ATFARA S7A7E CDTI PRO.'ECT
ORIGINAL: English COI,NTRYAIOTF.: NIGERIA ProiectNamez T.amfuz CDTI Prnject
Anproval Year: 1998 Launchins vear: 1998
Reoortine Period (Month/Year): JAITIUARY TO DECEMBER 2007
Proiectvearofthisrenorf,(circleone) l2 3 4 5 67I 10
Date submittedz 2UD7 NGD(O partner: SIGHTSAVERS INTERNATIONAL
NINETH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE coMMrrrEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC)
Sp**
i.CI3 No)',ilra!, hi cstr CoD &l+ 4 B For l;x:,..--l'cr j i i To, Aip- I n I Stp. i!108 I I i n.tsok#, rt I I I ANNUAL PROJECT TECHNICAL REPORT
SUBMITTED TO
TECHNICAL CONSULTATIVE COMMITTEE (rcc)
DEADLINE FOR SUBMISSION:
To APOC Management by 31 Janu ary for March TCC meeting
To APOC Management by 31 July for September TCC meeting
AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)
- WHO/APOC, 24 November 2004 I
ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
DEADLINE FOR SUBMISSION:
meeting To APOC Management by 31 Januarv for March TCC
meeting To APOC Management by 31 Julv for September TCC
AFRICANPROGRAMME FOR oNCHOCERCTASTS CONTROL (APOC)
- WHO/APOC, 24 November 2004 I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEME,NT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
Country: NIGERIA
National coordinator Name: Patricia ogbu Pearce
Signature, .@'*o
Date: .4.lPq. I {
Zonal Oncho Coordinator Name:Dr' F I
Signature
Date: ...2*
NGDO Representative Name Marthe Damina oxw-.*. ryf.?lev
Date
This report has been prepared by Name: Abdullahi Labbo
Designation: StaterCoordinatoP ,,r,;;.' e-q'^o/- Date .tQ..-..7*9.A...
- WHO/APOC, 24 November 2004 Table of contents
Acronyms vii Definitionsviii FOLLOW UP ON TCG REGOMMENDATIONS Executive Summary v SEGTION {: Background information vii VII GnNenalINFoRMATIoN...... '...' 1.1. vii Description of the project (brieJly) 1.1.1 .ix 1.1.2. Partnership 1.2. PoPulertoN.....'..'...... 1 SEGTION 2: lmPlementation of GDTI i 2.1 Truer,rNe oF ACTIVITIES ...... 2.2. Aovocncv ::;.-;J B;;id;; ;;;il';: 2.3. MoatltzRttoN, SENSITIZATIONANDHEALTHEDUCATIoNoFATRISKCOMMUNITIES.II 2.4 Cotr4NaLNtrY INVoLvEMENT ..' 2.5 Cepncttv BUILDING ....1 2.6. TRnarN4eNTS ...... I 2.6.1 . Treatment figures 2.6.2 Wat are the causes of absenteeism? 2.6.3 What are the reasons for refusals? -.. (SAEs) that 2.6.4 Brie/ly describe all lcnown and verified serious adverse events to the current year 2.6.5, Trend of treatment achievement from CDTI project inception Ennon! BoorruaRK Nor 2.7. ORoERINc, sroRAGE AND DELIVERY oF IVERMECTIN DEFINED. MeerNC EnnOn! BooxUa'Rx 2.8. COtvttrttrNtrY SELF-MONITORING eNo SrereHoLDERS NOT DEFINED. 2.9. SupeRvlstoN...... '.. 2.g.1. Provide aflow chart of supervision hierarchy....Error! Bookmark 2.g.2. Wat were the main issues identified during supervision? """""""' 2.9.3. Was a supervision checklist used?.-..."' supervision? 2.9.4. What were the outcomes at each level of CDTI implementation supervised? 2.9.5. l|ras feedback given to the person or groups performance of the project? 2.9.6. Hoi was the fiedback used to improve the overall ii SEGTION 3: SuPPort to CDTI Error! Bookmark not defined. 1 3.1 EeutptrlsNr COMMUNITIES 2 J.L FINaNCIaI CONTRIBUTIONS OF THE PARTNERS AND """""""""' J J.J Orupn FoRMS oF coMMUNITY suPPoRT.'.."""""" ,J 3.4. ExPr,NPtruRE PER ACTIvITY SECTION 4: SustainabilitY of GDTI Error! Bookmark not defined' EveluarloN.'....'..'...'.'...... ' 3 4.1. INrnnNel; INDEPENDENTPARTICIPATORY MoNIToRINc; the reporting period? (tick any 4.1. t Was Monitoring/evaluation carried out during ...... 4 of thefollowingwhich are applicable) """" "' not deJined' 4.1.2. Wat were the recommendations? "' .Error! Bookmark not defined' 4.1.3. How have they been implemented? " .Error! Bookmark SusreNeslLITY oF PRoJECTS: PLAN AND 4.2. 1 Yn 3)... :*l:::::::Y)::l:::ll: :: ,...4 4.2.1, Planning at oll relevant levels 4 4.2.2 Funds...... 4 4.2.3 Transport (replacement and maintenance)
- WHO/APOC, 24 November 2004 .....5 4.2.4. Otherresources...... 5 4.2.5. To what extent has the plan been implemented"""""""" .....5 4.3. INrscRArloN...... 5 4.3.1. Ivermectin delivery mechanisms"""""""" 4.3.2. Training...... 5 progroms...... 6 4. 3. 3. Joint supervision and monitoring with other .....6 4.3.4. Release offunds for project activities "' .....6 4.3.5. Is CDTI included in the PHC budget? """"""' how 4.3.6. Describe other health programmis that are using the CDTI structure and .....6 this was achieved. What have been the achievements? """""" ,.....6 4.3.7. Desffibe others issues considered in the integration of CDTI' ...... 6 4.4. OppnerloNAl RESEARCH. 4.4.1. Summarize in not more than one half of o page the operational research ...... 6 undertaken in the project area within the reporting period...... 6 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknessesr challenges, and opportunities 6 sEGTION 6: Unique features of the proiecuother matters 8
- WHO/APOC, 24 November 2004 Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Obj ective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring FLHF First Line Health Facility IEC Information Education and Communication LF Lymphatic Filariasis LGA Local Government Area LOCTs Local Onchocerciasis Control Teams MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers I.INICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization
- WHO/APOC, 24 November 2004 Definitions
(i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking).
