Ekiti State CDTI/APOC Project annual project technical report submitted to Technical Consultative Committee (TCC): December 2004-November 2005

RESERVED FOR PROJECT LOGO/HEADING ORIGINAL: English Proiect Name: EKITI STATE CDTI/APOC. PROJECT COUNTRY/NOTF: Nigeria Launchins vear: 2000Approyal vcari999 2004- NQV 2005DEC 4 (s) 6 7 E e l0(clrcleone) I 2 3 NSDO partncr: UNICEFDnte submi.tte4: June 2006 Z Ii $ tI u I fl fl 0 8 FEV ?fi07 fiot lnr$ormotlon Tq-\lc Ao hnftrg \ Fsr Arcti+a Tecjt{ To: $i!'t c5\ eo? AUE Afu rc \ WHO/APOC, 24 Novcmbcr 2004 ANNUAL PITOJECT TECIINICAL IIEPOITT . SUI'MITTED TO TEC|TN ICAL CONSULTATIVE COMMITTEE (TCC) , DEADLINE FOR SUBMISSION: To APOC Management by ll Januarv for March TCC meeting To APOC Management by 31 Julv for september TCC meeting ATRICANPROGRAMME FOR ONCHOCBRCIASIS CONTROL (APOC) t / t t t t- t_ t t WIIO/APOC, 24 Novembcr 2004 r. t- t: 4.2.1, l'lonning at all relevanl levels """"r'r"'r"' """"""""'40 4,,2:,21, Funds,,l.,.,i.,.r,'r',,...,,..r,.r.,,"rri,':r""""r""""" """""'40 4.2,3 l rnrtpuri iiipiireirrt ond malntenance) """"' 't't"",t"" """'40 4.2.4, Olher,resources.....,,........ """40 4.2.5. 'lb what ixtent has the plan been implemented """"' """""""""'41 4.3, lN'l'li(iRA'11oN,'.,,.,.,,,,,,,.,'..,,...,,'.,,..,.,.,.....1""""""'r'r""""" """"""""'41 4.3,t, trerr,rrtiiiettiie,imechanlsmt""""""""" """r"t't"t""ttt""")tt"'t"""""""'4t 4,3,2, 'li'Ctlttlttg,,,,,,,,,rr.,.....rr.r'.,r.,.'r.,,...rr,.,r..',.',rrr,.,.r..'..rtr.rr""r "'t"t't"tt')""""""'41 4.3,3, ,loint supentlslon and monllorlng wlth olhir programs ,,,,, .,,,,,,,,,, 4 I 4.3.4. llelease offundsfor proJect acttvlller.""'r',"""""""""""'rrr' """41 4,3.5. Is CDII {icUaeA n'ttti p\c budset? """""""';" ""'41 4t,3.6t. Describe other health progro^^-ts'lhut are uslng the CDTI structure ond how lltis rvqs ochieved. What hne bien ine achievements? """"""' """""""""41 4,i,7. Desuihe othters lssues eonsidered tn the integratlon of CDTL"""""""""'.,""a.! 4.4. OpUnn'l'lONAl, R8S84RC11.......,,,...,.....,.,....,.'.,..,...' ,,,,,,.,,,.,,,,,,',.,...'t..,.,...." """""'o""'42 ' 4.4. t , Suntnnrize in nol more lhan one haff of o page lhe operallonal research utnelertuketr tn tlrc proJect area wtlhln the ropirting pelod"""" """""""""42 4.4,2. ttou, ,uui, iii results applled ln the projecfi """"""' """""""""42 stlcTtoN 5: S'l'ltENGT[|S, WEAKNESSES, CIIALLENGES' AND oPPORI'UNttrt8s.......................r........r.i......................r.....1.............................. rrrrr.,,,,,,"',42 SECTION 6: UNIQUE FEATIIRES OF THE PROJECT/OTHER MATTERS."""""43 t r1; f; t E E t: v f $ q t; $ II il I I I i , li / t WHO/APOC, 24 Novembcr 2004 I{ Acronymr rii APOC ATO A',lio CBO CI)I) cul'l CSM l,cA MOll NGDO NCO NOTF l,l.lc IilIMO SAIl SIIM TCC 1'OT UNICEF U G wllo IUC LOCl' NOCP SOCT MDP African Programme for Onchocerciasis Control Anrrunl Trcatment Objective Aurunl'l'ralnlng Objectlvo Corn mun lty-Based Organlzatlon Conrrrrurrlty'Dlrcctcd Dlstrlbutor Cornrrrulrity-Directed Treatment with lvermectln Corn mun ity Sel f-Monitoring LocalGovernment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization Nationnl Onchocerciasis Task Force l)rirnary health care llnpirl lipitlenriological Mappirrg of Onchocerciasis Sevcrc odverse event ,, Stokeholders meeting I Techn ica I consu ttative comm ittee (APoc icienti fi c advisory group) Trainer of trainers United Nations Children's Fund Ultimate Trealment Ooal World llealth Organlzatlon . lrrfonnnlion, Eduoatlon and Communication Local Onchocerclasls Control Teatn NatiorralOnchocerciasis ControlTeam . , State Onchocerciasis ControlTeam i . Mectizan Donation Programme' i a ,/ i t. vl WHO/APOC, 24 Novcmbcr 2004 li f; t, u .{ ft fi I E t: t t, Ii rr fi u IJ tI 0 lr tl t: I tI I Detlnltlont (i) 'l'otal population: the totat population living in meso/hyper-endemic communities witlrinthe project area (based on REMO and census taking)' (ii) !:ligible pSBt'lation: calculated as 840/o of the total population in mcsofrypcr' cndctttis cotnmunlties in the project arca' (iii) Annuql Treatment Objective: (ATO): the cstimated.number of persons living in @taCDTlprojectintendstotreatwithivermectinina given year. (iv) Ultirnate Treatmcnt Goal (UTG.'I: catculated as the maximum number of pcople to t . tt.rrca ar,t uany ir, n*sonryper endemic areas within the project arca, ultirnately to be reached when the project has reached full geographic coverage lnormally the project shoutd be expected to reach the UTO at the end of the 3'o year ofthe project). (v)].lrgJgpgth-g9yff08llnumbcrofpcoplotrcatedlnaglvcnyearoverthctotal populntion (thls should be expressed as a percentage). (vi) Oeogrophical coveraqe: nu)nber of communitles treated in a given lqr 9v9r tlc ffiper.endemiccommunitlesasidentifiedbyREMolnthe project area (this should be expressed as a percentage). (vii) l.nteqrntion: delivering addilional health interventions (i.e. vitamin_A supplemcnts, otU.*turote for LF, icrcenlng for cataract, etc.) through CDTI (using thc rame systems, trainlng rupervlslon and personncl) ln ordcr to maxlmicc corh e-ffectiveness and-'cmpower communlties to solvc morc of thelr health problcms. This does not include activities or lnterventlons carried out by community distributors outside of CDTI. (viii) Suptpinabilit],: CDTI activities in an area are sustainible'whci ihey cortlnrlc to function effectively for the foreseeable future, with high tr?atment covcrage' integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government, (ix) Conrmunity self-monitoring (.QSM): 'l'he process bX,which the community is @andmonitortheperformancedfcDTI(oranycommunity. hnsed lrealth interventlon programme), with a view to ensuring that the programme is bcing executed in the way intended. lt encourages the cbmmunity to take full r.rpr'',rlbllity of lvermectin rlistribution and make appropriate modifications when necess0ry. vI WHO/APOC, 24 Novembcr 2004 ti f; t: E t- t; t; Ii rl ti u IJ II il U )t L:Li r! t: f tl FOLLOW UP O]I TGG RECOTTE]IDATIO]IS Using the table bclow, fill in the recommendations ofthe last TCC on the project and describe how they have been addressod. TCC rcssion - (Please add more rows I FOR NCAAPOC MGT USE ONLY ACNONS TA.XEN BYTIIEPROJECT TlCC RECOI}IMENDANONS Nunbaof Xa ntaffin lnthcRqrt Damgsd Mffit1@uc rrepairod Rrphcornpdr MOrcSdc I MatCDDshave bauaincdthoqh still belowthe rcquf,red ratio 6rc to inadcquatc fiEd. 2 IncracmbcrdcDl)r perpopddm MqefcaulcCDDs wereinvolwd Prmdcllvolvcncntd fcrrlcCDlh 3 Advocacyvisits wErc paid to the Policy ' Malgs bdh