World Health Organization African Programme for Onchocerciasis Control

Assessment of the Sustainability of the State CDTI project, .

December 2003

VOL. 1 - MAIN REPORT

Prof. Celestine Onwuliri Prof. Jodi Mas Dr. Obal Otu Dr. Yisa Saka Mr. Steven Orogwu Prof. Ekanem Ikpi Braide (Team Leader)

TABLE OF CONTENT Acronyms……………………………………………………………………………………………3

Acknowledgement …………………………………………………………………………………4

A. Executive summary ………………………………………………………………………..5

B. Introduction …………………………………………………………………………………8

C. Methodology ………………………………………………………………………………...10

D. Evaluation Findings ………………………………………………………………………...14 1. State level 2. LGA Level 3. District/Health Facility level 4. Community level

E. Overall sustainability grading for the project …………………………………………….29

F. Recommendations ………………………………………………………………………….32

G. The way forward …………………………………………………………………………….36

H. Appendices …………………………………………………………………………………38

I. Time table for the evaluation of sustainability of Abia State CDTI project. II. Agenda State level feedback/ planning meeting III. Agenda LGA level feedback/planning meeting IV. List of persons interviewed. V. Participants at planning meeting. VI. SWOT Analysis . VI. List and contact address of evaluators.

2 ACRONYMS

APOC African Programme for Onchocerciasis Control CDD Community Directed Distributor CDTI Community Directed Treatment with Ivermectin CHEW Community Health Extension Worker CSM Community Self Monitoring DHS District Health Supervisor FLHF First Line Health Facility HOD Head of Department HSAM Health Education, Sensitisation, Advocacy and Mobilisation IEC Information, Education and Communication LGA Local Government Area LOCT Local Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organisation NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primary Health Care REMO Rapid Epidemiological Mapping for Onchocerciasis SHM Stakeholders Meeting SOCT State Onchocerciasis Control Team SWOT Strength Weaknesses Opportunities and Threats WHO World Health Organisation WR World Health Organisation Country Representative DPHC Director, Primary Healthcare DB&P Director, Budget and Planning CBM Christoffel BlindenMission JICA Japanese International Cooperation Agency VBDCU Vector Borne Disease Control Unit

3 ACKNOWLEDGEMENT

The team is grateful to the following persons who have contributed to the success of this mission.

. APOC management for the planning and funding of the mission.

. The WR , and staff of WHO office in Kano for providing administrative support.

. Officials of the Ministry of Health: The Hon. Commissioner for Health, Permanent Secretary, Director of Public Health/PHC, Director of Budget/Planning, for participating effectively in the evaluation and providing necessary logistic support to the team.

. The State CDTI Coordinator and the SOCT members for working tirelessly throughout the duration of the exercise.

. CBM project officer for providing logistic support and assisting in facilitating the planning meetings.

. Chairmen of LGA Caretaker Committees and other LGA officials for providing information and documents relevant to the evaluation as well as participating in the planning meetings.

. Heads of Departments of health /Primary Health Care Coordinators, Oncho Focal Persons members of LOCTs for facilitating visits to the First Line Health Facilities and Communities, and also for participating in the workshop for production of the sustainability plans.

. Traditional Leaders and members of communities visited for cooperating maximally during the exercise.

4 A. EXECUTIVE SUMMARY

Kano State CDTI project has been funded by APOC for the past 5 years. The project is implemented with the support of Christoffel BlindenMission (CBM) with headquarters in Jos. Sustainability evaluation of the project was undertaken within the period Dec. 9 – 23, 2003 by a team of scientists from Nigeria (5) and Spain (1). The team was mandated by APOC to: • Evaluate the sustainability of the project. • Present and discuss the results of the evaluation with Government officials and CBM. • Support State level, LGA and health area personnel in developing post APOC sustainability plans using the guidelines for sustainability planning meeting developed by APOC and pretest the guidelines

Before commencement of the exercise, Government and NGDO officials were briefed on the purpose of, and procedure for, the evaluation. Appropriate permission was sought to carry out the exercise. Interviews were conducted with policy makers and CDTI implementers at state, Local Government Area Headquarters, First Line Health Facilities (FLHFs) and communities. In addition, relevant documents specified in the guidelines were examined.

Using multistage sampling approach, LGAs, Districts and communities to be visited were selected. Information was collected using four standardized instruments for sustainability evaluation (one of each level). Findings were recorded, scored and analysed under Planning, Monitoring/Supervision, Mectizan procurement/distribution, HSAM, integration of support services, financial resources, other material resources, human resources and coverage. Each indicator was scored for each level by each evaluator. The scores were discussed and an average score recorded for each indicator at each level.

At the State level, the average score for all the indicators is 3.4. The existing plan for CDTI is part of the overall annual PHC plan. Partners’ roles are clearly stated. There is a post APOC plan which needs to be revised to indicate sources of resources outside APOC. Five skilled and committed SOCT members implement the project at state level. Monitoring and supervision is integrated and resources are cost-effectively used. Supervisory checklists are presently being

5 harmonized into one common checklist to further enhance integration. Officials at various levels are empowered to solve problems through normal administrative channels and successes are recognized and rewarded. Mectizan procurement, storage, distribution, stock control documentation are as recommended for CDTI. Training is targeted and training materials are adequate. Integration is being achieved impressingly: CDTI is implemented within the Vector Borne Disease Control Unit alongside malaria, guinea worm, bilharziasis, cholera and filariasis with State Oncho Coordinators in charge. Adequate provision has been made for CDTI in 3 budgets: – PHC budget, Donor funds budget and VBDCU budget. Funds disbursed are properly managed. Equipment & vehicles are well maintained but project will need a new 4-wheel drive vehicle, computers and photocopier. Coverage is good but there are indications that therapeutic coverage is not properly calculated for some communities. The project was in the first four years not well funded because of uncooperative attitude of immediate past Commissioner for Health. However, the present policy makers in the Ministry have quickly repaired the damage done to the programme during the past four years. CDTI in 2004 will draw from funds approved for PHC & DC (50Million Naira), Counterpart funding in Donors funds (10Million Naira) and VBDC unit (20Million Naira).

At LGA level, average score for all indicators is 3.6. Plans exist but do not have budget estimates for CDTI. In most cases, the plans were not prepared in a participatory manner. The HOD health and LOCT members take full charge of CDTI activities in the LGA. Supervision is integrated and problems (mainly refusals) are adequately handled. There is no organized system for rewarding success. Training, though targeted, is not integrated. HSAM is properly planned and implemented with positive impact on release of funds for CDTI. Available transport is used in an integrated manner but will not last for 5 – 10 years. Coverage is good but there is need to restrain on calculation.

At Front Line Health Facility level, the average score on overall indicators is 3.3. This is the weakest of all the levels. There are no written plans. The health officials in charge of the facilities are knowledgeable and operate using weekly timetables. No budget is operated at this level because FLHFs are outposts of the LGAs. LGA Councils and the communities supply all funds and items required at this level. Supervisory checklists are not used but reports on supervisory visits and follow up records are available in some of the facilities. Problems (mainly

6 refusals) are satisfactorily solved and Mectizan supply is adequate. HSAM is effectively carried out with full participation of community leaders. More posters are needed at this level.

At Community level, the average score for all indicators is 3.7. This is the best performing level. CDTI activities are planned and managed efficiently by CDDs and community leaders. Community involvement is optimum, reported benefits are many and annual treatment is accepted. Community leaders have dispelled the initial fear that mectizan is a contraceptive by taking the lead in swallowing the tablets. Distribution is ongoing in some communities. The CDDs are not given transport money for Mectizan collection because FLHFs are near the communities. There is no central process of providing incentives to CDDs. Type and amount of incentives given vary with communities and it is not a common practice to give monetary incentives in the communities. The CDDs are satisfied and willing to continue serving. CDDs are knowledgeable skilled, and committed but require more training on calculation. The CDD: population ratio is not ideal and more CDDs are needed. However, this is not a major problem since the CDDs are not overworked. The houses are close to each other and they do not have to trek for long sessions.

During debriefing sessions/ planning workshops, findings were presented to policy makers, SOCT members and LOCT members. Findings for each level were exhaustively discussed and a SWOT analysis conducted. The participants were trained on planning and 3-year post APOC sustainability plans prepared for each level.

Of the seven aspects of sustainability, integration and resources (financial) are moderately helping sustainability, while attitude of staff; community ownership and effectiveness are excellently helping sustainability. There are no major problems with regards to the critical elements.

Based on the findings, the team assessed Kano State CDTI project as making progress towards sustainability. However, the project will require national and project staff to take recommended remedial actions on aspects of sustainability not completely fulfilled and sustain achievements with regards to critical elements.

7 The team recommends that as way forward, the project should  Conclude -work on the post Apoc sustainability plans for all levels.  Sensitise all stakeholders at state, LGA, and community levels on the need for increased and continued support of the project.  Ensure that CDTI continues to be budgeted for within PHC, VBDU, and Donor Projects budgets.  Facilitate integration through joint trainings, monitoring and supervision.  Retrain members of LOCTs, staff of FLHFs and CDDs on calculation of coverage and determination of quantity of tablets required.  Improve on CDD/ community population ratio.  Sustain- the present impressive leadership, good Mectizan requisition/collection/distribution, and good maintenance culture.

B. INTRODUCTION

Kano State is located in the Northern part of Nigeria and is bounded on the North East by

Jigawa State, North West by Katsina State, and South East by and Southwest by

Kaduna State. The population is 7.9 million (2003 projected population) made up of Hausas,

Fulanis and some migrants from Niger Republic. The state is administered in 44 local

Government areas.

