,a Z-i. :)-- -*-ti- MINISTRY OF HEALTH, CALABAR, NIGERIA, (dermyphils @yah oo. com) ORIGINAL :Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 January for March TC DEADLINE FOR SUBMISSION: C meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I I I I i I I COUNTRY/NOTF:NOTF NIGERIA Proiect Name: CROSS RMR NOTF/WHO-APOC CDTI PROJECT Approval year: 1997 Launching year:1998 From: JANUARY 20ll To: DECBMBBR 20ll Uonth/Year) ( Menth/Year) Reporting Period: (circleone) I 2 3 4 5 6 7 8 9 10 1l (circleone) t 2 3 4 s 6 7 I9 10 rrG)rS 13APOC fundins year: APOC Proiect implementation year report: Date submitted: Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - NGDO: UNICEF - 958 communities l^ ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA National Coordinator Name: Dr. Yisa A. Saka Signature Date: Zonal Oncho Coordinator Name: Mr. John Eluwa Signature: ... Date NGDO RePresentative Name: Saoondo Anom Signature Date This report has been prepared by Name: Asuquo Ekwe Signature: . Date Table of contents ACRONYMS 5 FOLLOW UP ON TCC RECOMMENDATIONS 7 EXECUTIVE SUMMARY........ .. ERREUR ! SIGNET NON DEFINI SECTION 1: BACKGROUND INFORMATION....... ....................10 1.1. General information ....... 10 1.1.1 Description of the project (briefly).... ....Erreur ! Signet non d6fini. 1.1.2. Partnership Erreur ! Signet non d6fini. 1.2. Population ..... 13 SECTION 2: IMPLEMENTATION OF CDTI............ ERREUR ! SIGNET NON DEFINI. 2.1. Timeline of activities................ ... Erreur ! Signet non d6fini. 2.2. Advocacy. ..... 18 2.3. Mobilization, sensitization and health education of at risk communities ................ l9 2.4. Community involvement............ ......21 2.5. Capacity building ...........23 2.6. Treatments Erreur ! Signet non d6fini. 2.6.1. Treatment figures Erreur ! Signet non d6fini. 2.6.2 What are the causes of absenteeism? ......... ..................28 2.6.3 What are the reasons for refusals? 28 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that...28 2.6.5. Trend of treatment achievement from CDTI project inception to the current year 30 2.7 . Ordering, storage and delivery of ivermectin............. .......... 3l 2.8. Community self-monitoring and Stakeholders Meeting ......33 2.9. Supervision............... . Erreur ! Signet non d6fini. 2.9.L Provide a flow chart of supervision hierarchy......... Erreur ! Signet non d6fini. 2.9.2. What were the main issues identified during supervision? ..............................34 2.9.3. Was a supervision checklist used? .......35 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 35 2.9.5. Was feedback given to the person or groups supervised?................................35 2.9.6. How was the feedback used to improve the overall performance of the project? 35 SECTION 3: SUPPORT TO CDTI ..............36 3.1. Equipment 3.2. J.J. 3.4. Financial contributions of the partners and communities Other forms of community support ..,.,..36 ,....,.36 .......40 .......40Expenditure per activity . SECTION 4: SUSTAINABILITY OF CDTI....... """"" 41 4.1. Intemal; independent participatory monitoring; Evaluation.....'...... ......41 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable)........... 4.1.2. What were the recommendations? 4.1.3. How have they been implemented?'......."" 4.2. Sustainability of projects: plan and set targets (mandatory at.............. Yr 3) ......... 4.2.1 4.2.2 4.3.2. 4.3.3. 4.3.4. 4.3.5. Planning at all relevant levels.... Funds 4.2.3 Transport (replacement and maintenance) .."""" 4.2.4. Other resources.' 4.2.5. To what extent has the plan been implemented """"""' 4.3. Integration 4.3.1. Ivermectin delivery mechanisms......'........' Training Joint supervision and monitoring with other programs.."' Release of funds for project activities Is CDTI included in the PHC budget?............... 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?""" """"' 44 4.3.7. Describe others issues considered in the integration of CDTI. .. Erreur ! Signet non d6fini. 4.4. Operational research............ """"""""" 48 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period' 4.4.2. How were the results applied in the project? SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES.... """""""""' 48 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........50 ..48 ..48 ..42 42 42 ...43 44 44 ..........44 44 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo SENOES CRNP CRT'C OCDES TCF GFKO PKEC CLK CNG BRHDO CDI African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization South Eastern Nigeria Outreach Eyecare Services Cross National Park Cross River Forestry Commission Ogoja Catholic Diocese Eyecare Services Tulsi Chanrai Foundation Great Friends Klub of Obudu Pacesetter Klub Exclusive of Calabar Calabar Leo Club Catholic Nurses Guild Beb Rural Health Development Options Community Directed Intervention Definitions (i) (ii) (i ii) (iv) (v) (vi) (vii) (viii) (ix) Total population: the total population living in meso/hyper-endemic communities *,th* tt" p.Ject area (based on REMO and census taking)' Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area' Annual Treatment Objective: (ATO): the estimated number of persons living in @hataCDTIprojectintendstotreatwithivermectinina given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to b" tr."t.d "r"*lly i* lhyper endemic areas within the project area' uttimately to be reached when the project has reached full geographic coverage (normally the project should be explcted to reach the UTG ut tt" ind of the 3'd year ofthe project). Therapeuticcoverage:numberofpeopletreatedinagivenyearoverthetotal population (this should be expressed as a percentage)' Geographical coverage: number of communities treated in a given year over the total numbe. of meil/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' Integration: delivering additional health interventions (i.e. vitamin A supplements' utU"nA-ot. for LF, icreening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and ..pL*.. communitils to solve more of their health problems' This does not inch,rde activities or interventions carried out by community distributors outside of CDTI. Sustainability: CDTI activities in an area are sustainable when they continue to fr".ti"" .ff*tively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership' using resources mobilised by the community and the government. Community self-monitoring (CSM): The process by -wh_ich the community is .