world Healtlt orgnniation African Pnognnutrc fu M Contrd
hmfara State CDTI Proiect, Nigeria: Fifth year Sustainability Evaluation Report
Novem ber- Decem ber, 2OO4 Zamfara State fifth vear CDTI Evaluafion Reporl
oodibdons adrec Wc arc Sfdcftl 16 rtc fdhning pctus od orpbaionc &r frdl uDqilio, d toreffi&G soocdul occutim dfiracdgmd mn&try ec r ft Dfuocmr, th. a sc&adt od ffirt AFoc t&aaqurgt houacdilgeu tu nnilslc of thll rqlnmcA mry Anircint mC togirUc roquirm for ttc recccs - - r 1tc Un, LFr hit-;fipro-,id.d ryost, wl{ch mimd b frl lmootl nrem4 dthc Emhtim Tcm "od of . Or firdnr Ji!a, Ndioml Onchosciacb Proicct Coodimrr, od hil m frcilihEltc ffil dc of 6poscire r DrEiz$cthE llarm,cmvncnrcamtc sigfu sgl/cn3lciliod'mFi& - _ _- . rtc rro omffi, (Dlr-ie,6mGd nollo gual ud kmcot socrctry (Mr Hslih Aliu A*e) ftr IIcaftt&@a $& frr$chryoit . ttc Dircctm d pslic- Ihlh Gviss in Za@a Stdc, Ih Umau l{ohmod ltlEu od thc Statc wb offil m frr rrolmcd t/sh$lc idormtkn r Ttc facar errrcr,t"tctt Ofidats in m, drco IIiAs visibd od thcir $b llcalfr f,ulrlrs ftr thG tclcclcs emaatosGHmdc\laMaa r [Icol6 r]u&crs od dmurfry mcmbcrs in rtc caryhd II]AI wto ptuvidsd iqqtm ifuim ud oooEmdbtcmofficnid@ firom SSI' M(xI . t rly thc tcm rrou6-!o ryldd. tt! nlcftrl emort twivcd fiom 6c blhwitr& Drivcll z-'nin Stdc ftr ffig 6c hg tipr ftr tb rcomptifucr dthb uL Zamfara State fifth year CDTI Evaluation Report 2
AbbrsvldondAclunYmt
AlDg Acquired lmmune Deficiency Syndrome ADPHC Aesistant Direc{or of Primary Healfi care
CBIT Communlty-Based lvermedin Trefinent CDD Community-Direciled Disfibutor (of ivermecilin) CDn Gommunity-Directed Trefrnent wih lvermec{in DAF Director of Administration and Finance
:- Dc Disease control I)PHC DirectorofPrimaryHealth (We :. DPHS Director Public Health Services FLHF Frontine Line Health FacIliU
Gorrernment Counte,rpart Confibution - . GCC HSAil Health Education sensiusation Ad'vocasy and Mobilization
LGA Local Governmcnt Arca
I,OCT ltral Crovernment Onohocc'rciasis Confiol Team
tOH MinisffY of Health tou Memoandum of Undergtanding Zamfara State fifth vear CDTI Evaluation Report
Non-Gorcm mental t)'evelopment Organisaton
NII' Naional ImnuiztionDeY ilocP National Onchocerciasis Gontol
I'IOTF National Onchocerciasis Task Force
NPI National Prognnme on Immunizdion
PHC Primary Health Care
REA F.4id Epideniological Assessmcnt
80cT Stafre Oncfrocercrails Conhd Tem
8PC Strtc Project Coordinator wHo World Heallh Organleatbn
TTR Wodd Health Organisation CountrY Reprerentatve a-
Zamfara State fifth year CDTI Evaluation Report 4
Drccnttw 3ummlly
htrodrcdor ffixsHHfi *ffiffi 6P ye6, eya1;11iol d tre pqiect uB cariod or* ichtsn thi 2dn of Noverter ad d ire6c beraxr4. by ;aem d sretr$lc from tsgslq E$tioph, and Camroon Tlp mlu$rs **" i*r tE'dkd mnxrro tle *rgakiD@ of tre Foiqd dlEr_m wiftharal d ipOit firandal atsirtrrce b * stil ptorannp and b stfPort ole fib rrd l@[ post AFOC tirrsruno1x mArsclail @rilrol barp Ur baCopfp thc ncrbd - 31ffiUV pl{ts. period' The evaluaton in the field was canictt out over a perbd d om wod( Dudng thb informtion *gj g!,tff4-'fronl-ea,oct tm eno mqior-fik$oldcrt m thc stloolss d file CDn il;j[; inAfiifr-trc ovlar' C oHvant docnlnerill and_ mpottr proritlcd by ffle.team ;ncrnbcrr. The.c rerc fn aOOtton b lcrlcs d irbwicwr end lLld obccryetml of rampbd $be e frte Sffi, LGA, F-mnt Unc ioelttr Fadltty end yillaec bvch. Thc cvalrration Prory ended alrd a fitlro.dey- sort$op- br ho tlcvelopmsnt 4 6i6pycor u,lilr EcOiC( lcni?m gteb ;ushhebiitty ptm 6tfitotponloH tbr-tre prugnmrp implemcntetm d frre " and local gonnttnanrt ladr.
trEndinfr
Evcry vrlagc fiet was khdilicd .s $ldiqcd. fur rnarr-trdncnt wih iic@ano tudncnt il ,86fon0 ilmo covcraf tUr itre State is owr ffl perent"-.Thig il thc ororage br fic past tlrft y.an. tnqtncnt fq afi4 ir rfrfi otl, lt€ll€ no nport on tfr covcngs.
The betn wag not $lo b inbrvicw tronun delpb ffirb at eudt ould mt asertain tre level ; l|ccfrzan ,trhkt.nd urc +pmprimnecs of drrg do.{c in trL grcup and dtlldtm &ve five year.
ln mort of tie snmuniEcs vilibd frre demand br llcdizen was ifit!!ilhgfy hit|h bccaur.gl trc arsodrO benffi srdr ac worm elgulglon, kiflim of hed lico and incruar of libido. No wolg riporOO u,hidt turtter ct*ttrc.s thc eoocp0mo Uf ,g.. ln all ttc sido trdt qrtinue { -Ot communlticr ybibd-porpd elQrccscO willingrcrs b wtut tetnent for ar lgng !! it F dhrrd. Coflfittnitci hiue oin clnporrqi b phy a lctffm mlc in CDn !t hc hcd levcl' a:nl somc e13 lullv tt ing ,rp to triir tob!. TircEc ommtnitbs bke varioul mcaerrcs b ;u6inr6ifty-C firc-bOn pog!mm., for inrtrro, whilc thc Evehrrlion Teem rDbd cn111g6 g!vc fil tlc- rafio * COtir b ponrlafrOh ii not onouragitg, thc ommunithc ln cdl cale sornd nton L br fitc runioir c COOr cng$d. ln mod oce, CDIL wup willhg b ontnue popular because g1e t blct i! hctptna fton anO tiir-peopf ar woll er mrkilg thcm in lhCr proillPt communitce. Vill1gc badd arr inrohlcl h monibdng trc tfirfributon Proalt .nd adio6 ig tskcn fr-Oe ,illagp leechnhp b tlsohre Poblcms, amoo,ttirp $e q${lntfiort erimlr,t, 1pr dc CoOr ino promoo g9o{ _ovcroe. ln colrr ommunitics CDDr all Eridrded lbr good-perbrllancc .t tho enl of ftc dirfrbuton. whib lhc comrmtnity ledel! omafn @rnmifud ahO urc theirr pcnonal rplqlloc b spport 0lc C[rt s, tlr ommmtty er a Zamfara State fifth vear CDTI Evaluotion Report u,holc docs rpt givc the dcsifld e3jltm€ b t13 COlh. frn f,xr11/aa1fra T1p1m @ndufu Ud CDn d A'f,- c;;nnt;WMttw tr',,t b ,x/tr,,ltmblc Pr!/Ylfid .pqtoglef .N &rrf arfflort crlrilntre 6 n drr, W tr hbttlr frlt*' galarier Fudine for con by stffi golommmt has bcen mainly in tE tlpcdl d and fravelg gprcrnrmt hag mdc uyilr me6nbnanco # t'c ;d*.r$idc in t,e hc onc ycer. rnc -qd, fir'iii,ntrpart iind-d;ftbuton tomrus tre rnppmlmemn d tho proeiammc. The sffi fiird,bd-'fu malnii-r.rilii'(+9rt lgti Got 6raxr4-md zxts Egpeditslv. somc or fie- proyi.{ed-turda br thc impBmlrt*ion of CDTI. Simihdy, the maintonane of LGAr tp1nev.r fi]d capt6 cqirli,nril dg!-fninod rom noniionrrnont tourolt. lt was enouragim b qft of l'lsalh in the steto ic eneFged.in ffi;is-;-hdgd linc for dlcfto ano ttre Commiscioner ppidr1ry ilk6g trc il-ndtpy of flre plgics a qti"t!r*, h hir q+. Thc anport b hg6lfi fr;-1[,en,n"6t-is;ffiifrJiIi,,ifr fiue'rtealtt care servi€s b uom€n and cttildon. f?tr c.iirJmr trtfrngorsrrltlredlrrr etac-or-or*o qlg ffiTm Aufrn ff. -effi, h NW n U tufrrra W frn tn Pr#n tt'tr trJvct F yar. ',,mrt ptamin0 was timibd to t|e sEb tevct hlt tle LGA! prior b gte :gtttinability plaglin-g Op @nopt anq qir nortarrq rtao n ,r"t?;- ,p a.rcrt.ets,, It! ?"gqEq+ploaafO iiir6lvlniint-d pdd;-irln[im ii introorpc'to tr*n. Thir-r.mdorrhdly will enguo betbr ;irfuj,nc in neir'ttrtrrc pderam tLwtopment md flmplcmcntetion. provlded alrd The Eveluetion Tcam rrag lati!ff.d wi0r fio !trong leqdcrshf, at trc Strsb ;;mm,illty. rtre g5t dc a :wt at fi. Sttb, LGA-lnd cotnmmity levtls wao sditf;ldory; low. Tho LGA howover thc lcvet 66rnmbring and cnpcMiion at ore FL}IF lcwl Yvas abyrmally iU. anO Ff-ff arcb did nd hry6 iro requiicd mmibring tool b fldlitetc ttc.cfit matc/nl br Thc loycl d awemncgs about CDTI is appr€debly high on thc averagB; horuanr HSAM wcrc inatlcqreb ettrc FLHF.nd LGA finlclr' pledged rspEqe or rcpair the Rcoarlrng frmlport trc of frle thnc Local coulrdb Yblbd ?nve to is almost non' A6C SSr knebd mobffio ard biftcg whfi thc ncGd adrcc. Tranrport ei{sht',rt rt,rc ff-xF]erel. garf * t|is l€vel mcet their frm$ort ne.& ftotn peflonal regourcec and maintaired fieir franrport frotn persond ftm&' NG['O pqqar' The ernont stptem of llec{izero agp,ply, at fio-Stab leyol,- fipends .q -me Homrrcrdrugtsss'cctidr*uy0lcqt dbfioLGAorcollcdedbythcLGAtuhointumd€livcr b 0t6 FLHF.ihc ommlnites-olnA dnrgr fiotn fio FLHF' got pogram ec The Ondto oontol protefi ln Nigeria h gcrpral ffi in Op {]ly er a.vcdcal ;,rdt-tr",,gh-CDit-'dtbe€n iir plao-tor ttp_ pa{ry9 !DeE, inbgretion hag beon dow trc LGA errd rulf 6rctt. irost of &rc n}lr *rr cnoemic commmiticc ao not "nr;ddt'hedivcly hvohn in CDTI impbmentston. and Thc invohnnrcril of flic FlllF rtdf will crhane thc nrmqir:.l !frtngtt of mrmorcr improve nrnlbring tlld supervicion ar wcll ar dab rnanqBmil
ln cvdr.ffip g1c pqiod on lhe blcs of fic t ytn erp.ct _rnd lhf. crltla.l rlonrntr d ;rfihsititi, rre'Evannion Teem conctudes frtrt fie ZarrEna CDTI proied it r,AKllG sr-,?sFAlt'ibRYmocnE$t row tus st/c,rililretufY. Zamfara State fifth vear CDTI Et'aluation Report
1r qtailfffin 15ril', d z"Cl dtil. tffitlto -b-etW b ,rrrtfu ffi.cfiy Pfoots tuu.re .uarmiw-.nd wottu contnuo rrpfltrrr fln lulrt'd tcflor" trronnarlnffi bY tn Enlurt1ott ltn uo ffia. 'i ln Thc 1766rytosor'f 1115 m rrol &rn &n b tn ril xind d lrrolvoliruil d Ar H'llF ii-rffi n-wi mlimtrutt un ft b gr,,tlvtttg b t|,fr ffi fl,L ffi td lnn on Itrlrrclotr Oto conioeP.
