GOMBE STATE C.D.T.I.PROJECT.
I
ORIGINAL: English
COUNTRY/NOTF: NIGERIA Proiect Name: NOTF/APOC- WHO CDTI PROJECT GOMBE STATE.
Aporoval vear: December 1999 Launchins vear: March 2000
Reportinq period (Month/Year): l't January 2006 - 31't December 2006
Proiectvearofthisreoort: (circleone)l 2 3 4 5(6)78 9 10
Date submitted: January 2007 NGDO nartner: UNICEF.
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' For hfcrmgilon ; g ro,5i R. i l I 0 8 JU|N 2007 I ffifu, I )/- d.gaKbna- I #rE# t ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC)
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AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
Country: _NIGERIA
National Coordinator Name: P. O PEARCE (MRS) s-t ) vtL- Signahre: .. W.t.\
z'- L5 -)/--\- L.' Date: ..?.iI I
Zonal Oncho Coordinator Name: P. O PEARCE (MRS).
Signature: . W*:!{- Date: ...L i. l,; I z vuV
This report has been prepared by Name : HARUNA ALI D
Designation
Signature
Date Table of contents
ACRoNYMS...... vt DEFTNITIONS""""' "'vlr FOLLOW UP ON TCC RECOMMENDATIONS...... 1 EXECUTTVE SUMMARY...... 2 SECTION 1: BACKGROUND INFOR]VIATION...... "'."""'3 1.1. GnNpneI- INFORMATION...... J 1.1.1 Description of the prolect (briefly) 3 1.1.2. Partnership... 5 1.2. PopuLerroN 6 SECTION 2: IMPLEMENTATION OF CDTI...... ""'8 2.1. Turmt,rxrB oF ACTIVITIES...... - --...... 8 2.2 Arvocacv ...... 11 23 2.4. COVN,TTXNYINVOLVEMENT . ..13 2.5. CepaCTrY BUILDING ...... 14 2.6. TRrnm,mwrs...... 2.6.1. Treatmentfigtres...... 2.6.2 What are the causes of absenteeism? 19 2.6.3 What are the reasonsfor refusals?.... t9 2.6.1 BrieJly describe all htown ondvenfied serious qdverse events (SAE{ that.... 2.6.5. Trend of treatment achievement from CDTI project inception to the current year 20 2 7 OROBRN.IC, STORAGE AND DELIVERY OF IVERMECTIN 2,8, COTWTMUTY SELF-MOMTORINGENN STETPHOLDERS MEETTNG.,. 2.9. SuppRvtsIoN 2.9. t. Provide aflow chart of xtpervision hierarchy -...... - 2.9.2. Wat were the main issues identified during supervision?..... not deftned 2.9.3. Was a supervision checklist used? ....Enor! Bookmark not delined 2.9.4. Whatwere the outcomes at each level of CDTI implementation rupervision? Enor! Bookmark not defined 2.9.5. Wasfeedback given to the person or groups xrpervised? Enor! Bookmark not deftned 2.9.6. How was the feedback used to improve the overall performance of the proiect? 26 SECTION 3: SUPPORT TO CDTI...... -...... 27 3.1. Equml,mur -.....27 3.2. FrXaNcnrCONTRIBUTIoNSoFTHEPARTNERSANDCoMMLINITIES...... 28 3.3 OrrmnFoRMSoFCoMMLINITYStlPPoRT...... 28 3.4. ErcsNDrnrRE PER ACTIVITY...... --...... 28 SECTION 4: SUSTAINABILITY OF CDTI...... 29 4.1. IwnNar; INDEPENDENT PARTICIPAToRY MoNIToRING, EveLuattoN ...... ,-.-...29 1. t. t Was Monitoring/evaluation cqrried out during the reporting period? (tick any of the fotlowing which are applicable) ...... , ...Error! Bookmarh not deJined 1.1.2. lV'hqt were the recommendations? ....Enor! Bookmark not delined 1.1.3. Hov,have they been implemented? ...... Etor! Bookmark not deJined 4.2. Susra.rt.{aerr-lTy oF rRoJECTS: eLAN AND sET TARGETs (vaNoaroRY AT...... 30 YR 3) 1.2.1. Planning at all relevant levels. 1,,-, Funds...... 1.2.3 Transport (replacement and maintenance)-.-.... 1.2.1. Otherresources.. 1.2.5. Towhat extent has the plan been implemented-.--. 4.3. IwcRanoN.... 4.3. l. Ivermectin delivery mechanisms....'...... '.. 1.3.2. Training..... 1.3.3. Joint supervision and monitoring with other programs 1.3.1. Release offundsfor proiect activities-'. 4.3.5. Is CDTI included in the PHC budget?...... 1.3.6. Describe other health progfammes that are usittg the CDTI structure and how this was achieved. What have been the achievemerrts?-...... 32 1.3.7. Describe others issues considered in the ifiegration of CDTI. JZ 4.4. OpPNETIONAL RESEARCH. 32 1.1.1. Summarize in not more than one half of a psge the operational research undertaken in the project area v'ithin the reporting period. Enor! Bookmark not deftned 1.1.2. How were the results applied in the project? .....Enor! Bookmark not defined SECTION 5: STRENGTHS, WEAKNESSES' CHALLENGES' ANI) OPPORTUNITM,S ...... 32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...... 32 Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBD Community Based Distributor CBO Community-Based Organization CDD Community-Directed Distributor CBIT Community - based Ivermectin Treatment CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring GMC Gombe Media Corporation. GSWC Gombe State Water Corporation LGA Local Government Area LOCT Local Onchocerciasis Control Team MLGCA Ministry for local government and Chieftaincy Affairs. MOA&NR Ministry of Agriculture & Natural Resources. MOH Ministry of Health NAFDAC National Agency for Food and Drug Administration and Control. NGDO Non-GovernmentalDevelopment Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care PHCC Primary health care Coordinator 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 LTNICEF United Nations Children's Fund UBRBDA Upper Benue River Basin Development Authority. UTG Ultimate Treatment Goal WHO World Health Organization ZOTF Zonal Onchocerciasis Task Force. Definitions
(i) Total pooulation: the total population living in meso/hyper-endemic commumfles within the project area (based on REMO and census taking).
