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NATIONAL ONCHOCERCIASIS TASK FORCE NIGERIA.

ORIGINAL: English

C O UN TRYAI O T E :NIGEXI,4 Proiect Name: PZT4TEAa

Approval vear:1997 Launching yearz 1998 Reportins Period: From:l't June 2004 To:31't May 2005 (Month/Year) (Month/Year) Proiectyearofthisreport: (circleone)l 2 3 4 5 (6)7 8 9 10

Date submitted: 24th Aug. 2005 NGDO oartnerz Global 2000

ANNUAL PROJECT TECHNICAL REPORT SUBMETTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)

AFFICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)

WHO/APOC, 24 November 2004 au-il, wc5D (EvAt'ttr Brn B€o t"L) 3 i:., Il( 1 2 grP lilir Av A*I\l,"L t) ENDORSEMENT

Please r;o rl ,t r rrl: i lta,,e rearithir; report by signing in the Aplrropriate Space. tr' 0:rr1 :t(S T0 Sl(iN THE REP0RT

Country: NIGERIA \ ,i\ \!\ { \ q National Coordinator: Nam e: ')

Signatu S s Date.. 3 J-c

.,r Zonal Onchrl, Coorrlinator: Narne: / r\ Itii<77i (.'-) '6, 1t', Lt. fi', r1i).C i -

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NGD0 Repnrsentative Narn': .7n o,J {c' L{n'{ru

Signature..., /) Date ol: s"'L""""' lus

This report has been preparr,d ll1 Name: HEN

Sigrrature

Date...... n/*tr

lt TABLE OF CONTENTS

ENDORSEMENT PAGE TABLE OF CONTENTS

FOLLOW UP ON TCC REGOMMENDATIONS...... EXECUTIVE SUMMARY SECTION 1: BACK GROUND INFORMATIONS...... 1.1 GENERALINFORMATION...... 1.1.1 Description of the project (briefly)... 1.1.2 Partnership. 1.2 POPUl3TtON...... SECTION 2: IMPLEMENTATION OF CDTI.... 2.1. TIMELINE OF ACTIVITIES...... 2.2. ADVOCACY 2.3. MOBILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES......

2.4. COMMUNITY I NVOLVEMENT... 2.5. CAPACITY BUILDING.. 2.6. TREATMENTS...... 2.6.1 Treatment figures... 2.6.2 Causes absenteeism 2.6.3 Reasons for refusal... 2.6.4 Serious adverse events (SAEs)... 2.6.5 Trend of treatment achievement from CDTI project inception to the current year 2.7 ORDERING, STORAGE AND DELIVERY OF IVERMECTIN...... 2.8. COMMUNITY SELF - MONITORING AND STAKEHOLDERS MEETING...... 2.9. SUPERVISION...... 2.9.1 Provide a flow chart of supervision hierarchy... 2.9.2 What were the main issue identified during supervision? 2.9.3 Was a supervision checklist used?... 2.9.5 Was feedback given to the person or groups supervised? 2.9.6 How was the feedback used to improve the overall performance of the project?. SECTION 3: SUPPORT TO CDTI. 3.1. EQUtPMENT...... 3.2, FINANCIAL CONTRIBUTION OF THE PARTINERS AND COMMUNITIES 3.3 OTHER FORMS OF COMMUNITY SUPPORT.... 3.4 EXPENDITURE PER ACTIVITY... SECTION 4: SUSTAINABILITY OF CDTI.... 4.1.1 INTERNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATION 4.1.2 Monitoring/evaluation... 4.1.3 Recommendations... 4.1.4 lmplementation of Recommendation... 4.2. SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS 4.2.1 Planning at allrelevant levels... 4.2.2. Funds... 4.2.2 Transport (replacement and maintenance)... 4.2.4 Other resources... 4.2.5 To what extent has the plan been implemented ...... 4.3 INTEGRATION...... 4.3.1. lvermectin Delivery Mechanisms 4.3.2. Training:... 4.3.3 Joint supervision and monitoring with other programs... 4.3.4 Release of funds for project activities...

lll 4.3.5 ls CDTI included in the PHC budget?... 33 Describe other health programmes that are using the CDTI structure and how this was 4.3.6 achieved?... 33 4.3.7 Describe others issues considered in the integration of CDTl... 33 4.4 OPERATIONAL RESEARCH... 33 4.4.1 Summarize in not more then one half of a page the operational research undertaken in 33 the project area within the reporting period? 4.4.2 How were the result applied in the project? 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES...... 34 SECTION6: UNIQUE FEATURE OF THE PROJECT/OTHER MATTERS.. 35

lv Acronyms ARVs At Risk Villages APOC African Programme for Onchocerciasis Control CDDs Com munity Directed Distributors CSM Community Self monitoring CDTI Community Directed Treatment with lvermectin DHS District Health Supervisors FLHF First line health facility GRBP Global 2000 River Blindness Program LOCTs Local Onchocerciasis Control Team Members LFEP Lymphatic filariasis Elimination Program LF Lymphatic filariasis LGA Local Government Area LGC Local Government Council MDP Mectizan Donation Program MEC/AC Mectizan Expert Committee/Albendazole Coordination MOH Ministry of Health MSD Merck Sharp and Dohnme NGDO Non Governmental Development Organization NPI National Programme on lmmunization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PA Project Administrator PHC Primary Health Care SHM Stake holders Meeting SMOH State Ministry of Health SOCTs State Onchocerciasis Control Team Members RBM Roll Back Malaria RBF River Blindness Foundation SVE Sentinel Village Evaluation SPO State Project Officer SPC State Project Coordinator UNICEF United Nation lnternational children educational funds WHO World Health Organization.

v Defin itions (i) Total population: The total population living in meso/hyper - endemic communities within the project area (based on REMO and census taking) (ii) Eliqible population: Calculated as 84o/o of the total population in meso/hyper- endemic communities in the project areas.

