AFRICAN PROGRAIWME FOR ONCHOCERCIASIS CONTROL (APOC)
Proposal for Sustainable Community-Directed Ivermectin Treatment
Bauchi State, Nigeria
E Non-CDTI LGAs I CDTI LGAs
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3 I MAt t999 APOC / PM PART IV
PROPOSAL FORM FOR
COMMIINITY.DIRECTED TREATMENT WITH IVERMECTIN Bauchi State, Nigeria 2
SECTION 1: COUNTRY PROFILE
1. INFORMATION ON THE PROJECT AREA FOR CDT!
1.1 Geographical and administrative area(s)
Please descrtbe the area(s) of the country in which the proposed CDTI will be canied out. (List the administrative units or parts thereof e.9., Local Government Areas, Districts, Anondissements, Heafth areas etc. that will be covered and provide a map showing their lay- out) The proposed project area is located in Bauchi State in the north-east of Nigeria. There are 20 Local Government Areas in the state, out of which 13 are hyper or meso endemic and have been selected for the proposed CDTI. These local governments are: Ningi, Warji, Darazo, Alkaleri, Kirfi, Dass, Tafawa Balewa, Toro, Shira, Bauchi, Katagum, Ganjuwa and Misau. The population of the state, according to the 1991 census, was 2,826,454. However, in 1997, Gombe State and a new Bauchi State were created out of the former Bauchi State. The present Bauchi State shares borders with Plateau, Kano, Jigawa, Yobe, Borno, Taraba and Gombe States. There are on-going CDTI programmes in all of these states except for Gombe. Taraba State is particularly hyper-endemic for onchocerciasis.
1.2 Topography, climate, access
1.2.1 Please describe the type of country or bio-climatic zones that will be covered by the CDTI (e.g., rain-fores( foresf-savannah mosaic, Guinea savannah, Sudan savannah, mountainous or flat), providing maps, if appropriate.
Bauchi State lies in the savannah region of Nigeria, with variation in ecological conditions depending on geography. The southern and westem part of the state is sudan and/or guinea savannah, having a relatively higher rainfall, with numerous rocky outcrops and hilly terrain. The northern part of the state is sahel savannah, with much drier conditions and fewer hills. Some major river systems traverse the state. These include the rivers Hadejia, Jama'are, Gongola and Dingaya. Most of the endemic local government areas lie along these river systems.
1.2.2 Give the approximate times of the rainy and dry seasons and the months covered by the farming season.
The state has two distinct seasons, dry season and rainy season. There is six months of rain, beginning in May and ending in October. The farming season is from May to December, including the harvest period, which takes place between October and December.
1 .2.3 Provide information on the state of the roads and the effect of this on the movements of CDTI personnel in the area at different times of the year. (A map may be useful)
Most of the onchocerciasis endemic communities have no year-round access roads. The dirt and laterite roads to these communities are usually not motorable during the height of the rainy season. Even in the dry season, where the roads are sandy, 4-wheel drive vehicles are required, along with motorcycles and bicycles. Letter of Endorsement from the Government of NIGERIA
In accordance with the memorandum of agreement forthe Atrican Programme for Onchocerciasis Control:
1. The Ministry of Health on behalf of the Government of NIGERIA hereby endorses the attached projea proposal to be submitted to APoC for financial support.
2. This proposal reflects the collaboration between the members of the Onchocerciasis Task Force and APOC with a view to conducting an onchocerciasis control project in Bauchi State.
3. The National Onchocerciasis Task Force is a partnership of the Government, Non-Government Development Organisations and other participating panies which will be responsible for the implementation of this project.
4. The Government shall assure free entry of ivermeain into the country for delivery to the applicant without imposing drry, rax, or other cosrs.
5. fhe Government of NIGERIA pledges rts full collaboration with the
Signature
DR. ABUBAKARALI-GOMBE
Name and tide of Signatory Hon. Minister of State for Health NIGERIA Date: xlilll RePu
I 5 JU|N t999 APOC I PM
RE: National Onchocerciasis Task Force (NOTF) of Nigeria Application for Support to the African Programme for Onchocerciasis Control (APOC)
In accordance with the memorandum of agreement for the African Programme for Onchocerciasis Control :
1. The NOTF on behalf of the Government of Nigeria, (a parhrership of govemment, the NGDOs and otherparhrers) hereby expresses its wish to enter into collaboration with the APOC and the MEC with a view of concluding an onchocerciasis control project in Nigeria.
2. Onchocerciasis in Nigeria is considered by the health authorities as a problem of sufficient importance to warant the implementation of a control project in the endemic areas with the aim of eliminating the disease as a public health and socio-economic problem throughout the country.
3. It is estimated that out of a total population of 100 million people, there are 40 million people at risk of infection of the parasite, onchocerca volvulus, which may result in blindness, serious visual impairment or debilitating skin disease.
4. The proposed control project will rely on community-based ivermectin treatment as its main intervention tool.
5. The NOTF has scrutinized the criteria and conditions for application to the APOC and is satisfied that the proposed projects meets all criteria and fulfils the conditions established by the APOC.
Details of the project proposal for control of onchocerciasis in Nigeria including the support requested from APOC to successfully implement the project are provided in the enclosed proposal.
7. The NOTF of Nigeria pledges its full collaboration with APOC in the expectation of acceptance of the present proposal.
Signature:. Ml/z<5g,1*'.,.,.
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For the purposes of this proposal, the level of endemicity in a community or a group of similar communities is defined on the basrs of the prevalence of nodule caniers. (See table 1) TABLE 1. Classification criteria for endemicity levels in rural communities ENDEMICITY LEVEL aNd Percent of nodule carriers in Estimated prevalence of O. recommended type of treatment REA sample volvulus in the (minimum sample 50 adult Whole community men) HYPER-ENDEMIC Gommunity Treatment (URGENT) greater than 39% greaterthan 59% MESO-ENDEMIC Community Treatment 20 - 39o/o 40 - 59% (DESTRABLE) HYPO.ENDEMIC (NON-URGENT) less than 20% less than 40% 1.3.1 Based on the sysfem in Table 1 and using the format in Appendix 1, please indicate the estimated numbers of communities at each endemic level and the numbers of persons in them. AREA COVERED: 10 Local Government Areas in Bauchi State, Nigeria COMMUNITY HYPER.ENDEMIC MESO-ENDEMIC HYPO-ENDEMIC ENDEMIC LEVEL TYPE OF Gommunity-based Community-based Community-based TREATMENT YEAR 1 No. of communities to 140 225 be treated Tota! population in 210,000 373,978 above communities See also table, next page, for Number of Treatment Communities by Endemicity and LGA 1.3.2 Complete Appendix 1 for each area covering the nert 5 years of the proiect. (See Appendix I completed) I 1.3.3 lf methods of assessing endemicity thresholds other than nodule prevalence were used when your endemicity data were collea'ted, please indicate the method used. The method used in determining endemicity was Rapid Assessment Method using nodules and leopard skin as indicators. 1.3.4 For areas still to be covered, where endemicity levels are not yet known, please describe the method you will use to collect ffie necessary endemicity data. Rapid epidemiological mapping (REMO) of the suspected areas will be undertaken using nodules and leopard skin as indicators. Remo map 6 1.4 Community Structure Provide background information on the social organisations of communities in the CDTI areas. This may include information on: Seftlement paftern of the community (e.9. hamlets, seasona/ farmsteads, dispersed populations, etc.) The settlement pattern varies in different parts of the state. Generally, there is a pattern of nucleated village settlements, with surrounding farmlands. ln some areas there is dispersed settlement, and in others, a combination of nucleated and dispersed settlement is found. There is a large population of pastoral Fulani in the state. Some of these live in settled homesteads, others are entirely nomadic, and still others migrate seasonally. The ethnic group(s) in the community There are numerous ethnic groups in the state, although the Hausa and Fulani are the largest, and are found all over the state. Other groups, most of which are localised to one or two local government areas, include: Jarawa, Kanuri, Kirfawa, Bolawa, Sangawa, Ribina, Zakshi, Ningawa, Fa'awa, Warjawa, Sayawa, and others. Please provide information about the area covered by CDTI indicating whether they are migrants, nomads, refugees or internally displaced populations. The vast majority of the indigenous population inhabit sedentary farming communities. They also keep herds of cattle, sheep and goats, and other domestic animals. There are, however, significant populations of nomadic Fulani cattle herders, who may visit communities on a seasonal basis. There are also fishermen (some of which migrate on a seasonal basis) along the river systems. Community leadership structure The community leadership structure is generally hierarchical in nature, with the family head responsible for the members of his family. He, in turn, is under the authority of the community head, ward head, district head, chiefs, and the emirs. Main occupation of community and periods of major communal activities The main occupation in the proposed CDTI communities is farming. However, animal husbandry, fishing, craft occupations, etc. are also practiced. Craft occupations including mat and basket weaving, calabash carving, blacksmithing, and many other crafts. A minority of the population are engaged in salaried employment and commerce. Farming activities are carried out during the rainy season, while crafts may be either seasonal or all year around. Along the river valleys, dry season farming of vegetables is also common. Major cultural festivals are usually held during the dry season. Prefened channels of communication in the community The channels of communication generally follow the leadership structure of the community. The chiefs communicate to district heads, who then inform village heads or councils of community elders, then to the family heads and to the entire community through town criers, as well as announcements in schools, association meetings, mosques and churches. Radio is also a widely used medium of communication. 7 . Existing active community associations/groups in the area (e.9. social, religious, etc.) The active community associations in the area include farmers' associations, religious organisations, youth and women's groups. Established distribution sysfems in the community The distribution system operates basically from the village heads to the heads of households, or through occupational, social or religious groups for men and women, or through the community development associations. This is the case in the distribution of fertiliser and other agricultural inputs. Social communal activities and months during which the activities take place Major communal activities such as cultural festivals are usually caried out during the dry season. Christian religious festivals like Christmas and Easter take place at their specified times, while lslamic festivals like Eid el Kabir and Eid el Fitr follow a lunar calendar and the times change on a yearly basis. Family celebrations such as mariages and naming ceremonies can take place at any time of the year. Care must to be taken to ensure that distribution activities do not take place during the Ramadan fast or any of the festivals. Any previous experience of the community with developmenUheafth projects? Building of roads, schools, mosques, churches and health centres has been carried out through community development projects. Description of other anthropological characteristics of the communities. The state is both culturally and religiously heterogeneous. There are about 56% Muslims, 40% Christians, and 4% followers of traditional religions. The literacy level in the state is said to be 650/o. However, many are literate in Hausa and Arabic, but not in English. Cultural differences need to be carefully considered when designing the CDTI for each community. ln predominantly lslamic communities, the women tend to be in purdah (seclusion), and may not be allowed out of the house except with the permission of their husband. Likewise, men are not allowed into the houses to treat such women. Hence, in these communities, it will be necessary to train female CDDs, who will be able to enter the houses and treat the women. ln such communities, centre-point distribution will not reach the female population, or even many of the young children. Mobilisers need to be sensitive to these issues and point them out to the community when the treatment strategy for the community is being discussed, as the men in the community may not consider the non-treatment of women as a problem. Health education messages need to stress the importance of aII members of the community being treated, and also stress the fact that the treatment of women also needs to be considered if the programme is to be successful in controlling onchocerciasis. ln other communities, women may not be in purdah, and indeed may be actively involved in farming and other economic pursuits. Hence the strategy for treatment may be different. ln some communities where various traditional beliefs about the nature of the disease create preconceptions about river blindness and its causes, it may be necessary to conduct KAP surveys to determine the best way of approaching the issue of health education for that community. Another factor which needs consideration is the fact that the large pastoral Fulani population is aware of the efficacy of ivermectin as a drug for cattle and other animals, and there is a thriving market for Mectizan@ tablets for animal use. ln these communities, where often the health of the animals is more important to the population than human health, (because of the I crucial economic importance of the animals), there could be a situation where the drug would be diverted for use on animals. Hence, the distribution strategy would need to ensure that drugs are taken in full view of the CDD or Village Health Committee. 