The climate is characterized by two seasons i.e. rainy and dry seasons. Kano State falls within the Sudan savannah and Sahel savannah zones. The terrain is generally flat or slightly undulating with sandy soil and there are occasional rocky outcrops and granite inselbergs. The region is drained by some rivers namely Rivers Kano, Zungur, Shimar, Challawa and their tributaries. There is a large irrigation scheme in the project area (Kadawa Scheme), which is marked by an extensive network of irrigation channels. Providing suitable breeding site for the black fly.

Onchocerciasis endemic areas are located mainly in the Sudan savannah areas in the Southern part of the State. Of the existing 44 LGAs, 18 are endemic for Onchocerciasis. These 8 are mainly meso endemic with a few hyper endemic foci. Ivermectin distribution programme (IDP) Started in Kano in 1996. In January 1998, a proposal to for the control of Onchocerciasis in Kano using the Community Directed Treatment with Ivermectin (CDTI) Strategy was submitted to APOC. On approval, implementation of CDTI commenced in Jan 1999 with CBM acting as the supporting NGDO. CDTI operates within the Vector Borne Diseases Control Unit of the MOH.

The project is implemented by 6 SOCT members, 53 LOCT members, 354 Health Facility staff, and 1850 CDDs, with the support of policy makers at all levels. All CDTI activities i.e. health education, sensitization, advocacy, mobilization, mectizan procurement/distribution, monitoring and supervision, are being implemented. The average ratio of CDDs to registered population is

1 CDD to 267 persons. In 2002, the 4th year of CDTI implementation, targeted trainings on

Stakeholders meetings and Community Self Monitoring were conducted in a cascading manner, facilitated by CBM (NGDO) and NOCP. Mobilization activities have been quite satisfactory and have resulted in acceptance of responsibility and ownership of the project. In the 2002 treatment round, out of a registered population of 494, 473 in 779 meso endemic communities,

412, 623 persons were treated using 1,067,452 tablets. Geographical coverage of 100% was recorded for the year and therapeutic coverage of over 65% was recorded for each of the CDTI communities.

During the last (2002) treatment round, partners made the following contributions:

State Government N700, 000

Local Government N1, 876,000

Communities Support for CDDs mainly in kind

NGDO Logistic support for collection of Mectizan and training.

9 There is a high degree of structural integration of CDTI into all health programs and there is a move to produce a single supervisory checklist.

Constraints encountered by the project include

• Lack of support to CDDs in some communities.

• Negative effect of payment of monetary rewards to local guides who participate in

other community based activities like polio vaccination.

C. METHODOLOGY

• Evaluation question……..How sustainable is the Kano State CDTI project ?

• Design……………………..Cross sectional, participatory and descriptive.

• Population………………. Kano State project, including its SOCT, its NGDO partner; It’s LGAs with their LOCTs, the project communities, project villages and their CDDs

• Sampling………………... Details of the sampled districts and villages are contained in Table 1 below. Sampling

The sampling for the evaluation was purposively done, based on the primary criteria of coverage (geographical & therapeutic). Secondary criteria for sampling were the following: • Endemicity level (the sample contained both hyper and meso endemic areas). • Geographical spread: sampled villages were from different areas of the project area. • Accessibility/convenience: sampled villages were selected taking into account accessibility and convenience to ensure that the state is covered within the limited period of the evaluation.

There are eighteen endemic LGAs out of which three were sample from each of the three geographical zones of the State. A 100% geographical coverage has been achieved in all 10 endemic LGAs during 2003 distribution except in Danbatta LGA, where 30 communities out of 42 (71.4%) had been treated by the time the evaluation team arrived. The three LGAs sampled include Garum Mallam (89%) with highest therapeutic coverage rate, (89%) medium level coverage and Danbatta (75%) as the LGA with the least coverage.

For each LGA, communities were first aggregated under the various health facilities, each under a First Line Health Facility staff as direct supervisor. Two health facilities (one with good coverage and the other with the least coverage) were sampled. From each of the health facilities selected, two communities (one with high coverage and another with lower coverage) were selected. A total of three LGAs, six First Line Health Facilities and twelve communities were selected as shown in Table 1.

Table 1: Distribution of sampled LGAs, health districts & villages

S/N LGA Therapeutic Endemicity Health Area Community/Villages Coverage (Therapeutic (Therapeutic Coverage) Coverage) 1 Garum 89% Meso Yadakwari 1. Dakasoyi (86%) Mallam (86%) 2. Mudawa (87%) Kadawa 1. Kadawa qtrs. (94%) (93.5%) 2.Kadawa Liki (93%) 2. Takai 85.7% Meso Faruruwa (92%) 1. Jigawa (91%)

2. Tarandai (95%) Falali (85%) 1. Fita (78%)

2. Falali village (85%) 3. Dambata 75% Meso Ruwantsa 1. Ruwantsa (84%) (82%) 2. Takuya (85%) Dukawa (85%) 1. Unguwa Bali (72%)

2. Dukawa ciki gari (85%)

11 Sources of information

Information was collected at State LGAs, FLHF and community levels from the following sources: • Verbal reports • Documents • Interviews State level ……………... SOCT leader, SOCT team members, policy-makers and management staff of the Ministry of Health. LGA level……………..… CDTI Focal person, LOCT members, policy makers, and management staff. FLHF Level ……… ……. Health staff. Community level ………. Community leaders, CDDs and community members. Procedure Information was recorded on the following evaluation instruments Instrument 1 for state level Instrument 2 for LGA level Instrument 3 for FLHF level Instrument 4 for community level Each indicator on each instrument was scored independently by each evaluator. Details of indicators scored at each level are shown in Table 2.

12 Table 2 Indicators scored at each level Category Indicator State LGA FLHF Community Planning     Leadership X    Activities & Progress which Supervision     support CDTI Mectizan supply     Training and HSAM     Integration  X X X

    Resource provided Funding (financial) Other resources    X (Transport etc)

Human resources    

Results achieved Coverage      = Scored X = Not scored

Based on the information collected, each indicator was graded on a scale of 0 – 4, in terms of its contribution to sustainability. Members of the evaluation team exhaustively discussed findings and average score for each of the indicators at each level was calculated.

A two-day feedback/-planning meeting was conducted in two batches for implementers and policy makers from endemic LGAs. Participants from , , , Tundun Wada, , Garum Mallam, Takai, , and LGAs attended on days 1 and 2 while participants from Dandatta, Kabo, Gaya, , Kura, Kiru, , , and LGAs attended on Days 3 and 4. Thereafter, a one-day planning/ feedback meeting was held for members of the SOCT and principal officers of the State Ministry of Health. During each of the meetings, findings at each level were presented by the evaluators and exhaustively discussed by the participants. Problems were identified and solutions to the problems proffered.

A SWOT analysis, facilitated by the NGDO representative and evaluation team members, was conducted. Participants at LGA level later worked in LGA groups to produce three year post- APOC sustainability plans for the LGA while the State team worked as a group to develop the State level sustainability plan.

13 D. EVALUATION FINDINGS

1. Findings at the State level

STATE OVERALL SCORES

4.5 3.9 4 4 3.6 3.5 3.4 3.5 3.2 3 3.1 3.1 3

S 2.5 E R O

C 2 S

1.5

1

0.5

0 Planning Monitoring & Mectizan Training & Integration Financing Transport & Human Coverage supervision HSAM other Resources resources INDICATORS

14 Planning (3.0, highly)

There is an existing plan for onchocerciasis activities and it is part of the overall annual plan of the Department of Public Health and Primary Health Care. Key CDTI activities are provided for within activities budget lines. The 2003 plan is an improvement of the previous years and not a re-write. While the previous years plans had as objective to establish sustainable CDTI in 98 endemic communities, objectives in the 2004 plan were specific on sustainability issues such as advocacy on policy makers, mobilization of stakeholders, training/retraining, review/appraisal of activities, evaluation, and community participation, attainment of adequate coverage, ensuring adequate and timely Mectizan supply, maintenance of existing vehicles and replacement of unserviceable vehicles. This plan needs to be revised to indicate sources of funding outside APOC.

The main partners i.e. Ministry of Health (State Oncho Coordinator, Chief planning officer), representative of CBM (NGDO), and Zonal Coordinator (NOCP) participated in the preparation of 2003 and 2004 plans. The plan was discussed during NOTF/NGDO review meetings. However, no minutes of these meetings were available. There was no indication that plans for previous years were drawn in a participatory manner.

Monitoring/supervision (3.2 Highly):

The CDTI team is made up of 5 SOCT members at the state level. Each SOCT member is responsible for monitoring and supervision of particular LGAs, with at least one visit per year. They routinely supervise and monitor CDTI activities at the LGA headquarters level and do not go to the FLHFs and communities except when there is a problem beyond the control of the LGAs staff. Staff members at lower levels are properly empowered to monitor and supervise levels under their charge. Ministry of health policy makers participate in monitoring when there is need for them to do so. The Zonal Coordinator and the NGDO officer carry out overall supervision. A CDTI Monitoring and supervision checklist is used and a common checklist is being proposed for better integration. Once in every two months, the SOCT holds a review meeting at the State capital with LOCT members. Minutes of some of these meetings were seen.

15 Monitoring and supervision in CDTI is integrated within the Vector Borne Disease Control Unit (Guinea worm, Malaria, Schistosomiasis, Polio and Immunization programmes) to maximise the use of resources, especially vehicles. Problems identified during supervisory visits are managed through normal administrative channels. Successes are recognized and broadcast in State and National media. Certificates of recognition are also awarded. A certificate presented to the Director of PHC during the Civil Service award in July 2003 as a State Prize for Excellent Service was seen. A sample of certificates presented as prizes to best performing LGA focal persons was seen.