( iii) Annual Treatment Obiective: (ATO); The estimated number of person living in meso/hyper-endemic areas that a CDTI project intends to treat with lvermectin/Albendazole in a given year. (iv) Ultimate Trea nt Goal (UTG): Calculated as the maximum number of people to be treated annually in meso/hyper - endemic area within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project) (v) Therapeutic coveraqe: Number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraqe: number of communities treated in a given year over the total number of meso/hper - endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) lnteqration: Delivering additional health interventions (i.e. vitamin A supplement, albendazole for LF, screening for cataract, etc.) through CDTI (using the same system, training, supervision and personnel) in order to maximize cost effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out buy community distributors outside of CDT!. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. (ix) communitv self-monitorins (GSM): The process by the which the

community is empowered to oversee and monitor the performance of CDTI ( or any community- based, health intervention programme), with a view to

vl ensuring that the programme is being executed in; the intended area. lt encourages the community to take full responsibility of lvermectin distribution and make appropriate modifications when necessary.

vll FOLLOW UP ON TGG REGOMMENDATIONS

TCC Session 18

Number of Recommendatio TCC ACTIONS TAKEN BY THE PROJECT FOR n in the Report RECOMMENDATIONS TCC/APOC MGT USE ONLY 120 (D Intensify advocacy to the Advocacy was intensified but state could state for release of funds by not release funds while 4 LGAs released the state and LGAs funds 120 (ii) Used new format for The new format has been used. subsequent report 120 (iiD Increase the N0. of CDDs N0. of CDDs has been increased and plan are under way to train more CDDs by kindred approach. Provide missing 120 (iv) information on:.

o Management of None SAE

o UTG The project has attained l00o/o Geographical coverage and the Eli. Pop. Is equal to the UTG. o Special advocacy Special advocacy workshop was carried workshop out By Dr. Korve in 2001 and the report was sent immediately to APOC HQs through NOCP Nigeria. Not available to us now.

o Revised ATO of 9 The 9 LGAs are being handled by LFEP LGAs since APOC did not approved their support. And therefore their ATO are being accounted for by LFEP (3 LGAs are in Plateau) o Monitoring and The project is making steady progress Supervision towards sustainability. And planning to decentralize monitoring and supervision to the clan level for better participation and effectiveness. o Ordering, storage Ordering start with the community and delivering of census when the number of eligible Ivermectin. persons is multiplied by factor 3, to arrive at the quantity of Mectizan tablets required. This is then sent to the LGAs HQS where collation is done forward to the state HQS and forward it to the state HQS. And the state collates the requirement of LGAs and forward to the NGDO who then apply for the project. Storage is done at the NGDO's HQS and state are supplied by NGDO according to their requirement, then the state now supply to LGAs according to their requirement. Storage at state and LGAs level are brief not longer then 3 days. At the community level drugs are kept with CDDs or Community Leaders. CDD's are in LF/Shisto, EPI and o Plan for Malaria control activities. Project integration vehicles and equipments are made available to other sister projects, when the need arises and the project also enjoys the same from other program. Health staffs work hand in hand with other health staff to collect field summaries and census up date.

) EXECUTIVE SUMMARY The implementation of CDTI in Plateau State started when APOC's letter of agreement was signed in Apri! 1998. The project is in it sixth year, 1't of post APOC period (June 2004 to May 2005. The project still maintains the old 5 LGAs initially approved by APOC for CDTI (Bassa, Bokkos, Jos East, Kanke and, Pankshin) with 296 meso endemic villages. Activities undertaken in the sixth year are: .f. Advocacy visits to State / LGA officials and community leaders A Mobilization and Health education of LGA and community levels. * Mectizan distribution at community levels. * Monitoring and Supervision, submission of treatment reports and drug balances. The project is in the sixth year archived 78.9% of its ATO and 91.9o/o of its UTG. A total of 287 villages were treated representing 96.9% of target villages (296) See detail on page 16. Also, the project received 1,898,426 tablets of Mectizan from Global 2000/ The Carter Center Jos Nigeria, and used 1, 243,899 (851,932 tablets in the CDTI villages and 391,967 in LF only communities). A total of 91,364 tablets were returned, out of which 23,413 were expired and 563,163 in the field. Training was carried out in all the LGAs. The following categories of staff were trained 163 are HFS, 867 CDDs and 36 LOCTs. The ratio of CDD to population in the sixth year is one CDD to 397 populations. Mobilization was carried out in 287 villages from the 296 CDTI villages in the sixth year of CDTI. 248 villages showed high level of commitment to the programme by giving incentives to 335 CDDs amounting to N206, 340.00 at an average of N615.90k per CDD. The Project conducted advocacy visit to all the LGAs. During the period, N235, 000.00 was contributed by three LGAs (Bassa, Jos East and Kanke) for CDTI activities. State government budgeted N1, 400,000.00 but yet to release. Major constraint is the non-release of counterpart contribution by both the state and some LGAs. The project is requesting the NOCP for advocacy visit to the State government to help facilitate the release of the 1.4 million-counterpart funds approved.

