OSUNSTATECDTI PROJECT
ORIGINAL: English
CO /|.{OTE : Nigeria Proiect Name : Osun State CDTI
Approval year: 1998 Launching year : 1998
Reportin s Period: From: 1" Jan., 2005 TO: 31't Dec.,,nO5
(Month / Year)
Proiect year of this report : (circleone) I 2 3 4 5 6 (7)89 l0
Date submitted: February 2007 NGDO Partner: UNICEF
ANNUAL PROJEGT TECHNICAL REPORT
SUBMTTTED TO
TECHNTCAL CONSULTATTVE COMMTTTEE (TCc)
DEADLINE FOR SUBMISSION
To APoC Management by 31 Januarv. 2007 for March rcc meeting
To APoC Management by 31 Jvlv. 2007 for september TCC meeting
AFRICAN PROG]RAMME FOR ONCHOCERCIASIS CONTROL (APOC) I I ,' "-j i o$ ,-) I i i 1 d 1 e r. a -D> ';> t bii q JUIL 2007 2 rt I b+b :'. lA ,! oii Li C, o B$r, i.i i fs ) ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMtrNT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
Country: NIGEzuA
National Coordinator Name: Mrs. P. Ogbu-Pearce Signature cr-'Y Crt-
Date: D D ()
Zonal Oncho Coordi nator Name: Otunba A. O. Jaiyeoba a Signature: ) t-
Date: EB D D
This report has been prepared by Name: Mr. M. E. Ilelaboye Designation: State Coordinator Signature: Signed 4 Date: l3th Feb .2007 L
ll TABLE OF CONTENTS
ACRONYMS VI
DEFINITIONS vil
FOLLOW UP ON TCC RECOMMENDATIONS 1
EXECUTIVE SUMMARY 2
SECTION 1: BACKGROUND INFORMATION 4
1,1 GENERAL INFORMATION 4
1.1.1 Description of the project (Elriefly) 4
1.1.2 Partnership 7
1.2 POPULATION 8
SECTION 2: IMPLEMENTATION OF CDTI I 2.1 TIMELINE OF ACTIVITIES I
2.2 ADVOCACY 10
2.3 MOBILIZATION, SENTIZATION AND HEALTH EDUCATION AT RISK
COMMUNITIES 10
2,4 COMMUNITY INVOLVEMENT 13
2.5 CAPACITY BUILDING 15
2.6 TREATMENTS 18
2.6.1 Treatment Figures 19
2.6.2 What are the causes of absenteeism 20
2.6.3 What are the reasons for rerfusals 20
, Briefly describe all known and verified serious adverse events (SAEs) 20 ?.0 2.6.5 Trend of treatment achievement from the CDTI project inception
lll to the current year 22
2.7 ORDERING, STORAGE AND DELIVERY OF INVERMECTIN 23
2.7.1 Mectizan inventory 24
2.8 COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING 25
2.9 SUPERVISION ?6
2.9.1 Provide a flow chart of supervision hierarchy 26
2.9.2 what are the main issues identified during supervision? 26
2.9.3 Was a supervision checklist used? 26 2.g'4 Wnat were the outcomes at all level of CDTI implementation supervision 26
2.9.5 was feedback given to the person or groups supervised? 26
How 2.9'6 was the feedback used to improve the overall performance of the project 26 SECTION 3: SUPPORT TO CDT| 27
3.1 EQUIPMENT 27
3.2 FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND
COMMUNITIES 29
3.3 OTHER FORMS OF COMMUNITY SUPPORT 29
3.4 EXPENDITURE PER ACTIVITY 30 SECTION 4: SUSTAINABILITY OF CDTI 31 4.1 INTERNAL:INDEPENDENTpARTtCtpATORy
MONITORING EVALUATION ' 31
4.1.1 was monitoring/evaluation carried out during the repcrting period?
(tick any of the following which are applicable) 31 4.1.2 What were the recommendations? 31 0.1., How have they been implemented? 31
4.2 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS
lv
) (MANDATORY AT YR 3) 31
4.2.1 Planning at all relevant levels 31
4.2.2 Funds 31
4.2.3 Transport (replacement and maintenance) 32
4.2.4 Other resources 32
4.3 INTERGRATION 32
4.3.1 lvermectin delivery mechanisms 32
4.3.2 Training 32
4.3.3 Joint supervision and monitoring with other programmes 33
4.3.4 Release of funds for project activities 33
4.3.5 ls CDTI included in the PHC budget 33
4.3.6 Describe other health programmes that are using the CDTI structure
and how this was achieved. What have been the achievements? 33
4.3.7 Describe other issues considered in the integration of CDTI? 33
SECTION 5: STRENGHTS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES 34
SECTION 6: UNIQUE FEATURES OF THE PROJECT / OTHER MATTERS 35 Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective AtrO Annual Training Objective cBo Community - Based Organization CDD Community - Directed Distributor CDTI Community - Directed Treatment with lvermectin CSM Community Self-Monitoring FLHF First Line Health Facility FMOH Federal Ministry of l'lrralth GCCC Government Cash Counterpart Contribution IFESH lnternational Foundation for Education and Self Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NID National lmmunization Day NOCP National Onchocerciasis Task Force NOTF National Onchocerciasis Task Force NPI National Programme on lmmunization PHC Primary Health Care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe Adverse Event SHM Stakeholders Meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of Trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization
vl Definitions
(i) Total Population: the total population living in meso / hyper-endemic communities within the project area (based on REMO and census taking)
(ii) Eligible Population: Calculated as 84% of the total population in meso/hyper- endemic communities in the project area.
(iii) Annual Treatment Objectives: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year.
(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in rrteso/hyper-endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project).
(v) Therapeutic Coverage: number of people treated in a given year over the total population (this should be expressed as a percentage)
(vi) Geographical Coverage: number of communities treated in a given year over the total number of meso/hyper-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 maximize cost effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by commun'ity distributors outside of CDTI.