Mectizan procurement and distribution (3.5 Highly):

Mectizan allocation for the state is cleared by UNICEF along with the general consignment for Nigeria. Once the State is notified of the availability of Mectizan, CBM assists in moving the consignment from Lagos to Kano. The drug is stored in the Vector Borne Disease Control Unit store with other supplies for the unit. The SOCT then invites the LGAs to collect their allocation. From the LGAs, Mectizan is sent to the FLHFs from where the CDDs pick up the drug for their communities. There is a Mectizan order and control stock documentation.

Training and HSAM (3.4 Highly):

SOCT members train the LOCT members who in turn train the CDDs. Training materials seen included manuals, posters, flipcharts, reporting forms, tally sheets. Training is targeted at specific aspects of the CDTI and last training was done on Sustainability Stakeholders Meetings (SHM) and Community Self Monitoring (CSM). There is a policy on integrated training and the PHC Department has plans to organize such trainings in the future.

SOCT members effectively carry out HSAM during briefings and routine sensitization as well as through the mass media. Radio Kano and other media outfits in the state are used to promote CDTI projects. The Honourable Commissioner participates in advocacy for the CDTI to LGAs.

16 Integration of support activities (3.1 Highly):

Support activities are planned and executed in an integrated manner. The Vector Borne Disease Control Unit integrates CDTI activities for efficient monitoring/supervision. Staff members in this unit are also involved in the control of guinea worm, malaria, cholera, and schistosomiasis as well as immunization.

Financial (3.1 Highly):

During the first 4 years of implementation, CDTI was not adequately funded because the Commissioner for Health was not cooperative. There is no record of funds released by State Government for CDTI for the years 1999 and 2000. In 2001, N700.000 was released while in 2002 there was no release of funds. In 2003, N250.000 was spent on maintenance of vehicles. The 2003 CDTI plan has budget lines for advocacy, mobilization, training, census, Mectizan supply, transport, I.E.C., facilitators, LOCT guide, register, household card, Mectizan allocation form, and supervisory checklist. This is subsumed in the overall PHC budget. The Vector Borne Disease Control plan has budget lines for mobilization, training, equipment/supplies, community empowerment, documentation, verification and evaluation. The present policy makers of MOH have already made provisions in the 2004 budget for sustainability of CDTI activities after APOC withdraws.

The budget for 2004 has made provision for N150 million for PHC and Diseases Control and 10 m for counterpart funding of all donor programs and 20 Million for control of Vector Borne Diseases. CDTI is provided for within each of the three budgets under activity budget lines. Funding of CDTI is guaranteed because of this nature of the budgeting, which provides funding for activities and not for programmes within PHC system. The policy makers of MOH have given assurance that CDTI activities will be funded adequately. There is proper management of the funds disbursed for this project. The normal administrative procedure is adopted in the approval of expenditure with requests going from the State Oncho Coordinator to the PHC/PHC to Permanent Secretary and finally to the Honourable Commissioner who approves.

17 Transport and other material resources (3.6 Highly):

The following transport and materials are available Item Number Provider Condition 4x4 WD vehicle 1 APOC functional 1 JICA “ Motorcycle 1 APOC “ Bicycle 0 APOC - Computer 1 APOC “ Printer 1 APOC “ Projector 1 APOC “ TV 1 APOC “ Video machine 1 APOC “ Fax machine 1 APOC “ Air conditioner 1 APOC “ Generator 1 APOC “ Magnetic board 1 APOC “

CBM provides additional vehicles when needed. The computer, printer and photocopier will need to be replaced soon. There is also a need to replace the vehicles presently in use. The Ministry plans to purchase 20 utility vehicles one or two of which will be assigned to CDTI. Though CDTI trips are authorized, conventional logbooks are not used. The vehicles and other material resources are well maintained by MOH. A total of N250.000 was spent on vehicle maintenance in 2003 and the source of funds for maintenance is dependable.

Human resources (3.9 Highly):

Project officials at the state level are academically sound, professionally competent, well trained in CDTI, adequately motivated and committed. In spite of lack of support during the first 4 years of the project, SOCT members have remained committed to the job. There are 5 SOCT members and 1 computer operator/data manager who is shared with the UNDP assisted programme

18 Skill number Planning 6 Report writing 6 Training and HSAM 6 Monitoring/supervision 6 Data management 1 Computer skills 6 Mectizan ordering/distribution 6 These SOCT members are stable, have been on the job for 6 years and have the potential of passing on their skills if transferred out.

9. Coverage (4 Fully):

All endemic LGAs have attained 100% geographical coverage and at least 65% therapeutic coverage has been achieved in all communities eligible for treatment. However, there is need to retrain all implementers on calculation of coverage.

Fig. 2. LGA OVERALL SCORES

4.5 4 4 4 3.8 3.6 3.7 3.4 3.4 3.5 3.1 3.1 3 S

E 2.5 R O

C 2 S

1.5

1

0.5

0 Planning Leadership Monitoring & Mectizan Training & Financing Transport & Human Coverage Supervision HSAM other resources resources 19 INDICATORS 2. Findings at LGA level

Planning (3.4, highly). Plans for Onchocerciasis control activities exist in all the endemic LGAs visited namely, Garum Mallam, Takai and Danbatta. The plans were drawn up in a participatory manner in some instances. The team sighted plans for 2001, 2002 and 2003 but could not see the 1999 and 2000 plans. CDTI activities appear under Disease Control (subheads 10 and 13) in the PHC section of the overall LGA plan. However, no budget estimates are provided for CDTI.

Leadership (4.0, fully).

The PHC Oncho Coordinator (HOD Health) takes full responsibility of CDTI activities. He/She also oversees all other PHC programmes. A focal person (equivalent of Oncho Coordinator in other CDTI projects) in each LGA is in charge of CDTI activities. In each LGA, there are 4 LOCT members who initiate CDTI activities at this level. These officials have been adequately trained on various components of CDTI, are knowledgeable and are committed. Leadership at this level is sound and dependable.

Monitoring/Supervision (3.1, Highly).

Reports concerning CDTI activities are processed and disseminated through routine government system. Reports go from the communities to the health officers at the FLHFs who pass these on to the LOCT. Copies of the reports are sent to the State Oncho Coordinator and finally to the State Ministry of Health with copies to the DPHC and DPRS. The team saw reports in all LGAs visited.

In Takai and Garum Mallam LGAs, the focal persons supervise only the FLHF staff but in Danbatta LGA, the focal person often supervises the communities working with the FLHF staff. 20 Though there is some degree of integrated supervision with other programs like malaria, polio, scabies, guinea worm etc, no shared checklists are used.

As soon as problems are identified, they are handled by the LOCTs who go with FLHF staff to communities to solve the problems. The problems are mainly refusals due to culture and religion. Most often, problems are referred to District Heads who are very powerful in control of community members. One of such District Heads is Dr. Muktar Abanan, the Sarkin Bai of Kano and District Head of Danbatta whom the team met and interacted with. The District Heads are very knowledgeable about CDTI and the role of the communities. They participate fully in HSAM and support the project materially. This explains why the quality of implementation of CDTI below the State level remained high even during the first 4 years when support from state Government was minimal.

There is no organized system for rewarding success at the LGA levels. However, the team ways told that verbal commendations are usually given and in some cases T-shirts, food and prayers are offered to deserving LOCT members and FLHF staff.

Mectizan Procurement and Distribution (3.6, Highly).

Sufficient quantities of mectizan are requested for and provided to LGAs. Mectizan supply is timely with no shortages and wastages. Backup allocations are provided when necessary. Mectizan consignments are collected and stored in central drug stores. The team saw, in most LGAs, impressive stores with good power supply. The system of Mectizan procurement and distribution is effective, uncomplicated and simple. The LGAs collect mectizan from the State CDTI office utilizing transport /transport fares provided by the LGA Council. The drug is controlled within the existing government drug procurement and distribution system.

Training and HSAM (3.1, Highly)

LOCTs train health facility staff and FLHF staff train CDDs. Training materials like tally sheets, measuring sticks, posters etc were seen. Resource materials for training and IEC have been translated into Hausa. Though Training is targeted, there is no integrated training at the

21 moment. HSAM activities are properly planned and executed. The LGAs have positively used HSAM to solve problems of refusal. HSAM activities targeted at policy members have led to prompt releases of funds for fuel, workshop attendance, Mectizan collection and others needs.

Financial (3.4, Highly)

CDTI activities are budgeted for adequately under PHC. Additionally, the Councils meet costs of transport, feeding and accommodation of CDTI staff attending meetings and workshops. A monthly allowance of N3, 000 is paid to each focal person (within salaries) for fueling and motorcycle maintenance. Vouchers for the various payments were shown to the team. Details of the funds budgeted/ spent on CDTI in the LGAs visited are shown below: GARUM MALLAM . 2000 - N96, 000 . 2001 - N96, 000 . 2002 - N96, 000 TOTAL N288, 000 TAKAI . 2001 - N225, 000 . 2002 - N318, 000 . 2003 - N340, 000 TOTAL N983, 000 DANBATTA . 2002 - N195, 000 . 2003 - N200, 000 TOTAL N395, 000 These exclude monthly allowances paid to focal persons in their salaries. The LGA also spend some money monthly for drugs for the FLHFs. A fixed amount of N1 million is released each month for drugs and supplies for FLHF in Danbatta. Though these drugs are not specifically for CDTI, the initiative is an indication that LGAs have the potential of providing regular financial support for CDTI. Generally government at all levels made disbursements of funds for CDTI activities. However, the team could not ascertain if the disbursements were directly from the budgets. The Chairmen of LGAs visited by the team corroborated these assurances earlier given the team by the Permanent Secretary and the Hon. Commissioner for Health; those CDTI activities will be adequately funded whenever APOC withdraws. The team noted that funds are allocated against specific activities/items and

22 approval for each item of expenditure is given. Though there is judicious management of funds, monitoring budget line balances is not done specifically because CDTI is budgeted for within PHC under activities budget lines. This is an advantage for CDTI because the project can always draw from PHC budget as long as there is money in the budget line relevant to the activities for which funding is required. This, incidentally, is the case in most LGAs where CDTI is the most ‘active’ health project.