(iD Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area.
(iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with Ivermectin in a given year.
(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverag_e (normally the project should be expected to reach the UTG at the end of the 3'' year ofthe project).
(u) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage).
(vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).
(vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- eifectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI.
(viii) Sustainability: 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 mobilised by the community and the government.
(ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full .esponribility of Ivermectin distribution and make appropriate modifications when necessary.
- WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC sessionz 24th Number of TCC RECOMMENDATIONS ACTIONS TAKEN FOR TCC/APOC Recommendation in BY THE PROJECT MGT USE ONLY the Report o Explanation for the The project has a 258. UTG (97% of total population of 181,177 population) as the UTG, which is 84% of the total population (215,685) of treatment area
a Why was training The appointment of conducted in new Onchocerciasis September after coordinator and the funds had become Director Public Health available when and Disease Control distribution had been was in April, 2006, completed in June? therefore the change of the B signatory was finalised by September, which resulted to conducting training late. The project did this ensuring that knowledge learnt would be used in the next and subsequent treatment rounds. a Why was only a The training was minority of CDDs conducted by health included in the staff in some facilities training? without any fund by the LGAs. a Less than 20% of The fund released was 259 funds budgeted by a total monthly impress the state were from the PHC released (95 000/500 department, which was 000) not part of the counterpart fund budgeted for the proiect.
- WHO/APOC, 24 November 2004 U It still has not been Based on the people possible to train tradition and religion female CDDs and female were not females still do not allowed to participate participate as CDDs despite the significantly in sensitisation. Effort meetings. through advocacy would continue to ensure this is achieved. a Late financial The bank approved for returns to APOC the project in most have made it occasions does refer the impossible for request (financial APOC to release statements) to be funds in a timely forwarded to the manner. In project from Lagos, conjunction with no and this do take time or few funds before the project will released by the state, lay hand on the this lack of funds statements. puts CDTI at jeopardy. TCC encourages the project to provide financial returns to APOC in a timely manner so that the project can at least receive APOC funds
a CSM and SHM need Due to non release of 260. to be implemented funds to advocate and with high priority sensitise communities on CSM and SHM such was not implemented, but the project hopes to implement these in 2008 if tund is made available. 262.TCC noted with concern that the state did not release ANY funds and that due to lack of funds, TCC21 recommendations were not implemented.
- WHO/APOC, 24 November 2004 a Implement TCC 2l 263. recommendations
a That the project The project has not integrates training of been able to integrate community the training of supervisors into their community strategy to increase supervisors, this is as a community ownership, result of to non release if funds are available. of counterpart funding due to the regular changing of policy makers at the state and LGAs government levels, and bureaucratic. More mobilization and advocacy visits would be undertaken by the project at the two levels (State and LGAs) to see to the implementation of these activities in 2008. a There is only I CDD The project could also per 551 people in the not train community project; however the distributors as range among LGAs is expected; this is as a from 1 CDD|227 to I result of the reasons CDD1964 people. mentioned above. Project should try to Further mobilization train at least double and advocacy visits overall, but preferably would be undertaken three-five times the by the project at the number of CDDs two levels (State and depending on the LGA LGAs) to see to the (along kinship lines) to implementation of this reduce workload/CDD activity in 2008. and better ensure sustainability.
a Project should start 2007 Mectizan@ ensuring that Mectizan Report &2009 ordering tasks are Mectizan@ Re- undertaken by application was done govemment and not along side the NGDO as soon as supporting NGDO, possible. next report and re- application would be
- WHO/APOC, 24 November 2004 the sole responsibility ofthe project o Project should try to Done shorten the period of distribution with a more intense social mobilization just before. o The local government This has remained a should try to find problem to the project. funds for increased With the stability of the training and polity now after the supervision activities. past political elections, the project will continue advocating and soliciting for LGAs to see the need of releasing budgeted counterpart funds toward sustaining CDTI activities. a A better and Advocacy, mobilisation acceptable way of and sensitisation were reaching, educating, identified and carried involving and out specifically for treating women in such. purdah should be identified and implemented.
a More CDDs per CDDs were selected population need to but training could not be trained, including take place as planned women CDDs. though few health facilities trained their CDDs. This will be carried out once fund is available. a A better strategy for The project identified counterpart fund advocacy and release at state and sensitisation on what LGA levels needs to CDTI strategy is were be developed and identified. These would employed. be implemented as a continuous process to seeing that funds are always released as budgeted despite the
- WHO/APOC, 24 November 2004 frequent transfer of stakeholders concern (Please add more rows if necessary) Executive Summary
Prepare an Executive Summary of the report in not more than one page.
1. Background on treatment ond population data - Total communities, communities treated, total population, UTG, ATO and persons treated.
2. Background on population movements.
3. Training data - CDDS, healthworkers, Total population (community) per CDD trained.
4. Challenges and how they were overcome-
EXECUTIVE SUMMARY
The African programme of Onchocerciasis Control (APOC) Community Directed Treatment with Ivermectin (CDTI) project in Zamfara State is in its ninth year of CDTI implementation. The state is made up of fourteen administrative Local Government Areas (LGAs) with five identified u, -..o-.ndemic for Onchocerciasis. These endemic LGAs are Anka, Bukkuyum, Bungudu, Maru and Zurmi and have 116 endemic communities. Their updated population in the lear under review according to census obtained by CDDs was 215,685. Out of this fig,|y7 people were treated in2007 from an annual treatment objective of 187,380 using 424,094 tr4eitizanO tablets. The geographic and therapeutic coverage is 100% and 83oh re YEAR POPULATION NO. TREATED GEOGRAPHIC THERAPEUTIC COVERAGE COVARAGE I 998 135,572 96,5t3 t00% 7r.t8% r999 140,424 108,092 r00% 76.97 % 2000 154,970 1t9,526 t00% 77.12% 2001 161,972 132,797 t00% 81.98% 2002 169,449 r40,267 t00% 82.77 % 2003 184,666 152,712 t00% 82.7 % 2004 193,r56 153,363 100% 79.3 % 2005 201,210 163,780 t00% 8r% 2006 204,092 165,421 100% 8t% 2007 215,685 179,027 r00% 83%
Within the year a total of one hundred and seventy five (175) LOCT/CDTI supervisors were trained on new data collection format, in which 36 of them newly trained, whilel39 were retrained. Two hundred and twenty one {221} community directed distributors [CDDs] were trained, 80 were newly trained and 141 retrained.