Tho Uay Folmrd
Tha bllonilp ir a lummary of fie highfiehtr d fie critical compones fic-\lay fo]wafir grrafnton { ;umned d ti jointfin l ;;iorr beilrrocn tre Tcen rrd Ore 7.Jirfrata Pnql.Gi bam. l. Docrrrnonffion: Thig wry imporbnt ar€a wat bmd b be deficient and neede b be tadded h 0163r b cnhm6i Od susAfnaUfty of CDn. Thir itration ems ag a ]€sult d p]oiecf. tcam O13 ;3lethrc lad, d arprfire in docum*rtiUm by $o $qb bam. Ttr amrily dcfidr m hJ r.teOO 6r fire @mputr pto6s*tg m"f tccfmictl_lrporb ic anO teg61r&rt ilate de$ib tho fad that thdy l€Gifwd corlpttErs"l ftrom APCIC. lt thcl61p impoilril b cnrup fiet fic ptqc,, bam eoquircr ompubr .kilb for su!0ah$lc oPerationr. Z. trfienfron:-Eiruc 61cr! ig no i,nt gpbdfraffi,t pbn d dl lewl.in Urc Sttb, rBlotltDt i1j6;"e atrdll1gnaecrnqtt of donebd-caplut e_quhmcril and vdririet a]l nn on wilical thir bndr finca. S1perri]on ir mt lnberdill as nitt t! the u !c_of apcrvirory dteddigt to make any ncw prpgnmnic b be nn on paralel line irlqpecfito d donof aOcndct gr.tidcffnc.. il-4.fi?udbd nd inbgstl dh *U be boncficiC and will cnhano thc iufifr$ilU d-Trrrrfiara CDTI PrcFcil. t fugnaor: lt rurr a mutral .gncmcnt Otrt t|rc contrthrtion of dl 0rc fikCtddcn b Ure rurmnace of tre Zarrtaristm projcd poC-APCTC ir a mafr challenge. .APO9 in ll Oelne cnouraecd b it{ti,ort en adrocacy 1lnit b.q?Pqlq mdc6 frtc SEb O cn*rlc frcfirre ani ffidcril.implemcnhtlon d the pod APCIC pla$. Zamfura Stote fifth year CDTI Evaluation Report
TABLE OT CONTENTS @ """"""'l AbbradetonCAcronynr3...... """'2 EcqIUre $mmary. """"""4 findin$ """""'4 """"'6 The Wry Forurad... n "'r""' f TABI"E-- OF CONTE1.ITS...... f-f gad,gturtrd b Ule larfrr a Project ErraluaUon """"E faOrgrumC """""t 1.2 EvaluaUon ArcOons """"""""'t 2.3 ErrduaUon Obrccilves """"""""9 2,0...... """""10 METHODOLO6Y...... """"'10 2.1 Deslgn ""'10 ,:, ibp,fraom """""""'ro i.i sairprrrg...... """10 ,:4 so,ft;?rnfrrnrauon """""'ll 2.5 AIIIALIEIS """"""""tt fufmafi rocom]INended by APOC' Reconmendati*t *.J ffiefrated in the """""""""'12ta 3.0...... """"" rr EVALlrATIoil FIllDIl{GS """""""""'13 3.1 SuislnaUfity it-nofct (StaE) leid """"""""""'13 3.2 Sustalnabfitti tt Ure fCn rcnet. """""""'19,< LCrA """-"""""iJ Recommendations-"..."...-.-.-...... -...... "30 3.4 Sus6fn6l-ttlr;h" C*tm,mlty taQ.:...... :.::...... 34 3.5 0ompara#'Anab,sd* Ure SdsbfnaU[ty d o,e Four leirels 4.0...... 3t """3t @llolJsloN...... - ;.ictadt g Ur" iilt3fi Srl*anaUlty of Tantfr1ra $aE CD11 Pndect"" ""'38 4.3 The Way Fonrard...... -. """'41 """'43 AITPEilDD(-Apd-tdb, I Feqfid narnrng !leedng... tr ivuot Anatysls...-...... """""# "'"'"'"'JvC'I Apecrdt.ItrSuotAnalysisLcAl{fl Errahntbn...... s55 AppEifDU fV:iiy Erpns-f.l4menrcneO ln tlre Zarfiara CDn AppEIiIDD(v-USTOf DOCUIIIEiiTS OSSERIIED """'s7 IEAIvI Appcodix vr.-appngssEs ron Bvaluluox MEMBERS """""""58AI ' ApeGodix VII fimo Tablo... ' ' ;; AppGndix VItr L€frcrsto IJGAS. Zamfara State fifth 1'ear CDTI Et'aluation Report l.o ITITRODUCTIO]I
1.1 ladgtotrtd b th. Zltnftn Ptrqfct Evllutdon Brclground pad of the country. mo of s Foderal $6r d Nlreria locdeqin fic noltnrca{n z,r,fiqilc lt is inhebibd by Thc steb *", orrid o,rt?-tte otd Soio6 sxab h le6 and hac 14 LGAg. nrral aoes in hub md thetcttctl houscs. '61astnroc llr, z.z mnnon-pcd6 trq5 *u,hlcfi lhn in fte agrhrtt,nt lanO ii tarcrceO by nurter of dven md dvefietlr. flvc LGAr CDTI Fh,r d tre 14 LGA3 d tlc rilb lr moscrder{c br o]rdrorcitrb. ln llreo and more than 15o,qr0 hac b331 imprcrrenti;tt-"ep"rt dAPOC and SSI ine 1908 taoPtc han'bccn blobd wih hbrmccfin dllitp 20fJ{.'
cDTl ig onganiued in Zarrfara fib in fotrr impHnentstion levelr namelr $nB Levol (ItloH, SOCT' SOTF rrd NGDO) LGA L.VCI Front Li,ne Hcdth Ftdlity (FLHF) . bommunity tcvel(Community, Commurity Lcedert, and CDt13) paparwag hitifrd trrqrcr-parhcnhh of eoramnrcnt (tlory qlqF)1-sqq9aft!. con progiam (APo-c) qP r,6;i6naiesrl iiiGDoi;nd-nirican Er orcrocerciasis conffi ltfft ornmunity-dlt gratufiy bkongrttr proitcr by meingftemlu it inbrrtion ttc eodmeniino govcmnrnt md ilb [,g.it"; hErr ffi6;rrriJb"-st;6 oi urc c6. urltt the *rpport of ommtmitty ltlourott.
l.2Behldonau*nr
1. How suCairnblc ir the Z;rrrrlqaCDTI plticcf, prcgramme as APOC 2. Whst ars tr $ucdrfno'r ln-phci 6 *rst in Zanrfara CDn pulls otlt itg lrppoil 6r thc itnptemnbfion? -fftr" prcollca of hceltt deliverv ln thc 3. Cofii"ooil-bAfia p.rt a ura mutine [X!fiicft arp thc stpport adivitiea of CDn inb tfre hoelth cyrbmr? 1. [; di.gtd p3fbfln6g? 5. H* aIE t ccfizrl patir6tnfit and dclhrery necfiafsrng av-ailabilitv local and 6. vthat is fte financil';edi;aam p,rt h b qlt1re the { -Al pttfig iipenOaOrc corcc'#nmOltg 7t;frffiCDn pqi.ciY'frn AFC,C off 9f mainbin' 7. ig the levet J'p"pfi*,"n d file siat ino tocat Gorrcmmcntr b vt/hd ontinucd ,.orro" eno sr*rritfiiiiiminty of bm+ort md capibr-c.l,Dmmt br 0'c .ffi"ny eueazam b fic p.oplc br long brmtcatncnt? in Zenfan CDn 8. How commitbtt ale tho humen Egourc; lbr CIrn fnefmcntmon lbcuc? g. t^ft* tie rudb of flhe CDTI proiect in thc H thleo yurt of implcmcnbtion d tl pAiecfi"r"
I I Zamfara State fifth year CDTI Evaluation Report 9
a. Alc all oommurlUct khfficd by REMO brtctrnent rroolving taetncnfl b. ls t€afiifit oorcraop > 65 per ccnf? c. Vtrhatar€ tho fcndr in bofir gpographicel and thenpeutic@rcragp rates?
23 PllulUon OUctus
The gmoral Anacfrtnc 6rhe evatuatftrn ororcilo were b dtrmine the sudlh*ilitly pohnthls of the Zamhna CDn proiod by i'b ffi year of opentim and acdst in developing a post-AFOC plan brsufiining fie pAiect
The specnfic obrec{ivos thercfiorc are: : , a) To asrc!8 fie perbtmane d fie difrlr€ril goups of indicabrs of anfiinatiltty of CDTI pqiodl in the Zamfara COn plqpci 3 P"ffifi#1"Hffi'[fffi ffiokbrs in rhe i;"ffiTlurtfraraCDn pQFct d) thvelop danc tun cudaining the Tanrrtan CDn proied post APOC Zamfara State Jifth vear CDTI Evaluation Reporl l0
2.O lIIETHODOLOGY
21 Hgn
Tho !frrdy dosign adopted 61tte evalr.nton of ertainabiffity of Zamhn Statc CDTI wac cDtE seciional and &lcriptrve. This was b encur a me.tirne @llcclion d data, sfildr permittcd the Oeccrlpton d ttc proosscs inrchrcd h fie fnpgncnttm of CDTI in the Stab. ln doing thic, we bok irb conrkleration the evaluation oOiectves and quedimg that need b be answer€d. Deb wac eilcdd by inbntfnvs ucim cfrrrctrcd qtcstoiltaitls ad ryailablc re@rds in order b povide the analpic nqrired
ZZ hpnffion
All key players in thc proooss d imflcmenfftg long brm amrnl totrncnt udtt lle@an@ of pelrons lhring in mcfiooriasir cndcmlc atc.r @mfifubd thc lampb popuht6n, hkcn fiottt lhru nnbmly cdeffi LGAg out of lh'e €ndemb LGAr d Zamhra Staic CDTI peicct They comeds.d, 0tc $ffi lrOH poficy mrlto!, SXeb ondro @nffi bem membcrs (SOCTT), local gorcmment ondto ontol bem membclr (LOCIS), CDDs, yillry hcdc and fuu community mqnbclr. Also hdud€d in lhe renplc popnhtim rer! fie pql&[ aounffi, SSI rsplrccnffve OGDO partter) and thc V\rtO Adnin Asifint in Gusau. 2.3 Srmp[ne
A multi fige nandom sampling tedrniqrc was adqbd urllg radom rumber hblo, b selcd tunh,c ommunitbs. Thc frlrt ltep wag thc random rclcdion of thlte end€mic LGAs fuin a frst d fno endemic LGA8 in the Tanilara CDTI prciocf ana. ln 7arrtar€ CDTI proiect FLHF wele nd acfhrcly involvad in dirrct implcmenbtirn d CDTI hn rry leryo ar frainirp or modizm cdlocffon poinb. ln LGAs wih mors fiar tno oollodion cenbes nandom rampllp nas dried out sucfi as in trmgudu LGA. Tho Oilrd stage w sclec{ion of vifagos ftom tte list ac@rd*E b cac|t ollcdim centp. Helo alao nandom rumber bble wa uled to aebct hrr vifiages pcr LGA if onc ollccfrrp point ortrio veflager pcra oflcdion poht ar in &mgudu LCrA ri,fiolrr tuo colledion poinb wcn randonly coleftd. ln Zurmi LGA rrvi$ trtro @lledion points, Ihb FIHF scn sd mly [hb ommuruty and wac sampled while thne yillag.s welo selcciled h tfuran Gntu. All the yillages wen elther hyperfinero fidemic by REilO dasrilication and indudod in CDTI (rce tsble 1). Zantfara State fifth vear CDTI Et aluation Report I I
I'Lbl. 1: DbUftrdon of Sempld tcf+ H.llFend Gommunl0c ln ZrnilLra $tU s,il LGA $rD. lrllhe.. DbtslctFLlF 1 Anlla t\Arye vn& [hka Vtfr4fa Yamffisl EHrnillthld 2. ernSJilr &nrgrrilr Zaman Gira Auld Ndrucfie Dangrrro lGn{tkai 3. arrr[ thle thb
Ifuran lIafrasaDe Sangarprm Trm.Bao
2.4 Souru of InformeUott
Fao b fae inbndewr, v€tbal roportl and docmenb weio the main coures d inbtmation and dtr oolhdrd. Thogc inbrviewrd at Sffie l€vd induded he Hon commiuioncr for heallh, Pennaent Secr$ry, trrldor of Pr$lic hcalfi srvi{F3, rnembcc of fie SXab ondto conffi team srd lh€ Sffi molsd Coodher. At the LGA ler€|, the Local Orcfiooniasis Contol Tcemc ad thc LGA Hclth Folisy makcn wctu inbndaled. O0tcr pcrlons inbwieupd weie ths Frcnfline Helth Fadlity (FLHF) dffi and membem d tho sarmled ommunitieg (community leeder!, CDDo, md ommmitty meffierc). lnbrmation vua3 recoded on the evafuatirn lnsfiumentB etd discrrss€d eldensively b6rs fio EvdtElfrm Tam underbok the gradim d fie lercl of perlumam per irdicabr by bvtl d CDTI implementatim.
