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TECHNICAL REPORT ON STATE CDTI PROJECT (YEAR FIVE)

JANUARY _ DECEMBER, 2OO2

BY:

MR. PHILIP D. SANKWAI STATE ONCHOCERCIASIS COORDINATOR For Actiou Tol TCc,,l-( C'Jn a6 1B csI C"s-p Jfl Cd 81m 8fic

E €Jr* RECU L4 u, u5 For lnformollon Tor *br ( rl 2 7 FE\,. 2003 Ito APOC/DIR ,s tl ,l .t ',fl lil 'ic .:f; t ,I Ct --.T 6 )o i 4" o" 3cr' t' c'o o' ADMI Sl v' NIST RATI V E MAP OF I(A DUNA STATE N It^ Jo' I(ANO STATE + fxarstr.ra _iD ! n ./ o I q XUDAN okorl i ',J a lk r'1 t r,j Sobo 't >< K v ] t) * x-,-lt\ o 'J * SO BA L l- IG A B )*4 >L K 4 r-r'- r'- *- * ,- * /- r->t K- * -a- a v- (aAu -o J- l- T U U /l k U * /-r' v- f- / /- f o 7 /- + + ;+ *r -i- t- f- D K/NONI UrU2a l- 1) * + f /- r'- f- t- 7 LE HE t +f- *'* + >-,t- *- I I O Kojuru l- /-tl >- t-t +t-/- Sominoko A Y-rtt'-* r-/-*4 KAJUR U )A y-* -/r * a -t_* y-f- *-.* * >--/- /^t r-tt- /-t'-f- t- l' )-* r* r> f * ** -* r' * { * * * t- t* t- t- * 1-* * /- f * 'l) z A N GON t- * S-* r(- * * KA T A F * 7a- f f t c t- x AIF 3OUN0Any f-t . -._ _ - ry-. rqr. t- * o n k o * 1 P I G.1IOUNOARy .. . .,.- L/^\_./ t * Ou t,r AUn X6 [,Rdeau.c,n's _ ._...___.-_ r A. A Kolonchon * /-r- a j- * j JEnA'a f *- * on * / *+ f) S (rl 5TA TE J Q-,

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i.l EXECUTIVE SUMMARY

The implementation of Community Directed Treatment with Ivermectin (CDTI) under the African Prograrnme for Onchocerciasis Control, (APOC) entered its Fifth year. All the 16 endemic LGAs are fully implementing CDTI.

The project was evaluated in January 2002 by a team of extemal evaluators. The result showed that the State is doing fairly well, thus, heading towards sustainability.

The Hon. Commissioner of Health gave a press briefing as part of activities commemorating Oncho week. He reiterated that APOC supports ends this year.However,SSl will continue to provide Mectizan and other logistics to sustain the programme,The 16 endemic LGAs Corporate organizations and individuals will also have to sustain the programme. He showered appreciations to Sight Savers International (SSD and APOC for their immense contribution in terms of logistics and financial support. He said the State would not forget the support and advice of the National Onchocerciasis Control Programme.

There is a sffong partnership in the programme.SSl and NOCP Zonal office have continued to train SOCT and LOCTs and provided minimal supervision. il 8 SOCT members were re trained on CDTI strategy, while 305 LOCTs were trained/re-trained in l6 LGAs on the control strategy of CDTI, community t roles and responsibilities, monitoring and supervision, Health Education and Community mobilization.5,55l CDDs were trained/re-trained. In our self- ["';l sustainability bid, all the Health workers in ,, Jema'a and Kaura LGAs were trained.

L] During the year, there has been increased Government involvement and commitment to CDTI programme in the State. The Hon. Commissioner, il Permanent Secretary and all Directors in the Ministry of Health were involved in advocacy visits/Social mobilization to endemic LGAs. The LGAs Hon. Chairmen, Traditional and Religious leaders and Community l members were re-sensitized on their roles and responsibility in CDTI implementation. l

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l1 t.l ti I Community mobilization/Health Education was carrieil out in all the 16 ,'l endemic LGAs, 1,215 Communities were mobilized.