-p"*.*d t" or..r.. und -onitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way" intended. It encourages the community to take full t..rponribility of ivermectin iistribution and make appropriate modifications when necessary. FOLLOW UP ON TGC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC Session TRC 6 Feb 20tt FOR TCC/APOC MGT ASE ONLY Number of Recommen dation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT 1.1.1 Advocacy visit to State policy makers to be sensitized for funds release. The key State policy makers sensitized for the release ofcounterpart funds in support of CDTI activities in the State were the SSG, State Accountant, Auditor general Commissioner of Health and Local Government Commission Chairman, Commissioner of Finance, SA to Governor IDS, Director of Public Health/Disease Control and Director State Planning Commission. This facilitate released of the sum 1,074,000 as Counterparl funds for CDI activities in 201 I . Women CBO should be used in the recruitment of female CDDs Different women CBOs used across the State in recruitment of female CDDs were from different LGAs such as Ukele Women Association, CWO (Catholic Women Organization) Women Guilt, Pacesetter Klub women Organization, Noble Ladies, and Kakwagom Women Association. Ladies of Hope Association. This has a yielded significant difference from previous year with support from APOC. Conduct operation research on non-parlicipation of women in community meetings and how to change community attitude toward female participation to community health meetings. The project is working on proposal on non- participation of women in community meetings and how to change community attitude towards women in CDI implementation to be submitted in 2012 TRC session. Training was held for health staff at all levels the total of 618 health staff were trained for CDI implementation which has increased the ratio to 55%o,with funds from APOC. Train all health staff in the treatment areas to raise the proportion of those trained from lToh to l00o/o EXECUTIVE SUMMARY Ivermectin treatment programme commenced in the State through UNICEF and Cross River State Government in 1995, under community base ivermectin treatment with CDTI. In 1997 African Programme on Onchocerciaisis Control (APOC), approved the commencement of Cross River State Community Directed Treatment with Ivermectin (CDTI) Currently 958 communities in 15 onchocerciaisis endemic LGAs are under mass ivermectin treatment in the State. Following, the success story of ivermectin project in Nigeria, CDTI strategy have been adopted for Mass Drugs Administration of mectizan and Albendazole, as well as other community health interventions. The 12th year was aimed at sustaining the distribution of ivermectin in 958 communities and albendazole in 835 communities to ensure l00oh geographical coverage and at leastS2Yo therapeutic coverage, ensuring that the project continue to provide a good structure to deliver simple primary health care interventions to the population, ensuring timely release of counterpart funds by govemment for the sustainability of the project through the implementation of community self monitoring (CSM) and stakeholders meeting (SHM), ensuring greater collaboration and participation of local CBOs and NGOs in CDI implementation, ensuring improvement of women participation in CDL Especially in the Southem senatorial district where they are a lot of stranger elements (Akamkpa, Odukpani and Akpabuyo. The project trained and retrained 618 health workers and 6,813 CDDs in all the LGAs to enhanced mectizan and albendazole delivery to all the endemic communities with support from APOC. A training of health workers and CDDs was also carried out in 2 LGAs (Calabar South and Abi), on co-implementation of LF mectizan and Albendazole with State government support ofbaseline survey conducted in southern and central senatorial district. The project treated a total of 1,019,714 persons in 958 communities with ivermectin and 1,414,682 persons in 835 communities with albendazole (with therapeutic coverage of 82% and 100% geographical coverage). The challenges faced include late released and inadequate counterpart funding, for CDI implementation, both at State and LGA Levels Lack of commitment and poor attitude by Frontline Health Facility staff and LOCTs to CDI implementation due to non support from the LGA policy makers. Inadequate supervision of CDI activities by health workers, Lack of incentives to CDDs. To addressed these challenges, the project embark on continuous High level advocacy visit to the SSG, State Accountant, Auditor general Commissioner of Health and Local Government Commission Chairman, Commissioner of Finance, SA to Governor Intemational Donor Support (IDS),other policy makers at all levels, continuous community mobilization, sensitization and dialogue with health personnel was done, to increased Ownership and participation by the communities in CDI implementation and health workers were re-oriented during appraisal and planning meeting for effective sustainability of CDI implementation in the State. Prepare an Executive summary of the report in not more than one page. SECTION 1: Background information 1.1. General information DescriPtion of the Project STUDY AREA Cross River State is one of the 10 States in South Eastern Nigeria Primary Health Care (PHC) zones. The state is situated within the cross River Basin between latitude 50 32'North, and 40 27' East.Ebonyi, Abia, and Akwa Ibom States bound the State in the West' in the North by Benue State. The southem boundary is the Atlantic ocean and it has international boundary with the Republic of Cameroon in the East' The main occupations of the people are farming, fishing and hunting' The State is situated within the tropical rainforest, one of Africa's most dense forests found on the eastern borders with the Cameroon and the secondary forest and