2.5AIIALV$S
The inbrmaton cdle6d was anatyzed and eadt indi:abr wac gnaded m a ccab d U (worS b b6t), in nlafron b ifr @ntihflton btmrds ar0alnabifity. Thc auerage'erdain$ili$ sotr' lbr escfi gtoup d frrdicatolr wa8 cabulabd, br dt level, and a graph wae plofied. Summary ctetbtics lbr tfie rooicr wrrc calcuhbd br odr Icrrd, and 6r ocfi gmup d indicabc, tld hbles and gnphica d ficse lcsulb w€re pr€cenbd and ertbnsively dircussed during the lbedbact $odrglrop. The ownll proicd pcrfnnarrce was algo a$ostcd ushg fie dificrent acpeds and critical ebmenb of rttfihSility ptelcnt in the prqiecil.
The fr€ crilical demenb md thc levrn lspoctl d rttdahdlility in the pqild wora gualihhnly diccussed and orulb agnod to by the toam on onsdrsus bacis. Ths projed rvas graded uring thcrc aspodl srd dcmnb blbtnim thc AFOC gufleflnee. The evdr6n discussed qualihtho doscription of problemr, and delibented on likely e{Epglionr br soMrp the probhrns idcntified. Zamfara State./ifth vear CDTI Evaluation Report t2
Thua iudgment Sout the susbinability pffitfiab d he proiod wat balcd on Ote quffi0vs assessrnent of fis eyemep $stalmbility rooras of the groups of indic&rr at noll as ttte quallbtiuo algersmontof fie crilical elementB and agpectr of sultainabilityof the pQiect
ReoommendatimE wor! gpnerabd in the brmat r€comm€nded by APCIC. : Zantfura State fifth.vear CDTI Evaluation Report l3
3.O EYALUATIOT FITTDI]IGS
3.1 $rtllnaullty !t Prrorct (strb) lgrd
FIG. I Z/T,rFARA CT,n $'TIARY OF EI'ALUANOil REFORTAT STATE LEVEL
4 3.5 3
rEilG}TTED 8GOREs"
\3 \3J\
IIUGATORS
Plennlng (fodcrmlyi 3.74
Ther€ ie no evidence of integfation in plannlng lbr the implementation of health prygraryqos work plan for the PHCTDC !Q fte State sln€ th€re ls no @mprehensive unlts of the Mlnlstry of Health. Horever therc is a dehiled yearly plan fur CDTI actMties.
Alttorgh all the partrers involved in the impbrnonHim of CDTI in Zamfta Stab are eaH to partch6 i,n the pbming meethg, fic pbn b evontnlly drrwn rrp by the Stete Oncfio Coordhsr (SOC). The mlel d partrcrg an dear and underrbod by all the parfierg. For t) ingtlre, it was nobd that Sl$t Sanelr lnbnniional, (NGITO parher) plot idos bdtniel and administuative asgifirm and does spot dt€ck monibring of $e imdemenhtion of fio Zamfara State fifth vear CDTI Evaluation Reporl t4 proemamme in thc Stato. The SEb bcm engagcc h fic @,bday itmilernentmon d fie gogremmo in thc stete.
Thc SOC meeb nguhrly wih fic t iro6rof Hcaffi Sentiee b brhf him on Ondto adhtilicg. Thcrgh it ir daimed fiattrc sffirtry meetirgs, a plmnirp and an evahtation msting alu held lnarly, no cvidencc war pmcenbd.
The absene d a snprohensive h€alth plan may have a negetlve implication fur sustalnetflity. lt shore that the vertical Orrcho oonm prognem on whicfi CDTI ruas fuilt has an lmpact on the running of heallh progranmes in the state.
Ac@rditg b the Stde ffiio Coordinator (SOC),
Wb lpw a planning meding bd the frn is dnwn by me. Thclo ale pbm of sufiirSilrty d fio pqicci by the SXtu. Theltr is a tundlrp plan wih tunds albcabd spconcafiybrOncfio contol in the hcelfi tudgs[ Smallcounbparttundirp hag been m.dc by fio LGAc and in NM tp ffi end LGA hate appotbrl fie CDTI ac{iyitieg. The Commirsbner d Health also r€ibrftd the need br lhom b engun the suCainability d fie pQied and inbrned ue that a apechl nqtst had been mede b fio Stab Govemorb srbin allhelh projcc[s. tmgrrton (fodcrrtrNy; 2.5,
The prognmme ig occaei,mally implemenbd in an lnbgr&d mmner wlren reports br o&er prog[ammes ao olledd on lhe samc ti,p or mqe than me pcco]r trat'ols b one locetion for difiercril adhriUes. The SOCT memben also parfrl@ in officr healh programrnos and Crale ,€soutots rruitr drr pogramrnes.
ExHrsive inbgrailion ie not poselUe as a Esult d the SOC'I iob dercriptim. The SOCT some tinu gtpentnps fic ommmity levd fiet€ by hnarsiU lhe LCrCT rtd FLHF levelg. lrrhnrhlp (Fully; 3.01
The SOC b wry m.rcfi ewrla of he prcblcmr of thc pQiaq urdr as @unbrpart frmdlng by the LGA not gefrim b fic Seb. The l€deahip hac good wortirp olatbnship wih olleagme. SOCI mertd! aru auigned b upervisc lomo LGAs. Furthemoru, the leaderCrip ig rp b dffi wih fierld acituitbs. tontlorlng eld Supen lrlon (noderetc;2.761
Stafi mcmber et this lcwl rcuthely e^pervise the LOCT memben and evsr monlbr teffinent at tho ommunity lcvrl. Thmc or mora af.n iryy virib are made b ttc LGA pcr year. Rerourcer 6r rupervision werc ellicienty used. Very fierv merters of !ffi ruen ured br eperyision. Somstmcr, otrcr CDTI adfuifie we]€ @mbird tfuiing iuperu[lory yisits. Cheddbt ie not ehrap urcd br rtpeMairn. Good perlumaes wort qnmonded \lerDally. Zamfara State fifth vear CDTI Evaluation Report l5
Probhmg srro trn hlndod oyer b the apptopiab dil b h.ndle. For ing0an6 CDD dropout or failup of fie oommmity b produe a CDD is handed over b t i!trict h€ad b rsloh€.
Omrione|ly LOCTc wole h,pssed etd fie SOCI membet! wcnt beymd lhdrfitubry levols br the implemenffion of COTI. Thir doea not only increase fio @st d CDn imphmentatiOn within fie pAiod aru hlt d$ hil b cmporcr0p LOCT rnembcn.
lmportant lucords on CDTI wsre oadlU availabb et Ote iilOH however thece wen very badly onrcnntl. All the docurneqb wrtr loocdy Crded m lhe lloor. Thett is a need for hdt leaver filc and a frling c*rinet for preceryalim d csenfnl documentr.
Hocflzeno Pnocrrnnrnt end Dhtrlhdon (Fully; U.El
Tho Mr[rO oflccts ilecfizan lio]n Lilos md delivelt b thc Staie. Occasi'onally 0te Sbb cdcfi Medizan fiom fie NGDO olfic in lGttuna md ddiveru b fic LGA imrrdiably. Tho dn4o ale not domd .t fic Stlb lcud, bccaure them ic no ryce 6r rtoragc. The team oru*Ien 0to Epbm rcry urdxhn, morpli*d and Cmple. Thelc ic erficbnt fitg b meet the nced of fie pqicci in gpod time. No oport d drug ltrortry wao made.
Trddtrg e HSAil (fodore0c; eE:rl
ln 2(tr3 only lolamb rcfidars uuetc halned.ln20ffi,,6 SOCT, 5 LOCT andZllfl GDIh welo hain€d trqph Otosc hreebd forhainiU uur 5, 30 ffd 5(X, nrpedivcly. The baitim of CDth is at tho LGA lerclar srcfi the CDDI arc nd aluvryr able b atbnd the secsbn.
lhough hahlng hs8 nd bcen ngularly ondu6 Ftnence (Hlghly; 3.0) The ftnd trailebb for CDn implementatbn ig effinry managed. The SOC wlibs fio prcpooal, and rerds b fie 7fiud ffier ufio approvec epcndihrte moding b fio ryort plan. The prcied aounffi is then arfrprizcd b rdEs a cficqc whiofi ir cent abngcire prcporl b ftc NGIrO Dira6r br appoval of fic propoEal and signim d the cftcquc. The cfieqm ic aDrq nty oslgned by d[tcr the tlim6r or tho SOC and cached by the aoomtmt uvho nlearer the ft.ndr b fic SOC. The SOC thmmcffid il!rcnoss d tund oOeAO for CDn imphtncntrlion and Olc bhl bndgst fafie wihin thc eryc6d inome. Budgebry @nfibu&n d eecfi parher was speft ant The orthfion d APIOC gtd NGDO m rpeft out Tbre ]tarc bcn srnd srnnt of tnds liom lhe $fr ttodl nd ac UuOgSd. Fl tro f year the $!b sxl LGA lrarc provitled thc ftmG trscd by tte prcirct ThEftrrG pruyided brfi6 S# in AIX! 6*l @yrarorf fie oEtof tdr*tg hbraic scfiobre u,lr heue aooess b Ut orffred uoflHr ae urel as the neds of fite SOGI. The faining d fie LOCT rrd ohor |erreb was mt poEsble ghnn fid thelt wBre m tm6 forfahhg @ilfrg llom AFOC or Sl. The hrdpt $ows a rbady inclcre h fic ffi onfibntion while hd of SSI is deouCrp. Zamfara State fifth vear CDTI Evqluation Report l6 At fie moment there is no evidene of a writbn agr€emmt of onfnuoug support from SSI b the Zamfara CDTI prqfod lrorrever there is tudg€trry allocafon of ftmds by SSI for the next thne yeers. Tnnrport md drcr tffirld Rerourcer OoderetrU; e6l Thcre is me hlr-nficel dlive v$ftie providcd by APCrC and a $!b plovHcd rnoblbike 6r CDfl imphmentation at this level. ln addition b thig Ote NGt O per[ter prcvider badop vehlde lbr fie implemenbtftm of CDn. Tnn+ort ig uled at this hycl b rttpport adiyiti$ et $e Stab and LGA levrls. The Oir!6r @nfiob tre uce d vohhle. As lttcfi Ote SOC necds to requegt br the usc d lhc vchtie eacfi time an adivity is scfiedulcd. Thelu is a logDook whldr hac never been used. Ihe SOC daimg fiet fio use of log book wag mly intotftred in May d 20fil. Runnip @st br vdtide war rnet ftom APCrC fundt tp b t{orember ?{J(B, cino fien fie $ab MOH hag been covedrp the maintenanoe and rurning cost d the Orfio rchide. Thelu ic no tlocumenbd evftlene of ,outine mainbnane of hansport md c?ihl equiment fut a@tding b fio SOC it is mahtainedwhen everneoessary. TheG ir m plan 6r teplaernent d rlehiole. The SCrCT bdhwg fiat AFC,C will lgplao the vehtXe. Humm Recourccl (Hlghlf 3.tl The bam ig cqnmittod and !ffing at this level ic dable. Evidere abounds of tlto commibnent of fio SOCT bwadg fie umsful imphmenhtion of fic pogmammc. Boft lhe NGDO parher and the fim6n d PHC eficsbd b tfiic. Evcn ufien APOC lin& anive let , tre SOCT ls able b motIlhe tun& ftorn fie [rOH b pu]u.p CDTI adhti[co. For ins0mcc, AFC,C tunds br the hrt dhfrltuton did mt anive on iime, but fio SOCT ruas &le b deliver thc drugr b lhe LGAs. The SOCT mertorr ale skilbd br fie offident implemenEtbn d fie progflffne, fiougft mt all are fully sldll€d in using the exoel omrubr program. This makea thern dependent m the NGt O br fie manaeernent d dab analygig. Attofiter inbnCftrg ffidirg is that fiouttrt fio qrcfio amunffi has been hmsferr€d b the Minlrfry d LGA and Chioftaincy Afiairs, he runaincaclhr. in the SOCT. Couqa0c (tullyr 40) G€ogr?hb ooveragc has ahnys bccn {(1196 brthe past thrce yeul. All ho ltcat idantified by REITIO br mags fietrnent am under tednent wih a fisatttent overegn rato of 81.9% in year 2$1 efi &, % in 2Cfr2, and 82.8% in 2flX! recpectwfy. The fitcr+eufic ooy'eregp ig aborre 65% br the last three y€r!. The women aro tpabd by proxy. RmmmqdetlomfuUp Prufd t ucl ffi Intdffithn PtanSo NffiIC HIGH Zamfara State fifth vear CDTI Evaluotton Report t7 Dernbp a irort ild lmg Um a.ffiiabffity ffitdre ptan stutlp rtl*egies br@ct ttdtdion e) Exbbned.dion plm endomd and &pendene m refiabb sqf,oas d by all perttert ftrnding b) ifinubs doknfom maefim Wbab& DlrebrdHeEr ffituffii Fch.tarv 2(X)5 fmm*f andgfrnfi|on Effii: Medium ffirsilw OteSEb a) CDTI Doomcntshnd h lhe ttloH urpbabffi Dincnor d Hoatrr ffitVffi End d nodffiibrfion nef*f lllSril Bffir, HIGH ffisdre fuqrs funre plans trram&g m tlree a) Tr*ringtaqfrddmasd n* nod b) RepoilBdommrfi*tc srHsilonand slsfr*$etn rnsilirod fipbffiffin smrr*tuffi Btd dnelGdlsillhfiol ffifibus nffin Medium fitffitsdre on es!