Zamfara CDTI seventh year annual project technical report to Technical Consultative Committee (TCC): January to December 2006

ZAMFARA STATE CDTI PROJECT COUNTRY/1.{OTF: NIGERIA Proiect Name: Zamfara CDTI Project Approval vear: 1998 Launchins year: 1998 Renortine Period (Month/Year): JANUARY TO DECEMBER 2006 7Proiectvearofthis renorfi (circle one) I 2 3 4 S 6 8910 ORIGINAL: English Date submitted:2007 NGDO partner: SIGHTSAVERS INTERNATIONAL So '; 9s- 1W ($Adlu BIM bP ftHE' , bFO ', trQ $iR ! t, 2I utt llrirlt AO. AA !tfr a: n.d"k;L ._.._.._..-.._) i SEVENTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CON SULTATIVE COMMTTTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I -,! il ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE(rcc) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 JuIy for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) lll (ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC. Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) V ANNUAL PROJECT TECHNICAL REPORT TO TECI{NICALCONSULTATIVECOMMITTEE(TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country NfLL"r Lrr\ National Coordinator Narne: .l-it- -.i,.;-i,l.i.f}. .Leit, f L-+ e- , L{_ 'I t : 'tq( : I I I iSignature: Date. 23..+- -7-.'1,,7 . Zonal Oncho Coordinator Name Signature NGDO RePresentative Name hr*IL e Sq /rrrtvt.t{ fue= 97ll"l Date Date. . . Rl7(:c:7 This report has been prepared by Name: Abdullahi Labbo Designation: Proiect Coordinator signature: er^4rC' Date t ]'l rlqT V Table of contents Acronyms viii Definitionsix FOLLOW UP O]II TCG REGOTTENDATION$ i Executive Surnmary ii SECTIOII l: Background information iv 1.1. GE].IERALINFORMATION ,.....IV 1.1.1 Descrtptrcno.f theproject (briefl! .......... iv 1.1.2. Partnership .....'.,...YI 1.2. PoPUr-ATroN ........I SEGTION 2: lmplementation of GDTI i 2.1. TtrvELtr{EoFACTIvrrIES................ ............. .......I 2.2. ADVOCACY ENNON! BOOTUANXNOTDEFINED. 2,3, MoenZAuoN, SENSITZATION AND HEALTH EDUCATION oF AT RISK COMMLTNMES... I 2.4. Coun'rrulnry INVoLVEMENT.............. ..................I 2.5. Capacrry BLTILDING .............I 2.6. Truraru91irs................ ....................I 2.o.i. TreatmentJigures........... ..................t 2.6.2 W'hat are the causes of absenteersm?.......... ......................t 2.6.3 Whatare the reasons for refusals? ................ .........t2.6.1 Bne.fly descnbe all known and verified serious adverse events (SAEI that.......i 2.6.5. Trend of treatment achievement from CDTI project inception to the cttrrent year. . . i2.7. ORt>gRruc. SToRAGEANDDELTvERyoFTvERMECTIN ............ ..................I 2.8. Comvrrnury SELF-MoNTToRING axo SraxerroLDERS MEETnIGERROR! BOOKMARK NOT DEFIITED. 2.9. SuprRvlstoN............... .........1 2.9.1. Provide a.flow chart of supervision hierarchy. . Enor! Bookmtrk not defined 2.9.2. Vf/hat were the moin issues identtfied during supervtston'| ................................i 2.9.3. Was a supervision checklistused?......... ......................., 2.9.1. Whatwere the outcomes at each level o.f CDTI implementation supervtsion? ...i 2.9.5. Was-feedbackgiventothepersonor groups supentsed? ... ............i 2.9.6 How was the.feedback used to improve the overall performance qf the projet:l''' i SEGTIOII 3: Support to GDTI Error! Bookmark not defined. 3. i. Eqrmmur ................... 1 3.2. FruaNcnLCoNTRIBUTIoNSoFTHEPARTNERSANDCoMMTINTTIES....................,..,,...2 3.3. OtmnFoRMSoF coMMrrNrTy suppoRT................ ......33.4. E>cEtomrREpERACTrvrry......... ... .................3 SEGTIOiI 4: Sustainability of GDTI Error! Bookmark not defined. 4 1. Iu-TERNAL: INDEpENDEN'rpARTICIpAToRyMoNTToRINc: EvRr-uanou .. ................4 1. 1.1 Was Monitoring/svqJyqtion carried out during the reportmg period? (tick ary: o.f the followingwhichare applicable) ............ ..........1 1. I . 2. Vf/hat were the recommerulations? . . Enor! Bookmark not detined. 1.1.3. How have thev been implemented?................ ... Enor! Bookmnrk not dsned 4.2. SusranIABUTyoFrR.oJECTS: rLANANDSETTARGETS(MANDATORvAT.................4 Yn 3)......... .............4 1.2.1. Planning al all relevant levels ...................4 1.2.2. Funds........ ............51.2.3 Transport (replacement and maintenance) ..................51.2.4. Other resources... ....................5 i\, 1.2.5. Towhat extent has the plan been implemented............ 4.3. INTEGRATIoN ............... 1.3.1. Ivermectin delivery mechanisms J . 3. 2 . Training .. . 1.3.3. Joint supervision and morulormg wfih olher programs .1. -3. J. Release of .funds for project activities 1.3.5. Is CDTI included in the PHC budget? 1.3.6. Describe other health programmes that are using the CDTI structure and how "^-^ "'^^ -^'^'^-''d. Whnt have been the achievemenls?....,........tttrr wltr ctctttyvcd. chi v menrs? ............ .....---.......""'6 1.3.7. Describe olhers issues considered in the integration of CDT'L...........--............6 4.4. OPERAIoNALRESEARCH.............. ........7 1.1.1. Summnnze in not more than one half of a page the operattonal research undertaken m the project area within the reporting period. ............-.--7 1.1.2. How were the results applied in the proiect? ............. .................-.-7 SECTTON 5: Strengths, weaknesses, challengesr and opportunities 7 SEGTION 6: Unique features of the proiecuother matters 7 5 5 5 6 6 6 6 VU Acronyms APOC ATO ATrO CBO CDD CDTI CSM DH GCR LGA MOH NGDO NCrO NOTF PHC RAM REMO SAE SHM T.r.ILL TCR TOT I.INICEF UTG .J,/HO African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Communitv-Based Organization C ommunity-Directed Distri butor C ommunity-Directed Treatment with I vermectin C ommunitl' S elf-Monitonng District Head Geographical Coverage Rate Local Govemment Area Ministry of Health Non-Govemmental Development Organization Non-Go vemmental Organi zaion National Onchocerciasis Task Force Prrmary health care Rapid Assessment and Mapping Rapid Epidemiolo grcal M apping of Onchocerci asr s Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Therapeutic Coverage Rate Trainer of trainers United Nations Children's Fund llltimate Treatment Goal World Health Organization aa, VIII Definitions (1) Total population: the total population living in meso/h1'per-endemic communitiee within the project area (based on REMO and census talitng) (ii) Eligible population: calculated as 84o/o of the total population in meso,liiper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesolhyper-endemic areas that a CDTI project intends to treat with Ivermectin in a glven year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/lryper endemic areas within the project area, ultimately to be reached when the project has reached firll geographic cgv.eragq (normally the project should be expected to reach the UTG it the end of tlle 3''1 year ofthe