J SECTION: I Background information

1.1 General information 1.1.1 Description of the Project Plateau state is located in the middle belt of Nigeria and is bounded to the South West by Nasarawa state, while to the North West and North East are Kaduna and Bauchi states respectively with Taraba state to the South. The people of the state are predominantly farmers living in scattered nucleated hamlets, with some scattered dispersed population. The terrain is rough, rocky and sometimes not motorable due to flood and lack of culvert and bridges. The rocky nature and terrain are sometimes serious impediment to effective transportation in some LGAs. There are over 50 different ethnic tribes in the state. Where CDTI activities are carried out, the major tribes are Angas, Kulere, Buji, Ron, lrigwe, Jere, Amo and Jarawa, Mushere, and Rukuba. The preferred channels of communication in the affected communities depend on the particular community structure. Where chiefs are significant, they are an important link with the state and local government structure. Communication down to the community is from the chiefs to the district heads to the village heads, to the ward heads, and to the heads of households. For mass community mobilization and awareness, Posters, Face to face and the use of town criers is used. The state enjoys two types of seasons, the raining season, (May - October) and the dry season (Nov. - April). Most treatmenUdistribution activities in the state are carried out during the dry season when farmers have less to do in their farms. Politically the state is divided into 17 local government areas but CDTI is carried out in only five with and estimated population of 344790. The five LGAs are further divided in to districts, district into villages and villages into ward and ward into hamlets (smallest unit) comprising of ten to fifteen households. !mplementation of CDTI in Plateau started when APOC's letter of Agreement was signed in April 1998. The CDTI programme is being executed in five LGAs as follows Bassa, Bokkos Jos East, Kanke and Pankshin LGA. There are 296 meso endemic villages in these LGAs with an estimated population of 344,790 persons. (See table 2).

4 The Plateau state health system is structured such that the Oncho control unit is under the directorate of the PHC/Disease control, headed by the SPO who is answerable to the Director PHC/ Disease control. A!! communications are passed through the Senior Medical Officer to the Director PHC/DC up to the commissioner. At the LGA each, there are Primary healthcare districts usually referred to as referral centers, and are headed by District health supervisors. Within each district are Primary health centers or first line health facilities (FLHF) headed by health facility staff (HFS) that oversees the activities of CDDs within their catchments area (See Table 2 on population of CDTI LGAs). A Primary health care director who supervises all health activities in the LGA heads each local government health department. The state ministry of health develops policies and sends to the LGAs through Ministry for Local Government for implementation. Each LGA has 37 staff that are involved in CDTI activities. At the state level, there are eight personne! who carry out Onchocerciasis control activities they include the programme officer, (SPO) 4 SOCTs, 1 Data clerk and (2) two drivers. The programme is integrated into the Primary health system at both the state and Local Government Ievels.

5 TABLE 1: NUMBER OF HEALTH STAFF INVOLVED IN CDTI

Tdd Nnberdfedh Nrrberdfpdtl rerettffi DSid/LCA Sdinertircpged ?ra Sdinvdrcd inCDn qffts*1m Br q

Rffia m 37 1tr/o

BddG D 37 1T/o "bed 1Q. 5t Wo l

hdin 245 37 15Yo

6 L,1.2. Partnership

Principal partners involved in CDTI activities in the state are NOCP (1998- Date), MSD (1998-Date), GRBP (1998-Date) and APOC (1998- 29 May 2005), the five LGAs, (Bassa, Bokkos, Jos east, Kanke and Pankshin) and the 296 Mesoendemic villages (1998 - Date) The state is the lmplementing agency and her major roles include Planning, staffing, Manpower development, Advocacy, counterpart funding, Mobilization/health education and supervision/d istribution. NGDO Provides technical assistance to the project, advocacy to high government functionaries, procurement of ivermectin tablets from MSD and development of Health education materials. While MSD provides Mectizan tablets, through WHO, Nigeria. The Local governments' roles include, Planning, Staffing, training, distribution, supervision, mobilization and health education. The roles of the communities include collection of Mectizan, selection of

CDDs, provision of registration books and incentive to CDDs. Other partners in CDTI are community based organizations (CBOs) such as Union of Road transport workers, Churches and women organization e g women fellowship (Matanzumunta). Their roles include social Mobilization of people, supervising distribution and sometimes assist in providing materials and drugs to LGAs and villages when the need arises.

1.2. Population

Plateau state has an estimated population of 2.7 million people out of which an estimated 344, 790 population are living in 296 villages of the five endemic LGAs namely Bassa, Bokkos, Jos East, Kanke, and Pankshin. This translates to 12.7% of the entire population. See table. 2

7 v, (,r 5 q) N oz { 'o x (- (D (D c) 0) 0, o o 0) tr, o :, f o x o =' {i { if m x o =o { @ o- o 0) o J o) ao 3 I +1" @ 4. an o! =' a -t c, N€ o o (D cl it o ET ol e an +o9 tt 6gr 1J o-{ C) o= =o!l o 3) .D-=' q, -!t a) @ (, (,l @ (o dE=o 3 _s N 5 -oN -o aD= = E -t @ (r'l A N c! a! ctA (0 J \l o) (,l o) (, (o (o{ o) or 6' a: tnl o (D (D- r, @ =' o, =.4 o P!t EX= CL -o !, €=B Eo c N 3 E' 0, (0 o) J o) @ ! Bl +6 E Ei. o, co { (^) (,) o ='g =E o 963 3 d ET f. = P6' (D o q, o o q,= o o=. * Hf 3 c =. - z z z z z z E o ='; f= F H f B oo o6' o N() o P9 =. (D il cL= * ol ='d ro (D ET N >98= o.D a (9 CD o) @ \l o o) (l) { (, (.) o ssE 5 =. !, o€ o - (Dr=o E' o o o o o o q, o q, @ G) (rl @ (0 EHF 3 A' -5 N -s Ju -o q,o -i @ (rl 5 o) N c c6.='E (D (0{ \| o) { (n q, o q) o) (o (o o) s63 { P6' o= (D= o E Hf (D a B z z z z z z ='; o= fi f + (D 6() !, E A' a o (D o Pg FO d E - gFf AI o o=-. (D !, (., 6' q, @ (l) (,t @ @ o- o _5 J\) 5 N -o = (D -t @ (rl 5 o) N qd CL CL (o J { o) ! (,r 6g o o CD o) (o (o o) }E o a ,'E = o F+o CL o-G)C cCL c or =' (0N \l N) s ! @ !, --. =. (cI GI N -@ -(f,) -@ J\) o -(0(,l N ! (o { N N N) o, CD { a G) @ o (o o) t (D CD 3 (D = SECTION 2: Implementation of CDTI

