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I YOBE STATE PROJECT
ORIGINAL : English
COT,NTRYAIOTF: NIGERIA Proiect Name: YOBE STATE
Approval year: 1999 Launching year: 1999
Reportins Period (JANUARY- DECEMBER :2006)
Proiectvearofthibreport: (circleone) I 2 3 4 5 6 7 (8) 9 10
Date submitted: JAI\IUARY 2007 NGDO partner: CBM JOS
8,h YEAR ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
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TccJ4 eEt DEADLINE FOR SUBMISSION: Btn C^$ To Co? APOC Management by 31 January for March TCC meeting fiE AB To APOC Management by 31 Julv for September TCC F, ,!i \,qI Aoi 0 8 FFV ?I}fl? P"[u6I tl-
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! AFRICANPROGRAMME FOR ! ONCHOCERCTASTS CONTROL (APOC) ANN[]At, I',RU.tl',( 't' I u(lllNl(lAL l{[]l'oR'l' 'l'o 'l'lr('l tNl('u\l ('( )NSt ll I A I lVl', ( ( )MN'll'l'l'llli ('l'(.(') IiNDORSIiMIINT'
Please confirlll You ltave reatl this report by signing in the a lt[)t'ol)l'ia tc sltacc.
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Country: N ieeria ) .*Llt,lca N ational Cloord intttttr Niunc: l.*.t Aq c. .i. 6.. . .[.G ri. !-
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ii Table of contents
ACROITYMS ...... v
DEFINITIONS YI
FOLLOW UP ON TCC RECOMMENDATIONS..... 1
EXECUTTVE SI]MMARY 3
SECTION l: BACKGROUND INFORIVIATION...... 4
1.1 . GeNeRar- INFoRMATToN ...... 4 1.1 I Description of the project (briefly). 4 1.1 2. Partnership 5 t.2. PopularroN ...... 7 SECTION 2: IMPLEMENTATION OF CDTI ...... 9 2.t. TtunlrNe oF ACTrvrrrES...... 9 2.2. Aovocncv ...... l0 2.3. MostI,tzetloN, SENSITIzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNnIes 10 2.4. CouvcrNrry rNVoLVEMENT...... t2 2.5. CnpncnvBUrLDrNG...... 14 2.6. TReanrrnNTS...... 16 2.6.1. Treatmentfigures...... Enor! Bookmark not deJined 2.6.2 What are the causes of absenteeism? ...... 19 2.6.3 What are the reasons for refusals? ...... 19 2.6.4 BrieJly describe all lmown and verified serious adverse events (SAEs) thot Enor! Bookmark not defined 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year20 2.7. ORoenrNc, sroRAcE AND DELIVERy oF IVERMECTTN 2t 2.8. CoupruNrry sELF-MoNrroRrNG eNp SrnreHoLDERs MeerrNc ...... 22 2.9. SuppRvrsroN ...... 23 2.9.1. Provide aflow chart of supervision hierarchly...... 24 2.9.2. Wat were the main issues identiJied during supervision? ...... 24 2.9.3. Was a supervision checHist used?...... Error! Booknark not deJlned 2.9.4. What were the outcomes at esch level of CDTI implementation supervision? Enor! Boohmarh not delined 2.9.5. Was feedback given to the person or groups supervised? Enor! Boohmarh not deJined 2.9.6. How was thefeedbackused to improve the overall performance of the project? Error! Bookmark not deJined SECTION 3: SUPPORT TO CDTI 3.1. EqunvreNr ,...... ,....25 3.2. FrNnNcrnl coNTRrBUTloNs oF THE pARTNERS AND coMMUNrrrES...... 26 3.3. OrHsn FoRMs oF coMMUNrry suppoRT ...... Ennon! Booxuanx Nor DEFTNED. 3.4. ExpENottuREpERAcTrvrry...... Ennon!Booxlr,LRr(NorDEFrNED. SECTION 4: SUSTAINABILITY OF CDTI ...... 28 4.1. INrnnNel; INDEnENDENT pARTrcrpAToRy MoNrroRrNc; EveluerroN ...... 29 4.1.I Was Monitoring/evaluation carried out during the reporting pertod? (tick any of thefollowingwhich are applicable)...... 29 4.1.2. What were the recommendations? ...... 29