€iliailr 6r rddist h @Et a) tlawlopedflrtdeclim taqetng mly tte osEontals frxrdlng @n actvilcbyactEfiy rUeashg b) FunG frchr{ry ltllcmcd for Odged ftm& lbr CDTI nrnplsmartmon- CDI aciMfix c) ErisHrca ditou sigr:d by end $e$dogotretn n6rtbr$e nest tree Zanfan$ab govsflfltatrd yeefl. ssir rbb&& ffintuuffi,Ditu6rof lladtr End drnrt disirfu.ffan Darlod Zamfura State fifth vear CDTI Evaluafion Reporl 18 tarpotldrltElllRmlr NffiI HIGH Dsffitsdw lLn& brfie nrnhg ad mahbnsu d TntGt, r&edin&hrnfit'ng hemport rtd oher caPitsil €st}msn ffif ard mainEtane dt €hicb and ea*rm*rt ubb&ffi Dirc6rdHeeltr ffituotffia End dtre nodrhthfion psbd Elbdhn rs dfte loehookftrlho PQiact PTffi HIGH cf- ffii;dw tlsage of tre crrccorded h lhe loobook rbb&ffi soc *bffi End dtp noddrfi&ulion pditd ItrtutRnrrg Nffir. HIGH Ittfu;dw cldlr espetially exol a) SOCT dfled hexd Ubb&ffi Dfrs6rof H€€lOr ffiptuanffi* End dtte nefidbfrhnion eetud Zamfara State fifth year CDTI Evaluation Report l9 32 $lrtalneblfitf ltdtC LGA LuC FIG. 2 ZUf,FTR/I CDTT STMNT,RY G EI'ALT'ANO{ REFORTAT lCA LEUEL 4 3.5 3 2.5 WECfiED A SGORE,I . 1.5 1 0.5 0 IIIIIiiil! TMAIORI Pfennlng ($lgrtfi; 1.60, The team of evaluators obs€ryed that consolldated yvork plans for primary health care programrme3 do not exist in mod LGAs visit€d. LGA !rcrters believe that it ie not part of their rcutne task to do so. Horsver, in Bungufu LGA work plans for oncfioeniasls @ntro! adfulties fur the leS hrc yearc w€r€ in plae. The CDTI adlvity urork plans developed by Op local govemrnont onchooerdasls team wtare not elabonate and devo6 of tmellrp ruith no lndlcdmg fur stafr responCb,b for the aclivities indicated. Minutee of plannnp meetilps wrone rd usrdly docurnonted by Op LOCT and rslease of funds lbr CDTI activities in the LGAs ane not done on the basis of planned actlvltes, thetEfuro, funds released for progrrnme implemntation ee hrdly meetlng the need of the LOCTS. mgreton of gupport Acttul0o (todcreffly3 Lln Zamfara ,\tate./ifth .t'ear CDTI ti'aluatron Report There is evidence of minimal integration of adivities at this level except for one of the three LGAs (Bungudu) where onchocerciasis control personnelwere occasionally involved in other community based health interuention adivities like cataract case search, taclroma and, malaria control. Statr members at this level rarely combine activities thereby making CDTI appear quite vertical and mainly executed by stffi members assigned to the programme. ln the same LGA the Head of Health Department is said to be oeasionally involved in monitorirp & supervision, training and HSAIII activities. Leaderahip (toderately; 2.831 ln all the LGAs visited, there are focal persons responsible for onchocerciasis control programme, but some of them are not providing the needed direction required of them for successftrl CDTI implementation. There is a limited extent of leadership for the CDTI activities at this level. Bungudu LGA however stands out prominently among the three visited. ln the LGA, the Diredor of Health who was onco an LOGT member gave a run dorn of routine activities that were undertaken by his department for the past few months. This is a demonstration of the level of commitment the officer has for the proiec{ implementation under his department. However, in the other LGAS visited the PHC direclors were newly posted from non-CDTI LGAs and as sucfr were not conversant with CDTI implementation but showed some reasonable level of commitment. tonitoring and SupeMsion (toderately; 2.Bl The LGAs undertake timely completion of detailed reports to the state team and reports for the last two yearc were available for ins@ion by the evaluation team. Though transmission of such reports were done through the existing health systems, quite often it had been the LOCT leader or his team members that go to collect the results directly from the CDDs and rarely through the FLHF closest to the endemic community. The thinkirq of the team at this level is to ensure quality and prompt collection of reports and semndly it o,ffers them the opportunity to addless any identified enors in such reports with the concemed CDDg. The evaluation team also observed that supervisory visits from this level often extend beyond the heallh fac{lity to the mmmunity level. lt was further discovered that the SOCTs made no supervisory checklists available to the LGAs for utilisation. Similarly all the supenrisory visits were undertaken without any documented itineraries and the only indication for such visits was the signing of visitors' book at the FLHF level. There exists a tnaditional method of problem solving at this levelwith positive impact on the reduction of mectizan refusals, as the tnaditional leaders are said to accompany CDDs during distributions to individual housetrold to ensure ompliane. Supervision is done mainly during drug distributions and collec'tion of treatment results from the field. /,am/bra ,\tote.fifth v,or ('l)7'l b'aluafion I?eport 2l This appeared to be reasonable, because the CDD attrition rate is very low, therefure does not warant frequent supeMsory visits. Very fenr and scanty supervisory visits reports were ssen highlighting problems enountered in the @urse of such visits and the necessary actions taken. The reports in plae do not convey mucfi infurmation nor vividly highlight the problems en@untered during supervisory visits. From the aforcmentioned no adequate orientation has been given to the LOCTs toruard the use of supeMsory checklists and doq.mentation of field ac{ivities, thus are more cornfortable solving problems verbally with their superior orfficels than in writing. This requires a paradigm shift on the part of the entire team at this level so that there will be increasing documentation of ac-tivities. tecfrzanc Supply and lllstribrfion (Hlghly; 3.251 Mec{izan applications are sent timely by the LOCT leaders to the state onchocerciasis ontrol mdinator througth the mrma! process of completion of mectizan requisition forms, with approval and release of the requested quantities of the drug to the LGAs. No cases of drug shortage have been erperiened over the last few years in all the Le'As visited due to proper ordering of mec'tizan by LOCTs. Mec'tizan@ request were based on previous yeafs treatnents with marginal buffer stock to accommodate populafon dynamics and unforeseen increase in demand. This arangement is very cornfortable for the programme workers at this level because of the high thenapeutic and nerly hundred percent geographic coverage of the project. Usually the drug is brought to the LGAs either directly by the state ooordinator or the LOCT leaders go for the drug instead, rrvhich are stored for a brief period before distibutions to the GDDs through some designated FLHFS. The role of the FLHFs here is the temporary receipt of the drug just for a day before the commencement of the training of CDDs wtro pick up their consignments immediately thereafter to their respec{ive communities for distributions. Sr.fficient quantities have been available over the previo.rs years. Discussions with the community leaders and members revealed that they ofren give the health workers the leverage to distribute the Mectizan drug during the dry seasons when they would have noticed that farm ac{ivities have been completed and most of them are at home during such period. They do not give the workens specific months for drug distributions. ln most of the LGAs visited proper reoords of drug colleded ftom the state and disbursed to the CDDs through their health facilities have been kept by LOCT leaders. The LGAs have never been hamstringed by non-availaHlity of transport for timely collection of their requisitioned drug as they usually have the needed supports trom their LGAs. Where all efforts have failed for timely mllection of their approved drug, the state team bring to them the Mectizan tablets at the LGAs. Zamforo State fi/ih .t'ear ('l)'l'l l\,alualtttn Report 22 Trraining and HSAil (toderately; 2.551 The evaluators observed that training was canied out routinely by the LOCTs, usually at a central point (nearest health facility) to the CDDs. ln one of the LGAs, obfectives for the training and re-taining were based on the outcome of the previous treatment results. ln the remaining two LGAs, training was canied out as a routine mainly for the GDDs with limited or no involvement of staff of the FLHFs. The feeling is that the LOCTs have not empowered FLHF stff adeqmtely to undertake the targeted training and re- training of CDDs. ln most of the LGAs visited, training materials were not seen, but where available they were grossly inadequate. Training reports were not seen nor was any list of participants for sucfr taining available at this level. lntegrated training is seen to be episodic especially during out breaks or NlDs when CDDs training is combined with other programmes. The evaluators infened that the ac'tions of the LOCTs may be ascribed to the levelof orientation from the state team and the supports being received from the LGA authority. LOCTs @try out HASM routinely not usually based on plan and ofien get dorvn to the community level, but making adeqmte use of infonnation, education and communications (l.E.C.) materials and town announ@rs to reach the gercral populations. lnterestingly the evaluators wsre informed that oommunity leaders accompany CDDs to households during mectizan distributions to reinforce awareness about the disease, and the rcles of tfp community members in the sustenane of this programme. Even though further discussions with the traditional leaders revealed that some of them lack indepth knoidedge of the disease and what is eleected of their role in the control programme. The team could not establish whether HSAIIi was done in an integrated mannerwith other health workers moving along with them during sucfr visits. Occasionally the traditional rulers will send for the householders in the community for health education/briefing centrally so that they could in-tum go back to inform their family members. The absence of female health workers does not allorfor satisfactory hea[fi education of \ilomen in the endemic eommunities. The level of awareness of this important group of the community rnembers could not bo established as the evaluation team members wero not allowed to inteMqr women even in the presence of their family memberc, and or health vrorkers like CDDs. The effec:tiveness c,f both training and HSAIVT can be adjudged from the impressive mec{izan @verage obsenred in rnost of the ommunities visited and the ability of the CDDs to enter treatments records conectly. Ohers include the enthusiasm of the traditional leadership in the programme who take the pains to go round with CDDs during mec{izan drug distributions. However, routine oommunity meetings and consultations on the selection & replacement of CDDs do not take place, and it is still (-DT'l ZantJara Stotc fi/ih .v'ear l';'alttafion Report the prerogative of the community leaders to appoint whoever they want for the job. Secondly, the LGAs offiicials seemed not to be very muctt familiar with the programme probably because of their frequent transfiers. Financlal (toderately ; 2.6i11 There was no evidence of consolidated br.rdget plans existing for Primary Health care services, but where such exist, they were not disaggregated to disease specific activities. The general pnac[ice hourcver is that each council makes ayearly counter- part financial contribution of thirtyone thousand, five hundred Naira (N31, 500.