Oyo Stat Yl Proiect ORIGINAL: English COUNTRYAIOTF:NIGERIA I\ame: NO'rr'7wHU APUC OYO STATE CDTI PROJECT
Approval yearz 1999 Launchine year: 1999
Renortinq Period: From: January 2006 To: December 2006 (Month/YearTth) ( Month/Year) Proiect vear of this report: (circleone) I 2 3 4 5 6(7) S 9 10
Date submitted NGDO partner: TINICEF
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I I AhINUAL PROJECT TECHNICAL REPORT I I SUBMITTED TO I I TECHNICAL CONSULTATIVE COMMITTEE (TCC)
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I I ENDORSEMENT I
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I I DEADLINE I FOR SUBMISSION:
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I To APOC Management by 3l January for March TCC meeting
To APOC Management by 31 Julv for September TCC meeting
AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) tlz
To: -ikcls cev aiH I cs!
Alt€ EFo tb
For lil;ir;;iion ro,!iR. I 0 I JU|N 2007 I Aon t An/rtl3l t , E I H. Batr'.eno- I I I I I I ANI\UAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the rePort:
Country: NIGERIA
National Coordinator Name: .Mrs.lOgbu-Pearce Signature: @*r.*-... Date: . z;f PeI2-? T.-J-
Zonal Oncho Coordinator Name: ...Otunba Adekunle Jaiyeoba
fr49*cl^?xD}
NGDORepresentative Name
Signature:
Date: .
This report was prepared by Name : ...... Mrs. J.A. Aliyu
Designation : State rrrl:":r*. . Signature , ..u.Al@tt
Date ../..7..:..11*.c.l: .. *2*o? I
,l WHO/APOC, 24 November 2004 Table of contents
ACRONYMS V DEFINITIONS...... VI FOLLOW UP ON TCC RECOMMENDATIONS I
EXECUTIVE SUMMARY 2
SECTION I : BACKGROT ND INFORMATION...... 3
I.1. GENERAL INFORMATION J l.l.l Description of the project (briefly) ...... ,3 1.1.2 Partnership .3 I.2. POPULATION. 4 SECTION 2 : IMPLEMENTATION OF CDTI. 5 2.1 TTMELINE oF ACTrvtrrvrES...... 5 2.2 ADVoCACY ,7 2.3 MoBILIZATIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES ...... 7 2.4 coMMUNrry INVoLVEMENT ...... 8 2.5 CAPACITY BUILDING .9 2.6 TREATMENTS...... lt 2.6.1. Treatment flgures...... l I 2.6.2. What are the causes of absenteeism? ...... l3 2.6.3. What are the reasons for refusals? l3 2.6.4. Briefly describe all known and verified serious advserve events (SAEs) that...... l3 2.6.5. Trend of treatment achievement from CDTI project inception to the current year l5 2.7. ORDERING, STORAGE AND DELIVERY OF IVERMECTIN l6 2.8, COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING...... l6 2.9. SUPERVISrON ...... l7 2.9.1. Provide a flow chart ofsupervision hierarchy...... t7 2.9.2. What were the main issues identified during supervision ?...... l7 2.9.3. Was a supervision checklist used?...... t7 2.9.4. What were the outcomes at each level of CDTI implementation supervision ?..,, l7 2.9.5. Was feedback given to the person or groups supervised? t7 2.9.6. How was the feedback used to improve the overall performance of the project... l7 SECTION 3 : SUPPORT TO CDTI 3.1. EQUrPMENT...... 17 3.2. FINANCIAL CONTRIBUTIONS OF THE PARTNERS AND COMMLINITIES...... l8 3.3. OTHER FORMS OF COMMUNITY SUPPORT. .. 18 3.4. EXPENDITURE PER ACTIVITY ...... l8 SECTION 4: SUSTAINABILITY OF CDTI...... 19 4.I. INTERNAL;INDEPENDENT PARTICIPATORY MONITORING;EVALUATIoN .t9 4.1 ' I Was Monitoring/evaluation carried out during the report period? (tick any of the following Which are applicable).... l9 4. 1.2. What were the recommendations ?...... l9 4.1.3. How have they been implemented?...... lg 4.2. SUSTAINABILITY oF PROJECTS: PLAN AND sET TARGETS (MANDATORY AT.. 20 YEAR 3)...... 20 4.2.1. Planning at all relevant Ieve|s...... 20 4.2.2. Funds...... 20 4.2.3. Transport (replacement and maintenance)...... 20 4.2.4. Other resources ...... 20 4.2.5. To what extent has the plan been implemented ...... 20 4.3. INTEGRATION...... 20 4.3.1. Ivermectin deliverymechanisms.. ..20 4.3.2. Training...... ,,.20 4.3.3. Joint supervision and monitoring with other programs ,,.20
4 4.3.4. Release of funds for project activities...... 20 4.3.5. Is CDTI included in the PHC budget? ,20 4.3.6. Describe other health programmes that are using the CDTI structure and how this was Achieved. What have been the achievements? ..20 4.3.7 Describe others issues considered in the integration of CDTI... 20
4.4.OPERATIONAL RESEARCH 20 4.4.1. Summarize in not more than one half of a page the operational research Undertaken in the project area within the reporting period...... 20 4.4.2. How were the results applied in the project? 20 SECTION 5: STRENGTH, WEAKNESSES, CHALLENGE, AND OPPORTUNITIES.... 2t
SECTION 6: UNIQUE FEATURES oF THB PROJECT/OrHER MATTERS ..21
3 Acronyms
AIDS Acquired Immune Deficiency Syndrome APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obj ective AtrO Annual Training Objective CDA Community Development Association CDD Community-Directed Distributor CDI Community Directed Intervention CDTI Community-Directed Treatment with Ivermectin CBO Community-Based Organ ization CSM Community Self-Monitoring DOTS Directly Observed Treatment Short-course DSN Disease Surveillance & Notifi cation FHFS First Line Health Facility HFS Health Faciliry Staff HMM Home Management of Malaria HQ Headquarters HIV Human Immuno Deficiency Virus IEC Information Education and Communication IFESH International Foundation for Education and Self Help ITN Insecticide Treated Net LG LocalGovemment LGA Local Government Area LOCT Local Government Oncho Control Team MDP Mectizan Donation Program MOH Ministry of Health NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NGDO Non-Governmental Development Organization NGO Non-Governmental Organ ization NPI National Programme on Immunization NURTW National Union of Road Transport Workers PHC Primary health care RBM RollBack Malaria REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SOCT State Oncho Control Team SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers TV Television UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organ ization ZOTF Zonal Task Force
+ Definitions
(i) Total ation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking).
(ii) Eligible population: calculated as 84Yo of the total population in meso4ryper- endemic communities in the project area.
