YEAR FOUR ANNUAL PROJECT TECHNICAL REPORT ON THE NIGER STATE COMMUNITY DIRECTED TREATMENT WITH TVERMECTIN
COUNTRY/I\OTF : Nigeria Proiect Name: NGNIG4
Approval Year: 1999 Launching vear: 2000
Renortine Period (Month/Year): January To Decemberpfi)3.
Date submitted : 30/1 2l2OO3 NGDO partner: UNICEF
ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
I AFRICAN PROGRAMME FOR For I I
I ONCHOCERCTASTS CONTROL (APOC) 'Io: I c,tPi coopt I C-Str I
CL.V o Btm 3t'o r{s" J l. c,t. cr1 l _b r0, fto ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSU LTATIVE COMM ITTEE (TCC) ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
country: NIGERIA/LIB
National Coordinator Name {
Signature -,......
Date 1 D
Zonal Oncho Coordinator Name ^/'aur J{:orrt t
Signature -\U Date: 9(:t
This report has been prepared by Name : Ry.patti
Designation : State Oncho. Coordinator.
Signature' &L* "6 D4e. adpilaqq*- FOLLOW UP ON TCC RECOMMENDATIONS I
EXECUTIVE SUMMARY ...... 2
SECTION 1: BACKGROUND INFORMATION ...... 3 l.l. GpNsnaLrNroRMATtoN ...... 3 l.l.l. Descriptionof thepro.ject (briefllt) ...... j
l. 1.2. Partnership . . j
SECTION 2: IMPLEMENTATION OF CDTI...... 11 2.1. PlnrooolrAcTrvt'uEs ...... 12 2.2. OnonRn.ic, SToRAGE AND DELIVERY oF IVTIRMECTIN ...... 15 2.3. Aovocacyaxo SnNsrnzATroN ...... 17 2.4. MoanzarloN ANDHIIALTH lil)ucATroN oF AT RISK coMMLrNrrrES ...... l9 2.5. CorwtrxurrEs INVoLVEMENT INDECTsToN-MAKTNG ...... 22 2.6. Capacrry BUTLDTNG ...... 24 2.6.1. Trairung...... 2J 2 6.2. Equipment arul humnn resources...... 27 * CoNotttou oF TF{E EeUIpMENT Pi.Easp srATE ...... 27 2.7. TRleruENrs ...... 29 2.7.1. Treatment.figures...... 28 2.7.3. Trend qf treatment achievement from CDTI propct inceptrcn to the current year2_p 2.8. SuppRvrsroN ...... 34 SECTION 3: SUPPORT TO CDTI ...... 39 3. I. FnlaNcrar CoNTRII]UTIoNS oF TIIE PARTNERS AND COMMLTNITmS ...... 39 3.2. OTgpnFORMS oI,coMMUNrry supR)RT ...... 40 3.3 EXPENDITURE PERACTIVITY ... 40 SECTION 4: SUSTAINABILITY OF CDTI ...... 41 4.1. INrpRNar: INDEPENDENT PARTICIPAToRY MoMToRING; EvaT-uaTIoN ...... 42 4.2. Comaulury sELF-MoNrroRINGaNp SrarnHoLDI,tRS MEHrnlc ..... 43 yR 4.3. SustarNagtLITY oF'PROJECTTs: eIAN AND sllr TARGETS (N{Ar.rDAroRy Ar 3 ) ...... 44 4.4. INrEcReuox ...... 45 4.5 OpsnarroNAl RESEARCH ...... 46 SECTION 5: STRENGTHS, WEAKNESSES AND CIIALLENGES ...... 44
APCTTdTX 1 MAP OIT MGER S'TATE SIIOWING THE ADMIMSTRATIVE BOLINDARIES .... :. APCNdiX 2 PLAN OF ACTION FOR YEAR iV CDTI IMPLIJMENTA,TION IN NIGER STATE...... j. . Appendrx 3 PROPOSED PI-AN oF ACTIoN FoR YIIAR v CDTI IMpt.EMENTATION ...... 53 IIIRST YEAR CDTI POST APOC SI]STAINARII,ITY PI,ANS FOR MGER STATE JAN-DEC,2OOs...... 57 Acrontms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obj ective ATO Annual Training Objecfir e CBO Community'-Based Organization CBS Communit;- Based Supervisor CDD Communitl,-Di rected Distri butor CDTI Community-Di rected Treatment with Ivermectin CSM Community Sel f-Monitoring DHS District Health S upervisor KAP Knowledge Attitude and Practice LGA Local Govemment Area LOCT Local Onchocerciasis Control Team Members MIS Management Information System MDP Mectizan Donation Programme M&E Monitoring and Evaluation MOH Ministr-v of Health N/A Not Available NIDs National lmmunization Days NGDO Non-Govemmental Devel opment Organization NGO Non-Governmental Organization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primar-v health care RBM Roll Back Malaria REMO Rapid Epidemiological Mapping of Onchocercias i s SAE Severe adverse event SHM Stalieholders meeting SOCT State Onchocerciasis Control Team Members TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers TINICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization Definitions
(r) Total population: the total population liring in meso/hyper-endemic communities within the project area (based on REMO and census taliing).
(ii) Eligible population: calculated as 84%o of thc total population in meso/hyper- endemic communities in the project area.
(iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hvper-endemic areas that a CDTI project intends to treat with h'ermectin in a given year.
(il) Ultimate Treatment Goal (UTG). calculated as the maximum number of people to be treated annuallv in meso/hvper endemic areas within the project area. ultimately to bc reachcd whcn thc projcct has rcachcd full gcographic covcragc (normally the project should be expecl.cd to reach the UTG at the end of the 3'd 1'ear of the project).
(.') Therapeutic ccivera-se: number of people treated in a given year over the total population (this should be expressed as a percentage).
(ui) Geographical coverage: number of communities treated in a given year over the total number of meso/h1per-endemic communities as identified b1' REMO in the project area (this should be expressed as a percentage). FOLLOW UP ON TCC RECOMMENDATIONS
Using the table below, fill in the recommendations of the last TCC on the project and describe horv thel' have been addressed.
TCC session !f
Number of TCC ACTIONS TAKEN BY THE FOR TCC/APOC Recommendation RECOMMENDATIONS PROJECT MGT USE in the Report ONLY 261 (i) State should contribute - The State Govemment noted funds to project TCC recommendation and directed that a fresh request be submitted. The sum of US$30.000 will be requested for. for year 200:1.
- A State level Stakcholdcrs' mceting is scheduled for the first quarter ofycar 2004. 26r(iD Census should be done in Census was updated during thc 30Yo of the LGAs using last treatment. and an intensive the appropriate levels of census update to be supported CDTI bv UNICEF. is scheduled for January',lFebruary 2004.
(Please add more rows i-f necessary)
W}IO/AIIOC. 26 September 2003 Executive Summarv
Niger State has 25 administrative divisions knorvn as Local Government Areas out of which 2l arc implementing CDTI. The projected population for the State is 3.2 million (i.e. based on the l99l census). There are 2.583 affected communities in these 2l LGAs rvith an estimaled population of 1.687.560 at risk of rnfection and blindness from Onchocerciasis.
Dunng the period of report. 1.092.069 people were treated in 2.193 communities. The ATO for the vcar was 1.139.606. These figrres represent 6-5% therapeutic and 85% geographic coverages respectireh'. The accurate Ultimate Treatment Goal (UTG) for the project rvill be determined b1,the end of the first quarter of year 2004 when census for 4 newly added LGAs, and additional communities of 7 old treatment LGfu which were flound to be qualified for CDTI (as a result of REMO update and finalization of Januarv. 2003) is completed. Horvever. based on estimate. the UTG for the project could be as much as l.4l 7.550 therefore the UTG coverage was 77Yo.
The population in over 40% of the project is very highly migratory. comprising of ethnic groups such as Grvaris. Kambaris and nomadic Fulanis. Due to the cultural beliefs and practices of the first two groups. thev migrate annually both rvithin and outside the State in search of virgin (fertile) land for growing cash crops such as yams. gninea corn. maize and millet. while in the case of the nomadic fulanis: theS' migrate in search of water and fresh fodder for their animals. The abore phenomenon is responsible for the highly nucleated and dispersed scttlcment pattern that features in over 60% ofthe \ast land area ofthe project.
5.315 CDDs rvere traincd./retrained. at a rafio of I CDD to 330 population. rvhile l0 SOCT and 664 LGA/PHC workers were trained and retrained on Communitv Self Monitoring as u'ell as for improved record keeping. The achievements represent 93oA. lOf/o and 8f'l The biggest challenge the project experienced rvithin the year ryas achiering its' ATO of 1.139.606 in the 2l CDTI LGAS. inspitc of lack of State government funding. and late receipl of donor funds. The situation at the LGA level rvas compounded b1, unstable leadership. Frequent change of political leadership. coupled with poor funding was therefore. a major consfiaint to the smooth conduct of CDTI activities at that level. In fact. the last leadership was dissolved during the first week of December 2003. in preparation for election of a permanent LGA council b1.the end of Janua4.. 20M. Unicef prorided funds (in July) to enablc the SOCT convey McctizanCR, from the State 1i.e. after it u'as received from the Zone C. NOCP Coordinator) to the LGAs. The SOCT supenised the distribution of the drugs to the comrnunities, and ensured that treatment commenced immediatell'. i.e. before their deparrure llom these LGAs. The commitment of most of the LOCT and the frontline health facilitv staffin retraining CDDs and supervision of treatment was nevertheless. a major strength rvhich helped us to ovcrcome the challenge. Thc LOCT in most LGAs utilized their personal funds (for travel) to supenise the activities in the districts and communities. ) WHOiAPOC. 26 September 2003 SECTION 1: Backsround information 1.1. Generalinformation l 1.1. Description of the project (briefly) - Geographical location. topogaphr'. climate - Population; activites. cultures. language - Communication svstem (road... ) - Administrationstructure - Health s)'stem & health care deliven (provide the number of health posts/centers in the project area if the information is available). 1.1.2. Partnership - Indicate the partners involved in project implementation at all levcls (MOH. NGDOs -national. internati onal ) - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, adl'ocary, planning, mobilization, etc) where all partners are invoh'ed. - State plans if an1, to mobilize the state/region/districVlGA decision-makers. NGDOs, NGOs. CBOs, to assist in CDTI implementation. I . I . l. Description of project Niger State is geographically located rvithin the middle belt of Nigeria. lt lies betrveen latitude'3 20' East and longitude 1'l 3' North. It is bordered by Zamfaru State on the North" Kebbi State on the North West. Kogi Statc on thc South. Kwara Statc on thc South West. Kaduna and Fedcral Capital Tcrritorl. of Abuja at the North East and South East respecrively. The State shares a common boundary with the Republic of Benin on the western border i.e. at Babanna district of Borgu local government area. The location of the State gives rise to common inter-border trade with it in all directions. see Appendix I. The topography of the State is highlv undulating. while the land is traversed by several fast florving rirers and streams such as River Niger. Oli. Kaduna. Kontagora. Gurara and seyeral tributaries that flow into thcm. As a result of the topography of the State. thc rnajor rivers of Niger and Kaduna have been dammed. for production of electriciry', therefore the State houses the largest number of hydro electric power stations in the country. thereby earning itself the title, 'Power State'. There are two prominent hydroelectric porver dams in the State i.e. that of Kainji across River Niger. and Shiroro. across River Kaduna. Despite its mcso endemicity, thc State is surroundcd by'the hr4oerendemic foci on its' Northeast. Southeast. South and Southwest. These States are Kaduna. the FCT. Kogi and Krvara States respectively. The vegetation is mainh' of the Guinea sal'anah type with forest mosaic savanah especiallv in the south and south ll'estern parts of the State. The climate is of distinct dry and \r-et season with rainfall ranging befween 1.l00mm in the North and 1.600mm in the south. The wet season ranges fiom WHO/AIOC. 26 Septernber 2003 l50days or more in thc no(hcrn part to 210 days or more in the southern part. The dry season colnmences in October and the humidity could be as low as l40'betlveen December and February'. Temperatures rise as much as 90F between March and June. with the lowest minimal temperatues usuallv in Decembcr and Januar"-. Most of the Onchocerciasis endcmic communities are located within the abundant flood plains of the nvers that trayerse the land. and