@) for oncfrocerciasis control activities $'hich eppear insufficient for the needs of the programme at this level. Some of the LGAs provide additionalfinancial supports in the form d monthly stipends for programme running to the LOCTs, u/hich range from one thousand six hundred Naina to two thousand Naira monthly. Sucfr financialassistance to the LOCTs is said to increase during the period of mectizan distributions and data mllections. This limitation in funds allocation is attibuted to othercompeting needs and a re{lection of the degree of importance attached to CDTI by some council fficials. Though the management at this level has the capacity to acommodate any shortfall, a lot of education, sensitisation and advocacy need to be canied out by both the LOCTs and the stiate team. lt was further established that contibutions trom the LGAs to the programme depend on the information received fom the state team as to the amount of money neoessary for prognamme implementation at this level. For sucft money to be increased the state will need to urite to the LGAs for increase in contributions to the programme. This as a routine would be further justified byexplanations trom the LOCT leaders and their heads of department. The evaluators could not obsenre any written commitment from the NGDO parher as to the amount of financial assistance that will be provided to the p@ec{ at the termination of APOC's financial support. At the LGAs level there were no records on onchocerciasis related e{cenditures both at the Health Department and Finance unit to substantiate claims of funds released for the related acfivities. This soenario calls fur intense advocacy ard continuous dialogue to address this policy decision Transpoil and Odrer taterlal Recources (Hoderately; 2.55) APOC and the facilitating NGDO - Sight Savers lntemational have provided bicycles and motorcycles for CDTI implementation in the LGAS, sfiich wero func'tional. These vehicles are under the management of the LOCTs and it appears they are not used strictly for oncfrocerciasis control activities as some of the LOGTs are seen to be actively involved in NlDs activities. They also go home Mth the vehicles and could be used for personal trips. Zan/ara ,\tate./ifth .t'ear ('DI'I [\,aluatron lTeport 24 The availability of fundional motorcycles and bicydes are grossly inadequate to meet the logistics nseds of the LGAs for the noxt couple of years in view of the wear and tear effsds, bad tenains and vastness of the proiec't aroas. The council ctrairmen in two of the three LGAs have pledged verbally to bear the costs of repairs and or replacement of the vdrides donated for oncho contrcl in their LGAs. It was also observed by the evaluation team that maintenan@ of these vehicles was done with APOC tunds with minimal or rp supports trom the govemments and these indude replaement of wom out tyres and other vehide parts. And the LOCTs carry out repairs regularly as the need arises in order to prolong the life span of the vehides. It was also noted that these vehides were used with no doqrmented permissions trom the superiorofficerc. Though the Local Govemments are aware of the dwindling resour@s from APOC and its finalpulloutfom the State, the proiec't is yet to enter into agreement with the facilitating NGDO for possible replacement of these vehicles in the foreseeable future.. Human Resources (Highly; 3.34) All the CDTI health workers are @mmitted and very stable. Most of the CDDs have been on the programme for nearly five yeals nqr with very low attrition rates. The CDDs believed that since the community ledership has appointed them they have no option than to continue in the programme as long as required. Both the CDDs and the LOCTs feel motivated because occasionally they receive in-kind incentives and supports from the oommunity leaders who sometimes become quite excited about their sellless commitments to the actualisation of the programme in their areas. Generally there are adequate numbers of stable and well-motivated CDTI workers in the LGAS who oeasionally benefit from in-servie training like any other staff in the health deparhent. ln one of the LGAs the evaluators were made to believe that some of the CDTI staff strffer ffom inadeguate furding because of their lack of tnansparenry in the management of project funds, therefore, the council became discouraged in the release of money forfurther ac{ivities. It is hereby suggested that FLHF stafr shqrld be lnvolved in order to lmprove the numerical strength of vuorkera ln tte LGAs. This will also cutdown the vuortload on the part of the prcsent crop of workec and ftee them up for poesible in- service halnlng to enhance tlreir knowledge and sHlls ln programme management. Zanfara ,State.fi.fth .t,ear ('DT'l livalualion Reporl 25 Coverage (FulU, a.0I For the past two years it has been observed that geographic coverage.in the LGAs has reachd a hundred p€rcent wtrile the coverage in the year 2W wes about Sn%. ln like manner the therapeutic coverage have remained equally impr_essive for the past three or four years where coverage is well above 65%, with some LGAs recording as high as 90016 and over. This may be a re'llection of wrong usage of the appropriate denominator for calculating therapeutic ooverage. Reommendation for fte tGA Lerrcil: LGARffi Inmlemffin Phn D*nilt: Medium Tesn shot.*t prod.m PrbY Yery ffisdW ptansffitake inbaccowtt a) ExisEne dyqly Phn @rffirrrnity rcqulrement with cornmumfi reorrernents Ubb&ffin: PtlC Coordiubr ffiptoranffir; Erxl d r:xt disfiihdixt oorbd nonhrtry t Stpgtftion Prbr* HIGH InfficafSm rgstonmdrareas a) LocTundertake mmlto*U and supen be at lhetsorrn level Suoervision mpbbba&n: PFE Coordin&rl LOCT leaders Mreftotffif,tt: Erd of next disEibufnn perbd ffeAiaato W and Dbt'btdon A*u*n HIGH Ittffitsaf$rc of tte $pdy of iledizan@b fie Tinely availabifty of mectizan d LGAS LGA b\rel. mpbbbffiu Meefizar0ftoln lhe SilSe hrd Pl{C Cmrliner ffit*ffia Btd d nqt dsUlhfion in 2fiI5 Trainitf l' HSIH fi*DfinHigh IffitsdW statr assessrnddRHF a) Ust dfaining needs d R}IFffi vued< or ladc anaas, urhere$e, arc a) Remrt dfafinim ddlb Ubb&& LOCI Coordnabr (' Z a m.[o r a'\t a t e ./i./i h .ve dr l )' l' l I'i, al u a t r o rt Re por t 26 ffiplVmrffio, End dn€rcdisuihrUon period in 20os Fmancb[ Iourc ffiu HIGH fiffisofffi esertids hr CDE ilr#nenta6on a) Reportmdivitiesfor 2005 $cuH be incr# b) vcnrhers d grcn emrnert fund rdeas brCDtI imolemerlatbn Utpbffiffiit: PfE Cmrdn&r Mpforatffit: End of nett disEihfion period in 2005 Trryt&Otts!ffilRanras nirltn HIGH Inffitsd*w mainHrarrcand rumirp d a) EdsEte dlogbook vehkhs and qripmert b) Voudrers of gorernment fund rdeses frr runnirp fte@ntrd of mmrqdes tnrspst ard m*rta[r*m eqiiDrnent YbbA*offit Pl{C Ooordine Mnpfuannffir: End d rpd distrihffii period in 200s Zamfaro State fifth .t'ear ('DTI l\'alttofion Report 27 3J mnt Linc Ecelth Fecility FIG.3 ZAtrFARACDI SIMXARY OF Er'AT'ANOil REFORTATFI.HF I.EVE 4 3.5 3 2.5 TAEISIIED .1 sooREsra z 1.5 1 o.5 o Ilf,XGAN)RS - Planning (Not at all; 0.5) This level appears notto be involved in CDTI in most LGAS visited ard as srcfi there is no planning at all. lntegnatlon (Not at all;0.83I Staff members at this level are not direcfly involved in CDTI but their facilities may serve as stores fur mectizan for a day or ttrc befure faining of CDDs by the LOCTs. lnbgration is very minimal. Leader:hlp (Not at all; 0.E3, ln all the FLHF visited the Statr at this level do not order Mectizan, because they are not involved in CDTI imPlementation. (' Za m fara,\t ate fi li h .t'e ar l )'il [i' a l u a t r on Re port 28 ilonitorlng and Supervlsion (ilot at all; 0.831 The Staff at this levet ar€ not involved in monitoring and supervision of CDDs. Supervision is routinely canied out by levels aborre (SOCTS and LtrTs). illectzanc and Supply (Sllghtly; 1l ln a ferr FLHF visibd, mec{izan is stored at the centre a day or trvo b CDD haining. They arc however not involved in the invertory. Tralnlng and HSAil (Sligh0y; 1.01 - . lnvolvement of healh personnel at this level in the training of CDDs is minimal, only LOCTs and occasionally SOCTs canyout CDD haining and HSAM. Trancport and other ilaterial Resources (Not At all; 0.5) There is no hansport available at this bvel wtticfi is also not involved in direc't CDTI implementation in the State. Human Resourcec (Sliglt0y; 1.171 The st# at this level wouH have been ideal 6r effective and efficient CDTI implementation because they are nearerto the ommunities and stable but not involved in CDTI. . Coverage (Fulln 4.0! Geographical orerage has remained shble atl0/J,% br fte past three years in all the health Disticts visited. Also the therapeutic coverage had remained above 6570 and need to be sustained. Zarnfara State,/ifih Year CDT'I Et'alttation Report 29 , . Romnrendatbn for ftc FLHF Leved: FlTfffi tnobnffitfat Plaonhe Affil: HHrGH ffitsdW irEgred teanh ilandthe tGA a) Mirures of danrfrp neetirg $cr.dd be doomenEd b) ErisHledirregrdEd dan irnolvino RHF ubffiffi: LOCr/Prrc Drffir ffirbaffit: End d noG disEihfion in 2005 fegr*oa BffiV HIGH IfficdW CDII and get $ern irnrchd a) MnuEs d tninirc on re@rd lqirg b) l{wnber d RHF tained and irndrcd in CDTI mpffiffi SFclLOCT Mffirptuuffit: Januarv 2005 ifonhtugand SuneniCon nffitn MEDIUM InMsdW arEErs a) R€putofmonitoring €xcrcbc Ubb*& Tte Ft}F sPo Mpl*mffiu End d ne*ffitributtm in m05 Tffi nffif HIGH ffisaf$rc iffiessmert a) UstdffitEtg n* b) RemrtofUaininq ubbffiffi; Trained ru{Fflr0Cf ffir Mtpfuffioa: End d nelt dsHhnion in 2fi)5 TtamrtidrclffilRmns NffiN HIGH Zan{itra Srote fi/ih .tear (-1.)'