Transport and other Materials (3.7, Highly).

There are 18 functional motorcycles available for CDTI in all the LGAs implementing the project. These motorcycles are also used for other health activities. In Danbatta, there is an NPI Land cruiser (donated by UNICEF), which is used for CDTI and other health activities. Other vehicles are available in the LGA vehicle pool, for CDTI activities. However, some of these may not be functional in the next 5 – 10 years and therefore need to be adequately maintained and/or replaced as the case may be. In Danbatta LGA, N20, 000 is released monthly for fueling and maintenance of vehicles and in all LGAs N3, 000 is paid to focal persons for motorcycle fueling and maintenance. Some LGAs are willing to buy new vehicles and provisions have been made accordingly in their 2004 budgets.

Human Resources (3.8, Highly).

Staff members involved in CDTI activities possess adequate skills for the job and are satisfied with their job. In each LGA there are 4 LOCTs and a focal person. The staff are stable competent and committed to the project. The staff members are highly motivated with salaries, wages and incentives paid to them regularly and as when due.

Coverage (4.0, Fully). than 65% therapeutic coverage rates as follows: GARUM MALLAM 89% TAKAI 85.7% DANBATTA 75%

23 3. Findings at FLHF level

Fig. 3 FLHF OVERALL SCORES

4.5 4 4 4 3.8 3.7 3.6 3.5 3.5

3

S 2.4 2.4 2.5 E R 2 O

C 2 S

1.5

1

0.5

0 Planning Leadership Monitoring & Mectizan Training & Financing Transport & Human Coverage SDupervision HSAM other resources resources INDICATORS

Planning (2.0 Moderately)

There are no written plans at this level. The officials operate using weekly timetables and meet each day to discuss activities to be carried out. Staff members here are not empowered to prepare comprehensive plans because FLHFs are extensions (outstations) of the LGAs. FLHFs are not self-accounting and therefore make no plans and control no budget. They are however very knowledge about CDTI activities and implement CDTI at this and timing for distribution.

24 Leadership (3.6 Highly)

FLHF officials take full responsibility at this level. They are very knowledgeable about key CDTI activities such as training CDD, HSAM, Monitoring and Supervision, Mectizan ordering and distribution. Political heads are well informed about CDTI and participate in the programs.

Monitoring/Supervision (3.5 Highly)

Reports are transmitted through routine but effective government system. FLHF officials collect reports from the CDDs and send them to focal persons in the LGAs. Treatment records for 2000, 2001 and 2002 were seen. Supervisory checklists were seen in only one of the FLHFS. Problems (mainly refusals and adverse reactions) identified in the communities are referred to FLHF staff by the CDDs. Officials at this level provide technical advice to the communities. They initiate approaches for solving problems and inform LGA if problem persists. Reports of supervisory visit and follow ups were seen in some of the FLHFs. Reward of success is not formalized. However, food, items of clothing, and prayers are offered to officials of the FLHFs by communities from time to time.

Mectizan® Procurement and Distribution (3.0 highly)

Mectizan is usually ordered in good time and distributed in an effective, uncomplicated, and simple manner. There have been no major shortages and no wastages. Mectizan is stored in a drug cupboard containing all drugs administered at this level and allocation from this level to the communities is quickly done and inventory properly kept.

Training and HSAM (3.7 highly)

Communities select CDDs who are trained annually by FLHF staff. The trainings are conducted in venues close to the communities. Content of training is based on current needs. Training materials, such as, posters, measuring sticks, register, etc are available. CDDs are also often trained and used as guides for other projects/programs e.g., NPI. HSAM is conducted at this level with the assistance of community leaders who often participate actively in all CDTI

25 activities. This has had positive impact on coverage in spite of problem of refusals. The team found the need for more training of CDDs on determination of quantity of Mectizan to be ordered for each treatment round as well as on calculation of coverage.

Financial (2,4 Moderately)

FLHFs do not prepare and operate any budget and do not administer any funds. The LGA PHC unit provides supplies needed for FLHF activities. In , the LGA provides N1 Million for drugs for all 30 FLHFs, which exist in the LGA. One of these FLHFs is a general hospital while 29 are health centers/posts (one in each of the 29 communities in the LGA). It is not clear why cash is not provided to officials at this level but indications are that this is not the routine practice. This is good for sustainability as it makes the communities take on more responsibility for healthcare activities. The team noted that, in one instance, the FLHF was built and maintained by the community, which also funds fueling, and maintenance of the motorcycle used by the FLHF staff. Most communities give assorted incentives to staff of FLHF.

Transport and other Material Resources (2.4 moderately)

LGAs provide some bicycles and motorcycles for FLHFs. Some FLHF use personal bicycles and motorcycles to move to villages for CDTI activities. Some communities assist FLHF in bicycle and motorcycle maintenance and are willing to replace existing bicycles and also provide HSAM materials for CDTI if need be. However, an official of one of the FLHFs complained that he spends personal funds to maintain his bicycle. Though there is integrated use of the bicycles and motorcycles, no logbooks are used.

Human Resources (4,0 Fully)

All the officials are skilled and knowledgeable about CDTI.

26 Coverage (4.0 Fully)

In 2003 almost 100% geographical coverage was achieved. About 10 communities are yet to be covered and distribution is still going on. Geographical coverage was 100% in 2001 and 2002.

4. Findings at community level

Fig. 4 COMMUNITY LEVEL SCORES

4.5 4 4 4 4 4 4 3.5 3.5 3 3 3

S 2.5 E R O

C 2 S

1.5

1

0.5

0 Planning Leadership Monitoring Mectizan HSAM Financing Human resources Coverage INDICATORS

Planning and Management (4.0)

CDTI activities are planned and managed efficiently by CDDs and community leaders. Communities decide on method of distribution (house to house or central). CDDs choose their distribution routes and, in conjunction with community members, the time most appropriate for distribution. The CDDs update their registers during each distribution cycle.

27 Leadership and ownership (4.0)

Community leaders are responsible for arranging for announcing the arrival of Mectizan. The CDDs are selected by community leaders and members, who also exert their authority in changing any non performing CDD. Communities determine the time and method of distribution. Treatment period is either morning or evening depending on community decision. In most communities, it has been decided that married women should be treated in the evening hours when their husbands are back from farm. Community members understand and appreciate the benefits of Mectizan and enumerated several benefits of the drug to include improved sight, generally health improvement and passage of worms. Generally, communities now understand that Mectizan is not a contraceptive and are willing to continue to take Mectizan for as long as necessary.

Monitoring (4.0)

CDDs send their report to FLHF on time for collation and transmission to the LGA. CDDs are not provided with funds for transportation because the health facilities are close to the communities.

Mectizan® Procurement and Distribution (3.5)

Mectizan is collected by CDDs from FLHF staff. In most instances, two or more visits are made by CDDs to collect drug. This is because of population dynamics; it is often difficult to accurately determine quantity of tablets required. In most cases, quantity of Mectizan required is based on previous years allocation/use. In two communities visited, community members expressed desire to have more drugs as there have been shortages recorded during distribution. These two communities are among those listed for mop-up distribution, which is scheduled to take place before the end of the year. CDDs, and at times community leaders, collect Mectizan from the nearest health Facility. There is no need for transport fare to be provided for CDDs because the communities are close to the health facilities.

28 Training and HSAM (4.0)

Community members and CDDs take on the responsibility of community mobilization and information dissemination. They encourage compliance by tracking down absentees and convincing those who initially refuse to take the drug to comply. Community leaders take the lead in taking the drug to encourage others.

Financing (3.0)

Communities in many instances do not have a central process of providing incentive to CDDs. Food items, soup ingredients, and prayers are offered. Individuals at times provide token gifts in either cash or kind to CDDs. In this part of Nigeria, provision of monetary incentives for community service is not commonly practiced. CDDs are content and willing to continue their job.

Human Resources (3.0)

The ratio, CDD: population is about 1:500. Though this is not the recommended ideal ratio, communities feel they do not need more CDDs since they live in clusters and CDDs do not have to travel long distances between households. However, in spite of this explanation, the team felt that, communities should be encouraged to increase the number of CDDs. CDDs are knowledgeable and skilled and have repeatedly been trained on various aspects of the programme. Community leaders have plan to replace CDDs if need be. The CDDs enjoy CDTI activities and are willing to continue on the job. They see their participation in the programme as their contribution to the development of their communities. Only a few CDDs have dropped out.

Coverage (4.0)

All the households have been treated. All communities visited had therapeutic coverage rate ranging from 72% to 95%. All the communities had not less than 65% therapeutic coverage,

29 E. OVERALL SUSTAINABILITY GRADING OF KANO STATE CDTI PROJECT.

With respect to the seven aspects of sustainability, efficiency, effectives, simplicity, attitude of staff, community ownership are found to be very much helping sustainability, while resources (particularly financial and integration are moderating helping sustainability) • Integration Integration of CDTI into PHC is just moderate at all levels. • Resources (Human, financial and material) Government financial contribution was poor during the first 4 years of CDTI implementation in the state. There are evidences of guaranteed government support to CDTI at all levels following the advent of a new political dispensation in the state. • Efficiency There is high level efficiency exhibited by the managers of CDTI activities at all levels. • Simplicity The procedures adopted for achieving the objectives of DTI are simple and uncomplicated. • Attitude of Staff The staff members are all very skilled, dedicated and willing to continue with the CDTI project at all levels. • Community Ownership CDTI in Kano is fully owned by the community with community leaders participating actively in all CDTI activities. As a result problems in CDTI related to religion and culture are easily solved. • Effectiveness Coverage rates (geographical and therapeutic) have been excellent as a result of effective procedures adopted in distribution, supervision and management of resources.