2.1 Time line of activities. The project year for CDTI implementation was from June 2004 to May 2005 (One year). Majority of CDTI activities especially training, distribution, supervision, and collection of Mectizan e.t.c were done during the dry season period when people had less to do in their farms. High peak period of activities falls between January and June. (See table 3).

Table. 3 Time lines of Activities June 2004 - May 2005

Comm. mob. Training Census/update Drugs distribution Supervision

Completion Gompletion Completion Completion Completion Startins month Startinq month Starting month Starting month Startins Month June 04. May-05 Mar.04 May-04 Jan. 05 Mar.05 June 04. May-05 June 04 May - 05 June 04. Mav-o5 Mar.04 May-04 Jan. 05 Mar.05 June 04. May-05 June 04 May - 05 June 04. May-05 Mar.04 May-04 Jan. 05 Mar. 05 June 04. May-05 June 04 May - 05 June 04. May-05 Mar.04 May-04 Jan. 05 Mar. 05 June 04. May-05 June 04 Mav - 05

June 04. May-05 Mar. 04 May-04 Jan. 05 Mar. 05 June 04. May-05 June 04 May - 05

9 2.2 Advocacy The Project Administrator Plateau/Nasarawa and the State Coordinator carried out advocacy visit, to the Commissioner Ministry of health and all the Chairmen of the five LGAs where CDT! activities is carried out. Non-payment of counterpart contribution was focus of discussion. The main issues discussed were on sustaining the programme through counterpart contribution. Most chairmen promised to release funds for project

activities but later failed due to none availability of fund however, Bassa ,Jos East , Kanke LGAs released the sum of N135, 000.00, Jos East N65,000.00 and N35, 000.00 respectively for CDTI activities. The project wishes to request the assistance of NOCP and Global 2000 The Carter Center to assist in the area of advocacy to the executives at both State and LGAs levels to facilitate the release of funds for project activities.

2.3 Mobilization, Sensitization and health education of at risk villages The objective of the project was to reach and mobilized 296 villages concerning CDTI activities through face-to-face discussions and by the use of posters, pamphlets, brochures and film shows. The method mostly adopted during the period was the face-to-face methods. Materials that were used to facilitate the mobilization were:-

l0 During the sixth year (June 2004 - May 2005), the project was able to mobilized 287 villages, which represented 96.9% of our target (296). Nine villages could not be reached due to bad terrains. However plans are made to commence treatment in these areas as early as possible in the next treatment year. Out come of the mobilization was impressive at the village level, as most of them were aware of their roles and responsibilities in CDTI. This is indicated by good treatment coverage of not less than 79% in all the LGAs. Villages were able to

A total of 248 villages provided incentives to their CDDs representing 83.7o/o of total villages. Financially a sum N206, 340.00k ($1,545.62) was provided to 335 CDDs as incentive with an average of N61S.90K ($4.021 per CDD. Major constraint during the period is inadequate motorcycles for health workers to visit remote areas for mobilization and health education. The project plans to intimate the LGA chairpersons to help refurbish broken down motorcycles and fuel other functional ones used in NPI for cDTl activities too.

ll 2.4 Communitylnvolvement.

Table. 4 Communities participation in the CDTI N0. Of comm. /Vill. Number of comm./Vill. With N0. Of GDDs and the comm. With female CDDs Comm. members as supervisols involved No. with N0. of Total No. Comm. Percentage comm. /Vill. Percentage Comm. in the Male CDDs Female Total 89 = members 86= With female 811 entire project BI CDDs B8 B7+88 = as 85/84-100 CDDs 810/84*100 area 84 DiskicULGA supervisors 810

Bassa 70 70 100 181 25 206 25 35.7%

Bokkos 83 83 100 138 14 152 14 16.8o/o

Jos East 63 63 100 {53 16 169 16 25.4o/o

Kanke 17 17 100 174 8 185 8 47.0o/o

Pankshin 63 63 100 289 31 320 31 49.2%

Total 296 296 100Yo 737 71 1032 71 31.7o/o

Community participation and involvement in CDTI is on the increase as evidenced by various supports and provision made by the communities to CDDs 80% of the communities were aware of their role in CDTI programme. e.g. issues like selection of CDDs, CDDs incentive, where to collect their drugs, and method of Mectizan distribution. Attendance of women in community meeting was on the average, but participation of women in CDTI was very low (23.3%) and the possible reason is lack of awareness of their roles in CDTI. Attrition of CDDs was decreasing due to improved community support and the new strategy of selecting CDDs based on clans. This was observed in two LGAs (Kanke and Jos east).