['l B'alttotton lleport 30 IlHFffi Imolarantation ffibsdW tansport and Eefnirg rn#iab ftr a) Reords d pqfinerts CDII imphmerilaUat made by LGA b HJ#/CDII b) t*snber d l{e#t edrdon and EadUrp aids pro,lded by mrrcmrnert frpbffifu: IIrcTOordntur Mplbsffiu End dnotdsrftutior in 2005 3.4 Sustainability atthe Community Level FIG. 4ZffiFMAGDTI, $.lNf,ERY OF ET'ru'ATIOil REPiORT AT GOITUIIIITY LEI,EL 4 3.5 3 IffitrE2:wr-i 1 o.5 o htIltcAToRs Zorttl'oro State fifth .t'ear (-D'l'[ Et'aluafiott lleVtrl 3l Planning (Highly; 3.0) ln all the communities, CDDs under the guide of their lea&ns were free to cttoose routes and adopt strategies that make their CDTI work easier. ln all the communities Health Workers det6rmined tre period of toatnent fiat is wtren Medizan anived the ommunity. ln most villages house-tohouse rnethod of distribution was chosen. ThE leadership communicabs efiedively with the CDDs, and bllowup problems issues in a most fficienf manner in all the communities. Follow-up of problems by tfe community leadershh is immediate and problems are dealt wih as they arise. Community members accept f6afnent easily and assist CDDs during freatnent and even follotv them around. Census update is canied out durfrg distibtttion in fttrer ommunities. Leadership and Ornerchip (Highly; 3.281 ln most cases community meetings were held among the leadership of the variotrs wards in the community in accordance wftfr their norms to plan fur cunent disfrihrtion and to review past . fsafrnent exerciss. lssues discussed rrere related to coverage, aurareness, HSAM and timely reporting to health. Leadership by council of chi€fs and village heads select CDDs, ard solrn community lerel distribution relabd problems wih the community at large. The same prooess ensures that CDDs are replaced wtren no€ssary. Timing distibution is convenient b the community members as the mode in all the communities was house-to-house disffibution and is determined by he communi$. It is only in one community Dole that the chief provides tmnsport support for their CDDs wfiile in others they do rrct. Various neasons, as to the benefits of fie featrnent were mentioned. They included the befrer heafth, elgulsion of intestinalurorms, improvennnt of vision and gives sfengtrt. . Very ferr communities were avirare of the need br longterm annual tneatment htt hot Ever desirg to continue taking ttre medicstion foras long as itwas ofrred. tonitoring (Highly; 3.01 Records are kept in notebooks wih family (household) infiormation in relation b featnent, along with a summary of the particular fEatment rounds. The CDDs use the 'back and fronf brm for the doqrmentation of the ffinent history of families and ommunities. lnbrmatbn is transmitted to the FLHF in a timely fashion basically by the tuming in of the notebooks. ln some communites hansportation in the brm of bicydes is provided, and in the others no speciftc transportation arangernents are made. This does not seem a problem br those close l,ontfora Stote.fifth .\'eor ('DTl livoluolion Reporl 32 to the heaffr facility (walking distane), hrt can be a problem br the far communities, delaying the reporting process (and convetsely, also efrecting the supervision proess). Obtainlng and tanaglng tec'tizan (Hlghly; 3.61I Communities on getting the information that medizan is available send their CDDs to fetch the drug ftom the cofecdion points. lnterviqrs with ommunity members and their leaders indicate that alleligible persons rverc ffeated and the issues of re{irsals or absenbeism were low in most villages visited. Adegr.rate amounb of Mec{izan wor€ reoBived eacfi year ard there were no cases of shortage in any of tre communities. Some tablets are left for those who were absent during the disfoibution oxercise, srhicfi lasted about tuo weeks. A few no d tfte oommunities ananged transport br the CDDs to collect mectizan. HSAil (Highly; 3.171 Leaders and CDDs anange for HSAM, information were passed to community members by appointed tom criers, who also use Mosque, special occasions and weddings b make anncxincements. ln special cases nfiere there is urgent need for heallh education CDDs and village leaders impart sucfr information. ln allthe communities visited their members had good knowledge of exdusion criteria ard dosage by height, in one communi$ (Iurga Bazae) the village leader brought his orrn copy of CDD guide, which he uses for HSAM. However, communifies have not been $rtrcienfry mobilized to provftle support fur CDDs in most communities except Dole wtrere the bader provides transport money at times b the CDD. Flnancing (Slightly; 1.5I The leadersfiip in rnost communities visited does not support the CDDs except in Dole where the leader occasionally provided fansport money for the CDD to collec{ mec*izan. The leaders and community members intervisired claimed they do not have money and cannot contribute in kind as rvel!. They acclaim fiat ffie CDDs are their sons and iust doing their elgecbd responsibilrty/duty to the community. Human Rsources (Highly; 3.57, The ratio of CDDs to population was found to be inadequate as a CDD served between Sfi) to 6(Xl persons. All the CDDs wele willing to continue their work as long as required of them by their communig. Attrition rate was low as only very hw CDDs left br other employment outside their communities. t oka village br example had no CDD and is annm{y beirU served by CDDs from Wuya in Anka LGA. The Village leader promised to call a rneeting within one week to selec't many CDDs b replace him. Coverage (Fully; 4.01 Thenapetrtic coverage rangd flrlm 79% to 91% in 2OO3 and 8916 6 %% in 2ffJ4 in the sampled communities. These showed some increase in the herapeutic coverage rates brfie tvrc years under compadson. Reoommendatlon llor $G vllhge Leyel Zamfara Stote fifth .v'ear ('D'l'l livaluafion lleport 33 ffi Imolqnffititn nmmclng Frffitt HIGH IffitsdW: take upthdr rdes in CDTI I\b d onmunifres proffirB fdEport implanenftatict, esPffiY m ard finilcial slpport frr CDn tnnsport and fnaneid $rpport irnolernentathn 6r UE prog[amme rbb*tu lIXlf Coordner ffil*anplatunt Brd drpGdsUihfion in 2005 ]hmaRorrs PTffiN HIGH btWdW: srpoortCDDsiltd Pm\rlde No d new CDDs sdecEd and trarlsp(rtburecDDstur $mord bvsnmumiEes aollecfion deug rbbabffic LOCilRHFff ommwtlfresb#nse Mntuwffi: @Dsiltd redtrcDD ratiob Etd d noGdstrihrtion in 2fi)5 mdation ard workbad. Zanfaro Slale./ifth .r'ear CD7.l l')valuafion Report 34 3,5 OomparaUue AnalyCs of $c Sustalnabllltt of fie Four leircts EG. * O(MIRTTSE PHFoR TrcE (T NC FOTN LB'E.E 4 3.5 3 TSTATE tEt'EL L5 rtqLEYEI Iz tIFIJf IEVEL 3 1.s [email protected] I1 I 0.5 IArtqn 0 All scores anyarded during the evaluation b the Tanrtara CDTI proieci fior the various sustainability indicators groups are shonn in Table 2, as well as average s@res for the adminishative levels, and the irdicator groups. The overall mean scors was 2.51. The FLHF level had the lonvest average score for CDTI implementation (Figure 7). This level (FLHO scored in the'Sllghflf sustainability pdential range (average 1.12) compared with other lwels which clusbred alound the 'Modenate to High' sustrainability potential rating (2.71-3.141. The urcakest groups of indicators are inbgnation, hansport ard finance. Zam/'ara Stale.lifih .r'eor ('l)'l'l l'-valuafion Report TaUe 2: Arrcragp $staimHlilty SorG of fte Difrrsil Gloupc dlndffirs ry letrGls of CDTI Imdementatftm in Zamfian CDTI Prciect t)o a e o. \ I a r B6 6 B o o .Ct O t il o c a 'tr -!E E u o EO $ EI d N !-u 6 .I o aB. E g Ct B !, E E b H t 6 E EI 6 a o 9 o tE3 !r! ltt () !i L 5 ^ l €E = f-. STATEI.EYEL ,.t7 2.5 , t.75 t.25 1.83 l 2.5 3.5 ,o5 LGALE\TEL 1.5 2.17 L83 L28 1.25 L55 L6it 255 3.34 t L71 FLHFLEVEL )-5 ).&t ).83 ).E3 I I 0.5 ).58 tJz COflh,ItII{TY ] t-ai, |.61 t-t7 I.) ,.57 I t11 /lEqlc LU I.AI L4x'. LZIs L7t ulg t-92 t.u Lln I L5l Values from Table 2 above are shoum gnaphically in Figures 5, 6 and 7. Tttc project level was weak in integrdion and hansport The stongest areas of the communi$ level ursre @verage, monitoring and supervision, Mec'tizan@ supply and leadership. Finances at this level was however not as gpod as others. Mean sustainability scores fur the groups of indicators arc shown gnaphically in Figure 6, below. The urcakest groups of andicators, overall, nere integration, the provision of Tnansport and FlG. 6: St ftARY OF OTER ILL PRO.TEGT PERFORTTWCE 3 2.5 2 WEI€HTED . scoREsra ''v" 1 0.5 0 EEEEEAIBEE , NDrcATORS Finsm (. 2.0), These trtfrtgF aro a good refrecfion d lho ujadmsss€s d lhe plgtect, *d Oe 7.anr.fora StoIe./i/ih .\:eor (-DT'I B'oIuotron ReporI Evah.ration Team made important na@mmendations in all of these areaE. These concems are addressed in the post-APOC sustrainability plans pr€pared in order to move the prcjed towads beirg fulty sustainable by the si: On the other hand, planning leadership, monitoring, Mectizan@ supply, and human rellources recorded the average scores of 2.0 points and above. Coverage did very well at 4.0 poittts translated as fully zustainable. The coverage s@re shows that geographical coverage is good at lAU/o and therapartic coverage is 650/o and above for the past three years in the State. This is also tnre of the average performance of the coverage indicator in the LGAs, FLHF areas and communities visited. ('l)'l'l /onr.faro '\taP rt.ftlt .v'eor Et'alttotton lleport 37 FtG.I:ffRtLL Pffim reEOF TICPRITJECT 4.00 3.50 3.00 ffir*2. 1.50 1.OO 0.50 0.00 %^ ,"a\ \o\ CTII! LEYEJE Zamfaro State.fifth vear CDT'I I'.valttation Report 38 .r.0 cotctusloil 4.1 Gnding Orc oucrrall sustainilllity of Zarrlbrrr stab cDTr ru€ct l,laldrU a rudgment of fie project in trnns of fie se\r€n aspects of s.IstainaHllty. (a) Make a judgment of the project, in terms of each of the seven 'aspe cts' of sustainabilitY: Judgment: to what extent is this aspect Aspect helping or blocking sustainability in this Proiect? lntegration EELPITTG Resources BII'CKI!