Distribution of Mectizanhas been completed; reports collated with 16 LGAs reporting 960,558 people treated.

TECHNICAL REPORT ON CDTI PROJECT I Section I BACKGROUND INFORMATION I Kaduna State is located in the north central part of . The State shares boundaries with to the east, Nasarawa to the southeast, Niger to the west, Federal Capital Territory to the south, Katsina and Kano State to the north. The State has 23 I I-Ges and a projected population of 4.7 million. The major rivers are river Kaduna, Galma and Gurara. The vegetation is mainly savannah grassland with pockets of forest mosaic. The climate consists of the dry season (November to March) and the wet season I (April to October). il The main occupation of the people is farming, fishing and trading. The people are mostly indigenes living in permanent settlements. Community leaders in consultation with their I elders and community members take decisions. i-J Mectizan distribution started in Kaduna State in 1988 in Lere and Kauru LGAs. Distribution was expanded to Bimin Gwari LGA in 1990 and and Zango Kataf LGA in 1993. Six thousand two hundred and seventy (6,270) people were treated in Lere LGA in 1988 and 6,149 in 1993. 5,694 in Lere, Birnin Gwari and Kauru LGAs in 1990, 5,015 in 1991 and 10,032 in 1992. From 1993 to 1997,37,464, 145,342,234,730, l 283,642 and 285,845 persons were treated respectively in the five LGAs of Kauru, Lere, Bimin Gwari, and Kachia. t.i The APOC project proposal was approved in May 1997 and funds received in October 1997. The first year (1998) of CDTI implementation 333,935 people were treated in the aforementioned LGAs. In the second year (1999) of CDTI implementation funds were tl received in April and September 1999 respectively. The State Ministry of Health contributed US$2,438.43 to' the project as counterpart funds in year one. US$5320 was approved for year two but was not released. In the second year of implementation, I 146,225 persons were treated in 10 LGAs. In the third year (2000) of implementation, 833,172 persons were treated in 13 LGAs. APOC released US$68,007, for CDTI activities in the State, while US$9,200 was approved, and released as State counterpart l funds. In the fourth year (2001), US$42,395'was approved by APOC while the State approved and released US$19,504 as counterpart funds; a total of 958,061 people were treated for the year. The State has approved the sum of US$19,410 as counterpart fund _l for year 2002. APOC has approved US$35,556 for CDTI implementation for the fifth year activities,'uvhile the State has approved US$19,410 as counterpart funds.

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:..1 I I TABLE I

THE TOTAL NUMBER OF COMMUNITIES IN HYPER AND MESO ENDEMIC LGAS 1 s/l\o LGAs HYPER MESO TOTAL COMM. UN TREATMENT I BIRI\IN GWARI 40 180 220 ) KACHIA 85 24 109 3 KAURU 84 85 169 :r 4 LERE 100 115 2ts 5 Z/KATAF 180 224 404 tl 6 JEMA'A 133 133 7 KAGARI(O 113 113 8 11 118 129 il 9 KAURA 185 185 10 SANGA 218 218 i-t 11 CHIKUN 196 196 ii t2 JABA 86 86 13 131 131 t4 GI\vA 2t 2t l5 62 62 16 26 26 I TOTAL 500 1,917 2,417 i.J

(i) 1 197 communities received IVermectin in 1998, 2,075 comm.unities in 1999 2,423 il communities received Ivermectin for year 2000,2,515 Communities were issued with Ivermectin in the year 2001. 2,417 communities were issued with 13 Ivermectin in the year 2002.

In the second year, the 5 additional APOC LGAs (Jema'a, Kaura, Kajuru, U and Sanga) with 872 communities received treatment for the third time, using the CDTI strategy. 1,203 communities (in Bimin Gwari, Lere, Kauru and ,} Zangon-Kataf LGAs) are on their fifth round of treatment under the project. J Treatment is on going in Chikun, Jaba and Kubau with 348 Communities, using the CDTI strategy for the third time. The last three LGAs (, Igabi, Ikara) -] with 109 communities commenced the CDTI strategy for the second time this year.