ttl 4.1.3. How have they been implemented? ...... Enor! Bookmark not defined 4.2. SusrerxngrLrry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRY AT...... 29 Yn 3) 29 4.2.1. Planning at all relevant levels...... 29 4.2.2. Funds ...... 29 4.2.3 Transport (replacement and maintenance) ...... 30 4.2.4. Other resources ...... 30 4.2.5. To what extent has the plan been implemented...... 30 4.3. INrecRenoN...... 30 4.3.1. Ivermectin delivery mechsnisms...... 30 4.3.2. Training...... 30 4.3.3. Joint supervision and monitoring with other progroms ...... 30 4.i.4. Release offundsfor project activities...... 31 4.3.5. Is CDTI included in the PHC budget?...... 31 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What hove been the achievements?...... 31 4.3.7. Describe others issues considered in the integration of CDTL...... 31 4.4. OpenerroNAl RESEARCH .....31 4.4.1. Summarize in not more than one half of a page the operationsl research undertaken in the project area within the reporting period...... 31 4.4.2. How were the results applied in the project? ...... 3 I SECTION 5r StRnncTHS, WEAKNESSES, CHALLENGES, AhtD OPPORTI]NITIES .....31
SECTION 6: UMQUE FEATURES OF THE PROJECT/OTHER MATTERS. ERROR! BOOKMARK NOT DEFINED.
IV Acronyms
APOC African Programme for Onchocerciasis Control ATO Annual Treatrnent Objec tive ATrO Annual Training Obj ective CBO Community-Based Organization CBM Christoffel Blinden Mission CDD Community-Directed Distributor CDTI Community-Directed Treatnent with Ivermectin CSM Community Self-Monitoring FLHF First line Health Facility LGA Local Govemment Area LOCT Local Govemment Oncho. Control Team MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PEC Primary Eye Care PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory goup) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization
v 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 84o/o of the total population in meso/hyper- 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 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).
(viD Inteeration: 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 CDTI.
(viii) Sustainability: 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 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 progrcmme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary.
4 FOLLOW UP ON TGG REGOMTIENDATIONS
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session 2t
Number of TCC ACTIONS TA"KEN BY FOR TCC/APOC Recommeudation RECOMMEIVDATIONS THE PR.OJECT MGT USE ONLY in the Repoil The Therapeutic The involvement of coverage and health staffis gradual involvement of health however, all health staff in CDTI staffwill be involve after their training in CDTI Involvement of women This is still maintained. in advocacy and It is difficult to change mobilization. CDDs ratio because CDD/population ratio community select and is still low with poor support their CDDs supervision however, the project has embark on intensive mobilization of community on this. Train all staffon CDTI The project has not achieved this. There is a plan for training all health staff by next year. Integrate drug delivery Drugs delivery will be into PHC to reduce cost fully integrated by and ensure 2007. sustainability. Continue sensitization, Sensitization was done health education and and will continue. mobilization of Communities are now communities to aware of their roles and improve awareness on responsibilities. community roles and responsibilities. Review training This is diffrcult because objectives for CDDs to communities see a attain a ratio of 2:250; burden of supporting esellect and train even one CDD talk less additional CDDs. of increasing their number. Communities were mobilized to select more CDDs to be train
2 IIIrn /a nA^ a, \r^..^-L^- ann / to meet a ratio of at least l:250. Improve integrated At the course of PHC supervision activity, health staff do supervise the CDDs and make necessary intervention. The sometimes help in collecting results from CDDs.. Although Census has Update census in 6 been updated using LGAs with therapeutic CDDs census update. coverages over84%oto There is still incorrect ensure correct population figure in denominator. some LGAs. This will be address next year. Continue integration of Already plan has been CDTI into PHC. made to try the distribution of mectizan together with Immunization campaigns in some LGAs.