so the population is mainll' agrarian in over 80% of the area. Among the large etluric groups. the Gwaris'. Kambaris' and nornadic Fulani's have a cultural habit of moving from place to place in search of virgin land for their crops and in the case of the Fulanis for s'ater and lrcsh fodder for their animals. Common cash crops produced by these groups include yams. maize. rnillet and guinea corn. The Nupes' iue one of the major ethnic groups in the State, and they are more stable in settlement. forming very Iargc clustered populations rvho reside w-ithin the marshy alluvial rich valleys rvhich abound in the State. The Nupes grorv rice as both food and cash crop and the1,are also very good fishermen. While the settlement pattern in 40%o of the State is dcnse and clustered. over 600lo is sparsely populated and highly nucleated with distances of up to 20 kilometers between some communities. Niger is in fact. the largest State in Nigeria, occupying about l2 million hectares of land i.e. about one tenth of the total land area of the country. The State has a fairly good road network in about 40olo of its' area. however due to its' highll'riverine nature. about 407o of the movement is by water u-sing local tug boats. engine boats and fern' lbr movement of goods. vehicles and humans across the river Niger and neighbouring Kebbi State. Heavy {looding as a result of overllow of dams. is a major threat to fishing communities that reside along the large rivers of the State. and several communities are therefore often either submerged or thel' are displaced during the rainy season. The administrativc sructure is typical of what obtains all over the country. with a politically elected Executive Gon'ernor at the State capital. and 25 [oca[ administrative councils. headed also bv politicalll' elected LGA Chainnen. There are several traditional institutions headed by Emirs of various hierarchies rvho olersee the districts and communities. The communities are also headed b1' traditional rulers who pay allegiance to the top hierarchy. The State government comprises of three arms i.e. the executive. legislative and judiciary- The health care delivcry system comprises of three lcvcls i.e. Priman' (Primary Health Care). Secondan' and Tertiary', all of which are quite well interlinked. The PHC system has been put quite A WHO/AI0C. 26 September 2003 well in place. and is becoming more functional cspcciallv with the presence of a resident German goverrunent assisted PHC development project knou,n as the GTZ (Lafia PHC project). There are over 1.400 health posts/hcalth centrcs in the State out of which about 1.000 eist within the CDTI project area. s WHO/APOC. 26 September 2003 1.1.2 Partnershio The partners involved in project implementation in the State arc the MOH. APOC. LINICEF. WHO. GTZ (PHC). local NGOs. CBOs and the benefiting communities themselves. The partsrershrp between Covernment. donors and thc benehting communities has grown in sEength over the 1'ears: holvever. unfortunatelv. financial input from Goternment (especiallv at State level) has diminished ovcr timc. Political instabiliw at LGA level. caused b1, delal. in election of pcrmancnt got'erning councils. (due to ongoing Local Govemment reforms. and reduced Federal revenue allocation to these LGAS). had a very frustrating effect on CDTI activities. As a matter of fact. the last but one LGA executive council rvas dissolved during the first rveek of December 2003 i.e.. in anticipatiott of elections scheduled to hold at the end of January'. 2004. There has been improved collaboration u-ith UNICEF. especialll, in the last h\o )'ears'. LTNICEF supported the project u,ith US$ 1.1.000 in year 2002 and it was utilized for orientation of local NGOs and CBOs. as well as for training of LGA/PHC staff for facilitation of CSM. The sum of U.S.$12.441 received from UNICEF in year 2003 was utilized for ensuring distribution of Mectizan to end users i.e support of the SOCT and LOCT in ensuring that Mectizan received by the State was released to the benefiting communities as soon as the drugs arrived the LGAs, and that communities were mobilized for immediate collection of their drugs for distribution to the benef,rciaries. orientation of women groups, as rvell as holding of stakeholders' meetings at LGA level. As a result of this support. 930 local NGOs and CBOs were oriented and mobilized for support and participation in CDTI. 227 LGAIPHC frontline health facilitv staff were trained as facilitators of CSM and SHMs. 650 Stalieholders met. and 700 women group representatives were mobilized for support of CDTI. A total of 1.092.069 people were treated out of an estimated population of 1.687.560 located in 2l CDTI LGAs. A proposed State level stakeholders' meeting has had to be rescheduled for the first quarter of vear 2004 i.e. rvhen hopefully. the local government elections would have been held. and there is promise of continuitv of governance at that level. UNICEF also participated in planning of actirities and in mobilization of Governnrent at State and LGA level. through paying of 3 advocacv r-isits to State executives and soliciting for counterpart funds. A UNICEF official also visited two CDTI LGAS. during which the LGA executives were mobilized for support. Sel'eral supervisory visits were also made to the benefiting commr.rnities by visiting UNICEF officials and the Zonal Programme Coordinator for NOCP/Zone C. in companv of the SOCT. LOCTs and supenising frontline PHC facilitv stafL UNICEF input was strengthened by the presence of the GTZ (Lafia) PHC project which supported the project with US$5.595 utilized for generation of data which helped to finalize the REMO for the State (in year 2002). GTZ also supported in year 2003 with the sum of U.S.$ 13.386 (t WHO/AK)C. 26 September 2003 rvhich was utilized for training of 103 LGA/PHC stafl. and Health Education/Mobilization of cornrnunities in 3 out of .l newl_v approved CDTI LGAs of Suleja Gurara and Aglvara. Communities iu Minna the State capital. were also mobilized for clinic based disnibution of Ivermectin fiom the support received from GTZ. All of these efforts by donors have greatly helped to boost the morale of both participating government officials as rvell as in improving the qualir-v of CDTI in the State. The improved partnership with LTNICEF might not be unconnected with rescheduling of activitics of its officials and its' identification of a focal officer for Oncho.. in person of Dr. Kenneth Kon'e. at its' National o{fice. The local NGOs and CBOs rvho rvere mobilized are verv much involved in CDTI activities. especially at the communitv level. where they advocated for prograrnme support as rvell as helped. to mobilize their communities for compliance with yearly treatment. Local NGOs and CBOs lolunteered to drstribute Mectizan in several urban centres of the CDTI project area this year. and thel' played a rnajor role. especiallv in newly added LGAs like Tafa. Suleja. Gurara and Agwara. where. because of constraint on time for communities to make decisions. and the urgent need to commence treatment in those LGAs. distribution was carried out actively. by CBIT and people uere mobilized to assemble at various treatment points i.e. clinics. r,illage head houses. churches. mosques. toNn squares etc for administration of treatment. The most prominent (active) among the CBOs were. the youth de'r'elopment organizations known as Kungiyan matasa i.e. the age grades. who volunteered to serl'e as CDDs in old treatment LGAS where others dropped out because thev were not motivated b1' their communities. The presence of these CBOs. might account for high retention of CDDs in 60% of the treatment communities. Other active groups are the union of road transport workers who volunteered their vehicles for collection of drugs from district health facilities in old treatment LGAs. The tremendous Technical and Financial support received from APOC, though it arrived the State in Jul1.. and was not approved for utilization until September. did realh, help in the conduct of CDTI activities. APOC funds. though fully received. could unfortunately. not all be utilized because of dilficulties encountered with obtaining UNICEF approral lor expenditures proposed. The changes at UNICEF brought in new personncl at the zonal office who appear not to be familiar with APOC financial procedures. and therefore lend to appll' IjNICEF rules to utilization of APOC funds! Some locally based international NGOs like the lions club of Borgu i.e. a unit of Rotarv international located at New Bussa. headquarters of Borgu Local Government. and one of the 17 old CDTI LGAs. have even voluntecred to commit frurds in support of the CDTI. More effort will be made to ensurc that such funds are released. In order to er$ure release of funds by' Government as well as availabilitv o[ frurds for yearly CDTI. MectizanCD distributton subcommittees have becn formed within Stalieholders' committees at LGA level. With this. it is hoped that yearlv drug collection and 7 WHO/AK)C. 26 September 2003 distnbution will be well funded. with the hope of ensuring a sustaincd annual drug distribution. for the long time required. Women participation in CDTI is verv poor. in this Sratc. mainll, duc to cultural and religious attitudes (in most parts of the project area) which secludes women from participating in public actit'ities. In ordcr to create capacitv for mobilization of women goups. there has been good collaboration with the department of rvomen affairs both at State and LGA level. where the focal persons for rvomen affairs at LGA lerel. have becn trained. and in fact. constitute a part of the LOCT. 700 womcn group leaders uere recentlv oriented and mobilized for CDTI in the 2l participating LGAS. There is a proposal to sensitize children and school teachers in the oncoming year. R WHO/APOC. 26 Septcmber 2003 q)E 3 q) ci crl c] \ \o c.l \o t-- c\ co co cr \o c.l H o F tr) lr) A rr) o 5 \o \o $ F- l'- ! Fo \o C! $ F- r-- co c.l t-. \o c.l $ * r.n aa \o ..f \n ct + r- + 1) \o t-- $ rt € tr- ri N 6 c.l o. i) q) a .o \o q) d.c cl .=-oo oN O S (l .- + * o .El cO eo * 0, Ei E> E el r.) C\ o\ \o co C-l L E:q ;ie 6 * * c.l e.l .* ta) L Yorc, a-I c{ o\ co al t L) ra) |r) c.l t-- ro- o\ t co ca N m r- N q c.) =f c.l w -s^ O ca^ 0) € N v s @ aal .: 6) tl (l) o ;c- 9E i o (l) I ot: >. 6) o Ho q) o N I I I I I t I t t t I I (I) E 'EEE )l z P=: a Yoroi cd gNo. \o t-- r* tt- o\ O \o ca 0) a trl c.l { A f (\ ea ra) (a o.t a o ra) C\.! (\t oo 0 (B a. o tr3,) .i+ q) o- o4)= .* 1 .-LlY eo aa * Gl ! !,? ra) r,-) JFV cit c.l o\ \o ca c.l v in lr) c.t cd F- \o $ co aal N ao l-- >i E O.gl o\ o\ c.l .f, a co aq E *cr= P' cil c.} $ G (l) !.) ,v9FL oc c.l { a ao t $ ot t '- \) -A-A F- tat ral m cn oi o l*\ c- .F€.9--!r+q)cJ oo (! (J\ Eeic L O. cS (B J1 o oo oo ho o) 0) ro o o orl 3{ ['H (B (g H a Cg cd o ! F(J.E := oo Cd U) oo ! ti.- a on E -ol Cd PLAN OF ACTION FOR CDTI IMPLEMI]NTATION IN NIGER STATE, S/N Activitds Time Action hy Participants Reporting Month of frame deadline Implementation I NOTF/APOC Jan-Mar NOCP SMOH. LGAs April8h January, June, Jull' advocacl'visits to APOC December. proiect State 2 Management and Jan-April APOC 2 SOCTs Feb. l0h JanrFeb operational planning NOCP I data officer Mal'30'h workshop for State Coords. J Procurement of Feb-July APOC wHo Feb.