inthe StdeaodLGAs 1 FsncroHrht Strtcrd LGAhrdr LOCTs andHealth FacilityOffioen wcre traindad irryumof mnitaingwas stcssed. Cordnwtnlftg hvolvhS.i nottorlry tcdtlrur*cndLGA rnd fi.ltttyla,rnt 5 Ccrs rydate*as dmc inthnportfug yrrtbq[not 100% amratc. Crductrpopuldm G:l!E a thcdmlnltr rccn ndtsbclurn 6 Th€rchts b€cn irryrovamt in fie prqiect 7 Cctirm cmtrdrdq rd lnprovhgthbycen rdlcwmcu6 WHO/APOC, 24 Novembcr 2004 11l H F] )tr tr t. I f Erecutfue SumlnalY Prqaru on F.xactfrvc surruJu/ty of the tqort ln rut nnrc thon one page Ekiti State is one of fire States in thc southwestqn part ofthe country and is locafed in the B Heahh Znne.It has a projected population of 2.5Million. There are 16 LGAs in the statq all ofwhfuh are imphmarting cDTl. The main indigenous populatitrn that con$itutes overwlrehningty the major €ftnic Soup in &e State is Yorubas' Individuals from other ethic grouPs such as trc Fulmig Igbiras, Ilausas and Egedes have migrared into the State and are cohabiting wift indigsmes. Christians form a high pefcentagp of the population ofthe State, so population moveme,lrts always take phce during religious rctivities or celebruions like Christmas ard Easter. Mor€oy€,f, tlrere are populrtion move,ments during muslim celebrations and during the fuming / trarvesting season. Closure and commencement of school periods also brings about some populdion movemcnts in ft€ Statc. During fltese p€rbd$ ftGre is a seasonal migration ofpeople from one plrce to another' The prevalencc surv€y of lgtt-1990 and the srbsequ€nt REMO of 1994 and 199g12000 revealed thd trc Stat€ is enderric for Onchocerciasis. The total trget populdion with fhe rgefrt op1uils update is 1,091,000 fi344 communitios' The UTG is gl6,1p10while ftc ATO for the reporting period is 916,440. Tredment commenced in the projcct area when it was still part offte old ondo stat8 with assist0oce from IJMCEF ad NOCP using the GBIT approach. CDTI strategy was initidcd in 1999. The project trainod and rrtrained 6 socTs, 32 LOCTS, I0PHC Coordinators, 3+z Health worlcers E1x6g37 cDDs thereby achitxing 63% overall for its training objectives 344 communities were mobilizod to selcct tteir CDDS ud collect moctizan fiom designated points. Cun€Nil CDD to population ratio stands at I CDD to 978 p€rsons' A total of 85e9t0 pcnons were treatsd in 344 oommunitie wifh2,l58,42l mcctizan tablas for the year under twbw, thus giving a geographic cov€ragc of l00p/o and thcrapeuti: covcragc of 78o/o. The numbertrded represented 93% ofthc ATO alrl 93% of the curent UTG. Mqior polisy makers md community leaders d both LGA md t- 9 WIIO/APOC, 24 Novcmber 2fi)4 f E I I E I: t. t; Ij r? I q II I l ii tr t: I tl nu fi fi t. t: t; ti H II tI ft tl I tI il , corrrnrunity lcvcl were nroblllzed in vorlous advocacy meetlngr to support CDT|.prdjcct ln the State. The major challenges that faced tlp project inctuded the suspension of funding by APOC manngenlent throughout the year, and lnadequate funding by other partners, both lcoding to inldcquote irnplementatfon ofl ptanned actlvltles. Other challenges were ddmand for incentivcs by cDDs, CDD attrition, and transfer of Health workers from one LoA to another. These challenges were addressed by continuous advocacy for release of funds by partners, re-constitution of the present SOCT coupled with leadership changg distribution ofumbrellas as incentives to the CDDs, trainingof new CDDs, trainingof additional health workers, t I I ,E ,/ t, t.i i' $ t ) l0 WHO/APOC, 24 Novcmber 2004 tl: E t, I t I t t fi f nti ti ti t: ) I; SECTlOil {: Background lnformetlon '1,1. Oononl lnformrtlon l.l.l Descrlptlon of the proJect (brletly) tj E ti ti Li tI U I] I l Geographical location, topography, climate Ekiti State, located in the southwcstern part of Nigeria, was c d owby presidcntiat fiat frorn Ondo State on October 1996. It covcrs an area of approximately 5,500 squarc kitomcteru while it has a blo-climate of rain forest in the southern area and Guinea Savannah in tha northern parts. A greater percentage of the landmass is made of ricks and mountainous reglons, 'l'he ralns cornmence ln Aprll and cnd ln October, whlle the dry season rtartr from October ending by March. Pop ulailon acfivllles, cullures, longuage E:. .: d \ tt ( i T il WHO/APOC, 24 Nov embcr 2004 "n a I,r,hc yorubos sonstituto ovcrwholmlngry tho maj.r cthnlo group ln the statc ond lt ls malnly the ln{!ge1o-uq populatlon-,-How cvcr, lndividuals from other ethnic grouis such as the fulanls, lgbiras, Agatus, lgbos, Hausas and Egcdes have migrated into the state and are cohabltlng with the lndlgenes, Wlth s ourrent prdccted populatlon of about 2,9 mlllion, the State is divided into 16 LGAs. Settlement pattern is compact with population densities of between 280 , 350 persons/ square kilometer. Farmsteads exist but are seasonal. Communlcolhn sYslem (rood,, ) It6ads between major cltes are ln good condltion, but accoss roads to most of the cndemic communities are in poor shope. Some are not passable during the rainy season. Despite this, transport by road remains a major means of communication among the communities, The electronic an{ print media are also vcritable channels of communication. Within thc communities the town announcers and announcements in churches / mosques communities meetings are preferred means of communication. Admlnlslrollo n slrucl ure ,l.he State is made up of l6 administrativJ units known as localOovcrnment arcas. Each LOA is headed by a Chairman, usually etectcd, who is assisted by career officers. Thcrc is a legistative arrn made up of elected councllors from the various wards that make up cach LOA. Beneath the ward levels are the communities. At the State level, the Ooverdor is thc chief exccurlve, and 1e ls asslsted by an cxccutlvc council madc up of commiesionerg in charge of vorious ministrios. \ There ls a legislative arm comprising electcd persons from the LGAs. ./. .. . .', Ileatth system & heatth care dellvery @rovlde lhe number of health posts / centers ln lhe There is an official pHC policy and structure ln the projcct area. It is a system of heatth carc services where community participation form the mainstay wi\UPWrt from the State, Local Government and NGOs. Levels of functionality howe{er vary across thc State. Scattered throughout the State are various health facilities ranging from health posts to hospitals. There are Sl2health facilities in thc project area. Nunber ol heollh sto![ tn prolect area ond numher of heollh slotf lnvolved ln GDTI acilvltles, Table t : Number