- WHO/APOC, 24 November 2004 There was no counter part fund and financial support from by the state and endemic LGAs, constant transfer of policy makers was an issue during the year under review. Some community members assisted CDDs with incentives. Like in previous years migration of nomads and youths from endemic communities to better grazing lands and cities to seek jobs during the dry season accounted for absenteeism.
As a result of absenteeism mop-up treatments were carried out in some of the endemic communities, advocacy and reminder were done and written respectively to stakeholders concerned but unfortunately for the project no fund was released despite the integration and recognition of CDTI into the PHC. The project will continue to advocate and solicit for the release of funds budgeted toward ensuring sustainability of the progralnme.
- WHO/APOC, 24 November 2004 SECTION 1: Background information
1.1. General in formation
1.1.1 Description of the project (briefly)
Geographical location, topography, climate P opulation : activities, cultures, language Communication systems (roads ...)
Admini s tr ation s tructure Health system & heolth care delivery (provide the number of health posts/centres in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities.
The State is located in the North-westem region of Nigeria and shares boundaries with Sokoto State and Niger Republic to the north, Katsina State to the east, Kebbi State to the west and Kaduna and Niger States to the south. The State is made up of 14 Local Government Areas. The vegetation of the state is mainly Sudan and Savannah grassland. There is a vast land of agriculture and two main rivers (River Bunsuru and River Ka). About 80% of the population lives in rural communities. The State has two seasons namely the rainy and dry seasons, the raining season commences from May to November, while the dry season starts from December to April.
The State has a population of over 3 million people (2006 census) with Hausa and Fulani being the main ethnic groups. Islam is the predominant religion in practice. The main activities of the people are crop production and animal husbandry.
The advent of the Global Satellite Mobile telecommunication system in the state has improved communication tremendously. The state populace also has access to the electronic media through the radio and television stations - Nigerian Television Authority owned by the Federal Government of Nigeria, the state owned radio station (Zamfara Radio) and also the Kaduna State Radio Station. The state has an established Ministry of Information with other local means of disseminating information to its people in rural communities.
Eighty percent (80%) of communities are difficult to be accessed during the rainy season. The road networks to some of the local governments are feeder roads with diffrcult terrains. Patients travel long distances for health services. Public means of transportation to most of these communities are available only on market days, the cost of which is high (about $8) for an average community member.
During the dry season there is a high migration of male youth to urban areas to engage in petty trading and other unskilled labours to earn a living. They however return to their communities in the rainy season for agricultural activities.
There are two main tiers of government operating in the state - the state and local goverrments. At state level there is an elected Executive Governor with elected state
- WHO/APOC, 24 November 2004 Assembly members, while at the L G A level, there is an elected Chairmen with his elected councillors. There are also the traditional and religious institutions of leadership, which have an influence on the administration at the local government. A General Hospital is based in each of the 14 LGA headquarters and in the surrounding districts; there are sporadic primary Health Care delivery infrastructures, ranging from comprehensive health centres to health clinics. The Primary Health Care facilities serve as training centres for CDDs and other trainings, as well as Mectizan@ collection points. The project area has a total number of 178 health staff and 72 are currently involved in CDTI activities.
Table l: Number of health staff involved in CDTI (Please odd more rows if necessary)
Number of health staff involved in CDTI activities.
Total Number of Number of health Percentage health staffin the staffinvolved in entire project area CDTI
District/LGA B B, Bs=Bzl Br *100 Anka 32 6 t9%
Bungudu 40 l9 48%
Bukkuyrm 36 27 750h
Maru 34 7 21%
Zurmi 55 l0 30%
State MOH 3 J 100%
178 72 40o/o Total 6
The change of cadre by some of the health staff, transfer, and involvement of other health workers in other health programmes at LGAs was what account for the shortfall of persons actively involved in CDTI activities during the year under review.
- WHO/APOC, 24 November 2004 l.l.2.Partnership
Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), c ommunitie s, loc al or ganizations, etc. J Describe overall working relationship among partners, clearly indicating specific oreas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, ,f ,ny, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to ossist in CDTI implementation.
Partners in the Zamfara CDTI project comprise of the following: -
l. Zarrfara State Ministry of Health 2. The Ministry for Local Govemment and Chieftaincy Affairs (representing the five endemic LGAs) J. African Programme for Onchocerciasis Control, (APOC). 4. Federal Ministry of Health 5. Communities in endemic LGAs 6. Sightsavers International
All the partners play roles and perform their responsibilities in the implementation of the project activities based on CDTI strategy.
Zamfara State Ministry of Health The Zamfara State Ministry of Health is structured in line with the Nigerian Health Structure that is based on the concept of the Alma Ata declaration of 1978.
Based on the above the National Health Care Delivery System is structured into primary, secondary and tertiary levels of care assigned to the local, state and federal governments respectively. The Zarrfara State Ministry of Health is therefore responsible for the provision of secondary health care, supervising LGAs to provide primary health care services to its population. There are 8 departments in the ministry; each of which has a role to play in the provision of health care services. The 8 departments are Administration, Public Health Services, Primary Health Care, Pharmaceutical Services, Nursing Services, Planning, Research and Statistics, Finance and Supplies and Inspectorate Services. The ministry supervises three parastatals - Hospital Service Management Board, School of Health Technology and Health System Development Project. The activities of the Ministry and health services provided are funded from budgetary allocation from the state govemment. The Ministry is involved in planning, advocacy to the LGAs, monitoring and provision of logistic support for implementation of CDTI in the state. However, provision of counterpart funding by the state and LGAs has been poor.
Sightsavers International Sightsavers International has been supporting Onchocerciasis control in six Local Government Areas (Bukkuyum, Bungudu, Tsafe, Anka, Maru and Zurmi) with Tsafe LGA as non APOC LGA this has been since 1996. The organisation has provided technical support in terms of training of project staff, planning and reporting; including logistics support (vehicles,
- WHO/APOC, 24 November 2004 IEC materials, spares, monitoring, advocacy etc). The organisation also supports trachoma control using the SAFE strategy and provision of cataract services in the state.