guinea savannah in the western and northern parts of the State. The climate is tropical, however temperate climate is found in Obudu plateau where altitudes are in the region of 1,500metres above sea level' The topography is mountainous in the cameroon border; plain fields are found in Yala and Ogoja axis. The population is approximately 3.1 million as projected by the 1991 population census. The State has three main languages, Efik, Ejagham and Bekwarra' one major festival celebrated in the State is the new yam festival, which takes place in the rainy season' There is a good road network, which links the state with other parts of the country' The state can be accessed through land, air and water. There is a two tier administrative structure at this level' A democratically elected Governor heads the State executive council' The local Government chairmen who are also democratically elected head the local councils' The health system operates at three levels, the primary, secondary and tertiary levels' the primary level which is community based is run by the Local Government administration in conjunction with the State Ministry of Health. The secondary level is managed by the State Ministry of Health and takes care of referrals from the primary level' The tertiary level is managed by the Federal Government and comprise of the teaching hospital in the university college where special cases are referred to for special care. There are 296 health centers and posts in the project area. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) i L I L i b t V 1 10 1l rt- ti t,^ t\ DistricVLGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staffinvolved in CDTI B2 Percentage Br=Brl Br *100 AKAMKPA 163 141 76v, AKPABUYO 135 101 66v, BAKASSI 72 72 100% BEKWARRA 172 130 60% BIASE t34 112 58v, BOKI 445 94 52Yo ETUNG 140 1 1 2 72Yo IKOM 463 311 84Yo OBANLIKU 252 214 76Yo OBUBRA 117 98 67% OBUDU 124 86 77% ODUKPANI 132 116 97Yo OGOJA 222 197 6l%o YAKURR 244 219 82% YALA 234 209 940 Total 2,648 1,876 71% 1.1.2 Partnership The partners in the Cross River State CDTI project are: l. The Federal Ministry of Health 2. APOC-WHO 3. State Ministry of Health 4. TheLGAs 5. The communities 6. LINICEF 7. Several other NGOs which include: i) South Eastern Nigeria outreach Eye care Services (sENoES) ii) Youth care iii) Ogoja Catholic Diocese Eye care Services iv) Ophthalmology Department University of Calabar v) Cross River National Park vi) Cross River Forestry Commission vii) Tulsi Chanrai foundation (8) The CBOs who are working in partnership include: i) Great Friends Klub of Obudu ii) Pacesetters Klub Exclusive of Calabar iii) Calabar Leo Klub iv) Catholic Nurses Guild v) Beb Rural Health Development Options The State Ministry of Health provides the manpower needs for the implementation of the project, provides counterpart funding for activities and monitors overall implementation strategy and administration. The NGDO GfNICEF) partner provides part funding, logistics and expert advice for project implementation' People from endemic areas residing in Calabar and other major towns in the State are treated with Mecti zan andAlbendazole in churches by other CBOs like the Catholic Nurses Guild, Archdiocese of Calabar, the Great Friends of Obudu, and The Pacesetters Klub Exclusive of calabar. 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2.2. Advocacy Advocacy visits to the Secretary to the State Government (SSG), State Accountant General and Auditor General, with the aid of Commissioner of Health and other policy makers in the State, Director of public Health and Disease Control and the State Onchocerciasis Control team constituted a team that visited all the LGAs for advocacy meetings with LGA policy makers. Advocacy and sensitization of these groups were carried out to enable them understand the concept of CDI and the roles of partners in the implementation of CDI project in the State, also the project used the period to educate them on co-implementation with LF. As a result of the advocacy and sensitization of policy makers, At the State level, the Governor approved the sum of 2.5 million Naira as State counterpart support for the project. However, the sum of N1, 074,000.00 was released to the project to carryout baseline survey on Lymphatic Filariasis in 2 sentinel sites Akamkpa and Ikom LGAs' All the LGA Chairmen were presented with a file jacket containing information on partners, stakeholders and roles on CDI, as well as an appeal letter for a monthly imprest of N25, 000 to Local Onchocerciasis Control Team for routine supervisory visit to communities to ensure that operational guidelines are maintained. The diff,rculties/constraints are inadequate support from State and LGAs policy makers for CDI implementation. -Poor terrain, high cost of maintaining and fueling of project and motorcycles at all level 18 WHO/APOC, 14 SePtember 2009 Suggested ways for improvement -The project will continue to encourage high level advocacy visit to State policy makers and also the local NGOs and CBOs to accompany the project staff for advocacy visits to the endemic LGAs and mobilizationof endemic communities, the project will ensure adequate plans to be put in place, to carry out advocacy visit to State and all the LGAs to ensure prompt released of counterpart funds and maintenance of all capital equipments, logistics and imprest given to the LOCT coordinator for CDI implementation. State lhe number ofpolicy/dectsron makers mobilred at each relevanl level dunng the carrenl )ear, the reason(s) for undertakrng the advocacyandtheoutcome Describedrfficultrcs/conslratnlsbetngfacedandsuggestronsonhov'lotmproveadvocacy. 