AFRICAN PROGRAMME FOR OIICHOCERCIASIS CONTROL (APOC)
Year 2 Report for Community Directed rreatment with Ivermectin CDTI
Yusufari Yunusari Nguru
Jakusko Tarmuwa
Fune aturu
Gujba
Gulani
Yobe State Nigeria
December 2000 EXECUTIVE SUMMARY.
Yobe State was created out of the formerBorno State inAugust 1991. It is situated in the North Eastern part of the country in Sahel Savannah and desert features in the northern part of the State charactenze its topogaphy while the southem part has rocky hills and mountainous terrain with rivers giving it the identity of the Sudan Savannah. The river Yobe is of particular mention as it cuts across Six (6) LGAs, and it serve as breeding sites of the black flies. The State covers an estimated landmass of 47,153 sq. kilometers, with a population of 1.4 million people.
Yobe State has a total of Seventeen (17) Local Government Councils. Twelve (12) of which are Meso-endemic with few southern areas having hyper-endemic communities, especially in those belts that run across the Biu LGA of Borno State. The people of the state are mostly involved in farming, cattle rearing, fishing etc.
Treatment started in the state in the year 1995, after CBM signed a Memorandum of Understanding to assist in the control effort. Over trvo hundred thousand persons have been treated since then. The State wrote a proposal to APOC for possible assistance in the year 1997 to implement CDTI, and this was approved for funding in September 1998.
The state is currently in its second year of CDTI implementation, with all emphasis shifted to community ownership of the prograrnme. The response is encouraging from the community members, despite the huge cry for poverry. The CDTI philosophy we found out is a better arrangement that will encourage sustainability within the community levels, since the communities now see the prograrnme as theirs and so the need to fully support and participate in its implementation.
The state govemment is well mobilized and is always ready to take up full responsibility of its partnership contributions towards the prografiIme. Successive government in Yobe state have given the control of onchocerciasis the required attention that it deserved. The Ministry of Health too has supported the prograrlme, by assembling crop of dedicated staff personnel that implement the programme. SECTION 1:
BACKGROUND INFOR]VIATION:
There are 244 communities undergoing treatment currently n 12 LGA's of the state. The coverage population of the communities is between 1000 to 3500. These communities are defined in terms of 8 to 15 people living in each household or even more.
1.2 Communities Implementing CDTI
A total of 242 communities are implementing CDTI as against a total of 98 communities that were receiving treatment in Twelve LGAs before the implementation of the progralnme. CDTI no doubt has given the state project the necessary support and focus it needed to e;rpand fast as well as work towards sustaining the prograrnme.
1.3 Endemic G.A.'s with rounds
Snl L.G.A.; ',r Round I Fika 6 2 Fune 6 3 Bursari 6 4 Gulani 6 5 Gujba 6 6 Tarmuwa 6 7 Jakusko 6 8 Nangere 6 9 Potiskum 6 10. Bade 6 l1 Karasuwa 6 12. Nguru 6
Note: Not all communities are in the sixth round of treatment because of our policy of gradual expansion over the years.
2 SECTION II.
TIIE NTATION OF CDTI
Table I ,No. ',Noofl No of No. of , of, ft-o. o-omm., s/N I ,, Comm.'l,|, villrgcs Comm. Comm., . Thrt dccidcd,: ,,i 'ion Thtt ,'" Thlt'l' month of ,ji selectcd i. collectcd , distribution'. " il tj' ;, CDD's drugs | 'r" ",'' ir';' 27 2',1 I Fika 27 27 27 40 40 40 9 2. Fune 40 40 49 22 49 49 49 3 49 l6 30 30 30 4. Gulani 30 30 23 6 23 23 23 5. Gujba 23 ll l1 l1 5 6. Tarmuwa ll 11 t4 t4 l4 8 7 Jakusko l4 t4 7 7 7 7 8. Nangere 7 9 5 9 9 9 9 Potiskum 9 l8 l8 l8 ll l0 Bade l8 l8 I 5 5 5 ll Karasuwa 5 5 2 l1 ll l1 t2 Nguru l1 ll 108 244 244 244 Total 244 244
the SOCT and LOCT' The One -year CDTI implementation period afforded the communities with the the opportunity to carry out severai visits to the community members' This objective of inte;ting with the leaders and coflrmunity compliance was responsible for the one hundred percent recorded above. to do all not easy to have all of these communities accepting It is definitely exercise' but that is required of them at the onset of the distribution small meas,re' plrrirt.n"e and awareness creation has helped in no
3 TRAINING OF NT LEVELS OF STAFF il\TVOLVED IN CDTI
Table II r] SAI DistricULGA No. of Tmining Na of T0T- '':i '1. |\[e.. sf 'No. of hcalth. Under teken District/LGA!i rlfl pnst stafi ':5 i..' F.mr$':t strff trrined'' ' '' trlined I I'ika 3 7 5 29 43
2. Fune 3 7 5 l9 68
3 Ilursari 3 7 5 t7 59
4. Gulani 3 7 5 40 53
5 Gujba 3 7 5 2t 32
6. Tarmuwa 3 7 5 25 28
7 .lakusko 3 7 5 20 28
8. I.langere 3 7 5 t9 l5
9. I'otiskum 5 7 5 l8 l8
10. Bade 3 7 5 9 34
I l. Karasuwa 3 7 5 23 8
t2 Nguru 3 7 5 ll t6
Total 3 84 60 251 402
Training activities was successfully carried out for all the cadres of personnel involved in the implementation of CDTI. Some CDDs were trained at a separate period on the job, because they could not turn up to be trained in the centers.