(iii) Annual Treatment Objective: (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 meso/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 3d year ofthe 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 covera&e: 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 maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL
(viii) Sustainabilit),: CDTI activities in an area are 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 mobilised by the community and the govemment.
(ix) community self-monitoring (cSM): The process by which the community is empowered to oversee and monitor the performance of GDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community io tat" futt responsibility of ivermectin distribution and make appropriate modifrcations when necessary.
5 FOLLOW UP ON TGG REGOMMENDATIOI{S
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session 20-
Number of TCC ACTIONS TAKEN BY THE FOR Recommendafion RECOMMENDATIONS PROJECT TCC/APOC in the Reporl MGT USE ONLY Train more CDDs per 1368 CDDs were trained in 2005, but in Community 2006 I,900 new CDDs were trained. The State is part of a special country initiative approved by APOC which targets increased number of CDDs, health workers and community supervisors. 5,700 CDDs are expected to be trained/ retrained. This will be carried out in 2007. Train more health 460 health staff were trained in 2005, workers to raise the no. of and 485 health workers were trained or health workers involved retrained in 2006. Under the special in CDTI initiative 560 health workers are expected to be trained in2007. Target those LGAs with The LGAs with low coverage are being consistently low coverage followed up. atea lmplement CSM/SHM in Not much was done in2006 as a follow all the LGAs in a clearly up to what had been carried out in 2005. defined phase in all the With the special initiative coming up it community is expected that the pace on CSM/SHM implementation will be quickened. About 4,600 community supervisors will be trained. These will be utilized to lm lement CSM. Report on the Additional follow up actions taken in sustainability evaluation the course ofthe year are reflected in results in the next report the appropriate section. and how the findings will be addressed Provide key sustainability Under the transition plan, and given the plan strategies especially funding available, more CDDs were for the low performing trained; Mectizan tablets released LCAs relatively on time to the communities; sensitization and mobilization of communities were continued; the process of identification, sensitization and mobilization of CBOs still continued; and there was some improvement in supervision and monitoring. Again with the special initiative coming up most of these activities will be dramati u in2007 (Please add more rows if necessary)
a Executive Summary
Oyo State is one of the States in South Western part of Nigeria and is located in B Health Zone. The 2005 estimated population is 5,097,882. Yorubas are overwhelmingly the major
ethnic group. Such other groups as Hausas, Fulanis, Igbos etc have migrated to the area. The partners involved in project implementation within the project area are LJNICEFAIIGERIA, NOCP (National and the B-Zonal Offices) the State Govemment, the various Local Governments and the endemic communities. Treatments commenced in the State since l99l with UNICEF assistance and number of persons treated has consistently risen over the years. However, due to faulty census figures
over time, it had appeared that treatment coverage had been low. A recent and comprehensive
census update sponsored by UNICEF and commenced late 2004 showed that very large urban areas where passive treatment (and sometimes limited mass treatments) had been on-going
were reflected in the data base. These, at the advice of NOCP HQs, have been excluded and
passive treatment only instituted. Moreover, the project learnt from the REMO map on the health mapper application that 7 LGAs fall under the definite CDTI area, and CDTI was expanded to three of these LGAs i.e Ibarapa East , olorunsogo, and oluyole.
Population movements occur in migration from rural to urban areas in search of better livelihood or temporary relocation by farmers to farm areas during the cultivation and harvesting seasons.
Total number of target communities is now 2150 in l9 LGAs. Of these 2100 communities were treated resulting in a geographical covera ge of 98oh. 739,602 persons were treated out of a total population of 900,236 giving a therapeutic coverage of 82%. 2070 CDDs were trained or retrained out of an ATrO of 3,268. 1900 of the trainees were new CDDs. 584 health workers (475 of them new trainees) were trained out of an ATro of 2030. The constraints/challenges faced include: political instability at State and LGA levels, lack of willingness by some LOCTs to take the initiative in CDTI implementation at their level, CDD attrition in the light of inadequate incentives, poor mobilization of communities to fulfill their roles on CDTI, inadequate logistics, late and inadequate funding from partners, and poor record keeping and reporting in some places. The project did the following to address the challenges faced:
I Continued community mobilization and sensitization to select more CDDs o Trained new CDDs to curb attrition o Conducted management training for LGA Coordinators during review meetings to ensure they take initiative for CDTI implementation at their level. o Made efforts at several occasions to improve record keeping by giving orientations and on-the-spot training to health workers.
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tU I Es I I I L ba \) 0O .I (! t € g o\ o\ c{ \o Co 9! I 'rB o (.) -ql \ 'a (dq cg! ss I ()r cd5 :o Y t 0)o.Y s' I I 5: gs 'ao.= o.yi i LV 9 s'I Pf: s 0.) r,l Eooi -o c.l s o\ 5\ o\ € rd EE\ o The State and LGAs through their Onchocerciasis Control Units are involved in training of field personnel; community mobilization and health education; management of side reactions; planning and management of project implementation; supervision and monitoring; and mectizan procurement and delivery. UNICEF and NOCP assist in supervision, advocacy and training. There had been fears that UNICEF was gradually withdrawing its support for CDTI implementation. In 2006, this appears to have dissipated with the appointment of a consultant who visited the project to assess first-hand the extent of CDTI implementation. She has promised increased UNICEF presence and support in the State. tFgSH is a partner in one LGA where it oversees mectizan distribution. The communities ensure collection of Mectizan; determine mode and period of distribution; ensure conduct of census updates; organize mectizan distribution, record and report treatments. The identified Local NGOs and CBOs such as Boys' Scouts, Girls Guilds, Civil Defense Corps, okada (Motorcycle) Riders' Associations, Lydia Groups and Man o War, and community development associations assist in mobilizing and health educating the community members on the importance of continuous mectizan treatment for at least 15 years. State plans, tf any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project intends to identify and sensitize more local NGOs and CBOs as well as community development associations and health committees to participate actively in CDTI implementation given the decreasing level of funding from all partners.