-Julv October essential project State State Coord. equipment and supplies ,l Training/Retrainin g of l3-14 Jan NOCP SOCT Feb 2"d October. Janua{' SOCT as TOT for ZOCT Community Self Monitoring(CSM) ) Training/retraining of Jan 15 - NOCP LOCTs Feb 31" Jan-Mar LOCT as supervisors Feb 15 SOCT and facilitators of (CSM) 6 Retraining of February SOCT LOCT. June 30h Aug. Sept, October, LGA/PHC StaJIon LGA/PHC staff improred MIS. 7 Mobilization of State Jan-July NOCP State policy l0h August Jan-Dec and Local Government SOCT maliers- LGA Public and Private LOCT/PHC policy makers. sector support stalT Traditional leaders. opinion leaders. Reps. of CBOs. Comm. leaders and comm. members. ti Community KAP Maly'June UNICEF Communities July 2I't Not done sun'ev GTZ ZOCT SOCT LOCT 9 Sel ection/replacem ent Feb-June Communiti Communitv Mar 3l't Feb. Aug Sept. of CDDs by CS leaders/member Jul.y 3 October. communitv members. S l0 Training/retraining of March-Julv LOCTs CDDs.CBOs Julr'30 Jan. Aug. Sept. CDDs No.r'. Dec. ll Community March-July LOCTs CDDs. March28- August-December registration and communities Jull' 3 I distribution schedule announced ll WHO/APOC. 26 September 2003 t2 Communitv ou,ned March - LGfu CDDs May-Nov l0 Aug-Dec Mectizan distribution October CDDs and Communities 1 ".2"d.3'd.rlth rounds health workers t3 Commurity Self Feb- Nov Community Communities Nov 30'' October-December Monitori n g/supervision Monitors. 2003. Januan'20M of distnbution Health activities. workers. Village heads. l.t LOCT supportive Feb-Dec LOCTs LGA/PHC staff Dec 5tn Aug. Sept. Nov monitoring/ CBOs CDDs supervision of Community distribution activities l-5 SOCT "spotcheck" Apnl SOCTs LOCTs/PHC Mav 4tn Aug. Sept monitoring and June staff lutv +s supenision of Sept. CDDs oci+" distribution activities. Comrnunities t6 Review meetings- Mar. April. LGA LGA/PHC April 15. Jan(a.b;.Mar(a).Apr (a)SoCT O)ZOTF Jun. Julv Coords personnell. June l2-Jul il(a). June(c). July(b. (c)NOTF/APOC. (d) Sept..Dec. State Coord SOCT:9 State 20. Sept l-5 d) UNICEF ZPC,APOC Coords. And Dec 7. Nov(c). Dec(d) .NOTFruNI deputies: State CEF Coords. NOTF proj.Accts. SOCTs LOCTs/lrlOTF/ UNICEF l7 NOTF Qualiw control Feb NOTF SOCT Mar 3ls team visit to project Aug- ZOCT LOCT Sept site Communities ,) 18 Project evaluation by APOC SOCT ? NOTF/APOC NOTF LOCT (internal/external) TINICEF Communities l9 Report collection/ June- Health LOCT Dec l0 Sept-Dec collation, analysis. Dec lOs workers Health workers -Planning for LOCT Communities adiustment SOCT 2t) Planning for year Dec llth- LOCT NOTF/SOCI' Dec 15 Dec.30 v(2004) l3s SOCT UNICEF LOCT t) WHO/ARX. 26 September 2003 l+ * ITJ * 7 * J+ X l-l w - o { - ? c X tt .5: o a DD ta @ o fio oo V) 7i E ED a t) o o x o to l(D o DT a oa 3 0q E oq D o a) ts OD t lx, F ; o (D (D o,+) tr) a) eo CD (D d tr -0 a E z '1 t E.i {a- ,: : : : : : ,: I .: ': ) t : .: a :'E oo I (D= i-E =N5a+ tDt (D a ,.7' (D o@ .) o o C-3E IDJ tn fa o' d *6 (D (D o t 4 TD c (D a- ? !D FO l! 7 ID I I -o o o !! .) (D I I t I t ': a : '? .: ,: .: ') .: =J o -0a+3 r.i !r (D (, (n (A (u U) (A (, Vt (Da (D (Da (D a (D a w a a w o G) ae au o (! o o o o CD Cl, o ,o 'd i3 .o r3 (D o 'o 'o 'o 'o 'o 'o 'o 'c '6 'o EE ,Q u' o o (D (D (D o (D o o (D o o o (} o o t (Ir J 9rc I o' o' o' o' o- o' ct d d o- o- d so .D ln o (D (D o o .D (D .D (D .} (D o o o E (JJ H B n t t H I t t I o a G a a (n (A a (, U1 (D o ,oo C0 -o(D o @ oc rc oc oq rlq oa oq 'c fjq oa rJq 'o '6 -vt F* (} o o L o o Ci (D V) q) q .t q .t q E U) E a V) o d d d d d d =.i o (D (D (D o CD t to o -0e ra O \ a CD t (u CA (A O O e o z r0 (! (D z z z (D .D z z o i a o o o ,do o o -c o q rra oa 'c 'd '3 'd 'c a c; (D (D (D cb (D (D (D (D JI q) o o o oi co of U) d H 3 o (D (} d d 5 d o' d d =d d (\ @ (D (D o o (D o (! o o o a Cu t t n I t I t t (\o -q -"1 (n q P (Da a a U) o CD o o ()o o o c) rra rrc tc E E 0q 'd oa rrc @ rra oo 'o 'd \_ a o (D -o ta o o t G ra qI o o 3 V) U a U V) a J =.i ) (D d o o o (! o @ (! !'E la t I I E t ra z U z Z o z z z z o o o (! o () o (! o o o o o E .) C) c) 4. o c c (D o 4A o o o o o o at (D o o a'i 3A cr o' d o q d (D o o (D o o' o- t I I o (D (l o' (D o' d q - o q (D o o o o (D H I I n I I t I t /< p (u U) (u (r) (D a a a (n t9 (! n(D (D o o (D o o (D o o\ o la la oa oc .JC oc 0c -o o G G o (D (D o E e" tr tr o o a p5 a a q V) -9 o' d o' o' C' o' o' o- =+ a .D o (D o o (D (D o o (D (D +E' I t t I B t I t B tD (i B w l! a z z z z O o z z o O @ o o C) o o o (! o o o o o o O 'o o O o o c (D (} o a (! a 33 o o o c o d I G d d o Oi 5 o * H oj o (D o o 5 d d t 6 € I d I B t o .o .D (D (D (D .D o (D I o to t I (, oa n !D' !) & IF a * * o- o o= 75 t- -l (! o a, o a => c)(J q =.oNi Fd g) i6 a H3 -(\ l- o (D r(D \o 0 0eo o A) o q 4 (D d q Cc tslr NB: o c) N aa- o o o o p. z z z z o. A) z, o o o !t (D (D (} (! Cv G (! o o5 ts (D +F) ts p- (i G tFU t, @ D] Io Io c)E o - t- !) (D =o t o A) o o (D o 5 E(D o o c) o +- a o- (D o o o C0 - O) ? 3 , 0 o o o oo' 8fJ o E) I I n t o FU !) @ o o- ri o (D -l (l (D fD t z t- (D (D @ o o o o O oF. o (D o (D d o' q !: E) t s) o (D t Sl (} d o (Dq (D I o H) oo (h (lt aD) (ra (D e. og a o o' I an 7 o o "o FA o (D o rr, H i o - a o ?!t @ o od (!c' t d d $ Eq o' o (D +- rf t t t iil 'u o (}(D (d o 0e !f 7, 2. z 'z NtD -t b o b, oa ^l 3.H o o o o S) (A o' o a q eP. t o o o S) B)@ 9 5O- e. o o o o g co' -l + o ; o z z z z .o Gi B: o o s, 9A o o o o o)e P tr- |_- a o o o o o oa z o S) P a E) H ? o (D o o + !) 6 r) O o o o. (D o a, o o (t I (D (D (D q (D (/) I n@ t IC! q ? (D +) @ O) oc o o o (! o o C) .) Fi 0 a o .D o o o oI A) o o 0 o E CD q .0 (D t o+l oa H B c) U) .) fd(D o ,o B) ct) U a c0 p U ? (D o o o o o ? (t (D o o C' oU) o- (D p o 0 d C' (D (D o (! (D t I I t o' o C o I E) N) o @ G, o o o' o a () .) oF+) a .D .D o E ts d (D cD o o - t I 2.2. Ordering, storage and delivery of Ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH N WHil UNICEF E NGDO tr Other (please speci[') Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH E wHd TJNICEF f] NGDO tr Other (p I ease specif-v) Please dacribe how Mectiunt:Bt is ordered and how it gds to the comnunities UNICEF is responsible for clearance of drugs that arrir-e at the Nigerian port and is also responsible for its storage before collection by the NOCP headquarters. The quantity of MectizanG required by the project is calculated based on 84% of the previous vears' populatioru and this is multiplied by 3. to obtain the accurate requirement. The request is subrnitted to the MDP through the NOCP. The State receives its allocation from the NOCP and releases to the LGfu through the LOCTs. LOCTs release drugs to district health supervisors. while the communities collect from the district health facility' within ttreir locality. In the case of very distant communities. drugs are deposited at the nearest llontline health post/facility for convenience of collection. The delivery process is as described by the following florv chart. NOCP headquarters SOCT LOCTs CBS DHS CBS COMMUN COMMTINITY Table 3: MectizanG.,lnventon' (Please add more rows i-f nece.s,sary) l5 WHO/APOC. 26 September 2003 State/District/ Number of Mectizan.' tablets LGA Requested Received Used Lost Waste Expired Kontagora 169.500 169.500 147.485 0 25 0 Rijau 164.000 164.000 160.090 0 203 0 Magama 230.500 230.500 200.369 0 94 0 Mariga 193.500 193.500 181.333 0 l9 0 Mashegu 132.500 132.500 l3l.5ll 0 726 0 Agaie 128._500 t28.500 125.359 0 tt2 0 Lapai 272.000 272.000 252.849 0 19.1 0 164-000 158-658 0 Mokua 164.000 t-637 0 188.500 1 83.1 33 0 Rafi 188.500 133 0 159.500 127 0 Wushishi 159.500 "806 8,10 0 336.000 233-4tl () Borgu 336.000 1.258 0 82.500 78.9,16 0 Lavun 82.500 139 0 56.000 45.607 0 Shiroro 56,(X)0 264 0 57.-500 -56._558 0 Gbalio 57.500 54 0 207.500 1,13.3 5-5 0 Katcha 207,500 478 0 126.000 80.548 0 Munya 126.000 0 0 169.500 12,1.398 0 Bosso 169.500 69 0 240.000 240.000 0 Suleja 240.000 0 0 105.000 77 -615 0 Gurara 105,000 0 0 73.000 49.529 0 Agwara 73.000 0 0 54.314 54.314 0 Tafa 54.314 0 0 0 TOTAL 3,3(D,814 3J09,814 2,852fi71 6,245 0 Stale activities under lverntectin delivery that are being carried out by heatth care penonnel in the project areu - Such activities include annual colleclion/altocation of Mectizan to communities. distribution at health facilities in hypo endemic foci as well as in urban centers of CDTI project area.. Training/retraining of CDDs/supportive mobilization of commurities. Supen'ision of drug distribution. Facilitation of CSM and training of monitors. 16 WHO/APOC- 26 September 2003 Collation o[treatment record and ensuring 2way fecdback on yearly activities Any other commenls None 2.3. Advocacy and Sensitization Stae the nuntber of policy/decision nukers mobilized at each relevant level during the current year; the reasons for the sensitiZation and outcomc- Descrihe dfficuhies/constraints heingfaced and suggestions on how to intpmve advocacy. 20 State policv makers wcrc mobilized for awarencss on CDTI. release of State counterpart funds and for their support, through advocacv for LGA release of funds. Requests u,-ere also made for release of State counter part funds by both NOCP and UNICEF during advocacy risits to the State. Pledges have been made by Golernment and a memo has already' been submitted in request of US$30.000 for conduct of vear 2004 CDTI acti\.ities. The outcome of the request will be ascertained in year 200.1. Several advocacy visits were made to all 2l CDTI LGAs by State offrcials and specifically to three LGAs bv TINICEF officials. for creation of alvareness on Onchocerciasis as a public health hazard in those areas. on the availabiliw of Mectizan free of charge. for confiol of the disease. the safetl'of the drug. and the need for Gor,ernment support in funding of the ongoing CDTI. 200 LGA policy makers and 1.300 traditional leaders wcre mobilized for support. From reports received so far, some LGAs released funds. others assisted vr,ith vehicles and fuel and even participated in communitl mobilization. Some traditional leaders and opinion leaders provided funds for torvn crving and dissemination of messages on cofirmencement of treatment. Several of them supervised distribution too!. This situation was even more pronounced in the -1 newly added LGAs of Suleja. Gurara. Agwara and Tafa where eyen though PHC Personnel had been trained- and communities had been mobilized for CDTI. treatment had to be conducted activelv bv CBIT because there wasn't much time available for community decision making" purchase of note books. census, selection of CDDs. decision on lreatment time and other CDTI requirements. therefore drugs were distributed at PHC facilities. mosques. church premises. in front of the traditional ruler's residences at ward level. rvithin the various LGAs. The distribution was conducted by CBOs. and local NGOs. The SOCT and LOCT coordinated and supervised the disfibution exercise. in collaboration wrth the traditional leaders. On the whole, the role of traditional leaders in mobilization of the communities for acceptance of treatment was verv encouraging. 17 WHO/APOC. 26 September 2003 Gcnerally spealiing. the LGA policy makcrs (particularll' the directors PHC and supervisorv councils on health) and the communitl' leaders fully participated in planning for the CBIT. Some community leaders even supported their drug distributors with funds. as incentivcs. Based on reports received so far. the sum of US$l.708 onlv was relcased br,8 old treatment LGAs. because full reports arc yet to be received on all ftrnds released at that level. Based on information on hand also. the sum of US$ 492 was released bv communities of 5 old treatment LGAs. As earlier explained. funding b1'Government at both State and LGA level. has not bcen very' encouraging. The poor release at LGA level lvas quite upsetting. although this situation is attributed to the political instabiliq,at that level. since there was constant change in leadership. As a matter of fact. the last political leadership was replaced early in December. 2003. in preparation for clection of permanent Local Government councils in January'. 2004. In vierv of nloves to establish better accountabilit-v at that level. several reforms are also being put in place. and these developments negatively affected release of funds from Federal revenue allocation to these LGAs. and this did in nrrn take its' toll on the implementation of CDTI at that level. ln order to overcome these challenges, media publicity would be intensified and radio jingles and local drama would be designcd and developcd for airing and awarcness creation on CDTI. Various stakeholders' meetings were held at 2l LGAs. The State level Stakeholders' meeting earlier scheduled to hold in December has been rescheduled for Februan. 