The CDTI approach has made community- training an ongoing activity, This has helped the trainers to identiff the needs and short- comings of the CDDs, and to fashion out the best approach to supervise them during distribution activities. The participation of the Health workers in this exercise is a welcome developmerrt, but we recently noticed that sustaining these personnel already trained on CDTI is a difficult thing, since the Local Government Service Commission often carry out frequent general transfers of the personnel to other LGAS that are not Oncho endemic.
4 2.1 Training obiectives / achievements
CATEGORY OF NUMBER TO I\ruMBER I PERCENTAGE, ,-i, 1,li : WORKERS TRAIN ' TRAINEI) COYERAGE L.O.C.T 60 59 98%
PHC Staff 260 251 96%
CDDs 600 402 67Yo
SOCT 7 7 t00%
Total 927 719 78'/"
The nunber of CDDs that were targeted for training fell short of the actual number trained because it is difficult to have qualified community- selected volunteers that are willing to be trained. In this case, we trained only those that were made available to be trained by the community members.
2.2 Developed material used
The project has produced all training Materials that were adopted by NOCP Nigeria, and have used them in the field during activities. 'Ihe project has also used its initiative to customize some of the materials to serve the needs of the communities in Yobe state. Although the trainer's flip chart is currently in English language, trainers use the local Hausa language to communicate to the CDDs during training.
2.3 Performance of CDDs
Although the literacy level of the CDDs is low, resulting in low perception during training, we still think that the performances ot'the CDDs is encouraging. They have done every thing humanly possible to ensure that their community members are treated with ivermectin. The problem that remains glaring is lack effective record keeping procedures, which is our source of concern at the moment. The CDDS
5 maintain their community registers, but some discrepancies are sometimes noticed during supervision.
One controversial issue that the project has to contend with at the moment is the issue of provision of incentives to other commturity volunteers during such activities as the National Programme on Immunization (NPI). This has discouraged some CDDs from performing their duties to their communities. They wonder why the rules of the game are different between prograrnmes.
2.4 Improvine the oualitv of trainine
In preparation for the CDD training, the SOCT and the LOCT have perfected their strategies in ensuring that the training is carried out in such a manner that comprehension and participation by the participants will be achieved. The project is placing more emphasis in the use of local languages as well as role plays during training activities.
The project will like to suggest here that NOTF Nigeria should help with more training materials outside the ones currently being useti and to conduct the TOT for the staff personnel involved in CDTI implementation on these new techniques.
6 M N AND C o TCO s
,i lltiii'l l N.9. of of s/N DistricULGA No. of I , No.,;of vislt to Communitics'l ln Mobilized I thet ,1i,. hcdth ti;
7 I I Fika 27 27 2
2 7 2 Fune 40 40
2 7 I 3 Bursari 49 49 ) 7 4. Gulani 30 30
2 7 5 Gujba 23 23
) 7 1 6. Jakusko t4 t4 .' 7 7 Bad;- l8 t8
4 2 7 I 8 Karasuwa 4
2 7 I 9 Nguru t2 12
2 7 l0 Nangere 7 7 2 7 I ll. Tarmuwa ll ll ) t2 Potiskum 9 9 7 I TOTAL 244 244 2
2.2.0 Mobilizotion strateev
at State Mobilization strategies involve the use of policy makers both As a and Local Governirent levels, which proved quite effective' their result of mobilization effort, communities were able to select to st'pport distributors. Although all communities showed willingness give pliysical CDDs but howeverl not all communities were able to incentives to the CDDs.
7 2.2.1 Response of Communities
Most communities are pleased with the partnership stratery of the prograrnme and are huppy to be involved in the planning and in decision-making. Their response is quite encouraging on their parl but often complain of being poor.
