OSUN STATE ]\OTF/}YIIO.APOC PROJECT
TECIINICAL REPORT OF TIIE CD'TI AC'I'I\/IT'II'S IN OST]N S'I';\]'E I'ITOJI'C'I'
,\llRIl, l99E - .IANtL\RY 1999
I'RINCE 1'lN'lO'[l IY OI,LIIIIINII ADlitr;\RAI(.\N (,1.p.) PITOJ Ii(]T COO RD I NA'IOR
NItt. A.()..t.\tYEOliA ZON,T L COO tI DI NA'I'O R. I}-ZO N Ii
Ir\Ntlr\iiY 1999
l EXECUTIVE SUIIIN,IARY
Osun State is onc of thc states in the southr.i'cstern pafl ol'the countri,and is locatecl in t5e ll 5clltlt .l'here Zorte lt has a 1998 projected popLrlation of about 4 nrillion arc 30 LG;\s in thc statcoLrt ol' rvhich l0 rvere selcctecl 'fhc lbr irttplenretttation ot'CD-I't in the lirst ycar ltrcr,alcltcc slrr'cy ol'l()tig 90 and the subseclr,rent lLllN4O of 199r4 re'u'ealcd thal the stateis cnclentic 1or Onchocerciasis
N4ectizan distribution in tlle state staftecl in 1993 unclcr the auspices ol'lnternatiglal lroupclatio. lbr- Education and Sell'-l'lelp (IITESIJ) in Irovolc LGA and later extenclccl in l<)9.1 to scven UNICI:tr assisted LGAs. Currently 27 LGAs are enjoying either actir.,e or / and passiye clistributio,
'l'he tert LGAs selected for the CD'l'l inrplcrnentation {or the Iirst y-ear arc Ail,cdire. I}oripe. Ecle Soutlr. II'c East. II'c Nor1h. ll'c sotrtlr. Ila. ruo. obokun and or.iaclc LGAs
Prer"ioLrsly 339 conrntunities had been reccir,'ing trcatnrent in the state and are,o\\. joired b' aclditional 76 communities in the fbcal LGAs
In inrplernenting CDTI so lbr the fbllolvin_q activitics havc been carried otrt. '/ Training of SOCTs, t.OCTs and CDDs '/ Mobilization ')- and health education ol3l7 target conrrnunities '/ N'lcctizan trcatrlcnt it-r 327 conturunitics. N,lonitoring and supervision of'the CD-l.l pr.ocess.
The acltievenlcnts ol'the proiect fbr ttolv are thc traininu of 26 soc]'s. 80 Loc-fs. 155 othcr hcalth r'vorkers and 1,054 CDDs. tlte treattnent of 151,355 p"rro,',, in327 coprrlulities. a,d,robilizatio. ol- 377 cortrmunities to select their CDDs and picl< up N,lectizan fionr designated collectio. poirts.
The strengths of the CDTI intplementation process inclucle the appointnrent ol'conr,rurity based supervisors, the revitalizatioll of donrtant village health conrnrittees, proqress ip i,teqratio, ol'CD'fl intothe I)FIC systern the high level ol'corn,nit,r-rent by pro.iect staff o,rt.t ti," rvillirgness.f quite a Itulrtbct' ol'corrtttrtttritics to livc up to lhcir rcsl;onsibiiitlcs gldcr ('l)-l'l
However, lack ol'adequate cotlltttittttertt to thc proccss bv l-GA coorciinatclrs. irraclecluatc supcr.r,isiorr of CDDs and the inability of sev'eral cornrtrunities to oft-er incentives to thcir CDDs ar-e *,eal< poi.ts in the irnplernentation pr.ocess
N4oreover the project is fiaught rvith sonre constraints rvhich ncecl to be aclclressccl to lbstcr *,icler coverage These include inadequate supply of N4ectizan tablels and IEC nraterials. biting {uelrsvr scarcitv-Jv(r a.d inaccessibility of solre targcr corrr*unitics
The project in the comitlg tnotrtlts intends to train nrore CDDs especiallf irr the harcl-to-re.c5 areas. intensily supervisiott and tnonitorin-e of cDDs to cnsure proper recorcl l SECTION I 8,,\C I(G I{O tl N D I N I.O IiNI i\'l'l O r\,{ Osurt State is ottc of the statcs irt thc soutltrvcstcrn part ot'Niccria and is locatccl ip tlrc []-llcalr6 zolc It shares boultdaries in the ltorth r.vith l(r.vara state. in tlle east tvith Ondo state. in the w,cst riilh Ovo state ancl in the south rvith Ogun statc 'I'he Yorubas coustitttte or,'errvhelnrin-uly the nrajor ethnic:4roup in the state ancl fbrrl t6c incli-qcqous population of the area Hor.vcr.'er indir.'iclr-rals llonr other cthnic,qrorrl)s such as t5c lrulagis. lgb-ir-as. Agatus, lbibios and the Ilausas har,.c .risrated i,to the ar-ca Bythe l99l census Osutt State has a population of 2,203.016 Currently it has a projectecl populaliorr of aborrt 4 nrillion fbr 1998. There are presently 30 LGAs in the stateor-rt o1'1v5ich l0 r.,'crc sclectcd fbr CDTI In the first year these ten LGAs rvere sclcctcd fbr thc inrplerrrerrtution of CDTI trut expansion 'uvill be made in later ,-ears to other endcrnic LGr\s Ottcllocerciasis related activities sta(ed in 1988 r.vith sl Mcctizan distribution startccl in thc statc in Ircw'olc t,GA in 1993 rv'ith assistancc ltonr lntcrnational Foundatiorl for Education and Self--tlelp (lFESIl) ln 1994 LINICDIT started assistance lbr rnass distributicln 'l'his itl seven LGAs assistaltce was exteltdccl to scvelt aclclitional LGAs irr 1995 \\/ith thc creation clltnorc LGAs in 1996 rnass distribr-rtion r.vith UNICEI; sLrpport \\,as cxtcndccl to includc lg LGAs Ctrrrerltly active attcl passir,'c clistribution is on going ilt 27 LGz\s u,itlr citlter tiNI('lrlr assistance or self sr-rpport by,thc LGAs IFESFI is currently cxtetrclitts assistance to Irer.vole and Isol J'he fen t-GAs selectccl lbr the irrtplernentation ol-CDT.l rvith assistancc lj.orn AIrOC lbrthc l99gig9 project cycle are Boripc, II-e North, Obokun. Ilb South. II'e lras1. r\i1,cclir-c. Ildc S6Lrt6. Iu,o. lla a,cl Oriade t-GAs + PITOJECT' PITO PI LI. N/IXIE OIt PRO.|ECT. Osun State i\OI'F/WFIO APOCCD-l'l l)rojcct DATE OF COilX'lENCEIIEhrr OF .4POC ,4SSIST,4^\CE April lees PIL4SE OF TECIINIC,4I. REI'OI(T-. ,\pril l99ti N{aroh 1999 Iablc I ENDE,IVIICI'IY LEVEL -fotal S/N LGAs No of No of Hi,per No of iVleso No of Target Ertdenric [rrrdenric lrndcnric llrdeuric [)opulatiou Districts Conri:runities Coninirinities Conrilrurliiies I IIa l0 7 49 56 28.21 l 1 2 Obokun t0 -)) 62 _-i9, t l8 -) Ife East IU 8 ci8 76 -\7.45() 4 Ife South t2 8 62 70 108.091 ,5 Ife North t0 7 48 55 .10.581 aa 6 A-ycdire 4 8 3O -r 1.4i0 7 lwo t2 t5 53 68 20.656 1 ?a 8 Bclripe 10 -ro 45 56. I 50 I Oriacle l0 8 57 65 70.5(r5 l0 Edc South l0 5 7? 11 32_662 TOTAL 98 80 479 60{ 470,934 ACTIVITIDS DONI! BI!'