2(X)4 i.e. in order to allow for establishment of Permanent Governing councils at the LGA level, (since the leadership at that level would be major participants at the proposed meeting). Moves are already being made. to get local government administrations to release funds into a central PHC account for yearll' funding of all PHC activities and it is expected that if this proposal passes through, there will be a sustainable source of funding of CDTI activities at that level. During the LGA level meetings. a total of 650 people of various groups including the intenm leadership met and deliberated on the ongoing CDTI at their various LGAs. Several rcsolutions werc made for improvement. and for ensuring sustainable annual Mectizan delivery. Among the resolutions made were:- IR WHOiAPOC. 26 Septernber 2003 To establish Mectizan,ln) distribulion committees that lvill ensure timely collection of Mectizan fiom the State and ensure its' adequacl' and avarlabilit-\'to all benefiting communities in the LGfu. To form pressure goups that rvould prompt Government at Statc and LGA level for annual release of counterpart funds. To conduct fund rarsing activities at all levels. and to establish Oncho./CDTI accounts at the LGAs. To better monitor thc commitment of frontline healthcare rvorkers to CDTI. 2.4. lllobilization and health education of at risk communities Provide informntion on : The use of nudia and/or other local systena to disseminale infonndion Mobilizalion ond health educution of women and minorities - method and response Response of tatgd communitiesh,il lages Accomplishments Wea k n q s e s/C o n st ra int s Suggest ways to intprove nnbilization of the targd communilies. Before and dunng communitv mobilization and treatment. information was disseminated in some LGAs using public information vans. Local tovrn criers u'ere also ven' much engaged. church and mosque microphones were employed and information was disseminated at local meetings, ceremonies. during festivities and on market days. Radro announcements rvere also made at some LGAs. These outlets rcallv helped to improve on awareness and coverage cspecially in the l7 old treatment LGAs. At the communitv level. threat of CDD attrition due to lack of motivation still poses a problem in at least .t07o of communities. The communities are also being mobilized to reduce the burden of CDD workload by selecting more CDDs especially at ward level. The response so far is slou'. but efforts to institutionalize this latter idea was initiated at thc Stalieholders' meetings. Campaigns were also intensified in religious fanatic areas where people. especially women. were discouraged from accepting treatment because of rumors about the drug being used (in disguise) for birth control. Megaphones received from APOC and those for polio eradication campaigns were well utilized during comurunity mobilization sessions. especially for reaching rvomen in purdah in areas rvhere religion and culture secludes women indoors. and therefore thev cannot participate in communitv mobilization lq WHO/APOC. 26 September 2003 Table 3: Mectizan(D Inventory' (Please add rutre rows if necessary) State/Districtl Number of Mectizant tablets LGA Requested Received Used Lost Waste Expircd Kontagora 169.500 169.500 147.485 0 25 0 tujau 164,000 164,000 160.090 0 203 0 Magama 230.500 230,500 200,369 0 94 0 Mariga 193.500 t 93.500 181.333 0 l9 0 Mashegu t32-500 132-500 l3l-511 0 726 0 Agare 128.500 128.500 125.359 0 1t2 0 Lapai 27z,Ot)O 272.000 252,849 0 t94 0 164.000 158.658 0 Moktva 164-000 1,637 0 188.500 1 83.1 33 0 Rafi 188,500 133 0 159.500 t27.806 0 Wushishr 159.500 840 0 33(r,000 233.41t 0 Borgu 336,000 1.258 0 82.500 78.946 0 Lavun tt2.500 139 0 56.000 45.607 0 Shiroro 56,000 264 0 57.500 56,558 0 Gbalio 57,500 54 0 207.500 143.355 0 Katcha 207,500 478 0 126.000 80,548 0 Munva 126.000 0 0 169.500 124.398 0 Bosso 169.500 69 0 240.000 240.000 0 Suleia 240,000 0 0 105.000 77.615 0 Gurara 105.000 0 0 73,000 4q \)q 0 Aswara 73.000 0 0 54.314 54,314 0 Tafa 54.314 0 0 0 TOTAL 3J09,814 3J09,814 21952,974 6,245 0 State activities under hermectin delivery that are being carried out by health care penonnel in the pmject areu - Such activities include annual collection/allocation of Mectizan to communities. distribution aI health facilities in hvpo endemic foci as rvell as in urban centers of CDTI project area-. )(\ MIO/AIOC" 26 Septernber 2003 Trarnin g/retrar ning of C DDs/supportive mobilizati on of communities. Supervision of drug distribution. Facilitation of CSM and training of monitors. Collation of treatment record and ensuring 2u'a1'feedback on vearll'activities Any other conurrents None 2.3. Advocacy and Sensitization State the number of policy/deckion mnkers mobilized at each reletwtl level during the current year; the reasons for the sensitizptinn and outanme Describe dfficulties/constraints beingfaced and suggestions on how to impruve adtmcaqt 20 State policl' makers rvere mobilized lor awareness on CDTI. release of State counterpart funds and for their support, through advocacy' for LGA release of funds. Requests were also made for release of State counter part fi.rnds by both NOCP and LINICEF during adl'ocacy visits to the State. Pledges have been made bv Gol'emment and a memo has alreadv been submitted in request of US$30.000 for conduct of vear 2004 CDTI activities. The outcome of the requesl will be asce(ained rn year 2004. Several advocacl' visits were made to dl 21 CDTI LGAs by State officials and specificallv to tfuee LGAs by UNICEF officials. for creation of au'areness on Onchocerciasis as a public health hazard in those areas. on the at ailabilitl' of Mectizan free of charge. for control of the disease, the safetl' of the drug. and the need for Govemment support in funding of the ongoing CDTI. 200 LGA policl' makers and I.300 traditional leaders r\rere mobilized for support. From reports received so far. some LGAs released funds. others assrsted rvith vehicles and fuel and even participated in communitv mobilization. Some faditional leaders and opinion leaders provided funds for town cn"ing and dissemination of messages on commencement of lreatment. Several of them supervised distnbution too!. This situation was even more pronounced in the 4 newlv added LGAs of Suleja Gurara, Agllara and Tafa^ u'here even though PHC Personnel had been trained. and communities had been mobilized for CDTI, treatment had to be conducted actively b1' CBIT because there w'asn't much time arailable for community decision making, purchase of note books, census. selection of CDDs. decision on treatment time and other CDTI requirements. therefore drugs rvere distributed at PHC facilities. mosques. church premises. in front of the traditional ruler's residences at ward level. u'ithin the various LGAs. The distribution )t WHO/APOC. 26 September 2003 - - ? X U { CD qe EO '5: I t fp ca 0a >: tr l=] b.) o o oq $ 0a A) 0a !D o l$h t< lrl(D r)ii @ .J @ O tJ s. .2, z tJ NJ -t 6 O ! li= s :8. 11++d^ -. 53eilaQg G 6t! ++ a lrf rd= r.l (? 9)1 A s s s O- 30 6 @ +. 5 5 -l 5 5 44 E+ ,.,i ?=E al t)4 U7-=!: +SrD t+ ='d .d +=; ljO-1 i'a ;J. t! o=' NJ +- t-J { A 0a ru { 5 l.J @ \o \o { lg r! 6 G ;.6 !, oa' $t L2o @ tJ t.J t TJ +, \c) +- N) nZ A-I O \o { -.I -] o\ HAi=';s=^eEi 3E; S-- +i; .6 0e A @ tJ o\ a=a S. t) s l'.J UI t!5 5{ \o -.] 6 -J ie=63=r= z : Sl o= \ 3;=-E ='3 d=- (\ Hq "t d z'< q4 C ci o\ rE O O O o O O O o O o cfi o O O O O O o j.o 0a(Dr! .i (\ i.J o t-J d+ IJ o, IJ tJ N) lJ o\ \o \o @ O @ l.J @ +. +. J- I o' & o? z >l-= G aE =; o O O O O O =6 OF E:i I 3.l^ 4E'UE 6ri o Fd ^E t) TJ a.J t) NJ o 6 & 6 NJ @ A +- 5 A 6 A I ,o rl I o tJ l! o\ I t!CN (D O O O O 8z z 3 ,a*- 3 5 >= (D Ui t e a- tJ 0a- O 9*=E.q 6' r!- U{ ^' O x+= t! a'B ila .S TD(! 6- s. ID tD H a a 'l ,,aP X o s rr,6 tt g. 3 o 7i t H?d.8'P + B N c $:j(DQrJ F tD o LH :9i(DouY ;roz. ='q^+rtr [.J { @ { .J ;@oP=b+d(D '(, l..J t-J E o\ $$E$i(\i{--(\ { A A 6ESEa N.) ()0oO.n 'i o\ ?&6'+i' s Yqi\- F-.\@= r.*5T:S' tr-=@ :=rFg€ Et * o\ tJ A t-) IJ s-s ! o\ + |.-) -J @ \o :94+=H i'= 1& J. QT€-),yq==-eOA I*s @so= ci.ssFI o;ji;' 1...) 5 l.J N) N) tJ N) 3?iEdroo FiE \o [.J \o A \.1 € F FE N H.G 6ZF;=.sq e t'R s o\ ssi -r9 0lo -..1 s tJ IA J. 5 O A 6 ess (.]6 +sE ^-A\ =F.)A, -*.$ oa='8.(D8 d' aD q s'i Eq EB+ a * ul+-(Dxo' *E b.a 5 o\ A @ l-.J O .Da;+o)4-= s* 5 -1 s s 7 265- s+ -l g?EEJ-E =(\s.\ )=t \F i. o L:. ct 3!X N.) qe6ga=-166 eF. t, t\ -I o O C O o tJ v)aod' cs O O O iX:B'- + - 8R 0+=q s=. 6briI:t Ul \c tJ 5 t.J O P =06S% (, tJ O s A C E'5 @ o tJ -l =(D = oaolP-+ -) = G 5'gat, G= UI O O i.J O lq@ 6(o(D d='Ea E a f G i'D=(Do -o.D/. *= !D=oo $ UI v TJ +\ tJ \o a3=tr -(, tJ o\ A O J. ;='.9Y ; @ s -.1 +ts;i.5'< s { Ul 0Q(d+etreRd a' 2:=1 u a Ul O O l.J ! E.&$ E E ':.B,ta E('D) (t OFq)5*h + FiD6o C s. t.irts Oe tr oo!l(}*ra)= o t-J o O tJ C)(D(Dh 6 ot4lJ(D a i.! fD 3.?i==CDo fa % @ o 6- !\ .?=.H .D I *= H aE== IJ =qo- a c to @ 2.6. Capacity building 2.6.1. Training During the period of report. the following categories of people werc trained and retrained: (l) SOCT- -10 $ere trained and retrained on. facilitation of CSM and Stakeholders' meetings (SHMs). (2)LOCT -124 were trained for facilitation of CSM and SHMs. They rvere also retrained on record keeping and utilization of the MIS for MectizanG-) This constitutes99Yo of ATrO. Health -540 district and frontline healthcare workers were trained for centre/ facilitation of CSM and SHM as well as on record keeping using the Post staff MIS. This constitutes 8l% of ATrO. (3) CDDs -5,315 were reported trained/retrained. and this represents 93olo of ATrO. Thcrc is thrcat of CDD attrition in some LGAs. while there is l-er1, good CDD retention in most. Communities are also being rnobilized to select CDDs at ward level. but the response is slou'. These issues are already being addressed by CSM and SHM. which are alreadv being instiruted in 328 CDTI communities of I7 LGAs. (1) CSM The total number of trained CSM monitors is not 1'et available since the CSM commenced- only in November. Hou'ever. based on reports received from 12 LGAs the number of selected/ trained CSM monitors is 4.920. -24 -WHO/APOC. 26 September 2003 7 a t' EO F 7 t- 7 g l-J X !, .J v X lo) o c) oc s)'> D) o c) t Et a lo o Uq a T 0a 7 9) (D l(D (D 0c s) ^l FJ -t (ra o U) lD oo so ts l* tD o F t o ; A) (,a J. A A A @ @ @ @ 6 & @ @ t0 -l (D a- -- -1 F ;-( O O (D' t 3 a (D O (D J. + +- +- J. @ -.1 ca @ @ @ @ J. (D a q DT o t! o s .t- +. J. 0a \J 00 @ @ co 6 J. -t -J N) \o l-.J { +. tJ (D ! +- ca @ i o\ a't Ir! (D Ir! z TD l-.J C { O IO t! ta E N] J. t9 tJ J. tJ iDe @ o\ @ @ o\ -J C1 0c E il s- t! (\L: D FI G tJ ]J ]J tJ J. tJ :s J. o, 0a O o\ 6 N) { o, -l \t e! N a>< z z o -2, o -t o q nt! rt tJ F' I o l aO='o 4 t 'f % i +- ^;i El 'r rtr a='ii o +. N.J p (D - O AIJ U) CT (! b NJ +: tJ t-J irJ 3 }J TJ o\ \o o\ @ @ @ t) I 0c +. C I'J -t N, Ft o I I t9 z O I I J. G (! '-';, o tJ tJ TJ TJ tJ I t-J s \o @ @ A { t'J 5 ! J. @ 5 F tJ tJ tJ tJ tJ J: o\ \o @ O @ t! .L \t t) @ I +- J. 5 @ A a * , i o a 2 00 Fl t l, D)' s) g. v) CD t x F s) o) :r o, s + i o tJ a I .D (D I> .:! .D t.J 3 J. * = o -----i til O O .f O NJ e + 0a A s S l.J I \o +- C - 5 IJ tJ \- +. I t-J t-J O (D 19 t! tl \o A @ s @ aI'J ! t'.) N) AD 5 o. 00 = @ o\ E \e o I A r! 6 loi I +- $ P ,U, O -J s sTJ 'U \o t-) +\ o :: N) O TJ i 00 o\ tJ @ (D ; tD o N) ; tJ A l.J tJ o\ o J- o @ (,J Table 6: T1'pe of training undertaken (fick the boxes v'here spea/ic tratning was carried out during the reportrng pertod) Trainees Other Health Community Workers members e.g (frontline MOH Type Community health stalf or Political of training CDDs supervisors facilities) Other Leaders Othen(specify) Program \i ./ !