2.2.4 Sussestion to Improve Mobilizotion
More emphasis should be geared towards encouraging commmities to support and increase number of CDD's since most of them feel that CDD's are members of their communities and hence finds it an honour to be selected to work without any incentive. Training wiil be further simplified for the CDDs because of the literacy level or'the people.
SECTION 3: (See table 4)
ACHIEVEMENTS
3.1..1 Treatment coverage ratet A totat of 271,840 persons representing 95o/o were treated, during the period under review.
3.2 Total kensust oooulation: A total of 318,710 persons were registered in the endemic communities of Yobe.
3.3 Elieible oooulotion: A total of 287,645 were eligible for treatment.
3.4 Absentees/Refusals
The project keeps recording higlr refusal and absentees rate bec'ruse of the economic activities of the community members who travel for farming as well as for some religious ground for those tliat see Mectizan to be family planning drugs. This group of people initially pretend that they will take the drugs before the exercise ends, but will end up not complying.
8 4.5 Some of the reasons for absentees and refusals soelt out bv sonrc of the communities include:
1) Lack of seriousness on the part of the CDDs, for not putting in their best during distribution exercise.
2) Farming activities has taken some family members to some larms that are quite far away from their original communities.
3) Personal reasons as well as on religious grounds.
3.6 The olans we have for reducins the number of absentees*and refusals durins the next round of distribution.
For the project to have appreciable reduction in the number of absentees and refusals after the distribution exercise, the follcwing measures shall be taken in the next treatment round:-
l) Discussing with the community members on how to get this group of people treated during distribution or after.
2) Increase the time for mobilization and education o1' the communities and also discuss the issue of CDD support.
3) Involve the traditional structure of the state in the suppori and mobilization issues.
4) Sharpening the sword, by training the staff personnel involi'ed in CDTI in the act of conducting effective health education cariipaign in the communities.
5) Plan a mop prograrnme for the treatment of absentees and those refusals that are willing to take the drugs.
9 TREATMENT RESULTS FOR YOBE STATE JANUARY TO DECEMBER 2OOO.
Table 4
s/N District No of No. of Cmt pcr No of No. of No. oI /LGA Target Eligiblc pGnt()n Comm/Vill Distributio trested Comm I pcoplc treatcd. sges ns Cornrn/ Villages treated in which superuiscd Viliages CDDS lrc by heelth witit heelth workers surrrmSr workers y forms
I Fika 27 42,528 l. 0 2 27
2 Fune 40 36,358 + 0 2 ,10
3 Bursari 49 34,716 * 0 2 49
4 Gulani 30 42,314 * 0 2 l0
5 Gujba 23 16,684 * 0 2 23
6 Tarmuwa ll 13,383 * 0 2 ll
7 Jakusko t4 15,978 * 0 ) t4
8 Nangere 7 14,458 * 0 2 7
9 Potiskum 9 15,898 t 0 2 9
l0 Bade l8 15,M8 * 0 2 18
* ll Karasuwa 5 825 I 0 2 5
t2 Nguru ll 15,824 * 0 2 u
Total 422 271,840 * 0 2 122
* Could not calculate cost per person treated because we still need input from the APOC finance department. The treatment figure above represents only the APOC supported LGAs and does not include the Clinic treatment in 2 other LGAs.
l0 SECTION fV:
STRENGTHS/WEAKNESSES & SUGGESTIONS
4.1. Strengths
(l) Yobe State Government's commitment to the program
(2) Dedicated SOCT working with the progralnme
(3) Support of NGDO and NOCP
(4) APOC support to the project
4.2. Weaknesses
(l) Low literacy level of the people
(2) Community members are claiming that they are poor an'J will find it difficult to adequately support CDDs.
(3) Frequent transfer of health personnel from one LGA to the other
4.3. Sussestions
(l) Increasedcommunitymobilization
(2) Advocacy visits should be intensified
(3) Increase training especially for PHC workers to assist CDDs in terms of mobilization and supervision.
ll MINISTRY OF HEALTH CONTRIBUTION.
The Yobe state government has indicated its commitment in the successful yearly release of implementation o}th. CDTI programme. This is evident in Naira u'as coirnterpart funds. In the yiat 2000, the sum of l '7 million approved and released alreadY/
FUTURE PLAN.
1. AdvocacY to LGAs
2. Training of LOCT and PHC workers
3. Community mobilization and selection of CDDs
4. Training of CDDs in community centres
5. Mectizan distribution activities
6. Monitoring and supervision activities
7. Rap- uP of treatment
8. Result analysis and presentation
9. Mop- up of poorly treated communities'
1 0. CommunitY self monitoring
1l.Review meeting and progralnme evaluation
l2.Appraisal workshoP
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