proJect) (v) Therapeutic coverage: number of people treated rn a given year over the total population (this should be expressed as a percentage). (t'i) Geographical coverage: number of communities treated in a given ]'ear over the totaf number of meso/hy,per-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (r'ii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) tlrough CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or intsrventions carried out by communih' disffibutors outside of CDTI. (r'iii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, wtth high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community- and the government. (ix) Communitv self-monitoring (CSM): The process by which the communiS' rs empowered to oversee and monitor the performance of CDTI (or any commtmity- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necgssary'. rx FOLLOW UP ON TGG REGOHHE]IDATIOilS Using the table below, fill in the recommendations of the last TCC on the project and describe hou'thry have been addressed. TCC session 27"t Number of Recommendttion in the lll lv 4 TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FORTCC/AP0C MGT ASE ONLY I The project integrates training of commrurity zupe.rvisors into the stratery to increase communitY ownership, if fimds are available. Otherwise APOC should provide fiurds. Fund was provided by APOC and SSI fbr trairung Two LGAs also contribuled fund for training. There is only one CDD per 540 persons rn the project; howwer the range across LGAs is from I CDD/250 to I CDD/over 950 people, Project should train at least double this hgure, but preferably' three-five times the number of CDDs dependrng on the LGA 1along kinship lines) to reduce the workload of CDDs and better ensure sultainability Local Government should trv to hnd fi-rxls to enable rnore training and supervision actinties. Communities were informed to select more CDDs based on kingship line tbr tretter coverage .Ne*, CDDs u,ere selected in commrmities of two LGAs. There were 84 old anl new CDDs trained. Advocacy visits were carried out to commtulity leaders, the,y were requested to select more CDDs. This is to enable meet the requrrement of ICDD/250 population. These would be trained to distribute t-et.Advocacy visits were undertaken to the state and locerl governmanls soliciting tbr support and release of counterpart funds to the project, Tu'o LGAs contribnrted fi.mds for the lrainurg of CDDs and activities. Project should ensure improved integratron into public health service to better sustaln orrchocerciasis projects after the end of APOC hoject is making effort to ensure improved rntegration into public trealth service to better s-rstain txrchocerciasis projects after the end of APOC. kolect should try to shorten the penod of distribution with a more rntense social mobilization just as before Project should start ensuring that Mectiizan ordering tasks a.re rurdertaken by goverrnnent and not NGDOs as soon as possible Within the year treatment started Iate. With the appointment of a new Coordinatcr it rs hoped that treatrnent m subseqr.rent years will be done This is being followed through with the State Ministry of Health - WHO/APOC- 24 Novembcr 2004 (Fi'ease add more rows i.f necessary) Executive Summary Prepare an Executive summflry af the report in not more than one page. l. Background on teatment and population data - Total communities, communities treated, total population, LITG, ATO and persons treated. 2. Background on population movements, 3 Training data - CDDS. health worl<zrs. Tolal population (communitlt) per CDD trained 4. Chollenges and how theywere overcome EXECUTIVE SUMMAR}' Support from African Programme of Onchocerciasis Control (APOC) Communitv Directed Treatment with Ivermectln- (CDTI) project n Zamfara State is in its seventh year of CDTI implementation. The state is made up of fourteen admrnistrative Local Govemment Areas (LGA5) with five identified as meso-endemic for Onchocerciasis. These LGAs (Anka Bukkulunr, Bungudu, Maru and Zurntt) and have 116 ordemic communities. Their updated population.in the year under review according to census obtained by CDDs is 204-092- Out of it ii tOS,+Zt p"ojl" were treated in 2006 from an annual treatment objective of 175,500 using 441,57G Mectizan@ tablets. The geographic and therapeutic coverage is 100% atd 8l% Withln the year two hundred and eight (208) Front Line Health Facility Workers (FLHFWs) in charge olt"ulth clinics. 5 Priman'Health Care Directors and Councillors of Health from the endemic LGAs were trained on CDTI. Eight-v four (84) old and new CDDs uere also trained /retrained in Bukkurmrm and Maru LGAs. Thev were trained on the CDTI stralegv r. THERAPEUTIC COVARAGEI I NO. TREATED GEOGRAPHIC COVERAGE YEAR POPULATION 7l .18 0/o7O0o/o135.572 96.5131998 76.97 Yotoo%140.424 108,0921999 77 .12 o/o100%2000 t54.970 119,526 81.98 %lOOo/ot32.7972001 t6t-972 82.77 %lOlYot69.149 t40,2672002 100%152,7122003 184,666 82.7 o/o 79 3 o/o100%193, I 56 153,3632004 SlYo100%201.21O 163,7802005 8loIOOYI204,092 165,4212006 - WHO/AjOC. 24 Novemher 2004 and were ancouraged to support implementation of activifies. The state and endemlc LGAs teok responsibilif for the 2006 treatment with support from APOC and Sightsavers i*lernational. Absenteeism for treatment during the dry season lvas due to migration of nomads to better gung lands. Migration of yoitt to the cities for menial jobs also accounted for the absenteeism. These \,\'ere mopped-up when they retumed' Advocac,y visits were conduited to the state and local govemments- communit-l' and religious leaders seeking for counterpart funding and support to the implementation of CDTI activities in tie year under review- Some of the challenges faced by the proiect which hindered timely implementation of activities included tfre Oetay' of appornting a ne\tu' State Oncho Coordinator. The former ooordinator was kansferred to the School of U"aU, Technolory Tsafe. Replacement of the Bukk-u11um LGA Oncho Coordinator due to poor performance was also delayed- Non- inclusion of female CDDs due to religious belief and non-compensahon of most selected CDDs were also experienced. Reaching women in purdah was therefore slow. To find a \'\'a)' around the issues, discussions \ryere held with community and religious leaders. It is antrcipated that the communities would be encouraged by their leaders to give incentives to CDDi. Women distributors are also expected to be selected. An improvement rn coverage and reporting was experienced as a result of replacement of the Bukkuylum LGA Coordinator. There ou* poor govemment financial support by the state and endemic LGAS. Letters were written to Chairmen through the Ministr-v for Local Govemment Affairs as reminders for release of counterpart funding. As a result of these. N95. 000 and N I I I . 