(viii) Sustainability: CDTI activities in an arca arc sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government.
(ix) Community 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), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when . necessary.
vll FOLLOW UP ON TCC RECOMMENDATIONS
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC Session 21- Number of TCC ACTIONS TAKEN BY THE PROJECT FOR TCC/ Recommendat RECOMMENDATI APOC ion in the orvs MGT USE Reporl ONLY 1 Project should use The new reporting format has been the new reporting used for this report format in the next report 2 Project should This has been done in the report harmonise LGA and Community data 3 The treatment The treatment period was reduced from period should be January to April. However, mop up reduced treatment carried out between November and December com limented the treatment riod 4 Select and train Comprehe nsive proposals on the more CDDs training of more CDDs and Health workers have been forwarded to ApOC via NOCP Abuja as a panacea to this persistent problem. However, the slight reduction observed in the population to be covered by a CDD was informed by on-the-spot training / retraining conducted by SOCT during field assignments. The FLHF staff also took the challenge of report rendition of CDDs on monthly basis for educating them on proper record keeping. LOCTs supervisory visits of Oncho field activities equally utilized for the informal training of CDDs during the od under review 5 Reduce absertees The number of either absentees and / or and Refusals refusals was significantly reduced (during the reporting period). This success was attributable to aggressive health education and mobilization of endemic communities. (Please add more rows if necessary)
I EXECUTIVE SUMMARY
Osun State is one of the States in the South Western part of Nigeria and is located
in the B Health Zone. The State has a population of about 2.2million (1991 census). lt is
estimated that 830310 people are at risk of Oncho infection in all the 30 LGAs in the
State. lt is predominantly Yoruba State. Other ethnic groups like Hausa, lbo, Fulanis and
Agatus also reside in all parts of the State.
Osun State project is in the seventh year of its implementation. Ennphasis was
mostly placed on grass-root involvement and participation for CDTI sustainability.
lntegration planning meetings were held as an important strategy to enlist the active
involvement of other PHC Programme Officers in the State.
Population movements occur with periodic relocation of some farmers from the
communities during the farming period, festivity migrations from rural to urban areas, and
some mothers travel to look after their sons' wives who have been delivered of babies.
CSM & SHM as at December 2005 had expanded to 287 and 142 communities in the entire project area. Consequently, 87oh of the 997 endemic communities in the project site supported CDDs either in cash or kind.
Expectedly, all the 997 endemic communities were mobilized and treated thus resulted in the sustenance of 100% geographical coverage. The total population is
830310. The Annual Treatment Objective (ATO) was 712,733. The Ultimate Treatment
Goal (UTG) is 697,461. A total of 722,364 people were treated during thc period with
1569799 tablets in the APOC Assisted 14 LGAs, representing 87% therapeutic coverage and achievement of 101 o/o of the ATO. ln addition, 137,2g7 people were passively treated with 360,284 mectizan tablets.
2 was done during monitoring and on the spot training of health workers and cDDs and a totar of 622 hearth workers were trained supervision of oncho fietd activities. rn ail, and retrained. 37 cDDs out of 3053 retrained, and a totar of 3os3 cDDs were trained represents 57% and 101% were newly trained while 3016 were retrained' This year hearth workers and cDDs respectively' achievement of training objectives for the for
CDD / population ratio now stands at ratio 11272'
ThemajorproblemaffectingtheStateCDT|Projectduringthisperiodwasthelack (GCCC) for cDTl activities at both the state of government cash counterpart contribution the imprementation of planned and few LGAs, and non rerease of Apoc fund for was invited for advocacy programme activities. The top management of Apoc authority However, socr paid at visit to the state governor and other top poriticar functionaries. administrative functionaries of fourteen least two advocacy visits to both the political and
(14) assisted LGAs on the subject-matter' SECTION 1: BACKGROUND INFORMATION
1.1 Generallnformation
1.1.1 Description of the Project (briefly)
Geographical Location, Topography, Climate
Osun State is one of the States in the South Western part of Nigeria and is located in B health zone. lt is bounded by Kwara State to the North, Ekiti and Ondo States to
East, Ogun State to the South and Oyo State to the West. The State has a land mass of about 8572 squares kilometers. The State has two distinct seasons - the dry and rainy season. The rainy season begins in March and is heaviest from June through September
/ October. Farming generally begins in April, but most farm work is completed by
October, after which the harvesting is carried out. The dry season begins in November and ends in Mid March.
Population: Activities, Culture, Language
Osun State has a population of aboul 2.2 million (1991 census). Yorubas constitute the major ethnic group, although some minorities such as the lgbos, Hausas,
Fulanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian State with about 70% of its population engaged in one form of agriculture or the other, ln addition, it is a State that is internationally recognized for its rich cultural and tourism potentials.
Co m.m u n icati o n Sysfem (Ro ad...)
The major roads in the State are tarred but access roads to most of the endemic communities are in poor condition. Some are only passable durrng the dry season.
Despite this, transportation by road remains the major means of communication among
4 the communities. l.E.C materials, electronics media and the use of community town crier,
announcements in Churches and Mosque also form part of the communication system
used.
Ad m i n i strative Stru ctu re
The State is made up of 30.Local Government Areas with the Chief Administrative
Officer being the Chairman. A legislative arm made up of selected councilors from various ward supports him. At the State Level the Executive Governor is the head of administration supported by an elected legislative arm and the judiciary. The capital of the State is located in Osogbo.
Health Sysfem & Health Care Delivery
There is an Official PHC system and it is implemented in the project area; it is a system where health care services are taken to the doorsteps of the rural populace; it is a system where conimunity participation forms the mainstay and thrust of health care delivery with support from the UN agencies, the State and Local Governments. Levels of functionality however vary across the state. Within the project area, there are 3 teaching hospitals' 9 State hospitals and 330 health facilities scattered throughout the entire State.