-The general elections are expected to take place between March and April 2007, and new administritors are to be in place at all levels by May 29, 2007. 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(/) 0) 0) C) C) o C) 0.) c) a a c/) V) c/) a c/) Ch (n (n (n CN (n F. c tr a a a o) 6 o Ltr F (, \o \o \o \o \o \o \o \o \o \o \o \o \o \o \o \o \o q) Sg o o o o o o o O o !E O o o o o h o) c.l o o o o o o o o d= c.l c.l c.l ol c.l c.l c.t c.l ct c.il cl c{ o^l c.l c.l c\l o (n- >' >r >l >. >' -4. --. )>r >. x x tr E c) \o \o .9 63 \o \o \o \o \o \o \o \o \o \o \o \o \o \o \o f (l) o O o O o o o O L O o o O o o o 3= N ct C.l N c.l N o O o o IE tt c{ c't c.l N c.l c.t c.l c..t N o.l c.l EE L fl (n d L' l.. L L d (g Cd (6 il d i L. (.) d cd 6d (n Cd Cd d'J d d (g tr L U d (d z o o Eo t \o \o \o \o \o L d \o \o \o \o \o \o \o \o \o \o \o \o P= o O o O o O AE 9E o o o o o o o o € c.l (\ c'l o o O o o ar't :e cl N c.l c..l c{ N c.l c.l c.l o{ N C.I E.i o o (n- ; ot c.l UJ 2 (n (d i ; ; EH .= (d (d (n cn (n d d (! (! (o (\, h (oo tro (! No o C) E -E L o o L o C) d o OE E (-) gl o0 o IL z (g o o a C) F (B d 'a a d o- o. o Fl- (n ,o (co o s oi) c) >r r! ..o o E E o .= 'a o o0l k o C' ".irol (n (€ o. 0 'a (g o d o () o) o L x .o -o -o L 6 v J] 6 o uti -ol .l o o o1 cdl o ..t |r) O 3,i FI c.i c.i + ,a; \o r-- od O. I -i $ r- -: = el \o \o o oO c.l c\l i i zo zo \o \o o o c..l o.l (di (d \o \o oO o c.l c.t d o) o H o o\o \o O o ot ol *) cl o \)U ()o x ak tbo q \ x o Eo (d q) a- \o \o q. o \ a.l C..l \n a a q) si o o) o CN Fs p \o \o o o c.l ol v2 h \td L \o \o a. o o o o \'q) c.l o.l i L d d l F..i U \o \o o oO o { c\.l N (d (6 l- (J q) .a q) q) a a q d C) la r{ I o) q) }4 jz tr a(d o(d o a) d O. Q -r. I Ft 2.2 Advocacy State the number of policy/decision makers mobilized at eoch relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. An advocacylmobilization workshop was carried out in the course of the year in which 140 State and LGA Policy Makers attended. They were all sensitized on the need for continual support for Onchocerciasis control activities in their respective LGAs. In addition, the policy makers wire paid advocacy visits, particularly when new ones came into office. At the State level, One Million Naira was approved in this year's budget estimates for Onchocerciasis Control activities and 827,000 Naira was released, with the various advocacy activities carried. This was an improvement over last year's release of about 400,000 Naira. This became the second time the State Government was making any significant contribution since CDTI was instituted in the project area. At the LGA level, more LG Councils started releasing 10,000 Naira monthly to LGA Onchocerciasis Coordinators TABLE: MOBILIZATION AND ADVOCACY VISITS To THE LGAS sn{ LOCAL GOVERNMENT NO OF POLICY NO OF PHC AREA MAKERS MOBILIZED COORDINATORS 2006 MOBILIZED 2006 I Atiba 5 I 2 Oyo East 5 I J Oyo West 5 I 4 Iseyin 5 I 5 Itesiwaju 5 I 6 Ibarapa Central 5 I 7 parapa North 5 I 8 lqgelu 5 I 9 Ido 5 I l0 Kajola 5 I ll Saki West 5 I t2 Saki East 5 I l3 Atisbo 5 I t4 Orire 5 I l5 Irepo 5 I t6 Iwajowa 5 I t7 East 5 I l8 ol le 5 I t9 Olorunsogo 5 I TOTAL 95 l9 The major constraint in achieving desired results is the rapidity in changes of policy makers at the LGA and State levels. This is due to the high political volatility of the State. to improve advocacy a high-level advocacy that will target the chief executive of the State was planned for 2006 with support from APOC Management in collaboration with NOCP, but could not be carried out due to political crises in the State that saw the Chief Executive being impeached. Subsequently, almost all policy makers at all levels were changed. ,4b However, there is still need to conduct a high-level advocacy but this time after the general elections in the first and second quarter of 2007. Production and airing ofjingles on radio and television should be a continuous exercise. This should be complemeitedLy-other Radio / TV discussions on the disease and control strategy. Additionally, there should be continuous advocacy visits to the prominent traditional rulers and policy makers at the Local Government level. It is this kind of media 'onslaught' that draws so much attention and funding to Npl. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminare informarion The communities were mobilized and health educated through jingles on local radios, public address systems mounted on moving van, stakeholders meetlngr, to*n announcers and face-to-face discussions with community members. Types of IEC materials used Few. hand bills and posters available at the State level, or where produced by the LG Councils were used in mobilizing and health educating community members. Tiie posters ibcused mainly on disease manifestations, and this has always elicited compliance to treatment. Mobilization sensitization and health education of woman ond minorities - method and response Within the project, there is an active participation of female members of the community at mobilization meetings and during health education sessions, except in areas where there are predominantly muslim populations. In such core Muslim areas participation of women is limited and public address systems mounted on vans are used to reach them in their households. Women groups such as market women associations and religious groups were also sensitized and mobilized. Furthermore, to enhance women participation, partiiipatory methods were used during health talks on onchocerciasis control and during meetings organiied for the market women in some selected LGAs, During the meetings they were sensitized on the need to be actively involved in CDTI activities. Respo nse of targ et co m m u n itie s/v il lag e s 2150 communities/villages mobilized iesponded to the mobilization and health education carried out by the SOCT, LOCT, First Line Health Facility Staff and the CDDs. They came forward to collect their mectizan' The awareness of ivermectin benefits is increasing, und .orrunities are sustaining treatments ensuring that potential refusals take ivermectin. Accomplishments (l) Increase in awareness ofthe disease control efforts (]) Uore community involvement in decision making (3) More awareness of ivermectin benefit (4) Villagers make more efforts to encourage potential refusals to take ivermectin (5) Communities come forward to collect their drug. /t1 Suggest woys to improve mobilization and sensitization of the target communities. The project believes that the following ways suggested earlier are time- honoured and will make for improved mobilization of the target communities: (l) Identiffing and building skills of localNGOs, Market Women Associations, Religious leaders, Road Transport Workers and other Community Based Organizations on community mobilization (2) Regular meetings and greater interactions with the community leaders. (3) Production and distribution of adequate number of IEC materiars (4) Greater involvement and capacity building of First line health facility staff to organize stakeholders meetings with communities within their areas ofjurisdiction periodically. ,48 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Number of communities/villages with Number of CDDs and the Number of communitics community members as supervisors communities involved /vitlages with fcmale CDDs Total no. Number with Percenta Male Female Tota! Number of Pcrcentag communitie community ge CDDs CDDs communities e s in the members as with femalc entire supervisors CDDs project area Bs Bo= Bs Be= B7tB6 Bro Blr= B. Bs/ 81 B7 Bro/B.