [;,]fJ:r REsp()Ns,rltr r.r.y. ,rri, " iiIii.r.r, .) (t l{<lw Is rlre <Irrrg lror rrrerrrbers? nnoiit:'iaj'10.lly lrtrrlrl'lrt irro rrre c<lrrrrrrrrriry rrrrrr rrisrr irrrre<l r. . poirrt of collectiorr r person responsible frtr brirrqirrg if to the corlrnrtrnitr,, ' I)ersorl res;lorsibre [<rr rric]tr i,,,,ii,l,,'r"i,l,il.r rrre c.rrrrrrrlri(v. nlo(le clI clislributiorr o rvltett \vas llte <Jrtrg srr,,allorr,1,1l cor nr ntr rt ity 7 \Vorrl<l yorr crireria),/' please rell 's rrr()"r' rr'rr, srrrlrrl<r rr<lt rrt tt(..r(,(r r'itrr i'errrrr:cti, (excrtrsiorr IS'; [r;13.U,t..Ail],JiE;,, rrrc (.r)r)s truring rrre rasr rrisrrirrtrriorr? pRoBE what probletrts llave y.tl ltn<l rvillt resn,'cr ro rrre distrirrrrri<,rr.rtlre rtrtrg? pRoRri rjoR lirrrelirress of supply to tlte corrrrrrrrrrily . ader;uacy crf .supply . . slorage Wltat problerns trave yorr lrad nf rer ral:ing tlre tlrugs? [low preparecl is the'cotrttttutli?y t. rake corrttol of ive,necrirr disrributiorr pr,gralrrrrre?(l{ow does rrre corrrrnrrity irrrenrr i,r.r.r.iu rr,. ox.r"ii.'iir'r.r..^t 1,ears?) what supp('rt tras rhe corrunrrrrity gir,e, r, r.e cDD? pRo,E Fort : lrrcerrlives irr caslr or irr kinrl f)rovi.siorr ol" rrrearrs oI tratrsporl M<lllilizatiorr oI corrrrrrrrni{y 8 t) to il t2 a a a Monltoriht lItt,u,,Fnr l(rrrrprlr , May l99g l3 l4 I .5, Uttsttr irtg corn;rl rarrcc could you;rlease'tell tts lr.rv y<ttt rv,srlrl ,refls're rrre.srrt.r.r:ss.r trrc (-.1).1.1 pr'grirrrrrrc,) llcrrv rveil lras trre cDr),cr[.rrrr.rrl (r,rt.,r]' r,.()* n.r-r;r,l tr),a) Wlral suggestiorrs do yotr lrave l() inr[)rove llre pr,grarrrrrre.,l I'ltrrrrlorirrj lnrlrlrtrnlt Krrrrpllo, Mny lt)t)t)

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) INDEPENDENT MONITORING OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI} IN EDO STATE, NIGERIA. AUGUST 14 . SEPTEMBER 4, 2OOO REPOP.T RECU I 7 ocT. 2000 APOC/DIR TABLE OF CONTENT A. ACRONYMS B. CERTIFICATION C. OTHER PARTICIPANTS D. EXECUTIVE SUMMARY E. INTRODUCTION F. TERMS OF REFERENCE G. STUDY SITE H. METHODOLOGY I. RESULTS J. DISCUSSION K. STRENGTHSNVEAKNESSES L. RECOMMENDATIONS M. ..WHAT THE PEOPLE SAID,, N. ACKNOWLEDGEMENT O. APPBNDICES t. Time plan for CDTI monitoring in Edo State.2. FGDs in Category A villages. 1. Sample of Village register. ! Sample of Village ,egister. t. Sample of LGA Summary form.6' summary from Edo state Technicar Report June 2000.7' summary from Edo state Technicar Reiort,lrn.2000. !. Sample of Edo SOCU monitoring fo"r.---'9, Instruments used in monitoring fxercise. Page 2 3 4 5 7 8 t0 ll l6 24 33 36 38 43 44 2A. ACRONYMS APOC Afi'rcan prograrnlne fbr' Onchocerciasis Control World Ilealth Organrzatron C'omlnunrty Directed Treatment with [vermectin Cornmunity Based Treatment with Ivermectin National Onchocerciasis Control programme Natronal Onchocerciasis Control Task Force State Onchocerciasis Control Unit State Onchocerciasis Control Team Local Government Onchocerciasis Control Unit Local Government Onchocerciasis Control Team Global 2000 River Bllndness programme Non Governmental Development Organisation Local Government Area Focus Group Discussion Annual Treatment Objective Corn nrunity Directed Distributors Prirnary Health Care Irrfirrrrratiolt. Eclucaticln and Communrcation Rapr d Ep r denr i ological mappin g for Onchocerciasis wHo CDTI CBTI NOCP NOTF SOCU SOCT LOCU LOCT "Cornrnunity' is used rnterchangeably wrth .village,, in this report. GRBP NGDO LGA FGD ATO CDD PHC IE( REMO MONITORING OF CDTI WAS CONDUCTED TN EDO STATE, NIGERIA BY: Ekanem Ikpi Braide (Team Leader) Department of Biological Sciences University of Calabar P. O. Box 3679 Calabar, Nigeria, West Africa Tel:087-230452 Ernail ekab @unical. anoa. net.ng t- Christopher Ogoshi (Team Member) Christoffel BI indenMi ssion (CBM) Onchocerciasis Programme 3,A' Gomwalk Close, P. O. Box 8426 Jos, Nigeria, West Africa Tel. 234-73-454230 Fax 234-73-456578 Email: JeffWatson@maf.org $6m^ -7-- Dr. Y. A. Saka (Team Member) Federal Ministry of Health Nati onal Onchocerciasi s Control Prograrnlne QI{OCP) Federal Secretariat Phase II Room 915 Ikoyi Lagos, Nigeria, West Africa Tel: 0l -2696013 Fax: 0l-2696013 4C. OTHER PARTICIPANTS ASSISTANTS I Mr. (Jwern Ekpo 2. Mr. Obono Marrrn 3 Mr Urna Udurna .1. Mr. Mike Urnoh 5 Miss Ekaette Akpaidiok SOCT FIELD GTIIDES I Mr A. O. Abu 2. Mr,. Salru Kadirr 3. Mrs patrence Irabor 4. Mrs Dora Akpata 5 Mrs Elizabeth Orbih 6 Mrs Dora E. Osoata DRIVERS I Mr. Drrisu Osrtb 2. Mr. Osamudiawawen Edobor 3 Mr. Eko J Eko Data assistant Field assistant Field assistant Field assistant Secretarial assistant 5D EXECUTIVE SLIMMARY A rnonitoring tearn set up by NoCP Nigena comprising prof. E. t. Braide, Mr.c' ogoshi and Dr Y'A Saka' tnouitored CDTI project in Edo state within theperiod of August l4 - septetnber 4 (field work and report writing). The aim ofthe rnonitoring was to assess the extent to which CDTI is being implemented inEdo State' A one day training of members of the monito,ng team and fieldassistants preceded fierd visits. During the monitoring period, briefing andinterview sessrons were held with key officials of NOCp. GRBP, SOCT, EdoState Government, LGA Council and LOCT. After field visits, a .lointdebriefing session was rrerr, with trre programme Assistant (pA) of GRBpEdo/Delta and Edo socT members. A totar of 2g (6 category A and, 23category B) vi,ages' serected through multistage sampring procedure werevisited rn 6 Locar Government Areas. Instruments developed by Apoctemporary advisers in ouagadougou, Burkina Faso and refined in Kabare,uganda were used' Infor:nation was gathered through key informant interviewsand Focus Group Discussions (FGDs) on drugprocuremenilstorage/delivery/distributlon, cornmunity involvement in decisionmaking, community support of distribution, communit satisfaction, troinins rp.nri t.^^-: y perception/expectation/ pHc, counrerparr,ri;,,""ffil:#;;il1ffi -;*j,T-n inro Procedure for procurement, storage and derivery of mectizan was found to be inline wit^ APoc guidelines except fbr the fact that mectizanrs yet to be stored instate and LGA facilities' In spite of lack of information on onchocerciasis and.DTI' a,d inadequate rnobil izationand sensit ization,freated communities weresatisfied with the therapeutic effect of mectizan. They were willing toparttclpate fully in the programrne as stakehorders, if tord what to do. Recordkeeping and reporting was not in accordance with Apoc/NOTF approved 6formats at commurrttl' level and was very poor in quality. Records were not available in l5 of the 29 villages visited and in all 6 LGAs visited. Data in Edo State Jttne 2000 I'eclmrcal Report did not tally with LGA Summary forms obtained from the SOCT office and none of the two sets of data agreed with data in village registers (notebooks). It was impossible to calculate coverage as onlS eligibles were recorded in registers. All CDDs seen had been trained at least ottce but quality of trainrng was found to be very poor. Though all 29 villages claimed to have received health education, there was no evidence of any posrtive effect of the health education as awareness was found to be very low' Strengths of the project were found to include high political commitment on the part of State Govemment and LGAs, commitment of SOCT and LOCT, structttral integratron into PHC, high literacy level of CDDs and willingness of communities to participate, weakness of the pro;ect were found to include poor sensitization and mobilization of State/LGAs/communities, Information gap berween NGDoNocp and the state/LcAs/communities, lack of tEC materials, lack of census data, poor haining, poor record keeping and poor supervision' There was also no arrangement for management and referral of adverse reactiotts and no follow up of refusals, absentees, underage and the sick. The team recommerlds that NOCP/GRBP should correct the structural defect inEdo/Delta prolect by ernpowerng each State to take control of their pro.;ect. These stakeholders should carry out joint advocacy visits to Edo State and fullytnform and sensitize Edo State government and LGA councils about GDTI andthe role of the Stakeholders. GRBP shoulcl take immediate actions to empower the Edo socT to take on thetr prescribed role. Edo state Government shouldpay her counrerpart funds for I 999 and 2000 and fortifi, the SOCT office for safe storage of mect izan and otlrer CDTI equipment and suppries. lntensive comrnunity mobirization, se,srtrzation and education using appropnate IEC tltaterlals should be conducted afresh in all target communities. Thorough 7training and retraining should be conducted for LOCT, health workers and CDDs orr all components of CDTI All Stakeholders should implement accurate distribution and proper reporting procedures and ensure that supervision is intensified, census is conducted and REMO updated. E. INTRODTIC]TION The African Programme for onchocerciasis Control (ApoC) was set up in December 1995 to implement an effective and self-sustaining programme for treatment of poptrlations in hyper and meso endemic areas using lvermectin donated by Merck company Inc. The programme began with communiry Based Treatment with lvermectin (cBTI) approach but in lgg6changed to the community Directed Treatment with Ivermectin (CDTI) approach after a multi- country study showed tlrat communities are capable of directing Ivermectindistribution This approaclt requires that communities own and sustain theprograrnme by taking on full responsibility for selection of distributors, decision making on date' rnode of distribution as well as supporting distribution. The first CDTI project EII'a'lts were awarded in 1997 andat present there are 47projects' 36 of which are specifically devoted to field operations for GDTIPro-;ects are impremented as partnership between Apoc, Government, NGDos and communities. Each project is funded for a period of 5 years over whichtime it is expected that support by partners wiil increase whire Apoc supportwill decrease' and cost of treatment per person will reduce by abou t gooh. It isexpected that GDTI activitres will be sustained for up to 15 years in order toguarantee effectiv,e control of onchocerciasis. o,e of trre key actrvities in the .DTI pran of action is regurar monitoring ofCDTI projects to detennine to what extent the key activities are being carried 8out, to highhght strengths and weaknesses and make recommendations for improvelnent of the plogralnme. Presented here is the repoft of monitoring exercise conducted in Edo State, Nigeria within the period August l4 to Septenrber. 4,2ooo. F. TERMS OF REFERENCE s,ccrnctly docurnent how Ivermectin treatments were undertaken in a number of communities in Edo State 2 Assess comtnunity involvement in drug collection, decision on the time of distribution. rnode of distribution and selection of distributors and the willingness of co,rr,unity to bear the responsibilities as designed in the CDTI projeus Document community perceptions of CDTI processes, especialry the issue of ownership attd expectations for onchocerciasis control, and basedon these perceptrorrs and expectations, determine the degree ofsatisfaction of trre cornrnu,ity with the drfferent programme activities and outcornes. J I Assess the quality of Distributors (CDDs). training received by Community Directed _5 Examrne tlre record books of cDDs and assess the quarity of recordkeep,rg ard therr abiritl, to keep accurate records. The same appries totlre lrealtlr serv,tces staff olt the projects. 96 7 8 Detennine the ntrrnber of Communities and eligible persons treated and compare findings with the records of CDDs and the records at the State and LGA levels. Determine whether health personnel participated in Ivermectin distribution and assess the degree of supervision by hearth staff (and the quality of training and/or orientation of such staffto CDTI). Identrfy constraints in trre distributions and make recommendations to the NorF and management of Apoc on corrective measures necessary before next treatment. Document reasons (e. g constraints) why a project did not comprete treatments (geographic and therapeutic) or achieved g0%o ofthe Annuar Treatmenr Objective (ATO) Examine IEC materials in use in the project. Obtain infonnatron on funding by State Gor,,enrrnent Local Government Area NGDO Discttss the pro;ect's sustainabilify based on the findings above Brief and debrief the national coordinator and the country representative of the NGDO suppor-ting the projects. 9 l0 ll 2 l3 10 t4 Submit data on lrousehold survey rrr category "A" villages and all other quantitatrve and qualrtative data on categories ..A,, and ..B,, villages (hard copy and diskettes). G. STTIDY SITES Nigeria, Africa's rnost popurous country, inspite of her size and immense natural and human resources, is still faced with many health problems one of which is onchocerciasis. It is estimated that Nigeria habours about 60%o of all onchocerciasis cases in west Africa and 30-40 o/o of the cases in the world. Expectedly Nigeria was among the first set of countries to receive grants from the APOC Trust Fund fbr CDTI Edo state and Delta state were carved out of the former Bendel State. EdoState is bounded to the East by Derta State, to the west by ondo State, and tothe North by Kogi State. The state, which is in the B zone of the pHC system,is made up of 18 local government areas of which 12 have been identified aslryper/meso endemic fbr onchocerciasis. As indicated in the June ZO00Technical Report, Edo/Derta proje* was approved in Aprir rggg forcommencetnent in June 1999 The first installment of funds was rereased byAPoc in July lggg' It is indicated in the technical report that atotar of 1,051persons were trained' 381,466 persons in 464 villages in l2LGAs were heated,and a therapeutic coverage of 68. lo/o achieved within the period June I ggg andMay 2000 (Appendix I) I2 3 4 5 6 7 8 8. 