000 were released bv the state and 5 LGAs respectively. The funds were used for drug distribution, repairs and fuelling of motorcycles foi monitoring and supervision Eight-v four (84) CDDs were trained/ retrained in Bulikuyyum and Maru LGAs to increase coverage. 3 - WHO/APOC. 24 Norember 2004 SEGTIOII't: Background information t .t. General infiormation Lf.l Description of the project (briefiy) - Geographtcal location, topography, climate - I'opulation: activities, cultures. language - Communication sYstems (roads ) - Administration structure - Health system & health care clelivery (provide the number o.f health posts/centrcs in the project area if the informatron s available)' - Number of health sta.ffin project area and number of heahh sta.ffinwlved in CDTI actNtties. The State is located in the North-westem regron of Nigeria and shares boundaries ll'ith Sokoto State and Niger Republic in the north, Katiina State in the east. Kebbi State in the west and Kaduna and Niger Stuto in the south. The State is made up of 14 Local Govemment Areas. The vegetatio., of the State is mainly Sudan and Savannah grassland. There is a vast land of agriculture and two main rivers (River Bunsuru and River Ka). About 80% of the population lives in rura-l commtrnities. The State has two seasons namely the rainy and dry seasonsl the rainy season commences from May to November, while the dry season starts from December to April. The State has a population of over 2 million people, with Hausa and Fulani being the main ethnic groups. Isiam is the predominant religion in practice. The main activities of the people are crop production and animal husbandry. With the advent of the Global Satellite Mobile telecommunication system in the State; communication has improved tremendously. The Stale populace also has access to the electronic media through the radio and television statiors - Nigerian Television Authority owned by the Federal Government of Nigeri4 the State owned radio station (Zarrfwa Radio) and also the Kaduna State Radio Station. The State has an established Ministry of Information u.ith other local means of disseminating information to its people in rural communities- Eighty percent (SO%) of communities are difficult to access during the rainy season. The roaci networks to some of the local govemments are feeder roads with difficult terrains. Patients travel long distances for health services. Public metrrs of trarsportation to most of these communities are available only on market days, the cost of which is high (about $8) for an average communit-v member. Durrng the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled professions to eam a living. They however retum to their communities in the rainy season for agricultural activities. There are two main trers of govemment operating in the State - the State and local govemmerrts. An elected Executive Govemor and elected Chairmen and Councillors at the State and local govemments govem respectively. There are also the traditional and religious 4 - WHO/APOC. 24 November 2004 institutions of leadership, u,'hich have an influence on the administration at the local gGr.emment- i General Hospital is based in each of the 14 LCA headquarters and in the surrounding districts; there are sporadic primary Health Care delivery ffiastructures. ranging from comprehensive health centres to health clinics. The Primary Health Care facilities serve as trarning centres for CDDs and other trainings as lvell as Mectizan@ collection pourts- The project area has a total number of 108 health staff and 76 arc currently involved in CDTI activities. Table 1: Number of health staffinvolved rr CDTI (Please add more rows if necessary) District/LGA Numtrer of health staff involved in CDTI activities Totel Nunber of health stalf in the entire project area B1 Number of health stalf irwolved in CDTI B, Perccntage *100 Anka t6 t2 7 5o/o Bungudu 25 l6 64o/o 2A 2A TlYo Maru l6 13 I 87o/o Z:;l.lri t7 t2 7 \o/a StateMOH 6 3 5OYo Totel 6 108 76 I 70.3o/o Bulikuyrun 5 - WHO/,APOC. 24 November 2004 l.l.Z.PartnershiP - Indicate the partners involved in proiect implementation at all levels MoH' NGDOs (na t i ona I t interna t t o nal), co mmum I t e s, I o cal or garu za I rc ns, e t c. J - Describe overall working relationship omong-partners, clearly inilcating specl/ic areas of project actvfiiei lplnnnrng, superwsrun, advocacy, planrung, niobiliZAtiOii, etc) where all partners are mvolved- - State plans, ,f ony, to mobilize the state/region/districtrlGA decision-makers, NGDOs. NGOs, CBOs. to assist in CDTI implementation' Partners in the z,Urrfiara CDTI project comprise of the following: - L Zamfara State Ministry of Health 2. The Ministry for Local Govemment and Chieftainc,v Affairs (representing the five endemic LGAs) 3. African Programme for Onchocerciasis Control, (APOC)'4. Federal Ministry of Health 5. Communities in endemic LGAs 6. Sightsavers Intemational All the partners play roles and perform their responsibilities in the implemurtation of the projcct activities based on CDTI stratery. Zamfara State Ministry of Health Tne Zarnfaa State Ministry of Health is structured in line with the Nigerian Health Structure that is based on the concept of the Alma Ata declaration of 1978. Based on the above the National Health Care Delivery System is structured into primary. secondaqv and tertiary levels of care assigned to the local, state and federal govemments respectively. The Zamfara State Ministry of Health is therefore responsible for the provision of secondar_v health c:re, supervising LGAs to provide primary health care services to its population. There are 8 departments in the mirustr"v: each of which has a role to play in the provision of eye care services. The 8 departments are Administration, Public Health Services, Primarv Health Care, Pharmaceutical Services, Nursing Services, Planning Research and Statistics, Finance and Supplies and tnspectorale Services. The ministry supervises three paiastatals - Hospital Service Management Board. School of Health Technolory and Hsalth bystem Development Project. fne activities of the Ministry and health sen'ices provided are frrnded from budgetar-v allocation from the state govemment. The Ministry is involved in planning, advocaiy to the LGAs, monitoring and provision of logistic support for implementation of CDTI in the state- despite that provision of counterpart funding by the State and LGAs has been poor. Sightsavers International Sightsavers International has been supporting Onchocerciasis conffol in six Local Govemment Areas (Bukliulum. Bungudu, Tsafe, Anka. Maru and Zurmll with Tsafe LGA as non APOC LGA. This has been since 1996. The organisation has provided technical support in terms of training of project staff- planning and reporting; including logistics support 6 - WHO/APOC. 24 November 2004 (vehicles, IEC materials, spares, monitoring, advocacy etc). The organisation also supports ffachoma control using the SAFE strategy and provision of cataract services in the State' Ministry for Local Government and chieftaincy Affairs/LGAs The Ministry is the supervisory organ of the loial government areas in the State and the endemic loial govemments fali unde. them. The frlirustr-l' has assisted the proiect through commumcation and advocacy towards ensuring that the local govemments provide the necessar-y support for implementation of CDTI. The local govemments under the minisfi involved in CDTI ttrough planning, advocacy to traditional/community leaders, monitoring and supervisiou heatth iducation and mobilization of communities, reporting and management of adverse reactions as a result of treatment with Mectizan@. The State Ministn' of Health and the LGAs provide office accommodation, pay salaries and emolumeffs Of SOCTs/ LOCTs. Within the year N95, 000 and Nl1 1, 000 was released by the State and LGA respectively. This was as a result of advocacy visits seeking for their political and financial s-ripport towards proj ect suSainabilit-v. African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is a WHO organ, wils established in 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Communiqv Directed Treatment with Ivermectin (CDTI) stratery. APOC has supported the Zantfara CDTI project with funds for implementation of project activities since 1999 and also provided capital equipment and logistic support for the project. Within the year APOC contriLuted fund based on the sustainabiliqv plan and also provided capital equipment to the project. Federa! Ministry of Health This is the organof the federal govemment that is responsible for formulating national health policies. The National Onchocerciasis Control Programme (NOCP) is a unit of the department of public health and is headed by a National Coordinator. There are foui zonal offices - Zone A (Enugu), B (Ibadan), C (Kaduna) and D (Bauchi), r+'hich are headed by zonal coordinators and have the responsibili{v of monitoring CDTI activities in their catchment States. Zanfua State is tnZone C. The NOCP on behalf of federal govemment endorses all letters of agreements with APOC and monitors implementation of CDTI in the State including advocac,y for support to the States. Endemic Communities A community or village n Zartfua State refers to people in either small or large groups, who live in the same place, share the same culture, customs and traditions with a cofilmon leadership. Inthe project areathere are l16 endemic communities that fit these descriptions. These communities have been receiving Mechzan@ for 11 years. 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'i- =(Ds? aTg:r I =s BoaE: + oleAJ,. elo !e!-^ +e ,'(Dui-. + -at 5'udi 0ut" t a^(! !J{B dB8 E =Beo^ (D +U -L* -iAdA15 iDli(D =F)+sZi:l it1(u E.RrYr)HE EY-<a (DEfr FP!9(9_ a-!) =+EA(D -@x 5 +ii oOar+PFK E .\ $aY-a +8F g -9E^BE E.rorJEq o)1--d5 )t+ a(D *o) siE39. a) Bg dl- ^oH/* V'A+o- s))+ =(DJ.5A UVH )+.) (DO E'o6o -^o:IcL Q:3J^1 :.+ do- ! r!U 'do ,o E N)A z g (DB NJ O ro Fl Fi F N c./ ? s,Ft ED oa ED F ,f FF) (r) El ?) t- ad .aj (Dq (D Frl(! ts!(! d =95+ FE z8i!!9 EF' ito(!Jo 11 (D o ,rl (D o o 9E ;(! 5 (, H 'U -l @ "l (, H ,l O H rl (D trl F-J _a !rtr oq rlrt 19 OQaH -l (, ill rl a trl 'o 'J (nE -t (r) an ,l oa =9 =6- o z l0rt z lo z rl 3 rt z l0 _a !r* =iloa oo ro u) t, 6 ? il 2 rt ? 19 3 t0 z rt o E:T;6 o tD !t ID (D tr(! tcG =? t+ 0a 0a a 0 - ETIt ID EIr! tr {! ttG ar! o 9= (! t!,(! co ,t, .! El,t} =9 E+ FE' a o I t, otD (! tD t,(! E'(! o E:I +6 (DL +E da At! da oa(h u) F' o a- o oco o (D o) o o (D oFn o oFt o- F0 ot \o o ru ,o TJs z d G N)O s 2.2. AdvocacY State the number of policyidecision makers mobilized at each relevant level during the current year: the reason(s) for undertaking the advocaclt and the outcome' Describe di/ficultiesiconstraints being "faced and suggestions on how to improve advocacl'' Advocacy was carried out to policy makers in all the endemic LGAs to solicit for support to CDTI activities implementation and release of counterpart funds. Five Directors of Primary Health care (PHC) in the endemic LcAs. the Director of Primary Health c*9 T the Ministry for Local Govemment and Chieftaincy Affarrs, Commissioner of Health and the Permanent Secretary Ministry of Health were visited for advocaq'. All the policy maliers promised to persuade relevant governrnent levels to release counterpart funds based on the sustainabili|' tudget. The Ministrl'of health budgeted N500,000 and released N95, 000 for mobilization' health education, data collectio, ard repairs of project vehicle. More advocacies would be Carned out to LGAs urd State govemmenti (the State Govemor and Honourablc Commissioners of Health and Local Govemment and Chieftaincy affairs), religiout Td traditional leaders to solicit for increased financial support. A staff of the State Ministrv for Local Govemment and Chieftaincy affairs will be part of the advocacy team. Advocacy to the Ministry for Local Govemment and Chieftaincy Aff,airs is anticipated to influence the LGAs Chairmen to release funds for project activities. Other requests made to the State and local govemments were to integtate CDTI into other community based programmes. Tlus is to cut cost of morutoring and supervision of CDTI actirities in the communitl. 2.3. tobilization, sensitisation and health edueation of at risk eommunities Provide informati on on: - The use of media and/or other local slxtems to disseminate information - Types of IEC materials used - Mobilization and health education of communities includingwomen and minoritrcs - Response of targel communiliestvillages - Accomplishments - Suggest woys to improve mobilizalion and sensitisation of the targel commuruties- The project did not use the media for mobilization and health education on CDTI, front line health Jtuff in collaboration with CDDs and local town criers were used to disserninate information on CDTI in their respective communities Zanfwa State people are predominantly Moslems and women are usually in purdah. The project made efforts to hold ipecial healttr education sessions for the people at the community leaders' houses; most of the women are however not reached due to cultural and religious hrndrances thus maklng information dissemination on CDTI slow. This is despite the training Islamic scholars received on CDTI in the year 2OO4 to mobilize women in purdah during school hours. Notwithstanding response -from communities was however encouraging. as most of the communities have tontrnued to respond positively to the programme ttfough annual compliance to treatrnent using Mectizan@ tablets. The communities in all the endemic LGAS were re-sensitized on the disease (the causative agent, signs and s)rynptom and