Judgment: to what extent is this aspect Aspect helping or blocking sustainability in this project? Integration Moderately helping Resources Moderately helping (financial) Efficiency Very much helping Simplicity Excellently helping Attitude of staff Excellently helping

30 Community Excellently helping ownership Effectiveness Excellently helping

There are no significant problems with any of the critical elements of sustainability.

. Money: Is there sufficient money available to undertake strictly necessary tasks, which have been carefully thought through and planned? (Absolute minimum residual activities). YES . Transport: Has provision been made for the replacement and repair of vehicles? Is there a reasonable assurance that vehicles will continue to be available for minimum essential activities? (Note that ‘vehicle’ does not necessarily imply ‘4x4’ or even ‘car’). YES . Supervision: Has provision been made for continued targeted supportive supervision? (The project will not be sustained without it). YES . Mectizan supply: Is the supply system dependable? (The bottom line is that enough drugs must arrive in villages at the time selected by the villagers). YES . Political commitment: Effectively demonstrated by awareness of the CDTI process among policy makers (resulting in tangible support); and a sense of community ownership of the programme. YES

Grouping the indicators under this categories, activities, resources, and results, the project has achieved good results. Average scores (all levels) are 3.5 for activities, 3.3 for resources and 4 for results.

Ranking of the levels in terms of performance of indicators is Community (3.7), LGA (3.6), State (3.4), and FLHF 3.3). This indication that the strength of CDTI in this state is at the community level, is good for sustainability of the project.

31 TABLE 3 Scoring under categories of indicators

Category Indicators Scores State LGA FLHF Community Planning 3 3.4 2 4 Activities and processes Leadership X 4 3.6 4 which support CDTI Supervision & Monitoring 3.2 3.1 3.5 4 Average overall score for Mectizan supply 3.5 3.6 3.8 3.5 category at all level is (3.5) Training & HSAM 3.4 3.1 3.7 4

Integration 3.1 X X X

Funding 3.1 3.4 2.4 3 Resources provided Transport & Other resources 3.6 3.7 2.4 X Average overall score for category at all level is (3.3) Human Resources 3.9 3.8 4 3

4 4 4 4 Results achieved Average overall score for Coverage category at all level is

(4) Average score 3.4 3.6 3.3 3.7 3.5

32 G. RECOMMENDATIONS

1. State Level Recommendations

Indicator Recommendation Priority Who to take action Deadline Rating for action 1 Planning Post Apoc Plan High SOCT, MOH policy March 2004 should be makers, CBM, NOCP completed (Zonal) 2 Monitoring Complete common High SOCT, MOH policy April 2004 and checklist for makers, CBM, NOCP Supervision supervision (Zone) 3 Mectizan Maintain efficient High SOCT, CBM NOCP Always supply mectizan requisition, (Zone) distribution and inventory 4 Training and Retraining of LOCTs High SOCT February HSAM on calculation 2004 coverage. 5 Integration Begin to integrate Medium August content of training to SOCT, DPHC&DC, 2004 cover CDTI and Managers of PHC other PHC programs/projects programmes 6 Funding Specify budget lines High MOH officials, March 2004 for CDTI within PHC DPHC&DC, DB &P and budget SOCT

7 Other Purchase 2 new Medium MOH policy makers Jan 2005 resources vehicles for CDTI

Use Logbook and maintenance book for vehicles. 8 Hurman Do not transfer High MOH policy makers Always resources SOCT members frequently 9 Coverage Maintain 100% High SOCT, CBM, NOCP Always geographical (Zonal) coverage and Above 65% therapeutic coverage

33 2. LGA Level Recommendation

S/no Indicator Recommendation Priority Who to take Deadline for Rating action Action 1. Planning Undertake High LOCT, HOD, March 2004 integrated training focal person of staff on planning 2. Leadership Maintain the High LOCT, HOD and Always impressive other leadership status programmes of the programmed. 3. Monitoring and Put in place High LOCT Always Supervision effective integrated monitoring and supervision. 4. Mectizan Maintain good High HOD, LOCT Always procurement and Mectizan Distribution requisition practice and collection.

5. Training and Commence Medium HOD, LOCT and August 2004 HSAM integrated training all staff of LGA Health staff.

6. Financial Ensure CDTI has High LGA Chairman, March 2004 its own budget line HOD, Treasurer within the overall LGA, LOCT PHC budget. 7. Transport Sustain High HOD, LGA Always maintenance of Chairman, existing Treasurer, LOCT motorcycles

8. Coverage Retrain LOCT and High HOD, LOCT March 2004 CDDs on calculation of coverage 9. Human resources Sustain prompt High LGA Chairman Always payment of HOD salaries and wages.

34 3. FLHF Level Recommendations

S/No Indicator Recommendation Priority Who to take Deadline Rating action for action 1 Planning Produce a written plan High FLHF staff March 2004 containing CTI activities. LGA/ LOCT 2 Leadership Intensify HSAM targeting High FLHF staff March 2004 politicians on the need for CDD own CDT. LGA/ LOCT 3 Monitoring and Produce adequate High LGA/LOCT March 2004 Supervision quantity of Checklists. HOD FLHF Prepare formal process for rewarding success. 4 Mectizan Train FLHF staff on High LGA/ LOCT March 2004 calculation of tablets of Mectizan required.

5 Training & Integrate CDTI training Medium FLHF staff August HSAM with training in other LGA/ LOCT 2004 health programs.

6 Financial Release adequate funds High LGA Council, Always for CDTI activities.

7 Transport and Sustain provision of funds High Chairmen/ Always other for motorcycle Caretaker resources maintenance and fuelling. LGA HOD health Replace unserviceable December motorcycles. 2004 8 Human Provide incentives for High LGA Council Always resources FLHF staff. HOD health

Sustain regular payment of salaries. 9 Coverage Maintain good coverage High FLHF/ LOCT Always HOD health Retrain CDDs on February calculation of coverage. 2004

35 4. Community Level

S/n Indicator Recommendation Priority Who to take Deadline Rating action for action 1. Planning Discuss and prepare plan High Community Always to sustain CDTI post leaders, APOC community members, LOCT members and FLHF staff

2. Leadership Maintain good leadership High SOCTs, LOCTs Always ownership &

3. Monitoring Commence Community High LOCTs, FLHFs March Self monitoring. 2004

4. Mectizan Train FLHF staff and High SOCTs, LOCTs, March, CDDs on determination of FLHFs, CDDs 2004 required Mectizan tablets. 5. HSAM Intensify HSAM to Medium FLHFs April 2004 community leaders and members. 6. Financial Sustain provision of non Medium SOCTs, LOCTs, Always monetary incentives to FLHFs 2004 CDDs. 6. Human Improve on CDD/ High SOCTs, LOCTs, March resources community population FLHFs 2004 ratio.

7. Coverage Retrain CDDs on coverage High SOCTs, LOCTs, March calculation. FLHFs 2004

36 H. THE WAY FORWARD As way forward the team recommends that the following priority actions be taken.

 Conclude -work on the post Apoc sustainability plans for all levels.  Sensitise all stakeholders at state, LGA, and community levels on the need for increased and continued support of the project.  Ensure that CDTI continues to be budgeted for within PHC, VBDU, and Donor Projects budgets.  Facilitate integration through joint trainings, monitoring and supervision.  Retrain members of LOCTs, staff of FLHFs and CDDs on calculation of coverage and determination of required tablets.  Improve on CDD/ community population ratio.  Sustain- the present impressive leadership, good Mectizan requisition/collection/distribution, and good maintenance culture.

I. APPENDICES

Appendix I. Time table for the evaluation of sustainability of Kano CDTI Project EVALUATION OF KANO STATE CDTI PROJECT PROVISIONAL TIME TABLE DATE TIME ALL MEMBERS Monday 8th Dec. 03 Arrival of External and internal evaluators to Kano city the Kano state capital. Tuesday 9th Dec. 03 8.00-10am Orientation of members on the instrument and review of the provisional timetable. 10.00-4.00pm Meeting with the state Onchocerciasis control team members (SOCT)/finalization of the workshop timetable. 4.00-5.00pm Evaluators review strategies for the evaluation in preparation for the assignment. Wednesday 10th Dec. 03 8.30-9.30am Courtesy call on the Ministry of Health Official 9.30am-5pm Data collection at the MOH project HQ conduct interview for the CBM project administrators & project accountant. Wednesday 10th Dec. 03 Visits to LGAs, FLHFs and communities Thursday 11th Dec. 03 Friday 12th Dec. 03 Saturday 13th Dec. 03

37 Appendix II. Agenda – LGA level “feedback”/planning meeting

EVALUATION OF KANO LGAs CDTI PROJECT DECEMBER 9-22, 2003. FEEDBACK/PLANNING MEETING FOR LGAs. SCHOOL OF HEALTH TECHNOLOGY, KANO CITY KANO FIRST BATCH DECEMBER 15 AND 16,2003 SECOND BATCH DECEMBER 17 AND 18,2003