9 2. PAST AND CURRENT STATUS OF CDTI IN PROJECT AREA 2.1 Please indicate if the CDTI is an expansion of an existing CDTI. Treatment in Bauchi State first began in 1991. However, it must be admitted that the lack of success in ivermectin treatment in the state has been a disappointment. lt is obvious that the programme in Bauchi has not lived up to its potential, and has not fulfilled the serious needs of the many onchocerciasis-endemic communities in the state. The reasons for this are numerous, including lack of support from govemment at all levels, lack of supervisory personnel (as UNICEF does not have personnel in the field), lack of support from the NOCP Zonal Office in previous years, frequent changes of staff at the local level due to changes in government and administration, lack of Mectizan@ when required, among others. There are curently lDPs in six of the thirteen proposed CDTI local government areas. However, even the existing programmes will need serious reorganisation and reorientation to comply with the CDTI strategy. As can be seen from the treatment figures, treatment has not been consistent, and the treated population has, in some years, declined, rather than expanded to meet the target. This is indicative of serious problems in the state, which are recognised by all of the parties involved government, international agencies, especially UNICEF, and the NOCP Zonal Office, All -of those involved in the Bauchi State programme have come together and committed themselves to a serious effort to remedy the past problems and place the proposed CDTI on a sound footing, so as to enable the treatment of the very large at risk population in the state. ln order to ensure that the proposed CDTI is successful, and that all resources committed are effectively utilised, it is proposed that all agencies redouble their efforts. lf the CDTI in Bauchi State is to succeed, it will require intensive advocacy at the state and local government level, to ensure government commitment to the project. ln the past, government commitment has been patchy, and subject to many changes of personnel as administrations changed at the state as well as local levels. However, as Nigeria is currently in the process of implementing a system of democratic govemance after many years of military rule, it is expected that the new government in the state will be more responsive to the needs of the people. Serious efforts will also be required in training and re-training staff at all levels, as well as mobilisation of endemic communities to educate them on the CDTI approach. The NOCP Zonal Oltice for Zone D, which is located in Bauchi, has employed more staff who will be able to support this effort. The Zonal Office has undertaken to be responsible for all initial training, utilising the APOC video and other aids. The Zonal Office will also, together with the state and local government staff, undertake the initial mobilisation of the endemic communities, as well as advocacy visits to state and local government personnel. UNICEF has also committed itself to greater financial and other support. Supervision in the first few years will involve Zonal Office personnel as well as those at the state and local government level. It is hoped that this renewed commitment by all parties, supported by APOC, will put in place an effective CDTI programme in the state which will overcome the problems of the past and ensure that the large endemic population receives much needed treatment. 2.2 Sfafe fhe number of years the programme has been operating, and if possible enclose previous statistical, financial and annual reports. Treatment in Bauchi State first began in 1991. (See 2.1 above) 10 2.3 State the number of persons treated each year for the last 5 years ,lgst ,l0g& :lrtJ* t99' 1.995 ,09e r, ltrf,9I {90& 63,064 27,131 31,411 112,860 96,095 67,464 50,853 168,889 Note: The sfafe was divided in 1997, so the treatment figures for 1997 and 1998 are for the new Bauchi State, and hence do not reflect a fall in persons treated, as the total population of the state was reduced. 2.4 List the organisation(s) involved in the programme, the sources and amount of funds used each year for the last 5 years. The organisations involved in the programme include the Bauchi SMOH, Local Governments, and UNICEF. Bauchi State has provided office accommodation and staff salaries for SMOH staff, while local governments have provided the same for LOCTS. UNICEF has provided logistical support, as well as financial support for training and other activities. State and Local Government inputs: (in US$) , .'.,,,4:g9l;,:r, ',...11:a92 {ggg'i' .*gg4:.. tg95 ...r:::r[;gEi6: {99r',' {998 SMOH _ 2,653 2,788 2,930 3,079 3,235 3,500 3,916 5,609 Salaries Local 694 1 093 1148 1205 1688 1773 2791 9750 Government - Salaries Local 894 1408 1479 1552 2175 2284 2596 11,582 Government - facilities Totals 4.241 5.289 5.557 5.836 7.098 7.557 9,303 26,941 Financial contributions by UNICEF in the past 5 years: Amount Activity/Purpose Year I $85 Training of LGA Health workers in Toro LGA 1994 (August) 2. $234 Training of health Workers in Toro LGA 1994 (December) 3. $4088 Mobilisation of community leaders in the 1 996 state 4. $62s6 Training of Community Based Distributors in 1998 (August) 5 LGAs of Bauchi State 5. $1750 Training of State Co-ordinator in TQM at 1 998 SMTG, Jos. $12,413 TOTAL 11 .ln addition to the cash contributions noted above, UNICEF has also contributed the following equipment to Local Govemments in Bauchi State, between 1994 and 1998: LGA Motor- Bicycle Microscope Calculators Public Camp Bed cycle Address Svstem Ninqi 3 4 2 1 1 1 Dukku* 1 3 2 1 1 1 Toro 2 5 Balanoa* 2 5 Alkaleri 1 Total 9 17 4 2 2 2 * Now in Gombe State 12 SECTION 2: PROJECT EXECUTION OUTLINE 3. DESCRIPTION OF PROPOSED COMMUNITY.DIRECTED IVERMEGTIN TREATMENT (cDTt) The main strategy of the project will be to develop and establish community-directed ivermectin treatment sysfems which can be susfained by the endemic communities themselves without erternal support after the S-year project period. This section should describe how the NOTF plans to develop and implement CDTI in all high-isk communities in the project area. The plan should take into account the need to develop approaches to CDTI which are appropriate for the different local situations, and the need to carefully evaluate the implementation of the selected approaches and adjust them when required. 3.1 Outline Plan and Timing (Note: For detailed Timeline refer to Sec. 9.3 below. Many of the following activities will be carried on simultaneously.) Activity/J ustifi cati o n Lenoth of Time Advocacy visits to state and local government officials - to be undertaken 4 weeks by NOCP/NOTF to enlist support of relevant personnel for the proiect. Agreement on definition of roles and responsibilities of all participants 4 weeks utilisinq APOC Drooosals. MOUs. etc. - Procurement of essential proiect equipment and suoolies 8 weeks Workshop on management and planning for State Co-ordinators - to impart 2 weeks necessary skills Training of State Oncho Control Teams as trainers/supervisors - to impart 2 weeks skills to those who will function as trainers and suoervisors ldentification of new endemic communities through RAM/REMO survevs 8 weeks Mobilisation of state and local governments, as well as the private sector to 4 weeks support the proiect. Training of Local (Government) Oncho Control Teams as mobilisers, 4 weeks supervisors, and monitors. Conduct of KAP surveys in communities where this has not been done. 4 weeks Mobilisation of endemic communities, stressing community ownership of 12 weeks proiect as well as relevant health education messaoes. Selection of Community Directed Distributors by community - method of 2 weeks selection to be determined bv the communitv. Training of CDDs as distributors and mobilisers. Also training in health 4 weeks education and supervision for other members of the community that will participate in the proiect as supervisors or mobilisers. Community registration of households. Announcement of distribution 4 weeks schedule. Distribution of Mectizan@ in endemic communities with supervision by 8 weeks specified members of the communitv. LOCT monitoring and supervision of distribution activities. I weeks SOCT'spot check' monitoring and supervision of distribution activities. 8 weeks NOTF Quality Control Team visits to oroiect sites around the countrv. 8 weeks NOTF/APOC evaluation team conduct intemaland external evaluation of 12 weeks proiects. Collection, collation and analysis of reports. Analysis of strengths and 12-16 weeks weaknesses of proiects, and plans for adiustment where reouired. Preparation for the next year's activities. 4 weeks 13 3.2 Health Education and Community lnteraction and Participation 3.2.1 How willyou approach and interact with the community? Communities will be approached through the local leadership with the help of the CDDs, in those areas where lDPs are already in place. ln areas where there has been no previous distribution programme, the Zonal Office of the NOCP along with the SOCTs, in conjunction with the LOCTS, will approach the community to explain the programme and arrange for community meetings at which discussions will be held with all community members. At these community meetings, videos and other methods will be utilised to educate the community about the nature of onchocerciasis and the benefits of ivermectin treatment. The community will be encouraged to make inputs about the organisation of the distribution programme, and the ownership of the programme by the community will be emphasised. lf there is a Village Health Committee in the community, the members will be actively involved in this process. The CDTI approach will be clearly spelled out, and the roles and responsibilities of all parties will be discussed thoroughly. Focus group discussions will also be held with various segments of the community, including the elders and religious leaders, youth and women's groups, development associations, etc. Cultural and religious sensitivities will be taken into consideration in devising the distribution programme. However, it will be stressed to all that the treatment of all members of the community, including women and children, is essential if the disease is to be controlled. Once this is understood, the community should be able to devise means for achieving this. 3.2.2 Health education Heafth education and community mobilisation will be an integral part of all approaches to CDTI. Health education activities should ensure a two way feedback with regards to knowledge, awareness, perception and obseruable aftitudinal changes about onchocerciasis and its treatment. Appropriate heafth education,??essages in the form of posferq pamphlets and verbal presentations will need to be developed and fesfed. Heafth education should address the following issues (Table 2): Table 2: Gritical issues in the development of Health Education for CDTI ISSUES Health Education Messages Knowledge of the disease o Local name of the disease . Symptoms r Causation/transmission (simple) Knowledge of treatment . Previous experiences with Di-Ethyl Carbamazine (DEc) r lntroduce Mectizan@ (lvermectin) o Dosage o Exclusions r Reactions o Beneficial side effects Attitude to treatment o Advantages of treatment o Free r Yearly treatment o Possibility of self treatment at community level. . lmportance of maximal coverage Attitude to disease o The disease can be controlled o Onchocerciasis blindness and skin changes can be prevented Attitude to good record keeping a Minimum requirements for record keeping a Records are confidential and strictly of health issues 14 a Records required are for subsequent drug supply a) Have any KAP surveys been done in the project area and if so, what were the results? None have been canied out. b) What methods willbe used to develop heafth education material for the communities and for the agents who will be responsible for ivermectin treatment? Health education materials have already been developed and approved by the NOTF, as well as by the existing lDPs. These will be utilised and translated into Hausa where appropriate. lnputs from the communities will also enable the development of further health educational materials to deal with particular local issues or perceptions of the disease. As the programme begins to be implemented, some problems might arise in particular communities which would necessitate additional health education. Local techniques of information dissemination will be utilised as needed, including drama, posters, town criers, etc. What methods will be used to provide heafth education to the endemic communities and to the agents responsible for treatment? 1. First, community leaders/elders will be enlightened about the disease and the necessity for regular treatment with ivermectin. These community leaders will then take on the responsibility for educating others in the community, in conjunction with trained onchocerciasis health workers. 2. All members of the community will be assembled in appropriate fora (women's groups, community halls, market places, or any other suitable venue) where health education messages can be discussed, and they will be able to ask questions to assuage any doubts they might have about the programme. Schools will be utilised to educate children, who can then pass on the information to their parents. Members of the community will also be able to make inputs to help design health education campaigns which will be most appropriate for their own community. 3. Use of posters, pamphlets, video/cinema, radio, TV, and hand bills where appropriate. Local languages will be utilised where necessary for better comprehension. 4. Use of town criers, religious and social group leaders for follow-up after members of the community have been adequately sensitised and made aware of the programme. 