(ii) Eligible population: calculated as 84Yo of the total populafion in meso/h1per- endemic communitres in the project area.
(iii) Annual Treatment Objective: (ATO): the estimated number of persons livtng in meso/hyper-endemic areas that a CDTI project intends to treat wifrr ivermectin in a given year.
(i") Illtimate 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 firll geographic coveragq (normally the project should be expected to reach the UTG at the end of the 3'o year ofthe project).
(v) Theraoeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage).
(-) Geographical coverage: number of communities treated in a given year over the total number of meso/tryper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).
(vii) lntegration: 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- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL
(viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, wrth high treatment coverage, integrated into the available healthcare sen,ice, with strong community ownership, using resources mobilised by the community and the govemment.
(i*) Communitv 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), *ith a view to ensuring that the programme is being executed in the way intended. It encourages the commrurity to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. FOLLOW UP OlI TGG REGOTTE]TDATIOI{S
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session
Number of TCC ACTIONS TAKEN FOR TCC/AMC MGT Recommenddion RECOMMENDAITONS BY THE PROJECT USE ONLY in the Report
(Please add more rows if necessary)
I WHO/APOC, 24 November 2004 Executive Summaty
Gombe State was carved out of the former Bauchi State on lst October 1996. It is made up of 11 L.G.As 10 of which are onchocerciasis endemic. Mectizan treatment started in the
State since l99l as part of the former Baichi State. CDTI implementation started in year 2000 and all the 10 endemic L.G.As are incorporated. The State has a total population of about 2,353,879 while the population of endemic communities in the l0 CDTI L.G.As is 1,384,864. In the period under review a total of 1,085,776 persons were treated in 966 communities in the 10 CDTI L.G.As while 603 persons were treated in Gombe L.G.A. (clinic-based treatment) The UTG as well as the ATO for the year is 1,163,258 The performance this year (under review) is 100% geographical coverage,
TsYoTherapeutic coverage and93%o of the UTG. Majority of the population of the endemic communities are peasant farmers who are always at home during the rainy season in order to cultivate their farmlands. In the dry season most of the youths in the rural areas move to various urban centers in the State and outside in such of white kola jobs. Similarly indigenes of other States troop into the State capital and down to the endemic communities. Towards the end of the rainy season, most of the cattle rearers travel down to the Southern part of the country in search of green pastures for their cattle and will not come back until the beginning of the next rainy season when green grass is available up north. Generally there is rural - urban migration where rural dwellers especially the youths, migrate to the urban centers for government employment or private enterprises. Trainings carried out in the year under review include: - 14l0 CDDs, 305 FLfmS, 39 LOCTs and 5 SOCTs SHM with 60 community leaders and l5 L.G.A policy makers was held in 4 L.G.As. This was carried out towards the tail end of the year when funds were available. The major problem faced by the project is lack of funds from all sources in the early part of the year, which hindered supervision, and timely implementation of activities. However, with the availability of funds efforts were intensified to cover most of the necessary activities at the end ofthe year.
2 WHO/APOC. 24 November 2004 SEGTIOI{ { : Background information
1.1, General information
1.1.f Description of the project (briefly) Gombe State was carved from the former Bauchi State on lst October 1996. It is located in the north east sub region of the country Nigeria. The State occupies a land mass of 17,048 square kilometers with an estimated population of 2.4 million.
Gombe State shares a common boundary with Adamawa, Bauchi, Borno, Taraba and Yobe
States. Topographically it consists of a plain land with undulating hills especially to the southern part. The entire State is drained by the Gongola river which passes through almost the entire State emptying into the river Benue at Numan (Adamawa State). The climate is mostly sudan and sahel savannah with a little of guinea savannah to the south eastern part.
The people are predominantly peasant farmers or petty traders and the major religion is Islam followed by Christianity. The major tribes are Hausa, Fulani, Kanuri, Tera, Tangale, Waja,
Tula etc. Communication is mostly by road and trunk A roads exist linking the State with the capitals of all neighbouring States. Other road networks are available linking the various towns and villages but some of the rural areas are difEcult to access in the wet season. Motor boats and canoes are used for transportation in the 4 L.G.As where communities are bordering the
Dadinkowa dam upstream.
The health system consists of Primary, Secondary and Tertiary levels. The Primary Health
Care facilities are at the L.G.A level where the maternity health clinics and dispensaries are found, while the secondary Health Care facilities consists of the general hospitals located in some of the L.G.A headquarters and tertiary is the referral hospital (Federal Medical Centre) located in the State capital. The number of health staffin the L.G.As varies depending on the literacy level of the L.G.A. and some other factors. The number of health staffas well as the number of health facilities in the 10 CDTI L.G.As are as shown in the tables below :-
3 Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessary)
Number of health staff involved in CDTI activities.
Total Number of Number of health Percentage health staff in the staff involved in entire project area CDTI
LGA Br B, B.=Br/ Br '100 Akko ll8 40 34% Balanga 74 40 54% Billiri 158 53 34% Dukku 119 35 29% Funakaye 50 29 s8% Kaltungo 53 37 70% Kwami 49 31 63% 69% Nafada 29 20 32 43% Shongom 75 52 36% YamaltuDeba 146 871 369 42Vo Total
Table 1a : showing the number of health facility by L.G.A. in the CDTI area in Gombe State.