*100 District/LGA * 100 l. Ibarapa C. 122 30 25o/o r80 r00 280 t00 8lo/o 2. Ibarapa N, 98 t5 30% 85 45 130 45 45Yo 3. Atiba 159 30 l8o/o 160 80 240 80 50% 4.Oyo East r63 30 t8% 85 79 t64 79 5lo/o 5. Oyo West 9l 36 39o/o t29 40 169 40 43% 6. Ido 65 25 46% 77 53 r30 53 8lo/o 7. Kajola l5l 30 l9o/o 88 42 130 42 27% 79 2 t3% 97 68 165 68 860/o 8. Iwaiowa 137 30 2lo/o 60 40 100 40 29o/o 9. Lagelu 187 30 t6% t70 60 230 60 3t% 10. Itesiwaju 64 30 46% r93 147 340 64 l00o/o I l. Iseyin 179 l5 8.3o/o 266 80 346 80 44o/o 12. Atisbo 96 l5 t5% t25 50 175 50 52o/" 13. Orire 46 l5 32o/o 84 50 r34 46 l00o/o 14. lrepo 241 60 40 r00 40 t6% 15. Saki East 24 30 l25o/o 85 50 135 24 100% 16. Saki West 80 60 40 r00 40 50o/o 17. Oluvole 63 75 25 100 25 39% 18. Olorunsogo 106 70 30 100 30 330/o 19. Ibarapa -East 2r50 39r 2t% t944 t024 2968 r 006 460/o Total Comment on: - Attendance offemale members of the community at health education meetings Affendance of female members of the community at health education meetings is g-ood but the ratio when compared with that of their male counterparts is low. Nevertheless the few females that attend actively participate during the health education sessions. l9 WHO/APOC, 24 November 2003 - In general, how do you rate the participotion offemale members of the communigt meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Women are sometimes allowed to participate and contribute to the decisions during generai community meeting. This is however does not apply in areas with muslim populations. But on special or key decisions on community matters, elderly men/ward heads ari usually the decision makers. - Incentives provided by communitiesfor the CDDs { few communities give financial (cash) incentives to their CDDs - and this is the preferred option for most CDDs. Others give in-kind support such as cultivation of farms for CDDs and exempiion from community levies. Incentive is an issue in the project, particularly due to payment of community-based workers by other programmes such as NPI. Moreover, due to withdrawal of CDDs in some communities for various reasons, the work load has increased and this has made for louder demands for financial incentives. Though this has somewhat mellowed down with the selection of more CDDs the demands are still present. - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Attrition is of some concern in most communities. CoOJ leave ihl work as a result of lack of/inadequate incentives, admission into schools, employment etc. To address this more CDDs have been selected by the communities and trained. The project intends to train more CDDs under a special country initiative package. Funds have already have been released for this. By 2007 about 5,700 CDDS are expected to be trained or retrained. - Other issues eo 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels, At the State level, there is inadequate number of health workers. This has affected staffing of most programmes. The CDTI programme with a staff of 4 is considered fortunate, though this number is not adequate to cover all the endemic LGAs. Even with integration of some programmes staffing is a problem. Enough health workers used to be available at the lower levels but this was affected by the transfer of environmental health officers to the new Ministry of Environment in 2005. To compound the staffing problem, most of the health workers at the LGAs are found in the large urban cities, rather than in the rural areas. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were talren to ensure adequate CDTI implementation where not enough l*towledgeable manpower was available or if staff are frequently transferred during the course of the campaign\. Efforts are being made to get more health workers - at least those available in the rural areas - involved in the CDTI process. More health workers are being trained and involved in the CDTI process, although the percentage is still low. The plan is to train all health staff so that transfers will not affect adversely CDTI implementation. Under the special country initiative, additional health workers will be trained. However, that would still not cover the entire health staff. 2l WHO/APOC, 24 November 2003 p 90 J 9 !^ i UJ !.) i- 90 { 9 !^ I U) N) (r) X o a I (J { (D (D d C o F) p) o- - (D A) 0) q. A) 0) I e. F o Ia e. o o p0 B a 5: (D D) A) F) cr o (D o) rrl o E o rrl e. tD 0) p) F' A) o o (D A) o 0 m o 7 o o) lh UJ UJ UJ (,) tJ) U) U) (,) trJ o o o o \o o o UJ oUJ oUJ UJ oUJ UJ (a Ur o z @ oET o qrr (, (Jr (,l Ur L'I Ut (, o o (Jr (, z U Ur a I I I I I I I I I I o I I I A I I .aE D D UJ UJ UJ UJ \o UJ UJ UJ UJ UJ UJ UJ UJ UJ UJ UJ O^-r+ !ro o o o o o o o L,I g oll * : \o o\ oo @ oo (,) NJ UJ oo UJ (,l o\ a NJ -l { o\ o \o (, f.J t9 \o O 5 NJ \o 5 N) o z tJ o\ f. 5 o E N) N) l..J tJ F.J tJ l..J t) b.J l..J NJ l..J N) o hJ tJ N.) NJ tJ b.J NJ (rl (,l (, (, 9r (,r (, z Ur (,l (, (i L,I (, o .iF D= I I I I I I I I I I o b ao I I I o $ o l..J UJ N l'.J NJ N) N N) t.) N NJ NJ tJ NJ N) N N) Ur- (, Ur (,l (Jl (,t (Jl Ur (, L,I (, O^'r (Jr AiiB D I I I I I I t I I I I I o z 6 5 o I I t I I I I I I I I o I o= o :t ,tr I I I I I I I I I o o=. I I "o i's ].J 5 I I I I I I I I I I I oz D o I I I I fo; 3 :oir E (!d i9 UJ N) UJ NJ o (,.) UJ UJ tJ o s (Jt -J o\ UJ s U) Or o\ 5 UJ 6 o o o\ o s o o \o 5 o o o .J a z o O o o O o 3 O O o O O 6 o o o o OF ! o O o o o r{ o I I I I I @ UJ I I o\ I b o \ D E! o O 6 tJJ o o o o o O o O o o o o o !