of health staff involved in CDTI (Please add more rows if necessary) a ) .d 12 WHO/APOC, 24 Novcntbcr 20Ol t- )li C I, I procurcment and delivery. Tho Zonal and National Offices assist ln supcrvision, monitorlng training, advocacy, Mectizan procurcment and evaluation of the programme. The communities play such rotes as selection and remuneration of CDDs, collection of Mectizan, tlctermlnatlon of motle and perlod of drug dlstribution, census update, Mectizan distributlon' and recortllng ond reportlng of treatments. Stote plans ll ory to mohltlze lhe dote heglon / tlktrlcl /LGA decklon .mohers; NGDOS, NGOI, CBOs la ossls/s ln CDTI lnrylemenlallon, T'he LGA policy makers were enlightened and mobilized to support CDTI activities. The Hon, Commissioner for llealth, the Permanent Sccretary and the Director of Diseasc Control mobilized the State policy makers.so that each LGA can contribute N 50,000 for CDTI ccnsus update 0s a first step towards cqunterpart funding. The Hon Commissioner and the State Onchocerciasis Coordinator moved round allthe l6 LGA to enlighten and mobilizc thepeople to support CD'l'l activitiQs. The Driver's union, CBO and market women association were also rnobilized.'l'hese will be further pursued in the corning year. The NOTF/APOC was invited to,pay advocacy visit to thc Ekiti State Governor and rnobilizc him to support the CDTI programme, but this is yet to take place. This high level advocacy visit shall be requested in the coming year, The Commissioner for llealth, Pcrrnancnt Sccrctary and Director of Discase control have plans to mcet thc LOA policy rnnkers and entighten them on Onchocerciasis control and seek for their support through the Comlnissioner, LCA Civil Service Commlssion. ln addition, the tlon. Commlssloner for Health, Permanent Secrqtary are working in conjunction with the $tate Pltly flkers on how to deduct moncy from source into the PHC account of each LOA. As usual the communities in I6LGA will continuously be mobilized including the drivers unions, rnarket women associations and CBOs. These will be followed in the coming Year. ,/ t4 WHO/APOC, 24 Novcmbcr 2004 I fi $ I I f; l I I fi FI II I ti il I I Ja l, ! oIEI E T BlrhI E E * l. E $ ;I B' rIli i, E B ,! * s I III otr B. m r { H. xI & TtIt 'gEE tt, al, B a g B E HIg H1 ? {I r I H F H: Er EE t, Or 1;\olrl IrE' Ot ttl IJ Or {I E ItsLI t,Atl tac { t,O E 1\,ttrL Ar F'O "}tr- t Or aH B Et,N'c { oitrIO E trr HO d t^t^t I ,oF{ Or F}., l-I il[ Ht,l t-(, f-{taO It9 to t-o Ft.) t,6 tr f,l I i \otF.a z a E r oxt gIII t H T taI lro dil r t TI t tr ,c F'{ ts}.'lJtq0 llF. I Ic) I6 o Ft\) ra,6 5Fl,otr t, orI,\otr, ? llI I t\,t,b56\ o\t,t| t-6 {5\oI IO ,F.{6 IJ65t O6 F. rJl5 s wt9o rA OrLtso L,I 1^ o dt, O , I I a I '1llr I a a t,o L, E I I I I{ Or[J50 6(,Lts6 {5 u s/ rrr C) rJt 1., C,\ 1r'tou, t!II [irIT' 6 Or aF tJrl O}\' L, ts t,Fltsc t,abto t,l,r 1,I Or tr,5 ttsa {f4t tntsO Io E{6 tI5tH { CN tJtO 7 Er B) B tl\oI\o 6r .li,\o E sa B t., .P dO eJ6 3[ls:-D\o I{trO5 5\obt Nt-lJo{ NO \o\ot, 6ts{O\o L c,L6\o l-uI Orrr)r tt6\o 3 o5o t, tj t; t fi I ti ti ti u ) t, ! L I s u H x zo * t, F I ti H, lj tJ ti I] I u I I EI 3,og (,l t,rbts ?t 3 t, ,C fI tO^ f,to ,d\o t,Ot TF.hl O C^bN'I Or)) "It,N ts "3 BO a I ts EtsI a C'r c,NI 6 -Ltt\, ilb Orct ur- 6oL, \ots '|IuO t i q. lI r & t' $r I I t & II I I li r I Nr t B It Higl r tq r ,lt Iq r I I 4 o.op f,I{ F Eo fl B g. r { B. 00 E D F H!{| z .P * E. r g tg r EL E E' r s o Bo g o [HEFt ellll i. figE itI EE d r .i o r $ t o E oHl f, L * B r EEe B. B B. r E ,9,I I H "8I Lo l. -I zo o\ s a Hi,T zo Er].) E lr E[; t: u I n ti fi I f t. t, I ti H. fi tj tI lI U ll I ) ,ilH o U U z o Ft F G' r t O OrbNl oIt o -l 6 - Nla II!I o 3 o a stI ot ot og ,l p rl a { f 3 oIf,t a o|t Ig aI r+ -o o lETE I6'H E' H+s E: ti i![.I":Hss' $E$9,qB: I83,fF: -lttbHd6Glnstr E,B Fl' \ *IgTdTit1r '5$ AIhr \d *.F8Eg, &?rgXH,B,f clBx' 1'o= ,s* (l E E' nIr!r C g o 5oca g t! r 00E3 o o lr Eti I' I I fi ti t: I) ! -1 I I t , , o 'uo C) i,,+ zo d5I b.) F L ti H ti II tI II II U I I F E H aIFe z F o E xh7tl, H7 o E Bo o B z a P Cnh HI 4 F,ttt -l x 'J 8cFlrl 4 t?,o .l H T Bg E z bI Ho 5Lq F o ! 2 n , 7 2 ts , ei ,4 , c F 2c F ,d F h ,ct 2 4 2 F D e DF( Dd nk > z n tg 1fi gH ET i. 8. i; Zit 3to Fo Fo 3 xI vo vo xo 7o *oE a ho 7o Fo o AE "1 E F rE F E F E F ts F tsD F ru F t F ED F !u F EF F E F E *t F IH H E. E,It ,Q 3 3 o iE "7 9 tl, 2 trt i t?, H at?t c2 trt 2 trl c2 tt, 2 t?, , tr, z t?, 2 ln 2 Eg BH. ooE u, eo Etr Dr|o F F EF cF ct F cF cF EF F F F F o o E ,E T. o , EoE * oc(n ,.1 oca -l oco -l e o a *t C octt{ C o Ca .,| C oco -l acorl c o Ca -l c oco -l d ocotl o Corl e o C,a{ zg aH Ufitrd' 3.t Et: o E U F' !") U tr,o U tr,(', Utt n otl,o U tr,o u F Utl, r) U m o U F'o U tf, n Utto Hn r?, E FI F o o E E E o ,g o mI rA ft, 'Ei o mI ott,T o tt,ru rr o trtIE' ,.1 IA mE !'l olt,E :r o E iJ o E .i Q Ei o Ei o t?,ru *l e,?a* PE' oa E zJ.t,la o E U tr,o U t?lo U lrto g Mp U tr, o t ta o U tr,o U tUp U Irt r) U tf,o Utl, n Utl,o F ig E ^$fffiH o CD frlrt FU o Uc 2. lDt.o U 2 zC F z F 2. F Fo Fo z Fo :u F - :u F - Fr 7 F 7 F F C z. rn -2 rn c 2. rn e - - er Co (n -i oc(h -l o o .l lr'o U rr, a U rr, a (r) rr, 'u -l a lr,:U *t a lrl -l U rr,O U rflo UIt !') > ''l-(! PBI+(D <=' +O- It ='a :.: <aDo_. .o !9' Fg Dl E. iD ID D<tD al 9(DDls =t;rEXq6- p (D !,(, D) .D ; rd o !9 .A(D (D N D' I raj xt (! (D 0 Ir t I ti tI tI fi ti I) ! t oo I o 'uo _o t'J5 z o o d(! tJ o5 u I tI H,- tJ t] tI I u tl fl IEIi I, ti ti n tt tI ti t: t: ) tl tI FI IJ tI fi I I II I ! i 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the urrent year; the reason(s) for undertaking the advocacy and the outcome. Describe being faced and s uggestions on how to improve advocacY. The top functionaries at the State level inclucling the chairman and key staff of the Local Government Service Commission were mobilized. As a result of the meeting held between NOCP ancl Chainnen of Local Governtnent Service Cotnmissiorr at Abuja, the LGA Chairmen witlrin the State were mobilized to support the CDTI project financially. The Director DC and State Coordinator met with all the LGA Chairmen together in a meeting at omuo-Ekiti in Ekiti East LGA and this was followed with advocacy visits to each qf the LCR Cttuirmen. These brought about the release o1N50,000 by both Moba and Ikere LGAs for the support of the progru,rrn" to train CDDs. Other Chairmen promised to release some funds in 2006. Meanw'hile-, the State Governor approved the release of I million Naira for the State programme. An advocacy