(Please add more rows if necessary)
3 IIIIn /l tai aA lr^.-^-L^- ann,
2 I Executive Summdty.
Yobe State was created out of former Borno State in August 1991. The river Yobe is of particular mention as it cuts across six (6) LGAs and it serves as breeding sites of the black flies. The project is in its I lh treatment round but in its 7tr year of CDTI implementation under APOC. A total of 247 communities are undergoing treafinent in 12 LGAs' of the state out of whichT are Meso - endemic & 5 hyper endemic zones. The population of the communities under treatment is 606,376 people. The ultimate treatment goal for the programme is 520,000 persons. In the year under review, a total of 465,ll0people were treated using 1,126,386 tablets of Mectizan glving 77 % therapeutic Coverage, 100% Geographical coverage and89o/, Ultimate Treatment Goal. Most of LGAs have Nomadic Fulani cattle rearers' whose movement is determined by climatic factors. Also, in Bade LGA there are populations of fishermen who move in to settle
towards end of rainy season and move out in the drier parts of the year. Targeted refresher training was conducted at all levels to various categories of staff. 370 CDDs and 184 health workers were ftained and retrained respectively. With this, the project achieved 77%o and 90.5o/o of its ATOs for CDDs and health workers respectively. Ratio of CDD to total population is l:1081.
Major challenges include lack of support by LGAs, which led to decrease in monitoring and supervision at that level. Also community support to CDDs is low, this led to high rate of CDDs attrition. The project is encouraging CBOs in the various communities to support especially where there are indications that the CBOs will be responsible for giving CDDs
some stipends. With respect to LGAs support in terms of counterpart contribution plans are put in place for LGAs to increase their contributions for OncholBlindness prevention activities . The project will identiff few women groups that will assist in the mobilization and health education of women and bring some degree of pressure to bear on the male dominated traditional stnrctures to allow increased participation of women in CDTI, especially women
participation as CDDs.
CDTI is integrated into PHC stnrcture in Yobe State. In the reporting year, A total of 400 persons were operated for cataract freely, and 38 lid surgery carried out. Free Cataract operations were conducted by the following organizations: 400 Patients by the Project in
collaboration with CBM, Diamond bank 100, Machina and Yunusari LGAs carried out 100. Already, the State Government has empowered FLHF staff through capacity building using health system development funds, to improve the performance of FLHF. The State approved and released 3.2 Million Naira for year 2006. Yobe state project vehicle is obsolete. There is need for its replacement.
4 rlflrn /^nn^ a, \r^-.^-L^- ann, SEGTION 1: Background information
1,1. General information
1.1.1 Description of the project (briefty)
- Geographical location, topography, climate
Yobe State lies in the Northeastem region of Nigeria. It was carved out of the old Borno State in 1991. It derives its name from the river Yobe that runs across the entire State. It occupies a landmass of 47,153 sq km. The State shares National boundaries with Bomo to the East, Jigawa to the Northwest, Bauchi and Gombe States to the West. Yunusari, Machina, Yusufari LGAs lie along the international boundaries with Niger Republic to the North. The metropolitan city of Damaturu is the administrative headquarters of the State.
The State is characteized by savannah vegetation with evident desertification that makes most areas sandy (and muddy in the rainy season) as a result of which the terrain is mostly difficult. The topography is varied with hard-to-reach areas in Gulani, Yunusari, Geidam, Yusufari, Karasuwa, Machina and Jakusko LGAs. Fika and flrne LGA are hard to reach dwing the rainy season.
Yobe state is in its 7th year of CDTI implementation in 12 LGAs of the state. Machin4Yusufari, Giedam, Yunusari and Damaturu LGAs are not endemic however, passive treatrnent is given in these LGAs.
Population: activities, cultures, language
Yobe state has a population of 3.2 millioru with rich cultural activiteis among which are farming, fishing and animal rearing. The major languages spoken are: Kanuri, Bolewa, Ngizim, Karai-karai, Ngamo, Bade, Manga,Bwa fulani and others. Most of the endemic communities are multi-ethnic and multi-lingual with population speaking several languages. Postural Cattle herders such as Fulani groups Koyam and Shuwa Arabs live interspersed with settled agricultural communities.
The State has 17 LGAs and 129 health districts and 178 political wards with structures for health care delivery services at all levels. - Number of health staff in project area and nunber of health staff involved in CDTI activities.
5 rrnrn /ln^i au lr^,.^-L^-^nn, Table 1: Number of health staffinvolved in CDTI (Please add more rows if necessary)
Number of heelth strff involved in CDTI ectivities.