Ministry for Local Government and Chieftaincy Affairs The Ministry is the supervisory organ of the local government areas in the state and the endemic local governments fall under them. The Ministry has assisted the project through communication and advocacy towards ensuring that the local governments provide the necessary support for implementation of CDTI. The local goverlments under the ministry involved in CDTI through planning, advocacy to traditional/community leaders, monitoring and supervision, health education and mobilization of communities, reporting and management of adverse reactions as a result of treatment with Mectizan@. The State Ministry of Health and the LGAs provide office accommodation, pay salaries and emoluments of SOCTsiLOCTs, but there was no released of counterpart funds despite advocacy visits conducted seeking for stakeholders' political and financial support towards the project sustainability.
African Programme for Onchocerciasis Control (APOC) The African Programme for Onchocerciasis Control (APOC), which is a WHO organ, was established in 1995 with the sole objective of supporting the control of Onchocerciasis in sub Saharan Africa using the Community Directed Treatment with Ivermectin (CDTI) strategy. APOC has supported the Zanfara CDTI project with funds for implementation of project activities since 1999 and also provided capital equipment and logistic support for the project. Within the year APOC contributed fund based on the sustainability plan and also provided capital equipment to the project.
Federal Ministry of Health This is the organ of the federal goverrment that is responsible for formulating national health policies. The National Onchocerciasis Control Programme (NOCP) is a unit of the department of public health and is headed by a National Coordinator. There are four zonal offices -Zone A (Enugu), B (Ibadan), C (Kaduna) and D (Bauchi), which are headed by zonal coordinators and have the responsibility of monitoring CDTI activities in their catchments states. The state happens to be in Zone C. The NOCP on behalf of federal government endorses all letters of agreements with APOC and monitors implementation of CDTI in the state including advocacy for support to the states.
Endemic Communities A community or village inZanfara State refers to people in either small or large groups, who live in the same place, share the same culture, customs and traditions with a common leadership. In the project area there are 116 endemic communities that fit these descriptions. These communities have been receiving Mectizan@ for 1l years. The communities are responsible for the selection of volunteers as distributors, provision of incentives for the volunteers, collection of Mectizan@ from central points, distribution of Mectizan@, monitoring and supervision and reporting among other responsibilities.
State the number of policy/decision makers mobilized at each relevant level during the current year; the reison(s) for undertaking the advocacy and the outcome. Desuibe dfficulties/constraints beingfaced and suggestions on how to improve advocacy.
Advocacy as a vital activity on CDTI was carried out to major stakeholders at both the State Ministry of Health and the 5 endemic LGAs of the state. The policy makers mobilised were the state Honourable commissioner of Health, 5 LGA Sote Administrators, 5 Heads of PHC in the LGAs and eight traditional leaders in Bungudu andZtrmr LGAs.
The essence of this was to solicit for their political and financial supports toward sustaining the programme at all levels, it was also solicited that CDTI should be integrated into other .o*-rrity based prograrnmes. However, due to political transition from a civilian government to another civilian government, constant change and transfer of policy makers at all level of government that the project advocated resulted to none release of the Five Hundred Thousand ($+500,000) naira budgeted as counterpart funds. These funds if released were intended to be use for mobilization, health education, data collection and repairs of old project vehicle. There was little contribution of incentives by community members as support to community directed distributors (CDDs).
Effort will not be relent by the project in advocating to all stakeholders concern in subsequent treatment years with the hope that support will be given in good time for sustaining CDTI.
WHO/APOC, 24 November 2003 2.3, Mobilization, sensitisation and health education of at risk communities
Provide information on:
- The use of media and/or other local systems to disseminate information - Types of IEC materials used - Mobilization qnd health education of communities includingwomen and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitisation of the target communities.
The project did not use the media for mobilization and health education on CDTI, but Front Line Health staff in collaboration with CDDs and local town criers were used to disseminate information on CDTI in their respective communities.
Posters of 300 copies each in Hausa, English and Arabic versions; 1,000 copies of hand bills each in Hausa, English and Arabic versions; and 1,000 copies of stickers were produced using the fund released by APOC toward supporting the project. All these were allocated to the 116 endemic communities for mobilisation, sensitization and health education. These IEC materials were produced to pass information on what the disease is, how to control it and the need to integrate CDTI with other Primary Health Care programmes.
Zarrfarastate is predominantly a Muslim State and women are usually in purdah. Traditional birth attendants (TBAs) were oriented to mobilize the women. Responses from communities were encouraging, as most of the communities have continued to respond positively to the programme through annual compliance to treatment using Mectizan@ tablets. The project intenas to henceforth plan the use of audio and audio-visual means to disseminate C D T I information to all endemic communities prior to release of fund to the project'
- WHO/APOC, 24 November 2004 2.4. Gommunity involvement
Table 4: Communities participation in the CDTI (Please add more rows if necessory)
Number of communities Number of communities/villages with Number of CDDs community members as suPervisors /villages with female CDDs Total no. Number with Percentage Male CDDs Female Total Number of Percentage communities community CDDs communities in the entire members as with female project area supervisors CDDs Bo= Brr= DistricULGA Br Bs BJ B. *100 Bu Br Bs= B:*Br Bro Bro/Br* 100 Anka l3 8 6l.5vo 39 0 39 0 0Yo
0 0o/o Bukkuyum 53 t7 32.3% l0r 0 l0l jYo Bungudu l9 l3 68.4o/o 8l 0 8l 0 jYo Maru 23 ll 47.3Yo 86 0 86 0
0o/o Zurmi 9 9 l00Yo 5l 0 5l 0
Total 116 58 50.o/o 358 0 3s8 0 0o/o Comment on: - Attendance offemale members of the community at health education meetings - In generol, how do you rate the participation of female members of the community mitings when CDTI issues are being discussed (attendance, participotion in the discussion etc). - Incentives provided by communities for the CDDs - Atffrtion;f CDD1. Is attrition a problemfor the project? If yes, how is it addressed? - Other issues
Involvement of female members in all endemic communities is still an issue. This is due to the people's cultural and religious beliefs (who are predominantly Moslems). This means partial o, non involvement of women in decision taking generally. Attendance and participation of women during CDTI discussion were poor, because younger and active wome; are in purdah. Mectizan@ only reached these women when approval was given by their husbands or head of the cluster. The project experienced problems with giving incentives to CDDs by their community members. Community members feel that other community health based prograrnmes such as the polio Immunisaiion Programme are paying community members involved in their activities. The community is therefore not expected to pay the CDDs as the CDTI project is also paying them. There is also attrition of CDDs. They go out of their communities seeking for meniailobs, business and to attend school. This situation is experienced by the project annually. To address this, community members were encouraged to select at least three CDDs for distribution, or to select CDDs using kinship strategy, i.e. using family members as CDDs.