5. Continuous involvement of the community in health education will be necessary to ensure sustainability of the programme. Community development organisations, women's groups, religious groups, etc. will be mobilised to help sensitise members of the community. When necessary, health education messages will be adapted to suit existing conditions, e.g. where there is declining compliance, new approaches will be called for. 15 3.2.3 CommunityParticipation It must be reminded that in community-directed ivermectin delivery sysfemg the execution of ivermectin treatment is done by members of the endemic communities fhemse/yes. Treatment may be provided by trained personnel, known as Community-Directed Distributors (CDDs), selected from various organisational structures at the community level ranging from women co-operatives to traditional organisational struc'tures. Whatever the treatment approach used, it should be fully supported by the communtty itself and the community should be responsible for its organisation and execution with minimum but effective medical supervision once it has received the necessary information and training. a) Explain the organisation of the intended community-based ivermectin treatment in the project. ln areas where the Local Government Oncho Control Teams have not yet been established, the State Co-ordinator, along with the NOCP Zonal Office team and the SOCTs will visit the affected Local Government to establish the LOCTs. These will then assist in contacting the community leaders in affected communities. They will explain the objective of the programme in those places where distribution has not taken place. They will discuss the selection of CDTI personnel, security/availability of drugs, distribution, enlightenment, mobilisation and management of reactions. Once community leaders have been mobilised, appropriate health education messages delivered to the community members, and selection and training of CDDs canied out, the community will be able to take on major responsibility for such activities as: collection of Mectizan@ from approved points, supervision of distribution activities, referral of severe reactions, keeping of appropriate records and fonrarding such records on to the Local Government Oncho Co-ordinator. ln communities where previous distribution programmes have been in place, the State Team along with Zonal Office personnel and the LOCTs will visit the communities to explain the CDTI approach, and discuss the modalities of reorienting the existing programmes towards the CDTI strategy. Retraining of existing personnel, and new selection of CDDs, may be required to establish an effective CDTI in the area. b) How will ivermectin distributors be selected? Selection of CDTI personnel shall be made by the communities according to any procedure which the community deems appropriate (either by community leaders, or by the community as a whole in assembly). They must be people of good repute, transparent honesty, educated at least up to primary school level, (but preferably secondary level), having a local means of livelihood, and also be permanently resident in the community. Due attention will be paid to community sensitivities, For instance, in predominantly Muslim communities where male CDDs cannot approach women in their homes, or where women are secluded, female CDDs will be trained. ln communities where there are large numbers of Fulani, especially nomadic families, special arrangements will be made to cater for their seasonal movements. CDDs should also be fluent in the language(s) of the communities in which they will work. It is proposed that as many individuals in the community as possible be trained in the techniques of distributing the drug. This will ensure the effective devolving of responsibilities to the community and the sustainability of the programme. For instance, after the second year of distribution, by which time they should have acquired sufficient experience, CDDs will be encouraged to train another individual to work with him/her on distribution. ln addition, older members of the community, who are more stable residents than the younger ones, will be involved in working along with the CDD in a participatory/supervisory capacity. Although these community elders may not have the literacy skills of the younger CDDs, they will be able to know who in the community has been treated. Their knowledge will provide an essential back-up in cases where the original CDD drops out of the programme for one reason or another. 16 c) How will non-eligibles be identified and defaufters be followed-up? 1. The basis for identifying non-eligibles, and checking on defaulters, lies in the intensive mobilisation of the community and the high level of awareness which will be created by the mobilisation and health education messages. Once all members of the community are sensitised and aware of who should take and who should not take the drug, the CDDs will have no problem identifying the non-eligibles. 2. ln dealing with defaulters, since the CDDs are members of the community, they will be aware of those who have not taken the drug for one reason or another. The situation can then be redressed by resort to community pressure as appropriate. House to house distribution shall also help to trace non-eligibles and defaulters as records will indicate those defaulting. 3. The treatment log book and household card will be used to follow up defaulters. These defaulters will be educated so that they will accept treatment. 3.3 Local Operational Research Are there any plans to conduct local operational research? Yes i No lf yes please give details Proposed research foplc. How the use of ivermectin as a veterinary drug might affect its use as a drug for humans in pastoral communities. Rationale: It is well known that ivermectin was first developed and used as a drug for animals. ln Nigeria it has been in use for many years by veterinarians for anima! treatment. lt has had a reputation as an outstanding drug for treatment of parasites of cattle. Bauchi State has a very large population of pastoral Fulani, who depend for their livelihood on their cattle, as well as on smaller animals like sheep and goats. The Fulani are extremely concerned about the health of their animals, as their own sustenance depends on this. lt has been observed by veterinary doctors who treat cattle in these communities that the Fulani have been giving Mectizan@ tablets to their cattle and other animals, and that, in fact, there is a high demand for the drug in tablet form for use in animals. lt has also been observed that there is also a high demand for the drug by the cattle rearers for their own (human) use. lt is presumed that there might be some interference with the taking of the drug by humans in such communities, as some Fulani might decide to give the drug to their animals instead of taking it themselves, particularly where there might not be obvious symptoms of onchocerciasis. ln such situations, it is likely that the less powerful members of the family/community, like women and children, might be particularly deprived of the opportunity to take the drug in order that some tablets might be reserved for the animals who also need it. This situation has obvious implications for the effective implementation of CDTI in such communities, and, if true, would necessitate special strategies to ensure that all of the people in such communities are treated and that no proportion of the tablets are diverted to use on animals. This research project intends to investigate this situation, to determine the extent to which Mectizan@ tablets might be being diverted for use on animals, and look into possible solutions which could make CDTI feasible in such communities. Methodology Research will be carried out through interviews and observation in pastoral communities in local governments where CDTIs are established or are in the process of establishment. Preliminary findings will be analysed and follow-up interviews conducted. Research Team: Dr. lta Umo, DVM, Dr. A. Umo, DVM, Norma Perchonock, M.Sc. (Sociology). 17 Estimated Budget: PerDiem: For Research Team $7,500.00 Travel: Fuel and vehicle maintenance 93,500.00 Supplies: Stationery,computerconsumabler $t,000.00 TOTAL $12.000.00 3.4 Training Training and re-training of community-based distributors to operate the CDTI is a vitalfirst step in organising the programme and remains a continuing commitment thereafier. a) lffiat training will be provided to ensure the development and sustainment of the CDTI? The CDTI personnelwill be trained to know and impart knowledge to their communities about: a) The cause of river blindness and how it is transmitted. b) The breeding sites of the vectors. c) Signs and symptoms of the disease and complications if early treatment is not given. d) Advantages of Mectizan@ over previous methods. e) Administration and management of Mectizan@ reactions. 0 Recording and reporting system. Zonal Project Officers would train SOCTs. The SOCTs, in conjunction with the Zonal project Officers, would train the LOCTs, while LOCTs would train CDDs and community leaders under the supervision of the SOCTs. At the community level, experienced CDDs would train others who would work alongside them and take over their responsibilities whenever necessary. b) lndicate criteria for selecting trainees (supelisors and community-directed distributors) 1. Those selected to be trained as supervisors, should be health workers already in the PHC system at the Local Government level, as well as members of Village Development Committees, teachers, and other respected members of the community who agree to take on such responsibility. The selection should be carried out by the community. 2. Those chosen as CDDs should be permanently resident in the community, should be literate, and must be willing to assist the community. He/she must be someone acceptable to the community as a whole. ln the case where there are divisions in the community along religious, ethnic or linguistic lines which may preclude certain individuals from treating other members of the community, those selected should be representative of each of the community segments so that no part of the community will be left out of the treatment process. 3. Those chosen should fulfilthe following requirements: o Be knowledgeable people with the desire of helping others in need in their communities. o Have stable vocations and be resident in the community. . Be known to be honest and will not pilfer the Mectizan@ drugs. 18 c) lndicate number, type and duration of training courses intended Type of training Participants Duration Number per year Conducted by (retraininol State Technical 6 SOCTs 4 days 2 for the state ZonalProgramme Training (retraining) (incl. Oncho Managers/ Workshop Co-ordinator UNICEF and Deputy co-ordinator) LocalGovt. Training 39 LOCTs 4 days 2 for each LGA SOCTs/ (retraining) Workshop ZonalStaff/ UNICEF CDD Training 2336 CDDs 3 days 2lor each group LOCTs and SOCTS, (retraining) Workshop of communities assisted by NOCP Zonal Office staff Nofe: Training workshops will be for the first year of the project; in succeeding years, retraining will be done. Given the particular problems of the Bauchi State programme in the past, it is proposed to double the number of training sessions for the local government and community levels (i.e., two per year) to ensure that the personnel involved in the CDTI can adequately fulfil their responsibilities. Content of training will include: 1. Training of 6 SOCTs on: . Knowledge of the disease, vector and treatment o CDTI orientation o Community mobilisation and health education o House numbering and census taking o Procedure for Mectizan@ administration . Use of approved forms (MlS) o Management of adverse reactions o Health education and mobilisation strategies o Procedures for monitoring and evaluation 2. Training of 39 LOCTs on: . Knowledge of the disease, vector and treatment o Community mobilisation and health education . CDTI strategy and orientation o House numbering and census r Procedure for dosing . Use of forms o Management of adverse reactions o Strategies for Mectizan@ distribution . Techniques of supervision 3. Training of 2336 CDDs on: r Knowledge of the disease, vector and treatment . Strategy of CDTI o Community mobilisation and health education 19 . House numbering and conduct of census e Procedure for dosing o Use of registers . Monitoring of patients and management of adverse reactions o Distribution strategies and follow up 4. SUPPLY, IMPORTATION, STORAGE, INVENTORYAND DELIVERY OF MECTIZAN@ TABLETS This section is only a reminder and concerns the supply, impoftation, storage, inventory and delivery of ivermectin tablets, donated by Merck & Co., who will also pay handling charges for ivermeciin to their accredited agents. PLEASE NOTE THAT REQUEST FOR IVERMECTIN AS WELL AS REPORTING OF ITS SUBSEQUENT USE MUST BE MADE DIRECTLY AND SEPAMTELY TO THE MECTIZAN@ EXPERT COMMITTEE, USING THE FORMS PROVIDED BY THE MECTIZAN@ DONATION PROGRAM AND A COPY SENT TO APOC. 20 5. SUPERVISION/MONITORING AND EVALUATION 5.1 Supervision during CDTI Proiects require to be superuised and monitored. However, APOC funded projects wiltneed to be designed to function with effective but minimum supervision compatibte with its objectives. a) Please describe the superuisory anangements you consider will be required for the CDTI you propose. How will this continue af fhe cessation of APOC support? ln view of the past problems of the Bauchi State programme, intensive supervision will be required in the initial stages of the CDTI, until the personnel involved, and the community members, are fully aware of their responsibilities in the programme and are able to carry them out. This initial supervision will involve Zonal Office staff, SOCTs and LOCTs, and also members of the community such as village heads and elders, community leaders, teachers, members of the Village Health Committee, PHC staff, etc. The supervisors will ensure the following: i) Proper documentation at all levels, from community level to the state level. iD Properly supervised and documented drug intake. iiD Thorough pre-distribution enumeration of recipients canied out. iv) Post-distribution verification is randomly done to ensure that