workshop initially planned could not be caried out because of inidequate funds released by the State Government and suspension of funding by APOC. At the community level these groups of people are rnobilized: The major constraint in achieving desired results is the rapidity in changes of policy makers at the LGA level. To improve advocacy there is need for a high-level advocacy that will target the chief executive of the State. Production and airing ofjingles on radio and television should be done. i Tfris will be completed by other Radio / TV discussions on tlre disease and control strategy. Additionally, there should be continuous advocacy visits to the prominent traditional rulers and policy ntakers at the Local Coverntlent levcl. LGA Traditional Rulers Opinion Leaders Religious Leaders Market Women Grps Other CBOs Ado Ekiti 23 32 3 l2 2 Efon 8 5 1 7 EkitiEast 37 l6 4 l5 J^ Ekiti s.w 24 27 5 9 Ekiti west t7 l3 3 8 Einure t2 6 7 t4 I Gbonyin 1l 8 6 8 2 ldo / Osi t8 23 4 l3 2 Iiero 32 34 J 2l Ikere t6 t4 4 ll Ikole 14 15 2 l4 Isp/ Orun 8 l3 I 4 4 2 Ilejemeje 8 8 l3 I Irgpodun / Ifelodun l4 22 2 l5 Moba t2 l8 I 9 2 ove 6 ll 2 8 I Total 260 265 52 162 16 19 WHO/APOC, 24 November 2003 )2.3. Mobilization, sensitization and health education of at risk communities Provide information on: , The use of mectia und/or other local systems to disseminote informalion i No media was used but megaphone was used to dissenrinate information' Types of IDC materinls used 'Postal were used. Mobilization sensitization and heallh educotiott of wornon and minorities - method and response Wittrin the project, there is an active participation of fernale members of the community at rnobilization meetings and during health education sessions' Sotne of the women have volunteered as CDDi whenever serving CDDs expressed unwillingness to continue due to lack of incentives. Some women have met with community leaders over incentive of CDDs while some gave out money from their personal purse to support CDDs. Response of target communities / villages Communities have responded by coming forth to collect their Mectizan tablets' Members have ,expressed willingness to compiy with Mectizan treatment. The communities have fulfilled most of their reiponsibilities under CDTI such as selection of their CDDs, giving some incentive to some of them and determination of the moclc of distribution. Accomplisltmenls . There is an increase in awareness of the comtnunities of the benefit of Mectizan, and its continual intake over a long period of tirne' . Involvement of more CBOs in the implementation process over what was obtained in the past . There is an increase in awareness of the roles of partncrs / communities in CDTI . The communities are still very much willing to keep on taking Mectizan provided it is available. l[/eaknesses / constraints . Inadequate funds to have more interactive sessions with communities. . Inadequate feedback to communities, again due to death of funds and partly poor "or,r',it*.nt and non - involvement of health facility staff o perception of some sections of the community that the programme is heavily funded and the community is being denied its fair share. Suggest ways to improve mobilization sensitization of the target communities- . -Equipping tocaiNCOs, market women, religious leaders, road transport workers and other "*111unily based organizations with necessary mobilization skills will help a great deal in improving mobilization of the communities ,. There should be regular meeting with the community leaders by health workers. . The project intends to collaborate with relevant sections of the ministry of information and culture in order to make use of appropriate staff with skills in community mobilization 20 WHO/APOC, 24 November 2004 Etl I ft fttI fI fi t; I rl Ii F! ti rI [} rI I tl il E[; I E tj fi I: Ii ,I 2.4. GommunitY lnvolvement I Table 4 ---i- Communities participation in the CDTI (Please add more rows f necessary) Comment on: - Attentlsnce offemale members of the communily al heilllt education meetings Female members of the community are allowed by men to attend health Education meetings and are allowed to participate and give suggestions in the mcetings. I ! Distlict/LGA Numbcr of communitics/villages with contnrunity ntcntbcrs als supcrvisors Numhcr of CDDs Number of communities /villagcs with female CDDs Total no. conr nr u nitics in the entire projccl nrca Ilr Nunrbcr with community mcmbcrs ils s u pc rviso rs Bs Pcrccntagc llr= I!s/ B. *l0o l\l a lc CDDs llz Fcnralc CDDs llrt Total l]e= B7+Bs Nrrnrbcr of corn nr unities rvith femalc CDDs Bro Pcrccntugc Br= B,o/8.* 100 ADO 10 5 50% 108 20 128 8 800h EFON l2 10 87% 120 l0 130 8 67% EKITI EAST l7 9 50% 100 40 140 t7 100% EKITI S WEST l0 7 72% t99 9 208 5 50% EKITI WEST l5 l5 100% 183 7 190 l0 67% EMURE 9 9 100% 129 l6 145 9 100% GB9NYIN 9 4 40% 270 20 290 5 55% IDO/OSI l5 5 45% 175 l0 r85 8 53% IJERO 58 49 67% 200 20 220 l5 26% IKERE 36 24 67% 122 8 130 8 22% IKqLE t2 3 27% 248 l2 260 ll 9z%o rsE/oRUN l0 6 60% 172 l8 t90 t0 t00% IEJEMEJE 48 48 100% 82 8 90 8 t6% IREPODLN/ IFELODUN l0 7 7t% 175 20 195 6 60% MOBA 58 53 9r% 162 l3 175 t2 2t% OYE l9 l3 68% 175 l5 r90 l0 53% TOTAL 344 262 64% 2620 246 2866 150 44% 2t WHO/APOC. 24 November 2004 I' I I IJ E rj I] tI t iI rl I; I tl u fi fi tI ,t: -Ingenerul,ltowcloyourotetheparticiputionoJ.Jbmole.membersofthecommunity mcetings wlten COT1 issac.s are being discussis (nttendanca, participation in the discussion etc).I Women are always allowed to participated and evcn contribute to the decisions during seneral community *..ii"g- But on special or key decisions- on community matters' elderly h;;;r" usually the decision makers and women do respcct them' - Incentives provided by contmunities for the CDDs Usually, incentives toCOOs are in kind iue to the poverty levels' Some communities give cash since there is cornparison with other inccntive-giv.ing community-based pl?ql1*'"t such as the immunization programme. Some communities are however yet to glve any incentive to their CDDs. - Attrition of CDDs, Is attrition a problem for the pr.ojec!? If ye.s, how .is it .addrxsed? Attrition of CDDs occurs within thJproject, Uut the tite is not alarming' Some of fhe younger CDDs secure admission to higher institutions; a few leave the job due to lack of lncentives as they "";;;;il; Cpff pto3i.t with immun tzation some few elderly CDDs die; {,;il'r;"jj;ffi. r;;jobs and therefore abandon the distribution' Sometimes' the gommunity leaders were mobilized to select new CDDs' i Other issues I ! 