WHO/APOC, 24 November 2003 2.5. Gapacity building
- Describe the adequacy of available knowledgeable manpower at all levels.
- Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough lcnowledgeable manpower was available or if staff are frequently transferued during the course of the campaign).
At state ministry of health there is an issue of insufficient human resource due to change of cadre and transfer of service to other health institutes. During the treatment year a planning meeting was held with the relevant staff of Ministry of Health, Environmental and Local Govemment Affairs Ministries, State and LGA Onchocerciasis Control teams to address such issue, one of the issue discussed towards buitding a capacity at the state level was to transfer two health staff (C H E Ws) from some LGAs to state C D T I project unit to assist the state project coordinator. This could not be done due to constant transfer ofstakeholders as a result of transition from a democratic government to another'
Training and re-training of health facility staff and community volunteers was planned. A total of {175} LOCT/CDTI supervisors and other health workers were trained and re- trained.(36 newly trained and 139 re-trained). This is to educate them on CDTI implementation activities in event that they are transferred to oncho endemic communities/LGAs. Two hundred and twenty one CDDs were trained and re-trained, (80 newly trained and 141 re-trained). Active CDDs were used to see to the success of this year's treatment round
WHO/APOC, 24 November 2003 dll \o t ra) \o co al EI c-.1 N 6)
L6l ao o\ @ (n o \o \o co t o n o Q q) c.) cl co ao € <) q)tr e t-6\ z o o o o\ F- N \o N F 00 c.l cl o\ r-
o ?rr:I ah q) cn .a'o' O cB- O rrh c.l .\. H t- t-{ q O F p0) o: o u 4 ith C) o!) 0) U k !r9 o u 0) z q) Lec E (h t 6)L o c) N o q v L o co o\ \o (,) co c{ o\ N L o z q) Or L q) L ia bo E ^ ?r c.t c\ E.'r c.) co co r- t ts q) co t cl q) ';u cl L ! L a cl q) 6l o\ o +. \o o\ o o\ ?n o q (.) co c.l N I 6) ts o( c.l c.l c) \ q) cl ah () L 5 q) o) F- r- N 00 o.l o z \o o (A B Cd cl z L tr l,o s tal la) € q 0,) o Otr) iA \o X tr F O $ F- co el q) 0) B () cn a GI tr s 6) 6 il 6t o o U o o F (h F E 0 M o O (t< (J t cl o Fl o L (r) q 6 o B .3e L () O o0) o\ L o q) 0) a!Y E H o t C) U eh l-< e o o) _0) o L q) L c) E o d -o 6l E E 0) s L C) crl e.l $ co N 6) F B o z () o cd Lah hI) \o q) cl (d l L l-r ,a F q)tr Fl F.1 .Ht E q) 6.)l (B t''( o .v o0 tr E -ol o .\l .v d L (Bt tr = FI a m ca N tr Table 6: Type of training undertaken (Iick the boxes where specific training was comied out during the reporting period)
Trainees Other Health Community Workers Other members e.g (frontline MOH (speciS) Type Community health staff or Political Islamic of training CDDs supervisors facilities) Other Leaders Teachers Program { management How to { conduct ^/ Health education Management { of SAEs CSM SHM Data { { collection Data analysis {
Report writing Others (specifu)
Any other comments The training of community self monitoring (CSM) and stakeholders meeting (SHM) was not carried out due to lack of funds from both the State Ministry of Health and the 5 endemic Local Government Areas.
WHO/APOC, 24 November 2003 2.6. Treatments
2.6.1. Treatmentfigures
If the project is not achieving t00% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this.
treated The project areahas a total of 1 l6 communities and all the endemic communities were giving a geographic coverage of 100%, I79,027 persons were treated out of the population of 215,685 giving a therapeutic coverage of 83%.
WHO/APOC, 24 November 2003 -o o H9 o o E6:* I O a) z iEHg;o.r: o q) r9 0- So a) I #? O ll Ea E zz $ to $ -o cn o\ Oo bs ral r $ ia (€ c-- $ oo \o .S ra! cl N :io f'] E9a9 (! \ zd Pi st) o) B ov U qio 'ad o6 -cE r- o\ o\ { E E,er H rn o\ r- o\ cO (.J Lro)eEE.H lar o\ .d-co q) PF0) ot'F s' E[=€E u! 'd-G dcr o \S !o E=g J OI) O d^ -o -o 9t!4 lt c.) Qkro ll o\ s 5\ s s s 'io 6a :/ c- o\ \o € € r- (.J E&'= t (\o ta oo r- tt. @ @ oo 6 tr>,= v't EO L() \J F .:va s -o q) .sH (* 0) o.- o\ oo ca r- (\lrr 6'tE!) .i-i L ur o\ c..l o\ o\ [i!(d o S b HB oo ! s.E v) oo q € + .=().= z Eb9 rr) lrl o\ !s $ o.! t F- c-<,tr C.t S z= rr1 r-. o] = EB EH€ L \J AJ F(ho o s 6.eI E.S =o o.=o PE E b.z oo N o\ N oEq aEo ca t N $ \o o E cd,=. \o q \o o.l trr o\ \ia \ < g€' r- o ol o SF B F\J ra) oo o\ c.i ! at > \) lr) \o N -l =E TU U,) .s 'oi. B E !B E A) tr E \.u * El'(!l e .$ .= -l rd tr sg F. ia o- LE\ o\ @ \o tr1 r- 6 q s$ + &E r.) c\I $ o\ la) \o ! !r+ t 5-€" lo oo \o^ C\ $ ES ah q ia T .-\ L € c.) \o $ c\l sts L)rS' E 9! r- oo C{ ol slB $3st cl tsE al s-$ 6 C)l *lL;lE..= ;13 -BEL. o F hll _t;lE Li >t >r _t gl cl dl 9 :T" q) Lrl El; Bl< El8 sl; s 's3 fr d c)l F G .9 ql -o -o >t p gl8 Fd \o \o EIE o\ o\ 6\ o\ o\ ol El:! El E TB ll . s o.rl .' C)l E ol a. cl rsd \o O O 'l - =l '9 bsY'rs E ooa oldl E.E EIE Eb s ov Ee glu s \: EIE slE BIE qJE s'{ -dlol XE rl GI 5E- bli tsl.E tsl€ $,: j cA Lrl gl o rl 5 rl' Ll ! G) brl = o! E.q .^ ol s :< (.) d r.E UE \o C)l €l: €l; €lE fl; ^\.lvE \U L 3 E Sf; c.) N o\ c.) o\ hrl tr c= o r.| CN I is U' rl 1lE ll1 zli ztE I $s =E>! trl .: sE '6 (n z6 b.UqJ 0) o st sa 'Q\ 9l ss ,t :: U\ ah ) Eo c)l il ri tr E 6.2 \o 0l * E* ca N o\ cn o\ dtLl ra) N ol $ $* a o T EF FIJ -dl I t!.q tis O 0)cd l Ss ;t HT cl dt \ott L (.) 3 tsss ad-r6 bo s (H o= ii o EI : s6 q) 5o ld \-g t€ iE.= EH \o OJ dilQE \= Sr II ca C.I o\ co o\ EI tn ol ol SB S'sSB cl u5E966o.,o) q) E EgEE- :l .oo ':S}l\ {4. li o>-o Ja E- $a € B Sg tr €l 'E5 cs o cJt .gl E5 95 s S> r-l JI 0- *- a- o H t\=' ol Fl trl 9io- il ll E .9< ! fr8.9b EI H6F P FS ;v (d .v oo tr E-( as .:1 )1 L fril F6iS \ F o\ tr (d o ca c0= N F 2.6.2 What are the causes of absenteeism?
