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ONGINAL: English
COUNTRY / NOTF: NIGERIA Project Name: Osun State CDTI
Approval Year : 1998 Launching Year : 1998
Reporting Period (Month Near): October 2003 - September 2004
Date Submitted : MAY, 2005 NGDO Partner : UNICEF
YEAR 6 ANNUAL PROJECT TECHNICAL REPORT
TO
TECHI{ICAL CONSULTATIVE COMMITTTE (TCC)
AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) _ [E&__
-', rD+\L tioR asl. co} \ 8s Ntl
for lniormotion ro, $f1\ 1 7 A0UT ?005 *\0 AYHf I
ANNUAL PROJECT TECHNICAL REPORT tr
I TO
TECHNICAL CONSULTATIVE COMMITTEE (TCC)
ENDORSEMENT
OFFICERS to sign the report:
Cou ntry N!GERIA
National Goordinator: Name: Dr. J. Y. Jiya
Signature: Date , oflofru' DEffi3 Zonal Oncho Coord i nator: Name: O. Jaiyeoba
Signature EDS Date ft$r^eh This report has been prepared by Name; Mr. Matthew Lelaboye
Designation: Sfafe Coordinator
Signature <-. 4 J Date: 4Alr
II WHO/APOC, 24 November 2004
I Table of contents
J ACRONYMS V
DEFINAT!ONS VI
FOLLOW UP ON TCC RECOMMENTIONS 1-2
EXECUTIVE SUMMARY 3
SECTION 1: BACKGROUND INFORMATION 4-7
1.1 General lnformation
1.1.1 Description of the project (briefly)
1.1.2 Partnership
1.2 Population and Health System
SECTION 2: IMPLEMENTATION OF CDT|.. 8-23
2.1 Period of Activities
2.2 Ordering, Storage and Delivery of lvermectin
2.3 Mectizan lnventory
2.4 Advocacy and Sensitization
2.5 Mobilization and Health Education of Risk Communities
2.6 Communities lnvolvement in Decision Making
2.7 Capacity Building
2.7.1 Training
2.7.2 Status of Equipment and human resources
2.7.3 Treatment figures
2.7.4 Trend of treatment
2.8 Supervision
2.8.1 Flow chart of Supervision
I 2.8.2 lssues of note
ilI WHO/APOC, 24 November 2004 2.8.3 The use of Checklist
2.8.4 Outcome of Supervision
2.8.5 Aftermath effect of Feedback
SECTION 3: SUPPORT TO CDT!...... 24 -25
3.1 FinancialContribution
3.2 Expenditure per Activity
SECTION 4: SUSTAINABILITY OF CDTI 26 -31
4.1.0 Sustainability at the State Level
4.2.1 Sustainability at LGA Level
4.3.1 Sustainability At First Line Health Facility Level
4.4.1 Sustainability at Community Level
SECTION 5: STRENGHTS AND WEAKNESSES 32
IV WHO/APOC, 24 November 2004 I r Acronyms I APOC African Programme for Onchocerciasis Control -.- ATO Annual Treatment Objective AtrO Annual Training Objective CBO Community Based Organisation CDD Community Directed Distributor CDTI Community Directed Treatment with lvermectin CSM Community Self Monitoring FLHF First Line Health Facility FMOH Federal Ministry of Health GCCC Government Cash Counterpart Contribution IFESH lnternational Foundation for Education and Self Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organ isation NGO Non-Governmental Organ isation NID National lmmunization Day NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NPl National Programme on lmmunization PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders Meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of Trainers UN ICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization
V WHO/APOC, 24 November 2004 Definitions: (i) Total Population: The total population living in meso/hyper-endemic communities within the project area (based on REITIO and census taking). (ii) 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 lvermectin 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 coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) 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).