^-l o o o O g o ;oll l+ rJ o p oz A' o o.1 F ^\ o@ (D 0q a o tD \o -i o \o o UJ o t! o) o F0 -o \o (, o\ Ur FD o) C' o 5 I I oI o- ta \o U) d \o o o o tJ -o 5 tr o\ \o (D o\ (n (, o\ io s>.) o (D o- 5 (D { tJ UI oc (D o le tv I o o tN Y A 7 O (aN) to Ur o,f I (h o\ t I o (.) A) (D I (D o o t! I V) I o o. o I d o I o o tr (, s N o o\ O qal a 6 o (D (D \o o o (,o\ s { I b,J o o{ Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Trainees Other Health Community Workers members e.g (frontline MOH Type Community health staff or Political of training CDDs supervisors facilities) Other Leaders Others(specifo) Program { { management How to { ./ ./ conduct Health education Management ./ ofSAEs CSM { { .v ^/ SHM { { -v ^/ ^i Data ./ .V collection Data analysis ./ ^/ Report { writing ^/ Others (specify) Any other comments 2,6. Treatments 2.6.1. Treatment figures - If the proiect is not achieving 100% geographical coverage and o minimum of 65% therapeutic coveroge or the coverage rate isfluctuating, stute the reasons and the plans being made to remedy this. For the last two years the project has been making a therapeutic coverage of over 7O%o. However, 100% geographical coverage is yet to be achieved as a few communities in Oyo West were not treated in 2006 due to CDD incentives/attrition. Before the situation was discovered and any meaningful intervention made, it was already late. Also in 2 of the newly added LGAs, Oluyole and Ibarapa East inadequate community mobilization coupled with poor supervision resulted in the inadequate geographical coverage rate secured. The project intends to pay closer attention to the newly added LGAs in the coming year, while strengthening the supervisory system overall. 24 WHO/APOC, 24 November 2003 G ,Yit-o d :9 9< o='5. € E€EEEs z 9(E o t- I o qIl.] , ar') AO vo 5trbE E3 a-l c{ c.t c.l \o o\ \o z.n I I N c{ € * ts.^ -3= E[*EE I I I I I I I '5oo ,o0 \o od ll r o\ g9 o\ al QA \o \o 00 \o -o \o \o -o oo s s o\ s o\ s s o\ s ^\ a\ EO F- c.l c.l C.l € $ c.l (\ c{ c.l C.l c.l c! F o\ € € oo t'- € 00 € € @ @ oo 00 6 s q)4 a o\ I o I I I L F \\) o D t 'a el od oo (o k t< O O a cd o\*\ o\ o { $ N \o H o) \ ()o o 'd 'a0) al< :\ H o .s I a i, o r! Ss I & .:sEoi p tl 1 E\) .s a C) (n x B t+! i}. a LC) ssd\ \o \o (c o\ o\ o\ 6\ C) N $ \o $ () o S 3* co co oo @ $aLu su \'s cn 0.) -\lS o..l Et *\:cr o a o c- o\ @ oo C) I \o \o N ()o L E ss -r: q c.) .tI oi o :r. co 6i \ r- tr o, r \o $ o\ c.l x s s\ \ibL: B- a gT FI o C) uF, o s 'sclP{ ! o\ o\ =L $ oo € \o^ N \o .tI A .!. t\. r- lj o t. s! \o $ r- \ \s \o ()cd E Es L o 'it *l3E C{ E c.) o 6t -o (: ! .\ o E s( \o ul a o I uv co o\ O co ol$ dlc o 'is t'- a..l co N N N gl:t a 3 Bl ()o !i N r- r- ol o.tl r 5 oo ao o\ qr a ueJqltt -l =lC o (rr gl li Ei El€ C) s (*l4- .o -tOI j $sE U!ta) \o o\ \o * E$ O 6\ o\ $ !a s o O t.- oo ot ct= CB o\ \o o\ - \s o E EI ;1HI EIE F F dt ES {oa\Jq ,->l S. sF 3l .s$ N g1 il tl t cdl $ $ N N lil S\$ N N r- r- ol Es x{ EI o ss$ odg L s t! trl ld o .3 rt c) bo El (d \o C\ k () s :c * $ c.l c.) (\ N oo \o q) t Sbn ElB' o Lcd t) :l!- ol o o () o E S\ rl o bo ! 9= N^ (c^ r d i''i €l .eG .Y ro (-) I Ei ,al E3) -o\ bs eJ $d () o s s'= N -l5l o. (.) o t\ N: \o bb F rr t + o c.) il s c.l EI H o o N 6 \o ol .tr o F R P$ rr.l F o\ \ bdo q bo o o J CB c) (! o rI] + c t'r ,v !d (n \*- a a o o F I I I (t \ C) r'l L< r I I F \) !o o D t 'a (n u () cBX H ll co o -ti $ r< 0) o\ o\ (rJ- o N \o r9 !) o.=o G' 'd^ p.! t3 LV (.) \s () i,'i =! r& .iiMA I I rl13 ser P B { =.o>c) 9 a .EH -o q () o\ a.i- L d\ a.l d \o \o oo o! ! o\ o\ o\ o S 3{ $ t u so oo 00 oo trE -a (.) Hrv E E{:s N o = .ES FB I E @ @ \o o]j H N o\ C) t :\. $ co co co .9E a. s s: N \ r- J EU:,1 \o .+ o\ c.t E ot tr 0) ol H \i s- ! H a E T. I -l C) e '\q)u") 6 xl 8 r P{ h =-h o\ co o\ B El.g N ili. $ @ 6 o, dltr \o \o^ ao P' S: N >; glb C) F: r-: a €l E \ '=^,ET \o \o * c.) c- A alc, cd \ 5l^,() E E ES d 6l g[ *l o.r (r ll ol ?l- xl ! r\ oll ?lE E PX (dl cl.H a-: I 0a e)h .il S sF o BI ol lt r !$ a{ dt $ C.t N Ll E $r C\ r- F- \o 6)l -ql9l (.) q) d SFs bd L r f S trl cn lr C) € rl o bo cB 00 L s sc N ot=l 63 c) l< 0.) \ s00 { o co o cC 0) N 6 \o EI o L E$ sbSl!' o C) o) 'ti :l (.) 00 s o- *^ .0^ o E !U €l (n ai t: .al E5 bs er $d (.) (! o (, S lll'= il a ! o N CB F \o l-r bb r r$ $ o cO EI C) o o N co \o ol c) F P Ps fril F s t iyo a G b( rI] o Fl (d () rl] aCd d Fr H e Jz (d o o (Ad o F o t'r 2.6.2 What are the causes of absenteeism? l. Rural urban migration in search of greener pasture 2. Farmers or others who had gone for their trades or occupation during the time of treatment, and were not followed up 2.6.2 What are the reasons for refusals? There were no reported cases of refusals for the treatment period. This might not entirely be the case, but the project intends to strengthen its reporting system to capture all the necessary indicators. 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. ! In 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 27 WHO/APOC, 24 November 2004 .tt *a li (!.b z l('la) \ lo o> loo oc ; te $ a t/) G o o \ x ln ,o oFi) 9< tJ7 (! oa= r-to JOQ o o o U) (! oFo (Di oV) rSEF (D N g) o U) oe 3J2 U EOiE (n (D ;i(D tr F- rn aJ) (n jd 5 s, ,o o o o o @ rl oI o- o- rt s q91:E (! x:lte 6 oq o s. eL tJ N 0aoi-S='si'E o 6 s) H 5 (D r5 o .+ .);t 5.P U -=a) 0e =o6Ob^ =.o !to o o o- e st'B*F (\ 3 a! Lt'==:, 6'o s -h+= G A) $ 3 =.(D E 6'E (\\ -r_^ = -6q d 5H) a *o 4 st G Eqo (\a o qe6 Sa q3 G'o !)t- po ooH 5N) -YX z geg o oos o S P. g'. 3 o qaA.E E NJ O s E 5'> 5<=i= Mectizan@ ied for by - Qtlease tick the appropriate answer) WHOtr UNICEFN NGDOtr specifo): Mectizan@ by - Qtlease tick the appropriate answer) wHo! UNTCEFtr NGDOtr Other specifo) Table l0: Mectizan@ Inventory (please add more rows if necessary) State/District/ Number of Mectizan tablets LGA ested Received Used Lost Wasted Remainin Ibarapa C I 35,000 135,000 130,5 I 5 224 4261 Ibarapa N 153,000 153,000 145,079 0 792t Atiba 150,000 134,000 I 30.836 3164 Oyo East 50,000 s0,000 47.222 l3 2765 Oyo West 70,000 70,000 67.391 337 2272 I 15,000 Ido l I 3,878 I 15,000 tt22 Kajola 82,000 68,045 512 82,000 13,443 100,000 Iwajowa 94.077 2 95,000 92t 52,500 52.49t 9 Lagelu 52,500 175,000 246,665 128 Itesiwaju 246,793 350,000 97,143 820 Iseyin 105,000 7,037 238,000 Atisbo 215,823 238,000 22,t77 r75,000 r50,6r6 2,t37 Orire I 75,000 22,247 150,000 r 50.000 Irepo r 50.000 203.000 Saki-East 200.222 78 203,000 2,700 52,500 45,460 49 Saki-West 52,500 6,991 I 25,500 121.251 2,177 Oluyole I 25,500 2,072 53,000 33,828 9t Ibarapa East 53,000 r 9,081 93,000 Olorunsogo 90,536 93,000 2,464 TOTAL 2,522,500 2,201,079 6,577 2,329,293 120,639 3l WHO/APOC, 24 November 2004 Pleqse describe how Mectizan@ is ordered and how it gets to the communities The mectizan ordering and delivery in Oyo State CDTI project originates from the endemic communities through the CDDs. The populations of the treated communities from the mectizan treatment / census registers are collated by the LCA health staff. The LOCTs compile this information from the various communities in the LGA and forward it to the State Oncho Control Office who uses the population figures to determine the total number of Mectizan tablets required. This is then submitted to the Zonal Office for onward transmission to the NOCP Headquarters. The NOCP Headquarters collate all the requests for mectizan and make application to MDP. On approval, the consignments are shipped to Nigeria, cleared by UNICEF, and stored at UNICEF Central Store on behalf of NOTF. From here the State picks up its consignments and delivers to the communities through the LGAs and the FLHFs. - How are the remaining ivermectin tablets collected and where are they kept? The remaining ivermectin tablets are collected by the Front Line Health Facilities from CDDs and initially stored at their various health posts. These are later taken to the local government headquarters and kept in the storage box by the co-ordinator. They become opening balances for the next treatment cycle. Lisl and brieJly describe the activities under ivermectin delivery that are being catied out by health care personnel in the project areas. The health staff in the project pick up their mectizan supplies and deliver them to the collection centers. Then they mobilize the communities to collect their mectizan requirements. They also monitor and supervise mectizan distribution and send returns to the appropriate quarters. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? None. 3a. Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages No of Communities that No of Communities that in the entire project area carried out self conducted stakeholders monitorins (CSM) meeting (SHM) Irepo 46 5 5 Iwajowa 79 2 5 Orire 96 5 Saki East 241 l0 l5 Saki West 24 l5 Atisbo 179 5 Oyo-East r63 30 30 Oyo West 9l 36 36 Atiba r59 30 30 Lagelu 137 30 30 Iseyin 64 J 30 Kaiola l5l 30 30 Ido 65 30 30 Ibarapa North 97 30 30 Ibarapa C. 122 30 30 Itesiwaju 187 30 30 Oluyole 80 Ibarapa East r06 Olorunsogo 63 Total 2150 328 351 Describe how the results of the community self- monitoring and stakeholders meetings have alfected project implementation or how they would be utilized during the next treatment cycle. The implementation of community self-monitoring and stakeholders' meeting has brought about some increase in community participation and help address the issue of CDD incentive. The success story will be extended to other communities. 73 2.9. Supervision 2.9.t. Provide a flow chart ofsupervision hierarchy NOCP NOCP QUARTERLY MONITORING ZONE STATE, LGAS AND COMMUNITIES ZONAL NOCP IBADAN ZONAL OFFICE-MONITORINGAND SUPERVISION OF STATE LGAS/AND COMMUNITIES STATE ONCHOCERCIASIS CoNTROL TEAM (SOCT) STATE-ROUTINE MONITORING AND SUPERVISION OF LCAS AND SPORT CHECK ON COMM. NEEDS LOCAL GOVERNMENT LGA-ROUTINE ONCHOCERCIASIS MON ITORING AND SUPERVISION CoNTROL TEAM (LOCT) OF COMMUNITIES - CDDS FLHFS _ COMMUNITY - CDDS COMMUNITIES COMMUNITY LEADERS AND COMMUNITY BASED ORGANISATION 2.9.2. Whot were the main issues identified during supervision? The main Issues identified are: o High CDDs attrition which was due to lack of provision of incentive by their various communities. o Inadequate logistics for monitoring and supervision at the LGA level. o Defective census registration by the CDDs due to lack of supervision by the H/S during registration. In some communities the children less than 5 years were not registered. o CDDs were not selected in some communities, which contributed to the drop in therapeutic coverage. o Lack ofproper record keeping. o Mectizan distribution were yet to be commenced in the LGAs visited during supervision e.g. Atisbo and Saki-East LGAs. 2.9.3. Was a supervision checklist used? Supervision checklist was used during the supervision exercise at the State level, but hardly at the lower levels. 3+ 2-9.4. what were the outcomes at each level of CDTI imprementation supervision? a At the community level, communities were requested to select additional CDDs. CDDs were asked to register all those living in the households including day-old babies. a At the LGA level, policy makers were encouraged to provide monthly allowances to LGA Coordinators for CDTI activities. In Atisbo and Saki East, eiforts were made to kick start the distribution process despite difficulties encountered. 2.9.5. Was feedback given to the person or groups supervised? Yes Feedback was given at all levels of implementation. 2.9.6. How was the feedback used to improve the overall performance of the project? Where communities selected additional/new CDDs, treatments were sustained. The quick intervention in Atisbo and Saki East ensured they did not lose out during the treatment cycle. Moreover, with the provision of some allowances to LGA coordinators supervision and community mobilization were enhanced. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source APOC MOH DISTRICT/ NGDO Others LGA Type No Condrtron of No Condrtron No Condrtron No Condrtton No Condrtion Equipment l. Vehicle I F 2. Motor cycle(s) t9 16F3 9 F CNFR 3. Computer(s) I F 4. Printer(s) I CNFR 5. Photocopier (s) I F !. Fax Machine(s) I F 7. Others a) TV I F b) vcR I F c) Public 2 F Address System d) Air 2 F Conditioner e) Generator I F *Condition of the equipment (F=Functional, CNFR :Currently non-functional but repairable, WO:Written off). 3{ How does the project intend to maintain and replace existing equipment and other materials? The maintenance of the equipment would be done out of the State Counterpart Account. The l3 out of the l9 LGAs are releasing imprest every month for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all other equipments. On the issue of replacement we have requested APOC to replace the project vehicle and other capital items supplied earlier. The UNICEF Consultant on Onchocerciasis has given indications of efforts being made to get the organization to procure some motorcycles for the project. This will be followed up. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years Year 5 (Aug. 2003 - July I'ear 6 (Jan. 2005 - Dec Year 7 (Jan. 2006 - Dcc. 2004) 200s) 2006) TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Cash Cash Cash Cash Cash Cash Budgeted Released Budgeted Released Budgeted Released Contributor (US$) (us$) (us$) (us$) (us$) (us$) MOH (Central + Provincial/State) t 8,940 Nit 6.666 2,666 7,937 7,278 MOH (District/LGA) 20.120 r3,733 r 2,800 8.800 I 8.095 r 2,38 I Local NGDO(s) ( if any) NGDO partner(s) r3,r50 6.459 Others a) b) Communities APOC Trust Fund s5,845 30,000 26, I 08 l 3,054 TOTAL 108,055 50,I92 19,466 1t,466 52,140 32,713 ' If there are problems with release of counterpart funds, how were they addressed? The State Government has released :N:827,000 out of :N: I m budgeted for the programme but there was some delay in the release of the fund. 3.3. Other forms of community support Farm cultivation for the CDDs. CDD exemption from community tax. Provision of CDD training venue. Hosting of CSM/SHM MEETING. 3f,, 3.4. Expenditure per activity - Indicate 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. Indicate exchange rate used here:: $tl26 to dollar. Table l4: Indicate how much the project spent for each activity listed below during the reporting period Expenditure Source(s) of Activity ($ us) funding Drug delivery from NOTF HQ area to central collection point 120 o_t_community State Mobilization and health education of communities* LGA Training of CDDs 3,427 LGAs/ APOC 6,165 LGAs/ APOC/ Training of health staff at all levels State Supervising CDDs and distribution + LGA Internal mon of CDTI qctivities Advocacy visits to health and political authorities 2,785 APOC/ State IE_C materials Summary (rspg(1ng) fops for treatment 3,524 Veh ic les/ Motorcyc I es/ !