5 NUMBER OF HEALTH STAFF INVOLVED IN CDT!
Table 1: Community participation in the CDTI (Please add more rows if necessary)
Number of health staff involved in CDTI activities District / L.G.A Total Number of health staff Number of health Percentage in the entire project area staff involved in CDTI 83 = B2l81 .1 B1 B2 00
Atakunmosa / W 62 36 5B Ayedaade 60 41 68 Ayedire 77 35 45 Boripe 128 60 47 Egbedore 110 54 49 lfe Central 60 32 53 lfelodun 70 37 52.9 lfe East 69 51 74 lla 61 34 55.7 lsokan 70 38 54 lwo 72 28 38.8 Obokun 72 47 65
Oriade 75 40 53 Orolu 50 29 58 TOTAL 1036 562 54.3 1.1.2 PARTNERSHIP ISSIJES
The partners involved in project implementation within the project area are UNICEF /
Nigeria, NOCP (National & the B-Zonal Offices), the State Government, the various Local
Governments and the endemic communities.
OVERALL WORKING RELATIONSHIP AMONG PARTNERS
Overall working relationship among all partners is cordial.
6 UNICEF is involved in supervision, advocacy, training and logistics provision. The Zonal and National offices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation cf the programme. The State played such roles as advocacy visits to the political functionaries, training of LOCTs/FLHFS, monitoring and supervision of CDTI activities and holding monthly meetings with LOCTS. The LGAs were empowered to train, monitor, supervise and report CDTI activities. The communities play such roles as selection and remuneration of CDDs, collection of Mectizan, distribution and reporting of treatments.
PLAN TO ASSIST IN IMPLEMENTATION
There are plans to sustain mobilization of existing policy makers occupying local government positions. The project hopes to revive and revitalize the mobilization of
CBOs so that they can actively assist in sustaining CDTI in the State.
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Policy makers in all the 14 endemic LGAs were sensitized and mobilized to support the CDTI implementation process through advocacy visits during supervisory trips to the LGAs by programme staff and external persons/evaluators. ln addition, during the monthly rotational meetings of the LOCTs with the SOCTs, LGA Chairmen are usually invited to give key note addresses. The meetings provide an avenue for interaction with the Chairmen, and for them to recall what they had done for the implementation of the programme. With the frequent changes of policy makers at this level and the low level of funding, these advocacy visits were absolutely necessary. Some LGAs have responded with government counterpart cash contributions being made available and some have supported the programme in other ways like Oncho day celebration, incentive (in cash or in kind) to the CDDs at the end of distribution, and sponsoring of monthly rotational review meetings.
At the State level, tl-e project relied on external bodies like UNICEF and NOCP officials when they came to visit the project and pay advocacy visits to the policy rnakers.
Though the State Government approved a total of $10,000 budgeted for the year under review, nothing was eventually released.
Constraints experienced were l'ack of logistics (the aged project vehicle can hardly move around without breaking down), change of political functionaries at the LGA level, and lack of IEC materials targeted at policy makers. To improve advocacy, high level visit need to be made to the State Chief Executive and a new project vehicle procured.
l0 2.3 Mobilization, sensitization and health education of at risk communities
Information on:
The Use of Med for Mobilization
The Communities were mobilized through jingles, on Local Radio Stations (i.e.
Radio Nigeria & Radio Osun); announcement in Mosques and Churches, use of Town
Criers,'use of Public Address Systems mounted on moving vans and distribution of IEC materials like posters and handbills. Village meetings were also used to mobilize the endemic communities.
To improve community participation, the following methods were employed:
- lnvolvement of more health facility staff in the CDTI process so that they can
mobilize the endemic communities more effectively.
Re-vitalization of non-functioning health committees and encouragement to
setup one where there is none.
- Utilization of community leaders' monthly meetings to disseminate rnformation.
- Organization of annual thanksgiving meeting for CDDs where they can be
praised and letters of appreciation presented to them.
- ldentification of viable CBOs and usage of adopt-a-community approach of the
guinea-worm eradication programme.
Mobilization & Health Education of Women and Minorities
The involvement of females and other minority tribal groups had continued in no small measure to the optimum support being received to sustain CDTI programme over the years. Women are increasingly participating in CDTI activities as evident in table 4. The Agatus in the LGAs continued to perform excellently well in CDTI activities. Some of them (i.e. Agatus) were appointed as Community Self-Monitors in Atakunmosa West LGA.
ll onse of Ta etC mm V
The Communities / Villages mobilized responded to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. Some gave funds for CDD training. There is more awareness of lvermectin benefits, more involvement in decision making and villagers make more efforts to encourage potential refusals to take lvermectin.
Accomplishments:
(a) Female members of the Community arc becoming more involved in the decision making and Mectizan drug distribution (b) The responses of the Community members to yearly Mectizan usage increased tremendously during the period under review. (c) Refusals to taking of drugs has decreased owing to (i) the regular interventions of our respected village heads, Bales & Kabiyesis, (ii) Programme integration into other PHC Sister Programmes e.g. National Programme on lmmunization (NPl).
To lmprove obilization a nd Sensitization of Tarqet Communities
To improve community mobilization, the following will be pursued in the coming year.
. lncrease emphasis on integration at all levels for effective mobilization.
. Greater involvement and participation of Health Facility staff
. Equipping of Health Staff on effective community mobilization skills.
o Utilization of LOCTS / SOCTS monthly meeting for community mobilization.
. Usage of treatment data as a tool for monitoring and follow up of mobilization.
. ldentification of local NGOs who will mobilize the community members at the
community levels.