t2 2.5 Capacity building. Plateau CDTI programme had adequately trained personnel at both the state and LGA levels although capacity building at all levels was a continuous exercise. Training/retaining was conducted for both health staff and CDDs. The trainings of CDDs were decentralized by FLHFs health staffs who were at LGA headquarters. Training of LOCTS, District supervisor and FLHF staff were done by the SOCTs while, that of the CDDs by LOCTs and HFs staff. See table 5. Materials used for training of CDDs included:

During training, emphasis was on the causes of the disease, signs and symptoms, drug administration using height, health education, programme management, exclusion criteria and the management of adverse side reactions. All trainings where integrated with other programmes e.g. Roll back Malaria, Schistosomiasis and Lymphatic filariasis, where applicable. Selection of CDDs based on clan/kinship and the involvement of CDDs in other health related activities e.g. Nation Program On lmmunization (NPl), Schistosomiasis control, LF and Roll back Malaria programme had reduce demand on incentive and attrition rate. Between March and May 2005, there was massive transfer of all health staff by the Local government service commission, and this affected all the trained staff involved in CDTI. Effort is being made to ensure that all newly posted staffs are trained on CDT to replace those transferred. (See table. 5 and 6). Longterm plan is to train all LGA Health workers on CDTI to enhance effective participation by all staff.

l3 ! E @ t, !,x o o !, { o F o =9iag o = = m F o >;' { o- o- ll o !, J o o 5' + s c)> q, (., N (., (., (, z, g o ogt N N N N N 6 c o = 6' E z, o o (D ST J o 3 or o o oN (, t o 5 c) aO { = ;i 6' ov oc,==. E. o- Ei (0 CD N J o N l\) s A (o c) o GI + an =' o{ o 0, o (rr (., N (.t q, (.t oir I o, 1+ N N N 5 N N - c)8L s CL {r { A,E o-h N N N N (,rN (,tN o 6o='E gr or Or or c) 0-o o- J z, o- r{. o I A' J 5 I q, o { @ N { o c) I o= I (D :- --: {(Don I o J I o (o (,tN (o @ 5 G) I !t 6 I o o I o oOol" ta, I o o N N N N N I o, N N (rr (rr o s or Or I + 9;o g s il I I { J- 0, a -r=l,'e,. 3 s o) c) vlD @ p. o o o =(D o 6' J J o) o o) N o { (D = o o 3 oI o "- n"" P. F}= = o o= 9) o(., { (,l (,r { o, a c) o =i.o +-6-i= E. P o G' crn-ttgL 9 o o) =(D = s) o s e o { C., N s 5o N o (0 5 o o q, o or o) (D c) o E= c) z, 6' ET N ! (o { A N) rE o o q,o, (o o, o @ = o o o- c) o N J J 0 N 5 { N) \l aq. o) J o) o N { o el{ *o ig E. (., aO, (D o N CL or N cxt (o (,t o c) c, (0 o Ol ot N o) OO I Table 6: Type of training undertaken

Other Health Trainees CDDs Comm. worker MOH staff or Political Others Type of training Members (frontline other Leaders (Specify) e.g. comm. health Supv. facilities Program t , v Management How to conduct v a health education Management of I v v v SAEs I r' a SHM v v Data analysis ( v Report writing

Legend v : Applicable

15 2.6 Treatments 2.6.1 Treatment figures.

Total census population 344,790 persons Eligible population (UTG) 299,526 persons Treated population 272,379 persons (See table .7) Therapeutic coverage 78.9o/o Geographic coverage. (Villages) 96.9%

2.6.2 Absenteeism reported during the distribution period accounted to 5.0% of the total eligible population. Causes of absenteeism include resettlements as a result of the crises in the state and also temporary relocation for farming activities.

2.6.3 No cases of refusal were reported by the CDDs during distribution, but that is not to say there were no cases. (CDDs could not make available of such figures). All the CDDs adopted the house-to-house treatment method for better coverage.

2.6.4 No severe adverse reaction reported during the period of this report. See table .8

N0 SAE Case to report v

2.6.5' Trend of treatment achievement from CDTI project inception to the current year.

Since treatment started in 1998, there has been a progressive increase in the number of persons treated each year. See table g for details of treatment achievement from 1998 to May 2004.

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o, @ (0 { (r) { { o o{ so I :.1 { o (o L ! { b) s s s s s s F-oE 5 9L " qt E --=E z z z z z z qlo B-x UI = s, rfligrutr 3 + tn F Je .} .G) N 'o t i (rl { J @ io s (o 5 5 5 dz. CD (, (rl (,t ! (Do C" =' oFq z z z z z z e3 Bg z z z z z z Gtt = E aF33 e+$E $ 8,6 -, ) I U' { z. q, ET (o @ o) (,r CD N J P o { 5 (D 99 =@ z z z z z z z z z z (CI z o o o< ch (l9. 6t z z z z z z z z z (El m = o n = o o c { =o U' lqB z z 1_ z z z z z z z !rN o o=-o, c) m = qt n g o UI €.8 UI m 836 o m z z z z O' ::L A z z z z z Eg s U' m = (D z o=. { E U' tn 3 o.AI CN= z z z z z z z z z z !t n o (D m o= UI ! (D o o EaH (D v{ z z z z z z z z z z N(D= m 3 rg cn tr, -at @ o G'O=E nC FilBP z o z z z z z z z z z z {e=E===.a g. { 6' ql = o m = o ilds9 c) ! e.= I B E m == J .D n z z z z z z z z z z €=6'o(DU)- (D gl a, CL o J CL P E ==. z z z z z z z z z z EsEBg o (D !to.r z z z z 8H. z z z z z o==o = 9-' d 9.8 g 93d o=. =E' = o. z z z z z z z z z z sE=.g, c, o, B*E e.== ='L c, o)= aio=t z z z z z z z z z J = o o t