[\\'EBN .IANTJAI{\' AND NIAITCII I993 After the revierv meeting for UNICEF assisted st{rtes fbr the y'ear I 997 he ld at ,\kLrrc. Ondo State in January the state prepared atrd later carried out various activities to ltrarli the national Onchoccrciasis day in February. This rnarkin-q was rnore irnportant to the state due to the neu's that thc proltosal fbr the itrtplcrrtelttation lor CDTI has bccn approvecl b1, AI,OC J'hus the pcriod w,as usccl to initial sensitization forthe actual execution of the project once tlre neccssary lirnds arc made available Shorrly after that the rtronthly review nrecting lbr Jarruary, lbr LOt"l's and SO("I-s n,as hcld Oncc again the trteeting provicled the opportunity to serrsitize the afl'ectcrl L.OC'l's on thr-- on-csntinr{ CDT'l irnp IcurentaLio n Training of'CDDs'. Training of CDDs on the process of CD'l'l rvas carriecl out in lre.,r,ole and lsol.arr LGAs betrveen 17(l'and 23'''rof FebrLlary sim,.iltaneor-rslv It nrust horvever be statecl that tlre training was not that comprcltensivc. btrt basic lirndamcntals on CDI'I were tnught ln lrervolc LCiA 67 CDDs were trailted whilc in Isok:rii LC,\,77 wcrc ti-aiiiccl. Llciriccrr lo'l'aii Mectizan Distributiott. Mcaltwhilc distlit:LrLiort ol'lver.tttectin corrLinucd in sorue corrrnrurritics \Vitlrin this quarter atotal o{'12,655 tttales and 13.635 I-enrales (total : 2b.290) n,ere (r.catecl ri'ith 38.7,1S 5 tablets t.J U) 5 rn E\ -I ED I l I I I I I I I I I \o o\ -I Fg F trJ { I 5t\, lJl \o Ur }J U' € b.J a- €A o\ (1 H - ttJ z zH o a a- tv o\ ,* NUI\IBEIT OF CONINIT.INITIES IU'CEIVING I\/EITN,TEC'TIN PITE\/IOLISLY r\NI) 1'IIOSI NO\ry INCI-TIDI'D IN ]'tIE,\POC PITO.IIC'I 'l'ablc 2 LGr\ r\.to No of Cornnrrrnities Additional Total No of Pl'cviousll, (lcrrurrunities tlndcr Conrntrrnitics Ilcceivin N'lcclizalt r\POC llcin rl AIYEDIRE l6 2_1 ? 25 BORIPtr 27 L-l -+ 27 IIDE SOTJ'| I I t4 l0 ) l) II]E EAST 21 6O 9 lFIl NORTI I 26 l9 l5 l-l IFE SOUTFI l4 -) -) -1.+ ILA 25 2t -\ 2L'' rwo l5 26 6 .1 ', OBOKUN je l(r ii 50 ORIADE 28 25 il 36 TOTAI, 200 339 76 -l t5 NB-r Treatnlertt is still on--soittg in not onll,tlre lbcal LGAs but also tlr-ougSout t5e state . Returns arc still bcinq crltcctecl li.onr nrarrl. cornrntrnilics ILevision of zYI'O For the first year 8o coullnunities r,vith a population of 226.160 rvere inclicatccl fbr the i'rplc,rc,tatio, of CDTI. N4ost of the conrnrunities so indicatcd are actually gr.oupings of r.,illaecs tSat are,.*, 1akc. as sepal'ate ctltltntttttities J'ltcre is 'l'reatnrent therefore a charrse in the Arrnual ob-iccti'e as i,dicatccl above as r'vell as in other relevaltt ltlaces N4ost of these villa-qes that Iornr a large c6rp,ru,itl,as slatcrJ i, the proposal Are llow know, to bc rreso e,cre,ric Cornmunity (Defi nition) A commutrity ref-ers to a group persons of that possess a conulron know,ledge. ideas and rvho has chosen a place as a central rneeting poi,t a,cl has a leacler appror,.ed of all (t SECTION 2 INIPLEMEN'I'A'I'loN ol' (lD'l't ('I'ti;\R l) -- NI1\JOR z\c--'r'r\/t't'ttas PRo C Tl R E A I I] N'I' 0 F I' IT0.I E C7"; U P H, I Ii,' & (",1 P I T",I I, I'r M I,I Consecluettt upotl tltc appror,'al ol'Osult statc projecl sornc lL(' nratcrials celtr-ally prorl,cccl bl.the 'fhese NOTF Secretariat r,verc supplied to the project inclurclcd ('DD l:'iclcl Ggic.le. IlouseSolcl Sutttttrary 'l-reatnrent fbrtrls, Posters, lndiviclual cards etc Thcsc nraterials r.verc suppliecl in preparation to the colllntencelnettt o1-CDTI irtrplerncntation in thc pro.iect area N4oreor"er, callital itents suclt as one desk-top computer-. onc orre clesli-jet printer. I_5 Yalnaha Itl This is a continuous cxcrcisc. All olfrccrs inv'olr,'cri in thc distribution of N,lcctiza. i, thc statc har,.c been subjected to one lbrnl of trainins orthe other since the inception o1'Orrcho c.rtr-ol i. the statc fcrrthe purpose of'CDTI inrplernentation rvhich !I911ever -fhese started in April l99g 26 rnernbers ol'thc SOCT have been trained included ofllcers in char.qe of the six 6ealt5 zopcs in t5e state T5e idea r'vas to train an adequatc ttunrber of personnel that,,.,,itt i,-r tr,,r-t."i,., tt.," l-oC't'S subsequently The B Coordinatot'' Osutt -Zonal State Coorclinator and 1hc Oyo Statc Cggrdipat.r. I.cilitarecl rSis Lraining o{-tlainers This took place li'onr the I't to the 3''d ol'septernber igqs adaitio,ally the State Coorditlator and fiVc LGA coordittators rcceivecl firrtlrcr training clrr CD I-l irnlllcrlcrrlzrtio, at Kar.JLr,a at a nreetilte organizcd by the NO'l'F Secrctariat The training of the L'ocal Govcrtlntetrt (lontrol -l-canrs onchoccrciasis tor CDI'l irnplcnre.tati., rvas carried out oll llte Str'through l0tr'olsepternber 1998 vvc rcvisecl our ilitial ob-icctive ol-trai,irq only five persotls per LGA to train eighi persons in orclcrto cnsurc the ar,'ailabilitv of trairccl Itlanpower in the eveitt of translers pre-occupatiorr or ol'pci'sonrrel rvirh other I,IJC actii'itics at a tir,e when they nray be needed 1br Onclro activirics I'he training \'vas conclucted irt trvo centcrs nanrely. osogbo ancl Ilesa. r.vit6 tcarls fi.r, llr,,c l-GAs at eaclt center' 'l'hetraining was fhcilitated by the trainerl Joc't', and superr,,isecl bl,ollrcer-s Iio,r t5c Il -Zonal office. Each group took tirle to produce'To Do Lists" for vaiious actir.ities to be carricd out ttnder CDTI These arc attacltcd as appcncliccs N4eanr,vhile all the ten Ibcal LG,,\s lra'e trairecl terr additional health slafreach 'l'hese u'ill serve as mobilizers and district sr-rpcr-r'isors 'l'6is is i, aclditi.n to some health staffalrcady traired by trre state staffearrier -l'Ilc CDD l'raining. initial trairring ol'the selccted CDDs was car.riccl .trt bctrvccrr l5,r,arrd 17,r, Septe[lber 1998 sirrlultaneousll,in 'l'his the cornnrunities u,as dppc bl,tlrc trai,c4 t-O(.'l.s a,d supervised by the SoC'l's 'l-lleir training was centerecl on identiflcation of'thc cliscasc. erurrerati... N4ectizan distribtrtiorl. lllal)agcnrettt ol-nrild reactions arrcl the rcl'er.r..l ol'sc'erc r.eacti,.s. N U N'I B M{ O F C D DS'l' Itr\ I N Ii D/lt ET' ltr\ I N Ii l) Table 3 1l/ I,GA zVI'O No of Nerv No of ()ld T'ot:rl /lt Duraliorr ol' ( ll) I)s C!)l)s ltc- ,,1ch icvrrrre:rt '!'r:rirrilrg 'l.raincrl ol'irrr t:tlctl Aiyedire _s 240 -l 75 r2ri 5-j_ -l da).S Boripe 300 il8 t2 t-10 43 -l rlal,s Ede South 230 98 1 lu5 46 .l da 'S '1 (n /-1 ()o a<' . .l^ lfb East L J\) t, / 2l oo -)J -t (l(l S () () lfe North 240 82 17 4l t cliLYL Ile South 260 82 t-+ 96 .'l da S lla 240 76 l5 Ill 4r., ida)! lwo 250 105 6 ilt 44 3 rla S Obokun 243 62 Nil 62 26 ida S taA Oriadc 740 I L-+ NiI t1nl;t 5) .i days Totnl 2,493 867 187 1,054 42 { 'tItAINING OI,' DIIrl.