AFRICAN PROGRAMME, FOR ONCHOCE,RCIASIS CONTROL (APOC)

Forth Year Technical RePort for Community Directed Treatment with Ivermectin (cDrI)

Dambatta

Bichi Lbasawa

Begwei

Gwarzo Kabo Gaya

Wudil Kiru Bebcii

Sumaila

Doguwa

Lp L For Acu-,,,

I r.. ..4+ Caoa5 C5D State clE' . l.r 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 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 7 2 7 J 7 4 Kura 7 5 Garun Malam 7 6 Gaya 7 7 Ajingi 7 8 Takai 7 9 7 10 6 ll Karaye 6 12. 6 13. Kiru 6 14. 6 15. 6 16. 6 l7 Kabo 6 18 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. Rogo 2 ) 2 t2 12 l8 t6 18. Makoda 2 ) 2 t2 t2 18 t6 Total 3 7t 52 50 410 368 2017 l85l SOURCE: KAI\O STATE ONCHO I,NIT

7 In the year 2002 few satellite communities that were identified selected their CDDs to be trained to distribute Mectizan drugs to them. This accounted for the high number of CDDs recorded in the report, greater than that of last year.

MOBILIZATION ATiD EDUCATION OF TARGET COMMT]IIITTES

2.2.1 The Use of Media in Mobilization

The Ivermectic Distribution Prograrnme for this year was launched by His Excellency the

deputy Governor of Kano State at one of the endemic communities of TAilada along with the flag off of National Immunization Days (NID). This approach to us is good for

integration, and both events were given adequate publicity by media houses.

The State commissioner for health and other officials of the ministry carried out advocacy visits to some LGAs during the period under review and such visits were given media publicity. He was also involved in community mobilization campaign for CDTI implementation.

2.2.2 Qlher Mobilization Efforts

Communities were fully mobilized using the following strategies: - Traditional and religious leaders - Face-to-frce discussion with community members - Town criers mobilizing community members - Electronic media (Radio/Television)

2.2.3 Response of the Communities

Mobilization activities have been quite satisfactory resulting in successful acceptance of responsibility by community members after understanding the CDTI concept. The

8 strategies. This reactions of the communities were favorable and positive to the CDTI the period and was noticed by the levels of their involvement in CDD selection, deciding method of distribution and high Mectizan intake by eligible people.

TABLE III MOBILIZ{TION AIYD EDUCATION OF TAITGET COMMUNITIES.

No. No. of S/N District/LGA No. of No. of No. of ofMOH comm. & targeted advocacy staff NGDO staff villages comm. visit to state involved in involved in mobilization /village that or regional mobilization mobilization. received director of tVEdu. health About the importance ofextended treatment 4 5 I 1 Doguwa 87 87 I 2 Tudun Wada 210 210 4 5 I J Kura 45 45 4 5 I 4. Garun Malam 42 42 4 5 J I 5. B€beji 70 70 4 J I 6. Gaya t2 t2 4 J I 7 Ajingi 23 23 4 I 8. Takai 39 39 4 3 I 9. Sumaila 30 30 4 3 3 I 10. Gwarzo 36 36 4 I ll Kabo. 49 49 4 J I t2. Karaye JJ 33 4 2 l3 Kiru 23 23 4 2 I t4 Madobi 32 32 4 2 I l5 Dawakin tofa l8 l8 4 2 I l6 Dambatta l8 l8 4 2 I t7 Rogo 8 8 4 2 I ) I 18. Makoda 4 4 4 Total 779 779 72 E I Source: KANO STATE ONCHO UNIT SECTION 3

9 3. ACHIEVEMENT

:412'623 :83yo 3.1 TREATMENT COVERAGE x 100 494,473 I last distribution is 83% for the The treatment coverage for the state during the cover those areas that we intend therapeutic coverage and we have also been able to is to sustain the ef[ort and to treat. What the project will continue to do now consolidate on the gains of CDTI implementation'

The total census population of the 3.2 TOTAL POPULATION (CENSUS) = persons' project area as per the 2002 census registrationts 494'473

population of the coverage alea 3.3 ELIGIBLE POPULATION = The eligible

is 436,412 Persons.

t0 2OO2 TREATMENT FOR KANO STATE

LGAs No. of Total pop. Total No. of Percentage No. of No. of No. of target Of treated people eligible coverage comm.. in distribution treated villages comm. eligible persons which supervised communities

treated for treated CDD is a by health with Mectizan health worker summary worker forms.

Doguwa 87 77148 69672 68291 E8 2 87

Tudun Wada 210 67585 s83 l9 546& 80 2 210

Kura 45 53117 45403 42786 80 2 45

G/IVIalam 42 34352 3 1708 30615 89 2 42

Bebeji 70 48632 40s99 349r6 7l 2 70 Gaya t2 12316 tttt2 10859 88 ) t2 Ajingi 23 14785 12741 12272 83 2 23

Takai 39 22143 19033 r 8998 8s.7 2 39

Sumaila 30 16414 14865 14177 90.5 2 30

Gwarzo 36 20805 1 8405 r 7015 82 2 36 Kabo. 49 15842 13826 129t8 8l ) 49

Karaye JJ r6209 14800 139s0 86 2 33

Kiru 23 17630 16355 l6l3 r 92 2 23

Madobi 32 22208 202t0 19157 86 2 32

Dawakin tofa l8 25t27 22718 21107 84 2 l8

Dambatta l8 155 l8 13175 I 1630 75 2 l8

Rogo 8 6890 6193 5998 87 2 8

Makoda 4 7752 7278 7139 90 ) 4

Sub total 779 494,473 436412 412623 830h 2 779 SOURCE: KANO STATE ONCHO tiNIT

11 STRENGTHS

* The LGAs are in the process of taking the fulI responsibility of the programme with community members. t Training of CDDs is at close distance to the communities that has open chances for other community members to join the training session as observers. {. More female workers are now participating in the programme and as selected CDDs. {. Increased number of CDDs that were trained this year has reduced workload of the CDDs. * The project was able to reach more satellite villages, and this accounted for the .high treatment coverage * Community members were also involved in the mobilization of their people to take Mectizan d.ugs through participatory learning & action (PLA) strategy.

WE.IJ(IYESSES

.E The lack of support to CDDs in some comrnunities is still a problem to the successful implementation of CDTI in the state. This though is relative. * Payment of monetary rewards to local guides who participated in other community based activities like polio vaccination has a negative effect on sustainability. This is lowering the morale ofthe CDDs.

AREAS OF WEAKNESSES IMPROYED UPON

{' The process of conceptualizing CDTI and practical application of the strategy in

endemic areas by LOCT/PHC staffis quite encouraging. * The state has released the sum of :N500, 000.00 as counter part to the progftlrnme.

t2 * LGAs are complimenting the efforts of both APOC and state Government through payment monthly fueling and maintenance allowance of :N3,000.00 for CDTI motorcycles : 3000 X 18LGAs X 12 months : 648,000.00 (six hundred & forty

eight thousand naira only). {. More over LGAs supported their teams in the following ways: -Sponsoring to attend centralized trainings and review meeting at state level in Kano; -Training materials and feeding for District, Health facility and CDD staff training; -Sponsoring advocacy gathering with traditional leaders at their levels.

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