the use of Mectizan as the drug of choice for the control of oichocerciasig. They were encouraged to take ownership of the programme. Posters, flip A4 WHO/APOC- tr 24 November 2003 charts and brochures developed by NOTF were used as IEC materials for mobilization health education and sensitisation of endemic communities' The project intends to henceforth continue the use of audio and audio-r'isual means to disseminate CDTI information to all endemic communities prior to release of fund to the project. Communities will be visited when other health related programmes eg' Tuberculosis and Lepros-v Programme (TBLP) are working there. This will 1:ffotd an opportunity to share means bf traiportation eg. motorcycles arid vehictes used by the programmes to mobilize ad sensitize communities' .12 - WHO/APOC. 24 Novernb€r 2004 Number of communitiesil.illages with communit5,' memtrers as supervisors Number of CDDs Number of commtmities /villeges with female C'DDs Total no. commtmities in th entire project area Br Nrrnber with cornmrmity membels es supervi^sors Br Percentage B,/ B; Ba* 100 Male CDDs Bz Female CDDs B- Total Br= Br+B* Numbcr of communities with female CDDs Brn Percentage Bn= 81o/B4*100 AnLs l3 8 61.50,o 39 0 -19 0 0oo tsukkulum D..- -..1.-DUTEIUUU 53 l9 t7 l3 32.39,o 68.40,0 l0l 0 0 l0l 8I 0 0 09.o 8t Ooo Maru 23 ll 47.390 86 0 86 0 006 Zrsrmi 9 l0 I I lozo 5t 0 5t 0 Crg'o Total 116 59 50.9.c/o 35E 0 358 0 Oo/o 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows tf necessarl Comment on: - Attendance o-f-female members of the community at health education meetings - In generaL how do you rate the particirytion ofJbmale members of the community meetings when CDTI issres are being discussed (attendance, participation in the discussion etc). - Incentives prowded bv communities -for the CDDs - Attrition o.f CDDs. Is attrition a problem.for the project? If yes. how rs it addressed? - Other issues lnvolvement of female members in all endemic communities is still an issue. This is due to the people's cultural and religrous beliefs (who are predominantly Moslems) This rneans pafiial or non involvement of women in decision tatiing generally. Attendance and participation of women during CDTI discussions were poor, because !,ounger and active women are in purdah. Mectizan@ only reached these women when approval was given by their husbands or head of the cluster. The project experienced problems with gtving incentives to CDDs by their community members. Community members feel that other community health based programmes such as the Polio Immunisation Programme are paying commuruty members involved in their aotivitics. The communilv is therefore not expectd to pay the CDDs as the CDTI project is (perceived to be) pa)'rng them There is also attrition of CDDs. They go out of their cornmunities seeking for menial jobs, business and to attend school. This situation is expedenced by the project annually. To address this, community members were encouraged to select at least three CDDs for distribution. 43 WHO/APOC. ! 24 November 2003 DistricUlGA 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent trarsfers of trained staff occur, state what the project is doing or intends to do. to remedy the situation. (The most tmportant NSue to descrbe n what measurgs v'ers taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staff are frequently trans.ferred during the course of the campaign). There is a State Protect Team with long term erperience in coordinafion of activities. Local govemments' onchocerciasis control teams work with train health workers to ensure communities treatment- During the treatment year a planning meeting was held with the relevant staff of health. environment and local government affairs minisffies, State and LGA Oncho Control teams. This was to expose them to CDTI activities and attract their support. Training and re-training of health faciliry staff and community volunteers was planned. Frontline health facilities staff r.l'ere trained as planned including those from non endemic LGAs. This is to educate them on CDTI activities in event that they are transferred to Oncho endemrc LGAs. Active CDDs were used to see to the success of this year's treatment round. /4q WHO/APOC. ! 24 Norember 2003 woa o. ri( x r' q, F f) Fl Fl F N pl -1 I E N)hJ t-) -€o\ a 6 (} tD N t-f $- s o NJ N) z o ;n) (!a F ah IA i ll zs r x s L a +r,'1 tJ l..J t) Ao\6 tJ O 5 i.J IrJ l..J { sO N tJ\o z r! o E) o- € a lt *i E r) x i a (a (r) o\ t! (D @ !J tJ o Ul -l(, t) \o tJ01 \o - Ft!\c 6 (D t! a O O O ----i O O O O ^xi'g a2 E3 - = A.l + -- o OIIE-: z -t tDt9 -tE'aJ=8;' Hq HF,o=' tD O - -t :. o\a O t.J tJ {O \o \U a .D t! ID E 6s 6L q J. O C z CDg $z(D:1 o- z (D o a t! G- $* ilP- z o @ to TDp. A 6Z o!1 l.J la)ld lo lu, ;Et t0 0q t0 (! p- ta(D'Ft .D (D (D o+) o UJ .-) rd a (D c, E (\ :s \G\ i % cn oG a4 Ca \e a s .G\ o t. s' a s > ci 6\ o B o qo o o o O o ooq, to -(D + le (D : (D DO(D o N o o ETFl o (D o oa a I \tn - > ts(Jp E NJs zo (D (! H O I * Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders (hher (specif5) Islamic Teachers Program nanagement ./ Horv to conduct Hcalth education .1 Man-a-gement of SAEs ^l CSM SHM Data collection ./ Data arnlysis Report nriting Others (spccifu) Table 6: Type of training undertalien Qick the boxes where spectfic trainingwas caruied out during the reporting penod) Anv other comments ,46 l tIO/APOC. n 24 November 2003 2.6. Treatments 2.6.1. Treatment ligures If the proiect is not achieving loooh geographical coverage and a mimmum of 65% therapeutic coverage or the coverage rate is fluctuatrng state the reasons and the plans being made to remedy this. The project area has a total of I 16 communities. The treatment report sent by the endemic LGA5 indicated 100% geographical coverage. This was as a result of merging of some communities in Bukkulum and Maru LGAs by CDDs during treatment. This r,l'as due to CDDs attrition, u,here CDDs from neighbouring commumties had to assist in distribution in their neighbouring communities In glving treatment reports CDDs could not separate report of their different communities where such cases occurred. The project looked into this issue and planned to continue advocatlng and training more CDDs to address such issues. The therapeutic coverage attained was 8l ozo' 41 WHO/APOC. ! 24 November 2003 Fl ri lr N ? g, E oq o. CiF t' ^9PA o\ \o Nl+) \o (,,lt..) (}) 9 r S.! _grfliF :1 ;'r@=a' g*fq* o o 9 (D o F'00(D(, o\ \o NUJ \o LNt'J (r) ^-lye > aP. t 3.x Ed3 o\ N) UJ \o (,,l t9 (JJ ood ifi = t d:,: + 'g:i v c s O ^\ O 10 \o oQ ^ :z(F -?d ts "fi8 f9 t\)o5 \ot) Ir, Lrl 01 N(, UJ\t @s o\I t.'.)N{ { "s N N.) r-tO^- tsaFi96'.7 +E!D; O LI5 ro 5 ot(, C o { oo OO tJ o\Ut O o\ O o\ OO oJ-grd Eo E.HgiE -- ; s o:i o\ UI 5 h) (,r{ Np @ t..) w o\ -J N o\ LatP\o{ c\ 5{ v z 694Ddde9dda; a s oo bo @{ .