supply/balance tally. iv) Close monitoring of activities during mass Mectizan@ distribution. Supervisory procedures would involve routine visits during Mectizan@ distribution, as well as spot checks on all documents, records and on Mectizan@ supplies in the store. It is envisaged that after the first two years of the CDTI, when roles and responsibilities have been fully institutionalised, that the community would take on more responsibility for supervision, and Zonal Staff, and the SOCTs would play less of a role. However, LOCTs would continue to be involved wherever necessary. The most effective supervision in the long term will come from the community itself, as a result of the initial impact of the distribution programme and the awareness this will create of the benefits of the CDTI. b) Describe how you would ensure that supervision will: . fallwithin the requirement accounting for ivermectin use . be susfained when the programme ends in 5 years . ensure maximum involvement of the communities in the process i) Pre-distribution visits to the communities will be undertaken by the SOCTs and Zonal Office personnel, in company of the LOCT, for the purpose of advocacy and mobilisation. iD Pre-distribution census will be cross checked by Zonal Office Staff, SOCTs and LOCTs together with the CDDs in the presence of the community leadersA/HCs. Based on this, the projected quantity of drugs required will be calculated. iiD All empty sachets of used drugs will be returned, and all drugs will be accounted for by those responsible. Drugs cannot be given to any community until the previous ones have been used and salisfactorily accounted for. The responsibility for accounting for the drugs will devolve on the CDDs along with the community leaders. iv) The community would assist the CDTI personnel in discharge of their duties by providing agreed assistance in cash or kind (e.9. assistance on the farm, provision of food during distribution, provision of transport fare for trips to collect Mectizan@ etc.) 21 to the CDD. The mode of support of the CDDs will be decided by each community according to its needs and abilities. v) Older residents of the communities would be encouraged to get involved in working side by side with the CDDs during distribution. Their knowledge of the treatment patterns in the village will form an important back-up to and check on the written records of the CDD. vi) Maximum involvement of the communities in all stages of the programme, from planning through to implementation would enhance community ownership and sustainability of the CDTI, as well as the full integration of the distribution programme into the already existing PHC system. 5.2 Monitoring of CDTI It is important to collect information to monitor the progress of the CDTI. lMhat indicators witl be used to monitor: . ivermectindistribution? . heafth education and community participation? o ff afidgement systems? The following itams may be considared lvermectin Distribution c numbers of communitias and persons treated with ivermectin c treatment coverage . regubrrty of treatment exercise c compliance , reporting adverse reactions Health Education and Communitv Mobilisation . numbers of communities being mobilised by the project o evidence of impact of health education Manaoement . are activities being caried out according to plan and on schedule? o inventory control, . are record forms accurate and completed on time? c numbers of persons trained o balance of genders in staff of the programme Monitoring the projects will be done initially by the LOCTs in conjunction with the SOCTs. However, at an early stage, members of the community will also be encouraged to participate in monitoring activities, and simple procedures will be devised so that by year 3 of the project, a substantial percentage of monitoring will devolve to the community level. This is important for sustainability, in that community awareness of the achievements of the project will help in generating momentum. ln addition, community assessment and discussion of problems of the project will help in finding solutions to these problems. Also, records will be continually scrutinised at the state and zonal level in order to assess the progress of the projects. ln addition to the above-mentioned indicators, we will also consider some of the following factors: 1 . lvermectin distribution: detailed demographic information about distribution of the drug in the community, to assess whether any categories of persons (e.9. women, children, etc.) are not receiving due attention. availability of supplies of Mectizan@ when required for distribution exercise. 22 . declining compliance (if any) and the reasons for this. 2. Health Education and Community Mobilisation o breadth of participation in mobilisation activities by all segments of the communities. . degree of involvement of community leaders in health education and mobilisation activities. r quantit! and quality of health education messages deriving from community inputs, i.e., devised by memberc of the community themselves. 3. Management o indication of financial and other commitment (personnel, equipment, etc.) from all participants in the programme (government, intemationalagencies, community). . degree of community directed supervision of distribution activities. . degree of community participation in monitoring and assessment. . degree of community involvement in solving problems, e.g., finding ways of ensuring continuing compliance, devising new health education messages to meet new situations, finding means of community financing for essential activities (such as collecting the drug, financing CDDs, replacing forms, logbooks, etc.). 5.3 Evaluation of CDTI Annual extemal review incorporating field visits will be undertaken to ensure that projects are meeting target indications outlined in this proposal. Such reviews will provide TCC with the assurance that each project is moving towards its long term stated goal and if appropriate make recommendations about any deficiencies or modifications fo fhis projed. Such reviews wiil draw on the indicators developed by ICC as a guide (see Appendix 3) for such evaluation. 23 6. SUSTAINMENT OF THE CDTI AFTER THE WITHDRAWAL OF EXTERNAL FUNDING The concept of sustainability refers to the ability of countries and affected communities following initial extemal investment to maintain the viability and continuity of the ivermectin treatment process without external support. For APOC funded projects, such support will normally lasf 5 years, as fhe APOC donors demand that there shall be a visible and achievable end point for the erternal donation aspecf of the programme, and that the community based distribution sysfems established shall thereafter be susfarnable by the governments of the endemic countries concemed. Progress and plans towards sustainment, including the phasing out of external and NGDO's support, must be repofted annually and satisfactory progress in this direction will be a condition for each succeeding year's funding instalment. Please address the following areas that relate to sustainability: "integration inb prtmary heafth care", "cost-recovery", and 'other sustainment lssues". 6.1 lntegration of the CDTI into other Community-based or Primary Health Care (PHC) Systems The principal goal of the APOC is fo esfabish cost-effective ivermectin-based control for onchocerciasis which can be susfained by the endemic communities and countries. One way to ensure sustainmenf is fo integrate the CDTI into the PHC system of the country, which means more than jusf using the system for ivermectin distribution. 6.1.1 ls there an officiat PHC poticy and structure in the project area? yes EI No tr lf yes, please give a brief outline of what it is; The Primary Health Care Policy of the Nigerian government is implemented by the National Primary Health Care Development Agency. Essentially the policy involves a system of health care based on community needs, with particular emphasis on preventative measures. As part of this policy, certain aspects of health care activities have been devolved to the local governments, such as EPl, essential drug programme, family planning, control of locally endemic diseases, etc. The structure of the PHC system follows a zonal system, both nationally and within the states, as below: FMOH (NPHDA) -> Zonal (NPHCDA) -> State (PHC) -> State Zones -> LGA -> District -> Communities a) How functional is the Wmary heafth care system? o Fully functional . Paftly functional / (Please specify) o Non Functional (Please spectfy) Many of the affected local governments do not have VHCs in place. Many of the activities that are supposed to be carried out underthe PHC system are non-existent or inadequate. b) Does it coverthe whole pflect area? yes EI No tr lf no, in what part(s) of the project area is there a fully functional PHC structure? c) What percentage of communities where onchocerciasis is endemic, and which are eligible for community-based treatment, have an existing and functional PHC structure? 24 About 70o/o of endemic communities have existing and functional (or partly functional) PHC facilities. d) What organisations are suppofting the development of PHC in your country? D National Primary Health Care Development Agency (NPHCDA) ii) UNICEF iii) WHO iv) UNDP v) USAID vi) IFESH vii) G2OOORBP e) ls there any past experience in the country of a programme integrating with the PHC? lf so, what programme was it and how successfu/ was the integration? Yes. The Family Support Programme and Guineaworm eradication are being integrated into the PHG system. f) Are there any plans to integrate other rural heafth programmes, such as the Expanded Programme of lmmunisation, Maternal and Child Heafth Programmes or programmes for the control of other parasific diseases, witi the PHC system? Yes. Programmes such as AIDS control, Leprosy control, Schistosomiasis control, Malaria control, etc. g) Describe how the CDTI witt be integrated into the PHC systeml; the way the PHC system witt be used to achieve integration and the key persons in the PHC system who witl be needed to achieve the integration. i) The CDTI is already in the process of integration, since the key officials handling the programme, i.e., the SOCTs and LOGTs, are PHC staff. They will be involved in community mobilisation, monitoring and supervision of the CDTI during the period of APOC support and also after APOC support ceases. PHC staff will be involved in the management of adverse reactions, and PHC facilities will be utilised for as drug storage, management and administration. iD The key persons to be involved are: o Community health extension workers,(CHEWS), Traditional Birth Attendants (l-BAs), etc. . PHC decision makerc and supervisors at both state and LGA levels. . Key officers of community development associations and village health committees. o Traditional rulers/family elders/opinion leaders, will be involved to enhance community support for the programme. h) lndicate how early in the CDTlfhe process of integration witt be introduced; how it wiil continue thereafter, and after how many years within the extematly-supported tifetime of the CDTI it will be completed. lntegration into the PHC system will begin from the planning stage, with the involvement of PHC facilities and personnel in all relevant aspects of the CDTI. As the programme develops the integration will have become institutionalised, and become an integral part of the CDTI. 1. Simply stating that the project will be integrated into PHC is not enough. 25 This should occur before the third year of the programme. As both government and the communities will be aware of the time period for APOC funding, and the fact that funding will cease after the fifih year, they will be able to plan how to talie on the responsibility foi the various activities that were externally funded in order to sustain the progiamme w1h local resources. They will be willing to do this once they see the benefits of tfre COfl. 6.1.2 lf there is af present no PHC sysfem in operation, or in those areas where these sfructures are non'functional, describe how the CDTI may be used to initiate and expand into such a sysfem, giving a time-frame for intended progress. ln those areas where there is no fully functional PHC system in operation, cDTl would assist in the formation of Viltage Health Committees who will participate' in the coltection, distribution, recording and reporting aspects of active Mectizan@ distribution. The training oi health workers in onchocerciasis control and the community-directed methods of treatmLnt will strengthen the health education base of the communities, and create a demand for the implementation of an effective pHC system in the area. 6.1.3 ln which way(s) can community-based ivermectin treatment initiate or strengthen pHc? . The community participation in and ownership of the CDTI could strengthen the pHC through the benefits derived from the CDTI method. The awareness of the benefits of Mectizan@ treatment, and the methods utilised to distribute the drug, particularly community participation in the process, will have a spill-over effect to other pHC programmes. Moreover, skills acquired by CDDs and other members of the community'in the process of implementing the CDTI can be applied to other areas of health care. . The communities will prioritise their health needs using the CDTI principles and manpower, and will seek training for more skilled health workers where necessary to address these needs. . The gains of community directed treatment programmes will be the motivating factor to ensure that the community embraces all the components of pHC. 26 6.2 cost-recovery systems during Gommunity-based lvermectin Treatment Cost recovery for Pimary Heafth Care is mandatory in some countries and it may be one means of sustaining an CDTI after APOC funding ceases. However, please note well that since ivermectin is donated free, there can be no cost recovery in respect of the value of the drug itself; cost recovery can only relate to the cosis of distribution. 6.2.1 Please state whether there will be any system of cost recovery (such as is recommended in the Bamako Initiative) to help cover outlays on the distribution of ivermectin in the present CDTI. None anticipated. 