9. II 12. I3. 14. I5. 16. 17. t8 19. 1t H. METHODOLOGY The Monitoring Exercise began immediatery after a training session was conducted for the monitors and the other assistants in Benin City on the 15ft of August,2000 Using appropriate interview guides/questionnaires the following policy makers and health workers were interviewed and briefed. Dr. Kenneth Korve, Dep. National Coord. GRBP Mr. John Eguagie, project Admin Edo/Delt4 GRBP Mr. A. O. Abu, oncho coordinator Ministry of health Edo State Mrs' C. o. [ru, Deputy Director PHCTDC Ministry of Hearth Edo stateDr. Peter Nosa 8., Director pHC/Dc Mrnistry of Hearth Edo StateDr. E' Irubera, pernranent Secretary Ministry of Hearth Edo StateDr' E' S' Okpaise' Head of Service Edo State Government Dr' odu Bamgbose, Assistant chief Scientific of;ficer, Nocp Mrs. Ruth O. Aigbokham, pHC Coordinator, Etsako East Hon' charres Inwumho, counciror for Hearth, Etsako EastHon. G. A. Eshieshi, Chainnan, Etsako East Mr' F' I' Akindo' Director of personner mgt., Etsako EastMrs. Esther E. Asse, pHC Coordinator, Owan West Hon. Okhiria Andrew, Councillor for Health, Owan WestMrs. T. E. Odiboh, pHC Coordinator, Esan South EastHo,. Iyamu, Councillor for Health, Ovia South West Mrs. C. A. Osazuwa, pHC Coordinator, Ovia South west Mr. S. E. Aghedo, LGA Secretary, Ovia South West Mr. Anselm Lnobige, Secretary of Council , Owan East t2 At the end of field vrsits the team held a Jomt debrrefing session with the following . Mr. John Eguagie . Mr. A. O. Abu . Mrs. D. E. Osata . Mr S A. Kadiri . Mrs. P. Akpata . Mrs. P. Irabor Ogunmola . Mrs. E Orbilr PA GRBP EdoiDelta Coordinator Edo SOCU Mernber Edo SCOT Member Edo SCOT Member Edo SCOT Member Edo SCOT Member Edo SCOT To aid selection of villages, Edo State REMO results, Iists of Local Government Areas (LGAs) and villages as well as the map of the State were examined. careful consideration was given to geographical and administrative spread irr the selection of "A" viilages. A totar of 6 category ..A,, villages were serected frorn six LGAs under the following catego rization. ' Two villages each with Hearth facirity and far from headquarters ' one village with Hearth facirity and near to headquarters ' Two villages each without rrearth facirity and far from headquarters ' one village without rrearth facirity and near to headquarters. In eaclr category "A" village, key irrformant interviews were conducted on cDD' village head and health worker after obtaining permission from the village head to work in the virage. In each category ..A,, v,rage arso, two Focus Group Discussions (IrGDs) were conducted with one female adult group and one male adurt group (FGDs) per virage in 3 A virages and with one female youth and one mare youth goups per vilrage in 3 vilrages (Appendix 2). care was taken to have g-r0 persons per group. The group discussions were 13 tape recorded in labelled cassettes and later transcribed. A sample of l0-15 hotrseholds was selected in each category "A" village for household survey. After obtaining perrnlssron fiom the household head, all members of the household were listed starting with the head of the household. Each household member was asked questions listed in the household survey form. A sample of 5 persons in 3 Category "A" villages were measured to determine the accuracy of number of tablets given. All available registers were collected for inspection. CDDs were requested to submit their measuring tools for inspection. For each category "A" villa ge, 4 category "B" villages were selected. tn each category "B" village, key informant interviews were conducted with CDD and village head' All available treatment registers and measuring tools were inspected. Limitations experienced during the exercise were the fo[owing: ' Settlement pattern in Edo state made it difficult to find ((8,, villages surrounding the "A" villages. Most villages are situated along the marn roads and therefbre are at the same revel of deveropment. ..B,, vilrages selected are therefore not necessarily smaller than ..A,, villages, and in most cases not "around,, ((A', villages. ' Inaccurate REMo results made it difficult for team to determine accurate endemicity of villages. 14 Table l. Profile Of Villages Monitored A En CI Odiguetue Iguonalchr II Eguare Eu'ohrml REMO YO(hlpo) but treatrnent donc *cDD and chief not at Itotne so no Key Informant interviews conducted WOHF Without Healtlr Facility With Health Facrlity Far fiom Headquarters Near Headquarters WHF FHQ NHQ S/N LGA B villages EndemicityAI O-r'ra N.E H)'per H]'per WHF' FHQ WOHC FHQ -U Adichr Hyper82 Orvan Hyper 83 Uhiere HYPer 84 Osasemoba+A2 Ovra SW 85 Obazumamwen Listed but no REMO resutt 86 Ora I Lrsted but no REMO result 87 Ora II Hypo 88 Okokpo I Meso 89 Okoro II Bl0 Aifasoba Hyper A3 Esako East Or.ao H)'pcr WHF FHQ Bll Ekwotsor Not on REMO lisr Bl2Iviukwe close to B14 Othameh Hypo but close to hyper A{ Ouan East Ihievbe H)'per WHF NHQ Bl5 Onarrake Not on REMOlisr 816 Okhuame Not on REMO lisr Bl7 Warrake BIE Osun Meso MesoA.5 Esan West Imulc Mcso WHF NHQ Bt9 Ille B20 Orvene Not on REMO listA6 Esan S, E NHF FHQ B2l Iheken MESO B22 Ewatto Not on REMO list 823 Ogbe Ewohimi B'24 Idumogo Ewohimi Not on REMO list Not on REMOtist Bl3 Agiere Meso EDO $TATE MAP trI0 z c ul Oc ,r" o. \.o AI(OKO.EDO EISAI(O EASI EISAI(OOWA}I EAII EISAIO CENIIAL ottAl't wESr 2 rtl rill EliAN SOUIHWEST UHUNITAU'ODC -alt6L, =(9 OVIA NORTHEAST ORHIONMWON / 'rt l6 I. RESTILTS General Information Table 2: Decis ion-makin rocesses at the commun level Number of LGAs visited Number of "A" villages visited Nurnber of "8" villages visrted Number of key Infbrrnarrt rnterviews: village "A" leaders Number of key Inforrnant lnterviews: village "B" leaders Nurnber of ln-depth Interviews: Village..Ai CDDs Number of In-depth Interviews: Village..B,, CDDs Nurnber of Health Personnel lnterviewed Number of Household rnernbers surveyed Number of Policy makers interviewed Number of FGDs conducted 6 6 23 6 23 7 22 il 37t 8 5 Input Indicators (using response fiorn vlllage head)E-l - 9 (31 0%) of the 2giommuniti"s ,nonitored-rlecidedln period of treatment,l0 (34 4Yo) of the 29 communities monrtored decided o, ,oa. of treatmentE-2 - 12 (4t 49/o) of 29 comrnunities ,nonito.ea ,"t""i"JCoo at village meeting. Information frotn the FGDs revealed that decisions were made mainly by thehealth workers and village elders. Vrllage Village Elders Village Health Worker Vrllage H, Village Others Total . Who decides on tl.rc month of Distributron . Mode of Drstnbutron Village Resporues on *'ho decides [,eader -.rAt'and ..Brt lon CDDa L2 .1L.r e (31 0) l0 (3.1 .1) 8 27.6 2 ((t B) 7 (21.t) J t7 3 (10.3) 0 (0.0) 3.+ 5 (t7.2) e (31.0) 2 r0 (34.4) 0 (0.0) (0. (3. 0 I 0) 4) 0 0 0 (0.0) 2 (6.8) 29 29 (100) 2e (100) Village r4r *4 rifn . Trme of Distnbutlon . Mode of DrstnbuUon CDD Selection of (ri5 7) I (t 9 (r.r 3) 121 t2 42. 0 (0.0) r (t4 3) s (7t.4)0 (0.0) 2 0 (0.0) 0 (0.0) 1 l (14.3) 0 (0.0) 0 (0.0) 0 (0.0) 28 7 (100) 7 (100) . Mode of drslnbutron G t *A ,,roup viDiscussion age ofTuue d.rstnbu lron a of 0 0 I 2 2 2 I I 0 2 0 (0.0) 0 (0.0) 2 2 2 0 0 0 0 0 0 o 0 0 5 5 5 l7 Table 3: Absentees and Refusals (Treatment Registers) LGA v Absentees Refusels TOTAL Output lndicators 9-]- Proportion and number of refusals two months after distribution : No records. o-2 - Proportion and number of absentees later treated : No records FGDs revealed that there were many absentees and refusals that were not followed up and also that not all eligibles had been treated. LGA summaries obtained from the SoCT has data for refusals, absentees, sick and underage. The meanirrg of these data is not clear as no such records exist in the village registers. Table 4: Proportion of villages treated and in which cDDs where changed after the firsitreatment (Key Informant interviews cDDs and vilrage Heads). LGA Village (B & A) Treated CDD Cha Yes No Yes NoEsan South East 4+ I 5 J ., 0 5Esan West 0 5 3 I 2Etsako East 4+ 1 5 0 I 4Ovia North East 3+ I 4 0 4 I 3Ovia South West 6+l 7 4+ I 5 5 2 I 6Owan East I 4 2 3Total 2s + 6 (29) t4 15 6 23 6 o-3 - l1 (48 3o/o) of zg villages monitored had been treated under CDTI9-1 99rat o.r person treated was not addressed au.ing tt e monitoring.o-5 - cDDs were changed after first treatment in 6 ed 7%)of 29 villiges monitored LOCT Record GRBP State Village Register LOCT Record Village Register GRBP State Esan South East Esan West Etsako East Ovia North East Ovia South West Owan East Equare Ewohimr Imule Ovao Odiguetue Iguoriakhi II Ihievbe A A A A A A NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR A NR NR NR 2+t(3) l8 Table 5: Proportion of villages which received health education and in which CDDs where srrpervised by henlth care personnel. (Data pooled from interview with CDD and Village head). LGA Esan South East CDD supervised by health system (o/ol 1L100) 4 (80) Esan West ., 3 (r00) 2 (66.7) Etsako East 5 s (100) 3 (60) Ovia North East 4 7 3 (7s) 1IJs)Ovia South West 7 I s (71 4)Owan East 5 4 80 3 60 Total 29 27 (93.1) 20 (6r.e6) 5 Nrrmber of Villnges Received health education (%o) tsako 0-6 - CDDS were supervised by Health care system in 20 (68.9 6%o) of zgvillages monitoredo-7 - Health Educatton about importance olivermectin treatment had been givenin2T(93 19%) of 29 communitiis monitored Table 6: Treatment summary (Data only from ,.A,, villages) No summary data were available in all the."A" vitlages visited Data below were calculatedfi'om registers (notebooks) where available una "oirpu;; u, indicated with data obtainedfrom household survey n S/E, Esun Wtrt IUi(' lts RI'(' 32 NA NI NI l8t () NA NA t? N/E uso o il 28 0 NI 0 5 lot r\bscntecs -lreated l1 NA 55 54 Fis .- ilousehokl S u:vct'. ltcc - I(ci,ords lrorn :VTlagc '- Not*-l otal retlrs to tolal rrunrbur ol'1rcoplc rn thc housc survc'v,sample, an<J total nurnbcr of pcopte rn thc villagc rcgisters. -NotAvarlablc Total population of villages was rtot available in village treatment notebooks asonly eligible persons were listed. o-lJ - Proportion and nttmber of persons 5 years and above whom received ivermectin. coverage of totar population in 6 catego ry "A" vi[ages computed from househordsurvey is 59 6 9/o None of r I persons measured in ovao.(4), Ihievebe (2), Imure llreh (r) and Eguare(3) was given correct dose of ivermectin IIS Owen Eart ITS REC ITSl-ota.lr 55 HS1 006 REC RI.:C 557 IIS 58 I0t 78 47 NA NA NA t, 78 NA NA l' 2 47 INA I NA NA t- Ovir SrV REC -to FD s.p a { { A) rfl FD ln U) s)i, U) E frj(t, e {(!(n rn v) FlF o r., o) F |iJ N)\o 5{lJl latLlr 3 S.ZZ = = '= E6 + N) -J Ao\5 (,(+.)(^ OEIFl-x9.0i a tzo \o 6\ \oP O@l{^ @O Oooo A oh.) oo u) t-EBErq' I b.) z o sh.)OUJ oo Ol-.J6 o\ OoN)o N)tJ oA i 20i.) dE aoQ D CEo z o sNJo(}JA(/r tJ@ o\ t\)o@o zz zz zzz I!FEE 3Bta I(r)(D(r, zo zz zz zzz NJ€ Ot\) N) ig38 =38-E+ o za \oo\5oN)\to\ o\ l-.)a 5o(,Jl'.)a oN) oN) ii?FF s. :. d6' s. FF =$ zo o\ \o 5Ooo \o6\oo *J+ A .t+ iJr* .t+ zo *(JJ*O stFi FFB$ rl I o\ N)oAoo oo o{ A \o 6\o\oo ON) (3 z o 9FE'g E'8..i. i *.J E .{l I -I oI\o tJooo stJoo O zoo o FFO(DiD='8H"- (!=a- | ig>6 ='< =.8.)=rrg .D oO rO o\o -l EE - tr! J zrE -l zU o r.i oF(t) 1, F9 z fr, TTT iii772 !CO{C\UrJ-!)N- qr ! 'p'v'o 1r'tr rc "c) 7 --lEEEEEEEE X ]:1::1:1:r:1:11:_r P =aa9g-ei=ai EE)sJtJ$$$oo(Jl-aaaeaaaB,d 63==,=====\E= EtE,C,E-,- 4 3 3 3 3 3 3 C L./q.IEqqqgI Eoooooooo -------- ic858QEE88 2 =F=FEE=T 9 =A=isIEE fi-qlF;=efa E ,E id==*, atT=eE=:sEL 6- ;3 E;:E€ g € arasFaEi g e=; i; U.r3 U =Eg?E'9BFEE'rg 9g€ e5 =9o'7G 6 I -o@ O = ht =: d E o<A =*9.(,=J61 r'DGC)O(E1F a ?i e= n tsts8 F Z<or ilod .)50 .iX=s=. .):l EFl.o+=55.) -F)6 .i=1,8 F EF 8'7!+E; :, 98 : @^ o J hJ 0aa ixrxsr-".!Ssis^' i59*9s- {-'- v ra =. -\ \o 20 Table 8 Treatment Register Data I LGA )r'ia N E Etsako East s.w sanS E mW an East Village Ebese Ivbaro Trcatrrrcnt Regrster scclt Nunrbcr of[anlcs ln rcSlstcr i f-I I I r- Number of psrsons recorded as tre;rtcd ofNumber absentees refusal ineligrbles Nurnber of tablets distributed Summary page in regster No i Orran Uhrere No No No Osasernoba No Ovao Yes I 280 17 Not indlcated l03E NoYes Yes No No El$votsor Iviulove 2t{t I{09 913 160 Not indrcated Not indicated 1906 478Aglere Yes Yes I 187 1t7 359 Not rndlcated Not rndicated Nor indicated 2500 1286 No NoII en I Ora I Ora II No Ycs 196 460 592 I8t -53 3t3 229 6l Not indicaied Not indicatcd Not mdicated Not 524 1028 588 401 No No No 188 54 Not indicated made an attempt mdrcating absentees. CDD sick 543 482 No No NoAifasoba Eguare Err'ohimr Ihckcn Euohrnrr Okoro I Ycs Yes 100(r I It.5 Not indicated An attempt nude by CDD at Not lndlcated No E$atto Ycs 688 Not rndrcatcd Not indrcated Not indicated No No No No No No No hnule Ille Okhuanre Onarrake Or 'be No No Ogbc En'ohrnrr Idumogo Eryohrmr Warrake t9E7 No Yes 802 620 Not indrcated No Ycs Ycs Y I INPUT INDI 0 n q Percentage of Villages 60 80 1m Trained CDDe Late Supply Drug Shortage Collec{irn from a print Meawrirg device Tredment regis{er Summary in Distric-t orffice Side reaction record E Esan South East I Esan West I Etsako East o Ovia North East ts Ovia South West 12 o o (U o €E

0 20 40 Percentage of Villages 60 80 100 120 Esan South East Esan West Etsako East vt (,J Ovia North East Ovia South West Oran East Total r Treated I CDD Changed I Health Education o Supervised I I I

