AFRICAN PROGRAMME, FOR ONCHOCE,RCIASIS CONTROL (APOC) Forth Year Technical RePort for Community Directed Treatment with Ivermectin (cDrI) Dambatta Bichi Lbasawa Begwei Shanono Ajingi Gwarzo Kabo Gaya Wudil Kiru Bebcii Rano Karaye Takai Sumaila Doguwa Lp L For Acu-,,, I r.. ..4+ Caoa5 C5D Kano State clE' . l.r Nigeria p il, /{l' 7 3-,\o tfmeat Novem ber 2002 [,:.r'nroini.;tion Tr-r,_ I pr_ A'"' EXECUTTVE SUMMARY Kano State is situated in the northern part of Nigeria. The State has 44local govemment areas out of which 18 are Meso endemic with few hyper-endemic foci. The State falls in the Sudan Savannah and Sahel zones. Howeyer, the endemic areas are generally located in the Sudan savannah. The Ivermectin Distribution Programme (IDP) is in the 7th treatment round in some of the LGAs while in the 6th treatment round in others. However, CDTI strategy started in 1999. The CDTI project is therefore implemented in 779 communities of the 18 APOC approved local governments. Mobilization of the community members was conducted in all the targeted communities. In addition to mobilization, the state officials conducted advocacy visits to all the endemic local government Areas. The Launching of the commencement of 2002 prograrnme, which was performed by His Excellency, the Deputy Governor of Kano State increased awareness and acceptance of Mectizan by the people in the State. Electronic media, town criers and CDDs were among the mobilization strategies adopted for community mobilization. Targeted Training and re-training of CDTI programme personnel was conducted at state, LGA, and community levels, for those that are new in the programme as well as those with training dfficulties. In all 9 SOCTs, 50 LOCTs, 368 PHC workers and 1851 CDDs are involved in the implementation of CDTI in the State. The community level training has greatly improved the knowledge and skills of not only the CDDs but also those community members who had opportunity to participate as observers. Treatment with Mectizan in the endemic communities for the year 2003 has been completed, and the result indicates that the state has attained its Ultimate Treatment Goal (UTG) to treat 390,000 persons. A total 412,623 persons were treated, and henceforttr, this number of persons will be retreated annually. We are also happy with the progress of I treatment in the state over the year, which has been of steady increases, making it possible for both therapeutic and geographic coverage to be achieved. Sustainability is crucial at this level of programme implementatiory since APOC support to the programme will soon come to an end. The state has line up activities aimed at getting all stakeholders together to discuss the sustainability question Practical approach that has to do with release of counterpart funding will also be discussed with the state and LGA officials. APOC will be required to constitute a high power delegation at this point in time to visit the state government to solicit for the release of counterpart funds to the programme. Summa.rv of Mectiza4 Treatment bv year YEAR TREATMENT 1996 208,837 t997 209,135 r998 241,518 1999 250,0978 2000 340,497 2001 368,292 2002 412,623 ) SECTION 1 BACK GROI]ND INFORMATION 1.1 Communities Implementine CDTI Presently, there are a total of 779 endemic communities that are implementing CDTI in the state, with a population of over 400,000 persons within the 18 targeted local government areas (LGAs). These communities are determined by households under the leader of a recognized village head and or ward head with an estimated average population of 1000 to 3000 persons. The households in these communities contain an average of 5-10 persons per household but with some as having up 20-30 members. 