2.3. Mobilization, sensitization and health education of at risk communities Community mobilization was done at a comprehensive scale in all the LGA with support from APOC. - With the use of media and or local systems to disseminate information. - Mobilization and health education of communities including women and minorities. - Response of target Communities Suggest ways to improve mobilization and sensitization of target communities The endemic communities were mobilized and sensitized on Onchocerciaisis and Lymphatic Filariaisis using poster for health education, radio/television jingles to educate the communities, the jingle were made in English and three local languages in Cross River Efik, Bekwarra and Ejagham and were broadcast at different times of the day to ensure that the massage get to all in the community. As a result of more awareness to be created for effective ownership and participation of CDI sustainability in the State. Religious leaders were also involved in the sensitization as it was believed that most of the community members tend to listen to their religious leaders. Meeting of councils of traditional rulers and community development meeting was also used to intimate the entire community. There was also mass mobilization of the entire communities; every member of the communities was taken into account most especially the women participation. Inclusion of more women as CDD3 was strongly emphasized. As a result of mobilization carried out on CDI implementation responses of the communities were recognized: - Increase involvement of female in CDI implementation as CDDs - Communities collect their mecti zan andAlbendazole tablets for treatment from the FLHF in the communities. - Improved on ownership/participation and to provide incentives to CDDs - Supervision of CDI activities by selected monitors/supervisors by the community' All endemic communities were visited despites poor terrain and high cost of maintenance of logistics for implementing of CDI activities, the community leaders promise to drive the CDI implementation to a SucceSS, this also increased treatment coverage. Suggest ways to improve mobilization and sensitization of target community Routine community mobilization, sensitization and Health Education. Adequate support of logistic, posters, motorcycles, adequate funding for maintenance and fueling attention would be given to mobilization to ensure that all communities are monitored effectively. 2.4 Community involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) District/LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire district/LGA area B. Number with community members as supervisors Bs Percentage Br= By' 84 *100 le CDDs B7 Female CDDs B8 Total Be= B7+Bg Number of communities with female CDDs B,o Percentage Brr= Bro/84* 100 AKAMKPA 93 93 l00Yo 468 tt4 583 85 9t% AKPABUYO 32 32 r00% 521 273 794 32 t00% BAKASSI 28 28 t00% 73 r89 262 22 780/o BEKWARRA 46 46 l00yo 354 55 409 44 96% BIASE 32 32 100% 223 132 355 23 7 lo/o BOKI 129 129 l00Yo 675 285 980 60 4704 ETLING 29 29 1000h 357 l6r 518 2t 720h IKOM 94 94 100% 704 291 991 87 92% OBANLIKU 67 67 100Yo 156 67 221 48 T l%o OBUBRA 24 24 100% 483 83 566 24 10070 OBUDU 39 39 100% 5ll 39 550 27 69% ODUKPANI 65 65 100% 433 235 668 58 89% OGOJA 56 56 100% 282 61 343 35 62Yo YAKURR t4 t4 r00% 337 82 419 t4 100v, YALA 210 210 l00Yo 596 52 648 49 33Yo Total 958 958 l00Yo 6,173 2,090 8,263 629 660 -Attendance of female member in community at health education meetings Attendance of female members in community at health education meetings is still not encouraging because of the culture and believes of the community saying women are not part of decision making concerning the community. It is only the men who are decision makers. Some communities provide little incentives while other community believed that it is the responsibility of the CDDs to do voluntary work to help their people which incentive for CDDs is not encouraging causing laxity in the part of the CDDs to carry out distribution of mectizan and Albend azole. -Attrition of CDDs attrition. Is attrition a problem for the project if yes how is it addressed? CDDs attrition is more or less not a problem to the project due to provision of bicycles and T- shirt donated by APOC to add on to the incentive provided by the community to motivate them to do the work. Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issies are being discusses (attendance, participation in the discussion etc)? Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? - Other issues 2.4. Capacity building There is adequate manpower in terms of numbers at the State and LGA levels but personnel lack commitment to drive CDI activities, however there is a renewed effort to improve on the commitment of personnel towards CDI activities. Communities are being mobilized to select more CDDs for training to meet a ratio of 2 CDDs: 100, and each house to give CDD, with emphasis on the selection of more women CDDs. There is an agreement reached with the Local Government Service Commission conceming posting of staff involved in CDI activities. District officers are usually posted from one CDI area to another CDI area. Where the health service cannot reach, efforts are been made to involve other service providers in the area, e.g. CBOs and NGOs - Descnbe the adequacy ofavatlable knowledgeable manpower at all levels. ' Wherefrequent lrans/ers oftramed staffoccur, state t'hal the proyct rc dorng, or intends to do, to remedy the sttualrcn. (fhe ntost ,mporlanl ssue lo descnbe rs v,hat measures were taken to ensure adequate CDTI mplenrentatrcn t,here not enough knou,ledgeoble manpover y,as avatlable or tf stafJ are Jrequently transferred dunng the course o/ the campargn) 23 WHO/APOC, 14 September 2009 o\ N L 0) -o (.) o. C)a$ (-) > bo o * o o +N B p c B o $ o\ L o t o\\ \i B B * o \ €(\ $\o r- co s co o\ F* o\ co \o o\ o ca \o\o co N s\o N \o c.l : \o c.lr- Ot N c.)$ o, O\o 00 ao NO \o N a.l o O N O$ $ co a.l c.l NN ca Oo c.lN rr \o O OO oo @ a.l Q Q +. R dll OO c.) N s a.l OO oO c.l O oO O co oo(\O oOs N 6) 6 ah (.) o 6) z U LF il: Q d F (J +. o< Qz UF ah 0) .A'vt cl F.r L3 6) .oE r- g{6)r z 6 : \o6 ?a) \o el ol $ O : co $ cn(\ c.) coc.l O c.l $ co N al co : @ : c.l N : C.l t F* r- : co rl co s O : cr\o N : c.l \o c.t c..l c.l C..l c.l N c.) N lt(, + U U U 6 F +. \o s rn ra or- \or$ \oc.l \o 00r-C.l t @00F sr- cgq) 0) z 0) c! en a.l N <. c.l cl € .I ?., \o .I .I N \o : \o r- $ c.l F- \o a.l \o € C\ ca o\ F- c-t(\N oo \o (\ \o +. 0( z O c.l o, al co \o N \o \or) \o € t-- r-\o o\o\ \o \o F c! ch an F.l 9e <J q) O$ o o z J I t-t Fr \o q) () 0) I o\ F- o o && Dv & cap EA o o cao z Fr !4pozDF frl M Fa V J z @ & IZ frl FA IJ]a ca v o OiV Z M ca M aa v ca .] o a S q) cq q) c) trl 3 (.) (r) c) 0) 0)! 