DECISION-MAKING PROCESS- MONTH OF DISTRIBUTION DECISION.MAKING PROCESS- MODE OF HSTRIBUTIoN DECISION.MAKING PROCESS- SELECTION OF (6.si6) (31.0%) (10.3%) (0.0%) (17.M) (34.5%) @Mllaga ll/bcting I Villagc Eldcrs ElMllagc hcalh Com r Vilhg.Comm. r Mlhgc Chiaf trl Hoalh Workars E Oth.E (6.e%) (0.s6%) (3,{.5%) (31.0e/6) (0.0%) (24.1%) a Mllago [lllccting I Vilhg. Eldcrt E Villag. hcalh Com I Mllagc Comm. r Vlllegc Chicf E l{cehh Worklr8 E Ot r6rs tMllega llhcting I Vilhgc Eld6{s E Vilhgc hcalth Com r Villagc Comm. I Mllagc Chicf IO0prr E Hcfllth Work rE (41.4%) 117.2%) (27.6%) (6.9,6) (3.4%) (3 4%) (0.0%) r--J F

24 J. DISCUSSION Procedure for drug procurement, delivery and distrihution Procedure for drug proourernent and delivery in Edo State conforms with APoc g*idehrres ,p to trre stage of collection fiom Nocp by GRBp. GRBP and NOCP apply for rnecti zan, L)nicef clears the consignment and infbrrns Nocp and GRBp, GRBP collects and stores in GRBp office in Benin fbrrn where it is released on requisition to Edo state socr State officials inform the team that the State Ministry of health does not yet have a safe store' GRBP project Administratcr stated that it is safest to store rnectizarr fbr Edo State irr GRBP office because ..mectizan is money,,. Ideally, the consigrrtnent of the drug for Edo State should be stored by Edo socT and delrvered throtrgh the LocT to collections points (health clinics)frorn where ffained cDDs pick up for distribution. All Edo state Goventment officials interviewed expressed the State willingness to take onthe resporrsibility of proviclirrg a safe store for the drug. The team found noinvelrtories for mectizan at community, LGA and state levers, a rapse, whilh arises frorn the fact trrat the drug is never stored at these revers. f)ecision on month and mode of distribution is taken at village meeting in9 (31'0o,'o) of virages rrorritored. Expectedry, therefore, cDDs pick up rnectizarr fbnn LcA i, onry g of the 2g v,rages monitored. The remaining21 villages ltave tnectizan delivered by health officials who decide on thettltte of dellvery'. l'he Focus Group Discussions revealed that decisions on month and mode of distribution were taken mainry by the village elders andhealth workers lrt most of'the villages, the vilragers were called without notice to gathe. at the hearth centre fbr treatment. Measuring stick was 25 found in only 2 ot'the 29 vrllages vrsrted, It was evident that CDDs were not aware of the importance of using Ineasuring sticks. They therefore freely used "maturity", "marital status" and "gender" as criteria for dosage. communify Perception, Expectations and satisfaction communities, including those last treated in l ggg, are satisfied with the therapeutic effect of mectizan and are prepared to do anything to continue getting the drug. Most indicate that mectizan is good for the eyes but do know much about onchocerciasis. Most communities believe that some philanthropist who came in "a particurar type of vehicle,, bring mectizan free of charge to them and they expect that the .. the drug free of charge to them. donor" will continue to provide It is evident that mobilization and sensitzation of the communities have been very poor and inadequate for a community directed programme. It is only after the communities have been given all available information aboutCDTI tha*hey wiil effectivery participate fulry as stakeholders. Training Though cDDs interviewed craimed to have been Fained, there is no evidence that adequate training was given. pooring together informationfiom interviews and Focus Group Discussions, it was clear that the quality of training (content and duratior) as weli as suitability of resource persons were inadequate. Most of the trainings were left to poorry trained LocT tohandle whereas the ideal situation wourd have been for training to behandled bv a rearn of Nocp, GRB., socr and LocT officiars. The cDDs are not aware that they need to compulsorily use measuring sticks for 26 tneasurlng persons in order to determine dosage. Most CDDs could not remember any toprc outsrde the actual distribution process. Obviously, they were not trained on community mobilization, dosage determination, record keeping' lnanagement and referral of adverse reactions, as well as follow up of absentees and refirsals. Record Keeping The team found record keeping at community and LGA levels to be very poor The only LGA treatment records seen were obtained from the State socT office and these were not complete for all LGAs. It was not clear where the data in the records seen at the Socr originated from as there were no corresponding records in the villages. Records in all t4 (44.g%) of the 29 villages (where they exrsred) wero not kept on Apocalocp approved format' Notebooks marnry purchased by the communities were used. only Name' Age, Sex, Tabs/Herght, and years of treatment were entered in the notebooks (Appendix 3)' In most notebooks number of tabrets were Lot indicated and fearment was indicated by a tick (J), onry erigibres were recorded in tlre rrotebooks making it impossible to calculated Eeatment coverage, determirre nurnber of underage, sick, absentees and refusals. None of the notebooks had surnmary forms. with such poor records, it w,r bedifficult for the cDDs t, krtow the number of tabrets distributed in any round of treatment and the number of tablets needed for next round oflreatment It will also be inrpossible fbr them to follow up treatment of the srck' pregnant, absentees, refusars and underage as these were not specifiedin the notebooks' These sh,rtcoming will resurt in inaccurate requisitrng, which wrll in turn lead to either short suppry or wastage. some cDDs made requests fbr nrore tablets through the monitoring teams as follows: 27 Village Ekwotsor Agiere Okokpon I Eguare lkeken Ogbokpa Ewatto Num of additi al tablets I,000 2,500 1,000 1,500 I,000 2,000 The cDDs were fotrnd to be literate and capable of keeping accurate recordsif properly trained. one cDD in Ikeken Ewohimi made commendable attempt to record absentees, sick and refusals beside the names in her notebook (Appendix 4). An unsolvedpuzzle in the Edo State CDTI data is t,at while there were no records of absentees, refusals, sick, pregnant and underage in the viilage registers (Appendix 5), LGA records had figures entered for these categories. Most worrisome is the discrepancy between data contained in June 2000 Technical report and information in registers at community level and in the LGA summaries. For example Technical report has it that 433 or 464 target viilages treated had summary forms, whereas no summary fbnns were seen rn any of the 29 vilages vrsited (Appendi x 6 &7)' Tecllnical report has rt tlrat no severe reactions were experienced in all 'rllages rreated' whereas LtiA reoords had a total of 152 adverse reactions in Etsako East alone as at June 2000. these were indeed adverse reactions. Focus Group Discussions revealed that 28 Coverage It is rmpossible to accurately calculate tlrerapeutic coverage from the information available in records in the villages. Only 14 of 29 villages visited had been treated withrn the perrod 1999 - 2000 giving a geo$aphical coverage (under CDTI) of 48.27oto. This does not agree with geographical coverage of 464 (99.59o) out of 466 at risk villages indicated in the technical report. The Teclrnical report also gives therapeutic coverage as 68.1%o for Edo State Thrs calculation was probably done using eligible population as denominator since no census of the communities had been carried out and village registers only had names of eligibles. The team could not effectively compare number treated from household survey in 6 ..A,, villages with number recorded as trealed in registers because most (4 of 6) of the regrsters did not have enough rnformation to allow for such comparison. Supervision Supervision was found to be grossly inadequate. The State officials citetl inadequate logistics proviston as reason for poor supervision. Lack of vehtcle and funds fbr per diem were principal constraints given, Supervision checkhst was not found at any level. The only supervision document found ts the time sheet (Appendix 8) obtained from the state coordinator. It is important that the SOCT and LOCT have access to funds and transportation for supervision. It rs also necessary for NOCP ZonalCoordinator and GRBp Programme Admrnrstrator to accompany the socr and LocT during some supervisory,visits. 29 Integration into PHC Potentral for future ttttegratron rnto PHC is high. Admrnrsffative framework for structural integratrorr exists in that SOCT and LOCT members are health officials with other functions. Drug delivery and storage can easily be integsated into the already existing drug storage system in the State and LGAs. Practical inte[ration will be achieved when the state and LGAs are made to understand that CDTI rs another health programme, which should fall into the "health programme basket" of the state. At present the State and LGAs are not fully aware of their responsibilities as they still view the programme as belonging to GRBP and Lions. Counterpart Funding So far' the state has approved the sum of N797, 000. 00 which is, yet to be released for CDTI for 1999 The State officials do not yet fully understand the role of the State Government in CDTI and seen not to be familiar with the APocNocp organogram The team was told of a document, which was submitted by a GRBP official to ttre Ministry within the week of monitoring. Had the document arrived earlier, they said, the State Ministry of Health would rrave applied for more firnding for 2000. It is very necessary for the National Coordinator, the Zonal Coordinator and the NGDO to.lointly pay an aclvocacy visit to Edo State and provide exhaustive information about CDTI to the state Government. If this is not immediately possible' the National Coordinator should send a letter with all supportirrg documents to Edo state Government giving all necessary information. In all six LGAs visited, Council officials have asked that the State project should send official letters to thern indicating the amount of counterpart 30 funding required and how ofien rt should be paid. Again, there is an indication that the LGAs ltave not been pr:operly briefed as to theu roles as stakeholders in CDTI The Technical report has it that funding has been received from four of the srx I-GAs monitored as follows: Ovia South East Ovia North East Etsako East Owan East Esan South East Esan West 35,000.00 20,000.00 0 0 50,000.00 20,000.00 The fact that these were "ad hoc" donations to the project is a pointer to the willingness and capability of the LGAs to give more sustained support if told exactly what to do. IEC Materials Apart fiom one stngle poster. placed three days before monitoring in ovao village' no other IEC nraterials were found in the villages monitored. However. the fbllowing IIIC and training materials were found in the GRB' office ' A practical gulde fbr trainers of community Directed Dishibutors ' Information brochure fierd guide for river brindness control ' Preventive health education for river blindness flip chart for Village Based Health Workers (VBHW). 31 Ten important questiotts and answers on onchocerciasis otherwise called river blindness Hand bills - rne ctizan dose by height cm onchocerciasis river blindness disease Calendar on health education messages. These materials need to get into the hands of SOCT, LOCT, health workers and CDDs Sustainability Two mandatory actions have a ripple effect on the elements of CDTI and therefore on sustainability of CDTI. The first is the ability and willingness of the NGDO and health workers at State and LGA levels to adequately mobilize and sensitize the communities on ther roles in CDTI the second is the willingness of the cornmunities to accept ther responsibilities. Fortunately the communities are willing to participate fully in GDTI inspite of the fact that CDTI philosophy is yet to be made clear to them and they are not empowered to take on their roles. Unfortunately the socT and LocT are themserves not empowered to faciritate the empowerment of the communities' The situation will remain unchanged until the NGD9 makes conscious effort to allow the State, LGAs, and communities play their roles as stakeholders. constraints observed in Edo state project, which w1r impact negatively on sustainability of CDTI, are: structural set up of the programme is not conducive for sustainability. Two State projects Edo and Delta are lumped into one proJect under a a rl 32 the ctmtrol ol- ths (;ltBP LJrrder this set up, it is difficult for individual states to take <;ontrol of their projects. Inadequate logistic support fbr effective supervision by SoCT and LOCT Paucity of accurate rnfbrmation about CDTI at State, LGA and communitles levels. Communication gap between NOCP and the State as the role of the NOCP zonal Coordinator seems to have been overshadowed by the strong control of the programme by GRBp. Lack of IEC materials at [,GA and community levels. Poor planning fbr implernentation and supervision. Sconng of Edo State CDTI with respect to performance in the basic elements of GDTI necessary for sustainability is as follows: Procedure for procurement, storage and delivery Community rnvolvernent Community perception Commtur ity expectat lolts Community satisfacti on Comrnunity wrllingness to be fully involved Politrcal wrll of State Political will of LGAs Level of adherence to disfibution regulations Record keeping and reporling Accuracy rn dosage Coverage of eligible populatron 2 3 4 5 6 C D D D B B B B D D D C 33 Quality of trainrng Quality of supervrsiorr Orientation of healtlr staff to CDTI Integration into PHC Facilitating role of NGDO