1.2 Endemic LGAs With Treatment Round The following are the treatment rounds for each endemic local government area: No. Local Govemment Area (LGA) Distribution Round 1 Doguwa 7 2 Tudun wada 7 J Bebeji 7 4 Kura 7 5 Garun Malam 7 6 Gaya 7 7 Ajingi 7 8 Takai 7 9 Sumaila 7 10 Gwarzo 6 ll Karaye 6 12. Rogo 6 13. Kiru 6 14. Madobi 6 15. Dawakin tofa 6 16. Dambatta 6 l7 Kabo 6 18 Makoda 6 J SECTION II CDTI IMPLEMENTATION TABLE I SN LGAs No. of No. of No. of No of No. of No. of No. of Comm./ Comm. village Comm. / Comm. / comm. / Comm. Village Village that Comm. villages villages villages Villages selected That that that with payrng CDDs collected decided on decided kained CDDs is d*gs month of on method CDDs cash or kind. dishibution of teatment I Doguwa 87 87 87 87 87 87 6l 2. Tudun Wada 210 210 210 210 210 210 148 J Kura 45 45 45 45 45 45 33 4. Garun Malam 42 42 42 42 42 42 3l 5 Bebeji 70 70 70 70 70 70 29 6 Gaya t2 t2 12 t2 t2 t2 ll 7 Ajingi 23 23 23 23 23 23 t2 8. Takai 39 39 39 39 39 39 l9 9 Sumaila 30 30 30 30 30 30 22 10. Gwarzo 36 36 36 36 36 36 18 ll Kabo. 49 49 49 49 49 49 28 t2 Karaye 33 JJ 33 33 JJ 33 t4 13. Kiru 23 23 23 23 23 23 t9 14. Madobi 32 32 32 32 32 32 24 l5 Dawakin toft l8 l8 l8 l8 l8 t8 t2 l6 Dambatta l8 l8 l8 l8 l8 l8 l6 17. Rogo 8 8 8 8 8 8 5 18. Makoda 4 4 4 4 4 4 3 Total 779 779 779 779 779 779 515 Source: KA}IO STATE ONCHO UNIT 4 The process of CDD selection has become part of the people, such that if they witness a drop out of any CDD, they easily select another to be trained. At this point in time of CDTI implementation in the state, some of this enquiries in the above table might not be very relevant since devolution of responsibilities at all Ievels has been encouraged. As for choice of the time of distributiorl community members in our project prefer receiving treatment when there is less farming activities, hence determining the season of distribution instead of the month. Support to CDDs is quite relative, and it becomes practically impossible to get the true position of the forms of support given by the community members. The repeated targeted training witnessed in the project over the years has made it possible for all the CDDs to be trained to carry out the distribution activities. 5 TRAINING OF DTFFERENT LEVE OF STAT'F INVOL IN CDTI IMPLEMENTATION 2.1 Trainingobiectives/achievement In this fourth year of CDTI implementation, different training activities took place, but in a targeted numner. The assisting NGDO, and NOCP assisted the state in conducting the training on Stake holders' meeting (SHM) and on Community Self Monitoring (CSM) for SOCT, while the MOH officials carried out the training of the LOCT, and the LGA personnel trained the CDDs at the various training centers close to the communities. Please refer to table 11 for details of training results for the entire state for the year under revrew. 2.2 Develooment of Trainine Material (Ised. The materials used during the training and retraining were the training manual for CDTI, CDD guide, and brochure translated into local language (Hausa), Oncho flipchart, posters and forms that were provided by ApOC fi.rnds. 2.3 Performance of CDDs The performance of CDDs in their respective communities indicated a good increase in the level of understanding of their roles in the programme. The task of Mectizan distribution has become a routine on their part as record is properly kept and drugs are accounted for. The only problem that the project faces is the perceived lack of support from the communities, and this has been noticed to be and unendurg issue, which will best be tackled by the community members themselves. 6 2.4 Improvins the Oualitv of trainins The quality of training needs to be improved upon, with more emphasis on the communities' role and responsibilities and correct census update by CDDs. LOCT members will be trained on SHIWCSM strategies in the 5th year to assume the roles of trainers in their LGAs. Though the literacy level is very low, different approaches are being employed to get CDDs to understand CDTI strategies and its implementation CDD training was mostly done in Hausa language to reinforce understanding. Table II TRAINING OF DIFFERENT LEVELS OF STAFF INVOLVED IN CDTI IMPLEMENTATION. S/N District/ No. of No. ofTOT No. of District or No. of PHC Staff No. of CDDs LGA Training trained (SOCT & LGA stafftraind trained on CDTI Trained under taking LOCT Target Actual Target Actual Target Actual (LOCT & ATO ATO ATO CDDs) I Doguwa J 6 4 4 2t 20 245 240 ) Tudun Wada 4 4 30 30 316 306 3 Kura 4 4 t7 l5 190 t'l0 4. Garun Malam 4 4 t8 18 170 158 5 Bebeji 5 4 4 25 2l 220 207 6. Gaya J 2 2 t7 t4 50 44 7 Ajingi aa 3 2 2 25 2t 70 59 8. Takai 4 2 2 24 23 75 71 9 Sumaila aa 3 4 2 29 29 92 90 l0 Gwarzo aa 4 J J 30 28 86 75 ll Kabo. J J ') 20 t7 90 83 t2 Karaye J 2 2 2t 20 60 54 t3 Kiru J 2 2 20 l8 ll0 88 t4 Madobi 3 2 2 25 I9 80 76 l5 Dawakin tofa 6 4 4 35 3l 75 60 16 Dambatta aa J 2 2 20 t5 45 37 17.