6)!F q) CE CE 3 <f,\o O c.)coc.l 00 Q Ei-l+ o (J ATRO for Frontline health facility and CDD training is low due to minima funds released for training of FLHFS. Table 6: Type of training undertaken (Tick the boxes where speciJic troining was carried out during the reporting period) Any other comments Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speci&) 25 WHO/APOC, 14 September 2009 o^,r -c.qE E; .r q 9b€;s€atr9 c o o q, o+- =IEES'2.=oe, otsh>oc ;o" 5Et?AA qOo o'E,, .= (); Eis d F'e,=.? 5 +6g;500 i I =E.^O91e €N ol $ € N O c.l ar a d N d It € E8 =-97-O (d \o O<f N N o\ N al N o, No, al KO ,E^-6q A 9E E2 b€ e EEo/J:Y U! sfN N6l o N N .+ € al tl o :jE -oxo^ EETEA z oe =chH*F F.EEE E.g x - at) crs5;:i -o'E q ir-oEE o 'Eo o d^ :ioo\ ooEOF tso? 6.2 < g*FU 6\N@ o\ € o\ 6 6\ € o\o € o.l € o\ € o\ @ o\6l € 6\ € o\ € o\ol € o\ al - o\ € sd € so: €- + o\ @ N o\ €@ oi o\r o,\o o r I { € & € @ cldI =f N o^ @$ r r o\q N ol €r €$ t r a +\o. o\ co+ v') + €F- ol a.l @ .i\o e.l $ F- \o o\ .o. \o\o c.l o\ 00 € o\ a.l o oo @ o\ $ r-\o oo @ co 00^ rn o\ rA af) @q rt Fl rl rn N N +ln (\ rl N ,ri co rl l/) st +r\ (o O'l d) ra @ rl st codOt Fl cO cO co oir\ Ortn 00 rJ)o Fl r-{ rl Fl o rn 6 cn rl o r.o Fl O) rl(o sf cn Fl!n sl(O r-{r\Nd Ol tJ) cO rn d)tn Fl o(\t r\ N$ o\lF-lNl N rn cl + ?.= L -tsa9oE O sO3 SFE ei= o.:^e > !Q tr- =? Eg3:Ee s il E.9 .- L.: O Yo c oo:: 6 -o J (! dAc c= o_ aE>-z6o oo =9p(g O-oFo:a3u =od O.= itroL=o < g€FU a o O 6\ O o\ o\ o\ 6\ o\ o\ o\O o\ o\ o\ O o, N 6N \o d N o\al N * r€ ar o\ N 6h6\ o\ at €N €$ d o\N o\N o\ r $N o\ \o o N €h o\ (o o) c{(o @N (os o)N o)N to) t-(o tc\t o,(o (olo o N t 6rr) C') ;q (LY $ o l d) o-Y a U) s @ lrJ U) dI =o d) (, zlt- IJJ =o Y )Y Jz d) o t col d) o lo ao(, o x&lY '] F F 5 o\\ .E e.l Irl q z F.l(J rl] ! I & D z rl d (€ o G J o E F A ot;iY =Jr- b0(,O ii-o L.r=)<ele+) o=6 EUq):EL U= F F.EF \oi .\oN.i <t ar o\ o\ oo c.l N (f) lo(o q) $\qJ s(,\lr *t* L sq) bO .s ri\v\ tJ5r v€(gP9u(d_i EBoq) AI S'v-LaE3 oLS d .L.a{ =AD5 .=81B.sS2.Stgg(ds3 .;*s L!i €EEE:.Si Et Sb\ :\iB9E!a\r9E .E '$s; r $$E g s\(') \ !$ 3E F EB;l{ : Ei El i s :L, CIE E Eiol O- u S-.l HE S $S oJ, o s &'tEIE i EE EI = S :FEIE D E: ,le I t* .s SE oa qrds' s\ " i.tES- oi lu *\ *$l' 5tI ET: ES #\eQx \ sEa E S$5 't da.H s sS riS:li=Y l\ l\='F rr nS? R HSo\ \ ag 0) ooF o c) C6 oLF o dLr obo!B^6S oo F (! C)tr(! o() 3r 0) o z rl]& .o o '.= C)p (r') (r) q) et E:t tr *l ERI ,-> El cgl 6PI E .hl Col 0) oo{.r o :t oEI g X -tA\l FQEl^< g .=l q i;Fl UL dl ." o) :I: O,El - ool H c) .:l* ilot tr o -l = Lol tr () -l-trl (d trit!* =lo =lzl? zl d C)L(! o c) 'a l- c) B (r) C) oo o C) o I ti 0) a. >. 9l (hOI o-) Xl - 6t ^^cdl c ojl . - .:l .z o.rl - F+6 RI Eql =ol o- rl Ool o- -ol _trl cd =t EZI? 0.) cdL C) oo(! L c) o Ua (€ t<bo oo o CdL 0) oo(€ L 0) oo o- 9^\ 0) a.(dL C) F 0)l b0dtLrl6)l BIol -tdlol -qlol(ctLI s c)l sil(!l ol Pl at ol cdlLI 0)l -cl €l od cl aH ol ol -l €l .ol JI EI ol fr. I 2.6.2 What are the causes of absenteeism? Absenteeism is caused bY Employment: some community member move to the city in search of work Rural urban migration of some community members migrate to urban where they have access to in fractures and search for a better living. 2.6.3 What are the reasons for refusals? The reasons for refusals are listed below - Reactions from previous treatment with mectizan and albendazole - Personal decision Negative responses from a community member who has taken the tablets Reli gious/cultural beliefs Briefly describe all known and verified serious adverse events (SAEs) that o".rr.r.d during the reporting period and provide (in table 8) the required information when available. o Parasitologist trained? Yes o Existence of microscope? Yes . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report I 28 WHO/APOC, 14 SePtember 2009 o\ c.l Lo -o () C)a ri- O - o o\ c.l q) a) o'\q) "a S\q ,F O) OC,E>:PoE .:=>. -4 1=. 3,PeE :ci::.e E E + j x=l- El 99 ot .2 EOoeg10 .=L LlJoa o 0 €: .-X q9^ ;.9 UOE tr rto.2 sC !Er-!idoO!Yq)nE&;e =a!e 0EL' vii-;5 f,'6a x;e c!f, a I oo.! -=^trtlgEEEg 0 o a 0 o; EE ;F* ,-l o Gl (g N 3-a.o9 a; i! ou0trSbo =.-ao xoa q) a0 * z o i U;q; q) .b v\ qJ S \\ B q,r ti a)Ft! L c) a0 L o c)L q) a0 q) LL ()() Gt eh ri a o q) () 4) U)L() CE ta) o L 0) U) U) c)a cll U €l crl -ol cElFI \o o, o, -o o\ o\ o\ o\\o o\ o\ F- o\ o\ o\ o\ \oo\ oo@ o\ \o c.t o, -o o\ c.l € \o $ co o\ c.l o\ \o $ o\ -o o\ \o \ao\ co oo \o r- F- 0) bora (d ^E bs /O O \o oo -oo\OO o\\o o\ o\ c- o\ o\ -o o\ oo oo \oo\ o\ \a co o\ \o o\ .o o\ co o\ \e co o\ o\$ o\\o \oo\t oo -oo\ r*Fr il- E] o eSc. - Oo\<a-. o @ .o o\ c.l € o\N co -o o\r- F- -oo\O oo o\ oo \oo\ o\r- o\(\ F- \o r- -o o\ o\\o o\ r- o\ 00r- 6\ c.l \o o\\o o\ \o tl l-1 o '5o ,ooo (d^ a' -o/ o\ oo -coF s r- o\F- o\ co o\ c.l o\ co t 00 o\ c.)r- co oo oo O o,$ rr, o\\o o F- + o\ c.l a.lF- a.) NF- t\oO c.ls € cor-|r) r-$ \o co\o (\ € N .o Ocd .o OE 9,a =At6AE o. r) r* al o\$ € o\ 00 o\ o\ N oo F- O c'l co r-t oo OO F- r- o O F- ar €r- c.) o\ c.) 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B c'- o E 1A6^\ ,'= o o; EO oI O O c.l o a.l r- c.l ooOON o\ N $ o c.l ct \oO(\c.l c.l c.l c.)OO al @ o' o\ o\ o\ o\ N r- o\ o\ & El -and v .- I Cq I )() c!q) q) a0 Lq)sl v *v\9$l- .\i t E I6r d v.j{\ v\9 _ -\AtY{r9(I '= -.-- trexoFE tr :Y sJ q,X\E ;tl q)9E 9!1 aii ct ocg s,9u -o=:q.) b09.-r- .-Aq ^LA .