-ERliNl' LEVITLS Otf S'l'i\I.F FOI( CD-l'l Table 4 No of TOT 'I'r':rinetl I,(;AS No of No of llealth No ol' 'f raining LOC'l'.s I'ost Stall' C.DDs [indertaken 'I'rained 'l'raincd I'r'airtcrl -) SOCT Zctnal Total Ai5rsd1.. 8 _-) r28 .L 20 6 -1 t_, B t0 Jlqlp"- - li0 L:.de Sor-rth tt lL) lu5 I t--- Il ^..r U .I (, () I I l.l lltl5 L () () () -t ll-c Nrrrtlr It Io ()() IIb South 8 t0 ,)6 lla 8 l5 ltl Irvo 8 l0 lll OLrokurt it I8 t'2 Oriadc 3 I3 r24 Totul 80 155 t.05{ 3 S tl NI N'l ;\ RY OF TI{,\ lN INC S Table 5 Type of 'f rainirrg 'l'ot:rl No T'1'pcs of Ii:rcililation NI ajor' r l',r.r r rr 'I'r':rincrt rrt.aa(al\,1-r^*i..1. l.arJ 1/J\alI lc,.,l a t r.rta (lolrstrairr ts SOCT Training 26 I landouts. Zonal Stafl-& 2 Iittcl scarcit),ancl lilipchar ts. Slatc inaclecpratc Posters. flD[) Coorclinators nunrber o{'lL(' Nlanual & rnaterials \\iriting N'lateriaIs LOCT Training 80 I lanclouts. SOC-f s Fucl scarcity ancl Irlipcharts. rnaderluatc [)oster s. CD[) nunrbcr- o1- Ilj(' N'lanual & nraterial s \\'ritin.q N4aterials CDD Training 1.054 Pclstcrs . LOCTs assislcrl Irrrcl scarcily arrd Conrrnunitl, by SOC'Is inaclcrpr rtc [(cgisters. T'apes. nunrbL-r ot'IEC Writing N{aterials nratcria ls & N'leasuring stick s Mattagenrent Trailring Thrcc trtet-nbers of the state stafl'have attencled tlre course on'l'otal Qualitl' Managetnent ('l'QM) at the Sustainablc Niana-eenrent'l'r'aining Center (Sill'lC) in Jos llont l9'l'to ?-+'l' 'f October I 998 he reunion. which is the conclucling part. is slatcd lbr April I tl99 Alreadv thc efl'ect of the training is being witnessed on the output of the atlbcted olllcers irr the execution of CD'II activitics NIOBII.IZTITION / I I EALTII Iil)UC,,l?-lON N4obilization at tlte cornmunity lel,e[ vvas ainrcd at cnsuring conlnutritf irtr,,olverncnt u,ith enrphasis otr their '. '/ nttitude and acceptance ol-thc projcct ./ Nonrination ol'CDDs Creation of lunctional Village Ilealth Conrurittees 'uvhere nonc exist / Tirnely collection o1'l\4cctizan desi_qnated '/ lioln agreed / points Payrncnt ol'incentivcs to CDDs selected by the contnrunity' 'r Deoision otr lhc urode ol'distribrrtiorr () Table 6 LGA r\TO No of No of No of No of No of No of -rr f .rr ,rr s f-rr rrr rrr c 'f'lr o f Colunrs. L,rrrrrrrarr. r tt.at Ccnrrrrs. Tlr:rl (lonr lrrs. (lcnrrns. 'l'hnt That tlccidcd on decided on \\/ith I'af ing -l'r':rincd selected Collccted tirc nretirod the rrrontir oI ('DDs irr CDDs Drrrg of Distribution (l l) I)s Cash or irr I)isl ribrr t io n Iiintl z\il,cclirc I6 ?6 t5 I5 l-5 26 N/,,\ 13oripe 27 (r 64 -)o 36 -l 64 l0 ( Ede South l4 t7 45 4_( .1 t7 IIb East /+ -, I -)l 3t -)l -)l t2 lf'e North 26 45 3[J i8 -t tt 45 l0 l1 lle South l+ tl tt tt la a i5 ll ll tt IJ _) Ila 25 5l 46 46 45 5l It) Iwo l5 65 L6 28 28 65 N/r\ Obokurr I6 /.t 32 32 -)' -.) Oriade 28 40 45 .TO1'AL 45 45 40 N/i\ all 7)1 200 7)1 7)1 377 58 I'he rnobilizatiorl and health education of the cndenric corrulunitics \\'cre supprlrtecl b1'thc use oI posters and radio/television jirtglcs 'l-[rc developed in thc local lansuagc jingles lbc.ssecl ., t6e disseltrinatiotl ol-intbrnratiolt on tlte scoLrr'ge ol'the discase ancl its soci.,-cccr]rtllric ipll)o11a,cc Hor'vever the project r,vill bc clcveloping-iinules that rvill fbcus prirrrarill,on thc roles ol'thc cornntunities unc'ler the CD'l'l process Iror a tnore e[' ctivc nrobilizatiort trainecl lrcalth stafl-w'cre put in place rvhile at the conrrrrulitl, lcr,,cl tor'vn criers'uvere used as mobilizers. The projeot also maCe use olchurchcs and nrosqu., n, for lnobilization. 1rla"., ItE s u LT s o F Tr{E i\I o tJ I LIZ z\T Io N/co i\t tVl ti i.r- I T Y t(E s po N s E r Conrtlunities selected their CDDs r,vithout delav / Non-tunctional 'r village health comnrittees \\ere reactir,,atecl Cotlltltt'tllity nlettltrers artd tlrcir leaclcrs rcgisterccl their'presc-lrce clurinq thc trailipg gl-tlre (.1)Ds F Afterthe CDD training sonte corllrnunit'r'leaders callecl the C'DDs 1o a rrreetip-s to disctrss t5e modality of perfornrine their acti,",ities /) ltr sotne rwere cotltntuttities traitlers utct bv traditional clruntrtrcr-s in appreciation over the CI)T'l process l() IN4 PRO\/I -I'AIT(;E-I' NG ]\,IOBI LIZAl'ION OII CON I ]\{ T ] N II'I I]S r N'lore \rillage l-lealth Conlrnittees have to be nracle lunctional ancl those lirnctiorral encoura_ucrl tcr parlicipatc rnore in the CDI-l process F Greater inr,,olvcurent ol-traditiorral rurler.s. rcliqious leadcrs ancl r.r,or.ucn orq,anizaticlns in thc nrobi lization of target oornntunities F ltrvolvetnent of local NGOs such as thc \\/AI Brigacle. N4an O'\\,ar. I{ed Cr-oss and I}o1.s'scouts irr thc lnobilizatioll l)r-occss SIJNINIAIt\' OF NlOIll LIZAT ION OIi 'l';\l{Glt'[ (]ONINItiNI't'tUS 'l'ablo 7 I,CA No of No of T'arget No of No of No of Cornnrunilics Corruns.'l'hnl ,t dyocac;, N'!Oll/St:rtc N(; DO/NGrJ Nlobilized Iteceived I I E Visits to Staff Irrvolvctl slaff invoh,cd about iurJrortance f,Cz\s irr in of extended f,'lobilizntion Nlobiliz:rtion 'i'r'e:ttnrent AIYEDIITE 26 ?6 -) IO BOI(IPtI 64 6-+ .T l0 -) I]DI] SOUTH t7 t'7 4 l0 IFE EAST 3l -rl + IO IFE NORTH 45 45 -) l0 IFE SOU'|H l5 I5 -) t0 ILA 5I 5t ., IO rwo 65 65 -) IO OI]OKLIN /-) :-) -) l() 1 ORIADE, 40 .TOTAL 40 4 t0 377 377 J4 5 AD'/0L'ACI' Advocacy for cDTl in the state started once the infbrrnatiorr n,as rccciverl i, Januarl,tSat t6c proposal fionr the state has beetr appror.'ed In Jr-rly a 1L-arn ol-olllccrs fiorn UNI(.81,- a,d thc lrecleral N4irristrl'o1'Flealth visitecl tltc statc io prescnt the cherluc Ior the lirrrds fl-.rrr Al)oc t. the state oflicially Meetings rverc ltelcl with tlio I'H('Directorl. the l)errrrarrent Secr-cta11.i. Health, 16c N,liristr.r, ol- the corttrnissiotters fbr Heatth anri [iinance, the Accountant Gcneral. ,;oil,"'i"....r"o]," r,.," State Goverlttnent and Head of service Thc objectir,'e of these advocacy,nreetirqs \\,as to se,sitize the policy tttakers to the ainls attd aspiratio.s of 'I'5e cDTI a,d to ericit their sul)por1 res,orse \vas quite fhvorable as the Secretary to tlie State Gor,'ernnrent inrnrediately presented a clrcclue of- -N-50'000 as part ol'the state's counterpaft lirnding fbr cD't'l implerricntatio. i. t5e state Duri.g the nleetillgs r'r'itlr the state policy lttakers. transparencies r.r,crc shov'rr on thc clirrical of onchocerciasis ,raril-cstati.rrs altcl tlte tteed to institutiorralize cD'I'l lbr long-tcrrn c.,tr..l lt tl At the Local Goverttment level advooacl' u'as carrieC out b1' a teall contprisipe t6c Statc's t)ll(' Director. the B Zonal Coordinator, thc statc l)rojcct Coor 114 ECT I ZA N D IST R I I}T]T I O N Shoflly alter the state received N4ectizan tablets liorn the tl Zonal otllce they u,erc distributed to t5c Various LGA Coordinators. 'l'he Coordittators collected these at the slate ofTice at Osogbo 1'5e LOCTs then rnade the tablets ar,'ailable to the district health lhcilities or agreecl collcctiop to be pickcd up by the contnrunitics ,.i.ts Each cotrltnLrlrity rvas lnobilizccl to dccidc on thc nrodc ancl tirrrc ol-clistribtrrion ('..scr1ucrrt11, cotl-ttltt'tnities held trleetittqs where tltese were a-greecl on befbre actual distributio, tooli lrlacc Alier thetraining of the CDDs. cotlrmunity registration took place b.y,the CDDs apd tSereafter distrilrutio, r'vas elJbcted. In sottte cottttttuttities the distribution tool placc in the r1orlilq phile irr s.,rc ir t.ok place in the afternootl, artd yet in sonre it place took in tlri evening, accordin! to r.rhat rvas agrccd by. tlte cotrllnunity. Sotrle corntnunities requestecl iheir CDDs to nrove fi-ont house to house w.hilc others pref-erred a central point of distribution. It must be poillted out that the sizeable nurnber of relusals/abscnts recordecl is dr-re to lack of a Iollou,- up of those rvlto r'vere ttot around cluring the trcatrncnt pcricld. includin-u the tirnc sorlc dr.urls rvcr.c lelt at the cottltrlutrity levcl Thc irnplicatiorr is tlrat the tinre selcctcd lbr thi clistritrLrtion r,.,,as rrot tavor.ablc to nrany and therefore needs to be r e,",isited. l)iscussirut Many cotttttlunitics.are irtcreasirtgly appreciating the distr.ibtrtion ot'N{ectizan. \\lrich starlccl in lg()3 in the state This is inlon,ed by the atiiibutes otitr. drug. It is tcrrrred a *,order clruri. a \vornr expeller and a severe itching antidotc It has also been associated rvith the renroval ol'head lice So.rc wonlen r'vho have beetr barretl lorthreeto flve l,ears and ha,u,e conceived alter irtake ol'N{ectiza, have attributcd thcir fiuitlLrlness 'l-ivo to thc clrLrg of'such wornen har,,c narnccl thcir r.alc chilclr.c.. "Silla" I'e' "opens the r'vay". Sottle old men on theiror.vn part har.,e testil-reil ol-a,rarked i*pror.,enrc,t in their sight after taking lvlectizart Moreover, sonre fhrnrers in lf-e Scluth and lla I.cal gor,,crrr,c,t areas have stated that their stretlgtlt atrd vigor \vere rene\.vccl aller takine the drug l-his clcr,,elop*ert has made the drug nlore popular and acceptable 'fhis than befbre arrrl nrore people are ,o\\, eascr to talie tlle drug developnte,l has the spillor.'er cll-ect of ,ral t2 i\lEC'I'IZAN'l'ltt'lA'l'N'It'lN'l'StlNlN'lAltY FOtt lo t,(i,\S (Al')ltll, lgefl'l'().1,\Nll,\ltY 1999) l'ablc tl SiN r,Gr\ No of 'l'otal l'op. ()l' No of No (-ov No No of 'l'rc:rted 'l-r.r'.rtorl 'l-.r Conrrnunit!cs I)ccllle t tt.ittr. ('i1,1 t\\l)nfi'c,',1 I tr!r\ ar lrla, s 'l'rentetl Cornnrrrnilirs titi g,t !f / Abscrrt [] scd t AtYtiDil{u t5 15.2 t5 I 1.082 6..1-15 416 4.117 a -!Z'7c'q,.5().i BORIPE 36 44.921 3 5.597 25.026 557 t0._s7l j 75 5 -) E,DE SOUTI{ 45 22.e94 18.0 l2 ll o37 -+8 0 6.975 17.455 5 al to4 4 IFE IrASl' .+ 3I -+. I o+ I 6.3 :t 675 -1.i (r3 23."le t 5 5 IFE NORTI I 38 r)17 ?4 R()" "R I 7.(> I Cr 628 25._s2e 0 6 I IFI SOUTI il 16.e86 l.+.995 l].5e.+ tio 0 I.:i9 I 17..+00 0 7 ILA 4L-' ? I 5t? (r,3 I C).0-lg l4.l t:5 Lr I.874 10.577 _s 8 rwo 28 7.682 6.034 5.540 120 4e4 tt.020 0 g OBOKUN 32 20,1q0 te.42l r4.075 6e7 5. j.{8 21.211 5 l0 OI{lADt1 15 .18.853 36r-1% -I'OTAI, 27.033 55 3 9.-+61 3(r.000 0 327 250,59.t 20J 5 t 51,355 60..t 52,500 2J(r.{189 N.R: llctv'aan.lnt tudt't' tuul l)cc't'trtht,r 199,\ I I 5,036 l)ct.,\.on,\. l'ct.(' lt't'ttlt'el u i non-,-l l'( )(' rt,s:.s't.tlt'tl L(iAs. MO N IT0RII| G AN D S(/ PE RI,'IS I O N At the cotrlmunity level there are comnrurlity supervisors r.vlro arc eithcr teac6ers clr retired cir.'il servants. They oversce the activitics clf thc CDDs durins ct'rnrnrunitl,ccpsr.rs apcl actrral distributiop These are assisted by the District Ilealth Superv'isors r,vho are ernployees olt6c L.ocal Gor,.e1rr1cpt LOCTs also supervise the CDT I process rvhile the SOCTs nral(e spot checlis ip selectecl corpprLrpities to ensure that thc laid dor.vn criteria ar-e be ing tollow.ed During the spot checks by tlte SOC't's it r,r,'as discoverecl that sorle CDDs rladc rrristales particr.rlarl' -l'lre in record keeping N'loreover records olnrinor reactions r,verc not bein_q l Generally the CDDs exhibited a high sense of responsibility and understandinq of t5e CDT'l corcepr Censtts of target colrtttrttttities wils satis{aclorily'carriecl out Tlrc tinrc ll-anrc rriccl lirr this ralqcrl 1l-opr Ottc day to ollc rveek clel;enclirrg tttt tltc size ol'thc cornutunitl,and tlte lrrrrll.lcr'ol'CI)Ds sclccicd El/ALUrlT-I0N ln orderto revier'v past perlbrttlances so as to lbnntrlatc ner,r,,strate-qies. rnonthll,rer.'icr,v rrrcetinss r'vere held on a l'otatiollal basis irl the LGAs l-hc statc also panicilrt".l i,, zonil rer,,i.