{G Efficiency Hm.pntc Simplictty HELPING Health StaffAccePtance EnLPIrrei (Attitude of staff) Community ownershiP IIrrlrNG Effectiveness Ef,LPTNG . InEgratlon atwtticft it is being tntegration is hetping the sustainability of fre plopq 9e.spit" the lor lewl &nilO out. ffri Uin appr€ciabs f,re Oenefit of integratiry the programmes. The bam rnemOers arB involvod in ifrer prognemmes but not in e planned and.inbgtded manner. The MoH also n€€ds a compr€fiensive healUr plan b 6sbr the inbgration of progftlmmos and adtuities. o Regourec (Human, Flnandal and illEdal) The ffi and local gpvemmonb have mde financial aontitutions b CDTI dir€ct impfementagon but rfitrc on, pertonnel oet. Houpver rnost d the funds fur CDTI imptimentaUon aro ftom APCrC inO rugOO parhor, up trnfl Novembor zfJfF. Zantfara State.fifth .vear CDTI Li'oltrafion Reporl 39 o Hnchncy Thera is a rational use d rasourues. Programme support adivities are tleang phnnod and sharcd, vfiacfi raeulb in lower cod and gfiicient rnanagorpnt of rasources. 6 . SlmpllcEy The poiect uses simple md urrcomplicated procedures br the implerrenHion of CDTI activities. . AttlGde of flrff At all levels, there is ample evidence that the stafr members ara positively dispo=sed to confnue CDTI imflementatirn. The Evaluation Team rahd fio afrifudo d $efr at all bvels towards CDT|to be very positive. . Gommunlty0m,or$lP Most aommunities make decisions in the implementation of CDTI wihin their respecilive domains. Hovrver, tho ability to fully onn ttre plognamme is yet to be actnlizod as most CDDs use parsonal funds br hansport to @lbcn mecilizan. . Elfttthrsrcgr rcmained 1flI per cent sine ineptm of fie programmes I Geographical correragB rate has in the dojecf ama. The projec't hae therapeutic coner:ags rate of more than 65 per cent Zantfara State.fifth t'ear ('DTI Evalttofion Reporl 40 (b) Next, the Evaluation Team examined the five key aspects of the proiect - ,critical elements'of sustainability. If these are not present it is unlikety that the project will be sustainable: Money: Is there suffrcient money available to NO undertake strictly necessary tasks, which have been carefully thought through and planned? (Absolute minimum residual activities). Transport: Has provision been made for the NO replacement and repair of vehicles? Is there a reasonable assurirnce that vehicles will continue to be available for minimum essential activities? (Note that 'vehicle' does not necessarily imply '4x4' or even'car'). Supervision: Has provision been made for YES continued targeted supportive supervision? (The project will not be sustained without it). Meaizan@ supply: Is the supply system YES dependable? (The bottom line is that enough drugs must arrive in villages at the time selected by the villagers). Politicol commitment: Effectively Y$l demonstrated by awareness of the CDTI process :rmong policy makers (resulting in tangible support); and a sense of community ownership of &e programme. and fivo critical ln line wig1 fie guideline for grading frre @rle projec'tusing fre.sgvelaspects elemen|s d sustainabititv fr6 evalu*m TeariT drnaroei fiat &e ?anrta'ra qDT Proiect.F *iiriG CniisFAiiohi iaoaaess towARos susrAr rABturY. Two of tlr elernants, uanspot and money aro not dependable. The Erralmtion Team cmsiders fie political offiirnenig096 atin levelg. one ottre espec'b, nosounoes, is blocking sustainability. proioci The qnantitatirre s691g d Z.l1also supporb the qualiHh,e decisirn, whicfi holds tlat tte is maidng satisfadory progr€8s brvards suatainability. Zamfara State fifth vear CDTI Evaluation Report 4t +2 Fcfiaddfihnmg HdtgP: One ft€dbeddplanning mceting, br Sffi and LGA level bems war suco8s!ilUlly oEa{zed. Thc oQfcdivco of fic luortrhop wut ac bllorc: 1. To give tr€dbad( on fie eyat|gtion findingg qV theJcam d Evatuetoa 2. Oifi; fic-nnOms anpng t]1e irphmcnrfin, fio polic,y r1jlo13 and the Tam of Evaluabn 3. ttircu$ the concept of tulhfnability in rdafon b tho Zamhn $fr-CDTI pqiect 4. Derolq ptena ti Up argtalnable implementrfron d Tanrrtan Stab CDTI fior tle rsnainingycan of lhe AFOC ftnding pctiod The workstrops hEbd br thrcc dayg. The prcgrsnme ir ffidted (appsndix l). The rufiflnab11y plans OanlopeO fiorn fic lUeOaArflmnit9 tneotn$ will bo lbmatdetl u,fien they are duly qm{ by the apprcpdatc Og1efi6r 'rylfi tL'neecrary iusmcaton iitrorit€s. Tholc wifl be forffi, wih the noelEary accotmmving doctmcnb o APCIC by the prcFd firough fie NOCP at a hbr date. The m4gr7 ircucs that emeOcd trr fie bdotrtg scelim aru fibd below. Thc$ entorc The inaultty b rre RH F rrc ffiibtrEt b &e orll€r studon (CBfD bcfor€ @TI and tttc arilon of'nerry hcdol cnts€s a treltfi posts, nfilch atglndly rYerc nd ln ad#te. The peffdpcnb atso acconpfghod a SlltOT anily$ of .fi. llndines. . This ensulld deer [ndedbnding of thcrc eriatuation ffiings trqqgh the-leaEetion dtlo efiang0tg, wcakncttes, opport nffiea-erO trnm b firo pmgren no. nL pertdp.ttb aho went furtter b idanfiry filc giiutions b fie kbntilied wetn*cas and threats b thc impbrrentrtion d CDn. thilt d fie Sl/lrOT analyds alo ffidrcd. Sc Appcndbc lll. .L3 ThG Way Fmmld Tho bl6ry6g ir a summary of fio highfghti of thc Gtiticel componenb { fite-\ry brnrf o,r0ineO A t[ pint nnal rcclion betuue.n frre Evaldion Team and fite Zamhra PQlecil teem. i. mgord locplm md documcntrtlon: Thic rcry llnpottrnt aru war_hrnd b bc week and needs tb be tr66ded in order b erfiae fio sulteinabillty of COn. Thir situation aroEe as a rccutt of fio olative tad( of erg.rt$ irn doanmentrtim by fie SqO, prcFci team. Tho bem cprensy dcpends m Uri NGIrO 6r the @rflpubr proerging d !h"ir bctmical rcporb arO fieimrt de despb fic lhd thd they neivsd omPtlbr! frort ApClC. lt ir tr€rtrla important b ensui thd thc proiect bam aoquirca omrubr cktlls 6r rudah&le oPerationc. Zamfara State fifth vear CDTI Et'aluation Reporl 42 L lffigrdon: Bccatrrc Ontt ic m irbgr$d hotlh plan d all lard in thc Stsie, l!!ouro! rhd|g and mamgpmant of donsd capital equipmcnt and vdrkiec el! lun on vortcal iinel. E plrrlgionla not in6grded er imlt as 0tc ucc of elpcrvitory dlcclditt Thig OnCr to'mekc g1y narv pminmme b bc run on parallel linc lnccpccffvc of domr i237dcs err5dfr1jr. nn Lrtfiulfid md irrtgrrOO plm wilt bc bcncllchl and wifl cnhan€Urc *ntainOility of Zamfan CDfl pQieot g. Rrormo: Ilrolph ffi and LGAI ptwidcd nffiffnrl npcouroca br COn implcmcnUlon duting the sbfi yoarttrcrc yyas lrourvorwualcre$ in hrnrmiting lomq of fuie oont6ntons c&ed.ty f6,m rcn b fic $ft. ln rome of fic L@s that rchared Anb1part tund, tp;e tunar dH not r€ecfi the apptWiab lcwl ag thc ft.ndr ruers oi0tcr dhrqbd or held by tro LGAr ffior! in dreOc. lt vvac thccfrc mttttally t9flcd tra-Urc contiOutd d-all thc rtrlceholrbn b ttc tuttmlno. of th. Zemf8n $eto projcct posCApOC ig a rqifi ch.[.ngo in amurtsbil;ty. fFOC ]nJtaedr€nt L behe ;ipurired b appoil m ad\rocacy Yitit b qp nollcf malrers in the Stab b engurc cmOvc-mO cltrcilnt irrplcrpntaim erd utilzdion d fr.md ltl€alcd dwing fie poC APCIC pcrlod. i I Zanrfara State fifth vear CDTI Evaluation Report 43 lpp6aplx r PR(rcRAMIM FON TEEDBACI( AITII' SI'STAII{ABILITY PL/\NNING ZAMTANA STATE CDfl; M6EIIA ii WOUsn mnfl-Hrmogo CTirrnE GLSAU, 30u NOVEMBEI rc t'o- DECErmgn, rmr. DAYY OITTE: TUEIDAY to TTOWUITN AMT S'N TiEG aelrvtrr TACII,IIATOR I r.30Ard ARRITIAT(FPANflcIPffi Ab&lhhi Ltbbo (s()cD 2 9.G9.3h *afucereaocyudwelmc IIE Commirsios 3 hoecincthcouticiPm FGTmSccMOH 4 9.30- Prcocdtkn Abub&rXrqre 9.'f;(h . TtcwqLrhqlprqgf@ $eCood . fM*mmffis (}tadi* 5 9.40- Prccem&s Ih 9.5(h . Tbcobjcctiveoflhccvahdirn- . lVhirffiitty? 6 9.$-l(h PtffitirnThecvehiinfu IhE Erqloh 10.0- TcaBt& ttficcpcr lO.15@ 7 t0.15- Prcracatio of&s m.i4 HiE$ Dr t'qilqh 1030m . , CommnnitylaGuruf t 10.30- . IIiALcrd DrObodiah l0.45sm 9 10.45- o tu/Pr$dlad IhBcfidi-Mcngrc ll.fih IO rr.(xh' (ituryfu SW0T udyrir in 3 gryo - Ttd is lb hahratioTem u:qm *udmqremYinmPnfrrt?' lS3tcspccivcly . Grry t: Thccmity.DdFttlF hlels . Grup 2: Tb ditttict/ local Sov€mmcd lsrcl . Grm3:Thcfubmiahtcl. It 12..30- fu of gry mdr, ftltortd by &ary IhV. F.itt€ I.30m diwio t2 1.30-2.r) II'T{CH BREAI( n/I(cr4rr m l3 2.30- Crrupwulc Tb @td bc frc colui(B o ihe EvahatioTcms 4.00pm malncacl rrydiq oralOmY o or Pniod?' t2J rcceGcttu*y . Glmrp l: Pbiry llaeodrydqcrvi*m . Grup2: FnryrocsrfninirysdlXsAlrd . Grup 3: Tracport }Iocia0 rytY h*ruciolr frcuro trinmiqg €ryanca; n*Amg rtsrnccs: intryAftn l4 4.m- ffi of gtup woft S'wy dtc dtY's wort MrCkkOgrhi 5-Ulm Zamfara State fifth vear CDTI Evaluation Report 4 DAy TWO: WEDNEIDAY la DECEMBEn' 200a sm Tinc ACTIVITY TACILTTATOR r-304M Abdu[ahiIrffio I (s()cT) Grdiah 2 9.04.Ih \rdffi Ih 3 9.10- Plese#tio: ItfirKora 9.Zh . Smy ofprvior daY's w'ort r Thcucrcildev'srure ErnluatioTcam 5 9.2V @ffirm6d rcmoe arcwc lftctYb hrrc, d 10.(h 6c dhttcil lqdt dlhc ptogt@' frr fu ocil 3 lA3ttspoahtt*y ,rEans?' . GroW 1: MocYodMtlrcsong. . CrruP2:T@ac r Grum3: Eruiffi/mbb. I0.0- TcaBtaL Ufoepcr l0.l5m 7 10.15- ffi of gup wqL trhmed bY Pl€mry IhFfrr€ lO.30am discoscnrn t 1030- PlGby st*dLGA- Dr Bcfidi-Ittlogttc t0.45m tahbdph (r,h isb bcdme' rfutr bYwhoq, &&b O86hi bvwhc indicebrs od). EtrhilknTcam 9 10.45- @ffillatiry a eurdneblo Phn frr eG Goni'E tt.ilh )rg ; 6gtqps ca& meib eabuldcd plu (x'h.t bb b" dmB sett;tyu,hm;by x,tcq' infuors; ooa)' . TtcDhnmrtft imothcgraiblGt@:- t2 1.30-2.30 LT'NCTIBREAK nmocpcr om l3 23G @a@hphntuthe ErnhaioTco 4.00p8 omiryfar l33rcsec.tircly . 6 gru4c each oomfrilc aAbubdp-UT (u,hd b to bc d-B uftDt byrfi@ bywtcn; idicatrs; ooct)' . Tbohm*ft iloec saih@ ttsorrocs:- t4 4.(n- @srmryofthodaY'swort IhE Ellulmfr 5.mm Zamfara State fifth vear CDTI Evaluation Report 45 DAY ffiNE3 THI'f,IIDAY ZP OECEMBEN, M' srlr Thc ACIIYITY FACILITATOR I r.30AM ARRIVALOFPARNCIPffi Ab&lbhi l^abbo (socTl 2 9.G0.I(b trIdo@c ILObrdieh 3 9.10- Pncrcuatim IhMengue 9.2(h . Smydpngviotdayrswort . Tborcccildrv'luogre 5 9zoh eilury umrt Cminrcs: llakiaga nutaimblcph frr EratcimTcos lo.(h eccmiqgycar l2,3rrspodhrc*y . 6gwpe€.cbooqft)edded@(u,tcbto bc doc, u,tt6 by u,tom; by wtcq indicous; coct). . Ib ph mlt ft iro thc ataibb rGgrrrpEl. lo,o- Tea Brc* gmccpcr I0.Ism 7 lo15- Prrffitim of glup wodr, frlloted by plcory XaalEjcre n.r5r dieossi* Gsryl, 2,, + 5, 6 ie Se & 5 LGAB OOmiBcach) t 12.15- Plcaarydinrsion: Ckb Ospei l.30pm . ItBiryemsicr'Sultrimblople' frrlhcprrioct, frrthccmimvcr. 9 1.30- LINUIBREAI( tWrrqq 23(h t2 13G3.30 Plmrydimtssim Dn Obadidud pm , hrctical $!psb irytcmcdmc rt$irod inttc Ftrnlqh 'Susdnahboh' t3 3.30- Way Fcward DITXS 43h 14 43G Oairyoccmmy IhnCm/Per 5.Uh Se. MOH U ts N z1 il ru E E z b B E a^ (lE E I f! (\ t !t D fl It & I E' E 6 I 4 t (\ I \ -t - uI N\ * r{l *ffi *EE zE c: !tB.E E 6 'ErEufEafgE 4I 'Bgrg {B (\ \o ta \ T a'z I 6, FF$T E r gE It{ B[uaE*r$$ tE "E a ssE !t ut E rg 14, trE L vf eF -!l H$r H E' s.E - Eo C $aFEsEE[$sF-Fg$E c h z g I ,EBBE= I a affiHg eE c rFi, t &gE'E iI 8"S IH 8g HUE$H ug'ifg* E [t E'B tr' r-Ft uE t eF il I c E=EEE FgTBE z I 5 o\ rrr 5 N sr -, .:T EUE .