Totel Numbcr of Numbcr of herlth Perccntege heelth stelf in the steff involvcd in entirc projcct erca CDTI
DistricULGA Br B2 f,.=f,2l 81 *l(X) BADE 32 2l 6
BURSARI 32 l9 59
FIKA 38 20 53
FI.JNE 45 40 88
GUJBA 3t 2l 67
GULANI 29 l5 66
JAKUSKO 28 l6 57
KARASUWA 25 l3 52
NANGERE l8 9 50
NGURU 42 29 69
POTISKTIM 5t 33 57
TARMUWA t9 9 47
397 245 6l Total 1.1.2. Partnership
The Partners involved in CDTI implementations are MOH, endemic LGAs, NGDO (CBM), NOCP, and local CBOs. These CBOs include 32 Community Developmental Associations in Fune LGA and 31 in Fika LGAs, 6 in Bade, 8 in Jakusko LGA, 7 in Gulani LGA, I in Potiskum LGA, and 14 in Gujba that are assisting in CDTI implementation at community level. Others are Damagum Development Association, Fune development Association both in Fune LGA, Bubaram Gakoko in Potiskum LGA
Relationship with partnerc
There is a very cordial relationship between the NGDO (CBM) and the State Government. A Memorandum of understanding was signed in 1995 between Yobe State and Christoffel Blindness Mission (CBM) to last as long as the Parfirers agree & it was also renewed at the end of the Project's 5ft Year for Post APOC Years. The NGDO (CBM) usually assist in advocacy, provision of IEC materials for training, provision of funds for various activities, and in training of State teams where necessary. The State performs such functions as training and re-training of LGA health workers, Mectizan procurement and supply to LGAs,
6 rrlrn/ a nnn a/ \r^-.^-L^- ann, monitoring and supervision of Mectizan distribution, formulation of operational guidelines in order to ensure good implementation of the programme, and community mobilization and education. The LGAs are responsible for training and re-training of health facility staff and CDDs, Mectizan procurement and supply to communities, community mobilization and education, monitoring and supervision of Mectizan distibution. The endemic communities
collect their yearly Mectizan supply from the health facilities, ensures distribution of Mectizan to eligible persons, selects distributors and determines times and methods of distribution. They also minimally monitor and supervise the distribution exercise. The NOCP through the
Zonal office provides technical and moral support to the progftrrnme, supervises the activities of the state of Oncho Control Programme, and pays advocacy visits to policy makers to solicit for support to programme implementation. The Local CBOs assist in advocacy, support of CDDs duriqg dishibution and cornmunity mobilization. Mobilizatiotr
There is a plan for an intensive mobilization in some LGAs and communities that are yet to prove evidence of ownership of CDTI project.
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All chairmen of the care taker commiffees and the district heads in each LGA were mobilized. Mobilization was done both at LGA and community levels with different target groups. Chairmen of the care taker committees were advocated to grasp CDTI and release their support. It was clearly explained to them that CDTI is the LGAs' project and it their responsibility to keep it going. Although all chairmen have shown commitnent, some of them failed to execute their responsibility of supporting the project in terms of cash. Advocacy should be done at state level where all stake holders will be brought together and be sensitized. I.3. ilobilization, sensitization and health education of at risk communities
A targeted mobilization was done in all the LGAs, having in focus those communities with difficulties in CDTI implementation. Community members were sensitized and Local NGOs were also educated on community self monitoring and supervision. Posters were used to disseminate information. Most communities seem to be aware of the projects however, it is still diffrcult for them to support the CDDs in terms of cash or kind. Intensive mobilization and sensitization in all the CDTI communities will be of paramount importance by use of medi4 and frlm show at community levels.
4t
rrITn / A nn - a, tI^-.^-L^- ann, 2.4. GommuniQl involvement
Table 4: Communities participation in the CDTI (Please add more rows if necessary)
Nu mber of communities/villrgcs with Number of communities Numbcr of CDIh community mcmbers rs supcrvisors /vilhgcs with fcmrlc CDDs Total no. Number with Perccntege Male CDDs Femelc Total Number of Pcrccntege communitics community CDI)s communities in the cntirc mcmbcrs as with fcmalc projcct eree supervisors CDDs Bg Brr= DistricULGA B. B( BJB. *IM E, B. h=Bb+& Bro 8,./B,*l(X) BADE l8 ll 6l 26 0 26 0 0
BURSARI 4t 9 22 55 0 55 0 0
FIKA 3l 5 l6 47 0 47 0 0
FLINE 45 28 62 59 0 59 0 0
GUJBA 2l 5 23 28 0 28 0 0
GULANI 36 l7 47 47 0 47 0 0
JAKUSKO t4 6 43 29 0 29 0 0
KARASUWA 5 5 100 l5 0 l5 0 0
NANGERE 9 4 u ll 0 ll 0 0
NGURU 8 3 38 t4 0 t4 0 0
POTISKUM 9 4 44 l9 0 l9 0 0
TARMUWA l0 3 30 22 0 22 0 0
247 100 40 370 0 370 0 0 Totd 12
Comment on:
- Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc).