VI WHO/APOC, 24 November 2004 t E)" N o
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N (f) Executive Summary
Osun State is one of the States in the South Western part of Nigeria and is located in the B Health Zone. The State has a population of about 2.2 million (1991 census). lt is estimated that 824125 people are at risk of Oncho. lnfection in all the 30 LGAs in the State. The latter is a predominantly Yoruba state. Other ethnic groups like Hausa, lbo, Fulanis and Agatus also reside in all parts of the State. Osun State project is in the sixth year of its implementation. Emphases were majorly placed on grassroot involvement and participation for CDTI sustainability. lntegration planning meetings were held as an important strategy to enlist the active involvement of other PHC Programme Officers in the State. lnauguration of CSM & SHM in 207 and 117 communities were maintained. Consequently, 85% of the 997 endemic communities in the project site supported CDDs in either cash or kind. Expectedly, all the 997 endemic communities were targeted and mobilized appropriately. However, it is pertinent to note that the 997 communities were treated giving 100% geographical coverage. The total population is 814030. The Annual Treatment Objective (ATO) is 701000. The Ultimate Treatment Goal (UTG) is 691926. ln summary, a total of 669018 people were treated during the period with 1617631 tablets. However, 149,714 people were treated with 431 ,006 tablets in the sixteen (16) at risk Local Governments. Targeted trainings were conducted for all categories of Oncho. extension workers. ln summary,200 CDDs were trained /retrained, while a total of 150 Health workers were trained during the period, sponsored by UNrcEF. Besides, uNlcEF also sponsored 2nd and 3'd quarterly state oncho. review meetings and advocacy to 14 endemic LGAs, which were used as opportunity for information dissemination, cross fertilization of ideas and support for programme implementation. The only major challenge confronting the project was the issue of provision of Government Cash Counterpart Contribution (GCCC) for CDTI activities at both the State and few LGAs.
3 SEGTION 1: BACKGROUND INFORMATION
1.1. General lnformation
1 .1.1 Description of the Project (briefly)
Geographical location, topography, climate
Osun State is one of the States in the South Western part of Nigeria and is
located in B Health Zone. lt is bounded by Kwara State to the North, Ekiti and
Ondo States to the East, Ogun State to the South and Oyo State to the West.
The State has a land mass of about 8,572 square kilometers. The State hastwo distinct seasons, dry season and rainy season. The rainy season begins in
March and is heaviest from June through September/ October. Farming generally begins in April, most farm work is completed by October, after which the harvesting is carried out. The dry season begins in November and ends in mid-
March.
Po p u latio n : Activities, c u ltu re, lang u age
Osun State has a population of about 2.2million (1991 census). Yorubas constitute the major ethnic group, although some minorities such as the lgbos,
Hausas, Fulanis and Agatus exist and cohabit peacefully with the indigenes. The
State is essentially an agrarian State with aboutT0% of its population engaged in one form of agriculture or the other. ln addition, it is a State that is internationally recognized for its rich cultural and tourism potentials.
Comm unication Sysfem (road...)
The major roads in the State are tarred but access roads to most of the endemic communities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major means of
+ communication among the communities. l. E. C. materials, electronic media and the use of community town crier, announcements in Churches and Mosque also form part of the communication system used. Admi nistrative Structure The State is made up of 30 Local Government Areas with the Chief administrative Officer being the Chairman. A legislative arm made up of selected councilors from various ward supports him. At the State Level the Executive Governor is the head of administration supported by an elected legislative arm and the judiciary. The capital of the State is located in Osogbo. Health System & Health care delivery There is an Official PHC system and it is implemented in the project area. It is a system where health care services are taken to the doorsteps of the rural populace. lt is system where community participation forms the mainstay and thrust of health care delivery with supporl from the UN agencies, the State and Local Governments. Levels of functionality however vary across the State. Within the project area, there are 3 teaching hospitals, 9 State hospitals and 330 health facilities scattered throughout the entire State. 1.1.2. PARTNERSHIP ' lndicate the paftners involved in project implementation at all levels (MoH, IVGDOs - national, international) The partners involved in project implementation within the project area are UNICEF / Nigeria, NOCP (National & the B-Zonal offices), the State Government, the various Local Governments and the endemic communities. An international NGDO, !FESH was formerly an active partner in lrewole LGA where it was overseeing Mectizan distribution, together with other programmes aimed at educating and empowering communities to develop socially and economically. However, the passive responses of IFESH in recent time at lrewole is a very serious concern to the project during the period under review.
5 ' Describe overall working relationship among partners, clearly indicating specific areas of project activities (Planning, supervision, advocacy, planning, mobilization, e.t.c) where all partners are involved. Overall working relationship among al! partners is cordial. However, IFESH had ceased to play its partnership roles in !rewole LGA during the period under review. UNICEF is involved in supervision, advocacy and training roles and assists in logistics provision. The Zonal and National offices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities play such roles as selection and remuneration of CDDs, coltection of Mectizan, determination of mode an period of drug distribution, census update. Mectizan distribution and recording and reporting of treatments. - Sfate plans if any to mobilize the State /region/ districULGA decision-makers, NGDOs, IVGOs, CBOs, to assisf in CDTI implementation. There are plans to sustain mobilization of existing policy makers occupying Local Government positions. An attempt was made in 2001 to mobilize CBOs to support the CDTI implementation process. The project hopes to revive and revitalize the programme so that they can activety assist in sustaining CDTI in the State.