\ @ {{ s i(, \o -t Oo 5E oJ60atoe, o ,y -v ! 6\a t]) o\ (n @t.) 14 .i:l *=o;J x=!1r€:ii ts &r8 F ot }.)(r) 5i.) -T@ { o\ ttJo\(}) 9l ..7aE'@5 oi9o O o> AE>+FnXa-x z. oo -o e9O 'iq.i3aHilFg **aEE.5i, >5 *- d9 l.J lA)td l5- l'-, ;H A) (D o) a (11 a o- o - O) OD (D A) U) o, ii o ,f E R-A 4(! A3"\ (\ s .a (\ o !e aJ\- I'dlol-rl5]J l3lrlo t9 E t(DIts lD) t(J l(D Itr lo o) lp- 00 lrD 10 0a lcl Tct lc)l6) loo l(Dlr tia l(D 1a -l o E) (D ^\ H.g,c)() o (D o) oa rD ts (D a0 o0ats .o) C) oo (DH o,ga(D 4$ o -t oo a{\o ta VB) 0a(D B A) (D -lc 0)() (D (D a- A il =.ta \ $ \ t d. h s \i :. o t .S G i. =. G S Oa 1 S :r \q6 € 'i - >t p E N) z o @ N) 4lZ. ,1 lZ.olc' olc o) lC FD l3 -ld -ld5 l.D '6 l(DeF oF!,lo r3loi lF+r tr l+r E 18 El8cilE 618FtlC E l=5ltr -l(eJ IH J.I+i'D l=. < l! =18 oa lAii l> ='lolli,Plv9l--l^glF BI- d; m El3 = l@ s.) elA .z ts'16 a;la Aolx ;iiI l- -d5ls s FF.5a) +63ts P PJAP i1 5ir ='t*(D a ut a q=. rJl ]Jfr3!)LTJ CD >9c.EE8 ir Dto!116 s3 &.(D(.) s,H @ >lz f,i td =larlr A,BF' t6slolto(DlE 3l(D elBCi. l!) a 16'14 to <lx(}l- lo 4tzOle s, 13 '|e,- 5l(D 5la 5 irrrlo alo +16id l(D8le etE co16 FIA dlx co l- *lo4l^(D,v e 6' tDo o j (DHt(D (D o Ol (Dg) o (D f(, H&.(D c) g){ CO erl III iar S! S 'l .Ns:s TS !F ct. IGE 1S\-: i=\sF$\ GS.{r' qt &E-ds \$ !. l\ SR .<S\] lisU s. :l' :ESq\l .ss\\ TS Is 6l!qb \q:ssGSts$ .daI'\{!a. a. F:! .\ B g u : $ F !t- S F t q. e + B * 0! fi €li q s n d Oq \ t-o { > P iJ5 z cD E oH N)O A 2.6.2 What are the causes of absenteeism? The main causes of absenteeism were due to movements of nomads to the southem part of the country and who may sometimes sta)'there for very long periods, farming actilities for communities that were treated during the rainy season: likewise some youth go to urban areas to seek for menial iobs. The project decided that the communities should be visited immediately after distribution by CDDs, to treat untreated persons. The CDDs were requested and encouraged to mop-up the communities as part of the year's work plan d-espite the stress and non-compensation by most communities. 2.6.3 What are the reasons for rrcfusals? Cases of refusals were due to either personal or religious beliefs by some people; some thought that ttre drug is not their immediate need, while others feel that the disease is not in existence despite the health education on the disease. The Islamic scholars trained on CDTI put in their best to see to it that refusal is at a mirumum level. It is hoped that with better rurderstanding people will not refuse treatment. 2.6.4 BrieIIy describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during tltis reporting period, please tick in the box. No SAE case to report ZO WHO/APOC. ! 24 November 2003 op Ort an o Oo o ar) (D d o o 6 (2 * .,a(\ (\ .o \ t9 oa .) ! ,i of-,A o G d (A z * 0a(D tr/, a15 --':ti6'= =' a)poQ o r <p@i5A AE I z o z F! I I I ? s c-'3 !E ti ='o'F E-iloo o "' = .7)AO -F.- I B,E VJ:El Fl ? ,7J@o -o!2- f q 'd E a CA ^ ql =*i6(! 5- = R E'P - dq 5Pr q q qtsE z9n) oc)Fn rVX9ts65 *P@oEcs+ ffdE o? *3 Pe5[ r15Xcio CD I 5 'oo! NJs z E do NJ a +. N) O\t t-J O o\ t.JoO t.r OA l'.JOO tJOO t-) N O t-JoO \o\o \o6 \o{ ln o\ o\ t) t.J tJ \o O6 \o\o o o3= : H"s s = i --< ao +H! d <-oo-<+ a; s da o (D o !D moq Ot NJO t-.) tJ i.J O@ \o ^+Ya > 9Aa6= o\ t9 N @ \o\o Oraoz. F.r-=5 rF5 q d *.a o+ l! O s \o \o O\o O o O o\ O o\ OO\o FioOq_og S'Y36 B€ =da'6o.,J \o \o \o \o \o O \o o^\ O\o O o\ o\ o ^< Doo J <. di .r o f-) A O\o l..J po FJ @A Ol o\ o\ sA\o \o -J 1..) s \c) -t +- 5tJs \t\o *d E -!.4+FJ;'o €- h i.B o;iY5 !l{d' + FU o s, o -t O -I OO O J:O O O t) o O \oO "o O ^'lddi P oi=?.6 Ed= a 5 t-J { @ TJ{ tJ s tJ o\ -.I tJ\\o -J \o tJ o\ C @ \o a.J \cI 9t?,? @-a io otro o o- @ \o 0a ^\ *J a @ TJ 6\ @P{ 6\ @ \, \o {J o\ {A '\o o\ { \o HofOo .iDEE!oo o ir.o o\;,'r',I {\o O tr tJ o\ @ ; o\ \o 9. \o \o .^ \o 9. N)\o {\o o ^? >-oo J :/63 - o rn ll l! I'l \o +- t-J ^\ i.) \o \o o\ {\o o o\ O l'.J o\ A o\ { \o o ,:? q}io F-l ooo :E l-J6', lll 0 laD(Dl.oF =' o\e=lu's'g;LiD36 *ge;eg =aioRd */:o'(D= ) 'ai-rrd65 E(Di+EIgBEl-c5 la =.E.iF 3+latPls6(Dlza3:s3 liEdLdTsI(jA lu)rl^(DVXoFlEIZ 5.E;e3 =E?'o-a -O-|El L.EB= 't+iD(DDra rr=9.ut\io t.-f e 5trL{*ssrP.8aE.:$i\JBs'=.I-sE -P!rR't =st4 E.;jxAN. aS dgrt D 0eo ag a t o ? &f, J o FU o .P E tJs 7 .D ot \l g 2.7. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH tr WHfl UNICEil NGDGtr/ Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH T WHd UNICEil NGD@ Other (please speci&): Please describe how Mectizan@ is ordered and horv it gets to the communities The supporting NGDO places the State's order of Mectizan@ to the donors through NOCP. This is based on an updated census of all endemic commumtres within the project area. When this is approved and procured NGDO collects Mectizan@ meant for the State from UNICEF. The State is given its allocation. Each endemic LGA Coordinator takes Mectizan@ from the State's medical store and in tum gives each front line health facilitv its allocation. Selected distnbutors from endemic communities receive their allocations based on census update conducted from agreed point of collection for distribution. The number of tablet ordered was based on the estimated population of people multiplied by a factor of 3. In future, the State ilill be erpected to completely take over the task of ordering Mectizan@ tablets meutt for their communities Table 10: Mectizan@ lnventory (Please add more rows if necessary) How are the remaining lvermectm tablets collected andwhere are they kept? The balance of Mectizan@ tablets was retumed to the front line health facility by the CDDs after distribution The project coordinalors at the LGA level received the drugs and finally retumed them to the State Onchocerciasis Office for safe keeping at the State medical store. The remaining drugs will be used for next treatment round. Ltst and bne-fly descrtbe the actiwties under lvermeclm delivery, lhal are being catied ou} b1t health care personnel in the project area. The State Ministr"v of Health receives md keeps custody of Mectizan@ allocation for distribution to endemrc LGAs. StatelDistrict/LGA Number of Mectizant tablets Number in stock Requested Received Used Person treated Lost Wasted Expired Remaining Anka 50,000 55,000 53,588 16,479 0 0 0 I 412 Bukkuyum 150,000 133,000 t28,477 50,917 0 0 0 4,523 B'mgudu 138,000 148,01I 148,011 67.026 0 0 0 0 Maru 46,000 60,000 59,632 20,823 0 0 0 368 Zurml 43,OOO 40,ooo 34,263 lo,l57 0 0 0 5,737 TOTAL 427,00O 436,01r 423971 165,421 o o o 12,040 a 23 WHO/APOC. !24 November 2004 Collection of MectizanG) for frontline health facilit-v by LGA coordinators at the State's medical store. Collection of Mectizan@ for endemic communities by FLHF health workers at the LGAs'medical store. Notilying communities to collect their allocahons of Mectizanrc) at FLHF b1' their selected CDDs. Any other comments 2.8. Gommunity self-monitoring