22 WHO/APOC, 24 November 2004 I; t tI E fi I] ! tI fl il ?.5. GaPacitY building -Describerheadequacyofavailableknowledgeuhlemanpowerat.alllTell., The availabl.;;;;;.r"for GDTI implemenlation is enough. Allthe.he.alth staff heeds to be trained and made to see cDTl progamme as part of their routine daily responsibility. The pro;."t needs to train morJCDDs to replace tltose that went away and reduce the workloaO oitne existing CDDs thereby reducing demand for i,centives' tI ,I . l|there ?requent transfers of trained staff occur, sfak what .the proiect is doing' or intends tro clo, to'remedy the siiuatioi. (The mosiimportanl issue lo describe is what measures were taken to ensure adequate CDTI implementaiion where not enough lvtowledgeable manpower wa's available or if staff are frequinlly lran,sferred during llrc cour"se oJ'the campaign)' Staffs ur. uruufiy ,iuUf.. During this reporting year, s.ome staff were transferred due to bstabtishment of new health facilities. Th.r. aie ptanJto train more LGA staff and health F;";rffi#';;.dr;" the area of supervision by each hearth staff and replace the transferred f#"r"ni];"rri""i,"re ptace dueio insufficilnt funds from partners and suspension of funding by APOC management throughout the year' I t I I II H G u I} il 0 u I 23 WHO/APOC, 24 November 2003 oU AF rn ki ooUU zz. r- frJ rn tU rr, 6 an oFC 2. X - IrJ x tnv rn rn o Uo oa TD z 2 rr,7 n lr, rn E .J rna -l rnX ..1 ? trla -l rr, x .l lr, a -l rr, "noz U U F o u) a (, t, u) UJ (,) UJ a UJ a ,la z E(! o -:b =' .r(Da l. q D tJ t.J N NJ N) N) N) N) N NJ N) NJ N) }J IJ N) l'.J tJ N) z o.F I ^.1 ^ll E o N) h.J NJ l.J N) N I.J N) t) N) N co N) oo NJ @ N)6 NJoo N)oo l.Joo NJoo N) co N)@ N)@ Noo 196 NJ 00 l.J co i o o a(D =t= -1. =E-* 3q :TE sgttt =(! NJ { tJ tt)N t.){ N NJ @ 5 -.t \c tJ o\ \o NJ NJ5 +- tJ N) o\ \o oo tJ (1o- c.'.F\ ;-19 e.allli \o -l oo t-J UJ i.J N) \o t-) N)o\ t ^? .-, : sq o =-ot olr 3 = o z ;tD ai.r 8o' '6 a'! FI199='(! q o o\ oo5 N) UJ t')o\ o\o o. \oo\ co -J{ \o O-l;a z (D ot Uo !, (!ao\o\ o\ o\ o { N) -ltJ 5t! sl.) UJ N6 N)@ t, o\ (, o\ o\\o o\\o o\ o, o\o\ N N) o\ N) o\{ 9F OF oi s,iF"'- 5 @ E ca -J\o {\o 5 o, 5 o\ NJ5 t.)5 Lt; t I l.lla)ld l.tl* ;Ft p0 0c F) o a +) -ot' o (D o U' t o -l (D o p) o3 e(\ s V1(\ $ S o\(!\ < U2 (\ o(\ U,4 .\ b..J+ o '!o _o N)+ zo o =<,-(D tJoo H rj t3 fi u tl t] tl I ti I nt; t: f 'r. t t I I ! I l.J rn -lo 'l F 56 u I (,J h) t\) (, },J tJ oo s t| (D o 56o N) @ 5UI o\!.)\o\) N -Io s (D o E (D EI (, A bJ Is a o (! -to\(,l -t UI \o(, tJ \ot,{ EN 5N o\ s a (D o o EI ? * s o I q o o D' (D (o o D9 (D tD(o {(D tD D) (D (D DC(, a! tDx !9 o (D D) (D D) tD ot) o Fl NJ lr f; I ri ri tI G t; t: t- \ o a- oI o\ oa o a o ; E. a ) I I o E q! o o -c) N) .L zo o (t o N os u G FI lj t] I} tI 0 0 I 'tl Table 6: Type of training undertaken (fick the boxes where specific training'was carrie cl out during the reporting period) Any other comments 2.6. Treatments ! I I :J Ij r+ IJ I} tl t] 0 tl il Trainees Type of training CDDs Other Comrnunity members e.g Community supervisors Health Workers (frontl ine health facilities) MOI-l staff or Other Political Leaders Others (specifo) Program management Hpw to cdnduct Health education x x M3nagement ofSAEs CSM I SHM Ddta collection x X Data analysis X X Report writing x x Others (sneci fy) 26 WHO/APOC. 24 November 2003 l-ll9'td lta l-r ;Ft opt o F) o- U) rrl tJ) d o- (h o t- o a o) F9 (D F)tn o) 0x e(\ et,(\ a$ S o ci\ eh S(\ o(! h V1 D .\ b.J{ lr tl t; I ti ti fi fi ti ti t. I I tj ) 80 o to ,o t.)+ zo .D = g(D i.Joo+ fi I lI lI tl I I x3 >6' rrJ 'rJoz Uo lnXI c/) rrl ra>Xa- -l= rn F lr, rr,X .l U o oa o E!oz 2 x rr,FE rr,Fo a Fl vC 2, Fot' rr, o EE fr, 11 rr,t- LlJ - rrl rn rr, lsgE* B! 5 3.og T TQ- -J NJ\o (Jt o(,t \ou)o\ UIooo N(,oo 5oo EBs tJo {\o \o €t'J U) o\o 5@ o(,l@ oory -<dc PDEd rrc 5 0 x @ 1.r 8Yb l.J oo -l \o (,(I \otJ U)o\ (rt@5@ o@ oo 5 c olh O s U lt c8 ^:q.QSE pjvD:l-q3= A' o\ OO\o 6\ O s o\ \oo\ oO s oO 6\ Oo s 5o s OO s 5O s Oo o\ O s o s J 5=Z BN ^ !L3QyqE5'.t +!qB'r N r' ='5 s o (,) o\ \o UJ o\ 5 o\ -l5\o\o\o @ UJ 5o f.J t'J5 o\ @ N) UJ t'.J ( o^\ 5 o 5 oo{ o\ @+ o\ @ o\ 5 UJ5 oo -J(r) (-lr oo o\ 5 UJ N) -lo\ l.J5@ E$i U)5 @ o\A tJJo{ UJ @ (i\o \o5\o o\f'J \o\o\o +\o oo o\ N N)o@ { t..) UJ o\\o o\\o 5\o 5\) trJ @s 5o 5 o\@ 5 o\ N)@ \o\o Ur o\ -t@ -J (,l o\o()) o\5 o5@ t.J \o o\ l, z -aeeE3 rH 5 o\ t.J l..J5\o N o\ \o -J@ f.J F.J \o -J5 o\ UJ 5 5 $ o\ N) o\ s o\ o\ -IN) -t o @ o\\o 5\o UJ5 L'I{ NJ 5t.) tJJ\o(^ 5(,l 5o @ o\\o UJ @ o\ U) 5 tJJ o\ U il *l o:too sq€v9) oGrtro=. o o\(,l o\ o\ \o \o -oo\ \o -J\o ooUf\o @ N.) -o o\ ooo -6 o\ @U) -o o\ oo5\o oo@\o 6\ -I\o\o 6\6\ 5 -l -o6\ -J -oo\ I s I 4, di, XE HeIET =A -e" IIIII .ZCC E+ o^ NJo(,l o 5oo\ou o\o\] tJ)(,lI \o az cni BB II I 40 'o o<o 66 Z STHBBEE E ieeff E Isrg ; I I I I III rl oFl F o rr, UJ5A \o UJ+5 \o UJAA \o oo\o o\ oo s o\o ooo @ o\ o N)5 \o o\5 UJ oo *J N) t.) o\o 6(.,r o \o6o {\o 5 N) {@ -oo\ \otJ s u.)o I tJ oo li E ti t; fi fi tI G $ G t E E T ) o ,! o _o tJ5 zo (D 3 o-(D a tJoo5 T T I E r u I Jr I I Nunrber of PeoPle treatccl x 100 T"t^l p"prl"t'." living in nreso/hyper-endemic QeographicalcoveragerateNumberofcommunities/villagestreatedxl00i(%)iotalnumberofmeso/lryper-endemiccommunltlesaS identified by REMO in the project area Number of People treated x I 00 Annual Treatment Objective Therapeutic coverage rate (%) communities within thc projcct area ATO coverage rate (%) No SAE case to report ) % UTG ach ieved Number of peorrle treated x I 00 , fotat *,"b"*f p*ple to be treated in rneso/hyper-endemic aieas within the project area (UTG) ATO = The esrintated number of people living in nteso/hyper-endenic areas rhu a GDTI proiect inlends to trual teith ivernrectin in a given Year. llrG = The nttxinrum nunrber of people ro be treoted itr nreso/hyper-enilemic oreas wilhin the proiecl area' ultimately lo be reached when the proiect has reachetlfull g"ogropi'i'riiiiriiitge lnornutty the proiecl shoutd be expected ro reach the II,TG at the entl ol the 3'd yeor of the proiect)' 2.6.1. Treatment figures - If ttre proiect is not achieving 100% geographical coueruge and a minimum of 65% ' llteropeulic coverage or the coveragi ro-te ii /luctuning, stile the reasons and the pluns being mude lo remedY tltis' The principal reason why community coverage has not been stable is that the project is faced with the problem of inua"qrute mobiiization of conrnrunities by health staff due to lack of counterpart ftrnding from LGA' 2.6.2 Whst are lhe causes of absenteeism? Some of the members in the communities might have gone to their farms or trading places. Unfortunately these absentees are not followed later' Some non-indigenous persons also travel down occasionally to their hometowns, and arc rnissed out during treatment periods. The major issue here has to do with ineffective or lack of mobilization of community members. 