. Printing of posters, jingles, radio messages including the use of mosques and
churches for improved mobilization.
t2 -{ o o o g d m @ o) o= o= =o (o I I o)-to ,rr o u o o o) @ g =. o _4, o o !r o) o i( m 6- o u i( :-. r5 E o- x 0) q) o- o o E g o- C o o c f @ c a o a 0) 6-i f f o o o) f, f o- 3 r o) o o o *= U) o 0) = ot = 3 z ,^\ o =o ob')= 3 q3 o 36 q=e o o (o J J J J o=.3o) @ @ s o) @ N N) s (Jl (, O) (, a o o N) (o G) \l (, l\) N) o o N o @ N) J { o HdaSzs.)E=o 0, =.o @ o o a o to -0Eoo+ ro 3 E' gf o )f q) C 3 f, U' o o 0: @ q.3cl1 @ q) ;qq5 d o=1. 5 (, (rl (, N (, (, N) (/) (, N) .A N) (o= N N) (, (, (rl o) o) N) o @ o o o N) o @ Bg *3 E ao =' 8a=i -{. aEq= J o o o o 3 o Bd 3 { (Jl @ (, c') o) = I 5 ru N) J 5 5 ! (l) O) (, (, J (rl (, N I J (, 9o O) (, \l s @ o 6- { E q) EH o o q) oz CL N J J oc o @ { (o N) J N l\) J J o? N (o s @ J { l\) N) 5 f\) O) o, uloR 33 (l) o o, o 5 \.1 (, G) J () !E;, 3 N s O) lo=o o q, o oi. 2U o @ (Jl J (o s @ s O) O) 5 J O) (Jl (, O) o;' { (, (/) J (, N) @Or @ ct) o (, s o) o O) o N) @od bo=o { @ ut 6- ga=g o =o o (oul o G) o o J N) N) J J J (, lu J N) (, J N) N) ll J o (, (, (, (, (, (, (,l J (, @ J @o' (, (/) (Jl O) @ N) A) @ s @ 5 s A \t (, (o J s @ :tr u) a @ o"z o 'rr o)J=c OJzI 6-8 1Ac 5 (/) @ N O) N) (rl N) (, N) N O) N) N 8a 5 o) N) (, (o (l) (o s o @ o) { (, (o (Jl o ooAqEB5 3 @b'O OaA 3 3 =J = o a= q! -(D (od (/) + a) = 5 o, @ N s (, s @ o) O) o) (o (l) @ ll o @ o o o O) (,l @ \l (,l (o (, B@q a s o o U YO):.A xii = 2.4 Health Education Meetings: ' More females are attending health education meetings and fully participating in discussions. At community meetings, females also participate but key decisions are often left to the elders who are males.
Many communities gave incentives to CDDs in cash but they are mostly in kind.
Attrition among CDDs is a problem within the project, and this is being addressed through:
. Plans for training of more CDDs with support from UNICEF
. Mobilization of communities to select more CDDs and provision of incentive for
the available CDDs.
Selection of CDDs as guides and recorders during NlDs programme in the
spirit of integration.
,
1tl m @ {N -{ o o o d o) (o > o o e o o= o= =o o 0) o =. o o u o o 6', o) o x m 6- o -4. o- is Bil g c o iF o) o) o- o D g c _4. o c ) q c o o- o 0) :l o 6- f f, f o o- ID (, 1 o_ 3 9l' o 0) o o o s a t- o) 6) ! o a 6' -lO = aoz 0) -l o o) .s (, s s s .r 5 5 A 5 (,l (Jl (rl 5 oI 3 o -o o)@= 5(D o +q3 (o t- f *n(J z q o= I t I I o o il 7; N € +O 8-g+'| oz oo) 5 (,t 5 5 s 5 s s 5 s (rl (rl (Jl s pd a o-O o o o il-l o o) s (rl 5 s s S 5 s s 5 (, (,l (,l s c)o O o Yil 6- C) o -o7 6 J o s (rl \l ! \.1 \J O) O) { o) J \J o) o) oF c (,l J (o N) C)-l G' o N) o f\) o o o @ ! o I\) -d +a@= o o o) o(, o a\ = 6q -t 6' N I (o N) U\ o (o O s,€ J OT E 3 (n o N) o) N (, (, (/) (rl o) ()) 6- J (.) s s 5 s s =o (., (o O ! @ @ N ! N 5 o (rl J o) eq o-=o0) 3 _: f, o o f, o 0) @ o f, (, Ctl (rl (rl (/) [-{ f o) N 5 s G) 1\) G) (, (, o) 5 (, oo a o 5 N (o o ! @ @ 5 J \l N) s o (,r J O) iq o f {o ! 6- aZ- 0) s o) I o) oi $= a :l o o 'a 5*=' rD =t ox oo_ 6' I I I I I aX o{9K o 3 o o 3 o a o o f, (D t I I I o) pd J o o - € p 0)- a N 5' [-l o = o o) I I I I O) Oo o= o 6d @ o + o o _r, U) @ (.f A) N N J J -l (/) N) J N (j) J N N z a o (,^) N (J) (, (Jl (,l (rl (, @ O) @ J N OI o) s G) o) s ! (Jl s 5 { (, (o J 5 @ dd 3 o (., \l Ca) { o 5{9K +to (, o N) N J (, N N (, .J 1\) l\) o o (/) N) (, G) (Jl (Jl (rl J (, @ O) @ J l\) pd (, (rr (o J o CD s (, s \t 5 s \l (, s @ @ o o. o (., ll o= J J N) N J J (, N J N (, J f\) N I o (Jr J Oo' o o Ol (, N) (, (, (, O) (, @ (o @ J N J q s (, (, 5 { (, J s ! (, (o J 5 @ 5.+- O) o Thble 6: Type of Training Undertaken
(Tick the boxes where specific training was carried out during the reporting period)
Trainees Types of CDDs Other Health MOH Politic Others Training Community Workers staff or al (Specify members (frontline other Leade ) e.g. health rS Community facilities) Supervisors Programme Management How to conduct Health Education Management of SAEs CSM SHM Data Collection Data Analysis Report Writing Other (Specify)
4b Describe the adequacy of available knowledge manpower at all levels
There is abundant knowledgeable manpower at every level of CDTI implementation in the
State. There is need to train more health facility staff to be involved in the programme.