-rv rlectin! as at and r'vhen due. Liker.vise the project rvas 1;aft ola national rcvicr.v rneetirrq lbr LJNI('lrt.--strllporiccl projects organized in ir4inna. Niger State N'loreover, the project hosted a trvo-t'nAn teanr fl-orn n I'}OC rvlto carne to er,.aluate CD-l'l activities i, the state. 1'he repoft is beirrg a,"vaitecl. N'leanwhile officers fi-orn the NO'f Ir Secrctariat r,r,er.c arourcl to lr ll.lollitor 'l-heir CDTI ilrllllenlent:tlion in the ltroiect area obserr,,alions alcl 1cc1ry'11111s11clati6ps harl [.1cr.1 rtoted and antencltrtents itttplentented rvltere rreedcd (1'he copl'o['one of the rnonitolin_r] visits is attached ) . Additioltally, a 4-ntentber teanr fl'onr the N4ectizan Accountabilitt,Conrrrittee assessecl tlte recol'ds at the project heaclcluarters in Osogbo as rvell as in Olorurrcla [-G,.\ apcl inspectccl t5e statc- IVlcctizan store SBCTION 3 ACll IEVIINI ENTS SO I.r\R l Training of 80 LOC'fs which is a 160 9/o itrcrease overthe annual training objective I\,lorco'er 155 other health staffr'vere trained to help supervise the irnplernentalion of tlre iOfl prc)cess II EAL'III STAIiI' 1'ITAIN II) Tablc 9 I,GA N tl iVI B[rlt OF LOC"IS'ilrAIN ttt) NO OIT 'l'O'l'r\1, O1'II UIT NTIN{I}ER OIr ATO No Traincd o,i, Achicv'ed I I EA L'I'I I I I Er\1,'l'l I STATTII S'TAI.-F 't't(AtNItI) .I'IU\INEI) Ai edire 5 8 160 23 ll Bori 5 8 60 l0 l8 Ede South 5 8 60 l0 t8 Ifb East 5 8 160 2t ?e IIb North 5 8 I60 t0 I8 Ile South 5 8 160 l0 l8 lla 5 8 160 25 -) -') lu,o s I I60 l0 I8 Obokun 5 8 160 t8 26 Oriade 5 8 I60 I8 26 'fotal 50 80 t60 t55 235 2 Nlobilization of 377 cotllrtturrities to select f'l)Ds n'ho hacJ been trairrecl rcpreserrtilg a lg9 oo increase over the ar,uar trairing objecti,,,e See tabre berorv The choice of the ('DDs was b) cotrmtunity rnenrbers through the \/illage I lealtS Con*rittecs but irr a fer'v cotttmunities the comnlunity leadels selectecl thcnt. Sorne of such cDDs selectecl bv lcaclers haVe been said to be ineftc-ctive The training and retrainirrg (lDDs ol'at least tu'o per comnllrrrity har,,e crrhanced c,r,,cra_*e arrl perlbrntance o1- suclt CDDs I+ I'ablc I C) LG;\ zYI-O No of Conrrnunilics No ol' (lolnrnrrrritics '2ir r\chicvcnrcnl Nlobilized u'ith'l'r':rirrerl (lDDs AIYEDIITE l6 26 ?(r I (,3 BOI{IPE 27 64 (;4 237 EDE SOTJI'II l4 t7 l7 l2l IFE EAST 24 -lt -1 I l7e at IC IFE NORTI.I (.) 4( I Al ^: +) 1) I l-) IFE SOUTI-I t4 l_s l-s t0l ILA 25 5l 5l 20-1 rwo I5 6-5 6_s 4l-j OBOKTJN l6 23 !-t t4J - OITIADT] 28 ,10 10 I.li TO-I'AI, 200 377 377 t39 3 Treatrllent of 327 cottlmuttities represcntirrg a 164 9,o achier.enrept oyer t6e arrnual tr.eatrrert objective and the treatlttent year is still to encl N4eanrvhile nrore rctLlrns are still cx,ectcd ll-o,r t5e af'fccted t-GAs llowevertlre population treatcd still Ialls short of the A'l'o b-v a 'l'lris is bccause of acute drug shortages 'i,icle,rar-si, experienced in nrost clf'the cornnrunities treated It,rr-rst be aclclccl that ceftai' large con,,urrities are !,ct to Lle cclr,,creci NtEC.I,tz,\N DISt.tUBtn.toN Tabtc il L(J,,\ No of (lost No of No o['(]ornlrrs. No o[ No ol"l'rc:rlr.tl J'or.rrIr\. r.ool D.',. iligib!e Irt u'hich CDI) Dislribu{ions L'onrnr.s. \f i!!r Corruns Persons Pel'son is a l{/Worker' Supcrvisctl bl' rrr '['reated -i-reateti Su nra r-\' Treated LOC-ri SOC'I Iiorrns AIYEDITTE (r I5 i15 N/A Ni.\* I5 l0 T}ORIPE 36 25.026 N/r\ NiA l6 l5 EDE 45 il.037 N/A N/A 45 SOT]TI{ 25 IFE ENST 3l l(r.334 N/n NiA .rl lt I Irlr 38 17.616 N/,,\ N/,,\ -)d 20 NORTFI tt IFE lt lt l -)-J./+ ll SOUTI-I ILA 46 14.765 N/A N/A -{6 () IWO 28 5,54r1 N/A N/A 28 l8 OBOKUN 32 l4.o7s N/r\ NiA -)- -) t., ORIADE 45 27.011 NiA NiA 45 2Ct TOTA[, 327 l5l ,355 *W'e 327 I (r0 krt l-i t{ (, 5 t\) EBB ET I I I r1 A 5 A) UI .s' {t}s tr?rt \ H*r z a 6 - 6 z E s\- 4; :' o\J H UT trl z o t! o\ trj t\)s F z G ta, h,-l g\ a I (,\ 41 pg\ { &'cr ^} Ur c (,Ut os 'fhe 4 CDl'l projcct is rcct-rrclinq An cltc()ura_rlins Ievcl ol'ltolitical sullPor.t [l.ont lhc slalt lo thc L(j.,\s The state governuletrt tlctnottstratcd this r.vhen they donatccl -N-50.(X)0 00 (i c about $b00 00) t. t5c National Onchocerciasis l'rust I'-uncl at thc olllcial irrcscntalion ol'tlrc cl;ali gl-AIrO["s Ilrst installnlent tothe project Sotne LGAs ltar,'c also fbllowecl :;uit and ntaclc clortations to thc-['r'rrst [iuncl Irr additiotr local authorilics har,'c expr-essccl lheir strppor-t lirr thc inrplcrncrrtalipp proccss;6t, lrrl6llile to a goocl 'l'hcv extcnt tlteir rcsptlrlsibilities as orrtlinccl in the pr-oposal srrbrnittcrl har.e c.rtri[rutc6 t. trainirlg, rcvicr'l'tllectitlgs. clcr,clopntclrt ol'l'itrlir-r.iinglcs. prirrting ol'llr('ltralcr-ials. N{cctiz., distr ibutiorr and strpcrvisiorr SECTION 4 STRENGII'I's oF -l't{E cDT't tNIpLIiNIEN'r,\'r'toN pRocliss I All conlrtltlllitics so lhl'treatctl attcl rvltere clislribuliolr is ctirrcnlli,u6ilru glr lrar,e. talic, olr thc t'csporrsibility ol'collecting tltc tlrtt-q li'ottt lhe a-r{rccd collccrii,rr 1li,r,rts ricar-cst tq t6crrr Irr s.rrrc ittstatlces CDI)s Itar,'e lttade returnito the colleition poinls alic/ llnishipq rr.eaLprerrt 2' It has been noted that irl lllost collltlrurtities. litcratc cclurnrunity nrcnrbcrs 5ar,.e bce. c(),stit.tecl as sullel-r"isors of the process CDTI at the cotrnrunitv lcvel Suclipersons chosep arc eilher-tc.aclers or retired ci'il scr'arrs rir,'ing irr tlrc c.rrr,u,ity. 3 In sollle conllilunities lvltere Village Flealth Comnritr.ecs havc becn rr 4' All the LGAs have tlot ortly expresscd thcir rvillirr-qncss to crnbrace thc pr-pr:r.arr b,t thc1, lrar,,c also lollor'r,'ed it up by either lending r,oral ,,,ppo,i rr,,ith the physical 0...";.. .r*io",i.l, ,r,,,*.,, ., relevant occasitllts orl attcl lry givirrg llnanciai assistancc to rhc irnplcnrcnlation llrocess At thc tirne of cornpiling this report rve Itave irrfbrrrration [.GAs. ol'cash assistancc-- I'.