-O)HF vO)! veU):-3b e '=() o\ :r-E 0\ =ir t-g. -€ i; xh e-l''i li r-r :h ;,;EEI S,) iHI Gt- Ul !.19-l vE cul q)ai ut '= - -l vE<1 t-opl a88, I -lU! -L9(.)L6l>O q9v 6 C) rt 6)il )' -=l<T UH:IwlJ CE caEE ;!0): *trc) ItiE;; A -YL-HEts E .iFol o) ,d9l H '.dfl g6i Fl Fr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities NOCP orders the total drug requirement for the whole country; UNICEF facilitates clearing of the drugs from the ports and storage in the central stores in Lagos. The State Ministry of Health collect the State consignment from Lagos and the drugs are stored in the Onchocerciasis control unit stores in Calabar. The LGA councils sponsor the collection of the drugs from the central store in Calabar. At the LGA level, the drugs are stored in the LGA central drug store. The drugs are distributed to the health facility in the LGAs. The communities around the districts come to the health facilities to collect the drugs for the end 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH tr WHOtr UNTCEF E Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH E WHO tr UNTCEF tr users. NGDO NGDO 31 WHO/APOC, l4 September 2009 tr Table 10: Mectizan@ Inventory 20ll (Please add more rows if necessary) Number of Mectizan tablets RemainingExpiredLost WastedUsedReceivedRequestedIn stock from previous year State /District /LGA 9,110llt4r3,678423,500423,500NilAKAMKPA 2,511121225,368228,000228,000NilAKPABUYO 98t225169,294I 70,500170,500NilBAKASSI l7 ,471232302,297320,000320,000NitBEKWARRA 7,782141300,000 289,788300,0002,416BIASE 50,767l3l599,102650,000650,000NilBOKI 206113l95,r8l195,500l 95,500NitETUNG 4,106129315,76s320,000320,000NitIKOM 2,69636177,230r 80,000180,000NilOBANLIKU 44874199,978200,500200,500NitOBUBRA 32.44128198,876200,500200,50030,945OBUDU 1,37622205,500 204,102205,500NilODUKPANI 81732292,500 291,651292,500NitOGOJA 39,14127124,675128,000128,00042,439YAKURR 39,996t47359,857400,000400,000NilYALA 540,050 231 121,269121,50012 I ,500540.050CLINIC BASE 749,899 1,5694,188,1 I I4,336,0004,336,000615,850 TOTAL 40,523 persons were treated passively (Clinic base) - How are the remaining ivermectin tablets collected and where are they kept? In some communities, the remaining tablets were kept with the FLHF staff at the health facilities nearest to them, while some communities kept their remaning with the supervisors or the CDDs, community leaders or monitors appointed by the community. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. . Collection of ivermectin from the LGA . Training of CDDs and community mobilization and sensitization . Keep records of mectizan and albendazole issued to the CDDs under their health facilities o Monitoring and supervising of mectizan and albendazole distribution o Organizing of Community self monitoring (CSM) and Stakeholders meeting (SHM) in the communities. 2,8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table I I Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Community self monitoring and stakeholders meeting was organizedin 354 communities of the 15 endemic LGAs, which will helps in the increased in participation of all community member in distribution and sustainability of the programme. The issue of incentives was resolved in some endemic communities, by each house hold to give someone to be trained as CDD for distribution of mectizan and Albend azole to increase no of CDDs trained and problems of incentives. District/ LGA Total # of communities/villages in the entire district/LGA area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHM) IAKAMKPA I AKPABIJYO BAKASSI BEKWARRA BoKI ETUNG IK-OM OBANLIKU ODUKPANI OBUBRA OBUDU OGOJA YAKURR YALA 93 t2 28 32 46 129 29 94 67 65 24 39 56 14 210 t6 13 t4 22 24 44 13 47 24 35 is t2 22 7 47- t6 13 t4 22 24 44 l3 47 24 35 13 12 22 7 47 TOTAL 9s8 354 354 2.9 Supervision 2.9.1. Provide a flow chart of supervision hierarchy' SI]PERVISION HIERACHY IN CR-CDTI PROJECT NGDO UNICEF Comm unity-Directed Treatment with Ivermectin (CommunitY Leader(s) Vill oge H ealth Commitlee, Communitv memhers. CD Ds) NOCP NOTF Zonal Onchocerciasis Control Team (ZPM, consultonls, & stafl) State Onchocerciasis Control Team (State Coordinator, SOCT, Dir. PHC, PHC Coordinator) Local Government Onchocerciasis Control Team (LOCTs Leade4 LOCT, PHC Coord', H ealt tt S u p ervis or, D ist r ict S u p ervi so r) 2.9.2. What were the main issues identified during supervision? . Poor supervision by health facility staff Inadequate commitment by some of the frontline health facility staff Poor record keeping and census update by CDDs Poor Data collection and reporting by frontline health facility staff Training of CDDs were not effectively carried out Non incentives to the CDDs by the communities. Lack of funds for FLHFS and LOCTs to carry out proper supervision 2.9.3. Was a supervision checklist used? Yes, The SOCTs and some of FLHFS/LOCTs make use of the checklist. While some did not make use checklist. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? COMMUNITY LEVEL: As a result of supervision of CDI activities carried out at each level, the health facility staffs were able to improve on data collection and appropriate reporting of activities. The CDDs were able to carry out proper recording and update their treatment registers. Appropriate implementation of CDI activities were put in place at the Health Facility and community. 2.9.5. Was feedback given to the person or groups supervised? Yes Feedback was given and it assisted the project for the community to take responsibility and ownership of the CDI activities. 2.9.6, How was the feedback used to improve the overall performance of the project? All Personnel involved in CDI implementation were able to identify their roles and responsibility to improve the performances, thereby increasing the total treatment coverage and reporting, the feedback was also used to develop their work plan and CDI implementation. a a a o a a SECTION 3: SuPPort to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=CurrentlY non-functional but rePairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The project intends to maintain and replace existing equipment with support from state counterpart funds released for CDTI implementation' 3.2. Financial contributions of the partners and communities -Fill tables 13a, 13b and 13c -If there are problems with release of counterpart funds, how were they addressed? Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condrtion No. Condition No. Condition No. Condition No. Condition 1. Vehicle 2 1F I CNFR 2. Motor cycle(s) 2l 13 F, 4CNFR, 4WO 3. Computer(s) 4 2F, 2CNFR b Lab 1 IF 4. Printer(s) 4 3WO IF I IF 5 S 2 2F 6. Fax MaqliryG)_ I IF 7. 