The main causes of absenteeism were due to movements of nomads to the southem part of the country and who may sometimes stay there for very long periods, farming activities for communities that were treated during the rainy season; likewise some youth go to urban areas to seek for jobs. The project decided that the communities should be visited immediately after distribution by CDDs, to treat untreated persons. The CDDs were requested and encouraged to mop-up the communities as part of the year's work plan despite the stress and non-compensation by most communities.
2.6.3 What are the reasons for refusals?
Cases of refusals were due either to personal or religious beliefs by some people; some thought that the drug is not their immediate need, while others feel that the disease is not in eiistence despite the health education on the disease. It is hoped that with better understanding people will not refuse treatment.
2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available.
In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box.
No SAE case to report
WHO/APOC, 24 November 2003 () ac)9 $ _ca, o 5 ci -EE ()L <.E E -o
L q) o E'.=;roB tr z ii(q.u $ (g()iD c.l a3r nEc L' EJ 5'5 O. (t o o ().9 octro f;3 I h 6E
q \.t (Dro a ,;e q9 \ ^ \S ;.9 ii &9d0)-c tr
(!i;o- o.9 -q F o c c- !LL'rd400 O E &,.I
, .9. =in>e aEu' vai- a!5:Y o O H-EqE q) €-99p.!cd =gEEtg =.o.5 0
Eq) L L I I a
cll o.
an c/) ;=o)tr! H -;6)=q.) 9HA o2 lJ6@(E^^* ri q) c) =o) q) .N -E th o8I q)L EE E z
GI q) 0n (H o o L o0E c q) q) d.: ar) =O0 o >5 z L ra q) q) X t) c) *a 6l a (.) o € bo q) L * q cl tr (A IT + O c) cl bI) .o .o .o -o ()L o\ o\ o\ o\ o\ o\ o\ o\ o\\o o\ P Es c.) o co F- + o\ -o ra \o \o r- F- oo oo o\ o\ o\ o -o(-) z \o \o \o -o \o \c \e 1O o o\ o\ o\ o\ 6\ o\ o\ o\ $ t,- c.l 9 c'l o9 cl \o F- c.l o Fo- ll r € oo N t-- o\ O F 6X o\ o\ o\ o o oO o o. -a rd E o c') 1Q \o o q q o\ o\ o\ 5 !o t'- \ I bI) \o t- cl c.l o\ ao ()cd= t'- F-- oo @ € r- € 00 00 s -o ll * = F9 o\ l{ .9 oo td EO I6l F ri o u0 co (\l \o t-- F- ct cr) O r- cll cl o\ \o \o oo C{ N ,,o t/I o\ TN c,- c\ F- C"I \ t B' O) od \o € oi c.l (-.l c.) co o\ E= o k9 o\ co s ra) \o \o t-- \5 2- f-l d \rr =o \trtJv a6 o q S- or L\Gt O o o O _E-o o o O O $s.= cd ().= (.) tr) co o\ Jtr- o\ N co + \o r- F- E] c{
Mectizan@ delivered by - (please tick the appropriate answer) MOH tr WHON UNICEFE NGD6/ Other (please specifu):
Please describe how Mectizan@ is ordered and how it gets to the communities
The supporting NGDO {SIGHTSAVERS} orders for the state's Mectizan@ requirement from the donors through NOCP. This is based on an updated census of all endemic communities within the project area. When this is approved and procured the NGDO collects Mectizan@ meant for the state from UNICEF. Each state is given its allocation. The endemic LGA Coordinator takes Mectizan@ from the state's medical store and in turn gives each front line health facility its allocation. Selected distributors from endemic communities receive their allocations based on census update conducted from agreed point of collection for distribution. The number of tablets ordered is based on the estimated population of people multiplied by a factor of 3. In future, the state will be expected to completely take over the task of ordering Mectizan@ tablets meant for their communities
WHO/APOC, 24 November 2004 Table { O: Mectizan@ ! nventory (Please add more rows if necessary)
Number of Mectizant tablets Number Requested Received Used Person Lost Wasted Expired Remaining I statelDistrict/LGA in stock treated Anka 0 60,000 55,000 54,914 14,899 0 0 0 -367
I Bukkuyum 0 150,000 134,000 123,928 55,928 0 0 0 10,072 Bungudu 0 140,000 I 50,100 149,840 75,890 0 0 0 260 !Maru 0 70,000 64,000 63,409 21,493 0 0 0 245 Zrtrmi 0 40,000 40,000 32,003 10,817 0 0 0 7,968
TOTAL 0 460,000 443,100 424,094 179,027 0 0 0 18,178 How are the remaining lvermectin tablets collected and where are they kept?
The balance of Mectizan@ tablets was returned to the front line health facility by the CDDs after distribution. The project coordinators at the LGA level received the drugs and finally retumed them to the State Onchocerciasis Office for safe keeping at the state medical store. In future, the state will completely take over the task of ordering Mectizan@ tablets meant for their communities.