-provitlccl til,the lirll.r,,.r.g llb East $470 00 Ilb North $ I.()-10 00 Obokun $ I.4t)0 0O Boripe $4.000 o0 we also l l6 7 Sirtce l\'lectizarl is lree ther-e is no cost reco.ier], irr rcspect of the value ol'the druq Ilsr,,,e'er. during cotrlttlunily Inobilizatiorl sollle cornnrurrities agrced to supplcnrept t6e cll.rts ol-tlre governnlellt itt areas Iike 'l'his firelinu ol'r,'chicle ancl printing of carcls u,as a clcyel.,rrert thal arose otr acccltlttt ol-the cotrttttttttities'satislirctirln r.l'ith the clilcac),o1'the clru_r{ 8 Integration ol'CDTI into thc pllC systern In the project arca tlte PIIC systcrtt is alrcacly orr srr-runcl arrcl cllirrts har,'e bccrr r.arlc to integrate lirll' CD'fl intothe systct:r ,At the stalc Io,el all kcl,ofl'iccrs in thc,ro.icct .;::;l:,1,.:';;H(- }VBAKNESSIIS OF TIIE CD'I-I INI I'LUNI EN'Ii\.I'ION PTTOCI'SS Poor reporting systern dtre to itlconsistency in inlbrrnation rcrluest Ibrnrat ancl liccluerrt c6arx{es fbrm design and data requir.crncnts. i, 2 Lack of adequate conlnlitlttent of t-GA coordirrators paflicularry in returrs rendition ancl of vital and ur-gent su,,ly infbrr,atio, as del,ancled by the NoTF Secretariat -t Inade.qtratc superu'ision of cDDs by LoC"t's obr,'iously cluc to late release scarcity of lirncls ancl tircl 4 Inability olseveral cottllrtuttities to ofl'er irrcenti';es of any fbrrn rvhatsoe'er to thc cl)t)s sclectccl by tlrelrr Ilowever-ir is it gcrrcl'al Practicc {br cDDs ro rcceive trarrsporl lhrc llorrr tlc conttnttt'tities for the collection cllN{ectizan fiour the a-ercccl collection 5 Sonle cotrlt'nunities are ll.irrts still finding it dilllcult to contribuie to the (.D'l'l inrplenrcntation particularll, in respect of training ot.tl,or. selected as CDDs NIAJOIT CONSTRAINTS SO IIAIT IN CDTI IFiPLE&IEN'TATION l rhe project area experienced acute shoflages of N'lcclizan ri,ithirr thc Ilrst six rnonths ol-cD-l.l ir,plementatiolt some cDDs r'vho had relionccl ru itr.i, coilection 1;oirts to picli clrugs several tilttes ottll'to bc tolcl of thc Ittrt-a'u'ailabiliiy tt ) l 4 I;rerlucnt dernarrd (br irrfbrrnutiorr rvitlrorrl proper e'xplanation has danrpertcil tltc crttltrrsrasnt ol' SOC'l's as rnuch tinre is'wasted on paper r.vork to the dctrirncnt of lleldr.iork 5 llracccssibility of sonre cor'lrrnunilics thc roacls that lirrl< up to cltrite a ntnttbcr o1'corttn.tulrtics are in bacl shape ancl make the at'tbcted conrrnunities c'lil-llcult to reach N'loreover some briclgcs tltat lirtk sonre of the cornn-runities to the nrajor torvns lrar,e been conrpletell'ri.'ashed arvav rendcrirrrr thern almost irraccessible all the tintc 6. Some cotnmunities especiall;- in N4odal IMPROVING'l'llE INIPLIIN{ EN]';\'ilON PROCESS r There should be quick release of turrds {br project inrplenrerrtation liorl all parlners r A standard fbrnrat should be designecl nraking returns '/ lbr on l\4cctizan tablets Contiltuous rnobilizations of tarqcl conrnrulrities 1o qcl thenr perfornr their roles uncier ['l) I'l 'r particularly in ternts of relnuneration of tlte CDDs Contirruous training and re-orientation ol'l.OC'f s and CDDs IN{N,I EDIATE FT]TUIIE PLANS 'Ihe {bllowing are being planned bet'uveerr this tirne and thc end olthe flrst year of the project cyclc I I\'lonitoring ancl supen'ision of the CD't-l l)roccss in thc afl'ectecl ten l.(iAs 2. Reorientation of LOCTs dr,rring the monthlSr re'"'ierv rneetings 3. [(e-nrobilization ol-cotrnturtitics iclentillccl as not har,'irrg unclcrstoocl llrcir rolcs [r1, LO(-]'s to trc assistcd by SOt"l-s 4 Advocacy meetings r.vith Local Governnrent polici, rnaliers in the tcn LG,^,s and scvcn other LGAs lhat r,vill Ihll within the expansion plan lbr 1999 5. I\'larking of Oncho r,vcek by the Ilrst or secclrd r.veek olFebnrary 1999 Activities planncd include. r }lealth talks to rnarket rvonlen and social orqanizations 'r Holding of Jumaat and churclt ser.,'iccs / Lecture presentatiorrs in schools r Various press briel'ings / I-aurrclring o('the ner.v 3ntg N4ectizan tablcts 6. Ilvaluation of the CDTI process 7. Preparation fbr next \,'ear's actil,ities lti ST]N,IN{AITY -l Itt sttttttttari'the project ltas bccrr a[rlc trr cxcet'cl thc itnnual training ob.jcctir,'c lirr hcaltlr rr,or-l,crs ltrs is itttltortant ott account of the neecl to train larqc nrrnrbers o[-(-DI)s ancl the ncccl to sul)cr'\ isr'1lrc 'l'lrc CI)1'l l)r1)ccss irrtcrrscll,at lclrst lilr tlrr: llrst lL.w, 1'cul's Pro-;cct llrs bccn ulrlc lrlso to rcirch rrror-c conrrrurrilics althougll sorlle ol'thcse c0rrrnrrrrrilics arc ntll la|qc 'l'he CD'l't iltrpletttetttatiotr itt tltc lrroject arca has bccu hanrl;crctl b1'thc late rcccil.lt ol'a1;irrovcd furlds, biting luel scarcit\'. acute shorta-u,e r-r1-clrlr-gs. irradequatc sultpll,ol-ll-.C nratcrials arrrl lacl< ol' approved callital itettts.'l'hese cornpor-rncl strch existing ltroblenrs as inaccessibility ol'sclnrc tarqet collttltunities attd tlte pl'esence of conllulral crisis in sonte parts of tlre statc TYPES OF IIELP NEEDED FRoIT GOI/EItNXTENT' F Increased jingles 'r airing of oncho in radio and teler.,ision stations Provision of aderluate otllcc