PROVISIONAL AGENDA

Day one

S/No Activity Time Resource person Facilitator 1. Registration/Administration matters 08:30-10:00hrs SOCT 2. Introductions 10:00-10:30hrs All 3. Welcome Address and update on Kano CDTI 10:30-11:00hrs State Coordinator project. 4. Objective of sustainability evaluation. 11:00-11:30hrs Braide Coffee Break 11:30-12:00hrs 5. Evaluation methodology 12:00-12:30hrs Braide 7. Presentations of main findings 12:30-13:30hrs State level Otu and Mas LGA level Onwuliri FLHF level Saka Community level Orogwu

General Discussions 8. Lunch break 13:30-14:30hrs 9. SWOT analysis…...LGA level 14:30-15:30hrs Ogoshi/SOCT 10. Guidelines for preparation sustainability plan 15:30-16:00hrs Pearce/Mas 11. Coffee break 16:00-16:15hrs Work in LGA groups on sustainability plans 16:45-18:00hrs LGA groups and SOCT

DAY 2

S/No Activity Time Facilitator 1. Work in LGA groups on sustainability plans 08:30-11:00hrs LGA groups and SOCT 2. Coffee Break 11:00-11:15hrs 3 Work in LGA groups on sustainability plans 11:15-13:30hrs LGA groups and SOCT 4. Lunch 13:30-14:30hrs 5. Presentation of LGA plans 14:30-16:30hrs H.O.Ds. Health 6. General discussions on “way forward” 16:30-17:00hrs All 7. Administrative matters and Closing 17:00-18:30hrs SOCT Recorders for days one and two ……….2 SOCT members to be appointed by State Coordinator. Each LGA should submit an endorsed plan (and diskette) by Friday December 20.

38 Appendix III. Agenda – LGA level “feedback”/planning meeting…Kano CDTI Project

EVALUATION OF KANO STATE CDTI PROJECT DECEMBER 9- 22, 2003 FEEDBACK/PLANNING MEETING FOR STATE LEVEL SCHOOL OF HEALTH TECHNOLOGY, KANO CITY KANO DECEMBER 19, 2003

TENTATIVE AGENDA

S/No Activity Time Facilitator 1. Registration/Administration matters 08:00-8.300hrs SOCT members Introduction 10:00-10:15hrs All 2. Welcome address and update on Kano CDTI 10:15-10:30hrs State Coordinator project 4. Objective of sustainability evaluation 10:30-10:45hrs Braide Coffee Break 10:45-11:00hrs 6. Evaluation methodology 11.00-11:30hrs Braide 7. Presentations of main findings 11:30-12:30hrs State level Otu and Mas LGA level Onwuliri FLHF level Saka Community level Orogwu 8. SWOT analysis…State level 12:30-13:30hrs Ogoshi 9. Lunch Break 13:00-14:00hrs 10. Work on sustainability plan 14:00 -16:30hrs SOCT ,Government officials and partners Tea Break 16:30-16:45hrs 15. Presentation of plan 16:45-17:15hrs State Coordinator 16. General discussions on “way forward” 17.15-17.45hrs All 17. Administrative matters and Closing 17.45-18.00hrs SOCT members

39 Appendix IV. List of persons met/ interviewed

NAMES DESIGNATION LOCATION Dr. Sanda Muhammad Hon. Comm. For Heath Kano City Engr. Abdulahi Idris Permanent Secretary Kano City Alh. Ubale Director Planning Kano City Dr. D. Muhammad Director PHC and DC Kano City Mr. Tukur Makama Getso State Oncho Coordinator Kano city Hojarami Lawan SOCT supervising Gwaozo, Kano City Kabo, Rogo and Karaye. Binta A. Sarki SOCT supervising Gaya, Kano City Sumaila, Ajinji and Takai Shehu Umar SOCT supervising Kura, Kano City Kuru, Madobi and Garum Mallam. Danladi Tanko SOCT supervising Dawakin Kano City Tofa, Makodi and Danbatta Yusuf Haruna SOCT supervising Doguwa, Kano City Bebeji and Sabiu Hamisu Focal person Garum Malam head quarters Sabiu Musa LOCT Garum Malam head quarters Jafaru I. Chiromawa LOCT Garum Malam head quarters Ja’afaru Y. Madaki LOCT Garum Malam head quarters Haruna Abdulkadir NPI manager Garum Malam head quarters Idris Ahmad G/Malam LOCT Garum Malam head quarters Ahmad Muhammad Panda D.P.M Garum Malam head quarters Isyaku Umar Jobawa Vice Chairman Garum Malam head quarters Adamu Mohd. Sha Yadakwari H/F Garum Malam head quarters Muhammad Daniya Ibrahim V. Head Yadakwari Garum Malam head quarters Wakili Tambai W/ head Dakasoyi Garum Malam head quarters Mohammad Sani Yadakwari Garum Malam head quarters Haladu Musa W/ head Damaji Garum Malam head quarters Mohammad Tasiu Ibrahim W/ head Mudawa Garum Malam head quarters Usaini Alasan Yadakwari Garum Malam head quarters Daiyabu Munkaila Mudawa Garum Malam head quarters Hudu Danladi Dakasoye Garum Malam head quarters Sammauna Usman Dakasoye Garum Malam head quarters Dantala Nayaya Dakasoye Garum Malam head quarters Farouk Garba Village head Fita village, Takai LGA Shehu Muhammad Suleman CDD Fita village Ya’u Wanzan Community member Fita village Haruna Sabo Community member Fita village Musa Bako Community member Fita village Lurwan Rabiu Community member Fita village Muhd. Abbani Takai Chairman Takai LGA, head quarters Muhd. B. Kachako Councilor medical Takai LGA, head quarters Alhaji Baba Kanu Community Dev. Takai LGA, head quarters Nadu Sarki APHCC H/ Edu. Takai LGA, head quarters Abdulrazak I. Usman Focal person Takai LGA, head quarters Iliyasu Ahmed Village head (Jigawa & Takai LGA, head quarters Tarandai) Sule Abba Ward head Jigawa & Taranda Takai LGA, head quarters Alhassan CDD (Taranda Comm. Takai LGA, head quarters 40 Usaini Adamu Ward Head “ Takai LGA, head quarters Usman Mohammad Mai unguwa Jigawa Takai LGA, head quarters Usaini Mohammad Bello Falali ward head Takai LGA, head quarters Ismaila CDD Falali Comm. Falali village Sani Ahmed CDD Falali Falali village Ahmed Isa CDD Falali Falali village Adamu Sale Health/F Dispen. Falali village Isa Ismaila Falali Falali village Amadu Mohammed Falali Falali village Yusuf Musa Falali Falali village Shehu A. Ibrahim Falali Falali village Dan’Azumi Garba Falali Falali village Umaru Mohammed Falali Falali village Adamu Umaru CDD falali Falali village Basiru Ali CDD Unguwar Bai village, Danbatta LGA Adamu Umaru Comm. Member Unguwar Bai village Bashari Lawan Comm. Member Unguwar Bai village Magaji Ibrahim Comm. Member Unguwar Bai village Dahiru Haruna Comm. Member Unguwar Bai village Idi Amadu Comm. Member Unguwar Bai village Ya’u Idris Comm. Member Unguwar Bai village Inusa Garba Comm. Member Unguwar Bai village Dalladi Amadu Comm. Member Unguwar Bai village Lawan Inusa Comm. Member Unguwar Bai village Wada Musa Comm. Member Unguwar Bai village Haladu Mohammad Mai Unguwa Dukawa ciki gari, Danbatta LGA Usman Mohammad Member Dukawa ciki gari village Yusif Musa CDD Dukawa ciki gari village Umar Isah Community member Dukawa ciki gari village Yusif Ladan Community member Dukawa ciki gari village Yusif Abubakar Community member Dukawa ciki gari village Shu’aibu Garba T.V. operator Dukawa ciki gari village Ibrahim Mohd. Community member Dukawa ciki gari village M. Yahaya Isyaku Community member Dukawa ciki gari village Jibrin Musa Community member Dukawa ciki gari village Salihu Yusif Community member Dukawa ciki gari village Nura Ibrahim CDD Dukawa ciki gari village Daha Isyaku Community member Dukawa ciki gari village Abubakar Yusif Community member Dukawa ciki gari village Abdulazizu Safiyanu Community member Dukawa ciki gari village Gambo Safiyanu Community member Dukawa ciki gari village Mohd. Musa Community member Dukawa ciki gari village Mohd. Yusif Community member Dukawa ciki gari village Mohd. Isah Community member Dukawa ciki gari village Tijjani Ibrahim Community member Dukawa ciki gari village Basiru S. Arewa Community member Dukawa ciki gari village Lawan Umar Community member Dukawa ciki gari village Abdullahi Umar Community member Dukawa ciki gari village Sani Ibrahim Community member Dukawa ciki gari village M. Ya’u Ibrahim Community member Dukawa ciki gari village Abdullahi Ibrahim Community member Dukawa ciki gari village Mohammad Sale Community member Dukawa ciki gari village Abubakar Ado Community member Dukawa ciki gari village Sabi’u Isyaku Community member Dukawa ciki gari village Bahari Isah Community member Dukawa ciki gari village Alasan Yaro Student Mudawa village, G/Malam LGA 41 Dan larai Malam Pharm. Tech. Mudawa village Dan’asabe Amadu Pharm. Tech. Mudawa village Hamisu Sanda Student Mudawa village Isyaku Abdu Student Mudawa village Ibrahim Sani Community member Mudawa village Hassan Saidu Community member Mudawa village A. Abdu Mudawa Community member Mudawa village Sule Direba Community member Mudawa village Mamuda A. Adamu Community member Mudawa village Shehu Umar Community member Mudawa village A. Suraja Muhammadu Community member Takuya village Dambatta LGA Shu’aibu Garba Focal person Takuya village Abdullahi Mohd. Community member Takuya village Jibrin Mohd. Community member Takuya village Hamza Mohd Community member Takuya village Isah Amadu Community member Takuya village Ya’u Mohd Community member Takuya village Ayuba Amadu Community member Takuya village Bala A. Garba CDD Takuya village Usaini Ibrahim Community member Takuya village Abba Labaran Community member Takuya village Ibrahim Mohd. Community member Takuya village Hambali Garba Community member Takuya village Adamu Hassan Community member Takuya village Dauda Musas Community member Takuya village Haruna Abdu Community member Takuya village Aminu Mohd. PHC Coordinator Kura LGA head quarters Shu’aibu Garba Focal person Kura LGA head quarters A. Lawan Garba Councilor Kura LGA head quarters Mohammad Yusuf Treasurer Kura LGA head quarters Yawale Ahmed Supervisor Kura LGA head quarters Alh. Inusa Mohd. Community member Ruwantsa village, Danbatta LGA Ali Usman Community member Ruwantsa village Biniya Yakubu Community member Ruwantsa village Abdulsalam Isyaku Community member Ruwantsa village Muktari Ibrahim Community member Ruwantsa village Auwalu Mohd. Community member Ruwantsa village Umar Yunusa Community member Ruwantsa village Sani Mohd. Community member Ruwantsa village Isah Sani Community member Ruwantsa village Sallau M. Ya’u Community member Ruwantsa village Nasiru Waziri Community member Ruwantsa village Ya’u Sani Community member Ruwantsa village Amadu Abdullahi Community member Ruwantsa village Kabiru Magaji Community member Ruwantsa village Abdullah Mohd. Community member Ruwantsa village Aminu Usman Community member Ruwantsa village Abdulrahim Shu’aibu Community member Ruwantsa village Sa’adu Garba Community member Ruwantsa village Maharazu Mohd. Community member Ruwantsa village Babangida Magaji Ward head Ruwantsa village Haruna Mohd. Community member Ruwantsa village Shu’aibu Magaji Community member Ruwantsa village Abbas Magaji Community member Ruwantsa village Gambo S/Fawa Community member Ruwantsa village Auwalu Garba Community member Ruwantsa village 42 Barau Mohd. Community member Ruwantsa village Mohd Umar Community member Ruwantsa village Hamza Abdullahi Community member Ruwantsa village Manzo Hadi Community member Ruwantsa village Yusif Magaji Community member Ruwantsa village