b o) .E o o J go ! o= (9 trol F t o 'Fc l o t- t- (f) t- rO $ t- o) lo (f) @ @ ol C o) lo o (f) o) s rO (o o C! (o t- o) o o (E (o o, rr) (o (0 $ lo (o $ lo (o c! o) lo @ lr) (a ro o r @ C! o) (o (a o) o (f) (f) $ t N s (o @ lr) r.c) t- rr) (o (o (o E o) \o tt o'E ! AL r!! i ! o i I oO ttl I o tr-oo) + ii : LC- I F iii ctl)6 d t:: i ii ! I o o iN 6t rI\ r(o r(o Cl tcf) t$ tc! rr) o, ll.() l(c) c) o il lco :(o lo) (oo - iN c Eq @ c):c):N N:@ $ o, 6:):tf) o (u o oD l(o loD ro o l(o lr lN $ lr) o, @l- lc! rt E* N !ro !sf ie o!N !N iN @ c! N !F- i.t o t !t !ro !|o cD l$ !l- Il- (o (o !c) lr- € f 3 o) o- --t--1----1-- -.i l'-i - r --t--f- o I I o- ! o.P$ i I i o bEto i i !a> t- ! I lf)llo r (f) lll, rr) (oi$ o (9 r- cf) I lo to N i o I (o lN (o o t o -65F o) o : $ $ o) lo @ rr) ro (o (9 Na i.t I I co io o, $ @ to :r: r:r F:F $ t : .: -l -L-J L J --_ L : -t-- I .: (u i--i --i : = tt I I I I I o i ,r.8$ I I !! I o ,.nio tr o - .=- Y tt i I (D t- o :T\: o:(o o) t- lr) $ o) @ c! N 'o o iSEPqo o Cf) t@l (o Nl@ I o) $ r o) @ @ o $ o oo9 (f) t- iI-: t- o:(o $ o to @ lo o) (f) (o N o) .6- ,N6_ o !o! o o !F- I @ N $ @ @ N o) @ o- $ !t (o ce lr) (o (o $ t- $ (f) (o @ U) t- : i't i i$ t' o- o) \o -c o o'E N .E oc)6L o c E!(D + o LC- .E c q 6 { o iN il os\ o Eo o) 6q N cnj N q _(E o N N rf) (f) N (f) N O o) =o ro (o (a o:o o o .t_ u) N $ @ -:$ @ C') o -YR O t:- r .ad vt .o L \ .9 =E E(trEeE f N 6\ o E E 3eB x= o gkg N O lf): N E.EA rF\ (f) OS.. o -
Mectiza@ ordered / applied for by -(Please tick the appropriate answer)
MOH/NOGP v WH UNICEF v NGDO
Other (please specify): NOTF
Ptease describe how Mectizal)P is ordered and how it gets to the
communities.
Mectizan is basically ordered by NOTF via UNICEF and based on requests from each state to the Zonal headquarters.
The State Project takes delivery of drugs from the FMOH through the
Zonal Coordinator. LGA Coordinators get their consignments from the State store based on their respective estimated requirements in accordance with their specific target population. ln like manner FLHF takes stock of their own drug consignment from LGA Coordinator for onward delivery to CDDs in endemic communities.
9 2.3 a Table 3: Mectizan lnventory (Please add more rows if necessary) Number of Mectizan tablets State /District LGA Requested Received Used Lost Waste Expired
Atakunmosa West 107255 1 05000 1 02099 11
Ayedaade 114218 1 50000 144846 I
Ayedire 1 37308 118705 113703 5
Boripe t2tioa 1 1 5000 112502 12
lfe Central 75050 70000 651 30 1
!felodun 119208 1 05000 99848 3
Egbedore t6oq4t 1 30000 128270 4
lfe East 1 80730 1 50000 148680 2
lla 171150 1 1 5000 1 1 0601 2
lsokan 1 53863 1 30000 127944 8
lwo zs2+ea 1 55000 122658 11
Obokun 157228 1 30000 128892 1 Oriade 92888 90000 85668 ,
Orolu 1 85565 1 30000 126790 6 TOTAL 20351 10 1693705 1617631 76
Major activities that are being carried out by health care personnel in the
project area include the followings:
Taking of Drug lnventory at the facility level and ensuring their safety.
Distribution of Mectizan to CDDs based on their respective target
populations
Ensuring that records are properly kept and
IV Monitoring of adverse reactions if any.