2.6.3 lYhat are the reasonsfor refusals? Refusais are not "o,riron 6".uN. the community leaders always. intervene' Some of the community members are even eager to use mectizan tab twice because of theeffectivenessofthetab,whichtheyhaveexperienced. 2.6.4 BrieJly describe all known and verified serious adverse events (sAEs) that occurred during tlre reporfirrg paiott und provide (in table 8) the required i nfo r ntatio n w h e n uva i la b le' The projlct is unaware of any case of serious adverse event' . In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box' t: I I t, t; ti ti t] II tI tl I U f,lo 29 WIIO/APOC, 24 November 2004 Forrnula for computing therapeutic and seographical coverages ti f ?IJ; ttt(D laD 1 lee DT ;8,rE(Dov) id F+)oE r-t o (n F)a- (DFt th(D (D (Dr 0 (A t-rj(h F' oo C, x(D o- a- tst 0c (D Ft o o :1 0a EoE oA e(\ C1(! s I \(\\o s si G o(\ ?1 a .\ It Cr)(\ a.G\ .o (\\ (\ (J.) C trII ti I tI t: t. t I fi ) I IJ o _o t-Js z o o d(D NJoO5 Ij I I} I u g 0 (A 2 + oq(D a o x s D) oao o+) oI 0q iEF el F'Ag N@@tsir<Y '6rIB6=iaH 5-.o-3 a 3 .o $F*H$ H'fr'8. F q-E.q o 5' ;i+gubooa);:J 5 0 .r=bo -3S- 5 5(D s 6'E -6o 6H,o-6 po OEqs6 95a'(! o I ooln;'o l-gs9 @oNEB.f. HfiEa\ a 5'>o!6-r lao x5e =3-(! ,! l-tF l!:-Dl l=u2 lta(! l.o !., =' o\A=ur8'q;6-!o:ldt +(DA =50.o7.0 l1 a: E: -:H =-o-;r/ o !gr+O;lsEiP)6ts3Er-ir .E.E F 316'9lrl Zla-(!liE 1t(DrtIA)Olrrlral=\JldFlIHlgE,t;ili'e. 1(!.!l-c)t'9 l.d='I E'3I)+E 'aD9.a e g +:* U). -. o rri ii !nR'(DOeSatr?aEl -rr rl(D\r-tH Eg+ eSv6sg at\i o'a E'EBtroF.Ers = E Fl o .Jo tD D9 0q(D .)!, f) F o c? u) I 'vo -o NJ +- z. o do - N)o 5 i'. I t f I f I t, I I ,[: + f IJ : t} il I I il tU\o\o m \o\o{l..Jo tJ \o\o\oN)UJ N)l.JN)Oo, tJoo N 5 N.) \o NJ O oo tJ \j l.J 55 65?3 E- i"q0,e_d , {=.=.D "v-^+ HE e3sB,' =D(,a5s 5+- UJ5A u)55 5+. UJ55 a55 55 a-l .Ya >6',9 H ?eE.o)5s uE5s5 55 5s55 a5555 5s NJ boZ- a >-5 tr o =5, B E'E E'*g 3',oa|.J NJ{ o, t)\o5 N)5 tJ\osA o5555 6oA6 r"*E s€ll <-d;-p do -O o5\o 6 o\ -l{ o\ \o o\ oo o\ o\ O o\ o o\ co o\\oo\o\ o o5 tra (D ? o, 0a @ t!, I o o- -< I e#o o \o s oo {{\o \o oo o\ 6\ o o\ O 6\ @ o\ soo\ 9a Eb"8 P3i*Bt HE i-B' + o\ Oo o,oo Oo o\ o,a a o\ UJ o\ @UJ\o \o 0a 5 oo -J \o Ooo o\o oo A-l;; > aryE ?EE@)-{ o \,t op 5\oo\ -JO o 5 o *J o {6o o o \o o\5U)6 =l --Io o aj 6,d igpo o t9 @ 5 o\ 5 o\ \oo{ 5\o @ l9\t a oo \o {5 \o o\ {A oa o\ N) oo ooo 6 5 5 EI ll .l o:'oo SE€vA, OMEo lf'o\\o s \o5 s a s {\o 6\ -.to\ s \) @ s --1 \o s F' il oo oo- a< }\oo Je#o o@ s 6 s o\ o, s N)5 o\s s co o\ .o o\ O 6\ o .ed '.lets ci 0q(! UJ o\ s N s N) -o6\ Uro s 5 s @ o\ s @ s { o\ s @\o s lr E t; I E ti ft fi ti tl ) 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the approprig) answer)^ ^--' - ^lrurorn wriotr tIl{IcBFLiOther (please sPecifY) STA I LG I DISTRICT TH FACILITY NGDON ZONAL OFFICE. Mectizan@ delivered by - Qtlease tick the appropriate answer) r/rvror! wHotr UNICEFU NGDON Other (please sPecif,) please describe how Mectizan@ is ordered and how it gets to the communities The State provides poputation data^and numbers of Mectizan tablets it believes itwill require to NOCP who processes the data after receiving similar infbrmation from other UNICEF- absisted States. Th" ;;;;i"1i* auo comes froir the census update conducted' which flows ;d'il;;;r;i,d to the LGAs (Locrs). These are compiled and forwarded to the State. NOCP submits u..-uppii"ution for tne UNICBF - assisted States to MDP' On approval' the drugs are shipped to tirl country and UNICEF facilitates clearance and storage' The State cpllects from NOCP while it ,.i.ur., to the LGAs' LOC1's release drugs to tlre district health supervisors or the health facility staff who in turn make thern available to the communities' FLOW CHART OF MECTIZAN DELIVERY. UNICEF/ NIGERIA. I t N i I tl t] A IJ t] ! 0 u I il 32 WHO/Al']Oc, 24 November 2004 l".l la)ld l(Dl-lo ; oo N F' @ oT o a e(\ C4(\ a-\ o\(\\ < v, (\ o(\ h C4 lls- L,J(,.) o '!o .O l.J5 zo G 35(! a tJo 5 Eli I tl u fi ti II f; t: t; t; E I tJ I} I] I 0 u U ) E6t .E E oz =GI c)o Ar o t ctt t -t ) t I! IIII llE E a Eo/ E o!t I I II II Ia Ia I 8L EtxH a I ra r/| F t\oN\oF rn o\Ni'ttt F rnF 6t\inN o ra € orf l'I\o t -a F o\tr r I a II I tI I II! E'l (art ra .a!6 6l vtIt I r GI6 6\o ta\o \oo rr1t-('I6 o6 Y1 € o\ oF !tt\ \or E - Io VI\o E \o oYIt\ ra6 8 r Cho(.t N oY'l o\ Fo (p6 E r6 o 8 v1 U1 o8 o\o o 8 oF oI g ooF \o v1 &o\ Ira r- Itt € o\ raO o\ o6 aYIo F E rF t o E& o 3ot.l(\l oI ottN (?t oI 8N o8 8N oIIN oa o('l ol oI oY}N IN o B o6t8N o v'tGI oIo8 oIIN oII ol oI olft IooI('l I6l o8 oa rI o L €)! EEz , -o E6I EEz tao rI tra E) ra ti v, EI B H H rt) 8 zoIr EI F. rh E] v ril o{II L u, EtI!a t u - IItI r ti I l_)_ -I4na:,r,t{ j { ; t I ! r{ o a a I a I a I I a I 1 Nt €t c.t GI Ho E z do D ra 6o B oc cd rauD E1 ! I T I - How are the yemrlnlng ivermectin tablets collected and where are they kept? The remaining tablets are sometimes kept with the LOCT leaders who utilize them for tlrc ncxt trenrnrerrt cyclc. 'l'he quantlty retalncd ls gubtractcd from that which will be rcquircd for that treatment cycte. At other times the drugs are returned to the State, where they are kcpt for tho next trcattnent cyclo. - Llst and brtefly dexilbe lhe octlvltles u,tdq lvermeclln dellvery lhol are belng corrled oul by heollh core peuonnel ln lhe prutecl orea, The heatth personnet at the various levets have been responsiblc for the followlng: o Storage of ivernrectin , r Supply ofivermectin o Record Keeping of drug distributed . Supervision of CDDs. - Any other comments 2.0. Gommuntty plf.monltorlng rnd Etlkoholdrrr tlortlng Ilos ony tralning (of trolners) for community seff-monltorlng had been done ln lhe proJecl urea? lf so, When? 'l'oble I l:Comnrunity self-monlhring and Stakeholders Mecting (Add rgryllffierded) a ) \ DhtrlcU LOA Tolal # of communltlodvlllagor in the cntire project area No of Communitlo thrt canied out self monitorine (CSM) No of Communltler thrl conducted stakeholdcru meetins (SHM) ./ ? 