V. Participants at planning meeting

Day one

S/N Name Designation Address 1. Makama Wada PHC T/Wada 2. Dalha Baba Doka Focal Person Mokoda 3. Bilya K. Sule Focal Person Dawakin Tofa 4. Muhd. Bashir T/Wada 5. Murtala A. Ajingi Treasurer T/Wada 6. Ahmed A. Rufai PHCC Takai 7. Sani Nasiru Focal Person T/Wada 8. Saidu Mu’azu Focal Person Ajingi 9. Hajara A. Lawan SOCT VBDC 10. Binta Abdu Sarki SOCT VBDC 11. Abdulrazak I. Usman Focal Person Takai 12. Shehu Umar SOCT VBDC 13. Danladi Tanko SOCT VBDC 17. Hassan Adam School Health Dawakin Tofa 18. Adama Shehu DPHCC Dawakin Tofa 19. Sabiu Hamisu Focal person Garun Malam 20. Alh. Mohd. Garba PHCC Makoda 21. Yusuf Haruna SOCT VBDC 22. Uwani Bala umar PHCC Madobi 23. Abdullahi Sha’aibu Medical T/Wada 24. Muhammadu Hamza PHCC Garun Malam 25. Chris Ogoshi Coordinator CBM 26. Tukur Makama Getso Kano Coordinator MOH 27. Yahya A. Danbala Treasurer Makoda 28. A. Abdu Abdullahi C/ Health Makoda 29. Lawan Yahaya Focal person Gwarzo 30. Isah Yusuf Focal person Madobi 31. Haladu Omar Doguwa PHCC Bebeji 32. Ya’u Uba Councillor Bebeji 33. Adu Musa Yako PHCC Gwarzo 34. Suleman Adamu Focal person Bebeji 35. Alh. Bala Yabuku Councillor Gwarzo 36. Ibrahim Jibril Comm. Member Takai 37. Jamilu Garba D/Iya Data Analysts MOH 38. Usman Tijjani VBDC 39. Salisu Inuwa VBDC

43 Day two

S/N Name Designation Address 1. Makama Wada PHC T/Wada 2. Dalha Baba Doka Focal Person Mokoda 3. Bilya K. Sule Focal Person Dawakin Tofa 4. Muhd. Bashir T/Wada 5. Ahmed A. Rufai PHCC Takai 6. Sani Nasiru Focal Person T/Wada 7. Saidu Mu’azu Focal Person Ajingi 8. Hajara A. Lawan SOCT VBDC 9. Binta Abdu Sarki SOCT VBDC 10. Abdulrazak I. Usman Focal Person Takai 11. Shehu Umar SOCT VBDC 12. Danladi Tanko SOCT VBDC 16. Hassan Adam School Health Dawakin Tofa 17. Adama Shehu DPHCC Dawakin Tofa 18. Sabiu Hamisu Kura Focal person Garun Malam 19. Alh. Mohd. Garba PHCC Makoda 20. Yusuf Haruna SOCT VBDC 21. Uwani Bala umar PHCC Madobi 22. Abdullahi Sha’aibu Medical T/Wada 23. Muhammadu Hamza PHCC Garun Malam 24. Chris Ogoshi Coordinator CBM 25. Tukur Makama Getso Kano Coordinator MOH 27. Yahya A. Danbala Treasurer Makoda 28. A. Abdu Abdullahi C/ Health Makoda 29. Lawan Yahaya Focal person Gwarzo 30. Isah Yusuf Focal person Madobi 31. Haladu Omar Dogua PHCC Bebeji 32. Ya’u Uba Councillor Bebeji 33. Ado Musa Yako PHCC Gwarzo 34. Alh. Bala Yabuku Councillor Gwarzo 35. Ibrahim Jibril Comm. Member Takai 36. Sirajo Usman PHC Madobi 37. Dahiru Mustapha PHCC Ajingi 38. Ya ‘afar Y. Madaki SCH Garun Malam 39. Ibrahim Tijjani Dawaki Treasurer Bedeji 40. Abdu Yusuf 41. Fatihu Mohd. 42. Sani Ali 43. Nura Uba 44. Ammani Ibrahim 45. Jamilu Garba D/Iya Data Analysts MOH 46 Usman Tijjani VBDC 47. Salisu Inuwa VBDC

44 Day three

S/N Name Designation Address 1. Usaini Hamza S/ Councillor Rogo 2. Suleiman Dahiru PHCC Rogo 3. Abubakar Shehu Focal person Rogo 4. Ibrahim Suleman PHCC Kabo 5. Haruna Mohd. Usman Focal person Kabo 6. Abdu Tsoho Focal person Doguwa 7. Nasiru Ibrahim Focal person Gaya 8. Umaru Garba Councillor Danbatta 9. Aminu Garba PHCC Danbatta 10. Sha’aibu Garba Focal person Danbatta 11. Maitama Y. Nadabo Councillor Karaye 12. Jubril M. Usman Councillor Kura 13. Idris S. Usman Focal person Kiru 14. Usaini K. Mohd. Oncho. Coordinator Kura 15. Haruna A. Mustapha PHCC Karaye 16. Rabiu Mamuda Focal person Karaye 17. Sagir Mohd. Sharif C/Health Kado 18. Ibrahim Garba C/Health Doguwa 19. Sadiya Mohd. Sharif C/Health Kiru 20. Abubakar S. Abubakar Focal person Rogo 21. Mansur Abdulkadir Oncho Coordinator Sumaila 22. Jamilu Ibrahim Focal person Sumaila 23. Falalu Sani Councillor Sumaila 24. Shehu Umar Councillor Kabo 25. Shazali Uba Focal person 26. Binta Jubril PHCC Kura 27. Manya Yahaya PHCC Sumaila 28. Bashir Bala PHCC Kiru 29. Zakari Ahmed Focal person Kura 30. Umaru Iliyasu Coordinator Karaye 31. Haruna Sani Coordinator Rogo 32. Ladan Mohd. C/ Health Rogo 33. Isa Yahaya Treasurer Kabo 34. Chris Ogoshi Coordinator CBM 35. Tukur Makama Getso Kano Coordinator MOH 37. Shehu Umar SOCT VBDC 38. Danladi Tanko SOCT VBDC 40. Binta Abdu Sarki SOCT VBDC 41. Hajara A. Lawan 44. Yusuf Haruna SOCT VBDC 45. Jamilu Garba D/Iya Data Analysts MOH 46. Usman Tijjani VBDC 47. Salisu Inuwa VBDC