- Participation of female members of the community at health education meetings and other meetings related to CDTI has been difficult in some Muslim dominated communities.
Despite the health education mobilization done efforts proved abortive. Efforts will still be made next year.
42
IlrLIr\ / a DNr a, rI^,,^-L^- ann, Incentives provided by communities for the CDDs Incentives provided by the communities to CDDs is not something to talk of since some communities claimed that the CDD is their son, so incentive is not necessary for the CDD.
This has brought about a high CDD attrition rate in the project. Attrition of CDDs.
CDDs attrition has been a problem for the project however; there is a plan for all CDDs to be incorporated in some of the health intervention programmes, e.g. IPDs and NIDs.
Moreover bicycles will be distributed to some CDDs with the aim of tying them to be committed.
43
lrrrrn / a Dnn a, \r^,.^_L^_ ann, 2.5. GapaciQl building
The project has enough manpower to carry out the project activity at all levels o CDTI implementation. A targeted training was organized, to update the knowledge of some staff and also to train those staffthat were transferred newly to the project area. New CDDs were also trained however this does not meet a ratio of 2:250
The project has a plan to train all existing health workers on CDTI activities across the state in addition to the frontline health staff(in charges of health clinics) that were previously trained. This scheduled to hold next year.
14
IITLI^ /A r)f\tavl/l rI^.,^*L^- rnn, FU EJ FI, g 4AZ -l -l z z X o O EU w la ito A O ID aD o o o L* ,( l6 -v -l F -l 7( 2 F U r. XEFI e z - EO (A a lo H ra, z a rn ln rnD..:. l- F o (aF (r) l,r, e X C rn X z F F E-=> F o ;r_t I trJ o t0 )-PE E' o-traU)O s s.dggF 0a iri F: t a o\ (, (i (.,l (,t (^ (Jt (,l !0 5'A 6 - (D o Fl z (DFx9td v aaj (D E o ,i5;J.. EI E (! (D r rt +EE*S E H{ E&sii o o o o o o o o o o o o tI' oQ s] 3 o { o 9l-s O H, FiJs c9 (D Il Trainees Other Health Community Workers members e.g (frontline MOH Type Community health staffor Political of training CDDs supervisors facilities) Other Leaders Others(specifo) Program management How to conduct Health education { { J Management of \1 SAEs { CSM { ,/ SHM I { Data collection { Data analysis { Report writing Others (specifr) PEC 16 It/un /A Dr\rr a, \I^,,^-.L^- .tnn, ru Fd rl z z X o o tl ED IE o o X Li. E F H X a z v t- z F U \f, aN (DH v) F o C TE rn U) rr, E!o (, a C X C rt z 6S oa D) +E h (D aio C F C >d' 'cl z fd o o ts-rf { o tso Ft; I () 9e. tD o i+ Of l.) \o @ \9 h) 5 5 o xA) 5 5 o\ (, 6 I S.R o) D o -t = r; ht 0!E - F o )- 0a HE o (D fliO Prd 5 :i.^ Ft *J "*ggEE o) 3 O) o'(D $ a (D FrA $ f {+ o o Oo 0 NI \o € \o (r) N 5 l]) 5 o Ei. a t 5 o\ 6 o \t ln d< V) il Fo tn Edr o.{ 9EEp- !' ro (a* O. o\ ='9 P a. (D U) o.6 h) \o 6 \o N) 5 lr) 5 lz, 5 5 o\ u 6 U) t Itr -{ q<-3E-82 () (D i ld s5 6v =ts l(! tri, *EE# E E p) t- 3: o 0a o t: (DQ olt o l+) TA tt, rr< lo iDoH lo o o o o o o o o o o a 6 o 8D !l o) o o o o a o o o o o Q o o r(_ oQ tct !i oa \o :ca l5' t-p FPall o\ ADj H tr-t drr (D Ira s) iJ E. o6' (n t+lp t 0) lta ,-Q lo- qo(Do s) Ix o\ 5 (,) (J) N) N o\ U! \o 5 T tst lJ) s (]) -) (r.){ t- EE. o o u) 5 \o o 6 @ o V) !