(teachers) management Hou to { { { \i i 1/11sachers. conduct NGOs.CBOs) Health education Management { { {<"1 ofSAEs CSM { { { {r-l SHM { -'.i { { ./ {r" l Data ./ { { { {(teachers) collection Data anall'sis { { {(teachers) Report ./ ./ nriting Others (specifi') - Any other comments 2.6.2. Equipment and human resources Tab-lcf: Status of equipment (Please add more row,s if necessary) Source APOC MOH DISTRICT/LGA NGDO Others (TTNICEF) Type of equipment Condition of the equipment * Please state l. Vehicle Functional (l) WROFF wRoFF (l) (l) 2. Motor cyclc " (18) CNFR (2) 3. Computers " (2) 4 Printers " (l) 5. Far Machines " (l) 6.Photocopier " (l) T.Bicycles (20) WROFF (80) 8.Prqector " (l) 9.Generator " (l) l().Air conditioners - (2) ,k Condition of the equipment (Functional (F1. Currently non-functional but repairable (CNFR). Wriuen off IWROFF). -27 -WHO/APOC. 26 September 2003 How does the project intend to mnintain and repltce existing equipment and other nmterials? Alailabilitl' of State government funds will be of utmost importance for such issues. othernise. equipment and other rnaterials will be rnaintained rvithin the central pool i.e. within the MOH cenffal ruraintenance budget for offrce and field equipment. The LGA councils rvill be encouraged to purchase and replace obsolete motorcycles and bicycles from counterpa.rt funds and anv other sources. how-ever. APOC will be requestcd to rcplacc most capital items as the need arises i.e. before the final disengagement of APOC. - Describe the adequacy of availahle knowledgenble manpower at all levels. Therc is fairl-v adequate knorvledgeable manpower at State and LGA level: However. lorv literacv at communitv levcl is a major factor in determining number of CDDs selected b1' the communities. because they do not hare rnuch confidence in the capabiliry' of illiterates in administering correct dosage of Mectizan@ to them. - lAherefrequent transfers af trained staffoccur, state what project is doing or intends to do to remedy the situalion (The most importanl issue is what measures were taken to ensure adeqaate CDTI implementation where not enough knowledgeoble manpower was arwiloble or staff ofien transfened during the course oJ'the campaign). There is stabilit)' of staff at State level while at LGA level. transfers are often onll' within the LGAs i.e. from disrict to district. Where frequent transfers occur. cfforts are made to train most PHC staff u'ithin the project area. and in an LGA like Borgu where there is irndequacv of PHC staff. school head teachers were trained and incorporated as supervisors. The school head teachers have remained at their postings for over se\.en years since they rvere incorporated in the programme, and they have been participating activelv since then. 2.7. Trratments 2.7.1. Treatmentfigures Treatment reports received from 2l LGfu are for Mectiizan distribution employrng tuo active strategies:- - CDTI in l7 old treatment LGAs and CBIT in 4 newly approved and added LGAs of Suleja. Gurara- Agrvara and Tafa. )9, WHO/APOC. 26 September 2003 CBIT rvas also emplol'ed for distribution of drugs in new communities of old treatment LGAs like Rijau- Bosso and Katcha. since there rvas constraint on time to allorv for communitv decision for conduct of CDTI. A total of 1.092.069 people were treated n 2.193 out of 2.583 commrurities. Thcsc figures represent 657o therapeutic and 857o geographical coverages respectivelr'. The Annual Treatment Objective for the year was 1,143.992 while the estimated Ultimate Treatment Goal was l.-117.550. The cost per trearment was U.S.$0.09. ?c) WHO/AI'OC- 26 September 2003 X o V) - F z - 7 7 A F 7( eo o) o { s, UA (=: o o FD gD tD t th ;r FD a Ft 0a C) Ia F FD l-l r (D oa o) ls, p) o .* (D * x9 o a F' oq F) oa td * It o) o PA I(D e0 lo" -l o\ @ t-) h..) o\ (D- @ i'J { NJ s \o s tJ A A O \o \I o\ -J 6 o G ;.=-3 o) { N * ii= '-x:i-<+#iE =i = B=:"s1r"$ (D =r+ A) a- o\ @ ca N J. lv 19 { l.J --l o a I \o O t) .CO P o 6'!r= qLrl :G!l @= YC' @ @ p o\ (D a TJ N) O N) 2, (n \] \o O o O N) E Et a= 3 c) ES r f13 c) - G oa ( (D o U) \] \o -l { a o\ +- O O oO { 6 O o (F G :: p) (F (D o tD po a 0) ta l..J o\ @ \o @ { J s tJ +. l.J 6 O^' (a .5 "ot 90 i P \o 5 NJ J. IJ a= E F { "O tJ +. o\ U l..J 5 o\ -t }J I o,l * 8 \o I E;*'€ 6: o G = ::r:t 3-E- % (f) A R* tJ N) N) N) { @ \o +. 5 5 \.1 I t-) ji a j!{ @ "5 P N x -J o\ tJ @ oJ- \t A \o @ -l a-I sQ f FU tJ { @ N) -J o\ o -.r 70!l .t1 \ A' q @ l-.J tJ @ o\ 00 A J. -l { o \o { ,{ J @ O po @ o z tr, @ \o tJ E A 6 a @ O O \o { iE (\ \o { ,.o Eui= @ TJ -,1 @ F3T (\a -t a o\ @ 6 @ @ o\ -J @ 6 A @ J. ! ,l ! @ \o NJ @ @ ].J o-t co :_ o.i D vpoo iE (FE o I F \o O N) s J- IJ 1s \o \o 19 -l =l @ icz t-) -l tJ XE/A- -,1 { @ J: =a1a= @--=ri E:-8 r { O- @ tJ l.J @ l-) s l.J o, @ eZ hJ l.J \o -l rc o l-'J E3 o @ o^Bq' TJ a o O o O c, o aa ^b5 c' (n as NJ O O E 9.3 z 3a';*FqE A==a\?6 p.50-srg!i >E A: (r) rl i Ed 7 00 o o .A { lFr, >z+ * A), Fl- g. U) stj.A$N s (Do lv t'Ictl =l + 0) I a (l gl c) : od o E 0) + + ll oe tD U r 70 + S ll -.1 o I IE F + .EN\ ql.( o S) (D I 247oQ E - S:S: lEi n) l* e'?P ErD 5 SE :-8 <- a) lo' \F*. 5 0q o = b.J 5 o\ (D o 8 AB.E 'rrt o\ { A e o t: 6 ! s *sx o (D lo 3 9 +d (, s) l5 rd oi t{ E' rs\. P (D :.1 (D .i- 4 t5 *.r ! o) oc EH;5 $=: oc (n lcl+ G F-sXs.s:- (D q=ht- yQ s& i ts (D fc OirP (/) (D + N s s -.t :.iQ. l= NJ -l 5 I?D (DU A r ir' lr !)O \o RS; IA: (DYdH 't6 o-P S.BB l II l(D ss$ ls "tD trs. '? : lo 9@ b.J +. 5 sc -c, N) O A :i'si le s)(D A -J S r- > lZ, ) t4 ,1 lZ, to- 3a- j9 s-ll lE o'l? I IE $a ::E iP= g)13 aP laD ot E gl8 IH - IH ;ls 'o 0a JV H:S E Itst (D\o €l: l!o =5GJIY aiil: lF) Eli!J Isa E l*, 16 $- +\T TE' lP. Oa) € -J Q€ I a li lE s lP' E-lH o-(D (,l O o oo = 5lo ,-rlY xlo la) J O s}i* ol9 (DtO a|rJ e16 a R t- S ,o-l:l ler :-a E. ro eIa +l= "15- lo a- r- ^ l- 5 l< sleH.l- IO till € ir E.th I$ v)6lE. l; ls td '!=s^= = trF'bi.:1 " (D lqj tO- gls $E Elr 0a l(D 5 @ s XHN J), 1007o geographical coverage is not being achio'ed this time around because of addition of 800 treatment communities as a result of REMO finalization and approlal for expansion into 4 additional LGAs as rvell as addition of about 500 new communities in old CDTI implementing LGAS. Not all of the communities could be covered due to constraint on time caused by late treatment. The major reason for late teatment was of lack of government funds and late receipt of donor funds. No funds u'ere ar,ailable until Ju11,. and this consfraint u,as caused b1' reasons explained uithin the earlier sections of this report. 2.7.2 Whal are the causes of absenteeism? Absenteeism is mainly caused by displacement of some community mcmbers during flood disasters rvhich occurred in seven communities during the rainy season. Others relocate to stay at their farm houses in the rainy seaso[ and do not return early for trcatmelrt. This pheuomenon is mainly caused b1' a lack of communig decision on preferred treatment time. as well as inadequate mobilization of communitv members on the need for them to be available during treatment period. Some members abstain deliberately from the communit_v, in order to escape from being compelled to tahe the drug against their wish. As is the case in more organized communities. 2.7.3. Briefly descrihe all known and veiJied serious adverse events (SAEA and provide in tahle 9 the required informilion when arwilahle. Not Known or Reported. 2.7.1. In case the project has no case of serious adverse event (SAE) daring this rqorting period, please tick in the hox No case to report ',/ WHO/APOC. l0 April2003 l.J p p p l.J IJ N) u 19 tJ TJ l.l C O O O O \o \o rr'l o O O O o I U t& & { 5 t'J C 6 -J lo l.J ICl- { o o3 "lFt *= (D -l tEsZi tr: J Y O 5 -. = s ^.Y =o (D N 6I'--3" \J l! ID @ I @ @ t.J tl \o \c oa p-B o r! -: -J o .;e > o:i s (D o G t t-J :'o E F) e O { \o o* (ra @ @ b') o (! o\ -l c ld 1< tD lr> @41 .D lF0 lo N) l5 { A s 3-18 :l la \o { TJ { o 3.o oa le o J. t-J J: N) = (D .!- (D -l FD aooC) ^<^ooo:lm o' o (F 00 I N) "O { (D (D (D o ^?> (! :di^ da- =l { 0a o @ @ @ @ o (}) o tD tf) 6- (,) *A E ,o e \o \o \c) (D & tJ O o,T5=r=YF=^l { N \o tJ A O Ei .D ix 5 o\ o\ O 3, s N) H, -.1 .d@'P^ @ @ A J. l-.J Etr= J. 0,o o== p +, +. "NJ '(, \o { s tJ oA=o!L l'.J @ s N) O 'U az s) h= O { { N) t-J N) \o Or \o 6 { o N) A @ o\ o\ dt-='li @ "00 s 'b "+. "oo o\ \o 6 O A \o +. @ N) o o o 13 p o rF { { o U @ \o { tJ P 'U o p ^?>oo J (J -E G \o @ A o NJ A @ t.J '6ts TJ o S ri .-.r da { C' -I I 2.8. Supervision 2.8.1. Provide a flow chart of supervision hierarchy TINICEF NOCP SOCT LOCT DHS CBS Communitl' Self Monitors CDDs Communities 2.8.2. What rvere the main issues identified during supen'ision. Issues idenrifi ed include:- - Lack of State counterpart funds and late commencement of CDTI activities. - Absence of LGA plans of action and very poor LGA funding of CDTI. - Lack of census update in some communities resulting in inadequate MectizanG.. - Absence of treatment summan, forms in communitl' registers. - Treatment record not accwately transferred from community notebooks. - Poor commitment of some of some LGA coordinators and frontline health faciliq- personnel. - Lack of posters in communities. - Large numbers of absentees and no mop-up treatment. ?4 WHO/APOC. l0 Apnl2003 - CDDs are often not motivated - Inadequate CDDs. - Large number of refusals in Borgu LGA and slow pace of treatment due to erlreme disenchantment of CDDs by community members attitudes. 2.8.3. Was supenison checklist used ? Yes. The superlision was conducted mainly by the Zonal Oncho. Coordinator for Zone C. who rvas funded by UNICEF. Some supervision was carried out by the SOCT and LOCT. Most of the supervision rvas b-v the frontline health facilit-v staff. 2.8.4. What were the outcomes at each level of CDTI implementation supervisd'? State level - There w'as no counterpart fund from the State Government. therefore activities did not commence earlv. Treatment would commcnce late and communities l\ere nol given the choice to decide on fieatmenl time since MectizanLn) had not been collected b1' June due to lack of funds for travel to and from the NOCP headquarters at Lagos for receipt of the drugs. LGA level - Lack of plans of action in 50% of LGAs and ven, weali and sometimes. no funding of CDTI in 60% of LGAs visited. - Lack of census update in several communities resulting in inadequate Mectizan,S) supply. - Ratio of CDDs to communitv drd not mect criteria of 2 CDDs to 250 people. - Household heads did not give accurate number of household membcrs to CDDs. which resulted in inaccurate census. - Several CDDs complained of work overload and poor motivation by their communities. - The fiontline health faciliry' StaIIwere not supervising CDTI aclivities. - Absence of treatment summary forms in community registcrs. Some community summarv fomrs rvere in custodv of supen'ising health staff for fear of its' being misplaced or destrol'ed in the communities. Treatment record not accurately transferred from communitl' register. Figures fomarded to SOCT did not tally u.ith data at communiry' level eg. in Munya LGA. ?5 WHO/AIOC. 26 September 2003 Lack of posters in most of the communities Large numbers of absentecs and no mop-up trcatmcnt. The drugs supplied was inadequate. and further request was not honoured - The number of CDDs topopulatron was in cxccss of l:800 in40Yo of communities. visited. There rvas no community support in tenns of incentives either materiallv or in kind (e.g. through assistance uttlr farm work). thereforc CDDs treated onlv at thcir convenicnce. often at night. and rvent to their farms in the da1'time. Completion of freatment in such communities took up to tuo months. There rvas also no follow-up of absentees or refisals. Poor commitment of LGA coordinators and fronlline health facility staffof tuo LGAs. Drugs were not released four ueeks after thev had been supplied to the LOCT (Borgu LGA). therefore treatment was flrther delayed. The frontline health facility staff in-charge of the communities. did not inform communiries about arrival of drugs and the need for them to go lbr collection from the distnct health facilities (Shagunu in Borgu LGA) The treatment record for prerious years w-as not properly kept. Large numbers of refusals leading to slow pace of treatment in Borgu and Rafi LGA. The CDDs rtere extremelv disenchanted rvith the poor community attrtude. Some CDDS were even clused out of households and threatened with beating if thcl'did not leave immediatell' (Waua. in Borgu LGA). 