I
I
l0 2.4 Advocacy and Sensitization Policy makers at all the 14 endemic LGAs were sensitized and
mobilized to support the CDTI implementation process through advocacy
visits during supervisory trips to the LGAs by programme staff and external persons/evaluators. ln addition, during the monthly rotational meetings of
the LOCTs with the SOCTs, LGA Chairman are usually invited to give key
note addresses. The meeting provides the forum for interaction with the Chairman, and for him to enlist what he has done for the implementation of
the programme. With the frequent changes in policy makers at this level
and the low level of funding, these advocacy visits were absolutely
necessary. Some LGAs have responded with government counterpart cash
contributions being made available and some have supported the
programme in order ways. The greatest difficulty has been lack of funds to
hold advocacy and stakeholders' meetings and to interact more with the LGA policy makers, so that the issue of counterpart funding for CDT! will
always be on the front burner. We also need to involve State Policy makers
to routinely visit the LGAs to solicit for counterpart funding.
At the State level, the project has relied more on external bodies like
UNICEF and NOCP officials who came to visit the project to pay advocacy visits to the policy makers.
However, it is gladden to note that the State Government approved a total
of $11,363.3 was budgeted for and a total of $4032.4 was released to the
project during the reporting year.
I
il 2.5 Mobilization and health education of at risk communities
Provide information on: Media Used for Mobilization
The Communities were mobilized through jingles on Local Radio
Stations i.e. Radio Nigeria & Radio Osun. ltlosques Churches Town Criers,
Public address systems mounted on moving vans, IEC materials like posters, handbills; and village meetings were also used to mobilize the endemic communities. Mobilization & Health ed ucation of women and minorities.
The involvement of females and other minority tribal groups had continued in no small measure to the optimum support being received to sustain CDTI programme over the years. More, women are now increasingly participating in CDTI activities where their male counterparts are no more interested as evident in table 4. The Agatus tribe in the LGA continue to perform excellently well in CDT! activities. Some of them (i.e Agatus) were appointed as Community Self-monitors in Atakumosa West LG. Response of tarqet communities/ villaqes The Communities A/illages mobilized responded to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. They came forward to collect their Mectizan and in some cases gave incentives to their CDDs. Some gave funds for CDD training. There is more awareness of ivermectin benefits, more involvement in decision making and villagers make more efforts to encourage potential refusals to take ivermectin.
IL Aeqomplishments:
(a) Female members of the Community are becoming more involved in
the decision making and Mectizan drug distribution.
(b) The responses of the Community members to yearly Mectizan usage
increased tremendously during period under review. (c) Refusals to taking of drug has decreased owing to (i) the regular interventions of our respected village heads, Bales & Kabiyesis, (ii)
Programme integration into other PHC Sister Programmes e.g. National Programme on lmmunisation (NPl).
(d) Adverse reactions are now being properly handled by Health workers due to their unalloyed commitments in CDTI implementation activities.
WEAKENESSES /CONSTRAINTS:
During the period under review the project suffered a major set back in areas of programme implementation activities as contained in 6th Year
Programme Plan of Activities (PPA) due to lack of fund and anticipated political support.
t3 o ;8 cD tr OA (! :^ tr q, dE 5e o II tr(, o ro |r) (o (r, el= : o o o, s o) \f 6 s o o o be o. @ @ (f) (o cf, @ (o @ (o (f) N N @ (o (f) tt uOo'E :'= -'Es o o ttooo !P J=.!O o trE' : E } EOM E E reo G' z==.! ,o o |r, O) tr) f- (f, O) (o rr) @ N @ $ @ -o !t N N (o N o, N (f) N rf, N (f) (o N $