S/NO. L.G.A. NO. OF HEALTH FACILITIES. 1 Akko 5l 2 Balanga 28 J Billiri 64 4 Dukku 44 5 Funakaye 31 6 Kaltungo 37 7 Kwami 35 8 Nafada 23 9 Shongom 29 10 YamaltuDeba 62 TOTAL 404
4 WHO/APOC. 24 November 2OO4 1.1.2. Partnership The partners involved in CDTI implementation include APOC, UNICEF, Federal Ministry of Health (NOCP), the State Ministry of Health, the 10 focal L.G.As and the endemic communities. UNICEF is the NGDO supporting the programme even before the advent of APOC. Another partner is the Ministry for Local Government and Chieftaincy Af,[airs (MLG&CA), which is the major link between the project and the 10 focal L.G.As. It is also involved in advocacy and mobilization of the L.G.A. policy makers as well as planning. It plays a very vital role in the release of counterpart funds by the 10 L.G.As.
The media houses in the state are always ready to help whenever they are called upon. They are actively involved in mobilization as well as coverage of all our activities. The management of the Upper Benue River Basin Development Authority, Dadinkowa Area office, is a partner in vector control as well as mobilization and education of their staff on CDTI implementation. The Ministry for Water Resources and Environment (MWR&E), Gombe State Water Corporation (GSWC), Ministry of Agriculture & Natural Resources (MOA &NR) and the Gombe Media Corporation (GMC) are all stakeholders in vector control and by inference CDTI implementation. In the l0 CDTI L.G.As, all the PHC Coordinators and the health facility staff are involved in all activities - supervision and monitoring, advocacy and mobilization. The policy makers are involved in advocacy and planning meetings. The community members are involved in all the activities carried out at the community level particularly now that community self-monitoring and stakeholders meeting is being introduced. The National Agency for Food and Drug Administration and Control
(NAFDAC) is very vigilant in checking the filtration of mectizan into the market. Efforts are still being made by the Zonal office and the Ministry of Health to mobilize local
NGOs and CBOs to assist in the implementation of the programme in the State.
The table below summarizes the communities and populations covered by the programme. 6 O=t E,E in F- N (..l cr- (J gE ca o\ o\ r) rf) c.l = >L!V ta) o\ C.I c.l co o\ o\ o\ r- L ;E \n la) \o^ $ \o @ rr1 ro () 3 tr=-\J q ..,^ \0 .o .E B TF t^ @ N ll.) c.t od a-t c..i i)- +LvF-f c.l tr co o o N oo lr) s () = DioS r r-. zo I =t {E. 6,) t tN b* \a) c.I s oi lri $ c- rr) ra) lal \o .=-q)o oN r- o\ la) \o 00 \o ra) O 6 + C\ $ F-- N a a r-- o hqr E s q t-* o\ o\ s Oi ::< E { P oo c.'l ca c.i oi Fi o\ o\ \o 6 il <.E t c.) \o ol c'l $ \o @ (o o F 8€ b c.l t- in(or€ E o Aoc) t oo o:! t- . <.rE I o ...-9j cltr o 9EE- h l/.) la) o() ra) (n t t t c.) @ in tr B€.; B < qbE c.l ol $ \n o\ rn O O tr- $ rn c..I la) (o o E E E'A cf) ca o r- $ !+ QC O o ol tf) \o o\ o\ ao t-- o o\ o -xL ;JT(l)()(l) .ir tr- a.) a.t $ ca N c.) !f, bo
L .9 C,1 E9i; .9 :ed 'E o ,, r- c..l N Eie td= rr)o \o o\ c.l O lal r- s * li o E'= OFH a.) o o\ la1 cil o\ oo a-) aa 6 o\ o gxE E€ E $ $ $ !f, \ d .r) H o -..; (l)CB C) o. oo () (€ *< B o () U) E9VL F € () t.: o0 Jo)I d iB=LV So E.E Lro q) (n (€u) o I>' =oo(H g e.. :Y=cB o) Jli c. d c) trr € C) f o L tr Q) o6 C) L (n o0 (l) Ea -6) t L ch€ t) (l) * t C) o FH o L/ C) -d (B P IB # b0 'q) .g () aXB* ao E E.o (I) -a\(J (.) cB E s9 _.C tr() (l) 6h0) ecg o0 )a (g L)A O ir .qE 06,)= (+< O'e tr O'a a. .= o !) o()€ +cges o.= ()(H .oo $i -q tr UE o do o tw aix tDt ox F cdF 63) C) E.oOE a9, () (E ts\o +rL(l)a) br) !-q t) a: AL a v 91 (D EE L ccg (s )!) ^o L .=c.) v dHS AO-J qrA +r (lLis,q z SEGTIOI{ 2: lmPlementation of GDTI 2.1. Timeline of activities The timeline for activities carried out during the reporting period is as shown in table 3 below rrIT/1/ l D/\r'a n I \r^-.^-L^- ar\r] | 8 + E k L k L () o C) C) o G) C) o) o c) N 6)9 -o -o -o .o .o -o .o ,o -o -o I r--= ()k (.) AL 3E o) o) C) C) C) C) 0) C) -() -o o O o () o () qv () EE o o o 0.) o C) o o) o o x _ t) t) I z z z o n o z a o z \ E9 E I \.L o ()L (.)fEa z a0 R e'F o3 (\I=f EE h k i 6E a fE () \-4-^ 5r- 9 ,o o o o tr o 0) !) .= o L L (n rn* s A #E (! (! .o() o a c! S OE O 2 f! o z z -i -6 'F E ol-r : T36o u) L L H k k =\J 5i o G) (.) 0-) r=()tr C,) -o .o 5 T F> H o 9: I -o o)/ E c.5 * (g (.) (.) C) i <\o oo) o oc) (J-l- ! EE o C) o (,) 0) 26 10 lr Q z o z o o 'R= tpcl iOt-o- E U2 b Eg (H 'o 6D 5 i'ii o o( EE ^.oj5d 1itr t L o o L o o S E L I n d d "EE #E 'oc) r ;b : z tJr z z Ersi(s-P Et E z,lC)crt k H H L k G) o) () pC) (.) (,) G) 9E E '-8 q) p +: 0)9 s 5 .o .o JVq -= aE G) () () C) () (,) c) li o o o o F 9H r o o o 0) () e EE () o a. C) n o d 'HE .; I a z a a a n .=H ar) + sa o U' AD h h, €8 EF CE g cL*- (B .ti e" cl €) E >. E. h (n P ,ito I a d cd S l-a c)E Q li c) o o O E .o L (o ii a) o 8 HR F.