'r'0'l'AL Not done due to insufficient funding and suspension of funding by APPOC management tluring the reporting perlod, Descrlbe how lhe results o!the community self- monltorlng and slokeholders mdeilngs have ulfected proJect lmplementailon or how they would be ullllzed durlng lhe next lreolment Q'cle, N/A 35 W[{O/APOC, 24 Novcmbcr 2004 2,e, tuporvlrlon 2,g,1, Provlde ollow charl otsupervlslon hlerarchy' N ZONAL N O.CP IBADAN I STATE ONCHOCERCIASIS CONTROL (socr) LOCAL OOVERNMENT ONCHOCERCIASIS CONTROL T (LOCr)) I t. I t I L I L COMMUNITY. CDDS 2,9,2, ll/hat were lhe nnln lssass lilentlfieil tlurlng supetvlslott? - 'l'he CDDs were demanding for incentives or payment as obtains in the Nl'l programlne. - inadequate involvement of health facility staff. - Transfer of health facility staff. - lmpropet ana lncomplcte registration of households in the regip$, .. , 2,g.3, lVas o supervlslon checktist useflYes, but not at the lower level. 2,g,1, |Vhal were lhe oulcomes ot each level of CDTI lmplementallon supervblon?l. During registration, a lot of mlstakcs were madc lnthcyegister, soinformal fralning *ar ionJon the reglstration. This made the populgtGn figures realistic and data management easier. Z. The comm-unity leaders were sensitized again on giving incentives to the CDDs. Some agreed while some did not. Therc is a better coverage where they agreed. 3. The hea'ith facility staffthat refuse to participate were cncouraged to continue and those transfened wcre rePlaced. 2,g,5. lfao leedhac* glvcn lo lhe person ot gtoupt supervbetl Yes on thc spot. 2,9,6, llow wos lhcleedbock used lo lmprove lhe overoll perlormonce of the ' protecl?ifi f.r.tUuck was used to havc more mobilization both with the policy makers in LGAs as well as community leaders and CDDs to give more support to CDTI activities. Those corrected chinged for better and improve the CDTI programme by better coverage, a better registration and supervision of the programme. I; 36 WHO/APOC, 24 Novcmbcr 2004 ! ti tJ tJ U U SECTION 3: SuPPort to GDTI 3,'1. EqulPmrnt 'l'able l2: status of equipment (Please.add more rows lf necessury) l I Lrr l':[.its fi I t, t: t t; fCondltion of the eqtrlprnent (F-Functlonal, WO-Wrltterr ofl). CNFR-CurrcntlY non-functlonal but rcpairable, I t; I; llow iloes the proJect lnlend lo nnlntohr and replace exlsllng equlpmenl ond other nnlerlnls? ln the inrerirn rhe project will repair and maintain all capital equiple{ with the_ funds provided by APOt, supplemented by the little madc available by the Statd and.Local bourrnrrnts. Efforts *ill br intensified to convince government to release counterpart funds for maintenance of project equipment and purchase of various materials. The project intends to request APOC to'provide i riplacement of most of the equipment supplied. ,/ Source Type of equipment APOC MOH Drs'[RlcT/ LCA NCDO Others No. Condition No. Conditlon No, Condition No, Conditlon No. l. Vehicle 2. Motor cycle(s) I F I NF 7 F 3. Computer(s) I F 4. l'rin s) 5. l'lrotocopicr (sl 6, l;nx Mnchine(ql I F I F 7.Otlrers n)Bicycles b)'IV set 50 CNF I F c)VClt I CNF d)Gencrntor_ I F 37 WHO/A POC, 24 Novcmbq 2A04 ) I (- t- t, f I t: f t; I I I !.2. Flnrnchl contilbutlonr of tho plrtnorr rnd communltlo 'l'able l3: Flnancialcontrlbuttons by all partncrs for the last three years - Ilthere ore problems wlth rclease of counterparlfunds, how wiry lhey addressed? No problem here, but if there ls any The Hon. Commissioner for Health, thc Permanent Secretary witl anange for an advoaaoy meetin! with the State Executivo to support Onchocirciasls prograrn me and llnk wlth tho dopt of LOA and chicftalncy matters., - Addlttonal comments i' t' "'' The policy makers at State level were well enllghtened and mobilize to support CDTI activities 3.3. Othcr tormr ol communlty rupport - Descrlbe (lndlcale lorms of ln-*lnd conlrlbatlons ol Word of appreciation. F ,o^^ooud y onyl 3.4. Expdndltur. p.r rctlYlty - lndicots ln tablo 14, tho amount oxpondcd durlng tho reportlng perlod for cach activity listed. Write the amount expendcd in US dollars uslng the current United Nations exchange rate to local curency. Indicate exchange rate used here- a ) t; I: I Contributor --Vaai5 iiProvtdt rht Pcrlod') Yctr 1 ('provldc the Ntlod') Yctt I ('prouldc tht wrlod') TOTAT AMOI.'NT (cAsH) Budgeted (us$) TOTAL CASH Relcased (us$) TOTAL AMOUNT (cAsH) Budgotod (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsH) Budgctcd (us$) TOTAL CASH Roleased (us$) MOll (Central r Provincial/State) t0 000 3 616 2 000 ,0^679 I 692 MOll (DistricULGA) Local NCDO(s) ( if any) 2t 440 4 t50 I 882 5 t82 NGDO partne(s) Others n) b) APOC'lrust Fund 107 6t0 57 2t0 42910 1t 000 t7 ll0 'l'()'l'AL 139 120 62 r30 32 468 11,982 l7 989 7 692 38 WHO/APOC, 24 NovGnrt# 2004 tr- i I 50 .l-ablc l4: lndicate how much thc project spent for each activity listed below during thc reporting perlod, - Any cotnmettts or exPlanations? SEGTIOil 4: tultalnrblllty ol CDTI i 1' .,. 4.1, lntorna!; lndoprndrnt plrtlclpltory monltorlngl Evaluetlon ) t f t: I t: I I, I t; u ti i li II I I] U T 4.1.1 Wrs Monltorlng/evrlu rtlon crrrlert out durlng thc reportlng perlod? (tlck any of the followlng whlch arc appllcnble) na{narnt monitoring ' . ,.. tl .. . - Other Evaluatlon by other partners Norre wns carried out withln the pcriod of reporting. Year I Participatory Mid Term Sustainability Evaluation 5 year SustainabilitY Evaluation Internal Monitoring by NOTF 1,1,2, llhal were lhe recommendollons? Drug from N HQ aroa to p0 nt of Mobilization and health education of communities rra[rng_9[9gPS_ 'l'rain of health staff at all levcls CDDs and distribution monitori CDTI activitiesInternal n Adypgggy vlpitp to [ea IEC materials Ith and authorities QUnUgg-(lepg$it'"s) fonns for treatment Vehicles/ MotorcYcles/ b icycles maintenance o[g-p Egq,p11gnt&.g Others printers etc) Expcndlture ($ us)- Source(r) offundlng t5 85 MOH MOH 2300 MOH MOH MOH MOH MOH 200 4000 400 200 7 200 MOII 'l'otnl nuntlrcl of perrcru treeted 850 980 39 WHO/APOC, 24 Novcmhr 2004 TI I I f; t: I r 1,1,3, llow huve they hoen lnrylenrcnlol? 4,2, Eurtrtnrblltty of protratu plrn rnd r.t trrgrtr (mendetoly tt Yr 8) Wns the project evaluated during thc reporting period? Was a sustainability plan writtcn?-Yes . When was the sustainabilitY Plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: l,2,L Plannlng ol all rclevanl levels After the evatua"tion of the State project, a planning/debriefing meeting was conducted tluring whlch a draft 3 - Ycar Sustalnabillty Plan was devolopcd. Prcsent at thc meeting lverc reprcientatives of the LGAs (policy makcrs and health workcrsland.the.Statc representativcs. 