List and brie/ly describe the octivities under lvermectin delivery that are being caruied out by health care personnel in the project area.
a The State Ministry of Health receives and keeps custody of Mectizan@ allocation for distribution to endemic LGAs. a Collection of Mectizan@ for frontline health facility by LGA coordinators at the state's medical store. a Collection of Mectizan@ for endemic communities by FLHF health workers at the LGAs'medical store.
Notifuing communities to collect their allocations of Mectizan@ at FLHF by their selected CDDs.
Any other comments
- WHO/APOC, 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting
Has any training (of trainers) for community self-monitoring been done in the project area?
If so, When?
Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed)
District/ LGA Total # of communities/villages No of Communities that No of Communities that in the entire project area carried out self conducted stakeholders monitoring (CSND meetins (SHIvt) None None None None
TOTAL
Describe how the results of the community self- monitoring and stakeholders meetings have fficted project implementation or how they would be utilized during the next treatment cycle.
- WHO/APOC, 24 November 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy.
NOCP/ZOTF NGDO
STATE ONCHO TEAM
LOCAL ONCHO TEAMS
FRONTLINE HEALTH FACILITY
COMMUNITY LEADERS
DISTRIBUTORS (CDDs)
COMMUNITIES
WHO/APOC, 24 Novembet 2004 2.9.2. What were the main issues identified during supervision? a None release of counterpart funds by State and LGAs during the treatment year o Re-entry of data using the newly introduced MIS forms in some endemic areas after entry has been done. a Poor support to CDDs by some communities leading to attrition of distributors a Non-selection of female as distributors. a Cases of refusals in some few communities. a Partial commitment to CDTI activities by some few endemic communities. a Political difference in a community which resulted to non treatment before the issue was addressed.
2.9.3. Was a supervision checklist used?
The developed checktist for supervision by APOC was used during supervision and monitoring of programme implementation.
2.9.4. What were the outcomes at each level of CDTI implementation supervision?
o The state level was supervised by the NGDOAIOCP and poor funding to the project was noted despite inclusion of CDTI budget into the Primary Health Care main allocation. Effort made through advocacy to state and LGAs to solicit support to the project yielded little results, no fund was released due to constant transfer of policy makers. Supervision at the LGAs and community levels were done despite lack of funds for fuelling, using the five new Yamaha motorcycles donated by APOC the LOC carried out supervision .Some LGAs kept good records of CDTI activities while other need to improve on it. Community involvement as a whole to CDTI was partial in some few communities.
2.9.5. Was feedback given to the person or groups supervised?
a Observations were made known to the supervised levels and the recommendations followed during subsequent CDTI activities. Implementation of these activities were however inadequate, thus the overall performance was not as planned, though the project however attained its treatment objective
- WHO/APOC, 24 November 2004 2.9.6. How was the feedback used to improve the overall performance of the project?
a Partners concerned were given feedback stressing areas where the project is weak, likewise consequences and solutions. They were encouraged to fully participate and carry out their roles and responsibilities as indicated by CDTI strategy. The front line health facility workers were asked to take CDTI as a responsibility which forms a part of their primary assignment. This gave staff involved in CDTI a better understanding of what is expected of them. This improved the results of the year treatment.
- WHO/APOC, 24 November 2004 SEGTION 3: Support to CDTI 3.{. Equipment
Table 12: Status of equipment (Please add more rows if necessory)
Source APOC MOH DISTRICT/LGA NGDO Others
Type of No. Condition No. Condition No. Condition No. Condition No. Condition Equipment l. Vehicle 2 IF, ICNFR 2. Motor cycle 6 6F 5 CNFR 3. Computers 2 2F 4. Printers ) 2F 5. Fax Machines 6. Others a) Bicycle t4 wo t4 wo b) T.V/ Video I I CNFR/ IF c) Over head I F Projector/Screen d) Generator I F e) LCD 1 F proiector II *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written ffi. How does the project intend to maintain and replace existing equipment and other materials?
a The project will ensure the use of these equipments for CDTI activities, and such equipments will continue to be maintained by the project through the use of release counterpart funds.
WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities
Table 13: Financial contributions by all partners for the last three years
Year 7 (2005 ) YearS(2006') Year9 (2007') TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL AMOUNT AMOUNT AMOUNT CASH CASH CASH (cASH) (cASH) (cASH) Released Released Released Budgeted (us$) Budgeted (us$) Budgeted (us$) Contributor (US$) (us$) (US$) MOH (Central + 10,669 0 3,876 736 3,968 0 Provincial/State) MOH 5,023.63 Only staff 3,846 Only staff 5,992 Only (DistricVlGA) salary salary staff salary Local NGDO(s) ( if 0 0 0 0 0 0 any) NGDO partner(s) 6,362 4989.77 3,656.5 3,72 I 4,113 3,615
Others 0 0 0 0 0 0 APOC Trust Fund 14,702 10,000 62,396 13,730 6,41r 6,411
TOTAL 36,756.63 14,989.77 73,774.5 18,187 20,484 10,026
- If there are problems with release of counterpartfunds, how were they addressed?
Major issues that related to release of counterpart funding have been the regular changing of policy makers at the state and LGAs government levels, and bureaucratic and lukewarm attitudes by some of the stakeholders. More mobilization and advocacy visits would b e undertaken by the project at the two levels (State and LGAs), where the project in collaboration with the supporting NGDO and NOCP would pay an advocacy visit to the executives of the state and liaised with Ministry for Local Governments and chieftaincy affairs to solicit for release of counterparts to the project.
Additional comments
- WHO/APOC, 24 November 2004 3.3. Other forms of community support
- Describe (indicate forms of in-kind contributions of communities if any)
The communities have been supporting the programme as much as they can through re- selection of most distributors that do refuse to continue with the distribution ,some health prograrnme do pay allowances to participants e.g polio eradication programme ,some few members do assist their CDDs with little fund while others do appreciate or motivate CDDs verbally. Distributors during the year under review gave a maximum support to the programme by distributing the drug with little or no compensation from members of their respective communities.
3.4. Expenditure per activity
Indicate in table 14, the amount expended during the reporting periodfor each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here 1$: N120
Table 14: Indicate how much the project spent for each activity listed below during the reporting period.