STRENGTHS AND WEAKNESSES Strengths ' There ls evidence of politrcal commitment on the part of the State Government and LGA Councils. The State Government approved the sum of N797, 000.00 fbr CDTI for 1999 and is willing to continue to support the programme rf properly bnefed. Some LGA councils have financially supported the programme and are prepared to pay counterpart funding if officially told to do so. ' The members of the SOCT and LoCT are willing to work hard to effect the success of CDTI if the constraints that have hindered their perfbrmance are addressed. There is cornmendable level of structural integration of CDTI into existing PHC system at afi revels as most socr and LocT members perform other functions In the health sector. They are in turn under the supervision of the Director Public Ilealth Services who is in charge of all PHC health programmes D D C C D a 34 + The LGAs have good drug storage facilities, which provide opportunity for integrating mectizan delivery and storage into the LGA drug supply system ' The CDDs are literate and capable of keeping acctrate records if properly trained and adequately supervised The communities are willing to be fully involved in GDTI and take on their responsibilities fully if appropriately briefed. o Weaknesses . The State, LGAs and communrties are not fully aware of their responsibilities. Information sharing between Nocp/NGDo and the State, LGAs and communities is not optimum. e communities are not adequatery invorved in decision making. e Accruate census data of communities are not avairable. e Record keeping is poor particularry in the communities e cDDs are not adequatery trained on community mobiluatron, dosing byheight and record keeprng. As a result, they do not have acceptable records and do not measure rreight before dosing. Accuracy of dosing based on "maturity", "maritar status,, and ..gender,,, is questionabre. ' supervision at a, Ievers is inadequate. period approved by NGDO forsocr and LocT to spend in the communities is too short for effective supervision. +35 Short supply of mectizan was experienced in most communities Allocatio, was not based on census tigures. Rationing was adopted ' Geographical coverage of some endemic villages was not achieved ' Edo State Ministry of health does not have a secure facility for storage of mectizan as welr as for keeping Apoc donated equipment such as computers, printers etc ' Edo state CDTI project does not have CDTI account as required. . Information, Education and Communication State, LGA and Community levels. materials are not available at 36 RECOMMENDATIONS The projec- intensive com should embark on munrty m obilization, sensrtization and CDTI S/N Recommendation taken Action to be Recommendation will im on ect OTN F and RG PB ;hs tdou correct the entpres structural whichdefect, has Edo/De Ita rhS an eth sameng hiveproposal Iescbudget etc Edo State ulsho d run one separate cte andproJ the SOCT and LOCT shou d make rntornput the nplan and eng mentationlmp of the NOCP GRBP . State support 2 Jr[r POC and GRBP S hould outcarry orntJ vocad ac to thev Edo StateGovernment brief the StateGovernm ten full aboutv TICD and Soli tct for S NOCP GRBP o State support 3 GR <aPB should let a bitgo aplayfaci itati lero ang nd theempower SOCT and LOC T to take on their escn bed ro le GRBP ustainabilityos 4 fort S tate Mi ISn oftry health hs ou d thefy TSOC o ffice and take custod of Edoty S tate s toupp ly me ctizan and ul ment Ministry of Health e Edo State ustainabilityo S 5 OCP/APOC fo The veh cle mean t for Edo State sho u d be appro lapriately bel ed.N, wHo-cDTI Edo S tate cThe llLIITC t labe Edo/De ta thegrves thrmpresston at Edo State does not fuI ownv the ect.proJThis ma affecv t the Edo S tateGovernm ten S reactron to any uest r fo CDTI GRBP o Sustainability . State Support 6 SOCT LOCT Community involvement Community a aeducation on ,) 37 Adequate time should b; allowedfor SOCT and LOC'[' members toproperly supervlse and monitorCDTI activities ln the communi tres Supervisory checklist should badeveloped for use by NOCP,GRBP, LOCT and SOCT A plan(schedule) for supervision should exrst at all Ievels State should write ofTicially toLGA councils and gtve adequateinforrnation otr tlrerr roles andresponsibilities ro enable thembud trfq r CDTI REMO foi Edo State shouidbe Exchange visits should be arranged such that Edo State SOCT andLOCT' can visit srrccessful projects outside Edo State should be used approved fbr reporting format 7 d be conducted afresh for SOCT, LOCT, health workers and CDDs. The training should cover information on onchocerciasis, concept of CDTI, Training shoul lnco unlIN blno trtzaty recordofl, keepl (,ts,r dosaccurate exc lus onrg, cr teria and adverse loreact sn CDTI off,rcials . Proper implementation of CDTI . Sustainability . Commitment of 9 proJ distriburio eTh tcc should uceprod throu cgh partl methorpatory ds IEC materials for s tate- dewl n. NOCP GRBP SOCT LOCT Communities SOCT . Awareness on CDTI . Proper implementation of CDIIl0 NOCP GRBP SOCU LOCT implementation of CDTI a koper ll Supervision a Effective t2 t3 NOCP MState ln ofstry Health NOCP GRBP SOCT LOCT a ) a LGA Sustai support inability Accurate recordst4 NOCP Edo Governrnent state CDTI officials a of t5 NOCP GRBP SOCT LOC CDDs Accurate recording a 38 WHA'[ TIIE PIiOPI,E Sr\tD Procurement, dclivery an(l tlistribution "The medicine gets to thrs village through the people they send i.e. thehealth officer from trre LcA rn t6qs. T#; ,u,n. twice in l99g but sincethen they've not come again',.["GD, Adurt rv{are, Iguoirakht rr'tiloge. ovia south l4e.gt LGA. "Some rnemb_ers of tlre vrllage were involved,,.I;GD, lvlale youth lhrevbe ,iitrg, Owan l:a.ct I.GA. "We doll't know". F-GD, Atlurt rvfure, otrrgue tua l,'tilage ovia North East LGA. community perception, expectations and satisfaction ;.ffi#'J:j:':,i:x';1j::1JJ}r take the medicine vc,u wilr not suffer from eye l;GD Aclult l;amale t)clrgua:trtc, Ovrct N. li. L(;A. "T'e first tirne yo., peopre came, they announced that everybody shouldcome and have their 'eig't.s measured and we all *"ri . ;; after theygave 's littre tabrets' . rh:I tord us it ui-tt " medicine works soeveryolle took it. Tlris was in l9gg,,. ----- ,l;GD Adulr l;cntale tgr,,,r,)iii vrllage Ovru South l,l/e.st LGA. "Help us talk to the white rrrcn make them still help_ us to send the medicine,,l;(il) Adutt l;cntqlt, tgr,,r,r,A.i, vtttage rii,i i""ii Iltest LGA. "About the persorrs *'rr. lrr,rrgrrt trre prolpamme to us, I cannot reary givedates, bur I kroy ,1,u1 about +'v.u^ ig"^ i saw peopre moving about with astick. They take heigrrt measure,nent before giving you medicine,,l;GD Aclutt lv,lulc lldt vrilag, t,iro, We,yt L(iA. Decision on month and mrde of distribution and serection of cDn "Meetings are rnafters fbr trre erders. we are not aware,,.l;GD l;cntale l'outh, tttrn l;,itri, li,ran East LGA. 39 "They (the onclro people) elected 2 people here that will represent thecommunity". I'-GD, Adult lvfale tlharkpcn liguarr Ewohirui Esqn south Eost LGA. "They just announced that everyone srrourd gather here,,.r'(;D [;entare Acrurt rgttrr.rakht r,1ilage. oriz iuth we';t LGA. Training ,il!'tili:ii5:ffiff,j:3'r,I)s rhe rast time we went ror training it was F'GD, Adult Mqle. tguoiiakhr L/rllage Ovia South LGA. "The health officers have been trained change processes are beingffi"::qff'xil;?;;1iiffi1llJ:tr ;"# time ror ;;; put thesi A.s's r.rtan I Nqt r on ql I ) r rcct o rl,-, ; ii n p Performance of CDDs "The cDDs are friendry because they are from this virage,,[.-GD, Malc youth, lhtivhe i,iiog", Owan liast. iilli,,Jifi'li,;i,;itiff:l ilH Ji:i:l,r nght' thev don't rorce, thev givel;(;D lvlata litu/lr, ttich t,,ttr,lJ,'r)*an l'ta,si t,(iA. *The rnan did hrslob happrl-1,. I;GD, Adurt rienturc rgrit)tt*ttt L,rilage ovta south we.rt LuA "He is trying his best. It arso depends on getting the tabrets.get the tablets he will not do tt,,joU,,I''(iD' '4dutt rrarc (/hrukpen it:i,io, r:'wohrnti, E^van south t,GA. Ifhe dces not 40 f)istribution - Dosage "He (cDD) had o,e stick r,easuring 5ft. He said anybody under that stickshould take the rnedicine" ITGD Adult rv{qra rgrutriukrtr ,rrage ovru south wesr. "Age was used,'. l;GD Adurt rvtara ( /hatkp,t r:guari riwohimr E.sqn south Eq'ir LGA -*m;tr:ytooody in rnv house - even those that were not there, they F-GD F-emale youth ttteh t,i,oge Li'an llrest LGA Record Keeping "we keep records very wer. As_they are doing it they record it down. The ;:ffil,,llSl;li;,'::J;:n''d' age evervthine iir,", r saw i, ir," ?Lro every PH('('oorrl. Ii.s.on ,\ortlh litr,tt l,(iA. "Yes we have records ... the cornmunities, we suppry them with this bignote. They record a, the no,r", ortrr" p*"pr"'rir* have treated, we in turnretrieve that one from them, pf,liortut and ,"tu_,,. lPHC: C)oord. l:tsako t;ast t.ii,a. Coverage ;:il[y,.mrly onrv mv morrrer rook. I refused because of the reaction I had I,-GD Youth l;cmalc llleh llllage, E,san West t,GA. Supervision "Despite mv busy schedure, I find time to go to the fierd to supervise,,.supervrso,y t'ou'nrrilor./or ttrrii owan Lve.vt LGA, Edo srarc. '-'-we do not go out as sucrr. 'r'rre time limit is very smalr,,.State Coordinator SO('.1' t :do Srare. "Transport fare is a probrern. They telr us there is no transportthey say there is no rnoney _ that is why,,.SOCT olficer lldo g1u1n. IEC Materials During normal routine 4t At ti.nes ""'give us posters showing people that have this Rrver blindness so thatother peopre wilr see it. AiJ;;-phrets ,rrourJ-L. circulated to those thatare educated so that they can rn iur, ,nlighten others,,.FGD yourh Mate, threrlii,tilii owan East LGA. Integration into pH(l "The oncho progralnlne ltas been incorporated into other pHc actrvitres. ttrs one of the work plan we ,nude fo. th;;;;;;s *,iPHC Coorcfinator li.s,an So,rti,iurt, lt.do Sitate. "Yes the programrne is r'tegrated into the pHc programme in the state. #';:X: huu. meeting uti om."r, ,il.;;'Lo brief others on their [.)irector pH(. D(,, titto Stott, "Yes, into Schistosorniasis and Npl programsimrnunization we ao *au"ri.,fr'ri"ople orr it,,.PHC Coord. Owa Sourh wr:rt t1ie, Edo State. Counterpart Funtling "This year, N30,000 lvas appr.v-ed but has not been released. Maybe bynext week or thereabout trrev'ir rerease th"-;;;,rSecrelary, Ovra ,s,6uth ll/c,st'1.( j,i.' "Four point somethi,g lnillr'rr has been approved by the Governor, but as Itold you, the money iiyet to b. ,Jl.ur.d,,.Deputy Drrec.tor ql Heitrh t|riu iiorr. 42 "If the Clrainnan is arvare he rs always ready to help,,PHC ()oord. li,yatt South l:a,st LGA. Sustainability "Personalry we wi, co.tribute. If th.: erders give us the opportunity asyouths to contribute, we will conhibute,,.FGD Mare youth thievbe o*ai'Eart LGA Edo stare. "we'll be willing-t,o,pay his transport to go and collect,,.FGD Mate Actut/ t)ctryicri;';,;;;sr, Ovia North Eost LGA "we'll do ail in our power to ensure sustainability of the programme,,.I ;G D I ;e m a I e .4 d u I t,' t ),1, g,,, t,,-"'ii t t ri"- iir,^r"i ri n, E o, t LGA. *&H:,[:1Xr:Tl#: o^'* has come, we win make iuransement to goI"-GD Adurt Mqre, Igu,rrukhr vrrage ovia sourh ,vest LGA. "It is going to take time because they ggn't realry want to hear that they erestill going to take care of *hoere. is giving tt e#tnese^services. Everything;ii?,:,i;f ,:;{i;f il:;,,_ntsrourEd;;"oreverythins,, 43 '.I ACKNOWLEDGEN,{ENT The team is gratefirl to ' Staff of National onolrocerciasis Control Programme office in Lagos and Abulat staff of GRBP Edo State . Staff of Edo State Mirristry of Health+ Edo State Goventment ' Edo LOCTs . Contrntrnities nronrlt>r.edfor their assorted contnbutions to monitoring. the successful completion of the 44 C-\ APPENDICES TIME PLAN F'OR I}IONI'I'ORING, OF CDTI PROJECT IN EDO STATE ACl'TVITIES Arrrval ln Benrn Debnefing o? Submrssion of NOCP Report of DATE NO. OF DAYS EXPECTEI) OUTCOME t4 I memTeam ,bers alTrve BeninrnTuesday August i5 ew NOCP officials lntervrew GRBP officialsInterview Edo SOCU officials Tramrng Monitors Adrninistration and financial lssues Intervr Selection of Vi Date of debriefing fixed Trarnrng Briefing complced Field materials prepared Date for debriefing fixed Villages selected Briefing on Mission Wednesday August l6 Al and B8 Review Data col lnlection vrllages B I -84 andta B5 Data entered into computer Review of day's work Data collected Plan for nextThursday August 17 Data col A389_ in villagesA4 Bl3 _ lection Bt2, Bl6 Revlew Data entered urto computer Revrew of day's work Plan for next Data collected Friday August 18 Iv August ection in villases B2O and ,{6 B2l - Debrrefing of GRBP andSOCU Data coll A5 BI7 - 824 Rer,,rew Data entry 20 Data entered rnto computer Review of day's work Plan for next day GRBP and SOCU;orntly debnefed Data collected Data entered D lscusslott of ResuAMonday 2ugust R"p ort Writmg Report produced Monda y Septem ber 4 I Report submrtod NOCP debriefed I I I I I Lt5 ODIGTIETTIE VILLAGE OVIA NORTH EAST LGA,FOCUS GROUP DISCTISSION TION ADULT _ MALE T- ktrou' about onchocerciasrs lreauncrrI Pleasc tell us rrhat )'ou llre rui*c us to sce well and cure other drscascs, Even the frn frme the,y can)c sonreone fronr the village rvas hclplng them. He's over there. Wc *crc told Llrat the nredicine will s .' iJrrn eyc ,t prOblem and other diseases. , drd not rcll us about the ol, -rship of the We were rold that if takeyou the me,l .il(mecitizan) 'twon Please descrr conmrunitl' took dccision ontime and mode of distribution he hory Thc Health u'orker at the health ccntrc decided the time and place. Thel aunourced that we should see althertr soSO rinle. was a village