2.8.5. Wasfeed-back ghen to the supemised, and howwas thefeedback used in improving the overallperformnnce of the project Yes. feedback was given to the supervised and the feedback rvas used in improling the overall performance of the project in the following manner:- State level The issue of need for release of counterpart funds was Presented to State MOH executives like the Director PHC. Permanent Secretary. and Honorable Commissioner of Health. u'ho doubles as deputy Governor of the State, in the presence of Senior Minisul' of health officials and other political heav-v weights at advocacv meetings held w-ith visiting NOCP and TINICEF officials in April and August. The State policv makers noted the problem and pledged to address the matter in order to ensure that funds are released bv Government. No lilnds rvere ?A WHO/APOC. 26 Scptember 2003 received but a memo was submitted in anticipation of release of the sum of US$ 30.000 for support of vear 2004 CDTI activities. A State level stalieholders'mceting is scheduled for the Iirst quarter ofyear 2004. and issues tlreatening the sustainabilitv of the State CDTI rvill be deliberated on. LGA lel'el The supervising SOCT were directed to guide the respective LOCT on writing of plans of action (rvith budgets) rvhich rvere to be submitted to the LGA authorities in request of funds. The written action plans were submitted as supporting document to a lefter of request from the State MOH. for release of the sun of approximatelv US$784 per LGA. A State review meeting was held in September and all LOCT leaders from l7 old treatment LGAs lvere informed of this obsenation. Thev were then directed to go back to ensure that the census was updated during Mectizan(D distribution. Follow-up monitoring of the above indicated that the census had been updated in over 507o of communities. Additional Mectizan uas then released to those requiring it for mop-up of treatment. ln order to boost capacity for drug distribution at a ratio of I CDD to 250 population. communities were remobilized and advised to appoint additional CDDs at rvard level. There is eridence of good compliance with the recommendation because thc present ratio of CDD to population is I to 330. Communities were also mobilized to support their CDDs in order to motivate them for long-term service. The achievement made in this regard is however hard to quanti$' because thc LOCT hardlv give fcedback on CDd rcmureration. Howcvcr. timelv feedback was received for treatment inTOYoof LGAs. The poor commitment of the participating LOCTs and health faciliqv personnel was also addressed at LGA level advocacy meetings' held at the LGA headquarters and also at stakeholders meetings held in all 2l LGAs. The PHC staff were reprimanded by both the traditional leaders and the LGA policl' makers. Thev have been advised to show more commitment otherwise. their salaries *'ould be u.ithheld. and they in return. have pledged to improve on their performance. The situation at Borgu and Lavun LGAS. rvho have completed 4 vears of CDTI is of particular concern because no trealment reports were received from these LGAs up to the time of submission of thrs report! ?7 WHO/APOC. 26 Septernber 2003 The impact of the actions talien to correct these anomalies can only be assessed in year 2004. because the above mentioned actions rvere tahen only during the last hr o months of year 2003. As a matter of fact. the stakeholders' meetings held only in December. i.e. at the end of the vears' treatment. The large numbers of refusals in Borgu LGA rvas said to be caused b1' defractors rvho rvere Islamic fanatics. These people. misinfornred their communities that the drug had a ver]' negative effect on their health. and accused America of attempting to reduce Muslint populations rvhile camouflaging the drug as being for river blindness control. The issues rvere tabled and thoroughll' addressed also at the LGA level Stake holders' meetings. The traditional leaders pronrised to go back and correct these erroneous impressions circulating in their communities. The supervising LGA/PHC personnel were once more advised to produce duplicate copies of community summary forms and always to leave behind one cop], in the communitr' registers while keeping the other. He was directed to advised the CDDs and village heads to ensure the safetl' and security of all MectizanG) treatment records. by keeping such record in a safe place. especially in custody of the village head. SOCT and LOCT were trained and retrained on record keeping and transfer of data into MIS. Thc data received this year was yery much improved. The LGA Coordinator for Munva has however not adjusted. and plans are on ground to reorganize the LOCT in that LGA because of this problem and several other administrative problems affecting the programme in that LGA. ?R WHO/APOC. 26 September 2003 SECTION 3: Supnort to CDTI 3.1. Financial contributions of the partners and communities Table I I: Financial conlributions by all partners for the last three years \ear I ('2000') Y'ear 2 (2001') Year 3 (2002') Year 1(2003') TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Budgeted Released Budgeted Released Budgeted Released Budgeted Released Contributor 1uS$) (JS$) (us$) luss) (us$) (us$) cjss) russ) Minist4'of 22.725 )) 1)\ 49.000 0 43.000 0 43.000 0 Health (MOH) Local NGDO(s) ( if anl') NGDO 24.N0 7 023 24.U)O 0 24.UN 14.m0 24.000 t2.441 partner(s) (uNlcEF) GTZ N/A 2.000 5.60{) 5.595 13.386 13.386 District/LGA 10"000 8.1 38 15.000 I ro..rzr 10.37I 9.t 00 8.236 1.708 i Communities t3.Ml 8.145 58.800 1.240 59.ofi) I.416 I 60.000 492 APOC Trust 128.940 66.715 100.700 &1.597 65.000 -r5.000 62.120 70.000* Fund TOTAL tvt,706 111,716 217,500 96,258 206,vn 65,1 1 1 2L0,742 %,o27 +-Instead of US$62,120, US$70.000 u'as received from APOC. Communiq'input was quite substantial, but very poorlv reported on. Il'there are problems wilh release o/-counterpart funds. how were thel' addressed? There are problems with release of State counterpart funds and several memos were written to government as reminder. Several advocacy risits were paid by both the NOTF and UNICEF officials during which they solicited for government release of counterpart funds at both State and LGA level. Funds were not released at State level. while US$1.708 was released by 8 old treatment LGAs. Stalieholders meetings were held in all 2l LGAs where the issue uas discussed- and plans are on ground for fund raising. The State level meeting rvill hold in February 2004 where the issue of "lack of government funding as a threat to sustainabilitl' of CDTI" u'ill be the theme for discussion. Further more. pressure groups are being identified through stalieholders' meetings (at all levels) to prompt government to release the required funds. ?q WHO/APOC. 26 September 2003 3.2, Other forms of community support - Describe (indicate forms of in-kind contributions of communities if an-v-) Most communities support CDDs with prayers. cash. foodstuff. and meals (during Mectizan(D distribution") farming. vehicles for collection of Mectizan and supen'ision. Other commurities (about -50). nominated their CDDs for political posts at LGA councils. soure recommended their CDDs for participation in NlDs. 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations uchange rale to local currenqt The UN exchange rate at the time of reporting was US$1.00 to #127.50 Table l2: Indicate hou, much the project spent for each actit'itv listed belo* during the reporting period Expenditure Activity ($ US) Source(s) of fundins Drug delivery from NOTF HQ area to central collection 6.902 point of community LINICEF/LGAS 39.729 APOCAII{ICEF/GTZIL Mobilization and health education of communities GAs/comms. Training of CDDs 2.569 APOC/LGAs/comms Trairung of health staffat all levels 12.519 APOC/LTNICEF/GTZ Supenising CDDs and distributron 8.343 APOC/LGAs/comms. Intemal monitoring of CDTI activities 0 0 Advocacv visits to health and political authorities 3.791 APOC/tlNlCEFiLGAs IEC materials 7.1 83 APOC/ Summan' (reporting) forms for treatment 0 0 Vehicles/ Motorcycles/ bicycles maintenance 2.692 APOC/LGAs Oflice equipment maintenance (e.g computers. printers 3.903 photocopiers) APOC 1.581 Communication APOC t2-549 Personnel APOC Othcrs (COT. Vchiclc insurancc) 2.000 TOTAL 103.791 Total numbcr of Dersons treated 1,o92,M9 Commcnts Although two irstallments of US$70"000 w'as received fiom APOC during the period of repo(. the second installmenl could not be fully utilized due to its' receipt only in December. coupled rvith 40 W}IO/A[0C. 26 September 2003 delay due to bureaucratic bottlenecks in approval for utilization of funds. by both LTNICEF and the Ministn'of Health. The unusually high expendirure on training was due to training of LOCTs on CSIWSHM as well as training for CDTI in the 4 nervly added LGAs of Suleja- Gurara. Tafa and Agwara. SECTION 4: Sustainabilitv of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4 l.l Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) No. There was only'year one participaton'independent monitoring in 1,ear one of the project. : Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability' Evalualion Intemal Monitoring bv NOTF Other Evaluation by other partners 4 t.2 What u'ere the recommendations? Not applicable 4r3 Horv have the-v been implemented'l Not applicable 41 WHOIAPOC. 26 September 2003 4.2. Community self-monitoringand Stakeholders' lVleeting Table l3: Communiry- self-monilorrng and Stalieholders Meeting (Please add more rows t/. necessary) District/ LGA Total # of communities/villages No of Communities that No of Communities that in the entire prqiect area carried out self conducted stakeholders monitoring (CSM) meeling (SHM) Kontagora 65 20 Activity ongoing Rijau t26 20 Magama -51 20 Mariga 217 22 3( Mashegu il6 20 aa Agaie 197 20 Lapai 2lt 20 q 6 Molcrva 147 20 6 Rafi 129 20 (a Wushishi 130 22 aa Borgu 174 25 20 Lalun 85 g Shiroro 103 20 20 s Gbako 62 aa Katcha 184 20 Munya 140 ll as Bosso 134 8 $a Suleia 37 0 Gurara 134 0 0 Agwara 65 0 0 Tafa 46 0 0 (a TOTAL 2,583 328 Dacribe how the results of the communigt self- montloring and stakeholders meetings have affected project implementation or how they would be utilized during the nert fieatmcnt cycle. CSM and SHM at communitv level commenced only in November and is still ongoing. therefore the results are not yet available. However. it is obvious from LGA level Stalieholders' meetings held in 2l LGAS. that there rvill be improved funding at all levels. and that the commitment of policy makers to CDTI would improve due to formation of Oncho. Control committees at that level. 