Where frequent transfers of trained staff occur, sfate what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI lmplementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign.
Whenever new staff is employed or when trained staff is transferred, training is usually organized for those that replaced them or the newly employed one. The state project intends to liaise with Local Government Services Commission for the retention of Oncho programme
Officers for longer periods of time for the purpose of continuity. On the tong run the besf thing is to train all health workers on CDTI.
/1 { m @ o o o qo 6 0) o= o= o= (o > o q) o o o o) 6' 0. =. o = ir m 6- u -. o o is g L o x 0) o- o o D o- q o c 5 a0) c o o- o o, c o--. f f o o o) f NN =, a q 3 g)-{ q) o o o r o, o) U' u 0) o 6- ) = 5C) DAIoo (D d s.q @ J = (0 @ 5 N) O) @ l\) N 5 (,l (, o) (Jr 33 o o o o (o (.) \l (, N) -{ -l oo N (o N) N ! o o =B sgr.fii ? q) o o6 o ! 'T'r o =fl4 o o 6' 3 o o (o J o > 3 @ J -l o (o o 5 o N o) @ N N s (,l (, O) C'I f, o o I\) o (o N (o 9) \l (, t\) N) ! o SfiE9q= 0) 6' o 3. 30) o= @ o. o @ (o J T >- Q Z €. (o @ s o) @ N N) 5 (, (Jl ='i.u C s f, o o o N) (o (/) (, (,t o) -O - d m (o N o (o N ! N N ! o xil,9fl= (o o ** o o) U' o=r oo q) J r.E 3 8eP lo- a o o o o o o o o o o o o o o o + ll 6' o o o o o O o o o o o O o o o o!!EP s8 8€ o c) O (.,o { o\ \o o, o\ ! 5 UJ ! 5 s o -J s 5 N) \o UJ @ o UJ t.) o\ o\ t, s g, { @ 6 -J @ { o\ o\ o\ o o\ { o (o \o 5 -J UJ UJ UJ N) o o N) o (j So o 6 m \o o\ @ o\ { \o o u$*e*gd (oo 0) o) (]) (Jl \J (Jl (Jl (Jl 5 (^) -{ 3 ! (Jl _.1 (rl N o) 5 s s (, J o O) (o (o (r) @ G) s \J N) (o a> q) a\ J., o (/) ! @ 5 N) @ @ (Jt @ -E (, N \l (Jl \| o) ! ! o' (., (,r N N) O) o) (o ! s (, B8-+= 0) (., N) 5 (]) (Jl N (rl @ (rr o o A @ T A) oj o o E o o c A) N 0) o o) (, (,l ! (, (,l o) 5 N s s 5 (r) N o o) @ o) 5 @ 5 (o (l) (o (D E- =. ad ! (r1 (rl (o o R C'I @ _6 o o) \l a o) o) N o) (rl A 5 ! \Jo ui o f, f o=. (o o) o) o O) (, o) o @ (rt o) @ (r) !6'g *6 r 5 @ { @ ! 5 J (, o ! s @ (tt o o-ii q o) t f, o o- o-l q, o of, o 3 @ (o (o +il^oo o @ @ @ @ @ (o (o @ @ @ (o (o ao N --l (f,) l\) @ @ .ts s \l (o (o ,@ (Jr (, gg.6 g q, o i CL (Jl\.,, (o c o ='. 3 0) o J o (rlo)
I N I I I o s I I I I I o{ f $qsEj a o =, oa d -o .rc0) o o o c (rr Bz J J J @c o 0 o o, N) @ (, N) G) (/, q @ o=. o q3 o oo I !) o ol o F- o a= (o0) I I I I I I I I I I I I r-*)o i o
Ed-6EOEts6e.=(4 o oi'>o < a. I I I I I I I I I I I I -= xffi5d6 3 - q \o =ge6B6 2.6.2 What are the causes of absenteeism?
Occasional festivities, communal crisis and normadic migrants accounted for the
absenteeism.
2.6.3 What are the reasons for refusals? Fear of reactions, religious belief and long years of administration (15 - 25 years) were recorded to be the causes of refusals. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that
occurred during the reporting period and provide (in table 8) the required
information when available.
ln case the project did not have any cases of serious adverse events (SAE) during this
reporting period, please tick in the box.
No SAE case to report
ZO a @ t0.rI{ a z lu o lo o_=. lo (o ) o c ; 3 ao) q a .ao o xo o o a o os a, o (ct 40, o E Gl c 0) ='Jo @ o=. 0) f 3 o- o *x f s a q 6 F'r o o, o o p f ** @ qE3 a b- o=U, am a J N, 3 q) E o o o o A o o- o- o- F'=Erqtr Y C c ArGl ni O = :. r- = (o= ) *='&- o o- ,e) *ila E - t o +. - =9.* f ,F o. (o E a.o o c$+;i o_ 'm t o q) ov, r EiaIH 0) aa_ FIT 1'e I X=o o Io i o- g) =i o,t o oa,=' € 6 (/) E.o='(a g o o =' o o5> (/) - eQ o) :e9 a) =B g !