45 Day four S/N Name Designation Address 1. Haruna A. Mustapha PHCC Karaye 2. Abdu Tsoho Focal person Doguwa 3. Abubakar S. Abubakar Focal person Rogo 4. Usaini Hamza S/ Councillor Rogo 5. Jubril M. Usman Councillor Kura 6. H. Binta Jubril PHCC Kura 7. Suleiman Dahiru PHCC Rogo 8. Haruna Mohd. Usman Focal person Kabo 9. Idris S. Usman Focal person Kiru 10. Ibrahim Suleman PHCC Kabo 11. Aminu Mohd. PHCC Danbatta 12. Umaru Garba Councillor Danbatta 13. Sha’aibu Garba Focal person Danbatta 14. Nasiru Ibrahim Focal person Gaya 15. Maitama Y. Nadabo Councillor Karaye 16. Rabiu Mamuda Focal person Karaye 17. Usaini K. Mohd. Oncho. Coordinator Kura 18. Sagir Mohd. Sharif C/Health Kado 19. Ibrahim Garba C/Health Doguwa 20. Sadiya Mohd. Sharif C/Health Kiru 21. Mansur Abdulkadir Oncho Coordinator Sumaila 22. Binta Jubril PHCC Kura 23. Mariya Yahaya PHCC Sumaila 24. Shehu Umar Councillor Kabo 25. Jamilu Ibrahim Focal person Sumaila 26. Falalu Sani Councillor Sumaila 27. Shazali Uba Focal person 28. Umaru Iliyasu Coordinator Karaye 29. Bashir Bala PHCC Kiru 30. Zakari Ahmed Focal person Kura 31. Sabiu Musa Councillor Bebeji 32. Haruna Sani Coordinator Rogo 33. Ladan Mohd. C/ Health Rogo 34. Isa Yahaya Treasurer Kado 35. Abdu Ibrahim Treasurer Sumaila 36. Habib Tijjani Treasurer Danbatta 37. Mohammed Sani Coordinator Doguwa 38. Chris Ogoshi Coordinator CBM 39. Tukur Makama Getso Kano Coordinator MOH 41. Shehu Umar SOCT VBDC 42. Danladi Tanko SOCT VBDC 44. Binta Abdu Sarki SOCT VBDC 45. Hajara A. Lawan SOCT VBDC 48. Yusuf Haruna SOCT VBDC 49. Jamilu Garba D/Iya Data Analysts MOH 50. Usman Tijjani VBDC 51. Salisu Inuwa VBDC

46 Day 5

Engr. Abdulahi Idris Permanent Secretary MOH Kano City Alh. Ubale Rano Director Planning MOH Kano City Dr. D. Muhammad Director PHC and DC MOH Kano City Mr. Makama Getso State Oncho Coordinator Kano city Hojarami Lawan SOCT supervising Gwaozo, Kano City Kabo, Rogo and Karaye. Binta A. Sarki SOCT supervising Gaya, Kano City Sumaila, Ajinji and Takai Shehu Umar SOCT supervising Kura, Kano City Kuru, Madobi and Garum Mallam. Danladi Tanko SOCT supervising Dawakin Kano City Tofa, Makodi and Danbatta Yusuf Haruna SOCT supervising Doguwa, Kano City Bebeji and Tudun wada

VI. SWOT ANALYSIS FOR EVALUATION OF SUSTAINABILITY OF CDTI PROJECT IN KANO

SWOT ANALYSIS…………STATE LEVEL Indicators Strength Weakness Opportunities Threats 1 Planning Plan exists No specific Partners met Should not include budget for CDTI APOC budget Integrated project Plan exist for 2004 Management accepts ownership 2 Monitoring MOH participates Not fully Common none And in all activities integrated with checklist Supervision Support activities other health proposed for integrated programmes better integration

SOCTs routinely supervise assigned LGAs

System in place to solve problems 3 Mectizan Drug system within None Enhancement of None Procurement & the normal integration Distribution government procedure

47 Timely and regular delivery

Stored in VBDCU

Order and control documentation 4 Training and Integrated training Integrated Media used to None HSAM policy training yet to be promote CDTI fully implemented Oncho staff academically and professionally competent

HSAM carried out at all levels

5 Integration of VBDCU integrates None Integration None Support CDTI provides practical Services integration of CDTI with other health programmes

6 Financial Funding provided Specific budget Policy makers Level of support for activities within for CDTI not spelt made provision in may change when PHC System out 2004 budget for present regime CDTI leaves sustainability

NGDO participation

7 Transport & Transport Computer will State More vehicles will other Material appropriately need replacement Government is be needed Resources managed and used purchasing 1-2 No maintenance vehicles for Routine book Oncho maintenance Programme provided by MOH and NGDO NGDO provides vehicle when Funds available for needed vehicle maintenance

8 Human Skilled, dedicated None Staff have a None Resources and stable staff potential of passing their

48 skills if they move away 9 Coverage 100% geographical Coverage The need to None coverage achieved calculated retrain all using eligible implementers on Therapeutic population in calculation of coverage above some coverage is an 65% communities opportunity to review other aspects of CDTI

49 SWOT ANALYSIS - LGA LEVEL

Indicators Strength Weakness Opportunities Threats 1 Planning Plans exists Plans were not Political Political integrated. commitment. differences. Plans done in a participatory Plans are not based Enlightened Poor attitude to manner on schedules. communities. work.

Plan for 3 years Plans do not tally with Integrated roles of exists distribution time. PHC workers.

Availability of materials 2 Leadership PHC coordinator None Support of Frequent change of takes full communities and regime/ transfer. responsibility of staff. CDTI. Political Regime of rewards. antagonism. Focal person for each LGA. LOCT initiate activities 3 Mectizan Reports Shared checklist not Availability of Bad roads. Procurement available in all used. needed & LGAs. materials. Frequent Distribution No written reports in breakdown of Monitoring & some LGAs. Integrated use vehicles. supervision in of resources cascading No follow ups in some (HFM) Lack of incentives pattern. LGAs. in some LGAs

Integrated monitoring & supervision. 4 Training and HSAM is Training has not been Integrate with None HSAM properly integrated. training of other planned and health programs executed. Poor attendance to organized trainings. LGA use HSAM to solve refusal problems.

Funds and incentives released as a result of HSAM in decision making 50 5 Financial Sufficient Wrong estimate of Use Mectizan Population quantity of Mectizan requirement. supply system movement affects Mectizan for new health project. supplied. Delay in collection of programs. supplies by LGAs. Back up Some LGAs supply provided when directly to need arises. communities

Drugs collected and stored in central (govt.) stores. Effective, uncomplicated & simple system.

LGA collects Mectizan from state coordinator. 6 Transport & Availability of Frequent breakdown. Political Bad roads other motorcycles & commitment to material vehicles. Inadequate fueling & replace with new Resources maintenance ones. UNICEF other allowances. logistics also available.

Use of transport is integrated.

LGAs are willing to buy new motorcycles in 2004 budget.

Proper management of transport. 7 Human Adequate staff None Additional Transfer. Resources at LGA level. knowledge & skills through training Lack of imprest. Focal person for each LGA.

LOCT are committed and willing to continue.

Workers salaries paid 51 regularly. 8 Coverage 100% Problems of Use same Population Geographical calculation distribution system movement. coverage. for other health programs Bad roads. Above 65%therapeutic coverage.

SWOT ANALYSIS - FLHF LEVEL

Indicators Strength Weakness Opportunities Threats 1 Planning Some have written Some do not Now have to learn No plan time table with have written plan how to write plan CDTI activities for CDTI activities and plan for CDTI activities 2 Leadership Leadership quality None To let politician None present. know about CDTI Effectively and efficiently implement activities 3 Monitoring & Integrated Some FLHF do Rewarding success Absence of Supervision monitoring/ not know how to is a form of checklist in some supervision. calculate. incentive facilities

Checklist seen in No checklist seen some FLHFs. in some FLHFs.

Solve problems within set up.

Supervise CDD effectively. 4 Mectizan Keep good record Wrong calculation Use same system Shortage and of Mectizan. of amount of for other health surplus tablets required in programmes Have ability to some FLHFs request for Mectizan requirement. Inventory form present.

Store Mectizan in cupboard.

Good inventory

52 No shortages. No surpluses

5 Training and Communities None CDD used as guide None HSAM select CDD. for other programs e.g. NPI. Effective training of CDDs.

HSAM used to solve problems.

6 Financial Communities give No budget. LGA Increased support None incentives, fund do not fund FLHF by communities activities such as monitoring/ supervision. HSAM, & Training. 7 Transport & Community No bicycles in Some communities Overwork of CDDs other Material support. some FLHFs can purchase without bicycles Resources repair and maintain bicycles transport.

Plan to replace by community/ LGA. Community built FLHF.

Integrated use of bicycle/ motorcycle 8 Human Well trained/ skilled None Integrate all PHC None Resources staff members stay activities long enough on job. No unnecessary transfer. 9 Coverage 100% geographical Poor calculation Use same system None coverage. ability in some in other health FLHF programmes

53 Appendix VI. List of evaluators

S/N Name Full contact address 1. Prof. Ekanem Ikpi Braide Department of Zoology, University of Calabar, Calabar. , Nigeria. Tel: 234 8033416842 E mail: [email protected]

2. Prof. Celestine Onwuliri Department of Zoology (Professor of Parasitology and Infectious University of Jos, Jos, diseases) , Nigeria P. M. B. 2084, Jos. Tel: 234 8037225385 E-mail: [email protected] [email protected]

3. Prof. Jodi Mas Department de Microbiologia; Parasitologia Sanitaries, Facultay de Medicina University de Barcelona C/Casanova 143 08036 Barcelona, Spain. Tel: (34) 932275522 Fax: (34) 932279372 e-mail: [email protected]

4. Dr. Obal Otu Adi Specialist Clinic 7a Otop Abasi street P. O. Box 1636,Calabar. Cross River State, Nigeria Tel:234 87231973 234 8023536817 e-mail: [email protected]

5. Dr.Yisa Saka NOCP Federal ministry of Health Federal secretariat (Second phase) Ikoyi ,Lagos, Nigeria. Tel: 234 8033029387 e-mail:[email protected]

6. Mr. Steven Orogwu Ebonyi State CDTI project Ministry of Health Abakaliki – Nigeria Tel:234 433220332 234 8046102402 Fax: 234 43221657 e-mail: [email protected]