+ o. o\ (, 5 5 NJ o o\ o o\ 6 (Jl 9a i 7f lo t, o\ (,) o hJ NJ N) 6 { € s \o ET lo d o \o \o 1..) N 6 \o u) o\ N (, FE ^ o o\-t it o :r-! A) o (i :rE G S Ft HE'T (\ C' Br 6' tr s o (]) u) t]) (, s { o. (,r5 (,N 1..) (/rs @ o\ UJ o o o o a6 o o o o o o o o lt o o o o o o o o o o oa o o ;e^-l > ru e o o o o o o o o o o o o U t'ts o .)3= = o G\ (! :' in F) r, (D=. \ C) t o g D) + q U) 5 UJ t\) N N) (, (, (r) { (, 6 NJ o q)tr o\ N) t'.) h,) 6 \o o o\ { u) \o Ut UJ U) UJ Ur hJ o\ s \o \o o (, t\) o\ t') i.J @ o s (! ill o\ o -t o\ t.J \t (Jr o\ o\ N) t.) t oo o $EI (\o ,.t V1 .D { -l 6 o\ o\ \o o\ { @ (, { € @ { -l -l o o\ s (, \o { -J 6 t\) o\ t\) o= o Oo + 1 vt0sEt oatrO o (r c'. o a i .o { o N u) o o o o tJ -l o o\ -t 5 o { \o UJ ()o o\ 6 IB.rf E 3r; q +5 :1, v) o\ N o\ t^J o\ o, t,) N) (JJ € u) l..J 5 UJ hJ o\ o 6 oZ u o\ u) \o o\ 5 { (r) 6 (,.) 6C -l N 83 (D 3d 5'q t= o^ FE +) o o o o o a o o o o o o o o -o X az 5N) ai o oz o, E* (D ct o o o o o o o o o o o o o .d o o O f:!.ie9 Z (D N) (n SaHB+H5 o o o e. o-^ ni t'(t 5 t.eafEEi s +1,1 B rl o SH I o i oa Bll ll Fl o r-t €s s cj o '\o -e - 2.6.3 What are the reasons for refusals? The reason for refusals is still not very well known. However some still claim that it is for family planning. I 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 llIrn / l Dar a, L]^-.^-L^- ann 1g / FU l-l N) l..J t\) t.J NJ N N) N o o o o o a \o \o \o frl b\ o o o o o o o \o \o \o 6' lP:. o\ Ur 5 ()) tJ o \o 6 -t v g.v, l.olFh o f o p o5 =ra *B e E, E'5i i tJ l..J N h.) t.) tJ N tJ l.J N q=.?.S 5 5 5 5 5 5 5 5 5 5 -3 *(DHB3'1 { { { -.t -I { -J { { -J ::Y d.o:lt Erpa HE d te, GAH u' p= Cn:ts 0q a::+FIPE o=l- Et(Dtr.ei I N) t..) N N) t'J N N .d.i P 5 5 5 5 5 5 5 \o (r! N It' t'E e :!oPJ { { { { (JI o o o o5= o -l -I :'o P o 6q30 o= p t EreE 5 €.t;B o- 6 lq: Ha ooZ (D ET >f E @ sltsa. l..J l.J N b.) N N) N !P plxB 5 s 5 5 5 5 s @ UI N) F' =51 t -J { { { o\ q N) 6 @ fl [fi'EU s.o o) E;tFcl l' o ts+) @ o(D (D- utlo* !t,oO N)FIH \o \o \o ornx -l (r)o\ 5 o o o o p I rJ 90 bHe. o o o o () \o 9 io \o irsfig€ OdO t5oit=ftr, :e'3 t18t(Db It o I \o \o \o \o o- t.6S. - o o o o p 6 o *rElq ro td l-r l. I 90 (.jto I it 0Ex o o o o { io @ eEo (a ErI= t Oa G:. O t(D+ (D-;a'.t f) lf, N) g- E :iij o BBo 6 s 5 5 UJ (j) ()) N N iDr!- o \o l.'J \o 6 u) \o 6 6 E o\ 5 t\J (Jr N \o a'q .i- -\o "9 -t.J E=.>:i!e o- c,gED'(D u) b -J 5 \) (,) (,l o F.s t.D5 { oo \o -t \o tJ o { 5 { 'o€ o\ o\ N) \o o \o \o b.) E! 5 - -t -J gT q cLEi+ g s"$ E'GtQ 5 5 UJ tJ) (/) (, N N N E' :h (, Ur fr) N) (J) \o ^-l p= { tj ;e > o P I o o P I o -o E' 6'8, ti. o o o o o o o o o c3E= rtB o o o o o a o o o :'a o) o o o o o o o (D= -(! Pr='s IE lo t4=tS t Q-r lo 5 5 (, (, u) (JJ N N) b.J c HS. o\ UJ o\ (rr @ o\ t/) € o9 (n 6 o\ 5I lD) AN { s -o o\ E' @7? o\ 's (rr "5 u) 5 3t} { { N) \o UJ u) 6 \o \o air o o N) s s \c) o 5 \o po 9,s oo'!, EE€ 0qo -l tl F' o:' tr @ 6 6 @ 6 Oo oo (lt @ 6 \o E' F' -l 90 9 9 { lr' N 6 90 1O a { UI 6 io i.J UJ '* 'fl 0ro6€ b i.r 0qtr o o g'. F t- t o ,U o o 0 _o o \o { o- i/ NJ \o \o D 5 o -I o o o o o o t! sr ^<>Re -l (j) i') (Jr 5 { (Jr A P b\ z Or ,lil o t "do(D o (Dct o I { ,-< \- N) 