= \-/ O) lL z z z \- ;!HA F. o B'Jr 2.2. Advocacy There were advocary visits to policy makers in the 10 CDTI L.G.As in February and March by the State Onchocerciasis and Roll Back Malaria progranrme ofEcers. During the period continuous support for the sustainability of the programme was solicited for. Also at the community level the LOCTs and FLfmS paid advocacy to the community leaders in the course of delivering mectizan to them. In the process they were educated and mobilized on the need to sustain the programme. The number and category of policy makers and leaders mobilized is hereby summarized in the table below. - Table 4.Showing the number of policy makers and leaders mobilized by L.G.A. S/N L.G.A Community PHC PHC L.GA Secretaty Treasurer leaders Superviso Coordinato Chairman ry r Councilor 1 Akko 56 I 1 I I 0 2 Balanga 51 I 1 1 I 0 J Billiri 53 I 1 0 1 0 4 Dukku 47 I 1 I 1 0 5 Funakaye 48 1 I 1 I 0 6 Kaltungo 52 1 I 1 I 0 7 Kwami 57 1 1 I I 0 8 Nafada 4t 1 1 I 1 0 9 Shongom 44 1 1 1 1 0 10 YamaltuD 68 I 1 I I 0 eba Total 517 10 10 9 10 0 During the period under review a total of 517 policy / decision makers in the l0 CDTI L.G.As were mobilized. The objective for the mobilizations is to ensure continuous support to CDTI implementation through the timely release of counterpart funds and moral support. The Honourable Commissioner for Local Government and Chieftaincy Affairs greatly advocated for the cause of CDTI during his meetings with the L.G.A. chairmen. The advocacies led to the release of the sum of two million naira (N2,000,000.00) as counterpart funds by the 10 L.G.As at the tail end of the year. The major constraint to advocacy is the frequent change of policy makers in the L.G.As coupled with the fact that they are not easily met on seat. l1 WHO/APOC. 24 November 2004 2,3. illobilization, sensitization and health education of at risk communities The media houses in the State are always ready to cover all functions on CDTI implementation in the State. Their reporters are present in the State capital while in the L.G.As information officers cover the functions/ activities and send reports to the media houses for airing. The use of town criers and other local means is now reduced to local announcements in the villages as a result of the wide coverage of the State media houses. No IEC materials were produced due too lack of funds. Only a few samples of the old ones are pasted at the venues of trainings or functions on CDTI taking place. Mobilization, education and advocacy are carried out simultaneously at the beginning of the year at the L.G.A and community levels. At times mectizan consignments for the communities are also delivered. Due to the nature of the society where women groups are very rare and not easy to access in some parts of the State, efforts have been made towards sensitization of NGOs and CBOs where women are highly involved. Mobilization of women is done through personal contacts during advocacy visits. Plans are being made to train more female health workers and CDDs to enhance the mobilization of women. The constraints regarding mobilization include inadequate logistics, lack of IEC materials and lack of commitment of some health workers. 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(D 6LL 4PO \ o. o'E= ,i6H o U) Hts \Jtr(H z U )v >,€ LF rEO st '; a.l x () iv .=o0 Es().E tr;o HL p '^(I)EtrO.= F\ 6= EEg fi o05 ebij lJ=r--i( a (h rh -{ r \e € o ra 0) (A N .U t- 9 lr} (B ^^ ';{ ih E Lh,.= E €\JF.F E ra rn b ta) c) (gcn o oF- c) E.E K ]s o O o !- c! \J o la =v O C) L |< m ()d z F U (cu)th FO s 1i'hr ra r.) 5R E N r- 00 ta) a oo la) o\ c\ tr t, ie,\ (\ co c.l rO 9 ro ca N : c..l c.l N LSZ- caL € (l)# .! \o \o o a q $ C..l \ :(l $ rn & oo tf-) o\ c-. q) Fd : za () Ov) aq i rf) UF JU \.) $ (.il (..l $or c) u +i L) ca c.t e.l c..l a.l c..l o.l co 'q o- E> O B qa 0-) zE p .F \e ra) OJ o\ a) F U c O O in i.) (a) € hor, c.) c.l c-l ca (-.l c\ o.l co c.l N 0) TJ" c\ ()lc$r+ u) tr. ts o\ o\ € o r; + (r) lrn 0 u) t.) Trainees Other Health Community Workers members e.g (frontline MOH Type Community health staffor Political of training CDDs supervisors facilities) Other Leaders Others(specifr) Program { { management How to / conduct Health education Management / r' ofSAEs CSM { SHM Data collection Data analysis { Report writing Others (speci8) 2.6. Treatments 2.6.1. Treatmentfigures For the year under review, therapeutic coverage is 78o/o while geographical coverage up to 100%. t6' =Zz9naai'E e.cE E€TEHlEE O o E tsE as*:E + a t'-: O a{ ()H -o () i?tU) a o I an o (B za -o z oI oi+ ct U o\ ..1 co t\.l oo t o -aE o, o\ t- 6 s ra) + \o (a N oo o\ r- o. t-o Eg (l) z6 o +r a E .H; o - o. o o taa s;E; hE q) z Eij c) $o -o =b0 I \o ra) c\ tr- \at tr- \o t r- s SEs r- r- oo & r- € o lhl 6 rr & r'. r\ t-- E E- E6a) He \o th O) ! ca o.l ca $ \o ca r- <.o r.EX \o t F- oo $ tr- (') F- € tr) ao € ca 'i t-. a \n 6 \,^) \O^ l,n o V o-r 33t tr- 6l o\ c\ & N a \o EbE $ o\ sl' tr) co aJj in (\ t'- o z= N -(dF* AC cl (Jr € eN q l,a ^o) o ca o\ o\ r- la) c'l N t< io N o{ ca o\ c- rn (l)(€ Cr rn rr) \O^ *f ,o" € r.,^ (r) + \o ,rI \0 EEB + oa N ca & ca a.l ot (t- co ...l oo |r) t cE f-. r- Ea c)>, t a6)g tr) o.l + o.l i.) t t.. la) rn \o 9) O o c- o\ rr) \o € \o rl^) oo 6 ai -i r- Eq) gE8€E- a\ q t F- a.l r-. r- s E oo a\t aa c.i F- ol rr o\ 6 F, ZEa $ CO \o o.l o.l t \o @ \o fa aoo (^.l bE>(€ ur3 6l .9 qr -o \Q qO rIj Ebo \o \o 6\ o\ o\ C)H aF- ll . o\ o\ o\ so o.o)< E 9o- O E0a- ^'^ o Ff;o Ee R'.