4) M{O/APOC. 26 September 2003 The mecting also noted that some frontline health care staflassigred to supervision of CDTI did not shorv much commitment. and therefore promised to inform the LGA authorities about any of such developments. AA WHO/AR)C. 26 September 2003 4.3. Sustainability of prcjects: plan and set targets (mandatorl' at Yr 3) 1.3.I l{hat arrangemetfis have been made to sustain CDT'I a.fter APO(- .fimdmg ceases m terms o.f:- -+.3.1 Planning at all relevant lerels. State and LGA plans will be made and realistic budgets will be tied to activiries clearly indicating sourcc offunds 4.3.2 Funds. State and LGAs are working in collaboration with UNICEF to make Gorernment to release funds based on amual PHC budgets. The outcome of Stakeholders' meetings indicate that pressure groups are being formed and these goups designated as Oncho. Control committees would ensure that government releases funds for CDTI activities. There are plans also for fund raising at all levels. The tradrtional leaders also pledged to see to selection of more CDDs especiallv at ward level. to mobilize their people for motivation of the CDDs tluough inceutives and to advocate for female participation in the CDTI. -1.3.3 Transport (replacement and maintenance) will be done centrally in MOH. i.e. if counterpart funds are not available. The LGA coordinators have been personallv responsible for maintenance of project motorcycles attached to them and will continue. since this is the usual practice over here. LGA administrators u'ill be encouraged to purchase motorcycles and bicycles for the programme whenever the need arises. At State level. efforts rvill be made to ensure full integration of the CDTI into viable projects like AIDS control. NPI. etc. so that there would be central maintenance of all participating PHC vehiclcs i.e including the CDTI project vehicle. APOC management will however. be requested to replace several capital equipment i.e. before the final disengagement of APOC. 4.3.4 Aher resources- Funds raised through State and LGA level fund raising activities J.3.5 Please provide a wrifren plan with set targets and achicvementsfor sofar. The project is yet to be evaluated for sustainability, however the plan of action for I'ear 2003, show.ing the implementation status of the activities is herebl'attached. The plan of action for year 2004- together rvith I "t I'ear (2005) post-APOC sustarnability plan are also attached to this report. 1.3.6 To what extent has the pbn been implemented The plan action for year 2003 rvas largely implemented. i.e. upto 9OV",and effort u,ill be made to integrate the post-APOC sustainabilitl' plan u'ith the 1'ear five plan of action. 44 WHO/APOC" 26 September 2003 4.4. Integration Outline the efient of ilrtegrution of CDTI into the PHC structure and the plansfor conqtlete integrafion J.1. l. Ivermectin delh,ery mechanisms Ivermectin is received and delivered through the existing PHC structure of the threc tiers of Government. Communities collect Mectizan'I-) from district health supenisors. While in hard to reach areas. from the frontline healthcare staff. The period of the NIDs is often suitable for drug dclivery. because the LGA/PHC staff are often invited to the State and LGA headquarters for collection of vaccines. Mectizan@ is included among the items for delivcr_l'to the communities. 1.1.2. Training LGA/PHC Personnel have been trained as TOTs. They are directly responsible for communitv mobilization and training/retraining of CDDs. Thc LGA Monitoring/Evaluation officers rvho serve as disease sun'eillance ofllcials are members of the LOCT and do collect Mectizanir. from the State to the LGAs 1.J.3. Joint supenision and monitoring with other programs At the State level. plans for integration of supenision and monitoring uith other programmes are on ground. LGA M&E officers are members of the LOCT. thereforc thel' w'ill integrate supervision of ongoing AFP sun'eillance rvith supervision of CDTI. 1.1.1. Release offands Alreadv there is a budget for Oncho. within the PHC budget. and plans are on ground to prompt Gort. for joint release of funds under the PHC l,ote of charge. 1.1.5. Is CDTI included in the PHC budgd? yes. 1.1.6. Dacrihe other health programmes that are using the CDTI structure and how this was achieved l{hal have been the achievements? Not vet. Horvever there are plans to integate distribution of ITNs for RBM into CDTI Vitamin A distribution is another programme being considered for utilizing the CDTI structure. .1S WHO/AIrOC. 26 September 2003 J.1.7. Describe others issues considered in the integralion of CDTI. 4.5 Operational research 1.5.1 Summnrize in nol more than one half of a page the operational research undertnken in the projeA area within the reporting period. None yet However there is a plan to sourceforfundsfrom UNICEFfoT conduct of KAP studies on ways to promote femal.e particrpation in CDTI in the Stule- 1.5.2. How were the resuhs applied in the project? SECTION 5: Strengths. weaknesses and challenses List the strengths and weaknesses of CDTI implementation process Strensths l. Ven' committedLOCTs in7tr/o ofLGAs. 2. Good communitv participahon and orvnership of CDTI. 3. Fairly good CDD retentiou in 6tr/o of communities. 4. Improved participation of LINICEF 5. Fairll' good integration of CDTI into PHC at all levels. especially NPI programme (CBOs oriented and mobilized for participation) 6. Finalized and approved REMO. This will enable us to determine UTG by March 2004 when census update would have been completed. 7. Availabilig of 227 trained LGA/PHC stafffor facilitation ongoing application of CSM/SHM to329 CDTI communities of 17 LGAs. 46 WHO/APOC. 26 September 2003 Weaknesses I . Poor political rvill of governments. as eridenced by non releasc of counterpart funds at State level. and poor release at LGA lelel. 2. Inadequate CDDs. The available ones are hardlr" motivated to continue. due to lack of communitv support and poor female participation. 3. Inadequate Vehicles (4W.D. Vehicle. 20 motorcycles and 100 bicycles additional required) for travel over vast project are i.e. 65million hectares. 4. Poor effort at integration rvith PHC by somc LGA Oncho. Coordinators. resulting in poor supervision in such LGAs 6. Late feedback on treatment in some LGAs. Constraints l. Lack of State counterpart funds and poor release at LGA level. 2. Late receipt of donor funds resulting in late commencement of CDTI coupled with pressure on LOCT and SOCT to meet up with annual objectives. 3. Large expanse of land for CDTI (6.5.million hectares) and inadequate vehicles for supenision especiallv in Borgu. Manga. Magama. Rijau. Katcha. Rafi. Agwara and Mashegu LGAs. 't. Late supplv of Mectizan. The complete quantity of drug requested was not received until September.2003. 5. Flood disasters in some LGAs leading to displaced communities 6. Inappropriate treatment time leading to delay in treatment b1' some communities. Therefore treatment was carried out only at night. 7. Delayed complelion of treatment and threat of CDD altrition in some communities. due to CDD disenchantment as a result of poor motivation b1' some commurities. Lis the challenges and indicate hmt they were addressed. Challenses l. Updating of census for determination of Ultimate Treatment Goal (UTC;. Leners were rwitten to LGAs where REMO was updated and thel were guided on areas for CDTI. The list of additional communities. rvas compiled and most communities were mobilize{ for thp CDTI. 47 WHO/AI'ICC. 26 September 2003 Census is already ongoing in several communities. rvhile UNICEF plans to fund a State wide celNus update earlf in 1'ear 2004. 2. Attaining at least 650/o of llltimate Treatment Goal. MectizanL0 distribution commenced earlier (i.e. in August) unlike in previous vears. hor.vever. the drugs supplied then covered onh' 9 LGAs. A Second consignment was not received until September. however all 17 LGAs had Mectizan3 in their custodv for at least three months. Mass distribution of Mectizan([] was also conducted in the 4 nervlv added LGAs and rvith these efforts. 85% geographical corerage was achieved in the project area and the therapeutic covcrage is 65Yo rvhile the UTG coverage was 77o/o. 3. Full integration of CDTI with PHC programmes like disease sun'cillance. M&E at Statc. LGA District and Communitl level. - The meetings for AFP sun'eillance rvere attended bv the SOCT and through that. M&E staff who are the participants were mobilized for beffer participation in CDTI activities. 3. Mobilizing Government at State and LGA level for timell, release of funds for conduct of CDTI. - Earlier efforts. as described within the report did not viel much result. The stalieholders' meetings' appear to old better promise for ensuring release of government frurds since pressure groups rvill be formed rvithin these committees. 4. Mobilizing communities for support of CDDs/ increasing number of CDDS through prompting of communities to select CDDs at r.vard level. Communities lr,ere mobilized and urged to motivate their CDDs through either provision of incentives or to reduce CDD workload tluough selection of addrtional CDDs i.e at rvard level. Several communities chose option trvo. rvhile others chose both options. 5. Inclusion of females as CDDs. Onentation meetings were held with 700 representatil'es of r-arious lvomen groups. Because the actilitl'held only in December. the impact could not be assessed during the period of report and would only be detemrined in the subsequent year. i.e. in terms of improved participation in CDTI and motivation of CDDs. There is houever. great promise for improved female participation in the CDTI. dR WHO/AIOC. 26 Septernber 2003 (r. Ensuring good treatment compliance (at least 75%) with reduction in absentees and refusals. - In 50% of LGAs i.e. where treatment commenced early. there was adequate time for ensuring compliance and mop-up. 7. Prompting LGA/PHC personnel for early fccdback on CDTI. Treatment commenced earlier i.e in August in 50Yo of LGAs. and this helped to ensure early feedback on treatment. Unfortunately. drugs for the other 50% of LGAs was received late i.e. rn September. 8. Poor attitude of some LGA coordrnators towards integration with PHC. - Efforts were made through visits to the LGfu. meetings were held with the LGA health team witlt DPHCs presiding over the meetings. Supervision schedules for LOCTs and frontline PHC stalf were drawn and shared uith SOCTs and the LGA teams. A State revicq-meeting rvas held rvith the aim of further addressing the issues. The poor attitude of some PHC pcrsonnel to integration u'as also addressed at stakeholders' meetings. 4q WHO/APOC- 26 September 2003 IMPLEMENTATION OF PLAN OF ACTION FOR CDTI IN NIGER STATE, JAN-DEC 2OO3 s/N Activit6s Time Action by Participants Reporting Implementation frame deadline status (yes/no) I NOTF/APOC Jan-Mar NOCP SMOH. LGAS April 8u' Yes advocacy visits to APOC goject Statc 2 Management and Jan-April APOC 2 SOCTs Fet lo- Yes operational planning NOCP I data officer Mav 30th workshop for State Coords. 3 Procurement of Feb-July APOC wHo Feb.-July Ycs essential project State State Coord. equtpment and supplies 4 TraininglRetrainin g of l3-14 Jan NOCP SOCT Feb 2"o Yes SOCT as TOT for ZOCT Community,Self Monitorine(CSM) 5 Training/retraining of Jan 15 - NOCP LOCTs Feb 3l't Yes LOCT as supervisors Feb 15 SOCT and facilitators of (csM) 6 Retraining of February SOCT LOCT. June 30h Yes LGA/PHC Staff on LGA/PHC staff improved MIS. 7 Mobilization of State Jan-July NOCP State policy lOb August Yes and Local Government SOCT makers. LGA Public and Prirate LOCT/PHC policy makers- sector support stalf Traditional leaders. opinion leaders. Reps. of CBOs. Comm. leaders and comm. members. 