1 N) N N N N N N N) N N N) J .l O o o o o o o o o o o (o (o (o m J o o o o o o o o o o (o (o (o o (o @ { o) (rl 5 G) N o (o @ \l n OT{NU)oqr_b, t' (o (o I J .l ra r CO (o O) o) o) ! { G) (r) (, @ @ @ o-Y. to -{ @ @ @ io--lofi)f- H$$-s*1 a 58 E q =6'3\+(D,+ (o (o J @ { { @ q6I6 (O (o .l o N) N O) gj> @o) ! ! (/) (/) o o o N l-- I J TE3= -r$5 +JE go a d (Df=oo) o t- o+= () o (o (o A @ ! s (, N) 3 ;+ R H (o (o (o ! ! @ \t 3 { ! (, o) @ o) A *-9= c J (ri-i.JE mo) o-= *f 2E q P -6'956= o- o.o\vo o.u @ g 3 F: l ilE 0t- s 3* R g o) (o al /Tl (U .+r ! O) N) N J o o o o (o @ @ () O) m o olYXo o o o e u.s^P LcD0)J TSR 6 E tss; a I ll-ojProl osA O = H { 5 'g i-'o"!d 3 a- F, J J J (Jl { (o O) G) f*O E. o o o (o { O) (l) J - o o o Ia P P qtsH =60loX: 3 JD 4. 33 !-6I =' a!! (o (o (o tlJ ,+ @ @ { \l ! =J (,^) .l 5 s s J J J o)(DO Av O s N N N) J oh'x o) o s 5 s ! ! ! B pog: I G) (,^) CJ (/) o O O +q3E; o o l\) N N -l J, Aacoo ofllsePq ()O Y (Do= ioooPo \l ! o) O) ! (rl (Jl o) n-l Eroc J o (, o o o O O N J 5 o ,O o o O Y6 > a oI { o o o o O o o m 69< (/) o o, o o o o o of= EBq CD { o) o(u o o o o o o ='oof d =xIU ! o, (,l 5 (,) (rl (, l\) -o J- (j) o JA N) o) ! ! N @ s E += N (o ! @ (o O) H3 (}) ! (o mii d o e c oo (, o N o N) s = 6t cta o) J o) N) N @ O) (o - dg -6 3. s @ o N s O) @ o-ii q o 6-3 f ('C O=' @ o' \l o) (,l (Jl 5 1\) ni @ (, \,1 m-l \/ a-o { o I O U f, (j) mm^< X ,o_ -5 .,* lo:=o ?:, $ l+lo) o(u=oqE lv I I J (o @ { (rl J \t s o (, @ J ga s s) s (Jlo a (,l tsrH r oU) --l rr ;il O 33 o' (o (o ! o) (rl ! (,l (, o e o o, O) @ 5 o, o) (,l OOr s ^< - d 6 n*$(o 2.7 Ordering, Storage and Delivery of lvermectin
Mectizan@ordered/applied for by - (Please tick the appropriate answer) MoHl/l wHo[] uNlcEF[] NGDo[]
Other (please specify)
Mectizan@delivered by _ (please tick the appropriate answer)
MoH l/) wHo [ ] uNrcEF [ ] NGDo [ ]
Other (please specify):
Ordering, storage and delivery of lvermectin mectizan is basically ordered by NOTF
via UNICEF and based on requests from each State through the Zonal offices.
The State project takes delivery of drugs from the FMOH through the zonal
Coordinator. LGA coordinators get their consignments from the State store based on their
respective estimated requirements in accordance with the specific target population. ln like
manner FLHF takes stock of their own drug consignment from LGA coordinator for onward delivery to CDDs in endemic communities.
23 Table 10: Mectizan@lnventory (Please add more rows if necessary)
Number of Mectizan @ tables
District / L.G.A Requested Received Used Lost Wasted Expired Remaining
AtakunmosaAff 1 05000 1 05000 831 39 2 21859 Ayedaade 21 0000 21 0000 142632 21 67347 '140500 Ayedire 140500 140287 6 207
Boripe 1 07000 1 07000 1 06040 7 953
Egbedore 1 05000 1 05000 83784 4 21212
lfe Central 1 05000 1 05000 99177 5 581 B lfelodun 1 50000 1 5C000 142858 16 7126 lfe East 140000 140000 117079 I 22912 lla 1 1 'l 0000 10000 108404 I 1 588 lsokan 1 05000 1 05000 91 800 5 13195 lwo 1 55000 1 55000 153847 14 1139
Obokun 120000 1 20000 114528 6 5466 Oriade 90000 90000 85800 1 41 99
Orolu 1 1 5000 1 1 5000 100424 1.0 14566
TOTAL 1757500 1757500 1 569799 114 187587
o How are the remaining ivermectin tablets coltected and where are they kept? - The remaining tablets with LGAs were retrieved and kept with the remainder in the State store and brought forward for the following year's distribution. a List and briefly described the act[vities under ivermectin delivery that are being carried out by health care personnel in the project area. - The activities carried out by health care personnel under ivermectin delivery include: Receiving and Storing of Mectizan Proper record keeping Distribution of Mectizan to the users Supervision and monitoring of mectizan distribution Collection, Collation of data for onward transfer to the appropriate quarters.
z+ 2.8 Community Self-Monitoring and Stakeholders Meeting
Has any training (of trainers) for community self-monitoring been done in the project
area? lf so, When? YES, 2004.
Table 11: Community Self-Monitoring and Stakeholders Meeting (Add rows if needed)
DistricULGA Total # of No of Communities No of Communities that communities/villages that carried out self conducted in the entire project monitoring (CSM) stakeholders meeting atea (sHM) Atakunmosa 50 22 '13 West
Ayedaade 67 26 14
Ayedire 32 12 8
Boripe 151 60 21
Egbedore 23 23 13 lfe Central 27 6 4 lfelodun 42 14 6 lfe East 83 16 7 lla 69 26 14 lsokan 122 25 7 lwo 109 12 B
Obokun 40 12 o
Oriade 102 15 14
Orolu 80 18 4 TOTAL 997 287 142
Consequent upon the inauguration of CSM and SHM in the assisted LGAs, the communities have now claimed the ownership of the programme. This has tielped some cOmmunities to support the programme by providing incentive in cash and kind to their
CDDs. Some communities CDDs held meetings every month with the self monitors to discuss their problems and proffer solutions to same.