and Stakeholders teeting Has anv training (o-f trainers) for community self-morutoring been done in the proiect area? If so, l{hen? Table I 1: Communitv self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monilormg, and stakeholders meetings have cffected project implementation or how theywould be utilized during the next treatmenl cycle. a a a DistricV LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) None None None None TOTAL 2.q - WI{O/APOC- 24 November 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarrchy. NOCP/ZOTF NGDO STATE ONCHO TEAM LOCAL ONCHO TEAMS FRONTLINE HEALTH FACILITY COIT{MUNITY LEADERS DISTRIBUTORS (CDDs) COMMUMTIES 25 WHO/APOC- !24 November 200-1 2.9.2. What were the main issues identified during supervision? o There lvas a poor release of countemart funds at State and LGAs levels. o Poor support to CDDs by some communities leading to attrition of distnbutors. . Non-selection of female as distnbutors. o Cases olrefusals in some few communities. r Partial commitment to CDTI activities b-v some few endemic communities. 2.9.3. Was a supelvision checklist used? The developed checklist for supenision by APOC was used during supervision and morutonng of programme implementation. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? The State level was supervised by the NGDO/NOCP and poor funding to the project was noted despite inclusion of CDTI budget into the Primary Health Care main allocation. Effiort made through advocacy to State and LGAs to solicit support to the project yrelded liule results. The fund released u'as not enough for implementatron of activities. Supervision at the LGAs and community levels was not sufficiently done due to lack of funds. Some LGAS kept good records of CDTI activities while other need to improve on it. Community involvement as a whole to CDTI was partial in some few communities. 2.9.5. Was feedback given to the person or groups supervised? Observations were made known to the supervised levels and the recommendations followed d unng subsequent CDTI activities. Implunentation of these activities recommendations were however inadequate, thus the overall performance was not as planned. The project however attained its treatment objective. a a a a 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback u,as given to partners stressing areas of r,r'ealiness in some aspects of the project and the consequences. Ways forward were discussed in an effort of finding lasting solutions. Training on CDTI strategl'\4,as grven to directors and councillors of health. they were also briefed on the need for communities to sustain and own the project. This was also to encourage them influence release olcounterpa( funds for project activities. The front line health facilrty workers n,ere asked to take CDTI .N a responsibility which forms a part of their primary 26 - WHO/APOC. 24 Novernber 2004 assignment. This gave staff involved rn CDTI a better understanding of what is erpected of them. This improved the results of the yeiy's treatment. L1 - WHO/AI"OC- 24 Novernhor 2004 SEGTION 3: Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows 1f necessarl) *Conditrcn of the equipment (F:Functional, CNFR-currenlly nsn-lit ttional but repairable, WO:Written ffi. How does the propct intend to maintain and replace existing equipment and other materials? o These equipment r.nll be maintained through counterpart funds if made available. Source Type of Eopipment APOC MOH DISTRICT/LGA NGDO Others No. Condition No. Condition No Ccndition No. Condition No. Condition 1. Vehicle 2 I new and I fairly flurctronal 2. Motor cycle 10 5 New 5 Old 2Fairly fi-rnctional ., Non finctronal 3. Computers 2 1 Nerv lFairly fimctional 4. Printers 1 I New lFairly h-rnctional 5. Fax Machines Fairly firnctional 6. Others Farly functronal a) Bicycle t4 Fairly lirnctional 13 Non fi:nctional b) T.V/ Video I Fairly functional c) Over head Prolector/Screen 1 Fairly functronal d) LCD hojector I New e) Generatcrr I Fauly fl-rnctional 28 WHO/APOC- n24 November 2004 Contributor Yerr 5 (2004') Year 6(2005') Y'ear7 OAAS't TOTAL AMOUNT (CASH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (CASll) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (CAS[I) Budgeted 6us$) TOTAL CASH Released (us$) MOH (Central + ProvinciaVState) 3,623.18 1,521.73 1o,669 0 3,876 736 MOH (Distnct/LGA) 0 0 5,023.62 0 3,846 730.7 Local NGDO(s) ( if any) 0 0 0 0 846 NGDO partner(s) 5,371.31 5,581.25 6 362 4,989.77 3,656.5 3,721 Others 0 0 10,000 0 108,834 0 0 0 APOC Trust Fund 14.702 0 48,064 t3,730 TOTAL 23,696.49 t7,to2.9E r30,tEE.62 4989.77 59,442.5 19,163.1 3.2. Financial contributions of the paltners and communities Table 13: Financial contributions by all partners for the last three years - If there are prohlem^s with release of counterpartfunds, how were thqt addressed? Major issues accounting to non-release of counterpart funding have been the regular changurg of poliry makers at the State and LGAs govemment levels, bureaucracy and lukewarm attitudes by some of the stakeholders. More mobilization and advocacy r,jsits need to be undertaken. The prqect however in collaboration with the supporting NGDO paid an advocacy visit to the officials of Ministry of Health and liaised r,r.ith Director of PHC in Ministry of Local Govemments so that counterparts can be released to the project. Additional comments 25 - W}{O/APOC- 24 November 2004 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) The communities have been supporting the prograrnme as much as thel' can tkough re- selection of most distributors that do refuse to continue with the distribution or got e $ or!. Or have to relocate. Some few members do assist their CDDs with little funds while others do appreciate or motivate CDDs verbally. Distributors during the year under review gave maximum support to the programme by distributing the drug rvith little or no compensation from members of their respective communities. 