\ E. g'8 (\ \ -N \\l a Frfr[EFtfl$$ff E E' 8'5 t gA $Egsc5$Bs FBIB3EEE \ \ BEETTB$E E,EEf,E [grE'E*$gnE EFEEFB=rE8[sFE I E H,Ei = 8a fi saE-g *HB-B$rrBErrEgr$ Ek fls {5 O { ( N 4 t, Fr EIt I EE (\ EB E FE n \s FE FE IF*EE $rygBEr*[E: { $EflTEEEqg. HB SE'' s o ]aE d- tr E' til ! \ I \ ItT ETEE Ee EFEE*BE EE'gEE TE B$EI$ Hg BR a tr E fi I 3 3 UBEFE EEBgSFEE E *$rEE HEF6EIIIEE E a Bri XB [ts i gE o$ ro N (= \ oe a rg a- D $ EE (\ \ i t) \iN BIIE 8 Fr F FtsE a $g*[$[$$$aH a o Es fBE$fEfl E o Q \o E8I 'El EEB !tsg BE Ci o-I a g.I ii tE s It€EB EEg$F rilt t,! IEEtE- 5 €) t.| t\) zQ. F t E g (l E z E, t N qa q E o E E' ,F o G rl \ !t- i, D c ia 7 a o2 a\ r+l Et 8.r BE. 919 o ' rl .N rg a6r.t H n \ 3E tsl r,l L) z - Eg E'H N XP oI \ € Eg dt t.l 3E t u2 oEre3o-, I ! \(\ \ ria 4 AEF fr ln sa" EFES*E lfsrErEarE (n E E zEI a t oF tst E x F*$EE*UrI Fl ts H*t t Ets ' r€' zo ESEEEEFE a e rt! 7 o rl7 C! H$E :z [[*EEEaE'E d IsH rEEs*EE UF t!'l E- u g E *n al{ sE€ 3 IE Fl '*H tIF= E FI FF r' $rE *s lE a 6: gF r, IE s s <> E! I $ FE*$F $*es 1F$ o\ rJl 5 u)Z EE' guF N EB €E' g'E0 ;J. \ oB a- r! 88S \ a 1t E' Fgrg *E*$'Erg*EHs U $rE \.iN E*r' BE 3€ s BF**[UEEF F FE t (\ \o HIB *E B.rg *f,IEE IEE Bg.f rsE u*g'E$$E$E r*FE E= 6o-C , EsI$$Es Ee E E CF.f ct E.[. F s Eg ,.raE' sE$[ElE ()oOO HFI12 rE rU Ftff e. Fr lil tf(i-- pe a E'< g tr -Fgi EI o:1' lrt 6i(!.4, E o \c, q, { E !' D N E' s (lCI HH BFg \ fa) (\ I I :5 \G rEE FEg$E {- EEg *1g E rBHEauE ._l IE3 FEI r HgE:p lar &[ a $Er "as i \ \ a.? 3 E.5'3 UBI$EAEE FEg EEEE 6g B B'qBE.g =I ri[EB s E9ES BEIgEEE =' s at E H t ! -F[rr-BEB*[E gEE EE P$B E[g F EEE iB=uBE H HUE H oel qH t! ?H? E.>E. iib ii g$FF cr tr srfiH ts rs oo r+' l{! r$E t -EHgle E qE.PE'tr 6s tts, F$[ r^ t\) 9Hso IIE*E o o g N & o \ i^ (\ iete \ F trts8 \tU r$E t-r EEh. tl-. o() - a b \ \o $$raE g{EH $EJr tt ;.-l: F!, H gaEEA aBEEts 3: E"< B Pr'r o c -o=t { o{ qr+ 6 rE' $BH lJr '*Ee;' t) FFE 3gr** Zamfara State fifth year CDTI Evalrution Report 55 APPCTDU ry tCy hlrrr tlct/lnEvlqrrd ln tlnz.mflrt CII]r tr lutuon STATE LEVDI/ PARTNERS Drt ohemmcd Bclo Btan Hon. Commlcrioncr for l'lccltt Mrlhftr Atru Anlc Fmrarurt Sccdtry Hc.trt I)r Umeru lhhenmcd Maru D$cc[or, Pubtc ]lc.lh Scrvlor tlr lbHr l{oltammcd Bmgufrt Adntn AlEHrril lrUl{O Gurer MrYusnfJ. Ssti Progprrrnc Penmncl SSI l&duna MrAbdtrllahi A lrbbo SOCT moder I,GA LEVEL Alh. R.btu lse 6urau Anla LGA Oltldor Ffflonnd lhnegamnt Alh. Lilef Suehu Dhcdor fthery tlcalfi Crp Alh. Sanl S. R.ll Oncfio Coodhetor ZUMI LGA Alh. RlDtu llomflmcd Counclhr For Hceth Alh. GrOe Mohammql AsC DhrdorPFlC Mr Haruna Abtut$l Ocpdy oldto Coodlnator Bugu&II}A AIh. Yusuf Abubakar Anka Directu of Finmcc AIh. Moharrnncd A. tlassm Diroctor PHC Alh" Atilru Abullshi Brccutive Chairman Alh. Bello Kado Ahmcd I"oCT lcader Alh" AbdullohDahiru FLIIF Bungu&r Ath. Bala Magnji FLIIF Nahuche FLm MrAllyu l,laden Hcrlh F.clllty $aff Yamatenkerl Ar*e COMMT'NTTY Alh. trlanlru AMulrhl Anlo LGA Communty le.dcr, Wuya Alh. Unnen ltl[hllrl Commmly m.mbcr, t/VU!,s Alh. lbnhlm Abubrkrr Communly lcrdcr, Yrmetankerl Afir. Afiml Shhfidt CommmlY mdnbcr ' Alh. tlohamcd Nerm Communfiylrlcmbe ' ilrAdrmr lbh.fim.d Communfty lodcrBlmln Dold ll Alh. AbduLhiA$!,u Communly mcmbcr BtnhDokl ll Alh. Hslrrn S. Pem Conmunlymcmbcr" llr. Urmen Abubeker CDD Blmln Dold ll Mr. AbubelorAbubalcr CDD Bmh Dold ll Alh hE$ S.rkl Conmunty lcedcr, Doka ZUMI LGA Alh. Moh.nmcd S.h,rr Communty l-cadcr, t al:!.ba Alh. Stthln n Hrnna Comtnmtty manbtr' Ah. AbduldtlAfnt Commrnlty mcfl$cr, " Allr. Yucrf lbnhlm Commmly mcntbcr, " MrLabaran iiohrmmcd CDD ilatar$a tlrBeh llohammcd CDD llahraba Zamfara State fifth year CDTI Etnluation Report 56 llrBah AMulhhl CDD tlrfiar$e Alh. Ugnan Wakfll Commrnfi lcadcr, Sangamowa Alh. Ugnrn Ab.thl Communlty ntcmbcr" Alh. WddllLSo Comnunlty mambcr " Ah. AfW Mendc Commnlty mcmbcr" Alh. Gado Mrgga$ Communlty mat$cr, " ilrilandoAbuf$l CDD, Srtgrnwa llr iluce lbnhlm CDD, Sangnmowa tlrBeh Magg.rl CDO, Smgnmoua. Alh. Abdu[CtlUmaru Communfry, Lcadcr Tunge-B Alh. AbubelorGarubc Commnfty llcmbcr" Alh. Abdufldtllbnhlm Communlty mcmbcr, " Alh. lraka Sulctilt CDD Alh. Ugnan lbrdtllt Dbtdct hcad/badet Dolc Mddn YuerlU Moharmcd Vfiagc lcadcr, Doh Alh.lbnrhlm ftlailsebr Comrunlty mcmbcr, Dolc Fhjlf Ahfirtu Srbrhl Cormunfymcn$cr, Eldc Alh. Sulelman lbnhfin CDD, Dolc Alh.lbnhlm thkeu LradcrZaman Gha Alh. Bcflo Burgudu tlbt. Hcrd Bungudu Alh.. Wadtru banu CDO Artd vilagc Alh. Nuttr Galadkna Cornunly mcrtcr Zaman Gln Alh. l{altu ADubelor CDD Zrmrn Glra Alh. Bc[o Srllhu Cormunfi mcn$cr Atkl vtfl.gc Alh. Usnen llohammcd CDO lGnkrlvflrec Alh. Sabon€ed ilohemmcd losdcr Kankal villrgc Alh. Gldo Krnkd Comnunty mcrtcr tGrakel Alh. Afl MelghlDangum tradcrDengum villqn Alh. Abub.ftr Sedlq Dlpulo Communlty rncmbcr Dmgum Alh. l-awall lsa Cil) Yamatrnlori Alh. Adamr tlohammcd LcrdcrDoka Zarnfara State Jifth ),ear CDTI Evalrction Report 57 APPEI{DIX Y LIST OF IX)CI'MENIII ODSERVEI) l. Strc lrvGt - CDTI wort plsr - TroaMoov€rtgp - Tochnical Rqorts - NGlrchdsdadphofdbn - AFOCapfovdfimdingProPosal - Iogbookbrprcjectvchiclc - CDTlsqcvisoryclt*klist 2. LGALevoI - Ptymil Voudtr 2ffi47ffi3 - L'GAActilnPln2WSnUJ4- - WorhplanforCDTI - Budga/JiIS - CDTI srrpwvisory clrcck list - tt[ectizm requisitbn form - Trdning rnmrnl 3, f,'Lmlcvcl - CDTIa.tivityplans2fil4 - lt{ectizm ffioriry frrm - Mestizur disEihrion summary rfirriZ0[iS|20iJ4 - ClrTlsrprvisiondGc&list - M€ctizulRegister - Itilectize roquost rqist6for6c orrrynity 2IXl4 - CDTI fiaining mont (pmctical guido for tafurrs) - Traininghealhc&Mbnpostss 4 Commmtty Lcvel - Comtmiry rqist€r - Measuing Stick Zamfara State fifth year CDT'I Evaluation Report 58 ApptodL l/t ADIDNDSSES NON EYALUATION TEAM MEIUBERSI Z.mltta $tb CD[I, illgcd. NA}TE AMETS DrMrrrOtfr Hdotr l(dlcr hcrneion4 lA AtilrY. MrcbgnRoedotr Natioat Hbrry, tros. Td/Fq, +Nn-7346'n email: mus aobadiah@hkhieeriaoq IDrnmfaAilcrCro tlth Swrstrca*lmrt, BP 4'ft4YDudA Cauoo- TcL xtl:t6ol,B06.;,2:n-zlttxr} Fu,237-tLl7!X? E-mit rbe fi di. S S I carnlDereolink. nd DrEmluclEml* TbCulcrCcoirlf crit l,[*iout Offiao, I J*rl(rdim SEoGt OtrTrr&m Uhda Riog Rod, P.O Box ??7a los TA B44tt71). Fu ?3tt-7?- lO00$t;cdl234-EIJ/,i6,62Z B+tff}iU7lg?t7. emil: cartercentemg@),ahoo. co m emukatre(2)vahoo.com MrKmfSre fimUoiversity, Jimm, P. O. Borr 37t Eirytot Tdtrs 251-?- I 14516; 251:l -ll0%1. Far 251- 7-ril45q, zst-?-ttz,4p [email protected] I)r. Vhctrt Cilhrrndu D&rl Ocerm sfTmb3g, Irnivcrdty of Nigrh, lk{dca TcL 234-frX-32tlt0t em't ejerevc@yahoo. com [email protected] UrG[fiOrpet CtsDIOncboComdnqrlre 3 AJ. Dcomwa& closeIos. Phcal Stic,Nigrir. Td.M 73-+5657r. 4v2?O. Cdl 234- W}Tl6Yll9. emal; [email protected] N LiE lll : ',/) 1F ! BQ ,{ \tr -) FE U a2 \l F] 82iF t* rE \E t o i TT E:ttsE eD Eo te EEE 7, an EE ** EI ES o2 E =l! Fgi EI7 1i }) h, e EJ rt I5 o l, $E EI 19 a gr EI 3 E t! 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Zamfara State fifth vear CDTI Evaluation Report 63 APPENDX VIII I,ETIERSI TO I,GAI Itc Chritnrn' Attcndon: DearColleague Inbrmlion 1[oa1 thc comiry cvduiinn of thc Onc.hoarcill (Rirctr Blfldncrr) contnol proSrammc Fc te part ftm pa6 pr hevc boco hcbitrg to nm 8 progrmo to cffiol river Uindnoss, by diltrihdngfio &ug MoctizanOto yitlagers inyonq!_tis prcrymc has bgeo sry,po,rt€dby e Afiicu ProgFam for Onc.hocerc&rsis Cffiol (AFOC) as well as )qtr Miniltry oftlc8ffi, ud some nonaovermcoal orgildldms. ft€Ec fimdsrs now wafr to tnow u,h€th€r tfe programe tcy havc fircd has booomc !fimg coilgbb cmime. Withintrcneocwea&Nonemb€r Zf ozf APtOCisgoingtogenda t€am,toinvcstigseth€ $taftEbility of6c rirler blinfu cdol prcgralrrmc in yor uca. Since y9qflay o iryorffi role inthpiogfam€thcyworld liketo mcctyor, totalktoyor aborttte follos'ing isstt€s mocrning tLo ooffiol Pngrmrc: . is programmc boing plmed yearly? :ffiffiPlaming: how the . (Hcriry and disrihrting lfccizanO: wtc prom is bcitrg foltorcd o uder md diciltihilE the MectizanO? . Trainingod rcositisdioo/mobiligaim: whdtrining ud mobilisfio actirdties arcta&ing - . lmrfirnding: u,td fnding is corrtdy araihble ud u,hd is likotyto bc araitablo in ftm€? trsdroes: rctd b arailabb now, od nhd ir tikcly to be _ ffiffi Ddcrial . ltm rcsqrrco!: u,ho fu availablc to rm tts psogamme, ud hm skiltod arc thsy? . C.ovcrage: how woll is yon arca being covered by ec programre? ft is dneccsearyfulur b m*o elaborm ptcpuUons fulhe vbit. Tbtcam mcmbos nesdto fitrd oil urhd fu plr€Gil siudion rs, ud yor do od trcod to ohuge mything ycr do b€fqctcy e arircl IIey siqlb wail to trft b )'or, b h€ar ftm yar wtd is tryecoing in yqr put oftc p6oglamr; We world te most gra0cfut if yor oqrld spar€ ttarn a brt of yor timc, on a agrced dae( . Zamfara State fifth vear CDTI Evaluation Report il Tho pcrsm hoding yan lhis documd nsy atso ask pu O gC come doctrm€ffi ready frr lhc team rvtich is oming to soe yan. Iho idormUio inffo$ documents will heh 6cm to lndcrsta1l yar furdm conEcdy. Wc wqrtd be graffit ifyqr qild assilt ru byhsving ttore documoo6 ready on thc day whoo tho t€am oomca to Yisil you. It may b th yu do nd have ghm somc oflho a6cuacm - th# is mt a poblem" Wh*rrcr yor a,ro abb to the tcam will bc uscful. Tbantyor verymrch! Yqus sinccrely, Dr Umnr MOH ltlau, Direcils Public Hcalth Strvices, Fa tlqrcablc Cormrigsi@ For thlth. *l -l 65 Zamfara State./ifth year CDTI Evaluation Report -l Lj The chairman, -: Attcndon: ! Ilc.r Colhlguc \ p6r AAOC Su*lnrumty Evrlurtion rGGdb.cL rnd Phnnlngmesqlgrol T,r'lfilnsfftc cDrl'llrd Lc/\Worlatop rtTYom udi-rrrpoac ccntrc Grrru bf Ilerbcr zltlui, : 3fNwcrbcr veruo' yo,r re ordially invitcd to thc aboyc all important urorffioP.trt thc above )(xr role to plan towards the prcsc.cc is rnanddory ; ;ry a"E a vcry riioinotot and crucid srssess ad sxtEinability ofCDTI in yor arca' yorr rubsistcncc dlowance Tho wortshop starts 8t t.o&m each day and cds by 5.0opm and tnncport-witl be trkcn caro ofby tho projcct' must dtctrd this very imporunt Ttre Hon Comnrigsionc,r hrs directod thd all conccrrcd wortlbP and bG trIocmd aP wclt' yo.rooopc,rcion irhighly solicito4 whilewe lmkforwardto sccing yor dthe wortshoP. Yqrs SinccrelY' - IhUmanr MOH lvfru, Director Public Hoalth Sonricos, For: Honorrble Commi$iolrr.