8 Community KAP Maly'June LINICEF Communities Jul1 21" No sun'eY GTZ ZocT SOCT LOCT 9 Selection/replacement Feb-June Communiti Community Mar 3l"t Yes of CDDs b1' es leaders/member Jull'3 conrmunitv mernbers. S l0 Traini nglretraini n g of March-July LOCTs CDDs.CBOs July 30 CDDs ll Community March-July LOCTs CDDs. March2S- Yes registration and communities Jull' 3l distribution schedule announced t2 Communitv orvned March - LGAs CDDs May-Nov 50 WHO/AP(rc. 26 September 2003 Mectizan disnibution October CDDs and Communities t0 l*.2"d.3'd.4th rounds health workers 13 Communitl'Self Feb- Nov Communitl' Comnrunities Nor'30'n Yes (ongoing) Monitoring/supen ision Monitors. of distribution Health acti.r'ities. rvorkers. Village heads. l-t LOCT supportive Feb-Dec LOCTs LGA/PHC staft Dec 5'n Yes monitoring/ CBOs CDDs supen'ision of Conrnrurity distribution activities l_5 SOCT "spotcheck" April SOCTs LOCTs/PHC Mav 4tn Yes morutonng and June staff Jutv +e supenision of Sept. CDDs oci+* distribution activities Communities l6 Review meetings- Mar. April LGA LGA/PHC April l-5. Yes (a)SOCT (b)ZOTF Jun. July Coords personnell. June l2.Jul (c)NOTF/APOC. (d) Sept..Dec. State Coord SOCT:9 State 20. Sept l-5 UNICEF ZPC.APOC Coords. And Dec7. .NOTF/tINI deputies: State CEF Coords. _D_epstlq.. NoJI proj.Accts. SOCTs LOCTs/NOTF/ UNICEF t7 NOTF Qualiw control Feb NOTF SOCT Mar 3l"t No team visit to project Aug. Z@T LOCT Sept site Communities ,| l8 Prqect elaluation by ? APOC SOCT No NOTF/APOC NOTF LOCT (internaVexternal) UNICEF Communities I9 Report collection/ June- Health LOCT Dec l0 Yes collation. analysis. Dec lOm workers Health rvorkers -Plaruring for LOCT Communitics adiustment SOCT 20 Planrung lbr vear Dec I lth- I-OCT NOTF/SOCT Dec 15 Yes v(2004) I 3d' SOCT I]MCEF LOCT 5t WHO/APOC. 26 September 2003 6t lr.) (U o o o a= c) = o n o (s o_ -c .9 (s o, I .C o (U i= o E. n E C ,9, -c o o o -o m o) = oL = o o) (U 5 q C (E o J ro f (U (U o, c\ o o) E. E -C -Y= o o o o o) G = o o I= cn trJ l- (t, Iq o,= t tUo f =1{ t-o, o o rt) o_ F{l { xl EI CI 8l ol $o \ a- s (,) ti 6 6 N \l { $h \e I q3 .E R OJ AJ $ N It bs (\ & 6 I\r) $ 6 $ 9N $ R c.) $ |r) I I a qJ (r) N I H H !t o \ H S \ S \ s 6 {6 H H H R o tr tRI x\ E \ \ o s i i E _Q $ =\ t N e- N ,q 'q e 'q 'q ,q I l 1 E \t (,) E rB o \a.t}\ .\ RH L- N ET $ $H I B t*' EEea \-{ \ \$ EE b !U (^ o o^ ru rB $* aq $ H* .{\Pt SB xS .s $s E F.p b$!ut (\ $ b{ E Sti s J .a Hfi \E * $x .{ 's Eer .\o\ G El $ ss .e F$ cl NI sH (u E NE ol \ PR S RN $ $t N R,Q s8 OI (J\ .qj e s !n (n (i qJ qi t.E t e ae $ $s i f, S l- l- \ \s \ $ E $ $ ${ $s$$$$t$ H ! I H { $ B ! $ tD b v) E $$s I I \ H H u8$ P H \ P $ E {) N {.\ (r)B G tfio I E"\ \- =\N\t s ^i t Sn t\. a !{ o x$ !{r e P'E \J 's H s N R\ s {rs s I (U Es H.\ s s lS E s I (r) [' ui \ Pt I SF .a t! E$ R .\ \ al\ E: QJ \(E Q) a p =o ,E H t$ \rd ="R H \ d s I I E-( H$ $ e P q.F' $$ e"R q \t. tO \ \ \ \o\ \ o ..1 ! o -c E (j ao \o ct o F. o \ u\ i\ tH on t\ nn sto !q ! h \s \ t" S s \ \ \ $ s u \ \I \I € a & snt \ (A .E $ Eei a t qJ c S (^ u \ qj .qj .E tr E Q a i 5 $ I \ 5 es $ \ (a\ (a\ E .\< h ci N t \ $$$ss B s$ $ B s $ B $ I E(\ \ (^ qj t a $ s ta) $ f, $r l-t tn Er G\ lr) 6 H E H$ I $${(a $ { $t ss E$ $ $ ab \ {i Es o \ \ ,P € + I I c ( $q I + 'q 'q ,q ,q lt 'q E (4 B .E E ir (6 (\ \i s e & E .e $ \ eS NE HE NQ \- I b $ o e \ SE ss N qJ ei o E\ b br E* +i a .s' s* Es FS .u I .ed t e a q) .\ ET e{ { s sN ut 6\ h'R$ $'s AJ $ r*f s FS SN 5 F BE I \s .s FS tqJ E !t q ss ..B l: s$ s$ ss$ \$ s \ \o \ h Ot \ \ \ O c.l r o I 4) a ao (\\o o 0i iH tO\ aI (^ .E 5 I s{ H H \c l- I $ E o H H { I(.) H s = \ & s € s $ \ a. L Q .\Or $ oO\ 1ST YEAR CDTI POSTAPOC SUSTAINABILITY PLANI FOR NIGER STATE JAN.DEC, 2005. SN ACTIVITY OBJECTI\ES PERSONNEU DURATION REQUIREMENT/ INDICATOR TOTAL SOURCES FOR SUCCESS RESPONSIBILIT]ES SUPPI-IES STATE NGDO OTHERS SEte - To athrn 84% DPHC, 2 Days '4 Reams ofpaper @ US$ -Avarlablfy of us$404 us$356 - Local NGO planning therapeutic and each u,uk plan at state meeting level for 100% Director of Frnance, US$48 sustamabrlit geographrcal Directorplanning = US$20 y ofCDTl in coverage -Yo ol Niga Sbte hrough - communttes 5 SOCTs 'Tea break @ US$2 each x 26 integitron of beated CDTI wh x 2 days= u5sroa otherPHC SPHCC -o/o activities in of eligble 'Lunch @ US$3 each x 26x2- . Niger oays Persons teated' sbte. 10 SpMs = u1$t56 each day x 2 1 UNICEF Rep 'Venue @ US$ days 6 Local NGOs = US$76 * Per diem for 1 Unicef Otrper @ *Per diem for 1 UNICEF driver @ * Local tsansport for 6 NGOs @ US$4 each x 2 days US$x2x6=US$8 5Y 57 2 Training of To impove 5 shte health 2 Days '8 reamsofpapa @ Nunber of gx 300 new Capacity of personnel US$5 each = US$= pepheral perpheral ftont line 40 healfi stafi health health urorkers 4 LGA healtr tained workas (75 on supefvEron * pasonnel 6 Pkb of bno pen @ per LGA) on and monitoring US$= US$ x6 = $36 CDTI for sustarnable superuison CDTI l diver .300 jackeb and file @ monrtonng in US$ 2 each = 300 x 4 LGAs US$ 2 = US$60 . Night out allowance for 5 state health personnel @ US$23 eachx5x2nighb= us$230 us$2,360 us$2,360 Fueling of vehtcle = US$38 * TranEot allouance for 300 LGA health staff @ US$2 3 each day X 2 daYs = US$2 3x300x2= us$ 1,380 * Lunch for 3(X) healttr workes @ US$1.0 per day x2 days = US$1 0x300x2= US$OO * Night out allouance for 1 diver @ US$8 a dayx2@s=US$16 *Repairs 3 CornmunicationPrornote Progamme manager 12 months of darnaged Effectiveness by telephone, sharing of phone hne = US$1 31 of rnformation FAX, E- mail , information sharing poshge and among among couner shkeholders shkeholders .Telephone bills @ US$4 per monh x12 montrs = US$48 us$1,4s1 us$1,451 - "e--rnail serurces@ US$6 per monh x 12 = US$552 'courier pouch @ US$20 per monft x Gmonths = us$120 58 58 .6reamsofpaper@ 4 Training of 15 To prornote 3 consuftanb 3Days -Number of us$3,868 US$236 US$,642 state healtr participatory US$5 each =6 x 5 = health personnel and and adrocacy US$30 personnel 42 LGA health skill of 42 tained personnel on Health . 1 Pkt of bro pen @ participatory Personnel for US$ ='lx US$6 - Number of approach, sustainability health of CDTI personnel wth = US$6 Net workrng improved and . skrlls collaboration 50 file lackets @ US$0.2 for each =50x US$0.2 sushinability of CDTI\ PHC = US$10 pogrammes .Nrghtout allowance @ US$23x42x3days= us$2,898' Honorarium for 3 consultants at 38 each day x3 days = 38x3x3= US$1 14 * Tea break @ US$2 x 3day each x46= US$252 * Lunch @ US$ each x 42x3days=US$378 'Local tans-port @ US$4 a day fu 15 State health personnel x3days = US$4x3x15 = US$180 5 Jornt PHC -To evaluate Programme 5 days 'night out fu 5 Number of US$1,630 US$l,630 - Spot performance manager pro$amme supervBory supervisory at LGAand managers @ US$3 vrsb made to and cornmunrty each x 5 days targeted LGAs monitoring levels and vrsb by 5 cornmunities = US$53x5x5 state PHC managers to 5% oftarget = US$1,325 cornmunty in .night 5 LGAs out for dwer @ US$ x5 days = US$0 ' Fueling of vehrle @ US$53 each day x 5 days = US$265 sg 59 * Bank charges To faolihte - Progamme Gmonths US$38 charges per us$228 APoC (228) 6 for banking managef month x Omonths tansaction of operation for NOTF-APOC NOTF-APOC -Project Accounhnt =US$x6months=US$228 account account *12 Procurement To achrale Penn sec MOH 6 months reams of paper @ 7 of supplies for documentation US$S each = 12x US$ CDTI ofCDTI Director of PHC actvrties actutes at the programrne manager = US$60 State Level 2 note books @ US$8 each x2 = US$16 *12 Pkts of staple prs @ US$.3 per pkt =0 3x12 = US$ 6 .6 DeskJet pinter ink at US$1 per 1 = US$31x0 Availability of ofiice = US$186 supplies '3 cartidges of LaserJet Number of pnnter ink @ US$108 reports eachx3 = US$324 produced us$702 us$702 *2 photocopier tona model @ US$31 each x 2 = US$2 5 pkb of drskettes @ US$.8 Pa Pktx5 = US$19 8 Airing of Awareness Perm sec MOH 2 months 'Airing of 30 mrnutes prunotional and long documentary for 4 term slob US$0 per advocacy DPHS @ jrngles and government slot = US$32 documenhry supportand on cornmftnent Programme TVand 'Armg of jingles on radn manager radio @ US$8 per slot for 40 slots (US$x 40 = US$20 us$342 US$342 Radio Niger Part fundrng 6 60 .Nrghtout 9 Visit to 10Pr6 To promote Perm sec MOH 1 wk allowance for No. of SHMs us$562 US$161 US$161 US240 of hrget appraisal of DPHS 1 0 state stafi @ US$23 supervbed cornmunilies CDTI per night for 7 nqhts = by state PHC activities at Progamme us$161 shff to he Managu supervbe the cunmunity . fuelling of vehrcle @ conduct of level Us$23per day for 7 SHMs (i.e days = US$l61 one cornm. in each of the .Feeding 120health fu 120 LGA drsticb healh workers @2per head for one day - us$240 *Nightout 10 Transportatnn To Emure Mectizan 3 for 1 state Availabilrty of of tuo milhon availability days shfi @US$38 per night Mectrzan tablets for of of Mect2an Oflrcer 2 nghts Mectizan frorn at state level Lagos to Minna (1x US$38x2= US$76 Drrver *Nightout for one druer @ US$l5 per night for 2 nights (1x US$15x2)= US$30 us$260 us$260 *Fueling of one vehicle to and from Lagos = us$154 = US$154 * 11 Repairs and To ProEamme 1 set oftyres - Road maintenance ensure managa divers us$308 worthiness of 2 fleld effectue of2 vehicles logrstics *2 project seb of tubes @ for CDTI US$9each(2xUS$) vehicles achvities = US$36 *1 sebofshock absorber @ US$92each us$,692) = US$3,692 'Routne maintenance us$,228 US$4,228 2 gllons of seal oil per vehicle x 3 times/Gmonths @ US$ per gllon US$96 vehrcles = US$96 I orl lilter per vehele x3 tmes/Omonths 2 61 6;t @US$ per vehicles (1x3x US$8x2) = US$6 1 setofplugs replaced 4 tmes @ US$/set for 2 vehicles 'l set x4x US$x2) = US$48 12 Fueling of 2 To ensure ProEamme 6 3000 lrters of tuel for 6 No of Trnes US$3,000 US$3,000 field vehicles mobility to manager months rnonths @ US$ 5 per Vehrcles were conduct liters for 2 vehicles = fuelled for activities and officral Dnver. US$,000 haining assrgnments *2tyres@US$12 13 Maintenance To ensure Data Officer 6 Motorrycle rn ofone road montrs each (2x US$12) good condihon motorrycle worthiness of = US$24 motorrycle 2 tubes US$ each (2x US$a) = US$ *2 Plugs @ US$2 each (2x US$2) = US$ US$39 US$39 1 chain @ US$3 = US$ *Nrghtout 14 Joint To solicrt for Shte Health 7 days allowance -No of policy US$1,776 US$166 us$1,610 - advocary cornmitnent Personnel for 10 shte makers visib to state to funding of progamme managers mobrlzed and CDTI US$23 pa day x 7 LGA SPHCC @ policy makers activites daYs -Amount DPHS, Zonal approved and PHCC =10x US$23x7 released for CDTI Directors, PHC = US$1,6'10 Director .Nightout allowance 2 divers @ US$15 x 2x3 days = US$90 *fueling of 2 vehicles @ US$38 each x2= US$76 €u 62 .2 '15 Maintenancd To provde Progamme 6months sfoke sealed fueling of altemative manager engine oil, 2 per generator pou,,er month US$8 x @ - AvailabihS of source in 6months US$48 = alternative he abserrce source of of public .Spark plug @ US$2 power to run pov,/er per quartr x 2 cunputers and supply and quarters=US$2x2= other for use US$4 equprnent for dunng field office and field bips *Gasket activities = US$11 5 - number Pston and nngs of tmes generator lias us$255 US$255 = US$27 used for work 'Sewcing of carburetor = US$15 .Fueling @ US$2.5 for 10 days a month x 6 months= US$150 16 Production To povide 10 Shte PHC Omonths Production of 20 of MIS standard2ed progrcmme reams of mtegrated forms and rnteEated mangers supervisory and integrated fmnat for monitoring check lbt supervsory supenrbron @ US$23 Per ream = check lst and monrtorrng 20 x US$23 for allPHC actvrties = US$460 Availability of integrated check hst and US$460 US$460 reporting forms 17 Zonal Task To revrew and Force appraise CDTI meetng activrties in 9 DPHC 2days, Night allowance for 2 -Number of States in Zone (June ofl'rcas US$38 zonal review c @ Programme 2003) each x 2nrght x2 meetings held quarters manager = US$154 2days 2 SOGTs Nrght allowance for 1 dnver US$8 ( Nov @ for 2 niglttx2Quartas= 2003) US$2 us$154 Vehicle tueling @ US$l x2Quorters= US$2 US$186 US32 6g 63 18 Purchase of To rmprove NOTF 3 months lvehicle Avarlability of new us$31,000 APOC one new logistic vehicle Toyota 4WD capacity of us$1,000 vehrcle for SOCT for CDTI sustainable actvtties rn coordinatpn of Nqer State CDTI actlities in 14 LGAs 19 Purchase of To NOTF I and Availability of new one new achreve 3months computa data us2,700 us$2,700 computer effectve UPS cornputer and UPS managernent, Desktop ( disease Penbum surveillance 233) and and reporbng UPS for the sustamabilrty of CDTI 20 Purchase of Availability of new one To rmprove 3rnonths pnnter USM6l USM6l documenhtion cornputu pglp 1 Printer pnnta and reporting (DeskJet to stakeholders 1120) GRAND IOTAL TOTAL STATE UNICEF APOC AND OTHERS us$56,992 us$11,688 US$7927 US$37,377 STATE: NGDO NAITIE: NAME DESIGNATION: DESIGNATION: SIGNATURE: SIG}.IATURE: I DATE DATE 64 64