zlz N N N N) N J o o o o o (o (o { P]P o o o o o (o (o J 9' I\' N) .r s (, N J o (o @ (o m ET N N N N (o CD 8E o o o o oN oN (o \l n o o) (o o o o o o o (o (o srr (,l 5 q, N J o (o ! Ntto o c) o ].,1 lcr o!, EI o N) N) @ @ @ @ @ T(., (o (o @ @ @ @ @ il 3E d ot) (,l (r! (,l (,l (,l == o) o) 3 5.=d 3r EL= o-o gr6'E o o =B o !, aoo"3 o E-rI = N N @ @ @ @ @ o= !r6 (o (o a= =C o id CL (rt@ (n@ (,l@ @ (,l@ '!, z ce0)* o) o) Ctt gr= {C U'. { r fi o (D O' CL r'O o o N N @ @ @ @ @ g= CL (J-0a @ @ @ @ @ @ @ F { N (,t (,t (,t (rl (rl o = o=' -{ o

Before the procurement of Mectizan was done by the NGDO, each CDD calculated his Mectizan, requirement based on the eligible population registered multiply by average of 3 tablets. Together with FLHFS they arrived at their requirement for each village and DHS, which in turn did the same and sent to the focal person at the LGA to the SOCTs. The SPO complied all requirements for the 5 LGAs and sent to the NGDO for procurement. When Mectizan arrives in the country, WHO clears it from the Customs and stores it in their warehouse. The NGDO then collects the drugs to her store. About the same for distribution at each LGA, the State makes requisition from NGDO's store When Mectizan is supplied to the SPO by NGDO, SOCTs collects for their respective LGAs and hands over to the LOCT team leader at LGA level. The team leader later hands over to the five DHS for allocation to the five FLHF or collection centers where CDDs come to collect for their respective communities.

o At the end of the distribution, remaining Mectizan tablets are retrieved in the following manner: CDD +HFS+DHS/LOCT > SOCT SPO NGDO Store for storage for next treatment cycle. -> . The project has 25 PHC districts in the five CDTI LGA that serves as collection centers for Mectizan with a total of 125 first line health facility (FLHF)

. Each of first line health facility staff performs the following activities in ivermectin delivery:- Estimation of Mectizan requirement based on community request.

20 l Collection of Mectizan and storage for delivery to CDDs. Keeping records of Mectizan transaction from DHO to CDDs and from CDDs to DHO. Management of serious side reaction if reported by CDDs

2t !rhA -{ 'o L tr @ @ !, x o qr o ++U-: o !, o o o o o, d3 ?t { r= = x o o o o- s o- o o += ?8 r o o H L e. F a o+- I !{O E { tJcL:- v ql ..1 E e-i 5 "@ (., 5 N \ A .8c o { I 6) 5 o (D ;Er(D @ I P I N UI I tro po \ N (, { 5 .D I x 5 o o o, C' CL - CD Or o o o=. N i o =; o) o= !ra Ei. 7 N I !) 9.+ "o (.t 5 N A (DI @ { I o) I o 8.6 I 9) :.1 1., 8.=' = JZ "@ \ N (., { A C' { o C., o o od 5 CX' rl N o) { or o f 3F, o) o @ o * (D N N N z, (II N or N (^t c) L - I !o N J- tr "(o o) P 9o o ,Ei (o (.tL o o) o EF (., o (0 ]\' { !,D N o, { t N C N E'f U' o (D o +6-g (., CL 5 CO z o= N o { o I I 90 P N '@ .o, 9'r o (o N -Tt N I o) N N 6i', o) (., { ro (o !,= oG-v { 6 I aB o oN I o aI C^, I ol N (, ie 5 o) N-l q, o s3 s .{ P l.) 9o 90 o o= dg G' N (.t 5 (o (o -{ -i CLtl '@ 5 { (r) or o N' * (0 I o { o o o=!A @ ) - { _* 5 q) o o o o o U' g oq o o () -ur' o o8 o=q, 8E' o o o o o o (D oB = CL J.F n C') J A (D 'nh (., cny i.| 'o6 l.) c, a @ ?rr \ o { (Jl o Ol o= o o o o CL r-= I o o I o= m :F O* I x N l -l N E. -{t q, 9) (0 CD L L b EI d€ B CD o o) o o- I I o o o9.AH (., C)E (Dn {6 (,t I o) q, -l (,l- o) !l; !o 5 =Ig. :.1 o so "(., o (.tP { EL= I { N \ Or (E' 5 A CD (.,o) o) q, ro o) 2.8. Community self-monitoring and stakeholders meeting.

Has any training (of trainers) for community been done in the project area? NO

It so when?

The Communities project did not conduct CSM in the sixth due to lack of funds but, SHM was conducted in 152 communities. See table below.

Table 11

No d corrrvillages that Total # of comfiillages in l,lo of conrn fiat canied out sdf DistuidrLC'As conduded stakeholders r:eting the entirc pojed area tmnitoing (CSIvl) (suM)

Bassa 70 Nit 32

Bold

Jc East 63 Nit %

]Gnke 17 Nit 11

Pankshin 63 Nit 42

Tdal m Nit 152

Describe how the results of the community self monitoring and stakeholders meetings have affected project implementation or how they would be utilized during next treatment cycles o Selection of CDDs became more democratic. . Support for CDDs improvement. o New CDDs were added to lighten the workload.

o Treatment coverage was generally better then previous year.