25 2.9 SUPERVISION
2.9.1 Zonal Office I 'To' Local Governments
First Jne Health
Facility Staff
Community Community Self Monitors Directed istributors
uni
2.9.2 Some of issues identified during supervision includes:
. Lacks of incentives to CDDs, in some communities, references were often made to other PHC Programmes e.g. NlDs in terms of incentives . Lukewarm attitude of coordinators due to lack of monetary gain from the programme occasioned by non release of counter part fund. o Maladministration of the drug which were corrected on the spot. o Non availability of posters o Poor record keeping which attracted on the spot training on same . Lack of follow up after treatment which was equally redressed etc. 2.9.3. Yes, designed checklists are being used for drug supervisions 2.9.4. Drastic improvement was observed on the part of Oncho extension workers i.e. FLHFs and CDDS during the follo'0vs up of supervision. 2.9.5. Feed back usually being given to person or group of persons supervised. 2.9.6. The feedback provided assisted significantly in correcting the anomalies detected in the area of Mectizan drug accountability and record keeping.
26
a, SECTION 3: SUPPORT TO CDTI
3.1 EQUIPMENT
Table 12: status of Equipment (Please add more rows if necessary)
Source APOC MOH DISTRICT / NGDO Others Type of LGA Equipment .Please Condition of the Equipment State 1. Vehicle 1 (Functional) (1) Grounded 2. Motor Cycle 20 (15 non 39 (2 functional; functional, others grounded) 3. Computers 2 (Functional) 1 table computer&aLaptop 4. Printers 1 (Functional) 5. Fax Machines
6. Bicycles 70 (Functional) 105 (22 functional; others grounded) 7. Others a) Photocopier 1(Nonfunctional I b) Projector butrepairable) c) TV Monitor Functional d) Generator 1 (Functronal) 1 (Functional)
, How does the project intend to maintain and reptace existing equipment and other materials?
At the LGA level, the Local Government sometimes give imprest for the maintenance
of the proiect motorcycles in their respective Local Government Areas. Storage facilities
were also provided for the safe keeping of all equipment. They are also being encouraged to
piovide the necessary materials for CDTI implementation. LGAs such as Boripe and
lfelodun have been in the forefront in meeting most of the needs of the programme within its
area' At the State level, the capital equipment and other materials available for the project
Z7 will hopefully be maintained from the money approved in the State Budget allocation for the
Oncho. Programme execution in the year 2006, if the money is released.
On the issue of replacement the project is requesting APOC to replace the project vehicle and other capital items supplied earlier.
21 3.2 Financial Contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Year 5 (Oct 2002- Year 6 (Oct 2003- YearT(Jan-Dec Sept. 2003) Sept 2004) 2005)
Contribution Total cash Total Total Total Total Total cash budgeted cash cash cash cash released (us$) released budgeted released budgeted (us$) (us$) (us$) (us$) (us$) MOH (Central + 52396.1 11363.3 40333 75758 1559.0 Provincial / State)
MOH (District /LGA) 2651 5 5076 29.167 10833.3 Local NGDO(s) (if any) NGDO Partner(s) 50262.1 41511.8 47727.3 5113.2 Others a) b) Communities
APOC Trust Fund 39141.6 21212.1 83332.9 NIL 1 9596
TOTAL 1417999.8 25723.9 17424'.1.7 25320.4 95354 12392,3
- lf there were problems with Release of Counterpart funds, how were they addressed?. Advocacy visit were paid to policy makers in the concerned LGAs (the Chairman, Secretary,
Director of Finance, PHC Director) to further educate them about the benefits of the
programme and solicit for fund releasing for. implementation of the programme.
21 3.4 Expenditure per activity
lndicate in table 14, the amount expended during the reporting period for each activity listed.
Write the amount expended in US dollars using the current United Nations exchange rate to
local currency. lndicate exchange rate used here Table 14: lndicate how mucl' the project spent-N132- for each activity listed below during the reporting period
IUS$ = N132.00
Activity Expenditure Source(s) of ($us1 funding Drug delivering from NOTF HQ area to central collection point of community 76 MOH Mobilization and health education of communities 150 SOCT Training of CDDs 3984.8 LGA Training of health staff at all levels 3030.3 LGA Supervising CDDs and distribution 1432.7 SOCT&LGA lnternal monitoring of CDTI activities 100 SOCT Advocacy visits to health and political authorities 50 SOCT
IEC materials 0
Summary (reporting) forms for treatment 0 Vehicles / Motorcycles / Bicycles maintenance 3568.5 rUOH&LGA
Office Equipments (e.g Computers, Printers etc) 0
Others 0 TOTAL 12392.3 Total Number of person treated. 722364
Any comments or explanations? The State Ministry of health and SOCT sourced a total of 1559 dollars forthe implementation of the activities above while the remaining 10833.3 was contributed by assisted LGAs.
3o SECTION 4: SUSTAINABILITY OF CDT|
4.1 lnternal: Independentparticipatorymonitoring; vatuation
4.1.1 Was Monitoring / Evaluation carried out during the reporting period? (Tick any of the following which are applicabte)
Year 1 participatory monitoring
Mid Term Sustainability Evaluation
5 Years Sustainability Evaluation
lnternal Monitoring by NOTF
Other Evaluation by other partners
4.1.2 Whatwere the recommendations?
It was recommended that:
i. Project should ensure and emphasis that CDDs carry out census update while treating
household.
ii' LGAs are to be encouraged to produce community registers and IEC materials.
iii. Health staff at all levels need training on good record keeping, particularly with regards to
mectizan inventories.
iv.. The state and LGAs should develop work plans for 2006 among others.