€ I U tfrO: |t) P E5' O u. 4) 2.6.3 What are the reasons for refusals? No cases of refusals were recorded during the reporting period. 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. D In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ l9 \Irun/APnr- ,)r[ I\Tnrramtrar ]AA.t o + bo 10 -o o\ 6\ ^\ O ^\ ^\la) soo c.l a.l P Es a c- $ ! \o t\ oo r- o\ o\ 0.) -oU -o s) o C) +. bI) \o z ^ il s o\ 6\ 6\ o\ .+ rl!, t)Ec o\ m oo oo co a\ ,; <' >v E] fEl $ tr- o\ o .9 o T o. s o I- -o ,o o =ooo (!^ ll r o\ o\ o\ s s o\ o\ -c€ o\ \o t- lr) ca & I B- -Ql trl El rnt \o c- \o (-. a r\ (l) sooo oo F G, Lq) .o \o u'o aa c.l <+ hCJ .0) sf N \o r- o 6.b sf oo o\ & o\ cn c\ €e rIl co tr) 4- lr) \n \o oo \Fi d lo ta) sr oo * t \n r-, € PD o '*? oo- o .\.= \) Fi o.t € E Eo o oo \o ss E EE oO \O^ € c.l E aFo @ in ca }I h !:(.) E O $ t \o a'.1 rgE ca ra) \o o\ L\OEN.E e3q)=$E C)IIE k .,3 c.l c.l ENc) -Ho \o r'r rat oo rn s lsrE tr xq l-. a\ \o .X ) t c.) (\ oo 9oY9 o a' .- c\ o.l t'- sf + ar) €EE*EF: rn \o $ \o oo O oo t*G F, ;i't l-t oo ca ca o:ra) F.. t'- O :Gl= 0 N 5E tr .E 'e .z o o s.: ll . s o\ s o\ 6\ o\ E E.€ r 0o\ rd Ii ra) c..l ra) a O .goo o\ F- e'.L2 I ri atrYls -(Do H(t)l,) o.oo= 10 10 -o o\ o\ o\ a\SN € ci-!s,:ili 6\ A\ O qE;u t rr ca C..l a uxB Ss i.) \o t- oo Gi r-r Ltr oaEl gE!-{ a €9 o qC) oo o:E 3- -ls @ v \o \o \o E E S.g ri \o + 00 \o \o \o EEI H 5 E E= O t la) \o r\ o\ o\ a EC>H E-El E C) z8- st .s .0E>1 tr 9.oI CL EoJ o =ii> O \o \o I &.t (J H.i=o E O O \o \o \o \o 9br--gv- .} ij5 sf \o r- o\ o\ u /i Err 6E 5 'r EEE oo (H (S ::.r6 -) qi =@> ., l'l o O> Y X h * rii 136 o\ la) \o \o \o \o :tro)*. E.t s lr) € \o \o \o \o 9q.el @ oo € o\ o\ o\ L-3 olaq-A -itct F tr () H'<, -(lllv tro U'-E o \dtr o ci o1 '; (ul tt) d r- 00 o\ 6l c.) + r-- m o\ o\ o\ o\ O o O O O -l- r! o\ o\ O (\.l Hs c.l a.l c.J et a{ ctl a\ a.l c.l 4.1 Fl Fi ' 2.7. Orderi and delivery of ivermectin Mectizan@ - Project Coordinator (MOH) MOH ON UNICETE NGDC Other Mectizan@ by - Project Coordinator (MOH). MO WHOD UNICETD NGDC Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan needed for treatment for the particular is applied for by the State Coordinator (based on the census update results or number of persons treated in the previous year. This request is forwarded to NOCP for consideration. When the tablets are available, the Project Coordinator will be invited to Lagos for collection. After collection, the tablets are kept in the State medical stores where it is entered in to the ledger. The tablets are allocated to the CDTI L.G.As based on their populations and the number of persons treated in the previous year. The L.G.As are invited to come for drugs. On arrival they sign the mectizan register and collect a note to the Store keeper where they collect and sign for the consignments. At the L.G.As the tablets are stored in the PHC store from where they are given to FLF{Fs to deliver to the communities through the CDD and community leader. An inventory is also kept at the health facilities. ZI WHO/APOC. 24 November 2004 Table 10: Mectizan@ Inventory (Please add more rows if necessary) Number of Mectizan tablets Number Requested Received Used Used/Person Lost \Yasted Expired Remai State/District/LGA in stock treated Akko 390000 390000 389972 127628 0 28 0 0 0 Balanga 490000 490000 489917 159788 0 83 0 Brllri 297987 297987 297832 109554 0 155 0 0 Dukku 375000 375000 374947 124937 0 53 0 0 0 Funakaye 263500 263500 263388 92102 0 l12 0 Kaltungo 295000 295000 99883 0 92 294908 0 0 Kwami 300000 300000 11 2004 0 193 299807 0 0 167,563 167,563 59,586 0 158 Nafada t67,405 0 0 227000 227000 72643 0 99 Shongom 226,901 0 0 386500 386s00 l3 1303 0 179 YamaltuDeba 386321 0 0 tt32 2500 2500 603 0 2 Gombe (clinic based) 20I0 0 48i tt32 3,195,050 3,195,050 L,O85,776 0 tt44 TOTAL 3,193,408 0 0 The remaining tablets of mectizan in the field are collected by the LOCTs and kept at the L.G.A. headquarters. It is added to the consignment for the subsequent year. Activities carried out by l{ealth Care personnel under ivermectin delivery in the project area. i). Collection of mectizan consignments for the State by the project Coordinator from NOCP Lagos or Zonal office Bauchi. ii). Offloading of mectizan consignment the PHC store at the Ministry of Health and entering into ledger. iii). Colleaion of mectizan consignment for each L.G.A. by PHC stafffrom the L.G.A. iv). Delivery of mectizan supplies from L.G.A. headquarters to FLUFF by PHC staff v). Delivery of mectizan supplies to CDDs / communities by FLFIF staff. 22 WHO/APOC. 24 November 2001 2.8, Gommunity self-monitoring and Stakcholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Stakeholders meetings were held with community leaders and policy makers in 4 L.G.As. It is expected that the communities involved will carry out SHIM and CSM before commencement of treatment for 2007. 