23 2.9. Supervision The Plateau CDTI project is so designed that Supervision is carried out at six Levels, (Zonal, NGDO, SMOH, LGA District and FLHF). At the NGDO level, the Director Plateau and Nasarawa project, Global 2000 and the Project Administrator did periodic supervision. At the state level, the SPO/SOCTS supervised the activities of the LOCTs while the LOCTS, DHS supervised those of the HFS. HFS supervised their CDDs. Community/leader the CDD/Community members. All the LOCTs and DHS were provided with Motorcycles by APOC, Carter center and LGA to facilitate supervision. Each LOCTs (DHS) is assigned five PHC or FLHF centers which serves as collection center for Mectizan while each FLHF supervises the activity of CDDs at the village level.

2.9.1 FIow chart of supervision

NOCP ZONE'D' ZONAL COORDINATOR

NGDO STATE (Dir/PA) SPO/SOCT I I LGA rI- I,OCT/DHS FLHF (clinic)

HFS

Community COMM. A/illage. LEADERS/Supv

24 2.9.2 What were the main issues identified during superuision? a. Some CDDs used small exercise books that would not withstand repeated usage and therefore no track records of past treatment. b Some communities supported their CDDs while others had difficulties in supporting them. c. Non-released of counterpart funds by state and LGAs. d. I nadequate logistics for supervision. e. Inadequate IEC materials f. Transfers of Health staff

2.9.3 Was a supervision checklist used? Yes The project within the period of reporting developed a check list for supervision at various levels, SOCT check list, LOCTs Check list and CDDs check list. These checklists are available at LGA levels but very few of the facility staff uses them during supervision. The project intends to intensify the use of this checklist by the Health workers in the years ahead.

2.9.4 What were the out come at each level of CDTI implementation supervision? With close supervision by each level, records were properly kept and mistakes avoided. Results of supervision were used in addressing problem areas to prevent feature occurrences. . Some LGAs released counterpart funds.

. Therapeutic Coverage = 78.9o/o . Geographic coverage = 96.9% . Community Support = US $319.768 . Community Mobilization = 287 . Training Recorded = 1,374

25 2.9.5 Was feedback given to the person or groups supervised? Yes.

2.9.6 How was the feedback used to improve the overall performance of the project? Communities collected their drugs from collection centers of their choice. Hard covers notebooks were bought by communities to replace flimsy registers. More communities supported their CDDs with a lot more incentives. More CDDs were selected for training and the old CDDs were encouraged to continue to render services. Some LGAs released some counterpart funds.

26 SECTION 3: Support to GDTI. 3.1. Equipment. How does the project intend to maintain and replace existing equipments and other materials? Capita! equipment and usage is properly integrated within the health system such that maintenance is done through the Local government system of operation. Existing equipment and other materials will be replaced or maintained by the state and LGA using their counterpart funds. Project staff and the NGDO may assist with simple maintenance where and when necessary and hopefully APOC would support replacements

27 Table 12: Status of Equipments

Suredq,irut lGDg-CBAL Tvpd ArcC irrcH Usfrid/LGA zm) OEErs

gN E+iprErt M 0mltim M Omdtiqr M Omdtim 1$ ffilicr N) Grdlim

1 Vdide 1 CI\FR 0 0 0 0 0 0 0 0

2 It'klcQfles 10 8F2! O 0 0 0 0 10 4F6\ O 1 \o

3 Ccnplels 1 F 0 0 0 0 0 0 0 0

4 ftirE 1 F 0 0 0 0 0 0 0 0

5 ftdoopeir I F 0 0 0 0 0 0 0 0

b TV 1 F 0 0 0 0 1 \o 0 0

7 vmm I F 0 0 0 0 1 \o 0 0

I GAEUTM 1 F 0 0 0 0 0 0 0 0 o StiliEr 0 0 0 0 0 0 1 F 0 0

10 furr 0 0 0 0 0 0 2 F 0 0

11 ddrytur 0 0 0 0 0 0 2 F 0 0

12 ffiigrdtr 0 0 1 F 0 0 0 0 0 0

13 Tdes 0 0 3 F 0 0 6 F 0 0

14 Gds 0 0 18 F 0 0 0 0 0 0

15 ffioad 0 0 0 0 0 0 1 F 0 0

16 FleGatirde 0 0 0 0 0 0 9 F 0 0

17 PAq,Etum 0 0 0 0 0 0 1 F 0 0

18 Ecrdes % F 0 0 0 0 10 F 0 0

19 Offices# 1 F 0 0 0 0 0 0 0 0

Condition of the equipment (F - Functional, CNFR - Currently non functional but repairable, WO - Written off).

28 3.2 Financial contributions of the partners and communities.

Table 13: Financial contribution by all partners for the last three CDTI years (2005 Rate) (N133.50 = US $1.00)

YEAR 4 YEAR 5 YEAR 6

MAY 2OO1 / JUNE 2OO2 MAY 2OO2 / JUNE 2OO3 MAY 2OO4 / JUNE 2OO5

Total cash Total cash Total cash Total cash Total cash Total cash Contributors budgeted releaseed budgeted releaseed budgeted releaseed 1us$) (us$) (us$) 1us$) 1us$) 1us$)

MOH (Provincial/State) 7,490.64 Nit 10,533.93 Nit 10,284.93 Nit

MOH (DistricULGA) 1 ,181.82 1,181.82 6,244.72 235 5,363.94 1,760.29

Local NGDO9 (s) ( lf any Nit Nit Nil Nit Nit Nit

NGDO Partner (s) 49,729.62 22,530.80 20,637.30 19,124.67 295,188.42 295,188.42

Otherss Nit Nit Nit Nit Nit Nit

Communities NA N1,341.00 NA 1,043.31 NA 2,395.26

APOC Trust Fund 35445.41 35,455.41 21,102.08 21j02.09 24,900 21,000

TOTAL 93,847.49 59,168.03 58,518.03 41,505.07 335,737.29 320,343.97

lf there are problems with the release of counterpart funds. How were they addressed? Advocacy visits were made to the relevant policy makers

Additional Comments.

