AFRICAN PROGRAMME FOR OIICHOCERCIASIS CONTROL (APOC) Year 2 Report for Community Directed rreatment with Ivermectin CDTI Yusufari Yunusari Nguru Bade Bursari Geidam 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.