we were told to meetlng ar assemble at the maternity to tal(e the dnrg. There which Pleasc dcscribc comnrunitl. took decisron on the persons responslblc for drstrrbution of thc dnrg ro comnrunih- nrernbcrs hou thc inforrrrat Tlrc hca lh ccntre tunonilnated tn, tlrc nlconl Itee. thc chairman theof hcal h conunil tec of the village nlno lta hrnrtcd ald onpassed the ton to andus rl was to us selection. We have no contribution t this process. It is the village head who does rhE herc abcen lnchange Iltc pcrson forresponslble distnbu tion no change in CDDThere has been WInt rvere l.ou told aboulthe need trcamrent w. for conlrnunrt\ ith Ivcrmcctrn It rs still the rcprcscnt';rtivc T'ho' lalked about lold us u.e'll take rs the the eyes They drugs for l0 same person, thc Yes we were measured and(heignt) on the thatbasis adults were grven two tablets childrenand one.Hog' is drug no*rallrl brought into thJ conrnrunrtt, and distribtrtc Pleasc tell us lhosc u,ho should not be trcaled wrth ivermectin Pregnant sickwomen, cannotpeople be treated. How' \r'as thc dosagc determine CDDby durrng Iastthe tondistnbut ccnlrc nas given. But not sick Wc don't know, COINC Ercn'bodv that came lo the health Thcv rycigh hcrglrt. Thev on a scale say our name with our lhen you and women. mcasuredThey our height using stick.measunng What problenrs havc had 1I','irh respcct drstnbutrorr of the _1',Or.r to None! conttilurilh' to take control What problerns have )'ou alierlud takmg drug Hon tsprepared of ivermedrn drstributron drc prcfer house to housG nl\\ -Crit\\. raSheS, what c.xpcrrcnccd. I c,xcreted tapcworm, rrlrrch nhcn I tirke other drugs I do not c\crclc ll Wc C Wc'll be ullhng to go and collecl, to pay lus transport our power to ensure sustainability of the programme We'lI do all in Wc'r 'c not paid an)'thing. Wc'G nol cn8r\ Thc:uy'thrng. man drstr rbu s frorn thrstrng fromplacc, the hcalth centre. He ls forworking hi S conr We do not knowcommurun, g,lvcn to CDD thc thc lurs Pleasc tcll us hou ]ou mcasurc thc succcss What support The atncd thc rcaction. If thcrc ls nran sard thc rcaction, hc Wc arc unablc to answcr thc I +b Oi CDTI -lrr\ ollrcr rcJcllon $c'll lulo$. lt ls r)rlr lx)d\ As soon as the nrcdtclne uc'll ltno* thc tlung is l,e4' good Irnd uc'll tcll lunr to coututuc r,lrstrrbtrt Horv uell has thc CDD I{c's good. lrc's domg a good job. Suggestion I bcg tlrc Gorcrnment to give more hclp to us br providrng the medrcine nrore and trtorc. Let the conte and cheuk us to sce rf the medicure is IHIEVBE VILLAGE, OWAN I]AST LGA FOCUS GROTIP DISCTISSION lon l\{alc Youth I I Plcasc tcll us ulurt rou krrorr, about the onchocercrasrs treatment Please descnbc horr comnturutl' took dccrsron on tirne and mode of drstflbutron Please descnbc horr thc commuruh' took dccrsron on the persons responsrblc for distnbutron of the drug ro communt rrrcrtrberu Has there been a changc rrr the person resprnsrblc lor dstnbutron What rrerc lou told atxut thc necd for coluruunlh treatment $rth IVermectrn Please tell us thosc rr ho should not be trcatcd trrth ivermectin Thc pr ogramme was brought by Unicef They said they want to help the community by giving them medicine against River Blindness which they have been doing And since that time especially during the rainy season they help the community and those that have sickness inteinally to solve their problems. -f here was a representative of the local government. He was the one who came to inform the Community then. Then they now slarted doing their operation. This was about 5 years () I can't remember the exact od came. 'l'hev had a meeting with the elders and told them about the <lrug They told us that each time they bring the drug we should take it [t is free of Sorne ntembers of the village were involved. The reason why they chose them is because they are educated. They are educationally viable. 'I'lrey are still the same people fhev did not lvlaybe they d iscussed that one with the elders betrr c they now announced that we should go to the maternity and take, I'rn not aware of that They only tell us that we,ll take tlre medicine (4 tablets) this year and after that they'll conrc back next ]'he d rug is passed to the local government and from the lccal gover ililrent to the community. It is the community that will now call those people that have been distributing the medicine who would now be distributi the medicine. Ther, said that anybody that is We'r'e not taken the drug tlus year We are unable to answer Hou ts drug nonuallr brought urto thc cornnttulltv and drstnbute wontan to mtscarry pregnant it would make the Hou' \\as thc closrgc determine bv CDD during the last distnbution What problcrns havc r ou lrad u'ith respcct to drstnbution of drc What problerrrs havc vou had afler taking drug Hou' prcparcd rs thc comnrunih' to taltc control of it'ermectrn distribut ron What support has Lhe communitl'grven to the CDD Personally we will contribute. If the elders give us the opportunity as youth to contribute, we will contribute. The fact is that there is no forum to address youth like this in this village When the people come they only go and inform the eldcrs who are not so much educated and so we don't see No infbrrnation. The elders will know that one what they can really tell us Please tell us holl't'ou u'ould measure the success of CDTI If the condition of the people improve like the woman who has swollen legs and the medicine cured her then I know the qrylicine is working. How rvell has thc CDD performcd The CDDs are friendly because they are from this community Suggestion I'll suggest that they give us posters showing this River Blindness so that other people will see it. AIso pamphlets should be circulated to those that are educated so that tlrey can in turn enlighten others- people that have lrl 81'age No problems that period The time they will give, they will only come Sonre of my friends w'hen they took the medicine some part of their body swelled up. Some of them were even complaining that ttrey will not take again. Some of them some part of the eye swell up as if they now have double face. After the thing go down again. Me I slept for 2 days without waking up. t also has rashes and I made a decision that I won't take this dru a n Another friend was worns *According to the male youths, their female counterparts had all either gone to the farm or the market and whatever ones remained would not heed to their cal[ because if they called the girls, the girls would be in "thinking of some purpose,'. We however tried to assernble them girls together but to no avail. ILLEH VILLAGE ESAN WES LGA FOCUS GROUP DISCUSSION Youth MaleQuestion Youth Female Please tell us rhat you knou' about thc onchocercrasls trealnlenl This are the programme established to carry out some certain processes so that these processes will get to the masses by taking care of people like the River blindness, they enlighten the people about the River I don't really know much about the programme. But I know some people have been coming to treat River Blindness. They take names of families'and share drugs The last time they came most people did not take the tablets because of the reactions it gave them (1997). In my family only my mother took. I refused because of the reaction I had before. Please descnbe hotr conrmuritv took decision on time and nrode of distribution Discussions were held with the elders and not with us and decisions made by elders and torvn crier informed the people no to go to f'arm that someone is coming to give the drugs Meetings are matters for the elders. We are not aware. Please descnbc horv the comnruniq' took dccisron on the persons responsrble for dstnbuUon of thc dnrg lo communih'membcrs I told you though they were doing it, it is not with the youths. It's '"vith the elders Those people that will carry out the operation, those people that will give otrt the drurgs those are the people that they enlightened. Thc clc'lers decided who and who would be chosen for the assigrrrnent After the meeting they sent the town crier to tell the town what had taken place and decisions reached Don't know Has there been a change in the person responsible for dmg drstnbution Don't know Wltat rvere 1-ou told about the need for conrmunitr treafment $ith Ivernreclin Hou' ls drug nonnalll brought rnto the commumh'and drstnbute Don't know Don't know Please tell us thosc \r ho should not be treatcd utth il'ermectur Don't know Horv u'as the dosagc determine by' CDD durrng thc last drstributron They gave everybody in my house even those that were not there, they kept for them +8 blirtdrt"'st s() that they'll know horv thc sickness, i e the symptonrs and the remedy for the sickness about the persons who brouglrt the programme to us I cannot really give dates, but I know that about 4 years ago I saw people moving about with a stick They take height measurernent before giving you ttredrcinc Yes We don't know. As we said belbre the elders make such decisiorrs It rs house by house(distribution) The medicine is brought liorn the local govt. Dru u,as swallowed on the('hildren under age People rvith high blood pressure. L)sing N{easuring stick Wtat problcnrs lrar e vou had rvith rcspcct to drstributron of thc drue. Don't know What problents lure lou had after takrng drue Swollen body and sickness Horv preparcd is thc commuflrb to take conLrol of ir-ermectin distribu tion Don't know Wlut support lus conuuunitl' given to CDD the thc The conrrnunity is giving them assistance but we cannot specific on it Don't know Please tell us horv 1,ou would measurc the success ofCDTI If the people that have bad sight now are cured within the next few years then I'll know that this lplegl4ru![q LS very effective They are doing it in a cool way. The1, don't fight, they don't fbrce, they give you if you are yllting if not rhey leave you. Don't know Hou u'ell has the CDD performed Don't know Suggestion More education, somebody like me I refused to take it berlause I did not even know where the drugs were coming from. There are many that don't even know what you are coming to do. +q After taking it I had rashes Yes we are prepared. If you look at the Nigerian Situation every hunran being they are willing to work l,ike me at any time this type ol'thing comes to our side['ll make sure I will be the first person to carry out this ASSI nnlcnt Come down whenever you arefiee You enlarge the campaign to all the youth and you assemble thenr together and talk to them in this manner I believe it would prornote the prclgramme UHAIKPEN EGUARI EWOHIMI VILLAGE, ESAN SOUTH EAST LGA FOCUS GROUP DISCUSSION Male Adult The first people that came here carne to our father to give a notice, so our f,ather called us then told us how they're coming lo use the medicine How they'r'e going to provide the nredicinc Right from that time Itrr or,er I rvecks we r,r,aited fbr thern, larcr they came back again and told us the day they'll start Question Female Adult Please tell us wtal you knorv about the onchocerciasis trcatnlcn t I understand this programme started about 2 or 3 years ago. But this last time they came the CDD came and said he wants to see the chief that he wants to tell them about this particular drug. The first time they came they said they shared the drugs. That the same drugs they shared\vrr the names Actuall the years ago and last year is what they want to share and they the chief said bring some people for them tolecture. So that was the discussion they had then he now appointed another date that he will be coming, that they should bring those people that day for theIecture. I was not there when they were doing the meeting so I do not know ifthe discussed the community ownership and 2 bidescribe how commturity. took dccision on time and mode of distrrbutron Please The people only h with the chief and chief called us to rally None of us here was present at the meeting Only the chief can explain what happenecl at the meeting. We were not the ones who gave them the date They gave us the date that they were coml ad a meeting after that the communtty rang the summoning werybody e at the chiefls house where we were briefed. The bell tob communi$' took decision on the persons responslble for drstribution of the drug to conrrnunitv menrbers Please describe hou, the Oncho(They people elected 2,) here that .wIpeople represent the The C'community DDs can ex,plain themsel wves hy they them They hel chief and call us and d meeting t"ith elders and they , told us. Has hc re bcen a nchange t.he forperson responslble ; drstnbutlon No, they're the started it first person who u'ere you told about the necd for conmrunrn, treatnlent u ith It.enueclrn What one of the that somebocJy who has blindness cannot taie the tablet and secondly if the tablet fell down you should leave it you cannot take that. A wornan with ex nedThey plai that ca em ate Ithough heard comm nc from cannot take the tablet They said there insect that cause River blindness and by the tlmeyou take this drug if the rnsect bite it would not affect you. is a certain drug nonrrall),Hou. is brought conrnruni tnlo thc and drstribute rug was swallowetJ on theThe d spot Please tell us those who should not be treatcd u,ith Pregnant women Pregnant children women and below 5 years, 5c> people but not everybody understood why the ,"ii"irl was being divided to them and this thing caused some little fight between your worker (CDD) ;d others who did not understand why the tablets were beingdistributed Even that boy wai giving a challenge that this is the medicine was being distributed to type of medicine that you people use to deceive people And