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(ii) A community is defined as a group of people living in one place, considered as a a-'I ,.r1 whole, sharing the same race and having the same leader.

--'t I I I TABLE 2

-l IMPLEMENTATTON OF CDTT (YEAR s) :l I District/ No. of No. of No. of No. of No. of No. of No. of .'-,'l LGA Cornmunities Communitics communities/ communities communities communities communitieVvi /Vilhges Villages /villages that /villeges /villeges llages paying ,l which which decided on which with trained CDDs in cesh selected coilected method of decided on CDDs or in kind CDDs drug distribution month(s) of :-) treatment I :i B/Grvari 220 220 220 220 172 220 196 Kachia 109 109 109 109 95 109 86 :-1 Kauru 169 169 169 169 141 169 r45 -j'l Lere 215 215 215 215 152 2t5 189 ZlKataf 404 404 404 404 287 404 329 Jenra'a 133 133 133 133 106 133 122 -)I : I Kagarko 113 ll3 ll3 l13 84 113 102 Kajuru r29 129 129 129 93 129 92 136 185 151 a-t Kaura 185 185 185 185 Sanga 2r8 218 2t8 218 173 218 159 Chikun t96 196 196 196 142 196 154 Jaba 86 86 86 86 82 86 72 Kubau r3l l3l l3l l3l tt2 l3l 96 Giwa 2t 2t 2t 2l 14 2t l8 Igabi 62 62 62 62 47 62 46 't Ikara 26 26 26 26 l9 26 20 TOTAL 2,417 2,417 2,417 2,417 1,861 2417 1,983 -t With the expansion of the project to 5 additional LGAs,2075 communities received Mectizan at the end of the second year (1999) compared to ll97 inthe first year (1998). 2,423 communities received Ivermectin for the third year (2000). 2,515 communities received Ivermectin for the forth year 2001.2417 communities received ivermectin in the il fifth year. The short fall in the number of communities issued with ivermectin was due to sectarian crisis in 2002. Although the last batch of LGAs, viz. Giwa, Igabi and Ikara have been implementing l CDTI strategy, they were not supported by APOC. APOC support was extended to them this year. The State Government bought 3 Suzuki motorcycles and donated them to each of the LGAs. Sight Savers International have all along been supporting Mectizan _l disrribution in these LGAs

With the expansion of the project to 5 additional LGAs,2075 communities received J Mectizan at the end of the second year (1999) compared to 1 I 97 in the first year ( 1 998). 2,423 communities received Ivermectin for the third year (2000). 2,515 communities rec:ived Ivermectin for the forth year 2001. 2,417 were issued with Ivermectin for the year 2002.

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i,i TABLE 3

TRAINING OF THE DIFFERENT LEVEL OF STAFF INVOLVED IN CDTI IMPLEMENTATION

J Dist/LGAs No. Of training No. OfTOTs No. Of District No. OfCDDS undertaken trained (SOCT) No LGA staff trained trained on I I cDTr (LOCT) B/GWARI I 36 483 KACHIA I 2t 439 l KAURTI I t9 420 LERE I t7 558 Z/KATAF I 18 652 ,, l JEMA'A 43 415 KAGARKO I t6 341 :-l KAJURII I 15 346 :,l KAURA ) 35 419 SANGA I 15 466 CHIKUN 1 l5 328 JABA I 16 230 KUBATT 1 l4 194 GIWA 1 7 47 l IGABI I 8 t4t IKARA I 10 72 Total l8 8 305 5,551 l The performance of the CDDs has continued to improve and there is minimal trt attrition. CDDs have now learnt and accepted their roles even with little or no incentives. This indicates that they understood the important role they play in CDTI. This can also be seen in the community registers where recording and reporting have improved. They have also been found to use measuring sticks and l marked walls to give community members their annual doses. I The project annual training objective for CDDs in year 5 was 3,500 - 4,600. In l the 16 LGAs 5,551 CDDs were trained. The percentage objective abhieved was l2lYo. 2. The project's annual training objective for LGA staff in year 5 was 220-241. 305 l LGA staff were trained. The percentage objective achieved wasl2To/o. The self-sustainability training has started with the training of all the Health j workers in Jema'a and Kaura LGAs. 45 Health workers were trained. The two

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EB m rl LGA Oncho Coordinators did the training while SSI and SOCT assisted only. The q aim of the training was to ensure that CDTI implementation does not suffer in any endemic LGA as a result of health workers transfer. I MATERIALS PRODUCED FOR YEAR 4:

I The following materials were developed by NOTF and purchased with APOC funds, SSI, and MOH for training of Health staff and CDDs and for community mobilization and Health Education. Also some IEC materials like posters are placed in community leaders houses and Health facilities.