-tgy"clgq m aintenance LGAy APq_C_ __ Office Equipment (e.g computers, printers etc) azo APOC Others* 4,560 APOC/State TOTAL 21,201 Total number of persons treated 739,602 These include top-up allowances, communication and vehicle insurance - Any comments or explanations? Some of the expenditures made by LGAs based on amount contributed could not be ascertained. It is however, known that some of the funds were used for supervision, community mobilization & motorcycle maintenance. We are making efforts to encourage reporting of both contributions and expenditures by LGAs. SEGTION 4: Sustainability of GDTI 4.1. lnterna!; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainabil ity Evaluation 5 year Sustainability Evaluation 3+ ./ Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? o Copies of the LGAs sustainability plans to be made available to the LOCTs. a The project's data manager should assist in the crosscheck, entry, analysis and summary of treatment data. To this end he needs proper and comprehensive training on CDTI especially as it relates to record keeping & collection. t Copies of the final treatment data by LGA are to be shared with the respective LGAs including copies of the State summarized data so that each LGA can relate itself with others in terms of performance. Additionally, copies of the community listing for each LGA should be made available to them. Each LGA will also be expected to make copies for their health facility staff for their areas of oversight. o The SOCT need to be beffer organized and to do more detailed planning in order to address the many thorny issues that need resolution. a Focus in supervision should be on poor performing areas or those with coverage rates that appear too good to be true. Spot checks will be for other areas. Checklists are to be used during such visits to the field. o LOCTs in some LGAs need to be re-organized, and it may be necessary to advocate for the change of Coordinators not performing well. PHC Coordinators will need to be better involved in programme management, and provide effective oversight. The resolutions reached during the PHC Coordinators' Orientation workshop should be implemented as soon as possible. o LGAs are to be encouraged to produce community registers and IEC materials. i NOCP (both HQs &B-Zonal office) should pay closer attention to CDTI implementation in the State, and maximize the opportunity of the special initiative to ensure quality training of health staff & CDDs. o As agreed on at earlier meetings with NOCP and APOC officials, the project should report and have copies of treatments BY COMMUNITY. Copies of such are expected at the LGA and health facility levels. o Census update needs to be done within the State. At each level the registration of all household members including those less than 5 years should be emphasized. o ltesiwaju and Olorunsogo LGAs need to be given additional Mectizan tablets to ensure adequate coverage of target population for 2006. As has already been noted, LGAs are to collect Mectizan supplies based on their target poputations. o The State should investigate cases like Ajagba where treatments were reported in 2005 but obviously did not take place. It should take appropriate steps to ensure that such communities are immediately followed up in subsequent distributions. 4.1.3. How have they been implemented? This section addresses additional actions taken based on the sustainability evaluation findings as well as the recommendations made above from the internal monitoring. lt must also be noted that the monitoring took place in the last quarter of 2006, and so not much has been done to implement the recommendations. They will be addressed better in 2007. o A detailed and comprehensive sustainability plan has been developed and shared with all partners. o The SOCT/LOCT review meetings were used for orientation of participants on record keeping/reporting. Time was also devoted to highlight basic principles of management, 38 with focus on the mix of men, materials and money for achievement of goals and objectives. o A meeting of PHC Coordinators was held in the course of the year to improve their involvement and oversight of the CDTI implementation in their LGAs. Several recommendations reached during that meeting are being tried out, but outcome will be clearer in2007. o SOCTs had been taken through detailed planning based on the weaknesses earlier identified in the project, and to utilize it as a tool to check on progress made on the various issues and actions to be taken. . The State project staff participated in a data management workshop organized by the NOTF with sponsorship from APOC. Experience and training gained from this workshop will be used to strengthen the data management process. o LG Councils are being mobilized to produce IEC (including reporting forms) and registers. Oyo East and Atiba LGAs produced quite a number of posters. o There has been an increase in the number of CDDs and health workers trained and involved in the CDTI process. More will be trained under the special country initiative in 2007. Additionally, more community supervisors will also be trained. This will reduce CDD workload and strengthen the supervisory system. i Itesiwaju and Olorunsogo LGAs have been given additional Mectizan tablets to ensure adequate coverage oftarget population for 2006. o The project with assistance from NOCP and APOC will be embarking on a data collection process in2007 to collect past community treatment data and use the opportunity to further sensitize health workers on the need for improved record keeping and reporting. 4.2. $ustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Yes When was the sustainability plan submitted? January 2006 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Shortly after the sustainability evaluation of the State CDTI project, partners met and came up with tentative Sustainability plan for State and LGA levels. The 3yr-work plans have been revised and shared with partners. At the State level, the work plans have been submitted to the relevant authourities for inclusion into the State health budget. Advocacy visits to the LGAs will be embarked upon to ensure incorporation of their work plans into the LGAs health budgets. 4.2.2. Funds The State Government has started releasing funds for the programme. Last year it released about:N:400,000 and in 2006 the amount released doubled that of 2005. The project expects this to continue. The LGAs have started releasing $+10,000 monthly for the programme. Some LGAs have also released lump sums for specialactivities. One of the priorities to be pursued in2007 will be to sensitize in-coming policy makers to ensure continuous support for CDTI at all levels. 