this our agent here (CDD) was unable to explain the condition of the tablets because majorit.y of us did not receive the tablets 5\ those with asthma cough and How' r!'as the dosagc determrne by CDD dunng the last distribution Age was used Measuring stick was used to measure. What problems have 1'ouhad *ith respcct to distnbuhon of the drug. The man did not go round the village. I went to him to ask why he did not come to my place The rnan told some us the medicine is finished he'll come back later No information What problems have you lud afler taking dmg No problems I took yesterday and it did not do me anything. Horv prepared is the community to take control of irermectrn drstnbution We'll call a meeting here and we'll send a delegate to collect our medicine. The community is ready to sustain the programme and shoulder the responsibility to lcgql the programme going It's okay at least you are helping both the poor rnd the village. By the grace of God we are willing to support and sustain the' programme. Whal suport has the corrrmunit-v given to the CDD We understand you. That the community will be ready to do that. No information Plcase tell us how you n'ould measure the success ofCDTI It depends on the result on what has happened whether it is good or bad. Even the insect that turn to that worm I don't even know it. So far I take I don't know how it works. I know it's working so I cannot really say this is what I am expecting. Hor\' u'ell has the CDD perfonned He is trying his best lt also depends on getting the tablets If he does not get the tablets he will !e! do the job No information Suggestron We want you people to pay visits. To check either with the palace here because this is the head of the whole town. The head will send message and call meeting for everyone to be present. Then ask anybody if they have complains so that we can appreciate your work tf even though you're not still doing it you'll find time to say Iet us go to the palace to know why they want us That's how we want it If you people can continue like that it will be good and we'll be happy ra?t- IGUORTAKHI VILLAGE, OVIA SOUTH WEST LGA, EDO STATE FOCAL GROUP DISCUSSION OUESTION ADULT_MALE ADULT -FEMALE Please tell us what you knou' about the onchocerciasis treatment Wetin we sabi about the programme na him be say thid tlpc of drsease ncver affecl anybody for tlus village some group of people canre to rnspect us. They check us. they naked us, not total nakedness o! But wc rcmove our shirt under that tree. We did that one for a time before they start to bnng all tlus rnedicine for only one year. I think that rvas 1998 when they brought ths thing they gave it to one man hcre. He's no\ry under going a school at Uniben. So when we discovcred he \ras away to University we had to appornt some other people to go for training. About two of them who went for training are there u'ith that man interviewrng them. So they told us what that medicinc rvill do for us if we take the medicine, that rve should be coming rndiridually. He lud one stick measuring 5ft. He said any'body under that stick should take the medicine. If you are above that strck you'll not take the mcdrcine. So hc gpve us onc-onc at first. Then the 2nd tinrc hc gave us 2 only the adults, other people did not go. Mrether the medlcinc is finished or it rs not finrshcd we don't knorv, But later u'c lrcard that he pcked thc medicine to the headquarters. Wlrcther thev brought other rnediciue all this days rve do not knorv. but accordurg to information lve gather from one of our fnends, the!' brought the nredicine. it's at Ikpebazorva. they havc not distributed lt so lvc've have not to collect our olyn The first time you people came, they announced that werybody should come and have their heights measured we all went to our mqNurement and afler that they gave us little tables. That day they told us that the medicine works when we take it. So everybody took rt. This was in 1998. Please descnbe how commuruS' took decision on time and mode of drstnbutron No they (i.e oncho people) d.rd not discuss with us the person who wcnt for training at Ikpcbozarva headquarter. They told him u'hen to take the medicine and how to takc it and the ttpe of peoplc to takc it, He w'as taugllt these things. Hc told us whcn hc camc back hcrc. But rvc drd not hold a group of pcople discuss something like that lrkc th;rt They just announced that weryone should gather there 53 Please describe horv the comrnunih' took decision on the persons responsible for drstnbutron of the drug to conrmunity members The conununity plcked th': p1s5.r1 CDDs No information Has there been a change in the person responsible for drug drstnbution Yes there has becn a cluurge in CDD Because the first pcrson lvent to school so the conlmunrtv picked ncrv pcrsons They never change am. What u'ere I'ou told about the need for commuruty treatrnent rvith Ivermectin No information They no tell us anything How' is drug normally brought rnto the conununity and drstnbute The medicine gets to this ullage through the people they send i.e. the health officer from the LGA in 1998. They came twice in l99E but since then they've not come Medince was teken (swallowed) on the spot) there Please tell us those r.l'ho should not be treated u'ith ivermectin Sick people Breast feedrng women Small children (below 5 years) Pregnent women How was the dosage determine by CDD during the last distnbution Measunng sick. He said any'body under that stick should take the medince lf you are above that stick y'ou will not take the medicine Measuring Sick What problems have you had with respect to distriblrtion of the drug. No Reaction No problem What problems hal'e 1.ou lp4 after taking drug No problem No problem Hor+' preprred is the community to take control of ivermectin drstnbution When we know (that the drug) we will make arrangemenl to go :rnd collect the nredicine. Thc iast unre we hold lhe workshop becausc I u'as there nryselfl The health olhccr in charge send lhc drug to us. Wc waited and we drd not sce thent. Thev didn't tcll us to conrc and collect it ourselves. tf thev strll tell us to corne and collect. w,c llrll come and collect We go send person so far we know where the medrcine dey. What support has the communitl' gt\en to the CDD Sponsored their training No informaoon Please tell us how you l'ould measure the success ofCDTI There's one thing. If I havc this disease if it rmproves I wrll know the medicine is working Or if I knorv any' other person rvho has thrs discase and I ask and hc says that it's improving thcm I'll knorv that thc medicrne lvorks. By thc tutlc we have this informatron rve'll bc able to determine u'hethcr the has succeeded or not If to say we don take the medicine we for krrow actually how the medrcine be. As we just take am once now, we never lnow. How well has Ore CDD performed They are doing well medrcine hrst carne W'hcn tho distnbutcd The rnan didhie job hapfly as it rcaches thcnl Suggestion Help us talk to the white men make denr still help us to send the medrcine. Regular inlonrratron rs I'ery important an\4lnle thc prognunnrc is conring out they should lct us know so tlut rve u'ill all respond to it. When the people in charge came to conrplain thal the nrcdrcrne is finished tho, should rcspond tolhcm. Therc should bc proper trainmg. The last time u,c u.ent for training il u,as .lust a fcrv hour w'orks lar t ("t l:i. l ') r') , ,'r,.,j ,' , i.l '...1 ,, ,,.. , , Lt E=i' 1- f:1:,6.7,e-:- f'{,y t- ',."1.,. i!.,€- i',(.',t-^t_, c/ 'i )-l-+t F. r-;t,..rr.- i.l(etnroi,A Iaa.l- r? G: l) .,L r4,uT4. u ( /:l ryl,-r ,a r fil<t. A*.*^^?n .3{1, ,1r /irr} ,r.wT11) ,\\ :-rI i 'l , ,= /.* .-) r) o ,') 'T, ,_, li ct 7 l:lr-l, .,,.bC. /y' E, is >7"rt-i. t (.irr;.yirSL .1 I(. 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H \)P*o Elr\Jl\e t/i JS dr\ ft-, \)N(n tv 96 n d d.J .ww '\)\}1 (^) u\s 1{d \tk$l -J F n N oet I\ u-{ or. o\ C'Q (t'.\) *, 6. -+\D -e\n \hL't' -+ + N NG' I I sp -c.P 2\A\n O) a\r c'(l I I tlP c\(^r i c\,\J I ,\ C'I F oAl @ \hr. * ItIb S6 D o$ m(, o\ptl t^l & p .lv C$f) o a\.(,t u\.Jlv c I !r{ hul *s -g OtcxJ (h -E !^.j \J \rl-s -r.:'cr(, \N \.l.to Fr\ \)' S, 1 I I I *) LSF rp lwNrs $ \Jdr\n -s) \, {(,{ -rLrl \-l\9 to-,$(\ -Ac\{-) +.* 0\ -t\9 o\\A rh u -tr -JN U.r +r6 \ n o\ o. +S -tsD\ 1., hA\^ rd!{@P, 5 l-Olx P g h,aq ol c. cr o G a f 1,}.q ) ) ) E F;l \5 o. B F9mt -+\c I l,$ P\,i,5 I I \lC -+ a o -l f; fi e fiz a o F m -s t--. I I w\AI \ lod\ th W \n t |.. *, 1s w N 0 th I I I tN xmo (AJ l.A T+, I d.J h l.) I t t EI tn \TJ I 1., u\ 0h ,{ I I I rI @.oA I l l s 5 \S -l ), -lP o ,I r, I 3 O -cw (.). T I I lAf I nmp t4 c,I irJ \"1 1.,, \)-CA cn I +, \ \,5 I I (Jl c,\ c^. --$f $-( \N-f i;\^l JF \^ w - n 5?, I G\ \,,.l (,|.\.o \,o( 4 W ilc, J J) aJ0q -stn I I 1 I = I !Ioi moI i I i I I I I I ,I c{\ +\: \rIc{ ur\ -sl^l t qt6l ;J t\ s \n\tt -ll; ic{ lri H -{o --{ r- l I N (nr A -S -F\J i i iule Y:(}, \4.(ri = o Fsp 3llJ.l - ri I tr lu t T o F I il I I I I I I {og o !,,ts lrlI o o{ { 1rI oz r) + o ooz{F ol. !Fo 6)7 33lil q{ {ca o .rt 3 mo{F{N -^Z -tf-, I t- l1>qrn; ET \o (- '{d5 tJJ Z ml{1z =>{<E lJ rn(JFPK -lilc>t!qo p(.) e-gl{m Ni. (, s6 *-Z tsPNT{3er 6) qt Hz m u o a{ { rn @ o o) z o =o o)a !'{ I O o € o) = m o) @ @ o € o) = = o9 O) CT C =3 €o o_ o A rn o. o o 9) -E5(t Bg s=ii'o 9l 3 ez .+6'9oJ.grr9 uto o)! !A @ o)(.r) J ll(,l-lN) lN) lN) I (, --A urO + Ot A @ J o) CI) .5 N) f\)@ (,(, 5 oo @ (tl O +@ ts(, i-l-tlr lo> l l 5 J f\) Or TU N)(, (o O)(, C^)5 + N) ut\o @ (.^) (J)(,(o() s J s u.) O'tO O) @(, ! CN (, o) (-tJ ur r\c, + 5 O)5 tG) l-crrso @ (rt qtl(o -@ N(Jt i i5loJ i(n l<o(, (.) co 5 o) o) J(rl l_-lololo J o(X) o(Jt -t !5 (noo @ J b o J O l-lo)l\l lcn G)Io o CD @ @(o .-\, (o -I O o J _\(o @(o o) A sco o io(,^) t- lo> lco lo> (Jl! o) O l-tiN) ibio lo (oI(Jl o --.1a ooo o))t(o o (o -N) -t(,t o) @ J o O J O C) -o oo (oI(o o A (.^)(o -rOOoJtrd'f3O.O @ (tt o) O) O (n ! o) 90 s o l6 io)l6 IAlols - O{ f;EriS 3R +g =6-9 o Fo) EgEl Or o(, ico o) -\N) JI N) J (,z o o o) U)oC €o(t (o m @ o)) @oC J o o) @ ,+ m U, o)xo = o(, \l o) (Jt 5 (, -oo(D = m (t, o)xo m O) @ m @q)) = o @+ m(tt o)f, z o =Jo O) CN xoiro m o_o 6) s (Jt @ s(Jt N)(o C^)! s(, { ,+I +i.q, <:aoF=ir.i E ig= =.=o og ='" 9. lcr + J^J \o u) A tO (.^)\o N)gt(, O(, +@ \o @(, f\)+(, Ot Or oo' = rq =qr! = 19 = o.:rG'q I I lru I rr> l-oo N) 5F(o --\, o) o) -(o(oo() (.^)s J o o)(, O) _.1(, N) @ o)! N)5 \.1 @(, N)! O) O)o J. -(l)s @ @ J .A J J(^) s(, @(o J (,t) J,^)(o @o I I r..>lN) t-l(.rrA(, s 5\l N) (Jt @ @ A a-l s=*a & $3xro =rr l-J lB -"9t "-3rct oo3 O o o @ .@ J s)r N)(o @I o) Table 3.4 EDO I DELTA STATES', ONCHO CONTROL PROGRAMME TREATMENT UNDER CDTI IMPLEMENTATION I't JUNE 7999 - 37't MAY 2ooo (Using 3mg tablets) EDO STATE PROJECT. s/N o Esan Noftheast 10. Owan East 34 Ei Owan West 4L IiL2 Uhunmwode 36 EDO TOTAL 464 38t,,466 1 2. I 31 18 36 District / LGAs Akoko Edo No. of Target Villages Treated No. of Eligible Persons Treated 58,814 Cost Per Person Treated$ No. of Villages in which CDD is a health worker No. of Distribu- tion super- vised by health workers No. of Treated Villages with summary forms 45 45 1 45 37 4I,,472 8 1 37 3 Esan Southeast 29 45 22F4s 33,990 6 1 29 4 Esan West 11 1 45 5. 6. Etsako East Etsako West 33 31 13,488 451891 33 1 33 31 1 7 Igueben 42 L4,tL3 18 1 Ovia Southwest Ovia Noftheast 4t 50 24,793 27,660 10 1 4L 5 1 50 28.,937 34 1 34 35,673 34,lto 34 3 1 34 1 238 433 7z irl C -_- -r1 . anF z rD o r- - -l ^9 C) z =o -oo -l z AP .) -IJa -j z = .D r. LJ - -l z (n (- a -l q z Z - a/aZ; 7Z E.r; Ad -/n -l- icel) ruia -rX0v>z aY Fa z* >-1 -l CN U Lrl U) z -t z t- ____l s Oa .0 t>tq 0c 6 5 -F 6A -U<_D qO t-- oq U .D <^ u q -= =a fir I , It': u f\nnc-x + I Key I rr fo rrluull-htcrulrru. vlllnBr.,, A " t,rrr r lcl Iltls inilrurnetil is to be adnittistoretl ott tlt? r,illage ltead or n ,.(ltr."srntttri,t,t, tt[ rlto villalTo ltt,rr,l'lltc ltt'ttl "t't t'rl'.,,tt,lltf, lr.'rr.)r, ttt.t\rirt tt,itlt litt, itlt,t't,i,tt, tttttl lrt t.t,t.,r l,t^, ,, i,r' tlttttrt, r,r,itilen'iew-, I)o ttot refuse' Llosr of'tlto qrtt,.r1i1111g ore stnt(trtr.t,rl. ('irrlt,,,lrl,,t,l,,itttt, 1.11111,1 !t,Prorrrlrt lltt re.r1tott.tes,, mtlr"r olltttt,tlte t.o.sltttttdenl to ..rrstt,er.wltilo,s,1t1l t.irt.l. tltr.rlrlrr(rl,tt,tt,olrtiott lo tlte teslt<ltttlettt'J ilrr.rrr,r,r. l.t,ttt,tt t.) tlre Clrlc! ,ur.t .,lrtr.r:1, ,t,r,t,,tX tlrt, ttt ttr.t l,,.,ttttt,l tllrc says sorttelltirtg dilferem selecl'other'ant! writi rlte actttol respo,t.se,?.\l)(,,,.r(, irt the.sltrttt,1tr'tttitlal. tr $,i Vlllnge Nnrrre: __ Villnge Corte: $,r Subcourrty/LGA ('(nltlr r':Dlstrlct/Stnte:, Morrlh etrd year of lost rllstrlbrrtlon l'lease tell us about atty l)loS,ralrltlle cottcentitrg (Itcttocercinsis tr(iirtiil(.rrt irr tlris villirgr..l(r'*o^n 1'iln r:or r,()wrNa ts.st,E.s ARE ni)t)RE.S.S'ir)) tvlto brottgltr trte itroa o.r trte oncrrccet.'ciasis 1tt'ogronr,,,e ro rrti.t t,.iyrtge? ' ryltetr did tlrc l)?t',r(),t(s) (ot,,? ro ttttk rvitlt.yott (rbout ttttrltrtcett.itt.ris? ' Did rhe person(s) ttteet u'itrt 1'611 and orrtcr viiluge reailers.rit.tti, ' Did tlrcy askfor.you to ilttdt,ge a r,,eeting? ' rvlnt did tlrcy tell 1'ott ttlrortt <.ottrrtttutitl, re.sltott.siltilirs, 2. llow rvas (he rirrre (rrr.rrrrr/sens,rr) [.r rrisrributiolr tlccirretr.r I 2 3 .l 5. 