'l'lie lllan tras been line.tuneti'antl iubmltted to tho MOI{ for lnslutlon lnto tho Yearly health pinn, li has been ptnnned that at the ctose of each year, .a revlew of the succeedlng year's plan will be undertaken nnd where necessary arnendcd, Subscquently (aller ihe third year), plans will be developed on a yearly basls. 1.2,2, Funds At the State level, there has been some countcrpart contribution, but these have been neither edequate nor regutar. With tho evaluatlon of the prdect, the SAtc Goy-cmment has renewed its commitrrit to fundlng the CDTI project and ensouraging thc'LGA! to do tikewise. Advocacy visits wlllcontinuc to ensure that LGA keep on releasing at least minima! amounts for CDT| implemcntation. By 2006 Govcrnment, contributionrls,oxpected to have reached a level that willsustain CDTI operations. ) I I I t i n I E t; u II tI tI u E 1,2,3 Tronsporl (replaccment and malnlenance) As Stated in the earlicr section of the report, the projcct expects APOC to rcplacc transport before it finally withdraws funding. This applies also to.other capital items, which it ruppiird to the projeci eartier. At the LGA level, the Natio12lzplryry Health Care Divelopment Agincy, which is supported by several intpmatisfral NGDOs occasionally, procures motorclclei for NIDs, whiili are distributcd, to thc LGAo, Thesc are being uscd for bDTl activities. At periodic intervals some of the motorcyclcs are replaced buy NPHCDA. Wlth respect to nraintenance, somo LGAs release minimal amounts for the pcriodic rnaintenance of the motorcycles. ln the meantime, a system of strict control of transport has bccn put in plocc. livcry trip and cvery cxpenditurc on (fuel, tyres and rgRaifl a.logbook and nronthly reconsiliation of trip authorlzatlon and logbook entrles has been institutlonalized. 1,2,1, Olher resources This has been partly addrssscd in thc prcvious sections. With regards to IEC. matcrials, tlre prdect ls sensltlzing the Oovernment on thc nccd to producc somc with the withdrawalof APOC funding. 40 WHO/APOC, 24 Novcmbcr 2004 t 1,2,5, To whal ulenl hoc lhe plan been lmplomonled. The plan *ur'fNu.irniO Auil'ng the reporting pe,rlod, and nothing mrylL has becn accomprished due to inuo.q*ir-r,,nuini'. Mid.riay into 4'h year, funding from the Trust Fund to the project wns susPended. 4.!. lntegrrtlon outllne the extent of integiatlon of cDTl lnto the pHC structure and the plans for complcte integration: 1,3,1, Ivermeclln dellvery mechonhms T6e Mectizan delivery p.ti* occurs within the existing PHg structurc' communities pick trrriirra..tian reiuirements from the health facilities, except in fcw cases il;;;,h;;;;i ir t r.r iothem during NIDs, for instance, the LGA /PHC staffwho come to pi.[up their v-accines also use thc opportunity to collect Mectizan. 1,3,2. Trolnlng Currently, CDTI trainlng ls not lntegratecl lnto any other hcalth programmc tralning actlvltles i 1,3,3, Jolnl supcrvlslon and monllorlng wll\otle1 Pro9roms At the S-ta:rc bv;t, thcrc arc no pians for jolnl supervlslon and.nonltoring at prcsent, A fd ,rrrbirr of thi SOCT partioipito in other health programntes.like guineworm eradication and immunization. on some occasions they takc opportu_niJl of thelr vlsl$ to the field hr these nctivitim to Uiitny bgk lnto CDTI lsiues. At the LOA level, some of the l,OC'Is are atso lnvolved ln othcrirogrammcs and sometimcs uso the opportunity of visitr to ,*riirriiyf heolth fucilitles for onc frogrrmme to took 'lnto other prograrnmes, whlch they are handling. 1,3.1, ' Releose of fundslor prolecl orttuttttt i' '' ' Where thiie are ieleisei of fund, impress is released for PHC activities and is controlled by the pHC dircctor. Rom there minimal amounts are made available to the Onchocerciasis Coordinator for some routine visits, collection of Mectizan or motorcycle maintenans,e. At both State and LGA levels, proposals. for the release of funds howcver must pass through the PHC director and other normal channels. 4,3,5. Is CDTI tncluded ln lhe PHC btudget? / Ar the SLLl.rii, here is a llne for-CDTI in the PHC budget. At the LGA Ievel, CDTI activities are subsumed under a general PHC budget' 1,3,6, Des$lhe ol.her health prugrommef lhut are uslng lhc GDTI slruclurc und how thls was achlevei, lihat have been lhe achlevemenls? None at the moment 4.3,7, Dercrlbe others lssues conslrtered ln thc lntegratlon of CDTI' ) ! I I I , t, t; ti tI ! I 11 0 I 4l WHO/APOC, 24 Novcmbcr 2004 tl t; I t' a r I, 4.4. Oporatlonal rorclrch l,l,L SumntorlZe ln nol more lhon one half of a poge lhe opetoilonol reseorch underloken ln lhe prolccl area wilhln lhe reportlng perlod, None was undertaken durlng tho rcpoillng porlod 1,1,2, How were lhe results opplled ln lhe protect? Not aPPlicable. sEcTloN $ ttrcngthr, weekncller, chlllenget, tnd opportunltlel - Llsl lhe slrenglhs ttttd weoknesses of CDT! lmplementailon process, I Strengths r Release of countcrpart fund from the Stats Govcrnmcnt' o Cooperation flom the LGA Onchocercjasis Managers' o Regular monitoring and supervision. o Sorne communlties are fulfilling thcir roles under CDTI' o Solne LOAs made counterpart contrlbutlon of N50,000 for thc tralning and other Cyfl nctlvltles. Wlll hopo that thoso wlllylold bcttor rcsult, o Additlortal comntentcd SOCT as belng put ln place. o l'ligh rate of CDD retention despite inadcquate motivation Weaknesres Suspension of funding bY APOC. Cornparing CDTI project with Imm_uniation programme by the CDDs on remuneration. Attrition of some of the CDDs on distribution of Mectizan. Few contmunities arc giving incentives to thcrc CDDs. Low involvemcnt of health facilities staffin implementation process t f a I I ) t: t t; t o a o o a o Inadequate number of bicycles for supervlsion. Demand for incentives by CDDs ln many communities / - Llst the challenges and lndicato how thcy were addressed. The challenges include the followlng: o Suspension of funding bY APOC r Non-release of counterpart fund from the State . Non-release of counterpart fund from the LGAs o No constltutlon of SOCTs o Conduct of census uptlate 'l1ese challenges were atldressed by continuous advocaoy for release of funds by.partners, rcconstitution -of th. prcscnt SOCT ioupled wlth lcadershlp change 1o mcgltlgconditions set Uy enOC to r.estorc fundlng, conduct of sensus update wlth support from IJNICIF.3{dvocacy vlcit to both tire State and iber' Policy Makers io release funds in support of CDTI proic,ct 42 WHO/APOC, 24 Novcmbcr 2004 It- [, SEGTlOll 0: Unlque lerturer ol the pro;ecUothor, mlfierr -t I t' t; ti f tr I l. t t; G ) ti E ) Ij I t] t] u / 43 WHO/APOC, 24 Novcmbcr 2004