3.4. Expenditure per activifi Indicate in table 11, the amount expended during the reporting period-for each activity hsted. Wnte the amount expended in US dollars using lhe curuent United Nations exchange rate to local currency. Indrcate exchange rate used here Ia!le-L[: Indicate how much the project spent for each activity listed below during the reporting period. Activitr' Expenditurc ($ us) Source(s) of ttn44s Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of Islamic scholars (Re-Training) Training of health staff at all levels and plaming meeting Supervising CDDs and distribution Internal monitoring of CDTI activities Advocary visits to health and political authorities IEC materials Summary (reportrng) forms for treatment Vehicles/ Motorcycles/ birycles maintenance (Major patu replacement, Reparrs, Fuel) Office Equipment (e.g. computers, printers etc) Communication (Telephone/Fax, Post/Courier) Travel to project areas for various CDTI activities Others - insurance, planning meeting and data management Z'J 956.9 10,669 620 r.253.8 310 1,008 388 605 3237.6 233 SSI State / LGAS APOC/SSI State/LGA APOC SSI SSI SSI SSI SSI APOC/SSI SSI TOTAL 19514.3 30 - WHO/AP(rc- 24 November 2004 165,421Total number of treated Ary- comments or explanations'l SEGTIOII 4: $ustainability of GDTI 4.1- lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which arrc applicable) Yes Year 1 Partici patory tndependurt monitoring No Mid Term Sustainabilit-v Evaluation 5 I'ear Sustainabilitv Evaluation Intemal Monitonng by NOTF Other Evaluation by other parfirers No No No 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period'l No Was a sustarnability plan written? Yes When was the sustainability plan submitted? Yes What arrangements have been made to sustarn CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Planning meetings at both the State and Local Govemment levels will be carried out before the commencement of subsequent treatment rounds. Advocac-v to stakeholders will be done continuousll' to ensure total commitment at all levels to the sustainability of the work plan developed on CDTI activities. Mobilisation. health education and sensitisation of endemic communities shall be of priorit_v for communities to take ownership of CDTI prograrnme. a o a 34 - WHO/APOC- 24 November 200'l 4.2.2. Funds Advocacy visits were used to relevant parhlers on the need to release counterpart funds toward sustaining the project. The state govemment budgeted N500, 000 out of which N95. 000 was released. The LGAs released Nl l l. 000. 4.2.3 Transport (rcplacement and maintenance) o The Ministry of Health and the endemic Local Govemment Areas will continue to maintarn some existrng vehicles and motorcvcles provided b1' supp orhng organisations. 4.2.4. Other resources Other resources would be maintained and replaced as counterpart funds are released by the State and the LGAs. Health workers from non endemic LGAs will be trained. This is to eripose them to CDTI activities in event that they are posted to endemic areas. a a a 4.2.5. To what extent has the plan been implemented SOCT/LOCTs developed a comprehensive CDTI work plan. This is being folloued through. Monitoring and supervision was carried out in areas where problems were anticipated using the checklist developed by NOTF. o a Frontline health facility workers supervised project activities at their own levels" Mectizan@ tablets were collected by the endemrc communities at agreed points. likewise LGAs. Endemic communities were mobilised. health educated and sensitised on how to take up CDTI responsibilities at communiq'level. The release of counterpart funding is hoped to improve as advocary visits are on going both at the state and LGA levels. There was full usage of vehicles and equipment for CDTI activities. 4.3. Integration Outlme the extent of integration of CDTI into the PHC structure and the plans for complete integratrcn: 4.3.1. Ivermectin delivery mechanisms a a a 3L - WHO/AP(XI. 24 November 2004 5 Vehicles for other health programmes such as disease surveillance, NPI and stalf were used by the project in the delivery of Ivermectin to the endemic LGAs and for collection of reports and balance of drugs. Likewise Front Line Health staff carried out CDTI activities w'hen implementing other community based health programmes. 4.3-2. Training Primary eye care was integrated into the past training of trainers for Ivermectin delivery in ',he previous vears. Re-training and training of communiS' distributors for identification of individuals with eye problems in their respectir-e communities u'as scheduled to continue in2006. Not much funding was received from the state and LGAs which limited activities and the identification of individuals that have eye probiems by CDDs. The project plans to carry out these activities next year with availabilit"v of funds. 4.3.3. Joint superuision and monitoring with other programs NPVDisease surveillance and CDTI staff help one another in supervision and mo nitoring, through inter pro gramme coll ab oration. 4.3.4. Release of funds for project activities A combined budget for all programmes under the Department of Disease Control had been established. The fund released by the state and local govemments during the 1'ear under review wils insufficient to carry out activities as budgeted and planned. Nevertheless it is hoped that funds will be released to the prograrnme as budgeted for subsequent treatment vear rounds. 4.3.5. Is CDTI included in the PHC budgetr Yes 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Health r.r'orkers in other community based health prograrnmes and CDDs u'ere trained in the CDTI strategy and on Primary Eye Care. This is anticipated to help them use the stratery in other related programmes and in screening, identification and referral of eye patients in their commurities using the CDTI structure. 4.3.7. Describe others issues considercd in the integration of CDTL The strategy is cost effective; people at the grassroots can easily be reached by primary health care services. This will help them take certain responsibilities towards sustaining and developing health programmes. 33 - WHO/APOC- 24 November 200-1 4,4. Operational research 4.4.1. Summarize in not morrc than one half of a page the operational research undeftaken in the proiect area within the reporting period. There was no operational research carried out within the project area during the y'ear under review. 4.4.2. How wert the rcsults applied in the proiect? SEGTIOil 5= Strengths, weaknessesr challenges, and opportunities - Lrst the strengths andweaknesses of CDTI implementalion process- - List the challenges and indicate how thelt were addressed. Strength: - Severe adverse events continued to decrease. - Integration of Primary Eye Care into CDTI. - Trained and committed SOCT/LOCTs. - Committed NGDO - Selection of distributors by a good number of communities. - Collection of Mectizan@ by communities. - Distribution of Mectrzan@ by most CDDs despite little or no compensation by their community members. Weakness: - Release of little counterpart funds for the year under review both at state and LGAs level. - The need to continue training Islamic scholars - Non availability of female CDDs - Frequent movement of the nomadic population. - Non compensation to CDDs in most communities Stalieholders support is being solicited for the release of counterpart funds, creating awareness for female CDDs to be selected. The communities are sensitised on compensation of CDDs. CDDs are informed to conduct mop-up treatment to ensure good therapeutic coverage. 3l{ - WHO/AP(XI. 24 November 2004 SEGTIOil 6: Unique features of the proiecUother matterc 3s WHO/AFIC. Il2-l November 2(X)'l