accolt)lno(latron and stores Itlr crlntprrtcr ipstallaliol lrrcl saf'e '/ keeping of' prcrject supplics Increased counlerlrarl firnding lionr all tiers of -sior,'enlnent Flt0ivl tlP0C P ftegular f'eedbacl< 'r otr er,'aluzrtion exercises corrducted b1' z\lrOC rn6lito1s Quick release of various inslallntertts o['furtcls allprovcci to a,"'oicl rlclal,irr llro.jcct ilnplc:6rclrtali.rr So firr the project ltas receir,'ed only tlre tlrst installnrent ol'l|i50,000 00 frorn r\lrOC'l'l-.st li,,d. FROXT NOCP/UI'iICEF 'F Regular supply of N,lcctizan / Supply o1'rcquirecl nurrber of ll:(' nraterials fbr prcr-icct usa_qe l() DDtICA'I'lON/N'IOlllLlSA't'lON T'Al{CEl'Glr0tiPS (Osogbo Ccnlcr') Appcrrtlix I 'fnrget (Jrorrll f,cvcl (Statc. Nl css:rgci Wlro \\i ill Nlcrrrs ol' (iovt.. Local Ilrlrlrnr:r(iorr Conrrrrulticlte L'olrr lrr u rr ic:r I iolr Corrrlrrrrnil tlre ilrlornr:rliorr -l'o Local Govt. LGA create ZO-IF. SUCI' Inter-ltcrsonaI Policy IV'lakers arvarencss aud conlacl & lE(' scck lbr'poiitical nratcrials 6t srrpporl tliscussirl rr '['o LGA Health LGA creatc soc'f & LocT Lccturc Workers a\!arencss on I)iscussion & llit' CI)'fl approaclr & rnalcrials to spcll out the rolcs Othcr LGA LCiA To crcate soc"l I)iscussion & Personnel arvarcness & tcl ll:(' ntater ials fbster iltter- deptal Cocr ur (ttltrrl Cornmunity Conrnrunity To create I,OCl' l .ecl ru'c Leaders ar.r,arcncss. to DiscLrssion & IIr( accept p[o-t]l-aut as tnatr-r-ia Is o\vners. to spclI out rolcs Local NGOs. 'l'cr Cornntunity creatc I_()C'.t- Nlectiltgs & Associations & ar.vareness & to Lcctul'e s Other G S trssist the CDDs Educational ('ouuuunity 'lo create LO("1'& llealth [ .ec t ure/-l'cachinqi lnstitutions a\\'al'elleSS (t tO \\'orkcrs liolc plav. spell out thc rcrle Discussion & -l-cl [iilrn shor', Cornrnunily as a Cornntrrnilv trttdcrslancl LO(']'. N(i()s & 'l-r'rs, lr cricrs, Whole the CD'l'l concept Flealth Workers Discussiou. I)tlslcr s CDDs 'l'o Conununity creatc LO(l'l'& l-lealth [-ec1ul'c ar,t,arencss fr. to Workers Discrrssion & Itic spell oLrt their rrrat eria ls rolcs on CDTI rtpp_r9qc! Nornadic 'l'o floururunit), create t-OC1'& I lealtlr N{cetitrgs arvarertess & to Workers I sLrcll out tltcir I I xrlcs orr tlrc CDTI I'oaclt I I l0 'r'ARc!,1'f EDLICA'I'roNiN'IoBILISAT'|oN (;Rotrps (ilcs:r cc,(cr.) ApJrcrrr!ix 2 'I'iu'gct (Jrorr;l Ler.cl (Slatc, il'l csslgc/ \\'ho \\'ill NIc:urs ol' (iovt., Loc:rl Irrl ll 'l'O D() LlSl OI"UiAININC AC'I'l\/11'lllS (llcsn C-cntcr) ,tppcntli:i 3 Tasksi 'finre 'l'r'aiuing ParticiJrants li:rcilit:rtors Locatiolr NI aterials Activitics I,'t':lrttc Nlclhorls Nccrlcrl Training of Other I Iealth LOCT & 2-3 LO('U Discussion & I)ostcr-s. other Health \Vorkers s()t"r' rlays l)cntorrst ration l.catlcts & otltcr Workers ll r(' ntatcrials Training ol' Ct)Ds LOC.t- -l-cachins. I tlay As l)ecidcd l)oslers. Icatle t s CDDs bi,'thc I)iscussioii & & hanilbills Courrnunitv Dernorrstt'atiorr Training ol- NGOs & LOC'f I rlal' LOCU Discussion & Postcrs. lcaflets Lclcal Teacher.s De rttonstr atiorr & lrarrdbills NGOs & Pry Sch Teachers To Do l,lsr oI"'r'r{r\rNrNG AC'I'r\/r'r'rES (osogbo cc.tcr) 'l'asl -) ') '[O DO LIST OF (]ONTltOl, ONCIIOCtiRCI/\SlS AC'l'l\/l'I'lES (llcs:r ('errrer.) ,\pJrerrrtir J -fasks iActivities Who 'l'irrre \\'ill \!'ho Will fr:r lne l)ue (lorrr lrr cnts/l lrs( rucl iorrs I'rogranr I)o lt ,4ssi.s( l).t I o o 'ations l. Advocacy visiti SOCT LOC'I clav [;or arvareness and nreeting w.ith political suppon Polic i\'lakcrs 2 Trainirrg of LOCT SOC'f 2 - 3 dai's 1'o cquip thcir knorvlcdgc I Iealth Workers ql2f] _o'l co1cc12r 3 Nlobilization of' LOCl- DHS/V DC 'l-cl _ Continuorrs cr-calc orrur",,"ii o,-, Conrnrurrit IIrc('l)llc()l)ccp[ 4 Selection of Conununity t)HS I 2 tlavs I o cnsLrr-c accclttarrcc CDD arrd 'fraining sustainabilitl' 5. of LOCT SOCT 2 --i 11n1,5 Iror ell-ective i CDD d stt'ibrrt iorr pcr Corrrnr ol'N{c.ct izalr rlr rrss 6. Eltunteration of CDi) _ DIJS 2 - 3 dai,s To krrc'rrv tlrc drtrgs Comrnunity per Conrnr rerluired 7 C--ollection of LOC'T SOC'i 'l't-r I day nralic tir ugs irr. aiiairlc D liom SOCI' 8. Collectiorr of DI IS/VDC -l'o t-oc'f I day urakc I)rug Iiorn I-OCT dr.trrrs available 9. Collcction ot' (.DI) 'l-o DI IS/\/tX' I day nrakc I)rug fi'onr Ilcalth r[r urls ar,,ailatrlc ttciu'cl' Iracili to 1l1q corrunu rril r l0 Distribution of CDD 'I'r DHS/VDC .] - 4 rveeks ealntent Dru ol' eligible itil.s!Ill II Supcrvision/ t.o("r I)I IS -l-o [)uri ng inrltr r-rvc ancl Monitorin_rq cnsrrrc L)istribution [)ropcr clistribLrtion ol' N{cct izan I2 Reporting CDD r.ocl' 'fo r\ lier givc acc()Llltt c-rf'cinrgs Distribution clistribLrted 13. Evaluation LOC'f \/DC 'l'o Alter asscss tlre srrcccss ol- Distr ibution thc target sct ancl col.llpafL- preseDt rr,ith St )l .I'O DO I,IST OII ONC}IOCIIRCIASIS CON'IITOL AC'TI\/ITII'S ( o Cq4!4 ;tg1q44i1 s 'I':rsks /r\ctivitics Who lVill Do !Vho Will 'I-inrcfi':t nre I)ue ( brnnrelrIs/l nst rrrc( ioni I'r'ograrrr Ir Assist Datc ations 'f I Aclvocacy visit soc't i I,(X'T I da1' o kce p tlrcnr inlirr-nrcd with l)olicy Makcrs a[rout Orrclro & 1o scculc their supporl 'frainirrg -l'o 2 ol' SOCI I r.oC't' J davs brrilrl capacitics orr I-lealth Workers CDl-I -l-o 3. Advocaoy With SOCU LOCl' 4 rlavs ttrobilize and crcate Cornnrunity Leaders a\\,arcncss anrl to crpluirr tlieii' roles 4 Mobilization of LOCT ['lealth 2 davs 'l'o creatr- a\\'itrc-ltess ()n Cornmunity \\'orkcrs g1liii\tlIlitLq q_rr! l ) I I 5. Selcction of Conrrlunity LOC-I 3 da1'5 Idcntii'y CDDs 1o Lrc traincd CDDs 6. Training of CDDs LOCT '['o SOCLJ 3 days pleprarc tltcrrr lirr ('l)T I st rat e 7. -l'o CDDs DIJS 3 days ensure aclequatc and Registratiorr/Census t'egu lar clrtr_u su ppl1, of Colnrnunity 8. Collcction of l,ocl- SOC{ I Whcn To cnsrrrc rcqrrlar suppll N4ect iza n Nccessary 9 Distribution -l-r-r of LOC'I LOC'I