High-Power advocacy visit to the various government levels by NGDO, APOC, and NOCP is solicited.

29 3.3. Other forms of community support ln Plateau state most of the incentive for CDDs were in Cash except for some communities which provide communal labour in area of need. lndicate in table 14 the amount expended during the reporting period for each activities listed. Write the amount expended in US$ using the current united nation exchange rate to local currency lndicate exchange used here N133.5 = US$ 1.000

3.4. Expenditure per activity Table 14. Project expenditure per activities June 2004 - May 2005

Any comments or explanations? Most activities were sustained by NGDO funding and the good will from the communities.

30 q (D a'r U' Dt> a) z { m ca1 E -{ -t c)< o- cr= c (D g. g. oEi 89 P o o 3 C) o {o =E (D o!a (D +(o =o=6 3 =< = = = ?N o@ 9L d o gE ID g) *O) sL _4. (o o o)

J { N @ N I (r) N \ _@ J\, -(,l -(rt _o -o) -5 -5 o o) o) o) (l) 5 (,l ! 5 o o) (l) o) o) A o 9t P I I I I srt I 90 I s, 9o :.1 o Lo o) CD o o o) o @ { C^) (,l (,t o, { o o o s o (,l { N) 5 o SECTION 4: SUSTAINABILITY OF CDTI

4.1 Internal, independent participatory monitoring, Evaluation. 4.1.1 Was Monitoring/evaluation carried out during the report period? (Tick any of the fottowing, which are applicable). NO

Year I Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnterna! Monitoring by NOTF 4.1.2 What were the recommendations? NIL 4.1.3 How have they been implemented? NIL

4.2. Sustainability of Project: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No

Was a sustainability plan written? Yes

When was the sustainability plan submitted? 2OO3

4.2.1 Planning at all relevant levels? Yes The project after the fifth year CDTI developed a three years sustainability plan for implementation by all the five LGAs and the State. These plans were all signed by various key persons of the LGAs and state ministry for execution. 4.2.2 Funds Only one LGA provided counterpart fund for CDTI. 4.2.3 All the LGAs included these plans in their budgets for implementation and voted various sums of money for CDTI activities but only one LGA (Bassa) was able to release N100, 000.00 as counter part fund. Four LGAs complaint of lack of funds but three LGAs were able to approval and release some funds as running cost for the project See tablet 14.

32 The state government voted and approved 1.4 million Naira for the CDTI project but yet to release. The project is therefore soliciting the support of NOCP, Global 2000 and APOC for a powerful advocacy visit to these policy makers. 4.2.4 Other resources, Nil 4.2.5 To what extent has the plan been implemented? Minimal

4.3 lntegration Outline the extent of integration of CDT! into the PHC structure and the plans for complete integration: 4.3.1 lvermectin delivery mechanisms - lntegrated with Albendazole, insecticide treated net (lTN) for LF and Malaria controls. 4.3.2 Training: lntegrated into LF, Schisto and Roll Back Malaria 4.3.3 Joint supervision and monitoring with other programs Yes 4.3.4 Release of funds for project activities, Yes not all LGA 4.3.5 ls CDTI included in the PHC budget Yes

4.3.6 Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? NPl, Roll Back Malaria, LF & Schistosomiasis. 4.3.7 Describe others issues considered in the integration of CDTI. Logistics, Staff, Funding.

4.4 Operational research 4.4.1 Summarize in not more then one half of a page the operational research undertaken in the project area within the reporting period? There was no operational research undertaken in the project area within the reporting period. 4.4.2 How were the result applied in the project? No operational research conducted.

33 SECTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process.

5.1 STRENGTHS

The CDTI activities in Plateau state wishes to observe the following strengths of the project during the sixth year of its activities:-

supervision.

5,2 WEAKNESS / CONSTRAINTS

six month

This posed a serious threat to CDTI sustainability in the state. List the challenges and indicate how they were addressed. Poor funding - Project depend on add - on funds to execute her activities or occasionally on the good will of community members

I SECTION 6: Unique features of the projecUother matters. The project operations were integrated where the same staff at the state, Local and community level were involved in CDTI, LF elimination programme, Schistosomiasis control and rol! back malaria activities. The project had the following achievement during the period under this reporting period in addition to CDTI: ADD - ON ACTIVITIES TO CDTI IN PLATEAU.

VILLAGES POPULATION

NO. s/No PROGRAMM E ATO NO. ATO % ATO PERS ATO % COVERAGE TX'D.

1 Lymphatic Filarial 227 233 84.11 177,422 137,494 77.49

2* Schistosomiasis Nit Nit Nit Nil Nit Nit RBM - lTNs 3 Distribution 87 83 95.4 14,815 13,748 92.7

* Prevalence has dropped below 107o and treatment suspended with heatth education intensified; to

monitor recrudescence or otherwise.

Entomological studies of Black flies and mosquitoes were also ongoing to monitor impact on lymphatic filariasis and Onchocerciasis