6 N o\ o\ o\ s t) o \o (/r 6 o\ o o s o\ 5$ d o 0a 5 (D 2.7. Ordering, storage and delively of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH N WHON UNICEFI] NGDOd Other (please specifu): Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH Efr wHo tl rjrrrcEF fI NGDO f] Other (ilease specify) : Please describe how Mectizan@ is ordered and how it gets to the communities - Mectizan is ordered by FLHF to LOCT to State Ministry of Health. - The State compiles all LGAs requirement and orders through NGDO Partner. - Ministry of Health receives Mectizan from NGDO partner. - Ministy of Health distributes to all LGAs - LOCTs deliver drugs to FLHF. - CDDs collect drugs from FLHF. 2l II[rn /aDnn a, lI^-.^_L__ ann, Table l0: Mectizan@ Inventory (Please add more rows if necessary) xumuer of Mecfirnu iabteii Nunber Requested Received Used Used/Person Lost Wasted Erpired Remaining State/DistricUlGA in stock treated BADE 70000 70000 68806 , 0 0 0 rt94 BURSARI 145000 145000 140'ts2 t 0 576 0 3672 FIKA 150000 150000 142194 2 0 357 0 7M9 FUNE 193000 193000 189949 2 0 1495 0 1556 GUJBA 88000 88000 87000 , 0 1000 0 0 GULANI 140000 140000 138400 I 0 376 0 1224 JAKUSKO 70000 70000 65558 I 0 830 0 3612 KARASUWA 40000 40000 39200 t 0 310 0 490 NANGERE 64000 64000 58026 ! 0 678 0 5296 NGURU 65000 65000 6372t t 0 473 0 806 POTISKUM 65000 65000 54728 , 0 0 0 10272 TARMUWA 8s000 85000 78052 t 0 232 0 r7t6 TOTAL 1170000 ll7fi|00 1126386 I 0 6327 0 37287 Mectizan are kept with the LOCT in charges of various LGAs after collection from the state office. At the cause of mectizan distribution, health do identifu some patients with cataract. Other activities include health education on general condition of living. Other activities carried out by health care personnel are sport checks on distribution of mectizan. Some include PEC activity e.g. screening of client for cataract surgery. During mectizan delivery, health workers carry out a supervisory roles and make necessary correction to CDDs, they also mobilize and educate the community on need to support CDDs. NOTE: Mectizan is always stock at state level. 22 II[rn /A n^f aa rT--.^-L^- ann, 2.8. GommuniQl self-monitoring and Stakeholders Meeting Training for CSM and SHM was done in all the LGAs. However not all communities carried out CSM. Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communitieVvillages No of Communities that No of Communities that in the entire project area canied out self conducted stakeholders monitorins (CSIO meetins (SHM) BADE l8 t4 t4 BURSARI 41 t2 t2 FIKA 31 9 9 FUNE 45 13 l3 GUJBA 2t 7 7 GULANI 36 t4 l4 JAKUSKO t4 8 8 KARASUWA 5 5 5 NANGERE 9 5 5 NGURU 8 6 6 POTISKUM 9 5 5 TARMUWA l0 4 4 247 97 97 Community self-monitoring and stakeholders meeting has contributed to the project as many policy makers and community members are aware of their responsibilities. IIII^ /A Dnn a' \]--,^-L^- 23 ^nn, 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. DIRECTOR DISEASE CONTROL MOH I PROJECT COORDINATOR CDTI I SOCTMEMBERS I LOCTMEMBERS I PHC UC / FLHF I CBO COMMUNITY \/ \/ CDDs 2.9.2. \ilhat were the main issues identified during superuision? 