4.1.3 How have they been imptemented?
' The LGA coordinators were charged to organize meetings with CDDs and used the
avenue to educate them to update their registers alongside with the yearly mectizan
distribution.
s4 o Advocacy visits were paid to LGA policy makers for their programme supports and
cornmitment most especially in releasing fund for the production of registers and IEC
materials.
a lmplementation of this vital activity on the training of health workers at all levels was
hindered due to lack of fund. Nonetheless, the project was able to train twenty nine new
health workers during the reporting period. o Development of year 2006 work plan at both the state and LGAs was handled with all
seriousness.
4.2. SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT
YRS 3)
What the Project evaluated during the reporting period?_ No
Was a sustainability plan written? Yes
When was the sustainability plan submitted? 14th June,2004
What arrangements have been made to sustain CDTI after APOC funding ceases in terms
of:
4.2.1 PLANNING: At every rotational meetings, the LGA coordinators are being enjoined to
initiate p.lanning meetings with the community leaders and opinion leaders focusing ways and manners of bringing in the viable CBOs and NGOs in the CDTI implementation of Osun
State. Efforts are equally geared to*rrO, making the community realized the essentiality of fulfilling their financial responsibilities, most especially is the area of incentive provision to
CDDs. Health workers were to be involved more than hitherto.
4.2.2. FUNDS: There was unrelenting efforts by the SOCTs in mobilizing the policy makers at all levels on the need to provide GCCC for the continuity of implementation of
32 onchoc'brciasis programme activities. These efforts yielded fruitful results as reflected in
Table 14. The LGA contributiorrs comparatively increased during the reporting period.
4.2.3 TRANSPORT: Owing to the fact that available vehicle and motorcycles are old and
in state of disrepairs the project has requested APOC to replace them. ln the
meantime, the project, through the Director PHC both at the State and LGA levels,
utilizes the vehicles and motorcycles of other PHC sister programmes for some
programme activities.
4.2.4 OTHER RESOURCES: The SOCTs are brainstorming on ways of bringing in of viable CBOs and philanthropists in committing themselves to CDTI implementation. These, when brought in, could assist in procurement of other resources. Meanwhile, efforts will continue to get government at all levels to procure needed resources. Besides, integration of
CDTI programme activities into other functioning PHC programmes is the focus of the project.
4.3. INTEGRATION:
4.3.1 IVERMECTIN DELIVERY MECHANISMS: A total of two million, four hundred and forty six.thousand, five hundred (2,446,500) mectizan tablets meant for the state distribution for the year under review were collected from the NOTF store with the use of NPI vehicle because of the old age of the project vehicle. ln the same vein, the assisted LGAs made use of the other projects' motorcycles or vehicles in the collection of their mectizan supplies for community d istributors.
4.3.2. TRAINING: The project conducted the on the sport training for the Oncho extension workers during the reporting period. Again, at every workshop on malaria, Vitamin A and
NPI attended by SOCT members, the avenue is used to educate participants on the rudimentary knowledge of Oncho control activities most importantly on mectizan distribution.
33 4.3.3 JOINT SUPERVISION A].ID MONITORING WITH OTHER PROGRAMMES
The integration of CDTI programme into the functioning PHC programme activities is
of enormous assistance in sustaining the programme through joint supervision of CDTI
activities.
The existing joint supervisory and monitoring checklist in the PHC Department, which
is currently being used would soon be revised and updated to accommodate some
suggestion and field observations to further enhance efficiency of affected PHC programmes.
The strategy gave other programme officers avenues for the inspection of CDD registers and
collection of raw data from the field in other to accelerate data rendition as well as conducting
on the spot training to correct errors where necessary with minimal resources.
4.3.4 RELEASE OF FUNDS: Post APOC assistance in term of fund promised and the
approved 10 million counterpart fund by the State Government were not released for the
project implementation during the period. Nonetheless, other PHC Sister programmes
assisted the project financially to the tune of N145,086 while the SOCT equally contributed
a: sum of N60,720 to the project for the implementation of programme activities. Efforts are
on to plan high-level advocacy to the State's Chief Executive.
4.3.5 The CDTI was included in the PHC budget to the tune of 10 Million naira.
4.3.6 The national programme on lmmunization - NPI is currently using CDTI structure for
their programme implementation in some of the LGAs in the State by making use of house to
house approach as well as using CDDs as their local guides and recorders.
4.3.7 The application of CDTI structure is being considered as the best option for the
vitamin A administration and lymphatic filariasis treatment and control.
! Z4 SECTION 5: Strength, Weaknesses, Challenges and Opportunities
STRENGHTS: z i. The rotational, monthly co-ordinator's meeting among all the 30 LGAs in the State
ii. lncreasing Political support for programme activities from Chairmen of LGAs.
iii. Moral and administrative support from the authority of State Ministry of Health
iv. lntegration of Oncho into other PHC Programmes.
C HALLE N G ES/WEAKN ESS ES
i. Provision of incentives to CDDs to avert CDDs attrition, most especially where they
are not being used as guides and recorders.
ii. Annual accurate census updating.
iii. Rekindling the interest of local NGOs and CBOs and enlisting their maximum
participation / involvement in sustainability of programme activities.
OPPORTUNITIES: Administrative and Moral support from the appropriate authority of the
Ministry of Health
.CONSTRAINTS: The major constraints confronted by the project during the reporting
period is non-release of funds budgeted and approved for CDTI implementation activities by
the state government.
SUGGESTIONS:
- Needs for annual advocacy visit by top NOCP officials to the State policy makers
- Provision of incentives and introdtrction of annual award to the best performing CDDs
would equally be an advantage.
- Provision of supplementary drugs like Puriton, VitBco and Vitamin C are equally
essential.
SECTION 6: UNIQUE FEATURES OF THE PROJECT / OTHER MATTERS
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