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 carned out self conducted stakeholders monitoring (CSM) meeting (SHIM) yet Akko 118 Not Not yet Balanga 156 )) Billri 104 ) ,, Dukku 7l Funakaye 84 Kaltungo 84 ) Kwami 76 Nafadal 5t ,, Shongom 74 YamaltuDeba t42 TOTAL 966 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. zt WHO/APOC ?4 Nnvemher ?OO4 2.9. Supervision 2.9.1. Flow chart of supervision hierarchy. The NOCP zonal Office Bauchi and IINICEF supervise the state team (SOCTs), while the SOCTs supervise the LOCTs and the LOCTs supervise the F{FS. The FIFS and some community members supervise the CDDs. This arrangement is not very rigid as the zonal office and UNICEF as well as the state team can go to the community level in order to ascertain the situation in the field. NOCP Zonal office / LINICEF SOCT i LOCTs I HFS I ttrS/Community Members I CDD 24 WHO/APOC. 24 November 2004 2.g.2. What were the main issues identified during supervision? The main issues identified during supervision include:- i). Delay in the disbursement of mectizan tablets to the Front line health facilities for delivery to the endemic communities. ii). Lack of comprehensive records at the L.G.A. level iii). There is no define channel of delivering mectizan to the communities. iv). Some LOCTs are still monopolizing the programme. v). Integration is taking place gradually at the L.G.A' vi). Most FLI{F staffare not participating in CDTI either because they are not committed or they have been sidelined. vii). Records on CDTI are scarce in most health facilities. viii). Most communities have forgotten about CSM and SHM ix). Female CDDs are O Yo in many L.G.As and very negligible in a few L'G.As. x). CDD attrition is still very high because of them are still young school leavers. xi). The ratio of CDD to total population is still very high' xii). Census update is not comprehensive due lack of good registers. 'I'!;* itcries \iiticil itttrii('-[!{' !ii -}iiiiiiti.;,,',1;',t,'i,!ii:fii"rt':? i;r ]t}i)5.'l"llis itlc.ttlc t-itrlttr -rt:I;' mii i,ii ii 01,i8 l'l;li il ir li l,lr'ri4ilitrI lllt' ioil; tlte gl.o.icrl ir iiu,t i,r[]r,'., rJli 1;l "i ;iesiiitt" frlt;tt *irs *'tiiiii'lr.i, *ii ittilil(.;iAir', ,ri t-rt';-.iit'rr! 1i11i !;;'tll {lii"*il llt* ir.itltr l}li'"1 1lt'culilu' {qi illis i i";1", "r" ''r-"5'.iiii's'*., 2.9.3. Was a supervision checklist used? Supervisory checklists were not used by SOCTs and LOCTs' 2.9.4. what were the outcomes at each level of CDTI implementation supervision? The supervision revealed that CDTi implementation is sustainable but more efforts are needed to improve the process. !'lr:rsr. l'tirtid rt'." i 2.9.5. Was feedback given to the person or groups supervised? Yes feedback was given to the CDDs, LOCTs, FLFIFs and the PHC Coordinators. 25 WHO/APOC. 24 November 2O04 2.9.6. How was the feedback used to improve the overall performance of the project? i). Mectizan supplies are disbursed to the FLFIFs for distribution to the endemic communities without long delays while an inventory is kept at the L.G.A. headquarters. ii). Many FLF{Fs are now involved and keep records at their levels iii). More PHC staffare now involved in CDTI activities through integration. iv). Communities have been reminded of their roles in CDTI including CSM, SHM and giving incentives to CDDs. v). Communities were enlightened on the need to select more CDDs including females and elderly people who are not likely to leave the community. vi). Communities were urged to provide the correct registers or the L.G.A / State should do so. 2.9.7 Was feedback given to the person or groups supervised? Yes feedback was given to the CDDs, LOCTs, FLF{Fs and the PHC Coordinators. 2.9.8 How was the feedback used to improve the overall per{ormance of the project? i). Mectizan supplies are disbursed to the FLFtrs for distribution to the endemic communities without long delays while an inventory is kept at the L.G.A. headquarters. ii). Many FLIIFs are now involved and have been urged to keep records at their levels iii). More PHC staffare now involved in CDTI activities through integration. iv). Communities have been reminded of their roles in CDTI including CSM, SHM and gMng incentives to CDDs. v). Communities were enlightened on the need to select more CDDs including females and elderly people who are not likely to leave the community. vi), Communities were urged to provide the correct registers or the L.G.A / State should do so. ,;l * Ir,:;- 1,i,,li'ti ir'ri \'."';i l-his ir fl l'elielition 0f 2.').{,: iillt! "t ;"4 1,1;i{i',rt "! i' ).6 WHO/APOC. 24 November 2004 SEGTION 3: SuPPort to GDTI 3.