35 4.2.3 Tronsport (replacement and maintenance) On the issue of replacement we have requested APOC to replace the project vehicle and other capital items supplied earlier while efforts will continue to get the maintenance of equipments sourced from counterpart funds. At LGA level, it has already been stated that quite a number of LGAs has started releasing amounts monthly, part of which is expected to be used for maintenance of the motorcycles. Moreover, some of the motorcycles given forNPI, HIV- AIDs, Roll Back Malaria (RBM) activities are also being used for oncho control activities through an integrated monitoring mechanism under PHC structure. UNICEF has indicated that it might be of assistance to the project in getting additional motorcycles and bicycles. 4.2.4 Other resources Identification and mobilization of sources of funding from LocalNGos, cBos and community development associations at the LGAs level will be pursued to enable project secure other needed resources. However, government will remain the primary focus to target for the procurement ofthese needed resources. 4.2.5 To what extent has the plan been implemented The 3-year sustainability work-plan for both the State and LCAs developed shortly after the evaluation has been revised. For 2006, about 60oh of activities planned were carried out. The others could not be carried out, or fully implemented as a result of delayed funding by both APOC and the government. The project shares part of the blame for the delay in getting approved funds from APOC as it lagged behind in prompt financial reporting. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermection delivery has been fully integrated into the Primary Health Care structure. PHC facilities are used for drug storage, delivery and as well as for supervision. The CDDs go to the nearest health facilities to collect mectizan. 4.3.2. Training Some health personnel have been trained on early detection and reporting of Guinea worm and some other public health diseases during training sessions on CDTI. 4.3.3. Joint supervision and monitoring with other programs Presently there is no joint supervision with other programmes, and there are no plans for this at the State level. At the LGA level, occasionally when LOCTs are on other PHC assignments like routine immunization they check on CDTI matters. Efforts are on to get LGA DSN officers to be part of the supervisory and reporting system. The conscientious health workers at the FLHF level integrate a lot of their activities in visits to the communities. 4.3.4. Release offunds for project activities Funds are released through the routine PHC channels at all levels, but they are not utilized on an integrated basis. 4.3.5. Is CDTI included in the PHC budget? Yes 4o 4.3.6. Describe other health programmes that are using the CDTI structure ond how this was achieved. l{hat have been the achievements? An operational research on CDI sponsored by WHO which started last year in the State entered the second year. The study seeks to determine the effectiveness of the CDI process for the delivery of interventions with different degrees of complexity, i.e. Vitamin A, Insecticide Treated Nets, Directly Observed Treatment Shorts-course and Home-Management of Malaria. There are 2 sites and in 4 LGAs pilot integration of HMM, DOTs, Vitamin A Supplementation and ITN distribution is being tested. 4-3.7. Describe others issues considered in the integration of cDTI. 4.4. Operational research 4.4.1. Summorize in not more than one half of a poge the operational reseorch undertaken in the project area within the reporting period. See 4.3.6 above. Overall finding so far was that the varioui interventions were effective in the LGAs they were introduced using CDI, and these interventions did not affect effectiveness of CDTI. 4,4.2. How were the results applied in the project? This is the second year of the study that is expected to end in 2007 . SEGTION 5: Strengths, weaknesses, challengesr and opportunities Strensths l) Increasing number of communities with female CDDs 2) There is a great deal of integration at most levels. 3) Increasing financial commitment of the State. 4) The level of community ownership though still not acceptable is increasing especially with implementation of CSM and SHM 5) Availability of highly committed health workers at State level and in some LGAs. 6) Willingness of a lot of CDDs to continue despite the lack of incentives. 7) Awareness of the control effort by most policy makers at both State and LGA levels. 8) counterpart Fund contribution by most of the LGAs where CDTI is being implemented has improved. The directive of the Ministry of Local Goveinment that each CDTI LGAs should release a monthly counterpart fund of #10,000 and the various advocacy visits to the LGAs have yielded success as l3 LGAs have been paying their counterpart contributions. In addition some LCAs have released lump sums for IEC production and CDD training. 9) Active participation of some community based organizations in community mobilization which has contributed immensely to the successful implementation of CDTI where they are present and mobilized. Weaknesses l) Poor commitment of some health workers 2) ln adequate supervision of CDDs by LOCTs/HFS V,L 3) Inadequate follow up on issues identified during supervision 4) Low CDD/population ratio 5) ln adequate funding from the State Government 6) Inadequate understanding of communities of their roles under CDTI, particularly in the newly added LGAs. 7) In ability of communities to give incentives to CDDs Challenses - List the challenges and indicate how they were oddressed. a. Political instability at State and LCA levels b. Some LOCTS appear unwilling to take the initiative in CDTI implementation at their level. c. CDD attrition in the Iight of inadequate incentives d. Proper mobilization of communities to fulfill their roles on CDTI e. Inadequate logistics particularly vehicle and motorcycles. f. Late and inadequate funding from the State. g. Poor record keeping and reporting in some places During the course of the year, the project did the following to address the challenges faced: o Continued community mobilization and sensitization to select more CDDs o Trained new CDDs to curb attrition t Conducted management training for LGA Coordinators during review meetings to ensure they take initiative for CDTI implementation at their level. o Made efforts at several occasions to improve record keeping by giving orientations and on-the-spot training to health workers. 0 Requested APOC Management to replace the logistics earlier given to the State. SEGTION 6: Unique features of the proiect/other matters Oyo State has a history of political volatility. In 2006, it lived up to its name as politicians wrecked violence in various parts of the State, particularly in the capital city, Ibadan. Several State legislators were removed and the Executive Governor impeached. The tussle to have the upper hand in the State has led to uncertainty and crises. At several times the State secretariat where the seat of govemment is, and where the civil servants have their offices, has been placed under lock and key. Policy makers at various levels have been changed in the same manner alady changes her wears. Management and coordination of CDTI project implementation in the State had been adversely affected. L+2