1000 Oncho Posters supplied by the State. T 2000 Posters for SOCT, LOCTs and CDDs to place in community Heads housesAlealth facilities; supplied using APOC funds. 2,000 Posters supplied by SSL il 3,000 MIS summary Forms supplied by SSI. 12,000 MIS summary forms supplied by the SSI it U TABLE 4 n U NIOBILIZATION AIID EDUCATION OF TARGET COMMUNITIES t Disti LGAs No of No of Target No of No of MOH staff No of NCDO Comm/Villages Comm/Vlllages, Advocacy vtstt involved rn staff involved rn mobrlized which received to State or mobilization mobilizatron H/Ed about the regional importance of directors of il extended Health treatment. B/GWARI 82 82 I 2 I ll KACHIA 73 73 I 3 I KAURU 120 120 I 1 1 LERE 129 129 I 3 2 Z{KATAF 150 150 I 2 2 n JEMA'A 85 85 I 2 2 KAGARKO 66 66 I 2 I KAruRU 62 62 I I I t KAURA 86 86 I 2 1 SANGA 99 99 I a I CHIKLIN 84 84 I 2 I JJ I I L] JABA 33 I KUBAU 4l 47 I 2 I GIWA 2t 2t I I I IGABI 54 54 I I I l IKARA 24 24 I I I TOTAL I,215 1,215 16 28 r-2

:J l ii Communrty mobilization and Health Education activities have been completed, only poorly performing communities were mobilized. The Hon. Commissioner, Permanent Secretary and all Directors in the Ministry of Health paid advocacy visits to Hon. Chairmen and their Councils in the endemic LGAs, Traditional, Religious leaders and Community members to re-sensitize and mobilize them on their roles and responsibilities in CDTI implementation.

In our self-sustainability bid the officer'in charge of Kamuku National Park in Birnin Gwari LGA was approached. The project solicited with the Parks Management on areas of co-operation, like delivery of Mectizan to health facilities or collecting points, delivery of IEC Materials or any other way the Park could assist the project in reaching endemic communities with difficult terrains. The officer in charge bssured the project of the parks assistance at any time

The following are the various organizations/systems used to disseminate information for the implementation of CDTI.

Kaduna State Ministry of Information Local Government Commission Local Government Information Departments Radio Television Religious leaders Town criers Community leaders ll Health education was provided by the following methods:

Health education talks at Community levels Community leaders Community elders Community members Community Directed Distributors Religious leaders Women group lll. Meeting community members at home during community mobilization and health education makes sensitization on CDTI easier and acceptable by them. Each community has various posters in the community leader's house to further create awareness to those who may refuse to take Mectizan. Copies are also left r,vith the CDDs.

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--:) .:i I 3 TABLE 5 l ACHIEVEMENTS DrsI/LGA No. Of Total No. of No. of LGA Cost per No. Of No. Of No of I target Populatio Eligible Tablets used Cover persons Commu CDTI treated . Communiti nof persons age treated nities/V distribut Commun ES Comm. heated illages ions ities/Vill I in supervis ages wrth which ed by summary ---r CDD is Health forms ,l a workers -, worker

B/GWAzu 220 83,848 16,945 228,658 9t% 5 220 -T KACHIA 109 56,904 47,970 144,1 80 84% 5 109