{. Equipment Table l2'. Status of equipment (Please add more rows if necessary) Source APOC MOH DISTRICT/ NGDO Others LGA No. Condirion Type of No. Condit No. Condition No. Condition No. Conditron Equipment ion 1. Vehicle I F 0 0 0 0 2. Motor cycle(s) l4 6F8 0 0 0 ol CNFR 3. Computer(s) I F 0 0 0 0 4. Printer(s) 2 F 0 0 0 0 5. Photocopier (s) 2 1F 0 0 0 0 rwo 6. Fax Machine(s) I F 0 0 0 0 7. Bicycles 60 wo 0 0 0 0 8. Slide projector I F 0 0 0 0 9. Standby I F 0 0 0 0 generator 10. Air conditioner I CNFR 0 0 0 0 1 1. Electric type 1 F 0 0 0 0 writer. I2. UPS 1 CNFR 0 0 0 0 0 13. Coloured 1 F 0 0 0 Television 14. VCR. I CNFR 0 0 0 0 15. PAS 5 F 0 0 0 0 16. Photo camera I F 0 0 0 0 17. Filing cabinet 1 F 1 F 0 0 0 18. Safe I F 0 0 0 0 19. Writine board. I F 0 0 0 0 20. Laptop 1 FI 0 0 0 0 (computer) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO=Written off). IIow does the project intend to maintain and replace existing equipment and other materials? Maintenance of the present capital equipment will not be diflicult because these equipments are utilized in an integrated manner by other programmes in the Ministry of Health. Therefore in the absence of counterpart funds, resources from the mother Ministry or any of the programmes benefiting from these equipments can be used for maintenance. Replacement of these equipments may not be possible except for the grace of APOC. 27 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 (2004- 2006). Contributor (March 2004-DEc (JAN. 2o0s DEC. (JAN. 2006 - DEC. 2006) 2004) 200s) Total Total $ $ $ $ budgeted released Total Total Total budgeted Total $ $ budgeted released released Ministry of 20,000 29,000.00 20.000.00 0.0 0.0 Health L.G.As 12,500 12,500 12,500.00 15,300.00 28,271.00 Communities 20,000 1,800.00 1,000.00 UNICEF 23,100 1,584 0.0 0.0 0.00 APOC. 69,156 40,000 24,043.00 10,000.00 28,271.00 28,271.00 Total 34961 36,961 34,961 21,000.00 43,571.00 44,571.00 52543 For the year under review funds were released by APOC at the end of October and mid December 2006. The 10 L.G.As. released counterpart contribution of N2,000.000..as reflected on the table above. 3.3. Other forms of community support Another form of community support is in terms of recognition where the CDD is respected and given regard by the community members. He is given an upper hand over opponents in everything including contest for elections. 3.4 Expenditure per activity - Table 14, showing the amount expended during the reporting period for 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 US$-: Nl30.00 A T)nrr a,, \r^-.^*L^- ann I zg trrlrr\,/ Table 14: Indicate how much the project spent for each activity listed below during the reporting Period. Expenditure Source(s) of ($ us) funding Drug delivery fromNOTF HQ area to central collection point of 1000.00 communtty NOII/LGAs 3,000 Mobilization and health education of communities MOH/L.G.A 2,500.00 Training of CDDs MOII/L.G.A 9,500.00 Training of health staffat all levels MOH/L.G.A 1,817.00 Supervising CDDs and distribution MOTYL.G.A 0.00 Internal monitoring of CDTI activities 957.00 Advocacy visits to health and political authorities MOH/L.G.A 00 IEC materials 500.00 Summary (reporting) forms for treatment MOTYL.G.A 2091.00 APOC/A4O Vehicles/ Motorcycles/ bicycles maintenance H 750.00 Office Equipment (e.g. computers, printers etc) MOTVAPOC 3,460 Vector control MOH/L.G.A. TOTAL 25,575.00 1,088,424 Total number of persons treated - Any comments or explanations? The coiumn MOH / L.GA. combines funds released by the state and the l0 L.G.As whether the State has released anything or not and vice versa. As for APOC funds which were released at the tail end of the yeai lo"tober and December 2006) a balance of fourteen thousand dollars is still in the account. SEGTIOil 4: Sustainability of GDTI 4..1. lnternal; independent pailicapatoly monitoring; Evaluation The newly appointed I-INICEF consultant on the programme (Dr. Lola Okwuosa) together with the former Zonal Coordinator (now national Coordinator NOCP) were in the State for internal monitoring and evaluation in September. During their stay they visited the weakest L.G.As. (Nafada & Funakaye) in the project. Many weaknesses were identified and recommendations were made towards addressing them. i)lC;tre t.5eCl" flr.rtt:tE ttii*i 6st, l'ir'i'.'. i'lti. thC lli-,1;l'i;1,i'i.it+-' "r-i.'tir.,i;i "rrt'i EriUhlight lhl' reconrn!crttllttlons ctr:ll!r. l'r"tr*l ilte rtsi! lilt.lc"r'tlt* lr;'tit'',:gll'i,ltt:;llir its";trl illu' (5ee t!rt' rec{}rtrr!ertrl:tliorts !rr.'lrtrr tls.r :lrJtlr"t's.^ [ittt .il'irlrlllerrlt'trtrl{tttlt lrf llir-' ; "rtL'itq rettllirllelltl:tt ttlttc in t tr e lt lttirrttlt'ilt t t rttlt lttlttlit rq l(f cu iu riirrrtlrt ( iti ris tl'tilt* I ili', i rlii r{Ell'iir r:, \ i'' t i. The State should as a matter of urgency release counterpart funds to enable SOCT implement scheduled activities, and supervise effectively. The State PHC Director and 29 WHO/APOC, 24 November 20O4 a a State Onchocerciasis Coordinator should follow up with Nafada and Funakaye LG authorities to ensure release of counterpart funds. ll The SOCT should embark on immediate supervision and monitoring of Nafada and Funakaye LGAs to ensure adequate treatment coverage. ll l. CDTI personnel should be given reorientatiorVtraining on proper management of Mectizan inventory. IV Health workers and CDDs, particularly in Nafada and Funakaye LGAs, should be trained/ retrained. The SOCTs need training on data management. The project should embark on a data reconciliation exercise to assure accuracy of data submitted and reported. vt. The LOCTs need to be reorganzed and made functional' vii. More IEC materials should be produced to address sustainability and continued compliance to Mectizan treatments. vlll Quarterly reporting of CDTI activities should be instituted at State & LGA levels. 