o E (Y) rrQ (f) -tr!O !, o @ $ f- cf, l- o, cf, o @r s (os (f) s !t> o N @ s @ ca cf) lo lo N (o N E! N N N N N N @ r N N N OC A'; 9oqo UE EO tr @ E N o (o f- o (o ro (o .t (f) (f) o ro c) a o= fo (o l.r) ro @ (o l- N (o s lr) @ s N qU) lttroE q) EO ts ro o 6 (o s ro o Cf) (f) (o @ o (f) (o q) io EA (o (o N @ N N f- |r) o)o @ s o) g) r N r r lf) ;f- r r @ h q g,o (E 6 oO 't o dto e= o [;- oq c? u? oo (o (o \ \ \ o) oL o o @ @ F- (o N CO rf) N t- N E|,o o. ro s (o N N f- (o (a s N @ \f tt (v) o 6U, \ =>>6 B o= EaSe b 3d i'E o 9 a '=6 E E.E'i @ EEEE o =.!Eg, (o q tro @ o N o o o o N tr) (f) co N (o N E'$ b: ;8Et N !t N ro (f) r N (f) cf) N (f) ro (o t EO ()E sOoE + Ed(E\' 9oo : Ea 2cc.odE5 E EF E= J o!i rQ -SEqE @ iF P g N O) N N o 5: o l- N N cf, N (f) o, N o o o o o) 5o (o (f) (o '.a e o ro $ N N @ s @ o) o {-, tr o ED d' oc o .E E'; o o trE o [;- u? q \: oq .= .o ; (f) (f) o o @ @ @ lr) l- o, N o ro:$ @ ro @ G' 2 o. ro (o (f) \f |r) ro N lr) ;ro CO (o ro ro to EH o s o'= .=6 r-E E- i!E o= € (Y) ;.: sttE'o > (o lt so =- - -l rr, o N f- N $:@ @ f- o o) (I, --5 o .='- cf) s (f) $ LO (f) (f) (f):(f) N $ N ld, 9a =(!(E s s o sh O (ll g ';= o bE.E o= o .ct EEg EE- N E ' o o o Zi.E5 n!'d N o l- o o o o o N N ro o o =x z E (o (o l- (o l- (o (o l- N f- F- |r, I tsv' E (, =(U o a o (5 Lo L o E C os o E G' o o c o C J o c (U .= o E ) (u C ) o L f o- o o E (u .Y E f E E tu (U qt o .Y o c) L -o o o tz o o .E o F (\F i5 o o o) 0) o o o -o t- o d] r.u -(g o = = o o o F 2.7. Gapacity Building
2.7.1 Training
Training and Retraining of all categories of health workers in CDTI project were decentralized from the State, to the LGAs, the first line health facilities and to the communities
t5 I o t,o iE + tr io o O O (u 1F oo N (\ N c^l N al N N N c.l oo \o o |r) (o $ @ N (o (f) t- @ o) &d I r I I r r F o r o o i* U) o .o v) *d lo s @ N @ I s t- I (o N a) E C) q) z o O o o o IL id N c.l c.l N N N cl I I N c.l N q : = o Q o 6il? L 6SP o o F()(J (o .=a o EO!EF * LL b Ol- t o (o b xEi o o.= o o o.:LO a= () q -o I G E a) o z F (J o- (o C N o O (u + o o o o gI c o ro o. o6 o FO I I I E o o o- (f) F 'tr!tE &d $ N CO ro o N $ $ j r I r I I E =(E(Es o I d =o o lE (9 N I N I s lr) I I cf) O lto o E ie o f iF (J (t, z r< |r) r() tn o) j I ll o L(! o o .o9 + c o Or o FOO s lr) |r, r() v t $ $ $ s s s ro sf L o o J rl- 9u Pd oO rr) (r, (f, Lr) E '-C s ro lr) s \r s \t \r $ s o EE -C o- d P o :E (U I I I r I I I I I oL o, -o E o .Ec f F o .N z s ro lr) rO s s $ s s s $ s |r) s L F B o o J o o c) o E ri'i o o L L cE o q) o c c a c g f o .= o E o f c f o) .9, E E o- q) E o o .v. ! f lt o -Yo o o L -o o o LU o .Y o .Eo o (E o o) o) o o o -o L (D I I lg a F LrJ = = o o o 2.7.2.
Table 7: Status of equipment (Please add more rows if necessary)
Source APOC MOH DISTRICT NGDO Others Type of /LGA Equipment Condition of the equipment *Please State
1. Vehicle 1 (Functional) 1 2. Motor Cycle 20 (15 non-functional, 39 (2 functional; but repairable) others grounded) 3. Computers 2 (Functional) 1 table computer & a Lap top. 4. Printers 1 (Functional) 5. Fax Machines
6. Bicycles 70 (Functional) 105 (22 functional; others grounded) 7. Others a) Photocopier 1 (nonfunctional /butrepairable) b) Projector Functional c) TV Monitor 1 (Functional) d) Generator 1 (Functional)
How does the proiect intend to maintain and replace existing equipment and other materials? At the LGA level, the Local Government sometimes give imprest for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all equipment. They are also being encouraged to provide the necessary materials for CDTI implementation. LGAs such as Boripe have been very fonruard in meeting most of
t7 the needs of the programme within its area. At the State level, the capital equipment and other materials available for the project will hopefully be maintained from the money approved in the State Budget allocation for the Oncho. Programme execution in the year 2005. On the issue of replacement the project is requesting APOC to replace the project vehicle and other capital items supplied earlier while efforts continue to get government or UNICEF to replace them on the long run. - Describe the adequacy of available knowledgeable manpower at all levels. There is abundant knowledgeable manpower at every level of CDTI implementation in the State. There is need to train more health facility staff to be involved in the programme. - Where frequent transfers of trained staff occur, sfafe what project is doing or intends to do to remedy the situation (The most impoftant issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). Whenever new staff was employed or when trained staff was transferred, training was usually organized for those that replaced them or the newly employed one. The State Project also intends to liaise with Local Government Services Commissioner for the retention of Oncho. Programme Officers forlonger periods of time the purpose of continuity. On the long run the besf thing is fo train all health workers on CDTI.