Expenditure Source(s) of ($ us) funding Drug delivery from NOTF HQ area to central collection point of 346 SSI
Mobilization and health education of communities -l Training of CDDs (Re-Training) Training of health staff at all levels and planning meeting 5,000 APOC S CDDs and distribution Intemal monitoring of CDTI activities A{y.qcqcyvil_,EIql,,9eItr3!4p.o_!!liqclqutbql4'_es APOC IEC materials r,4ll 250 SSI Summary for treatment Vehicles/ Motorcycles/ bicycles maintenance (Major parts replacement, Repairs, Fuel) 840 SSI 603 O_ffi ceEgllip$qllc_.s.cgqrPu!_qlg?plintery_e!_c) SSI Communication (Telephone/Fax, Post/Courier) ior SSI 693 Trqygl t9 p,Igjgq! arqq_s for various CDTI activities _ $SI 582 Others - SSI TOTAL 10,026 SSI/APOC Total number of persons treated 179,027 Any comments or explanations?
- WHO/APOC, 24 November 2004 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation
4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)
Year 1 Participatory Independent monitoring
Mid Term Sustainability Evaluation
5 year Sustainability Evaluation
Internal Monitoring by NOTF
Other Evaluation by other partners
4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3)
Was the project evaluated during the reporting period ?NO
Was a sustainability plan written? No
When was the sustainability plan submitted?
4,2.1. Planning at all relevant levels
a Planning meetings at both the State and Local Government levels will be carried out before the commencement of subsequent treatment rounds. a Advocacy to stakeholders will be done continuously to ensure total commitment at all levels to the sustainability of the work plan developed on CDTI activities. a Mobilisation, health education and sensitisation of endemic communities shall be of priority for communities to take ownership of CDTI prograflrme.
4.2.2. Funds
a Advocacy visits willbe paid to relevant partners on the need to release counterpart funds toward sustaining project activities.
4.2.3 Transport(replacementandmaintenance)
a The Ministry of Health and the endemic Local Government Areas will ensure maintenance of existing vehicles and motor cycles provided by supporting organisations, this will be achieved when counterpart funds are released by the authorities concerned
- WHO/APOC, 24 November 2004 a Effort will be put to ensure the repairs of none functional of motorcycles by Si gthsavers International.
4,2.4. Other resources
o More resources would be requested, maintained, and replaced as counterpart funds are released by the state and the LGAs. o Health workers from non endemic LGAs will be trained; so as to address the issue of transfer of health workers from non endemic LGAs to endemic areas and to build capacity toward sustaining the programme.
4.2.5. To what extent has the plan been implemented
a SOCT/LOCTs developed CDTI implementation work plan.
a Monitoring and supervision was carried out in areas where problems were anticipated using the checklist developed by NOTF.
a Frontline health facility workers supervised project activities at their own levels.
a Mectizan@ tablets were collected by the endemic communities at agreed points, likewise LGAs.
a Endemic communities were mobilised, health educated and sensitised on how to take up CDTI responsibilities at community level.
a The release of counterpart funding is hopefully will improve as advocacy visits to both at the state and LGA policy makers.
Despite non release of fund by the project both at state and LGA levels, some health workers were able to carry out the above CDTI activities at their various health facilities.
4.3. Integration
Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration:
4.3.1. Ivermectin delivery mechanisms
Vehicles for other health prografirmes such as disease surveillance, TBL, NPI and staff were used by the project in the delivery of Ivermectin to the endemic LGAs and for collection of reports and balance of drugs. Likewise Front Line Health staff carried out CDTI activities when implementing other community based health programmes.
4.3.2. Training
Primary eye care was integrated into the past training of trainers for Ivermectin delivery in the previous years. Re-training and training of community distributors for identification of individuals with eye problems in their respective communities was
- WHO/APOC, 24 November 2004 scheduled to continue in2007, due to lack of fund this was not implemented. The project plans to carry out this activity next year once funds are available.
4.3.3. Joint supervision and monitoring with other programs
NPl/Disease surveillance, TBL, and CDTI staffs help one another in supervision and monitoring, through inter programme collaboration.
4.3.4. Release of funds for project activities
A combined budget for all programmes under the Department of Disease Control had been established. The fund released by the state and local governments during the year under review there was nothing released for the project to carry out CDTI activities as planned. Nevertheless it is hoped that funds will be released to the progralnme as planned for subsequent treatment year rounds.
4.3.5. Is 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?
Health workers in other community based health prograrnmes and CDDS were trained in the CDTI strategy and on Primary Eye Care. This is anticipated to help them use the strategy in other related prograrnmes and in screening, identification and referral of eye patients in their communities using the CDTI structure.
4.3.7. Describe others issues considered in the integration of CDTI.
The strategy is cost effective; people at the grassroots can easily be reached by primary health care services. This will help them take certain responsibilities towards sustaining and developing health progrilnmes.
4.4. Operational research
4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period.
There was no operational research carried out within the project area during the year under review.
4.4.2. How were the results applied in the project?
- WHO/APOC, 24 November 2004 SEGTION 5: Strengths, weaknesses, challenges, and opportunities
- List the strengths and wealvtesses of CDTI implementation process. - List the challenges and indicate how they were addressed.
Strength:
Severe adverse events continued to decrease. Integration of Primary Eye Care into CDTI. Trained and committed SOCT/LOCTs. Committed NGDO Selection of distributors by a good number of communities. Collection of Mectizan@ by communities. Distribution of Mectizan@ by most CDDs despite lifile or no compensation by their community members.
Weakness: - None Release of counterpart funds for the year under review at state and LGA levels. - Some trained Islamic scholars were reluctant to participate to CDTI activities. - Non availability of female CDDs - Frequent movement of the nomadic population. - Non compensation to CDDs in most communities - Reluctance by head of households to allow selected CDDs to dispense Mectizan@ to their wives along with other members of the households.
Challenges:
Non release of counterpart fund by state and endemic LGAs Constant transfer of policy makers. Insufficient human resource at the state Onchocerciasis office
Advocacy visits to key stakeholders to solicit for the release of counterpart funds; creating awareness for female CDDs to be selected and sensitisation for CDDs to be compensated are still on. Likewise, emphasis is still on to see how CDDs will conduct mop-up treatment for a good therapeutic coverage.
- WHO/APOC, 24 November 2004 SEGTION 6: Unique features of the proiect/other matters
- WHO/APOC, 24 November 2004