6.2.2 State exactly how any such system will be organised, including answers to the questions listed below. o What charge will be made per person or per family? Not applicable. o Which groups of persons will be exempted from payment? . Will payments be in cash or in kind? lf in kind how will this ensure sustainability? o What provision will be made to ensure that all those eligible to take ivermectin, but who are unable to pay, will also receive treatment? How will it be determined who is unable to pay? . Who will collect the payments? How will this person safely transport funds to a place of safe keeping? o Where and by whom will any funds collected be safely kept? o What systems will be put in place to ensure the proper use and management of collected funds? o For what purpose(s), including defrayment of distribution costs, will the funds collected be used? o What role will Village Health Committees play in the management and allocation of the funds raised? 27 6.3 Otfierissues Please provide information on other issues and constraints relating fo susfainability of CDTI you anticipate and identify how they will be overcome. For example: . the mobilisation of endemic communities o the maintenance of adequate superuision and monitoring . inadequate human resources o /ogisfics and communications . social/cufturalfactors o declining community compliance The above constraints could be overcome in the following ways: A) Mobilisation of endemic communities Mobilisation of endemic communities is perhaps the most important aspect of the CDTI. Without sufficient community awareness and involvement, the programme cannot attain its objectives. Mobilisation is a continuous process, and must involve CDTI personnel at all levels, from the Zonal Office staff, to the SOCTS, the LOCTs as well as the CDDs and others at the community level. Community sensitivities must be taken into account, and the members of the community fully involved in the programme from the planning stage through to implementation, and even supervision, monitoring and evaluation through continuous feed-back to programme personnel. Successfu I mobi I isation necessari ly entails: . sustained advocacy visits. . adequate public motivation by wards heads, elders and other opinion leaders. . use of enlightenment campaign materials (hand bills, posters, drama, radio etc.) . mass education meetings. . KAP surveys to be conducted periodically in order to monitor changing belief systems, and carefully and discourage beliefs that are harmfu! to health and interfere with Mectizan@ compliance while respecting those not harmful. B) Maintenance of adequate supervision and monitorinq . After the house to house enumeration, the community leaders need to be aware of the quantity of ivermectin tabs that will be available for distribution. . The community leaders must be involved or represented in the process of Mectizan@ distribution. . Supervisors at all levels must make sure that every aspect of the programme is on course. Supervisors of CDDs must ensure that all forms are completed accordingly and drugs distributed tally with the available data. Records could be verified at the collation centre at the local government level. There should be occasional unscheduled visits to the communities by SOCTs & LOCTs to verify records and hold group discussions with the eligible recipients on the dose of Mectizan@ received. The CDTI personnel should endeavour to keep all policy makers, technical heads and community leaders informed at every stage of the programme in order to build up confidence and remove any element of suspicion. The community should be fully involved in the process at all times. C) lnadequate human resources . With adequate motivation and remuneration there will be enough human resources to carry out the programme. ln addition to the CDDs and other project personnel, teachers will also be trained to help in the work of distribution of the drug, as well as in supervising the work of the CDDs. o Continuous training and re-training will ensure that personnel have the requisite skills for the task. 28 D) Loqistics and communications. Judicious utilisation of available logistics will be required, and the most efficient and least expensive forms of transport such as bicycles will be utilised wherever possible. Distribution of Mectizan@ will be carried out in the dry season to ensure adequate accessibility, especially in the case of communities which are cut off by bad roads during the rainy season. ln the case of communities which are located far from the Local Govemment Area headquarters, distribution will be done through the nearest PHC facility. Wherever possible, telephones and other forms of rapid communication will be put in place to facilitate urgent communications. E) Social/Cultura! Factors . Careful attention will be paid to the cultural requirements of distribution in each community. Community norms will be respected, and ways found to address problems created by cultural taboos and/or beliefs. Wherever possible, CDDs should speak the language of those they are treating in order to best explain the necessity for treatment and deal effectively with any possible adverse reactions. Mectizan@ distribution periods will be scheduled so as not to interfere with any cultural activities of the communities. Measures will be put in place to ensure that no groups are left out of the distribution. The situation of women and children, particularly, will be carefully monitored, and in lslamic communities, females will be trained as CDDs to enable distribution to be carried out house-to-house for women who may be in purdah (seclusion). F) Declininq Gommunitv Gompliance o Community compliance would have to be sustained by constant re-mobilisation, and evolving new health education messages where necessary. Where there is evidence of poor Mectizan@ compliance from the communities, social surveys will be conducted and the results utilised in developing appropriate mobilisation and information messages. The problem will be also put to members of the community who will be requested to find an appropriate solution. 29 6.4 How do you intend to monitor and measure the progress towards sustainabitity (See Appendix 3 for a /isf of possible indicators of sustainability)? Progress towards sustainability will be monitored and measured by the Zonal Project officers/consultants and the SOCTs using NOTF guidelines. The following indicators will be utilised: r Political will and commitment of state/local governments and communities including participation of govemment officials in programme, participation on Oncho DayM/eek activities, etc. o Sustainable annual financing by government and communities (sustaining of expenditure). . Progress towards integration by use of PHC personnel in specified tasks. . Evidence of community empowerment and ownership. . lnvolvement of local community-based organisations in various aspects of the programme. These will be monitored through in-depth interviews, focus group discussions and direct observation. It should be noted that the new democratic dispensation in Nigeria should facilitate the sustainability of the programmes, as public elected officials will be responsible to their constituents, unlike the case under military rule. lf community members perceive the CDTI as beneficial to them, they will put pressure on local officials to ensure that the programme continues, and that resources are allocated to facilitate this. PROJECT EVALUATION Management: . To be evaluated periodically using an approved financial management system acceptable to all parties concerned. lnventory of all materials supplied or expected to be purchased through cash advance will be verified. Also, satisfactory retirement of cash advances for the project when due in line with approved financial instructions will be mandatory. o The commitment of sponsors could be evaluated through the speed with which cash advancement, logistics and supplies are released to the project.. Project Effectiveness The project effectiveness could be assessed based on the following, using the NOCp Management lnformation System : o Mectizan@ treatment coverage. . l(AP survey results. . Sentinel Village Survey results or clinical condition of onchocerciasis victims after treatment. o Verification of available data through cross-validation process. o Community assessment of project effectiveness through town meetings and other means. 30 S USTAINABI LITY/I NTEGRATION Political Will of Host Government This can be assessed by: o Financial/political commitment including releasing of staff and vehicles as and when needed. o Non-interference in programme implementation as well as assistance in maintaining project vehicles and equipment. . Protection of project supplies from theft and misuse. . Statements of commitment to project and participation of host government officials at all levels in such activities as Oncho Day, etc. . Degree to which elected officials at state and local government level demonstrate awareness of onchocerciasis as a health problem in their communities by including onchocerciasis control as part of their political platform on healthcare. Long-term Planning ls there a long-term plan to sustain the financing and the management of the programme? YES This involves: o Orientation of the community towards the ownership of the programme. . Planning for availability of Mectizan@ as and when needed. . Advocacy visits by CDTI personnel to government authorities at all levels in the course of formulating policy for sustained financial commitment to the programme. o Satisfactory participation of communities at every stage of the distribution process, i.e., enumeration of recipients, distribution of the drug, retrieval of the drug, managemenUreferral of reactions, submission of records and forms. Secondly, the communities will be motivated to gradually increase their financia! commitment to the project once they begin to realise the benefits of taking the drug. . Continuous strengthening of all available structures in the CDTI and PHC programmes. This will be done through increasing community involvement and commitment to the programme through continuous mobilisation and health education activities. Progress Towards Financial Sustainability lf programme sponsors cannot continue their current levelof commitment for at least another 5 years, what percentage of running cost now paid for by host govemment? g!l%- This could be achieved through: . Use of available infrastructure (office accommodation, telephone/fax, etc.) o Personnel . Logistic support 31 Progress Towards lntegration To what extent has ivermectin distribution been integrated with other heafth programmes? . Use of PHC vehicles for drug delivery. . Use of PHC staff for supervision of Mectizan@ treatment. o The use of PHC facilities for Mectizan@ storage, administration and public enlightenment campaigns. . The use of PHC refenal system at the community level. . The use of CHEWs in supervision, management of adverse reactions, and training. 7. CROSS-BORDERCONSIDERATIONS Where an endemic area extends across the borders of two or more adjacent sfafes, special problems of co-operation between the respective country CDTI may arise. ln the event that there are areas to be covered by your proposed CDTI where the endemic zone extends across the frontier into one or more neighbourtng counties, and where there are likely to be transitory or even large-scale migrations of Onchocerca-infected persons eithdr way across the border. 7.1 P/ease describe the particular situation as if is likely to affect ivermectin treatment, and the methods you willuse to deal with it. As noted in Sec. 1.1, Bauchi State shares borders with seven other states in Nigeria (but has no international border). Except for Gombe State, all of the states bordering Bauchi have ongoing APOC sponsored CDTI programmes. Taraba State, which borders Bauchi to the south east, is particularly endemic for onchocerciasis. 7.2 lnclude pertinent obseruations on current political and heafth relations with the neighbouring sfafe(s,). 8. SPECIAL R'SK'SSUES ln some areas of some countries there may be specia/nsks which could hinder the smooth running of an CDTI. 8.1 P/ease describe the situation in any areas covered by your proposed CDTI where this factor may interfere with the programme, and assess future prospecfs. Not applicable. 32 SECTION 3: ADMINISTRATION/FINANCIAL 9. ADMINISTRATION ' 9.1 Organogram of the CDTI Project 9.1.1 Please provide an organogram for the CDTI showing the organisational structure responsible for implementing this proposal. (See organogram on following page) 33 Organisational Structure of Community-Directed Treatment with lvermectin NOCP NOTF Procurement of Mectizan Steering Committee Poliry formulation Formulation of National Plan of Action NGDO Monitoring Srryervision Non-Government Org. Evaluation & Coalition GroupA.tigeria Zonal Onchocerciasis Control Team (Zonal Co-ordinator & staff) Colleoion of Drug from lagos Training of SOCTs Operation Researoh State Onchocerciasis Control Team (State Coordinator,.SocT, Dir. PHC,, PHC Coordinator) Collection of Me ctiz,ai from Zone Training ofLOCTs Supervision ofLOCTs Monitoring & Evaluation of Ivermectin dishibution Advocacy & mobilization of policy makers, NGDOs & private sector Local Government Onchocerciasis Control Team (LOCTLeader,LOCT,PH{,u|f^Ii{^lfiX*"!f*ervisor,DistrictSupervisor) Advocacy & Mobilization of LGA policy makers Training of CDDs Community-Directed Treatment with Ivermectin (CommunityLeader(s)WWg1#:!l*"#ffi#f Ivermectin distribution "CommunityMembers,CDDn) Supervision of community distribution activities Management ofadverse reacdion & referral Funds fortranspod of CDD to oollect drug Inoentive for CDDs 34 9.2 Financial Administration Mechanisms of disbursements and transfer of funds from the World Bank to countries Funds from the World Bank APOC Trust Fund will be channelled through WHO and APOC to the Project bank accounf. Disbursements of funds will require 2 signatures from members of the NOTF, one representing the Ministry of Heafth (Govemment) and one representing the NDGO partners. APOC will issue cheques (advances) in accordance with WHO rules and the previously agreed project documents and/or plans of operations. When the total payment in cash required for the projed exceeds $100,000, the payment must be made in instalments. The first instalmenUadvance could cover 3 months or 6 months of activity depending on the duration and magnitude of the project. Management of funds by projects and WHO/APOC mechanism for monitoring The size of the project will determine which of WHO's contractualsysfems is used e.g. Technical Service Agreement, Lefter of Agreement, Contractual Seruice Agreement or Agreement for the Performance of work. A document on Administrative and Financial Procedure will be made available to projects being funded by APOC. Buift into this document is an imprest mechanism, whereby the project will repoft its expenditure on a quarterly basis andreceive fufther advances on that basis. Each project funded by APOC will require a periodic erternal audit at project expense. Each project must have one senior staff member who is accountable for the management and control of project funds. Standard intemal ftnancial checks and balances musf be incorporated into each project's financial management plan. 9.2.1 lnput from the Ministry of Health a) lndicate resources that willbe provided by the Ministry of heafth and other govemment agencies. o PERSONNEL o COUNTERPART FUNDING o LOG/SI/CS o LEGALPROTECTION/SECURIW 35 Support from Ministry of Health (State and Federal): slNo. gIV,r.rar' 1 Tovota HLLux (Off the road) SMOH 1 $1000.00 2 Office table 2 $50.00 3 Chairs u 5 $100.00 4 File cabinet 2 $800.00 a 5 Ceilino Fan 1 $25.00 ! 