IB Saq
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2.8.1. Provide a flow chaft of supervision hierarchy
ZONAL OFFICE I STATE MINISTRY OF HEALTH I LOCAL GOVERNMENTS I FIRST LINE HEALTH FACILITY (FLHF)
COMMUNITY SELF MONITORS COMMUNlTY DIRECTED DTSTRTBUTORS (CDDS)
2.8.2. what were the main issues identified during superuision. lssues identified during supervision include: - Lack of incentives to CDDs by communities - Poor record keeping in few endemic communities - lnadequate commitment of some LGA Coordinators to the implementation process especially when their expectations of monetary rewards are not being met. - Professional rivalry among health workers. Sometimes to the detriment of the work; as there are disagreements over who should do what. - Some refusals who had mild reactions when they look Mectizan at the previous treatment cycle. I 2.8.3. Was supervision checklist used?
Efforts were made to use the integrated checklist at the State level. 7Oo/o of LOCTs I are now making use of checklist during their supervisory visits.
ZZ l 2.8.4. What were the outcomes at each level of CDTI implementation supervised.
The project is encouraging the use of CDDs as guides during immunization campaigns
Refusals have been health educated and followed up, and there is a good level of
compliance.
At the LGA level efforts have been made to emphasize importance of good record
keeping, ln 2005 the State project is planning another comprehensive census update in
all endemic communities. Chairmen of endemic LGAs have also been mobilized support
the health facility workers more in programme implementation.
2.8.5. Was feed-back given to the superuised, and how was the feedback used in
improving the overall pertormance of the project.
Usually, when SOCTs go on supervisory visits they go with the LGA Coordinators or one
of the LOCTs so that whatever is found out is discussed. LOCTs are encouraged to go
with the health facility staff in charge of the area they are supervising so that they can
discuss what the findings. There is also a monthly meeting of LOCTs with the SOCTs
which is rotated among the different LGAs. This provides the opportunity to share the
outcome of supervisory visits with all the LGA coordinators for their further action. lt also
provides the forum to review programme implementation and discuss the way fonrvard.
Community leaders are informed of what needs to be done where there is need.
23 I N t N .t c, (f) c"j t- (\t (f) r r (f) r J o_ @ d E$g$ $ rr) r z (\l a t oe lIJ tJo-ER !! FHE(,T)=vq'o IJJ 969.,i (f) \ @ Fo)zo c? N o) IJJ tr, EO (a F- d t (o r ni (\t l-I =N N CO CO +j cf)_ @- o r\ cf) d -t- r- cf) z: 9. r .t (f) @ =.n-F JE,^ r C') oq (Y =5 E $ q ii N N 8H rr) N d ztrOF I $ N N 6' uaut tt frRo IU E, J=rrli1-) z ltJ FZ FH(5U) q UF 9t9*'x r CD r q CD c.i r CD (o (o EK +j o) s \ IIJ O. CO o (f)_ N IJ g N o o, t FJ ro rr) cr) JE+ d- U'rl (o (0 zz s- $ $ t N oo E # o d trtr (o (l' omff a o Y a@N o E EE .fE o L.,ooHzz ni FXo CO oooFJJ E I';'o [9 q a Cri z N N N (, $ (o $ C0'r=N rr)- cf) C) N Hoo o N (c'd Yzz I rf) rr) (o 5 22 - r/)EL o c o @a -c = o ac f =(o a rtr q) o o LL= 6c I o EL .9 o z o o o .ts tri o = o o (L J tr = b z o F z trid o o E o .at, E o o; o o E o F .c o o .9, o (L o ruG J o a! .ct o OF z o o F * l 3.2 Expenditure per activity
lndicate the expenditure on activities below in US dollars using the
current United Nations exchange rate to local currency
Tab 12: lndicate how much the project spent for each activity listed below
during the reporting period
Activity Expenditure Source(s)of ($ us1 Funding APOC UNICEF MOH Drug delivery from NOTF HQ area to central 75.7 a collection point of Community Mobilization and health education of 484.9 v communities rriinins oiCDbs 2000 a Training of health staff at all levels 1212.2 a Supervising-Cbos"ino oistri ouiion 1250 v t--.-..-.-,.--..- lnternal monitoring of CDTI activities 189.4 Advocacy visits to health and political 2550:3 ( r' authorities -- irc miteriats Summary (reporting) forms for treatment veniCtesl uotorcvcieil biCt;ies miintenance 227.3 I Ofice Equipment fe.g. Computeis, printeis uo.l v e.t.c.) tr/eeting; 1036.3 a v tvtanageriiiAssiitince" " TOTAL * 9146.2 N.B: 1US$ = N132.00K
- comments: During the reporting year 2004, nothing was forth
coming from APOC as it could be seen in the table above. The amount
therefore represented the total expenditures from both the MOH and UNICEF
exc! tnq LGA contributions of $16174.2 as reflected in Table 11.