42. 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? Yes When was the sustainability plan submitted?-September 2004 4.3. lntegration What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The sustainability plans were prepared jointly with all stakeholders from all the L.G.As.and the State. 4.2.2. Funds Although plans have been made for the release of counterpart funds on annual basis as contained in annual budgets for the ministry of health and the 10 CDTI L.G.As., the release of funds by all partners has not been easy this year. Only APOC released ten thousand dollars towards the end of the year. 30 WHO/APOC. 24 Novembe r 2004 a t Transport (replacement and maintenance) 4.2.3.Maintenance oivehicle will be done by the State while some L.G.As. were able to maintain their motorcycles. Replacement of these motorcycles and vehicle is likely to be done by APOC. A request has been forwarded to APOC in the year 6 budgets. 4.2.4. other resources Human resources will be sustained while capital equipments may be provided by APOC in the 6th financial year. Also request forwarded to APOC in year 6 budgets. 4.2.5. To what extent has the plan been implemented The sustainability plans were not fully implemented due to inadequacy and delay in the release of funds from all sources. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms At the state level mectizan is collected by the State Coordinator from Lagos and down loaded at the PHC store where all PHC supplies and vaccines are kept. L.G.As collect their mectizan supplies directly from the store as they collect other PHC materials. Any designated officer can collect mectizan for his L.G.A 4.3.2. Training At the L.G.A. and health facility levels LOCTs and FLFIFS are involved in all training activities for the various PHC progralnmes. Likewise CDDs are trained as guides or vaccinators during most of the immunisation campaigns in many L.G.As. At State level SOCTS attend trainings on measles campaign. 4.3.3. Joint supervision and monitoring with other programs At the State level there is integration in the use of vehicles and delivery of information to and from the L.G.As. 4.3.4. Release of funds for project activities The CDTI project is one of the programmes under the Disease Control department. Prpoposals for every activity has to be forwarded to the Director Disease Control who will in turn forawrd it to the Permanent Secretary from where it is forwarded to the Honourable Commissioner for final approval.. The file follows the same route down to the Project Coordinator then a cheque is signed by the Director Disease Control and the Project Coordinator for the collection of funds from the bank by the project accontant. 4.3.5. Is CDTI included in the PHC budget? Yes, CDTI is included in the PHC budget 31 WHO/APOC, 24 November 2004 ) a I I a 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. what have been the achievements? Efforts have been made towards the integration of Vitamin A supplementation, surveillance of Guinea worrn and measles. These prografilmes have been added to the jobs of the CDDs and health facility staffin addition to NPI. 4.3.7. Describe others issues considered in the integration of CDTI. I The most important issue in integration is the behaviour of the personnel involved which will change faster with the organisation of programmes in an integrated manner. 4.4. Operational research No operational research was carried out during the reporting period SEGTION 5: Strengths, weaknessesr challengest and opportunities. Strengths 1. The identification of the CDTI structure by other PHC programmes as very suitable for integration particularly at theL.G.A. and community levels. 2. The involvement of NAFDAC in the control of mectizan pilferages. 3. Increased support and commitment from UNICEF.. WEAKNESSES. l. Lack of commitment by some health Staffat the State and L.G.A.levels 2. Delay in the release of funds from APOC State and L.G.As" 3. Inadequate logistics for LOTCs because most of the motorcycles are too\old to be maintained. CHALLENGES. 1. Sustainability of CDTI with dwindling funds when other PHC programmes are pumprng out money at all levels.. a SEGTION 6: Unique features of the proiectlother matters The unique feature of this project is the existence of identified permanent breeding sites for the black flies in one of the L.G.As. The populations of the flies tend to grow excessively and the persistent bites of the flies constitute a serious nuisance to the surrounding communities. 32 I t' This is the basis of vector control activities through the spray of insecticides / larvicide's at the breeding and resting sites of the flies in order to reduce their population and biting menace. The breeding sites provide an opportunity for operational research and evaluation of the , effects of mectizan treatment on transmission rate. I JJ WHO/APOC. 24 November 2004