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C) t-< (n cd o t< € d (h .o tr o() d o (d t! q) ?a 0) GF I I !, o oo!,)E I -If there are problems with release of counterpart funds, how were they addressed? Counterpart funds for 2011 were approved by the Governor, based on the effort of SSG, AG, Auditor General of the State and Commissioner of health who is highly enthusiastic about the project part of the funds approved has been release to the project for the implementation of CDTI activities in the state. Additional comments The project is aware of the need for counterpart funding and has used both the media and direct consultation to ensure that Government is aware of her responsibility in CDTI and to ensure that they are aware that tackling neglected diseases generally is a very quick way of addressing poverty and realizing the millennial development goals' 3.3. Other forms of community support -Describe (indicate forms of in-kind contributions of communities if any) Some of the endemic communities provide incentives to their CDDs although very inadequate, such incentives includes food items like Yam, drinks, cash and paying transport for collection of drugs from the health facility, also recognition of CDDs during celebrations in the community' 3.4 Expenditure Per activitY -Indicate in table 13, the amount expended during the reporting period for each-activity listed' write the amount expended in US djollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here 153'80: $ 1 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Source(s) ofExpenditure U State Government32s.t0 Drug delivery from NOTF HQ area to central collection Point of commu APOC55.995bilization of communitiesSensitiza Mo APOC5,238.34Trainin of CDDs APOC3,894.63of health staff at all levelsTrain APOC/LINICEF3,907.67CDDs and distributionion/MoS APOCruNICEF72.10IMon of CDTI activities APOC1 ,269.83olitical authoritiesvisits to health andAdvo 40 WHO/APOC, 14 SePtember 2009 Summary (reporting) forms for treatment 1,544.21 APOC Vehicles/ Motot!:ycles/ bicycles maintenance Office Equipment (Adminjstrative charges) 1,950.59 APOC Others: (Epidemiological surveillance and vector Elimination) 28,027.90 APOC Baseline suryey in two sentinel site 6,983.09 State Government TOTAL 74,599.93 Total number of persons treated 1,019,714 IEC materials 2,529.59 APOC -Any comments or explanations? SECTION 4: Sustainability of CDTI 4,1. Internal; independentparticipatorymonitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) ,/ Year I Participatory Independent monitoring ,/ Mid Term Sustainability Evaluation ,/ 5 year Sustainability Evaluation ,/ Internal Monitoring by NOTF ,/ Other Evaluation by other partners '/ Evaluation of Mectizan treatment '/ Epidemiological surveillance and vector collection '/ Geographical treatmentcoverage 4.1.2. What were the recommendations? Government both at the state and LGA level timely released of counterpart support to the projects. FLHF Staff to be sensitized on record keeping and data entry Training of Health workers and LOCTs on CDI implementation and the use of new format for collection of data. The project to establish more Community Self Monitoring(CSM) and Stakeholders Meeting(SHM) in the endemic communities o a o community mobilization towards giving incentives to their cDDs. o C) Mobilized women CBOs to assist in the recruitment of female CDDs in the communities to increase the number of CDDs. +.1.3. How have they been implemented? o Advocacy visit to SSG, State Accountant General and Auditor General and all policy markers at all level. o Community mobili zationwere carried out through visits, radio jingle and community meetings o Training of LOCTs and health staff were carried out for CDI implementation and to update their skill and knowledge on the reporting format. . The project is working to further increase Community Self Monitoring (CSM) and Stakeholder Meeting (SHM) in the endemic communities. . The project is working on writing of proposal to conduct operational research on non- participation of women to CDI implementation and CBOs to assist in the recruitment of women CDDs in the communities to increase the number of Female CDDs. 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Yes Was a sustainability plan written? Yes o When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofl 4.2.L. Planning at all relevant levels The project ensured that adequate planning was carried out with the relevant partners, these includes the State representatives, SSG, AG and Auditor general, Local Government Service Commissions, Ministry of Finance. This will ensure proper implementation of the CDTI activities and also ensure sustainability of the programme at all levels. The State also carried UNICEF along in planning to ensure sustainability of the project. 20t0 4.2.2. Funds As a result of effective advocacy and improved mobilization, the State approved the release of funds for the project to carry out CDI activities in the State. Some LGAs also release some funds for collection of items like bicycles donator by APOC and support of CDI activities. 4.2.3 Transport (replacement and maintenance) The project has requested for the replacement of the motorcycles that are not functioning by APOCAIGDO for CDI implementation in the State. The project is also working in collaboration with the State governments/LGAs to be fully involved and committed to the maintenance of logistics for effective CDI implementation. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented In achieving at least 83o/o therapeutic coverage and 100% geographical coverage for Mectizan/Albendazole treatment, the sustainability plans were carried out and this includes: - Community mobilizationand advocacy to the policy makers at all levels. - Training and retraining of health workers, LOCTs and CDDs - Implementation of Community self monitoring (CSM) and Stakeholders meeting were held in some endemic communities. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.L. Ivermectin delivery mechanisms The State project request for quantity of mectizan and Albend azole tablets for the State through SOCT, the LOCTs received their tablet from the State and supply to FLHF which will issue them to the community through the selected CDDs in the community for distribution to the community members. Frontline health facility staff are also engaged in other health programme such as NpI, malaria control and distribution of treated net and other disease surveillance were also involved in the process of Ivermectin and Albendazole delivery to LOCTs, FLHFS or CDDs at the community level +.3.2. Training There is integration in training, the training period for CDI activities are used to highlight some important issues in other PHC activities such as identification of guinea worn measles rashes in children and use of treated bed net for prevention of malaria. A total of FLHFS involved in CDI were trained on LF in addition to retraining on identified areas of need in CD implementation. A total of CDDs were also trained on Onchocerciaisis and Lymphatic Filariasis. 4.3.3. toint supervision and monitoring with other programs The project carried out supervisory visit and monitoring of CDI activities at different levels by LTNICEF Consultant, SocTs, LOCTs and FLHFS during PHC activities such as home visiting, immunization and other health related activities. 4.3.4. Release of funds for proiect activities The funds for CDI implementation was released Late in the year 4.3.5. Is CDTI included in the PHC budget? The current strategic frame work for Cross River State has Onchocerciasis as a component in the PHC/DC department and provisions have been made for 2006 to 2018' 4.3.6. Describe other health programmes that are using the GDTI structure and how this was achieved. what have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI' Other health programmes that are using the CDI structure to carry out their activities are the Sight saver, roll back malaria and distribution of Albendazole to control Lymphatic Filariasis. This was made possible through proper integration and training of FLHFS and the CDDs at the communitY levels. Some of the achievements include: - Increase in community participation and ownership - Increase in awareness and commitment of CDDs - Therapeutic and geographical coverage made stable The project has been able to use the CDI structure to carry out the distribution of Albendazole. And other PHC related activities. Albendazole distribution in 9 LGAs where co-implementation is ongoing. o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. what have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? o Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (at the same time?) o\oO c.l L 0) -o q) q o a .f, o a. - \o+ q q) \ s F< ,q) 4 q) L a) .a lg \) q q o q) Lq) q) ca q) ql o o 0) z Cg F $ r- c.l 00\o^ $q lt 0 c) 6g 0)tr F-O cO \o c\l$ I-r ll 0 0) c.)\o 00 od oo$ NN n"OO F- lll 0)() OD cq q t- c) () .o lz C! 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(d a L o k(d (d z L (g a o F (t) o(!L (! O o C) o-t) U)L C) o I q) o' q \) *A u 0) (.) !)a R(-) b0 a a C) o0 o O. C) rii F( o GF t 4.4. Operational research +.4.1. Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting period. No operational research was conducted during the period. Though TRC 6 session recommended for operational research on non-participation of women in community meetings and how to change community attitude towards Women CDDs' The project is working on the proposals which will be submitted in the TRC 8 session' 4.4.2. How were the results applied in the proiect? SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities STRENGHTS: a Proper planning and timely implementations of CDI activities. Good interaction and integration with other health programmes. Availability of working logistics and committed SOCTs Good working relationship between the project and the NGDO partner UNICEF' Some committed LOCTs and FLHFS Frontline health facility staff and CDDs were trained on Lymphatic filariasis control. This has built their capacity to enhance readiness for co-implementation of onchocerciaisis, Lymphatic and other PHC activities' The community so far treated and where distribution is currently going on have taken the responsibility of collecting drug in a nearby health facility. a a o a a o tt The CDDs exhibit a high sense of responsibility and understanding of the CDTI concept even in absence of incentives, most of them have resolved to continue doing the work with or without incentives. Increased involvement and ownership of the programme during supervision of distribution and increasing recognition of CDDs work even when no incentives are given. WEAKNESSES Poor attitude, lack of initiative and laxity on the part of the frontline health facility workers who are key to CDI implementation at the grassroots. Poor management of CDI records Untimely release of funds Transfer of health personnel Inadequate and poor quality of supervision at all level In accessible and hard to reach community Poor reporting and record keeping CDDs problems in record keeping Inadequate community participation due to weak community. Inability of communities to provide incentives to CDDs Communal clashes between members of the communities CHALLENGES AND HOW THEY WERE ADDRESSED. Increased operational costs particularly the cost of supervisory visit to the communities, fuelling the project and maintenance of old one in the face of inadequate counterpart funding and increased external support Inconsistency in annual census updates o o o a a a o o a a a a a a a aa o Lack of incentives to CDDS in some communities o Late submission of reports from FLHFS and LOCTs' HOW CHANLLENGES ADDRESSED ' . Continuous High level advocacy to SSG, Accountant General and Auditor general and other policy maker at all level. o Frontline Health Facility staff were trained and retrained for need on report o Increase number of CDDs and mobilized communities to provide register for proper census updates and treatments. o Communities monitoring and re-mobilization of communities supported by LINICEF sEGTION 6: Unique features of the proiecuother matters The strength of the Cross River CDI project lies with the communities who are supportive and are willing to go the extra mile to ensure that they receive their treatment every year. The project will carry out more advocacy, mobilization and general enlightenment to ensure adequate funding at all level both State and LGA levels. Adequate trainings on record keeping, reporting and data collection will be organized to enhance distribution of mectizan and albendazole in all the endemic LGAs.