Z5 a
SUSTA!NABILITY OF CDTI 4.1.0 SUSTAINABILITY AT THE STATE LEVEL 4.1.1 PLANNING: The 6th year Sustainability plan was properly integrated
into the overall States health plan. The activity plans were summarized and
incorporated into the Free Health Services Programme of the present
administration in the State.
4.1.2 MECTIZAN SUPPLY: The fund utilized for the collection of One [/i!!ion,
five hundred (1,500,00) mectizan tablets in February, 2004 from NOCP Lagos
and other expenses for their subsequent distribution to Local Governments
(both endemic and non-endemic) was from the State Government.
4.1.3 TRAINING & HSAM: The project conducted needs assessment of
training among Coordinators in assisted LGAs. Targeted training was
conducted for four (4) Coordinators who were recently posted to their present
stations during the period under review. However the targeted training of 150
Health workers sponsored by UNICEF was conducted by LOCTs but
supervised by the SOCTS. ln like manner, the 200 CDDs trained in 1 0
assisted LGAs was done by FLHF staff under the close supervisions of
LOCTs
4.1.4 FINANCE:lt was unfortunate to remark that the GCCC of ten Million
Naira ($+10,000,000) promised by the State Govt. as reported in the 5th year
evaluation report could not be actualized. This was due to some technical and
administrative problems arising from State budget formalities and
preparations. ln addition , the high level advocacy visit from NOTF anticipated
ZO I Despite all Odds, the Director (PHC/DC) sourced for a total of One t t- hundred thousand (N100,000.00) Naira from, other Sister PHC programme in
the concept of system integration to sustain CDTI project during the period
The above amount was to complement the Sixty-four thousand naira
(N64,000.00) released by the State Govt. for Mectizan distribution.
4.1.5 TRANSPORT & OTHER MATERIALS: ln the course of programme
implementations, NPI Vehicle or that of the HSF project was always available
for integrated monitoring and supervision when the project vehicle was in a
State of disrepairs. By and large, the State MOH expended a total of forty five
thousand (N45,000.00) for repairs & maintenance of project vehicle during the
period under review
4.1.6 HUMAN RESOURCES: The high level of commitment & team spirit
to programme implementation by SOCT members are being sustained
4.2.1 SUSTAINABILITY AT LGA LEVEL.
4.2.2 PLAINING: The review of integrated PPA of each of the 14 endemic LGAs took place during the months of January and February, 2004. There were clear indications of programme integration into the overall LGA
health plan in affected LGAs (as evident in LGA PHC comprehensive PPA for
each Local Government for year 2004).
4.2.3 LEADERSHIP ISSUES: !t is worthy of note to remark that every
health personnel in assisted LGAs have been initiated into CDTI activities and
their practices well articulated in consonance with the philosophy of CDTI sustainability.
27 I 4.2.4 MONITORING AND SUPERVISION: A replica of the State Project
monitoring and superuision checklist was developed by all the 14 APOC
assisted LGAs and this was confirmed during the targeted Monitoring and
Supervision conducted by SOCT. LOCTs and FHF staff carried out the
monitoring and supervision of CDT! activities at facility level and community
level (CDDs) the respectively with the used of approved integrated checklist
designed by the State. LOCTs were fully empowered to train, monitor and
supervise the CDT! activities at facility level while the FHF staff adequately
handled the CDTI activities at the community level. These activites are being
performed in consonant with the spirit of programme integration.
4.2.5 MECTIZAN PREGUREMENT / DISTRIBUTION: Significant
improvement have been observed in the areas of Mectizan ordering storage
and distribution. Recorded/ lnventory of Mectizan at Local Governments,
Health posts and communities are being kept on relevant designed MIS forms
for proper accou ntability.
4.2.6 TRAINING AND HSAM:- During the period under review the
UNICEF sponsored the training of 150 Health workers and 200 CDDs. The
LOCTs and FHF staff were empowered to facilitate the training above which
lasted for 2days respectively.
Equally too, the UNICEF sponsored Advocacy visits during the year
2004 afforded the SOCTs the opportunity of mobilizing the Local Government
Policy makers in the 14 APOC assisted LGAs for programme support and
28 commitment as well as in the area of giving approval to the release of at least
N250,000.00 into LGAs project account as counterpart fund.