6 7. at a villaqe nreetinll villagc cldcr s tnccturg village chief/leatler lrcrrlllt \\,rrri.r.l village lrealrlr corrrrrriuie vlllnpa rolrrrri6r,n rrres.lilsp other (specily) ',I 3. What rrrode of distributiorr rvas rjccitletl? l. house-to-lrorrse .) r r.nlt:,1 Il.r.,. /rlrr.r.ily) , ,'rrrl ccnltirl pl;rr;r_. rr,!y.I't , lt.ll,r 'tr] T{ I I I4 I 2 3 4 llow wnr ttre rrrtxto of rtlatrlltutkrr rtecltlerl?l. at I .vlllnge lneeli,tp2. vlllage eltlers ,r"oti,,,3. villnge chief/lentter4. health rvorker5 vlll[ge llentrtr cotrlIrltteC6. villag6 cotnrrrittee,n,..iifg ,7. olher (rpcclfy) -""1 ,ll I , tlr l^ J 6 lluw rrrlrry l,erso,,s (CDDs) r .',rl,t (ft(lln thls vlllage glve out the drug for onchoeerclask? .t | 'll tiI lorv rrrrrrry rrrrrle Cl)l)s?.....-.-- ,t torv rr1n11y ferrrnle Cll)l)s? llorv rvuc tlle pcrsorrs (Ct)l)s).sclectetl lo rju ttle rvork,/ rrt u vllllgc rrreellrrg village eltlers rrrietirrg vlllnge clrlef/teadeh I lealth rvorket " . , 2 3 4. 5 6. 7. Irealth corrrrrrlttee corrirliiliee rrreetirrg'' rpec lfy). Wlry tlitl 1,ou clrouse these per.sorr(s)? (l,robg,fgr crirerla) Vlllage villtsi' orherr.(s 8 9. l-lave the CDDs received nrry lrnirrirrg? l, yer l0' tf yes ro Qg, rvrrerr riltt rrrey recelv. r.n'rrrr,rgz 2. No 3., Dorr't ktrqw Ir S lle[<rre tlre first tlistributiorr Durirrg dlsrrlbutlorr Soon nfter ltre l'irst tlislributlotr Dorr't krrorv/Carr,t renrerrrber II l.lorv rvell trave ttre CDDs done the work? I 2 3 4 -$ 1t) t,. l111 I 2. fair 3. pdor t2. f lnve you chntrged arry of your CDDs? l. yes 2. No 3. Dorr,t klrorv l. rvell (Exptnlrr) t' .l- trr Mrrrltrrr lrr3 rn!l? r,nrc?tlr r(ttxrrttr, May I ggg I OF (; ,,A" C[) 'l?t ltc orltttittistered ottb, itt group tltrttt ottt, CDDs. At c'tul oI tlte ittte "A" yilhges. lnlen,i(1, 2 CDDs n,it,tt, rtsk tlrc tli,s,tr.ilttttor to lct pcr villul4c if there 0K tnot.t tl c y i.t t,, t.t' g i.t t c rs, rettuttttittl4 rlntg i/.it i.s thc crt.re \'0tt ,sec lti.r tools,; tttctturinllUltetr a questiott requtrcs utttltiple re.tponses, do tutt./itrget ro pul u circle arotttttl eoclrtltltltt.rtltlc re'sl)()ns( t'ttrle. Irntltc wlte'ra ttJtltnrytriutt, Nrrrrrc ol'Vill:rgc I) isrrict/.Slate Vill;rgc crxlc: _.Srrbcourrty/l -(iA Nalne <lf CDD Sex: l. Irelnale 2. Male Main Occupation Mrrrrlr,,tr year o'r'irst cDl'r rristrirrution i. trre virag e _/_ M'rrrlr :rrrd year .r'rasl cD'r'r rristrirrrrli., ilr rrrc vir.g e r IIow was the tinre (lnolrth/.scasorr) Ibr distrihuli on decidcd ? at a villagc r)lceting village elders' meeting villagc chicf/leader health workcr village health cornrrrittee I 2 3 4. 5. 6. 7. vill:rgc conllll ollrcr (spccily 2. Wlrat rnode of distribution was decided,/ house-to-horrse ccntral place (spccily) lJolh lrouse-to-lrorr other (specify) sc antl cerrlral placc Ilorv rvas llrc rrrotlc ol'tlistribuli<lrr tlccirlctl,/ l. at a villagc lrrcctirrg 2. villagc cklcrs' nrcclirrg 3. villagc clricl/leatler 4. hcalth rvorker -5. villlgc lrc:rltlr corrrrrriilcc(t. villirgc colrrrrriltcc lucctilrg 7. olhcr (spccily) _ illcc lnccliltg ) I 2 1 -) 4 I\lorrrlor trrlt lil\lt Ulnct)l\ Kirril;lrl,r , lrlay ;r;,1,,1 t4 l'il1 4 Ilorv rvcrc you sclectctl to tkl lhe wrlrk,/ al a villagc rneeting village elders' rnceting vill:rgc chicl/leader lrealth wurker villuge hcalth cournriftcc village cornrnittec nreetirrg olhcr (specify) 5. II.s ^,y cDD bce, clra.ged after thc firsr tlistrirruti.,,/ l. Yes Z. No 3. Don't know (r. Il'YES to Q5, Why was the CDD changed,l 7. I lave you ever hcen supcrvised ? l. Yes 2. No 3. Don'tknow 8a. If yes to Q7, who supervised you ? (lF NAME wAs MENTIoNED, PLEASE ASK FoR I DENTTTy/posrTION/STATUS OF TrrD PERSON) I . Ilealth staff 2. Village health comlnittee member 3. NGO partner 4. Culnrrnrnity lncltrlrcr/chicf 5. Other (specity)_ tlb. WIrat tlid tlre supervisor do'/ I. Checked thc ivennectin inventory 2. Checked thc records/treatnlent rcgister 3. Cullltctl thc rcporls 4. Advised on the treatnlent of, abscntces 5. otlrer (spccify) t). n t rvllar occusiorrs wcrc you supcrvisctr'/ (('lltCl.l: AI-l.l'llA'l- At,l)1.\,) I 2 3 4 5 6. 7. l. Belirre distribution 2. During tlistribution 3. Soon after rlistribution l. Yes l. \'cs2 l Yes2 2. Ntr No No lOir. llavc ytlu reccived cdttcalion on thc inrporlancc ol'takirrg ivcnrrcctirr tablcls arutually frrr several years'/ 2. No l. Can't rertrcrnbcr ls Yes I\lontlr)t ur[,, lrrslr rrrrrttls K :rtrtp.rl,r, N l.ry l t)()() l0b. Il'ycs, rvhat wcrc you told'/ I I. Did yotr llrovidc tltc colttrtturrity lvitlr cdtrc:rtiolr on ivcrrrrcctirr trca(rncrrt'/ l. Ycs 2. No 12. ll'ycs (rl Qll, wlrcrr tlid yotr llrovitlc tlrc ctlucution (o tlrc corrrrrrrrrritl,'l (('ll{('l.lr Al,l 'l'llA'f n I,l,l.Y) L l)urirrg thc fir'st rrrcctirrg I . )'cs 2. Ilelbre tlrc llrst distribution l. \'cs 3. During rlistribution I. Ycs 4. Soort aftcr tlistribution l. Ycs 5. Otlrer (spc.ify) 2. No 2. No '2. No 2. No 13. lf ycs ro Ql l, wlrat did you rcll lhc corrrnruniry'l (Cll{CLIa AL.t. 'l'llA'l'n l,l,l-\,) 'l'akirrg ivcnncc(in anlrually lor scvcr:rl ycars Bcttclits of trcatrncnt Cornrnunity rcsponsibility Sidc c[[ccts Othcr (spccily) 14. Ditl you rcccivc atty training on how (o trcatcornluunity rucurtrcrs? l. Yes 2. N<r 15. If Ycs to Q14, whcn did you rcceivc training? l(r. Wlro traincd you? l. Ilcalth pcrsonucl/Onclro courdinator 2. NGDO staff (spccily)_ 3. Artothcr CDD 4. Othcr (spccify)_ 17. llorv long did tlrc trainirrg l:rst'l l" traiuing_ 2"d trainilrg_ Last tr:rirrilrg 18. llorv rnany CDDs wcre traincd togclhcr (sizc ol'tlrc group)'l l'' trairring_ I-ast training I 2 3 4 6 Ycs Ycs 'l'cs Ycs 2. Nrr 2. No 2. No 2. No Nlotrloutrll lnslnrrcnls Krrrrprlir , Nl:ry lt)()() l6 19. Wlrcrc u,as tltc vcllttc ol'tltc last lraittirrg'l Witlrirr lltc cottttttttttilY Outside [ltc cotttttlttltitY I.lealthcare faci I ity/lrospital Othcr (spccilY) 20. Was lhc vcrruc o['tritittittg llcilr l() yotll c()llllllttttitl") l. Ycs 2. Ntt 2t Whilt rvcrc you t:ruglrt duriltg traitrirrg abtlut ottclltrccrciasis (Cll{(ll-11 Al'l 'l'llA'l' n l,l.,l-\') I Z 3 tl I 2 3 4 5 (r Cause Syurptouts Socio-ecotttltttic itltllortaltcc Cortttnuttity nrobilisatiolt attd ctlucatitltt lvenncctitt as trcatlllcllt lirr a loltg tirlrc l. Duration ol' trcatttlcltt 2. Coverage o[ distribution 3. Dosage tlctcrtninatiott by ttlcasurilrg hciglrt 4. Expiratiolr of drug aftcr reltloviltg cotttailtcr scal -5.'l'rcatlttcttt tll' allsctttccs alttl rcfttsals(r. Sidc efl'ccts (coulrscling alrd rc[crral) 7. Exclusion critcria 8. Ilecord kecPing(). Ccltsus 10. Othcr (spccilY)_- Nurnber o[ Pcrsolts trcated I Nunttrcr of rclusals I Nutttber tll'attsctttccs I Nutttlrcr ol'cxcltttlctl 1)cl'solls I Nuurlrcr rvitlt scvcrc sitlc clll'cts I Othcr (spccilY)- Ycs Ycs YCS Ycs Ycs Ycs Ycs Ycs Ycs 2. No 2. Nrr 2. Ntr 2. Ntr 2. Ntr 2. No 2. Ntr 2. Ntr 2. No 2. Ntr 2. Nrr 2. No 2. Ntt 7. No Othcr (specify) 22. What werc you taught about tltc drug? (CII{CLE ALI-'IIIAl'APPLY) 23. What wcre you rflught about rcprtt'rirrg'/ (Clltcl-li n I-L'l'lln'l'n l'l'LY) I 2 J \ -5 6 Ycs Ycs Ycs Ycs Ycs 2. No 2. No 2. No 2. Ntr 2. Ntr 2,1 I)irl :r.y rrrclr5cr ol'tlrc corrrrrrrurily collcct (lrc tlrtrg ll.ttltt it crtllccttotl ltoittl tlurtttg tlrc litst tlistrilttrtitlrt'/ Ycs 2. No 3. Dtltt't kltorv 25. ll "tto" to Q24. 'uvllY'l I . \'cs L Ycs I . \'cs I . \',cs I . \'cs 26. Wlrcrc is thc collcctiorr poirrt,l )1 l)itl -yrltr cxltctictlcc lrrlc supply ol tllugs tluring thc last clistriSuti,.,/ Ycs ). No I)lc:rsc cxplailt 28 Ilrtrv tltt ytltt lttlrrttltlly tlctcrtttiltc tltc tltralrlity ol'rllrrgs rcrlrrilcrl by tlrc c11lrrrrurrrtv,/ Ccnsus/regislration rccrlrtl I)rcvi0rrs lrcatnlent recttr.rls Ily coultting the nurnber ol'lrouselrolds Other (specify) 29a' l)id yotr expericttcc sltortage ol'tlrugs tluring lhe l:rsr rlistrilruti6rr'/ l. Ycs Z. No 29b. ll'ycs, pleasc explairr 30' IIorv do you (letertnittc thc lturnller of tablets to givc to arr irrtlividuill? (CIttCLIl n I-L .I'I IN'I' AI'I't-Y) I 2 3 4 l. 'l'ake heiglrt ntcasurr:nlcllt 2. Use weight 3. Visual observatiorr 4. Agc 5. Othcr (spccily) l. Yes l. Yes l. Ycs l. Yes 2. No 2. No 2. No 2. No 3l Wlrat tlo yott do aboul indivitluals who are absent tlurirrg norlnal tlistrillution peliod'/ 32. whul do you tkl alxlrrt irrtlivitlrrars rvrro rclirsc trc:rrrrrcrrr'/ 33. Wlticlr catcgorics 0l'peoplc $,()rrlcl you lx)l givc tlrc tablets (l,l-llASIj clltcLlr AI-L T'llAl- API)LY) lnrlividrrals lrclorv -5 ye:rrs ol'agc/ lrclow 90cltr l)rcgttattt w()lllcn wonren wlro tlclivercd less than onc rvcck lrclirrc tlistrillrrliorr .Sick irrtlivithrlls Visitors Olhcr (spccily) ___ -l-l llotv tlo y()tt cnsurc tltitt tlrcse c:rlcgorics ol'pcolllc cvcrrlrrirlly rcccivc I 2 3 tl .5 (, l. Ycs 2. l. Yes 2. l. Ycs 2 l. \'cs 2 l. Yes 2. Nrl No Nrt No No Ir cirlrtrcnl') Nlorrrlor rrrl, ln\lnrn( nl\ K.rtttp,tlrt . Nlay I()'.)() Iti --< 35u' IIorv r,,g d. y.u rr,rlrrary kccp trrc rarrlcts ilr (rrc c,,,rrrrrrrr-y/ --15,' '.rv lru,ry rr;ry.s tritr yrlrr rrrkc r, c,rrrllrcrc rrrc r:rs1 tristl irrrrri,rr,/3(r. Wlrcrc tkl y<lu lrontrally kccp lhc lirlllctsT 37. I)r I you havc drugs lo takc car.c ol.rrrinor sirlc cflL,cls,/ l. Ycs l. Ycs 39 4t PLEASE INI;ORM 38 What kilrd of .supporr 'li'ir rr.sllorta I iolr hrcelrtives (.spccify) Othcl.(.spcc No dt.r you rcccivc liolrr llrc corlrrrrurily? for tlnrg ctrllccliorr I 2 1 -1 2 ilv) Do you havc problcnrs rvith rccortl kccltirrgZ [#.""ft 'llr, * ::r. mi, '#- 'i.r! . ":l)-'; - . 2. No 4l . lrlease tell ASK FOR REGISTIA]'ION 1lt AND MItASi(llUN(; 44a. I.s rrrca.surilrg device for hcight prcscrrt/ 40. If yes to e39, pleasc cxplairr us horv you lbcl aboul thc l)lr)granlllc rvitlr rcsl)cct to a) sustailring dre progralrune t ) cornrnunity resporr.se c) constrairrts ' what 'o you rrrirk srrourd rrc crrxrc t, irr,rovc rrrc ,rrgrarrrrre i) 43. Are you will Ing lo corrtinuc fls a CI)l)? l. Yes 2. No Please explain l)liVISitr't() t,t{OVIt)t: I;OI_t_O\VIN(; l() I\lorrrkrr llrg lnslt Untcllls Karrrp:r l.r, I\ 1.r1, ; r;r,)9 >,16 l. Yes, scelr 2 Ycs, llrrl lrol sccrr (lixpllrirr) :1. No, lixPlrrirr .l.llr Ilorv rkr y()u usc tt./ .l-5 ls trcitttncnt rcgislcr prcscrrl,/ l. Yes, scerr 7. \'cs, lrrrt lrot scclt (lixJllairr) l. No, cxplailr ll'Q45 is "Ycs, sccn" lixAMINIi'fltEn 'fMIiN't' IUicts'ilit( AND OI]1.AtN ,iltEITOLLOWING INIIORMAI'ION ON: Total poprrlalion__ Agc c<lrugrositiolr ol'pco;rlc: lle low 5 ycars 5 years and above .Scx ct'rrnpositiolr oI llre populatiolr: Male I?eltrale Nrrnrlrcr oI pcrsorrs trcirlctl M:rlc I;cnrale Nulrrlrcr ol' grcrsolrs tuulcr --5 yc:rrs rvlrrl rcccivctl lrcalrrrcrrt Nurnber of relusals Nurnber abscnt during last treatnrent Nuntber witlr severe side effects Nunrber of tablets received Nrrrrrlrcr ol' l:rblcts uscrt Nuntlrcr ol'lahlcts le li ilr r hc tlrug kit I 2 1 -t 4 5 6. 7. 8. 9. I0 II I\lorrrlotrrrl' ln\ltlrn(.nl\ K.rrrrJr,rl.r . Nl.ry lr)r)r) ^)0 I\ l(cv lrrlbrrrt:tttl Iltlt't'r'it'rr': \/illirgt"' ll" l't'irrlt'r's I lttt tttrtl t.t t() lr(, tttlttttttttlr,tr,tl ttt tltr, r'tllrt,t;r' ltt'rrrl tlt tt tt'1ttr'.lt'ttlttti|t' rtl tltt' t'tlltt!:t' ltttttl ttt ttll (.ttl(,,q()t\, "l|" r.t//rt11r,.r ltt tltr' t tt.\t, tlt(tl tltt' t'tlltt,rir' lrt'ttrl r|rtttl.t '\ottt('ott(' t'l.tt ttt (l'\'\lsl rt'ltll llt(' ,tl(,t,t(,,,, tltt n,tt tt,ftttr, l'ut tt tu(l('(tttttutrl tllt'(tl)l),t)l)tt(ttt',c.\l)()tl.\( r'tttlt,t' l)(' t'()t l],lt)tltl)l tt,.\l)()tt.\(,.\ tttttl ttllrtry tt,tltttrtrlt,ttt lrttrt'frtt uil\\t't'tut,ri lltt'tltt(',\tlotl. lJ.sc tltt'()l)tiotl "()ll'(r" wltett' tltt, t t,.t1tttil,t(' t.\ il(tl 1,.r1,,,1 ltrtt t (,nt(,ilt1)('t lt) \l)('( tlt' fltr' t(.\l)t,ll.\(' ttl tll( .sltttt't' 1tt'ttt'ttltrl. ll tt rtll(lX( ltCrtrl t.s il()l (tr,(ttl(tlrl(. ttlt('t t'tt'tt' /,t.t tt,\.\t,\lttttl t)t t ('l)1."\('ltlttllr'('. \/illlrgc Nirtttc Strr I c/ l)istr ic t \/illrrgc (lorlt':, stll)c(,lttlt.l'11,1)t\: Corrrrtr..1,: Nlorrllr lrrrrl '\t':rl ol l:tsl rlislrilru(iort I I Ilirye 1tcl1llc 1t llls ( ()l11ll1tly lrt't'lr lrt':rlt'rl r,,,tllr r\,(-'ntlL'e Iltt lll lllc l)ilsl ()llc ]'c;ll'1 I Yes ,l No .\ l)ott'l httort' II; NO 'l'O Q l lrNl) IN'l'l1l{Vll,\\/ II; YLS'l'O Ql (:ON'l'lNtll,'l'lll1 lN'l'l:l{VIlrW 2. llorv was (llc tintc (rttott(lr/scltsott) lot tltslt tl)lt(l()ll tlccitlcrl'/ irt ir villirAc nlcc(iilA vrllrrltc t:ltlct s' rr('('l urll vrl lrrgc c:lr rc [/lr',rtlt r Ircirlllr rvolkrl V tlllgt' lrc:rltlt c()nunltt(i(' vrIlrrltt' c( )rIillrlll(-'(' rIl('('l IItli otltcr (spct:rlv) 3. What tn(xlc ol rlrslr rlrult()n \virs tlt.t:rtlcrl'/ llottsc lo llott.r' cclllr ill l)litLr' (sl)('('t I \' ) llollt lttrrrst' to-llol.,r ,lrrl r t.rtlr:rl pl,rr t olltcr (spcr'rlt') 4. Ilcrw tvas lltc ntorlc ol rlrslr rlrrrtrrrt rlccrrlcrl') l . rt( ;r vrll;rgc nt('('lltJl 2. villirgc cltlcrs' lu('r'lltli 3 vrllirgc clricl/lclrtk'r ,l lrcirl(lt \\/( rr kur -5 Vill;rgc lrcltllir c()nuutil(.c f) vtll;lgcr()nutltll('('tucclllll 7 ollrcr (spccrlt') ti iii x .+,. *iit :t ..rJr#.ii{'t 'at' . itr I ) 3 4 5 6 7 I I 1 3 4 rr ' ' urt,, rr I r,rl',rl.r NI.t\ l')'r', )t I 5 llorr l)l(11\, l)('tr(rlls ll) tllls vtllitllt: (( l)l.r ; P,lvc ()tl{ tltc tlrtrg lot'ottclttlCcrClitsis'/ 'i llo\v \\,clc tlle l)('ll'()llr, (('l)l))sc'lt'tlt:tl lo tlo tltc: rvork'l ,rl il vlll,lll(' lll('(.'lllll', vlllirgc cltlct's' lll('cllllll v tll;tllc clrit' l/lr'irtlt'r' lre rrltlr tvtltl.ct v rll,rlit' lrt'lrl(lt ( ()llrtlllll('(' v tlllttit: ( ()nurltll{.'L' Iltucl llll', ()tllct I ) I -t s () T. ll,rvt-' llrc (it)l)s tcc:ctt't'tl ,lll\/ {l'lllllllll'/ l Ycs .l l',,1o .1 , l)orr't ktttlrv/ Clttt t t'ctttctttllcr lllr. llitvc yott cltlttgetl illlv (rl )/()rll'('l)l)'') l ycs ) No J I)ott'l kttorv tllr ll yt's, t',,1t1,'/ t) l)rtl lul),nt(.nll)ct ol lllu c()nlllruntty collccl llrc clrttg ll'ottr it crlllcctiott llrlittt'l l. Ycs I No l. l)ort'tknorv lO, l)rtl yort ('\l)('lcnc(: l:rtt'srrpply ol tlrrrli rlurttrll tltc lirsl (listnl)lltl()n'/ l. \'c's f. No 'l l)orr'l ktrorv II I)ltl ;'ou cxllt:ticlrcc slrrtirgc ol tlrrr13r; rlrrrrrrg tlrc lirst rlistritlutiorr'l | \'cs 2 No .i l)on'{ lirrorv II I)ocs tlrc c()ntulunty lurvt. lr ttciltnt(.nl rc.lirste r'l l, \'t:s^l Nrli l)()n't l,rrorv l\lililjrr,rltl, lrr',lrtrrrrt rrt', l,.tr[1l,tl,l , Nl.l\ l'r'/'l t.l 4Nxe*e r1 District/Stete -:T:---__ Narrre of CDD Sex: l. Fernale 2. Male Maln occupatiolt: - . ---- Molrlh arrd year o[ ]ast <tistrilrrrtiorr t To be adrttittistered o1ily itt gr<ttt1t "tl" t'illoges. lrtterviettt 2 Cl)D.s lter village i! tltere Q,? ,,t(rr? tltttrt ttttecDDs' At tlrc at<I ctf tlic trttirviirv tt.rk rhe rii.stribtttir i'to, yoi,r.ree ril.r tttrtrs'; ttieosrrittg crevi.re, registers,t'ettnittittg clntg if owiloble, lv,ert a tltte.rtirttt ,'eq,rir.c.r ,,,,iriitrtn ,?:trr(r,,,r".t, rr, tt,t {rttpet to t,,t, ., ?;..