6 Comoound microscooe 1 $300.00 ! 7 Taoe recorder 1 $100.00 ,gtIEflEElEf:'Al:;IElduilomafil|:,.' .: ::' *37*.AO Salaries SMOH $6,000.00 Cash commitment SMOH TOr..{iL $&,378 Support from Local Governments: lncludes staff salaries, office accommodation & furniture, maintenance, training, and contribution to cost of Mectizan@ distribution. For information on salaries and other Local Government inputs, see Sec. 2.4 above. Equipment currently in Local Governments: Item No. UnECost Total 1 Ningi Motor cycle 6 (3 functional) $1 000 $6000 Bicvcle 4 (2 functional) $s0 $200 2 Warji Motor cycle 1 $1 000 $1 000 Bicvcle 1 $50 $s0 3 Alkaleri Motor cvcle 1 $1 000 $1 000 4 Toro Motor cvcle 2 $1 000 $2000 5 Dass 6 Tafawa Balewa 7 KirR Bicycle 5 $50 $2s0 8 Darazo 9 Jama'are 10 Shira ?F0;T:AL,. $10.500 36 b) Please provide a list of personnel assigned by the MOH to this project, including their name and proposed time (state percentage of time allocated to the project) for the project and where appropriate, their experience in onchocerciasis confrol through ivermectin treatment. Name POS' $tate/LOA Ytrfs *f iFtercentage Eroprbnce '' ''llmp Dr. MaoaiiDachi DPHC/D. Control SMOH 5 50 AlhajiMohammed Baba Deputy Director, 3 50 Gar D/Control Mal. Yusuf Abdu Baraza Oncho Control Co- 11 100 ordinator u Mal. Admad B. Gamawa Deputy Oncho Co- 5 100 ordinator ! Abba Mohammed SOCT 11 50 a SaniGarba 10 50 Ms. Juliana Umar T 4 50 Mrs. Hassana William 3 50 Alh. Mohammed Yakubu PHC Co-ordinator NinoiLGA 8 10 Bala Shehu Oncho co-ordinator u I 50 Haruna Abdullahi LOCT 8 50 g Tata Mamman LOCT 6 50 Yahaya Garba LOCT 7 50 Alh. Mohammed Adamu PHC Co-ordinator Toro LGA 5 10 AbdullahiYakubu Oncho Co-ordinator 4 80 lliya Musa LOCT 4 50 Adamu Mohammed LOCT 4 4 50 Yunusa AMullahi LOCT 4 50 Alhaji Abdulkadir PHC Co-ordinator Warji LGA 4 10 Mohammed Alhassan Mohammed Oncho Go-ordinator 2 80 Mrs. Elizabeth Sule LOCT I 2 50 t Munkaila Yunusa Asst. Co-ordinator 2 50 Saleh Hodi Oncho Co-ordinator Shira LGA 1 80 Saminu Adamu LOCT 1 50 Garba A. Bukar LOCT 1 50 Yakubu Sani LOCT 1 50 '::.1 I Alh. Hashimu Mohammed PHC Co-ordinator Tafawa Balewa 10 LGA lshava T. Chiroma Oncho co-ordinator 2 80 John Timothv LOCT 2 50 tr Markus Anoulu 2 50 .il ... !' ' Mr. Nuhu Barde PHC Co-ordinator Dass LGA ? 10 Abdulkadiri Turawa Oncho Co-ordinator 2 80 Musa M. Baraza LOCT 2 50 Abdulkadiri Saleh LOCT I 2 50 Mrs. RabiMusa LOCT c 2 50 37 Mal. Garba Sale PHC Co-ordinator AlkaleriLGA ? 10 Amadi M. Bukar Oncho Co-odinator c 2 80 Alivu Ahmadu LOCT 2 50 Audu Garba LOCT ! 2 50 g SaniChiroma LOCT 2 50 l.: i. Alh. Korau ldi PHC Co-ordinator Kirfi LGA ? 10 Sule M. Yakubu Oncho Co-ordinator s 2 80 Umaru Mohammed LOCT 2 50 Ladan Mohammed LOCT u 2 50 Mrs. LamiMaqem PHC Co-ordinator Darazo LGA 10 Tasiu Mohammed Oncho Co-ordinator 2 80 MaioariMohammed LOCT 2 50 AbdulhalalA. Hamza LOCT 2 50 Umaru Galadima LOCT 2 50 38 9.2.2 lnput from the Partner NGDO(s) a) Please provide a letter from the Executive Director or the Director of Onchocerciasis Programmes of each participating NGDO stating their intentions to participate in and support the National Onchocerciasis Control Program me. b) Give information of the input from each NGDO participating in this project. 1 . OFFICE ACCCOMMODATION 2. PERSONNEL COUNTER-PART 3. LOGISTICS CONTRIBUTIONS/FUNDING 4. EOUIPMENT 5. PUBLICITY Note: See also 10.3 below. UNICEF Support for one year TTE{I,I EUAHTITY :AT{OIIHT{US fi} Vehicles - 1 (used - reouires reoairs) $1.000 Motorcycles 6 (used) $3.000 Microscope 2 $2.000 Bicvcles 9 (used) $900 Bu'b,Totel ., '$E-: Cash Support: Traininq /Travel/Supplies 18.810 : TOT.AL,. .,...... "|..,'' 9s.7.1.0.. c) P/ease provide also a nominal list, grading and post desaiption for the personnel to be provided by partner NGDO(s). lndicate clearly what will be their functions in the programme and their experience in onchocerciasis controlthrough ivermectin distribution. Not applicable. 9.2.3 lnput from other Agencies. Please list any other agencies or parties that will be involved in the running or financing of the CDTI, and indicate clearly their roles, functions and contributions. The NOCP Zonal Office for Zone D, located in Bauchi, will be an active participant in the Bauchi State programme. The Zonal Office Staff will be involved in nearly all aspects of the programme, in order to give additional support in such areas as advocacy, mobilisation, training, monitoring and supervision, distribution of the drug to the state, writing of reports, and evaluation. ln order to support the Bauchi State programme and other programmes in the Zone, the staff strength at the Zonal Office has been increased. (See following table). 39 Zonal Office Staff: $lqrn* Rallk YBA{5 Experience 1. Patricia Ogbu- Zonal Co- 12 20 General liaison, Pearce ordinator supervision, training of SOCT, LOCT, CDDS. 2. GabrielO. Entonu Scientific 5 20 Conduct training, supervise Officer SOCTs 3. Jonathan Adamu Health Educator 5 20 Training, supervision 4. Adamu Samande Data Clerk 3 20 Collection, collation & analysis, Mectizan@ stock and record keeping 5. Mrs. Margaret Administrative 2 20 Assists Co-ordinator in Amadi Assistant general office work, conespondence, etc. 6. l. Yerima Personnel 3 20 Responsible for staff Officer matters. 7. Mrs. Victoria Accountant 1 20 Keeps accounts for the Oloche ZonelAPOC. L Malam Farouq Finance clerk 6 20 Assists in accounts and Abubakar record keeping. 9. Mallam Yusuf Driver 20 20 ZonallProject vehicle Mohammed driver. 10. Mallam Sale Driver 4 20 ZonallProject vehicle Adamu driver. 9.3 Timed plan of action Provide a time chart(s) showing how the various activities of the CDTI will proceed over the course of the proposed programme. Numerical annual targets for all planned activities should be provided for each time point. The time charts should also indicate how external support will be phased out over the 5 year period. (See following page for timeline) 40 IO BUDGET 1O.1 Budget estimate Budgets must indicate total funds to undertake the project. The amount of funding requested from APOC, and the amount provided by the MOH, NGDO(s), and other partners. All esfimafes must be made in US dollars. Each budget must include at least the following major categories (see Appendix 2) indicating the contribution of the partners to reflect sustainability of CDTI: c pofsotrtel(services) o capitalequipment . supp/ies . training . travel . communications . consurfanfs e opetatifig expenses . externalaudit (See budget attached) 1 0.2 Budget Justification Please provide a narrative description of the reasons for each proposed line items of the budget. ln o N .o I o N 'tIJ o F- .F U L o tIJ Z J @ . Irl E u F (, E o E] IIJ _- ]L >Irl t-E F Z FIIJ o o c, o c tr I .9o o =t .9 .E .otr .Eol E lu U fE 0) o. v-c o. a o @fi a o o- 6 E, D Eq) E, .E F ,N .c .E o o B+ o Z {E 9,tr E(n ^LOYOJ EO -o o- FE or cE 5E ..!- > >.2'E oo o(\I u,E6,, Ti EEo'! Eg $s be cL- Ii> CH 'FO t6E 6a) -? EU E5 f- -O (ULUtr tr .gl .= 0J xo' o.9 tsE LX UA (J! J1' O- oJ a' $ rr.t @ 41 10.3 Current resources available in GDTIs Existing CDTIs (for continuation or expansion) will have resources already available. Please provide a detailed list of all existing personnel, equipment and supplies (including vehicles, etc.) belonging to the programme, indicating their ownership (MOH, NGDO, other Agency, etc.) and their level of functionality. (Note: lnformation on all existing personnel is provided in 9.2.1 and 9.2.2 above) Equipment inventory: Item MOH/ UNICEF Total Functionality LGA Tovota Hilux 1 1 Non-functional Motorcvcles 5 10 15 2 Non-functional Bicvcles 10 10 8 Functional Compound Microscopes 1 2 3 Functional Office tables 2 2 t Chairs 5 5 g Ceilino fan 1 1 Steelfilino cabinet 2 2 ! Calculators 2 2 g c Public Address Svstem 1 1 ! Camo Bed 1 1 Tape recorder 1 1 PART V: APPENDIGES 43 APPENDIX 1= ESTIMATED ATUTIfBERS OF COMMUNITIES AND PERSOTVS TO BETREATED EACH YEAR, BY ENDEMICITY LEVEL AREA COVERED: 13 Local Government Areas in Bauchi State, Nigeria COMMUNITY ENDEMIC HYPER.ENDEMIC MESO-ENDEMIC HYPO-ENDEMIC LEVEL TYPE OF Community-based Community-based Community-based TREATMENT YEAR 1 No. of communities to be 140 225 treated Tota! population in above 210,000 373,978 communities YEAR 2** No. of communities to be 191 350 treated Total population in 286,500 581,700 above communities YEAR 3'' No. of communities to be 225 459 treated Total population in 337,500 762,858 above communities YEAR 4** No. of communities to be 225 725 treated Total population in 345,947 1,078,306 above communities YEAR 5*' No. of communities to be 225 725 treated Total population in 359,659 1,205,041 above communities ** Years 2 through 5 are estimates. )nchocerciasis is not considered an important Public Health problern in hypo+ndemic communities and APOC will not normally fund .:ommunity-based treatment in such communities. The inclusion of such conununities in the proposa! will require a special justilication for consideration by the TCC. 44 APPENDTX 3: INDICATORS FOR EVALUATION, SUSTAINABILITY/INTEGRATION OF CDTI Project Evaluation Management o Financial management . Effectiveness of communications o Training and capacity building o lnstitutionalcommitment o Fulfilment of other relevant sectors o Problem solving capacity o lntegration of operational research Project effectiveness . Result of KAP studies . Treatment coverage . Follow-up of non-eligible and absentees o Managoment of adverse reactions . Reliability of reporting S u stai n ab i I ity/I nteg rati o n Political will of host government o politicalwill as shown in policy statements and apparent commitment of high-level officials r official action assigning personnel, funds, vehicles to programme Long-term planning . is there a long-term plan for sustaining the financing and the management of the programme? Progress toward financia! sustainability . if programme sponsors cannot continue their current level of commitment for at least another five year, what percentage of running costs is now paid for host governments or fees? Progress toward integration . to what extent has ivermectin distribution been integrated with other health service programmes? . evidence of community empowerment and ownership . change in KAP over time o extent of involvement of both genderc and non-literate o extent of involvement of local community-based organisations lI. cil, uJ o o o o o o o o @ lo )o o o o o o o o s 9 (t)_ o o o o to o_ o o)- z \C\1 (o $ o, f c.i Fi rt N N ro o o o o (f, t I (f) @ o o o o c) o o F- N rr) o o) s o o o o o o (o_ ro od rr) o @ d @ Fj o T\ N = (o o c{ ot $ o o o o o o o o o o ro o o o o o o o rr) s o @ ol o (v) o o o_ N lo o. (\t ot + o) F- c\i c.i c\t l! @ lu o o o o o o o o lo ro o o o o o o ro s o)- I t- (t) o- N- o |r) (f) lr) (r, z r{. (o t .