4.2.7 TRANSPORT AND MATERIALS RESOURCES: The monitoring and
supervisory visit conducted to the APOC assisted LGAs revealed that each of
the LGAs had project motorcycle on ground and to these motorcycles are
being used for the purpose they are meant for. The LGA coordinator with
broken down motorcycles were mobilized to repair them with the immediate
effect. ln the same vein the beneficiaries of bicycles are making the best use
of them in Mectizan distribution.
4.2.8 COVERAGE: ln order to enhance better coverage, CDDs were
selected among the migrant (Agatus) for uninterrupted yearly Mectizan usage.
4.3.1 SUSTAINABILITY AT FIRST LINE HEALTH FACILITY LEVEL
4.3.2 PLANNING: The FLHF staff had been trained on how to write the
yearly plan and on the essentiality of the programme integration.
4.3.3 LEADERSHIP: lt had been observed that the FLHF staff trained the
CDDs after receiving their own training.
4.3.4 MONITORING / SUPERVISION: The Health facility staff at various
assisted LGAs place much premium on the supervision of the communities
with peculiar problems and the successes of this is being reflected from the
response to the distribution processes during the year under review.
I
29 I 4.3.5 MECTIZAN PROCUREMENT / DISTRIBUTION: Based on request,
the FHF staff are collecting their Mectizan requirement for the year from the
Local Government Coordinator, and the transportation to the Local
Government Headquarter is being enhanced from the monthly imprest.
4.3.6 TRAINING AND HSAM: Areas of deficiency were identified through
the follow up being conducted by the facility staff and are being rectified
through the constant Health talk by the staff. The FHF staff adequately
empowered to identify and conduct training needs, as well as ensuring
adequate mobilization / Health education.
4.3.7 FINANCIAL: FLHF staff budgeted for CDTI activities which
adequately reflected in the overall LGA DTI budget. Efforts are equally in top
gear to provide vote to the FLHF for the assemblage of reports concerning
CDTI activities.
4.3.8 Human Resources: During the reporting year the Health Facility staff
were adequately involved in the implementation of CDTI activities.
4.3.9 COVERAGE: The repeated visits of the absentees by FHF staff and
their adequate involvement enhanced the most needed yearly treatment of the
eligibles.
4.4.1 SUSTAINABILITY AT COMMUNITY LEVEL.
4.4.2 HSAM: The communities were mobilized and Health educated on
how to claim the full ownership of the programme and in this process the
community members signified their readiness to contribute token amount to
enhance uninterrupted yearly Mectizan treatment. ln summary, five hundred
and fifty eight (558) communities spread over eight (8) endemic Local
3o I Governments are presently giving incentive (either in cash or kind) to their
Community Directed Distributors (CDDs).
4.4.3. COMMUNITY SELF.MONITORING & STAKEHOLDERS MEETING:
Consequent upon continued mobilization and sensitilization of major
stakeholders in CDTI, the number of communities carrying out CSM and SHM
increased considerably as shown in the table below.
Table 14: Community Self-monitoring & Stakeholders Meeting.
Tota! # of No of Communities I No of Communities that District / LGA Community in the that carried out self i Conducted Stakeholders entire project area monitoring (CSM) i meeting (SHM) Atakunmosa West 50 22 13 Ayedaade 67 26 14
Ayedire 32 12 8
Boripe 154 30 18 Egbedore 42 23 13
lfe Central 23 6 4
lfe East 83 14 6
lla 69 16 7
lsokan 122 26 14 lwo 109 I 7 lfelodun 27 12 8 Obokun 40 12 I Oriade 102 15 14
Orolu 80 18 4 Total 997 241 142
The CSM & SHM continued to help in motoring CDDs activities before, during and after Mectizan distribution. They were activities aimed at improving CDDs performances on the field and more importantly an avenue for realistic conferment of Community ownership of CDTI project.
3l I SECTION 5: STRENGHTS AND WEAKNESSES t STRENGTHS:
1. Sustainability plans based on realistic budgeting continued to be in
existence during the period in question
2. lncreasing political support for programme activities from Chairmen of
LGAs
3. Moral and Administrative support from the Authority of State Ministry of
Health
4. High level of Community ownership; Several indicators such as number
of communities selecting new CDDs and collecting their Mectizan from
pick up centers show an appreciable level of community ownership
5. Availability of highly committed Health Workers to CDTI activities
especially at FLHF level
6. Availability of adequate census update
WEAKNESSESS:
1. Non release of fund by APOC authority.
2. Non release of fund budgeted for the CDTI implementation activities by
the State Government
3. Lack of basic Computer skills by SOCT
t
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