(.,r.t'ot,ttd olrlt qqtlicaltlt ra3nn11r, t.otln, lrtnl,p ttrlir*g Nltltr.Wttlt,n. ll- c-., l. l.low were you setecterl lo do tlre rvork./ I . at a village nteelingZ. village elders' rrreetilrg3. village chfef/leader 4. healtjr worker 5. village health corrrrlriiler:(t. village conrrrriilcc nrec(irrg6. <lther (specil,y) 2. I las .rry CDD beerr clrarrgecl after tlte lir st dislribuli,rr,/ , l. Yes 2. No i. Dorr.l krrow/carr,l rerrrerrrller 3. llave you ever beerr superviserl ,l L yes Z. No -]. I)orr,t klrorv 4' If yes roQ3, *r,o::q:,riserJyru ? (*; Nn ME wns MEN,r.r,NuD, r,r_Ensu nsK r;.,r{IDENTtTy/postTtoNls.rnrits or .il tE pErrsoN) I lialrh statf Village healtlt colrrrrriltec rrrenrltc.r NGO partrrer Corrrrrrunily,rr rerrrber/clr ie I Other (specify) 5. l{ave you receivetl e<lucg:vernl years? nliotr orr rrre irrrporrnrrce oI rnkirrg ivernr<-.clin rnrrtt:ls irrrrru;rily ror I 2 3 4 5. -1 . Cnrr'l rcrrrolrrlrcr(t Did y,u receive alty trai,irrg o, rr,rv r(, trear co,rrrrurriry rrrc,rrrcr.s./ L Yes l. Yes 2. No 2. No Morritorln6 lnltrunE,tt, Krrrpoh ,Mny 199\) ', ."r, ,l'"r, bu(;rrut seerr (l!.rpl;rirr) or1r,: r) lrirr (rl ,,,,,',:,i',"1,'',li,r;=, ;--_' 8. ls lrealtneIl register preserrt/ ls rrrcrrsurirrg tJevice Ior trciglrl prr,.sr.rr(,/ I . Yes, scr:rr Yes, seerr 7 "r'l r$r't.r,t.,, I 2 3 Yes, but nt-ll seen (lixlrlirirr) No, (explnirr) lfl'.3-l,it:ffi:rfiil,iT_I; rRrn rMr:Nf r.,(;rs,ir( AN, r)rru\r{ ,r I .'lbtfl I populaliorr-1 2,Age corrrllosiliorr of jreoplr:. 11.t,,., .s ycnrs 9 -l .5ex ct-rruposiliorr ol tlrr.. 1ro;.ul;rtiorr ] yc;u.s;rrrtl altovc Male Ivl;r le 4 l.lurrrlxtr oI lretsr_rtrs lt(:ill.,rl 5 Nullbcr o[ lrersurrs agctl 5 6 Nurrrber oI re[u.sals yr';rts lttttl nlr0ve rviro r,,,.,,ivr:rl llenrrrrr.,rrt I;t't r rr lr. l 'r.r r rr lt. 7 Nurrrlrcr abserrt t.tulirrg lasl trellrrrerrl I Nurrrber.tvitlr severe sirle ellr:t.ts 9 Nurlrber oI tabtets receivetl l0 NurrrLler of rablets ,,r",i'" I I Nurrrber oI tablets 12. UlrrJa(e of recortJs lelr irr tlre tlrug kit_ ',lt; t I t,'l 'rlll,r,,t, .,t,1.r , .,1 Allrrrl,,ri,: lltltr,,r,r.rrrr.,,,rlI tt ')5. X' :x :i' 'n 13 t'' y't(_ij ;r ii ii 'i =Jzcg() ;1 (! il p z x ,i\ t{r r,lo i. rrq ID 2. N :-1 aY7. rgEoo lr o vt r1r ri [-1 t "' olrl v1 "' iJ v\ r!H6(D--{;,r?4--l ,- .' I 'J Iii !j ,i i, ,LJtl q -.= 7F!l:,,ea E s";f a 3<Ei.-f-'6 a>dcr ii-g '- {Ei A H dJ * ',.:'g ;' :;,tr ,"=;'zcE i1 nE6; 3sfr 56 Eo@E q E ;9 ^ 'DJ ' ;- (D6 ii ut-'2 * (, !CJ6i- 8[!ii1[ ,-r, < gli^.d!!6 r(D 5 E '; I 3'a *3 i; cr = 6 aD -.5 -'.>'h- J= r 5'=t 99E'.I ii ;5rr i^ cr'll < l.'- H #dq,3'ii P i o.h .)(D} E f Fd8;+ "93!l- to. g.u ?-.rpJ6:j J .D I o't h.E.9A)ocac,v1 o: gUfi ou,o o E63:r a->l =59rod'bA-'- -filrnJ5a)d t E s[- 58:o- ?3 2=l3'o xd<E -rD oo-I tro ;3'arlD= =5o!.>a rlo.X \l?vt ,il 'ri l? lrcft O c- c >J - lo) L t a ct </. E'It? .l () & ID I < o iJ =o il'2 (D DJi(D = I ocq(D 9. c!. U z.I Io(, U 5 OJ 3 ID r ! 1t f e dI ti tIIi I g :) F'S' TTE.ggE F fl ? E,Egs,rru : -'q d F' Irfi[:3$,f,F FEr 5 grE f fl#€5 $FJ!I [[Pr3fxl^o .J{ ?E F$ 3 * t ' o. lr{a'g 1*r$EE r=[[F Ff f Fkoc x ='EXrlo13!I{ * B'o. o. 7i* rE Psu - p' [ ] gEc. llr(D Eg. H 3g HrD -r, tr, l^ *,(-) /) u -l o : T zO *l C) o tr, 3 -. a tu 3o z IJ *'() CtI' 3o 7- EE>(r= r)?TrJ A "EFo\<*" g, I I : I I t[: , ? I '/ t. I- a, ,:. L O O tl o oTJ i-l lt:3E .- 'o o (,EHL'OI .tIr a ..; ll ,rr '/1 llV .\, HIU .= ..) r= .:;ll trLr ::1,'Ell €-lla, :: 5| it .:i tt ['] EfiEt'Eal"E r Q E-g d..t ')ro ., 'i' ilLitu';.: i_i'H 'Egll trS.f one X ll EEEH a, 'rJ c, l)I T \oOr-ll o c,i u\ onll C) c-n - .E 9'll rtr.= 5l: ;',[5 r Eq A; ri;gr ii} E E,i)E'a ()_q) cril il .33 UEHIIIiggHs'gE 3 6;r.N Hr c c.Br:i Ii: I t: tn I: I t \l , I ,, l It t: L'(t a I ,i t ! - t)I r< +- , ll' L) ;t :- l-' r(t(-\ Ft ll l't il) t, '_ r: o 5 I t:t, lt:: \, \ !, l: I ) I .l '! t .!, t:: 'I 'l (, I t. ,l I 7\ f: t , I J I t- L a t' al :1 I I lrf ) L't t,ril{ , tll il r ,litl'l ;ii,!,I rllll t 4 tl IN'I'EI{VIIIW C (,II)ll IfoIl I,()LINIANAGIIITS/. ooItI)rNn 7.o It.s '/ /tts ttttct.vtctv t,t rt cl t t t t t t t,t t a rctl o t t Co-ot dtttrttot.s.r.tt CDfl, ilitti.rrty t[ ltutltlt polrr-y111s11g,..r. ,utd tlte, ,, l.(l \'-A I /\ I( til(S/ ryiX,,] f I Ut,It usuN't.A,t,r v t,l/ t,It () G It A l\{ t\,t I' N:i t t t t c 1.vi st y1t rlf t t <,a t ti:/t 1tt'r.rottttcl f)ttt tttttcttt.t s ttc'lt u,t t:;o t/ tttt t t t /b nt til I i,ou cen be 7,y1, ttt'tt'tl for tltt il b L-lc-ntcrrts of c oIl:rlror.utiorrSPI]CIFIC RO r.E.s) bcrrvccl; Qe11 '!lulli ) 1, I "4 ; ; !,: 6,i : :ii,i i,ii i,;, a t, r c r (,,, (,,,,, c s ",ti1tyqrr,'r:tio,;;;i;;ir':;,,!:;;;,';:;r"i; 'tt,it.i, tl'NGDOs irt t,ct I t'ctlIt i,r sitttilttr to tltetlte.fontml itilr,tt'iew .S'llCT'tON A: ptt OGItz\f\,lN,l, NtAN z\CUl(S/ ONC 'l I,rogr:unlnc-, IIO s lrc ng llt l{DtNA1-Or{.s tlrlcrtrclltcrJ tI y()ur itl.cit I)lcasc rlcscrillc lrorv llrc C'I).II'I(OIJI: I.'Ott 'l'lrc a111,lroaclr uscrJ lor rrtrroclucittl.l Cqtl:jt,i Iillc corurrrrrrrit rc.s I 'r i Ucncral re-oflcnl:tliorr <ll_ lrc,rltlr l)cr.s()nl lrlobilrs.rtrou ()l (ilc cotnlll[rntttcs ty,, I{calth .systcnl :rrrcl NGDOs (IDEN.I.lI..y rrl f':t{tls CD'l'l f)rogr.ltrlntc !|1r ]'rlIt L Il 't(.) rl c l)lcasc cx I'ITOUU I ,1 :l g l)ilfcr;tqc S{or:rgc l)is(r rlrrrtlon (o corttrnunitic.s Colr.str.r rlr (.s ( s(()r.lgc, (r arl,\l)(rr( J'r';rirrrrrg ol lruairlr s(alll as (rillucrs Irlaltt JrrclccsS .l'r.r,r.r,i,i,,.. " , ','il'JUI<. (('rvillg rv(:l.nlce(lrr., ;', I)cl.rys rrr .ru1.rply o;rt rvlr,;rt lcvcl irrrtJ wlry/ Adcr;tr;rcy ol. llrc rlrlrnrlty t,ccclvcd/$,tor | ',' t, ' / ' *r 1 , ,,t l, I' L' I I rrll; / urgl.::, I f ,,t',ilj'f ili I 11,, r r.,i i ',: i i,l:1 1,,[ : ,,r i d (itc) I [.,NDINC,: /)/c;rs<.. Irrolrr, /,r ' : , ljci,r,l," ,l .rr,.lrorscrttcll ol. Icltcr * ,rl .;,gr ""rrtc!tt\l'11r"' ,r -" lr I)r'l;rr,.s lll lcccrylt,g lulld.\ . ,tl \\,lt,t( l(,\ (,1 iltrl rr i 11, r ., ; ! 1, i tl Dcl;rys lrr rlrslrrrrscrrrcrtr o/ /urttJs At w/r;rt lcycl ;trrtl tvlty'! l I I I ^lrltllot tlg ltr!t urrr,rrlr k.,,,,1,.,1., Nl,r.1 , /,Jr.7'1 a c .5 (l . trtuclctltrtrcy ol ;lrevrt.lus lrrr11g", c Iiurt<l :rcltrrilristnrlir.rrr. <lcllrys irr r rrl crr.slrrrr.scrrrcrrr .rrrr ;,,,;;;.;;'',:1,:':.' rrrtrl,\riro'r ot l'irrrrrrciar rcr)or r.s, ,r,,r;r1,s,,,,uJ:,;l:l:'*';l:l:l'il[ir rsgi/1,1",, I'rcirsc rlc.scr.rllc (rrr " citdtltt'll tcl s oll ltttattcial reporls : I)rogtililltIlc's g)l,ir,r,, l()r lrIrltr()virtg sustainallility Wlrrclr otlrcr hc:rltll ilctivitics rlo the ( r ,,.1 .ctrvrrlcs.., . ,,ro suJ.rcrvisrlr.s cor.rrbirrc witlr tltcir Orrclto Corrtrol lrrogralnrne Wotrl<l you plcasc t ax,r nr r'r.r rj il;il il'l&jii 3':'.1 1 ;.. l*f.I rcc. r, r kcc;, i ng l,^,ccrr rr rcs () 7 .Srrrnrturry slrcets I A vir ilrrt,l, 2 No( lvlilaLllcliX'I'It/tC,I' I NI,'Olt lll A,I,I ON ONst:llc iul(l LCjA) il. liltll I)<lltulrrtrorr Nurrtltcr ol vrllagc.s tn lllu ir,, ;l Nurrrbcr ol' villagcs wilh srrr,.,,,,,ry lbrnt., Nrrrntrcr of' vill:rAcs trcarcii Ntrrrtlrcr rvrllr scvcrc "ttj".,r Uvrdcrrcc ol rcp<lrt updatc ( I I Jp<ta rc,< I -, .sllcl'loN Il; At()II lr()l rr ,\, ^ . . .. _.-I IIOLIC}' I\{AI(IJI(S ( 8lr Do yott ltlrvc ;r r):rr;,r,,.,r r,, ,,,'"1,,,"".i.,,,-,-'..,r,,1,,t,'lrtion:rl l'rrrrr ror (lrc * kUrtl rll .sUI)l)()r{ rl0 ytr11 pfoVt, 'l'l ui, I,'OLLOWING (rclatc to lltc tcvcl of opcr.atiotr c.g. lr c. cl . t,\ ,'ck, irrrlrual r.ctrlrns alicr <tistriblrtion) ')t rJi)da(cd Slr \\,lr.rr INPI /T) . r nluncnl Scclctary/Dircc(or Diseasc Control) lrol t)t orrclroccrcta.st s ( I)robe. for lhe irnporlancc attaclrccJ t<l ,lor Onclro, Conlr()l . ,,:,iviric.s (PROBE FOIi ITINANCIAL I0 ls rhc t,Icg, itt l;:,1,1" you pcrcervc r,)c cr).r.1 srrarc,r ,l'AJrOC (tritr,," Ibr 1>crsorral <.rlrirri<rrr auc! oilicia! poticy onOncho l)rograrrrnrt, r()rr .r,(i,,*;r.;j;;;;;,,ijl;:J';l::jl;, sys(cnr ( I,r.otrc lbr actjviries whjc,h indicate A lr rlrlr l ra' ,,r,tlrc lrculth r r r;rllilily __r_h.!.i,rrr i,rnlont\ Kurrrll;11 , MJy l()(){l 32 .) )t 'i I j('-l'l()N (- : \\/l I () C( )t,N.l,tt' It I,it,It t,.it,iN.l,A,t.I;i,f ,,' ,I l'\\/lrirt is y.trr licrceJltirllt rtlrrrrrr (lrc n I)()(' srr:rtcgy lr,rr rr,t:rlrcc(i, tlrstri[lutrorr( l)r.trc lirr tL'ri'sibiliry .t'the cD'l'l aPPrt,,,"t, irlrlrtui,i,',',,,r,". rrcirrrrr pr.rrrcr,.s) ll' wlr:rt i's tltc rclatitlttsltiP bclrvscrt tlrc Wllo.l'l'icc,,,,,r rl," Natirl':rl orrcltoccrciasis,rask Force (NoTF))il:l'l;:ffi.,t to CD'll itrtplcr.crtririinn"'il""i* ,.,;'i.;,;ir.",',r1ii,,,, r() (r'.rr.src*r.rurrtrs, sur)r)o* ro No.r.r..anr, a !r lrlil|rlilr trrl lrrrlr rrrr,e|llt X,rr,, Al.r1, I r,1r1r1 tl I 'rl Axr-rexe ? GIIOUI' i, Itt oaclt cat, cottttttetcd, ltttttole youths_att For tttottitorittg TARGET GROUPS FEMALES ?ysION G L,I DE r\tr I ()N( J ( t()Ail\t UNI.I,1, At IiAf tllitt.S: V t Lt,A< ; t., A ' villago' otto A10ra atrd otto Fetttttre arrtrlt 2trtttlt tritt tt.r.rirttr ,rrr,rt rr?rt/ tlta slt t ilten.rr t, /..r,illngo.t, ,trot;p"riltt.tt,t.rltttt.t ttttt,tt lta e ttttrlttt:tod tvltltrltc rettmittittg tr't?" viilttgei. )&'r)t:tirrt,t ,.,,,_.rt be rterd rvirlt /etrmte vortr,s.'projects, T,otttlt.r ote defitted u ir,r,iir,-ia),rrtl.r ltetx,eort lS rtrttl 24 yvn,..r. i;:rf:,?:;:".tL|i',i,i'lt'fur o cort{onottte lttace tt'rt olrers sottte privocy ilt,(, (,t,),stt iii'),i,i,Z,i'' ,,,iii,'i"li'i"fj::.i':' :i:7;: :l',',{,,i:: i:;:;:::;"u,ii;;;,::',:,:l,rii,,j,,,r',,jr,,ji,:,iiii:,,speoklh'eely' otte of rlte ittlcrttal ,,,o,riirr,r.tltr>ttrd tc tttelociTit)tor ,,ltite tt rrr-ttr gttitre.takes ttotes (recot.cler). 7-lte gt.ottlt,li,rr.,,r.rr,),,, rttttst be tttlte-rcccttdetl. At tltc ettd oJ tlte se'tsiott'.1tla1' bock !lto tttlte fttr tt /ctv tttitttttes r(, r)" ,J,tre tltrtt trte dt,tt.ttssitttt tva,rprolterly rccordcd' Lobct thi cassette/N'ios (Natie rtiir"-riit)ge, trte grottp itrcrttit-1,, tlatc), ADULT tvtAL.E.Sl n t)(rL.r FEMn LES; yOtrN(j Mn t-E.S ()ll 2 Please lell us \\'llat you lltl()\v at)r)ur rlre ()nctr()cerciasis rrcilrll]cnl J,r(,.grnrnrrc (rrr-EAsI;PROBE FOR 'iltr -rot-t_<lrvtN(; l.s.sL,ES.) llle ,ers.tt(s) rvlt<l lrt.ttgllt tlre i<l.a .f tlre,rtclr.<:r.rci:rsis r,,()glirrrr(. r() rrris virage . trre (irrre r'rrerr rrre,ersorr(s) carre ro tark witrr y,rr arr.rrr,lrcrr.cerci;rsis rvltetlrer tlrere rvas a villagc rrrcetirrg at llral tinle Issues (lrat,,vere rliscusse<J at rlte rrreelilrg . orvltersltip of the llrogran.une . expectatiorr frOrrr llre prograrrrnte , respolrsibility of llre corrrrnrrrriry Please <Jescribe lrow (lre conlnruntty rocrk <Jrof disrriburiorr. pLEASE pROIIE FOR. sctstolr ou rlrc rirrre (rrrolrtlr/.seasolr) and rtrode I)ersorrs irrvolvecl irr rJecisiorr-rnakirrg Tirne of <Jistributiorr \Vlry tlre lirne was clrosen lr4erlrod of <Jistribut iolr WJry tlre ntelltocj of drstr rlrut ron \vas clrcrsclr Please <Je.scrilre ltorv. tlre corrrrnurrity took <Jecision on llre ;rersorr.sdistributing the drugs lo c.rrrrrrrrrri,, ,,1.,,,iirr. pLE SII t,lf flili fOn. 3 resrronsjble f<lr a a Persolrs irrvolved irt r.leci.siorr-rrrakirrg lVho wiil be resporrsibt. n,r- ,lirrrii,ulio,r Monrtoilng ,nrtru,trDll Ktnrprh ,Mty tg)g 4a 4b t1 o How lhe Det ' wl,y,t;;[:::l'weresereererl . rr,r.rr,o; #:r_::tJ;:..;:,;.,., if ilffi *:t:l lfl ;iil:;,11,1,", iffii!r.#il:,,f.r1il?,f r, isr r i,,,, r i,,,, (( )D r,) si,rcc llas trrere beerr any crrarrge i, the pi,grarnrre? -' "" tt It r, . Who brr . !Vr,a,;lrflffilJ'. Wltat rvere yorr lrllrl alrout rlrr. ttr.,,tl ftt a,. ffi .Hs'iy^ iTii il,, iT, i; ii ; i#$li'i', : ; ; ;'Ji: ", ;; i l, I ;;i [] ;ilr:", [;,]fJ:r REsp()Ns,rltr r.r.y. ,rri, " iiIii.r.r, .) (t l{<lw Is rlre <Irrrg lror rrrerrrbers? nnoiit:'iaj'10.lly lrtrrlrl'lrt irro rrre c<lrrrrrrrrriry rrrrrr rrisrr irrrre<l r. . poirrt of collectiorr r person responsible frtr brirrqirrg if to the corlrnrtrnitr,, ' I)ersorl res;lorsibre [<rr rric]tr i,,,,ii,l,,'r"i,l,il.r rrre c.rrrrrrrlri(v. nlo(le clI clislributiorr o rvltett \vas llte <Jrtrg srr,,allorr,1,1l cor nr ntr rt ity 7 \Vorrl<l yorr crireria),/' please rell 's rrr()"r' rr'rr, srrrlrrl<r rr<lt rrt tt(..r(,(r r'itrr i'errrrr:cti, (excrtrsiorr IS'; [r;13.U,t..Ail],JiE;,, rrrc (.r)r)s truring rrre rasr rrisrrirrtrriorr? pRoBE what probletrts llave y.tl ltn<l rvillt resn,'cr ro rrre distrirrrrri<,rr.rtlre rtrtrg? pRoRri rjoR lirrrelirress of supply to tlte corrrrrrrrrrily . ader;uacy crf .supply . . slorage Wltat problerns trave yorr lrad nf rer ral:ing tlre tlrugs? [low preparecl is the'cotrttttutli?y t. rake corrttol of ive,necrirr disrributiorr pr,gralrrrrre?(l{ow does rrre corrrrnrrity irrrenrr i,r.r.r.iu rr,. ox.r"ii.'iir'r.r..^t 1,ears?) what supp('rt tras rhe corrunrrrrity gir,e, r, r.e cDD? pRo,E Fort : lrrcerrlives irr caslr or irr kinrl f)rovi.siorr ol" rrrearrs oI tratrsporl M<lllilizatiorr oI corrrrrrrrni{y 8 t) to il t2 a a a Monltoriht lItt,u,,Fnr l(rrrrprlr , May l99g l3 l4 I .5, Uttsttr irtg corn;rl rarrcc could you;rlease'tell tts lr.rv y<ttt rv,srlrl ,refls're rrre.srrt.r.r:ss.r trrc (-.1).1.1 pr'grirrrrrrc,) llcrrv rveil lras trre cDr),cr[.rrrr.rrl (r,rt.,r]' r,.()* n.r-r;r,l tr),a) Wlral suggestiorrs do yotr lrave l() inr[)rove llre pr,grarrrrrre.,l I'ltrrrrlorirrj lnrlrlrtrnlt Krrrrpllo, Mny lt)t)t)