+ t' N 3 e.i d t' 6at $t @ CD (D o o o o o (v) I @ o o o o loo o o (o o) @ (9 o_ o tf, o s o o N. @- o (o o N \i o e.i (f) 1I) N = (o I\ o o o o o o o o o o lr) o o o o o o o |r) o (o I ro- o o o t t- s $ o. (o N o $ o, s d d (V) oi (Y) rt N o (\t @ N I l! (o o o CD o uJ o o o o o o o t* I\- o o o o o o N o loo o s o o o o N o $ o (o @ z N lo (f) F- o (Y) ro o o N (r) aqt = a,o c, $ (o o o o o o rr)o r, N ro (r) o o o roo o o lo o @ o N t* s o o (o @_ .t @ a N ro (o ni d (o .t d (o \l = ro F N N U (o (l o o o N o o o o $ t- 1r) lo t- o o o o o @ o I o (r) o r* s tr o- (o o o o) ti d od (o \rr (ft d (o $ oi t C\l 6l oi N rrro +, (, lt o o t U) uJ o o o o o o o t* (.r- o o o N o o o (o_ s 1' o ro c, o o F- o lo o (o rt (ft rt (o a) z oi -f rt rt ri (f) (a E = L (f) o (f) o 6 I o o o o o N a s (f) c) o (o o rr) o s s o o o o lr, o (o_ ro o) (\to (o d (f) L o d o F- o @ (r) L = to N N a o o ro o N o o o o s o, lr) F- o N o o o o o N s o @ N o o ro_ o o o r- o o. o (\l ro (o (f) o, lr) + itt r{. (o c{ s c\i (o lr o o o (\ta) uJ o o o o o o @ o o o (t)o c{ o o o o or- \r- o{ N lo t- s I o o (o O) d z d F F s (fJ ai s l.r) @ 3 01I (r) t- C\t o |r) o o o o o o o o - @ o @ lo @ lf, @ o ro N (x)o (o (o o s o o $ @- @- N (f) N lf) $ lo (o @ (o @ (o = $ @ N N o o o o ol o o o o rt o(o ro lo rl) t- @ o o r{) o |r, o lr)_ o o o t* s o. @- @ o (ft @ o lo- (o to c.i ui N rr) v @ c\i rt (f) N N N E o >oc o a c o .l c o tr o o oti c G o _L E' e0 J G E tr .9 L E c o J o .Ea o= (, LE CL B, 'a'5 -cL c 9E ES o o oo 9, CL G (! c .gEL .s EE o .E ET o x o m= o. OUJ o= ES 8E o UI 66 F s EE Bauchi State Year 1 Budget Year: 2000 $1.00 US : 80 Naira Budget Line APOC MOH UNICEF Total Item Personnel 4,650 45,582 50,232 Capital 80,550 '1.4,200 10,000 1o4,750 Equipment Supplies 2,150 5,495 1,910 9,545 Training 45,O72 8,800 '1.,400 55,272 Education/ 31,590 1,650 1,200 34,430 Mobilisation Travel 26,000 26,610 14,300 66,910 Communication 5,800 18,660 3,720 28,'1,90 Consultants 2,000 3,000 5,000 External Audit 1,650 450 2,700 Other Expenses 25,704 6,200 5,000 36,904 Total 223,506 l2g,g37 33,790 386,723 % Input 58% 3s% 9% 1,00% Cost per dose: $.65 46 Bauchi State Year 2 Budget Year: 2OOl $1.00 US : 80 Naira Budget Line APOC MOH UNICEF Total Item Personnel 4,650 50,140 54,790 Capital 40,275 40,275 Equipment Supplies 2,000 6,033 2,500 10,533 Training 45,O72 10,000 4,000 59,072 Education/ 31,580 7,500 3,000 42,O80 Mobilisation Travel 26,000 26,610 15,000 67,6'l.0 Communication 4,000 20,000 3,720 27,720 Consultants 2,000 3,000 5,000 External Audit 1,650 450 2,'l.oo Other Expenses 13,704 8,500 5,000 16,400 Total 769,291 1,30,423 36,670 336,374 % Input 50% 39% tt% 100% Cost per dose : $.34 47 Bauchi State Year 3 Budget Year: 2OO2 $1.00 US = 80 Naira Budget Line APOC MOH UNICEF Total Item Personnel 4,650 55,154 59,804 Capital Equipment Supplies 2,150 6,636 2,000 10,786 Training 40,072 12,500 5,000 57,572 EducatiorV 28,300 10,000 3,000 41,300 Mobilisation Travel 26,O00 26,610 17,000 69,610 Communication 4,000 24,OOO 3,720 31,720 Consultants 2,000 3,000 5,000 External Audit 1,650 450 2,1o0 Other kpenses 1,3,704 10,200 5,000 28,904 Total 1,20,876 146,750 39,170 306,796 % Input 397o 48% t3% too% Cost per dose: $.28 48 Bauchi State Year 4 Budget Year: 2OO3 51.00 US = 80 Naira Budget Line APOC MOH (INICEF Total Item Personnel 4,650 60,669 65,379 Capital Equipment Supplies 1,500 7,299 2,750 '/..1,549 Training 20,000 '/..2,600 4,350 36,950 Education/ 15,000 14,300 4,100 33,400 Mobilisation Travel 16,000 1 1,000 11,000 38,000 Communication 3,200 10,000 4,200 17,400 Consultants 2,000 3,000 5,000 External Audit 1,650 450 2,100 Other Expenses 3,400 12,500 4,300 20,200 Total 65,750 130,018 34,'/..50 229,918 % Input 29% 56% t5% 1,OO% Cost per dose = $.16 49 Bauchi State Year 5 Budget Year: 2OO4 $1.00 US = 80 Naira Budget Line APOC MOH UNICEF Total Item Personnel 4,650 66,735 71,385 Capital Equipment Supplies "1.,200 8,028 1,350 1o,578 Training 9,000 20,000 2,loo 31,100 Education/ 2,300 16,000 2,000 20,300 Mobilisation Travel 7,000 17,000 7,000 31,000 Communication 2,100 10,000 3,000 15,100 Consultants 2,000 3,000 5,000 External Audit 1,650 450 2,'].,00 Other kpenses 1,000 9,500 2,'l.oo 12,600 Total 29,250 148,913 21,000 199,163 % Input t5% 75% to% too% Cost per dose : $.12 50 Budget for Bauchi State CDTI, 2OOO-2OO4 Introduction The budget for the Bauchi State programme reflects the concern to address the problems that IDPs have faced in the state since their inception. These problems include lack of commitment by state and local governments, and lack of sufficient input from the supeMsing Intemational Agency. The resulting lack of sufficient training for programme personnel, and lack of supervision by the agencies hvolved, had led to problems of accountability, and administration of the programme by personnel wtro lacked the requisite skills to conduct it effectively. Consequently, this budget has a relatively high expenditure on advocacy, on training, and on health education and mobilisation in the affected communities. The number of training sessions has been doubled, as it is felt that only in this way can the problem of lack of trained personnel be overcome. Training and re-training of CDDs twice annually will help to cushion the effect of high turnover rates among the CDDs. Zonal Office Staff will participate in the programme in nearly all aspects for the first few years, to give more supPort to programme activities at all levels. It is expected that the intensive education and mobilisation of the affected communities will create the basis for the sustainability of CDTI in those communities. 51 1. Personnel The budget for personnel reflects the need for staff at various levels (Agency, SMOH, and Local Government) to support the activities of the CDDs and the VHCs in the affected communities. Community Directed Treatment requires the support given by the MOH and Local Govemment health staff, as well as those of the NOCP Zonal Office. These staff will provide the important functions of: o initial advocacy and mobilisation of relevant authorities; . . mobilisation and health education in the communities, as well as sensitising the public at large on the aims of the programme; ' . aiding the communities in the organisation of the distribution programme, including incorporation of the community's input on the organisation of the programme; o training of CDDs and other village level health workers, and those to be involved in monitoring and supervision at the community level; getting the drug to local pick-up points; . transportation of other essential supplies; " . ensuring proper supervision of drug distribution, and helping to solve problems associated with this; . ensuring proper record keeping and accountability; . accounting for funds spent, including those from APOC; - . participating in the evaluation of programmes and helping to provide feedback to local communities so that problems associated with the distrhution of the drug can be speedily rectified. AII of the staff at the state and local government level are already in place, as are those in the Zonal Office. Many communities already have VHCs in place, and functioning PHC centres and staff. It is expected that in the first few years of the programme, health professionals at all levels will be involved in most asPects of the - CDTI. However, by the third/fourth years, this involvement will decrease as the community takes on more responsibility for running the programme. 52 Line Item - Personnel Position Source Annual Number of Total Salary E:glanation Benefft Staff 1 State Co-ordinator SMOH 1.200 I 1.200 Full time position 2. State Oncho Control SMOH 1,000 4 4,000 Full time position Team (SOCT) 3. PHC Director SMOH 1,800 I 420 Part time position (257o) 4. PHC Deputy Director SMOH 1,200 I 240 Part time position (20%\ 5. Driver SMOH 600 1 600 Full time position STATE Sub-Total 6.242 6. LOCT leader LGA 1000 13 13.000 Full time position 7. Local Government LGA 600 l3x3 23,400 Full time, with PHC Oncho Control Team activities (LOCT) 8. LCA PHC Co-ordinator LGA 1.200 Yn xl3 3.900 Part time (25%) LGA Sub-Total 39.300 mOH TotaJ wffi APOq 1.:.... : 9. Zonal Co-ordinator APOC 600 1 600 Part time (20%) 10. State Co-ordinator APOC 1200 1 1200 Management allowance 11 State Oncho Team APOC 600 4 2400 Management allowance 12. Driver (State) APOC 450 1 450 Managerial allowance AFOC Total 4.,68o Cournrurritf, (for fr4{yiIH+$l giil* 13. CDD Community 10 2336 23,360 Part time position 1 CDD per 250 DOD. ,:;l**r*6b1 53 2. Capital Equipment The programme requires a relatively high capital budget to put essential facilities in place, as these have been . sorely lacking in the past. The capital equipment requested is designed to facilitate the work of MOH and other staff involved in all aspects of the project. It will do this by: providing mobility (vehicles, motorcycles); . equipping staff with communications facilities (such as faxes, phones, e-mail, etc.) . . facilitating accurate and efficient record keeping and data analpis through the use of computers; providing means of mobilising and advocacy using TV/VCRs; r training equipment (projectors, writing boards). The request for provision of basic infrastructure such as generators, electrical connections, and security devices reflects the lack of these essential items at present. Expenditure on capital items is concentrated in the . first two years of the programme. Once the equipment and facilities are in place, proper maintenance should ensure they can be used for the life of the project. 54 . Line Item - Capital Equipment ItIini*W of Heailth'* SfAUc E:rpense Item Souree Unit cost Number of Total Cost E:rplanation (Inits I Office fwniture/security SMOH 2,000 1 1,200 Furnishing of office and provision of security for state office STATE Sub-Total 1.200 lvlinistry qf Haatth * ilGfi, 1 Office SMOH 1,000 13 13,000 Provision of office sp ac ef urniture/sec urity (LCAs) space and furniture for each endemic LGA LGASub-Total 13,000 MOH Tntal...... ,,....,,,.,. 1., : .:r...:.r.r'... i.r..r.r" rd':lorl UHICEF 1 Vehicle (used) UNICEF 1,000 1 1,000 State traveV transportation 2. Motorcvcles (used) (lNICEF 300 6 1,800 State transportation 0NICEF Total 4.ppo AFOSi',,i,,,":' 1 Vehicle (new) with APOC 27,OOO 1 27,OOO Trave/transport for securitv svstem state office 2. Computer desktop APOC 2,000 I 2,000 Data entry and with software- analysis, reports, accounts state office- 3. Printer APOC 800 'l 800 Printing of documents 4. Computer - laptop, with APOC 2,000 1 2,000 Data entry and software analysis for Zonal Office 5. Photocopies + APOC 1,500 I 1,500 Duplication of accessories and parts documents 6. Fax machine APOC 1,000 1 1,000 Communication to NOCP Abuja and Laqos 7. Air conditioner APOC 1,000 1 1,000 Conducive work environment 8. TV//CR APOC 1,000 1 1,000 Field advocacy/ mobilisation visits 9, Motorcycle APOC 2,500 13 32,500 LOCT field work including supervision and monitoring (1 for each LGA) 10. Motorcycle storage box APOC 100 13 1,300 Carrier box for Mectizan@ forms and other materials 55 11. Portable generator APOC 2,000 1 2,000 For state advocacy and mobilisation visits and traininq 1,2. Writing board APOC 500 1 500 Presentations t' trainino for state 13. Overhead projector APOC 750 1 750 Presentation t' traininq for state 74. Bicycle APOC 100 52 5,200 Mobilisation E' (4 per LGA) training of CDDs, distribution of druo lP*gg Total ' '1. 8CI;5.S0 56 3. Supplies Consumable supplies are essential to the running of the programme, despite their relatively high cost. The MOH at all levels provides general office supplies such as papet, pencils, pens, fasteners, file folders, ete. However, the greatly expanded reporting requirements of the CDTIs will necessitate many more than are normally used at present. High-cost consumables such as toner cartridges for photocopiers and computer printers, computer diskettes, etc. are being requested from APOC to enable the effective use of the capital equipment being requested. Calculators are also requested to enable staff to ensure accuracy in accounting and data calculations. 57 Line ltem -Supplies E:rpense ltem Source Unit cost Number of Total Cost Enplanation (Initg 1. Paper SMOH 5.00/ream 50 250 Printing of reports and documents 2. File folders SMOH 1.00 650 650 Storage/ organisation of documents 3. Pens/pencils SMOH .50 650 325 Record keeping E writino of reports 4. Fasteners/punches SMOH 1.00/set 200 200 Orqanisation of files 5. Notebooks SMOH 2.50 30 75 Note taking t, drafting of documents 6. Writing tablets EMOH 2.50 30 75 Drafting of reports t' documents 7, Etaplers t' staples SMOH 5.00 2 10 Stapling of documents STATE Sub-Total 1.585 Ministry of Health . -.,LGA.,,.,t.-.. " 1 Paper LGA 5.OO/ream (130) 650 Printing of reports 10x13 and documents 2. File folders LGA 1,00 1,300 1,300 Storage/ (100x13) organisation of documents 3. Pens/pencils LGA .50 390 195 Record keeping E (30x13) writina of reoorts 4. Fasteners/punches LGA 1.00/set 390 390 Oroanisation of files 5. Notebooks LGA 2.50 260 650 Note taking E (20x13) drafting of documents 6. Writing tablets LGA 2,50 260 650 Drafting of reports 6 documents 7. Etaplers €' staples LGA 5.00 13 65 Stapling of documents LGASub-Total 3.900 IiIOH Tota] , SCtE qNICEF I Paper UNICEF 5.0O/ream 30 150 Printing of reports and documents 2, File folders UNICEF 1.00 300 300 Storage/ organisation of documents 3. Pens/pencils UNICEF .50 100 50 Record keeping €, writinq of reDorts 4. Fasteners/punches UNICEF 1.00/set 100 100 Orqanisation of files 5, Notebooks UNICEF 2.50 30 75 Note taking €' drafting of documents 6. Writing tablets UNICEF 2.50 30 75 Drafting of reports t, documents 7. Staplers E, staples UNICEF 5.00 2 10 Stapling of documents 58 8. Toner cartridge for laser UNICEF 80 5 400 Printing of Drinter documents 9. Toner cartridge for qNICEF 75 10 750 Duplication of ohotocopier documents UHICEF Total 1.910 AFOC 1 Computer diskettes APOC 2Obox 20 400 Storage of comouter files 2. Toner for laser printer APOC 80 5 400 Printing of documents and reDorts 3, Toner for photocopier APOC 75 10 750 Duplication of documents 4, Printer ink APOC 30 10 300 Printing of computer work 5. Calculators (state) APOC 15 20 300 Data calculation 6 accounting functions APOC' tqtHjiiiiititr:r:i:i:,:,: .'ill't,,fifl TOTAL #*lfrll$ COMMUNITY I Measuring sticks for Community 2 2336 4,672 Dose measuring dosino sticks 59 Training As previously noted, it is felt that sufficient training and re-training is the key to success in the Bauchi State programme. Consequently, the number of training sessions for each cadre of personnel has been doubled to two a year, in addition to special training programmes (such as on MIS, etc.). Although training is a costly exercise, especially where the distances are great and the number of people involved high, it is absolutely essential to impart skills that can keep the programme going once APOC funding and external supervision is withdrawn. 60 Line Item -Training fiIinistrv of ,,Hsalfti."i* $.tf,fie' ' t tl E: 1 CDD Training Workshop LGA 300 26 7,800 Facilities and -3daw refreshments LCiASub-Total 7.800 FIOI{Total 4.800 UNICEF 1 State Co-ordinator UNICEF 400 1 400 Facility t' Management Workshop refreshment for Management Training Workshop for Co-ordinators 2, Retraining of LOCTs UNICEF 1000 1 1000 Technical6 Workshop management traininq for LOCTs UNICEF'Total 1.400 AFOC ,l Computer training APOC 200 4 800 GIS/MIS computer traininq of staff 2. State Technical APOC 1000 2 annually 2,000 Technical training Workshop workshop for co- ordinators 3. LOCT training/retraining APOC 39 LOCTs x 2 annually 6,240 Training of new workshop $20 x 4 days LOCTs and retraining/ reorientation of existinq ones 4. CDD Training 6 APOC $Tperson for 2336 CDDs 28,O32 Training of CDDs in Retraining 3 days x 2 trainings communities Der vear Printing of Training & Field l4aterials 5. Trainers Flip Chart APOC 25 50 1,250 Visual aid for traininq 6. Trainers Curriculum APOC 5 50 250 Curriculum guide Guide for trainers 7. SOCT/LOCT Field Guide APOC 5 100 500 Reference guide for SOCTs and LOCTs 8. CDD Field Guide APOC 2 3000 6,000 Field reference for CDDs (Extra copies required due to turnover in CDDs) AF,OC Total ,\,i t 949fi72 61 CornmuiiriW 1 Community training Community 2/year 2336 CDDg 2336 Community support support for CDD training t' transDort Gsmmtmitr TCItat #4&12 62 5. Education t, Mobilisation The support of government at all levels, and the support of the wider populace, is an important factor h the conduct of an effective ivermectin distribution programme. This is especially true in the new democratic dispensation in Nigeria, where elected and state and local government officials will be responsible for deciding on budgetary allocations for the health and other sectors. Hence intensive advocacy, education and mobilisation will be necessary if the government is to fulfil its obligations to the programme, financially and in other aspects of support such as releasing personnel, logistics, etc. Although advocacy, education and mobilisation activities will be concentrated in the first few years of the programme, they will need to continue throughout its duration, as changes in personnel and administrations bring in new individuals who also require to be mobilised and educated. At the community level, it is obvious that intensive mobilisation efforts will need to continue long after the life of the APOC-sponsored programme if the effective distribution of the drug is to be carried out for the required number of years before the disease is controlled. 