KAURU 169 79,628 60,826 171,782 76% 5 6v il LERE 215 90,460 76,989 221,843 85% 5 215 ZIKATAF 404 143,514 1r6,697 348,1 66 8t% 5 404 n Lr JEMA'A r33 1 54,1 19 136,51I 347,914 89% 4 3 L) KAruRU 129 63,663 51,31 I 144,987 81% 4 KAGARKO I 13 59,536 41,993 137,827 82% 4 113 KAURA 185 51,687 42,564 127,441 82% 4 SANGA 218 94,332 86,620 265,746 92% 4 218 CHIKLIN 196 8r,269 71,012 204,331 88% 3 JABA 86 51,023 4l,089 120,637 80% J 86 il KUBAU 131 49,740 38,721 107,429 78% J tJ GIWA 2l 15,933 13,8 I 5 33,r01 87% 2 IGABI 62 46,823 37,347 93,229 80Y" 2 62 IKARA 26 16,628 14,148 38,078 85% 2 il TOTAL 2.417 l,l3g,167 960,558 2,741,3498 84tJh 2,417 t] n il THE MAJOR ACHIEVEMENTS OF THE PROJECT SO FAR HAVE BEEN:

High-powered advocacy visits to policy makers in endemic LGAs by Hon. Commissioner, Perrnanent Secretary and all Directors of the Ministry of Health.

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IT Training of 8 SOCT members

Training of 305 LOCTs.

Training of 5,551 CDDs.

1 Tl-re most common reasons for absenteeism as mentioned earlier are migration to it farming areas. Students after completion of their education leave the communities to look forjobs in urban areas.

rl 2. Some community members have temporary settlements in their farms, and move there during the rainy season.

il 3 Treatment should be carried out in the dry season so those community members who move to their farms during the. rainy season will not miss their annual fl treatment.

il Section 4

il 1 The State Government has been actively involved in the implementation of CDTI. The SOCT is actively involved in implementation of CDTI project through n training and supervision. One SOCT member is assigned to take responsibility of it CDTI implementation in an LGA. This ensures improved monitoring and supervision and also reduces the workload on the State coordinator and his assistant. This division of labour has also been extended to the LGAs. LGA il coordinators have assistants.'The Ministry of Information is using its Media, (Radio and Television) to disseminate information arrd to create awareness on the concept of CDTI. il Sight Savers are involved in training, monitoring and supervision of the I programme together with the SOCT/LOCT. Sight Savers provide vehicles to assist the project during community mobilization, monitoring and supervision.

The LGA staff (LOCTs) participates in the training of CDDs and provides il supervision. Some LGAs provide vehicles and motorcycles during mobilization/llealth Education, monitoring /supervision ,Ind accommodation for il SOCT when the need arose. I j

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I Strengths:

APOC Financial and Logistic support I

I Formidable State Onchocerciasis Control Team (SOCT) :l:1 .) Formidable Local Onchocerciasis Control Teams (LOCTs) .-l Community members willing to implement CDTI activities 'I :--i CCDs willing to distribute Mectizan

1.1 Availability of Mectizan LJil

-l Corporation of some LGAs in accommodating SOCT, Logistic support like vehicles and education I motor motorcycles during mobilization[Iealth 'l Strong partnership between NOCP Zonal office and SSI i iT SSI support in-terms of assisting the project . with vehicles during mobilization/Health Education, Monitoring and supervision and other I ) logistics like motorcycles and Bicycles spares.

] Greater involvement of policy makers at the State MOH in CDTI LJ implementation. :l J CONSTRAINTS: il Socio-cultural belief in some LGAs, which make it difficult for women to attend education and mobilization sessions. il .J Arbitrary transfer of trained Mectizan supervisors to non endemic LGAs

J CHALLENGES: Access to women in purdah

_l Community ownership in communities with strong socio-cultural beliefs

Identification of Local NGOs interested in Oncho. Control.

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F] HELP REQUIRED:

I, GOVERNMENTI

- Irrcreased advocacy to LGAs

:r - Early release of counterpart funds by State and Local Govemment t il ll APOC MANAGEMENT:

Advocacy visit to State, Ministry g of Health and LGAs Early release of funds as and when due. g

iii. OTHER PARTIES: g

Increased advocacy to State and LGAs. $ lncrease community support of CDDs. n iJ

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