When cnsulc lcgular sLrltplr Mcctizan to Ncccssary' designated celrters 'l'o l0 Collcction o{' CDDs NGO/DHS/ When ensure prol)ct' Drug by Cornnrunity CortttttunrIy iirlecqlsrl-v d istribu t ion I N4ectizan ('l)Ds I \z illagc , Nrccks 'l'o crrsul'c pr()l)ct Distribution llealth clisiribut ion aurl rccor tl SLr cr-vrs(.)r kcc 12. Supervision/ -l'o socu/t-oc1' LOC'I 2 rvccks cnsurc adcqrralc anrl Monitoring [)ro[)cr rccorcl kceping 13. Record Data & CDD/ Cncho 'n'i I lage Contiiiuotis To cnstire adcc'iuaie airci Collection Coorclilralor' I lcalth Flxorcisc I)t'ollcr rccrlr r+ REPORT OF THE MOI{ITORING VISIT TO OSUN STATII t IqOVEMBIIR 2 7, lgg8 After initial discussions.with the project coordinator on areas to visit it rvas agreed that the following LGAs be used..rwo, ,\yedlre, E AT TI{E CONIIIIUNIry LEVEL I I, places ' like Ede South LGA some of the cDDs are involved in other comnrunity Sealth programs like management of PTF.drug revolvinge iund.---- rhis is part of integratio, process, which is good for sustainabilit!. 2 Most cDDs met are erderly persons, and this is a prus for contin,ity. .,) ln all cases the communities selectccl CDDs. 4 sonre of the cDDs in Ayedire LGA, Kuta warcl ll are females. f 5 Most commttnities ar€ collecting drugs lrom agrecd designated centers. In fact sonrc tr'iJ" o,. more ffiHJil:flfijonffi;"":::; times ouf to sho'tages orrurecti,on bei.g 6 Most cDDs had goocl rccollections of what they were taught during their training. B. AT TTIE LGA LEVIIL I l LGA.chairpersons lf we r)ret denronsrrared rhe tntplementation1t-." political commirrnent to the of cD'ft' l-his is evidenced in cash o,luun".. nracle available lbr prograrrr In Ede South, ti," ortrre pric il-,Tfffi;|il" "r,n,itr,ent coorainato, *a, quit. eviclcnt 2 N{ost oflthe LocTs were involvecl in NID, wlrich happcred the rnonirorirrg to fall withi, tle period ofl trip. This is goor.l tb,:i,rtcgr.ation purl)oscs. I 3' Irr Ilde Soutlt parLicularly tltcrc was a gootl clclcgation ol'autlror.ity antl a1 acl.ivc involvenrent of all LoCTs in the cDl1 pro""rrll'he coorclinator had gone lor a workshop and his subordinates had absolutely no problenrs locating the approprlate records an C. AT TIIE S'TATE LEVIL There l. was a willingness and conrrnitrne.t to lvork by members of soCU. 2. A clear division of labor was obvious. 3' Most SOCU members were also involved in other PIiC activities Iike Guinealvornr eradication and NID activities. The 4' record keeping was impressive even though done manuaily. 5' About 20 SOCU mentbers plus 6 zonal officers had been trained tbr CDTI implementation- This is good for effrcient supervision, nronitoring and retrainirrg LOCTVCDDs. of 6' Nobody seems to be in the dark in respect of'CDTI activities in tlie projcct area. The areas that need improvernent are as follows: 1' Record keeping at both LGA ancl community levels neecl to bc redressecl. CDDs a'cj some LocTs have problems accurately completing the necessary fornrs. 2' There are no summary forms at the community level. These fornrs are rather at level. thc LCA 3' Spacing in the community registers is inadequate for updates in ce.sus olconrnrunitics. 4' There is a perceived inadequate health education of target comnrunities particularly need for r o, t5e extended treatment with Ivermectin fbr ten to fitl""n years. 5' Most cDDs are ignorant of the iliffcrcncc betwcen what they havc bccn cloing belorc arrrl the current CDTI strategy. 6' In many communities there are no household carcls, although same are availaSlc at LC.\ FIQ' Sometimes the excuse is that the CDDs complain olbeing overburcleped rvith work demands and there are no incentives. 7' Sonle Locrs/LGAs do not liave a clear picture or records of e.denricity i* their areas. 8' In some communities thcre are probletns of correct closing. In sonre cases all rpenrbcrs of an entire household are given two tablets each inclucling pcrsons rccorclc 9' There are problcrns of supcrvision and monitoring of the cDTl procsss by bot5 t5e LocTs and the SoCTs. More oflen than not the ionitoring done does not specific indicators. ar1dress 10. Botli SOCTs and LOCTs need a bctter understanding ol tlie CDTI concept I l. No provision fbr reaction lornts was made at the health centcrs. Specifrc details oIthese as well as the strengths of thc CDTI process in the state have bcerr discussed with the SOCTs CONSTITATNTS o Gross inadequacy of Mectizan tablets a Gross inadequacy of IEC nraterials nrade available to the projcct. Tlrcrc Arc no houschold forms at all, and all levels have no knowlecige of this lbrm. Conrnrunity and l-GA summary forms are inadecluate. 'this is rather surprising since the Il Zonal Coordinator had earlier assured me that there are no problems of availability of thesc forrns par-ticularly the old ones in his zone. This assurance was givcn rvhen he was rcqLlestcd [o take some of the lorms at NOCP Headquarters for UNlCL,F-assisted states. t Unavailability of petroleum products. t Lack of approved capital iterns fbr the project. ,) Inadequate cooperation of LGA Coordinators with SOCTs. RECOMMT]NDAl'IONS o There should be retraining of all field statlon the CDTI concept, particularly in resllcct o[ the roles of the community. I During the retraining more time should be given to record keeping. SOC'l's ncecl a thorough training on the MIS forms. o Supervision and monitoring by both thc LOCTs and the SOCl's shoulcl be clone using specific indicators. t All necessary MIS lorms should be provided at all levels atter training. These recommendations have bee. cliscussed rvith the Socrs. The other two days were used in assisting the state to prepare tlreir technical report and to discuss issues arising lrom the monitoring viiit. The hospitality at all levels is highly grarifying. Chukwu Okoronkwo NOCP, Lagos,