63 6. Line Item -Education/Mobilisation ,'linistsv of Hcalth * S,rirfd E:rpense I tern/Activity Source Unit cost Number of Total Cost E:rplanation descriotion (Inits 1 State Training sMor-y 400 % 200 Facilities/ Orientation (lNICEF refreshments for workshon 2. Oncho DayActivities SMOFV 500 % 250 Media coverage and UNICEF supporting services: 50% sMoH, 50% UNICEF 3. LGA Training Orientation SMOI-V LGA 1000 Yz 500 Provision of facility t' refreshments: 50% sMoH, 50% LCAs STATE MOH Sub-Total 1,000 Ministry of Hcattrr ;'tk&trd 1 LGA Training Orientation LGA/UNICEF 1000 Y2 500 Facilities and refreshments 2, Oncho DayActivities LGA/ SMOH 300 % 150 Media coverage €' supporting services: 5O7oLQA,5O7o SMOH LGA Sub-Total 650 ,IIOH Total I,6EO UNICEF I Zonal Training FMOI-y 500 % 250 Facilities and Orientation ONICEF refreshments for workshops; press coverage, presentations. 2. Oncho DayActivities SMOFY 500 % 250 Media coverage 6 UNICEF support; 50% sMoH,50% UNICEF 3, State Training UNICEF/ 400 % 200 Press coverage/ Orientation SMOH presentation materials 4. LCA Training Orientation UNICEF/LGA 1000 % 500 Press coverage/ presentation materials ONICEF Total 1.200 APOC 1 Advocacy Workshop - APOC 1000 1 1,000 To sensitise policy State makers at state government level on problems of Oncho 2, Advocacy Workshop - APOC 1000 2 2,000 To sensitise policy Local Governments makers at local government level on problems of Oncho 64 3. Press Kit for State level APOC 10 300 3,000 lnformation packet for media practitioners Printing of Training and Field mateials 4. Heahh Education APOC 5 2,000 10,000 Health education Flipcards visual aids 5. Health Education Poster APOC 1 2,500 2,500 Health education visual aids, primarily for communities 6. Brochure APOC I 2,000 2,000 lnformation for schools and public education 7. Stickers with messages APOC .5 2,000 1,000 For Oncho workers at state, local government and community levels - for public education and awareness 8. T-shirts with printed APOC 3 2,000 6,000 For use by field messaoe3 workers 9. Calendar APOC 4 1,000 4,000 For distribution to oDinion leaders 10. Painted logo for APOC 4 20 80 To create public motorcycle storage interest and boxes awareness APOC To'tal s31,5gO EornrmrniW 1. Community educatiory' Community s10/ 954 9,54O Community mobilisation community discussion and decision makinq ConnntmltsTotdl #8.5r$0 65 6. Travel Mobility of staff is crucial in onchocerciasis control programmes, given the fact that most endemic communities are found in remote areas. Travel is also very costly, from expensive air fares, to vehicle maintenance and fuelling, and high costs for even local travel by public transportation. But there is no alternative to devoting funds to this necessary activity, since travel by personnel at all levels is necessary for advocacy visits, REIVIO and other assessment, training, retraining, supervision and monitoring, evaluating programmes, as well as collection of the drug by affected communities and returning records of distribution, etc. In fact, virtually every aspect of the programme requires travelling, usually over long distances and difficult terrain. In a state like Bauchi, wtrich is extremely large, and with a large population, the budget for travel is one of the essential aspects of the programme, and one wtrich requires APOC assistance due to its very high cost. 66 Line ltem -Travel IIini slry of t{saltl} *+: $.tate E:rpens e I tem/Activity Source Unit cost Number of Total Cost E;rplanation description (Inits I Vehicle maintenance SMOH 2,OOO/yr, t 500 Servicing, replacing parts, tyres, tubes; 25%time for oncho use 2. Vehicle fuelling SIvIOH 2,400/yr 1 600 Fuelling of vehicle for supervision, training, etc. 3. Motorcycle maintenance SMOFYLGA 5OOlyr l3 3,250 Servicing, tires, (new) tubes, etc.(5O%MOH,50% LGA) 4. Motorcyrcle maintenance SMOI-YLGA 5OO/yr 6 1,500 Eervicing, tires, (old) tubes, etc. (5O%MOH,50% LGA) 5. Motorcycle fuelling SMOI-YLGA 30O/yr 13 1,950 Fuelling of motorcycle for supervision, training, etc. (50%MOH,50% LGA) 6. Motorcycle fuelling (old) SMOI-VLGA 30O/yr 6 900 Fuelling of motorcycle for supervision, etc. (5O%MOH,50% LCA) 7, Public transport SMOH 50o/yr I 500 Travel bytaxi, car, bus, etc, for oncho activities 8. Accommodation SMOH 1000/year 1,000 Lodgrng for oncho staff on field duties 9. Per diem travel allowance SMOH 300/yrlLAA 13 3,900 Feeding and incidentals 10. Re gistration/insurance of SMOI-YLGA 1O/yrlcple 19 95 Third party liability/ motorclrcle renewal of registration (5O%MOH,50% LGA) 11. Registratiory'insurance of SMOH 1OO/year 1 100 Third party vehicle liability/renewal of reqistration STATE MOH Eub-Total s14.295 I Motorcyrcle maintenance SMOI-VLGA 5OO/yr 13 3,250 Servicing, tires, (new) tubes, etc. (50%MOH,50% LGA) 2. Motorcycle maintenance SMOI.YLGA 5OO/yr 6 1,500 Servicing, tires, (old) tubes, etc. (50%MOH,50% LGA) 67 3. Motorcyrcle fuelling (new) SMOFYLCA 3OO/yr l3 1,950 Fuelling of motorcycle for supervision, training, etc. (50%MOH,50% LGA) 4. Motorcycle fuelling (old) SMOFYLGA 30O/yr 6 900 Fuelling of motorcycle for supervision, etc. (50%MOH,50% LGA) 5, Public transport LGA 2OO/yr I 200 Travel by taxi, car, bus, etc. for oncho activities 6. Accommodation LGA 1OO/year per 13 1,300 Lodgrng for oncho LGA staff 7. Per diem travel allowance LGA 200lyrlLCA 13 2,600 Feeding and incidentals 8. Re gistration/insurance of SMOI-VLGA 1O/yrlcyrcle 19 95 Third party liability/ motorclrc'le renewal of registration.(50% MOH.50% LGA) 9. Bicple repair €' LGA ro/w 52 520 Maintenance, maintenance replacement of tires. tubes. etc. LGA Sub-Totat 12.31,5 llIOH Total $28.6[O UMCEF 1. Vehicle Maintenance UNICEF 200/month t2 2,400 Eervicing, tires, tubes, etc. 2. Vehicle fuellino UNICEF 200/month t2 2.400 Fuellinq of vehicle 3. Air travel, domestic UNICEF 200/trip 20 4,000 Travel within Niqeria 4. Air Travel, international UNICEF 2SOltttu 2 500 International travel 5, Public transport UNICEF 10/trip 100 1,000 Travel by taxi, bus, etc. 6. Per diem allowance UNICEF 100/day 40 4,000 Feeding and incidentals (international and domestic) GNICEF ?otal s14.300 APOC 1 Vehicle maintenance APOC 2,OOO/yr I 2,000 Servicing, tires €, (new) tubes. etc. 2. Vehicle fuellinq (new) APOC 2.OOO/w I 2.000 Fuellino of vehicle 3. Repair of existing Toyota APOC 2,000 I 2,000 Repair of existing Hi-Lux faulty vehicle to facilitate travel in the state 4. Vehicle fuellinq (old) APOC 2.000/w 1 2,000 Fuellinq of vehicle 3. Air travel, domestic APOC 10O/trip 30 3,000 Travel within the countrv 4. Travel allowance APOC Part funding 5,000 Eryenses incurred during travelling, including visits of National Co- ordinator and other headquarters staff 68 Comnriffity I Public transport Community t5l 954 14,310 Transport for community CDDs for training and drug collection and retirement Cora'rnurrifv-T6taI *t4-8ts 69 7. Communications Efficient means of communication are essential for the implementation and sustaining of the programmes. The bulk of the communication expenses are being borne by the communities, UNICEF and the MOH. APOC is being requested to provide funds for courier pouching of urgent documents, as well as e-mail facilities for the Zonal Office. 70 Line ltem -Communications E:rpens e I tern/Activity Source Unit cost Number of Total Cost Enplanation descriptlon (Inits 1 Telephone/fax SMOH 2OOlmo t2 2,400 Communication to ZonelUNICEF/ NOCP Headouarters 2. Courier pouch SMOH 1OO/month t2 1,200 Urgent documents to field 3. Regular mail SMOH 2Olmonth 12 240 Not urgent documents to field STATE MOH Sub-Total s3.840 Ministrr of Hc*lfit ; htiit 1. Telephone/fax LGA 50/month l2xl3 7,800 Communication to ZonelState/ UNICEF/ NOCP Headquarters 2, Courier pouch LGA 25lmonth l2xl3 3,900 Urgent documents to field 3. Regular mail LCA 2Olmonth l2xl3 3,120 Not urgent documents to field LGA Sub-Total 14.820 IIIOH'Total *t8r66O (IMqEF 1. Telephone/Fax UNICEF 200/month t2 2,400 Communication to StatdZone/NOCP headquarters 2, Courier Pouch UNICEF 10O/month t2 1,200 Urgent communication to field 3. Regular mail UNICEF 1O/month t2 120 Not urgent communication to field UNICEF'Total s3.?ZO APOg 1 lnstallation of e-mail APOC 1,000 I 1,000 Rapid facility for Zonal Office communication Iocally and internationallv 2. Maintenance of e-mail APOC 2OOlmonth lxl2 2,4OO Rapid facility for Zonal Office communication locally and internationallv 3. Courier Pouch APOC 200/month 12 2,4OO Urgent documents to field APOC Total ,.,,,',:.i ' SSr80O 71 Communltv 1 Support of town crier Community tO/yr 954 9,540 Communicate information to community members 2, Messenger to LGA Community 20lyt 954 19,080 Communication with LGA headquarters and State office Lo^tirntuii-fr:'f,*ital 8.*&r&*g 72 8. Consultants Consultants will be utilised for such specialist tasks as computer maintenance, and for consultancy in the area of health education, to help in the development and refinement of health education and other materials. Consultants will also be involved in programme evaluation. APOC is being requested to share in some of these costs, part of uhich will also be borne by ONICEF. 73 Line ltem -Consultants E:rpens e I tern/Acttvity Source (Init cost Number of Total Cost Enplanation description Units 1 None anticipated at Dresent STATE MOH Sub-Total Mlnlstrvof H*alth LGA 1, None anticipated -at Dresent LGA Sub-Total IIIOH fqtal TIHTCEF 1. Evaluation team UNICEF 50/day 20 1,000 Payment for members evaluation team 2. Computer consultants UNICEF 1,000/yr 1 1,000 Computer up- dating and maintenance of software 3. Health Education UNICEF 1,000/yr 1 1,000 Re-working of Consultants existing health education materials and production of new ones. UNICEF'Total $3lxlo $ears 1-5) Apoc 1 Computer consultant APOC 1,000/yt 1 1,000 Updating of software, computer maintenance 2. Health education APOC 1000/yr 1 1,000 Refining of consultants materials t,, .,*2i100i.D.,' f#|of,:'y5* '|. *#jffiHilliiii:iili Community None anticipated presentlv x,,o-*mrntml&'rCItal. 1., 74 9. External Audit . Auditing by internal and extemal firms and individuals is required in order to ensure that funds are disbursed as budgeted, and that full accountability is to be assured. The MOH and all other agencies involved are to bear the costs of their auditors. APOC is requested to bear the costs of its own extemal auditors. 75 Line ltem Audit -External Itlinisinr of tlralth * Eltate Enpense ltern/ActMty Source qnit cost Number of Total Cost Enplanation description (Intts 1 State Accountant SMOH 30/day 5 150 State member of audit team STATE MOH Sub-Total s150 Minist{$ of Hcalft * LSilt 1 LCAAccountant LGA 20/day 5 daya x 13 1,300 LCA member of audit team LGA Sub-Total 1.300 Federal ilIitrietrr'of Hcatrfr ' ..:: ::' 1 Zonal Accountant FMOH 40/day 5 days 200 Zonal member of audit team F|4QHSub=Iotal 200 ItlO-H Tstal 81.650 UNICEF 1 UNICEF Accountant UNICEF 90/day 5 450 UNICEF member of audit team ONICEFTotal $450 76 10. Other Expenses Other expenses include such items as office utilities (to be borne by Agency/MOH), and costs of development and maintenance of MIS (wtrich is being requested to be shared by APOC with UNICEF). lncluded here also are printing of essential reporting forms in sufficient quantity. These forms are the basis of information reporting in the programme at all levels. In the past, shortages of these forms has been a major impediment to reporting and collection of accurate data. Operational Research (described in Sec. 3.3 of the Proposal) is also being included here. 77 11. Line ltem Enpenses -Other Itliniatrn of tlcriltft ,.,r.' State E:rpens e I tern/Acfivtty Source Unit cost Number of Total Cost E:rplanation descrlptlon (Idts 1. Office utilities SMOH 1000/yr I 1000 Electricity/water and other utilities; upkeep STATE MOH Sub-Total s1.000 I[inistryof l{ealB tGA I Office utilities - LGA 4OOlyr 13 5,200 Electricity, water and other utilities; upkeep of office facilities LGA Sub-Total 5.200 IIOfIT6tal 86,2M UT{rcEF 1 Office utilities UNICEF 1,000/yr 1 1,000 Office upkeep and utilities 2. Management lnformation UNICEF 2,OOO/yr 1 2,000 Development and Svstem maintenance of MIS 3. Geographical UNICEF 2,OOO/yr 1 2,000 Geographical lnformation Sristem mappino of data UilICEF,Total $s.ooo AFOg 1 Management I nformation APOC 500 1 500 Development/ s\Btem for state level maintenance of MIS 2. Operational Research APOC 12,000 1 12,000 See Sec. 3.3 - Research to ascertain problem of treatment in Fulani pastoral communities 3. StatdLGASummary APOC .5O/form 50x13 325 Compilation of forms reports to NOCP 4, CommunitySummary APOC .501 954 477 Etandard summary Forms community form for literate community reDorters 5. Low-literate Summary APOC .50/ 954 477 Pictorial form for form community low literate areas, back up for community summary forms 6. Household cards APOC .05/card x 954 11,925 1 card per 250 household for 10 households years per communitv AFOC Total g%.roi{ iafi'!ff,ffiliiiii:ii:illltlill, 78 trotnmunity 1' Communitylog book Community 5/book 954 4,770 Hard cover log book for 10 vears Cormnunlft 1r;rtf6tffif ;,;,,,,: #1,7rfi 79