1. Improper documentation of treatnents data. 2. Inability of the LGA to play their parts as needed. 3. Late distribution by some CDDs sometimes due to unsteady support for CDDs by some Communities. 4. The supervisory checklists are not properly utilized for all supervisory visits. 2.9.3. Was a supervision checklist used? Supervisory checklists were used at all levels of supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? On the job training to the first line health facility staff on the proper way of documentation was carried out. Communities were also reminded through CBOs to assist the CDDs. These intervention measures resulted in ensuring coverage of all endemic communities and maintenance of high therapeutic coverage rate for the project. 2.9.5. Was feedback given to the person or groups supervised? There is feedback of information at State / LGA levels during supervision. 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback of information are used for future planinig. Other informations are used for corection during subsiquent trainig. 2+ IIIrnlaDnn a, lt^-.^_L^- aAA i SEGTION 3: Support to GDTI 3.'1. Equipment Table 12: Status of equipment (Please add more rows if necessary) Source APOC MOH DISTRICT/ NGDO Others LGA Type of No. Condition No. Condition No. Condition No. Condition No. Condition equipment 1. Vehicle I F I NF 0 4 F 0 2. Motor cycle(s) l4 CNFR 0 6 NF 0 0 3. Computer(s) I F 0 0 0 0 4. Printer(s) 1 F 0 0 0 0 5. Photocopier (s) I NF 0 0 0 0 6. Fax Machine(s) I F 0 0 0 0 7. Others a) b) c) *Condition of the oquiprnent (F:Functional, CNFR{urrently non-firnctional but repairable, WO:lWritten off). How does the project intend to maintain and replace existing equipment and other materials? The agreement signed with a consulting firm, which maintains all existing equipment using State counterpart funds is still in place. At the LGA level, some firnds are being released for maintenance of motorcycles. In terms of replacement, efforts are still being made to secure a budgetary provision from the State or LGAS. Moreover, the Project is still expecting NOCP Management to arrange a date for the collection of the equipment donated by APOC management. Meanwhiler, the project vehicle is obsolete. The project is especting its replacement soonest by APOC management. Materials like; IEC materials, flip charts in local dialects & pictorial tally sheets were provided by the NGDO Partrers (CBM). 25 rI[In/a Dnn a, lI^-,^-L^- ann, 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Yerr 6 ('2004') YcrrT ('2005') Yeert QN6') TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL AMOT]N AMOUN AMOUN CASH CASH CASH T T T Released Released (cAsH) Released (cASH) (cASH) (us$) (us$) (us$) Budgeted Budgeted Budgeted Contributor (US$) (us$) (US$) MOH (Central + 20,000 18,fi)0 20,000 20,000 25,000 25,fi)o ProvinciaVState) MOH 20,000 t 8,518 20,000 7,000 7,500 7,500 (District/LGA) Local NGDO(s) ( t,000 1,000 200 1,000 2s0 if any) NGDO partner(s) 5,000 3,000 5,000 3,000 5,000 3,000 Others a)Communities 600 600 7,000 7,000 7,000 APOC Trust Fund 0 0 70,000 0 r50,000 99297 TOTAL 45,000 4t,l l8 r 15,000 37,000 195,500 t42,M7 Released of firnds is not timely and difficult by all parfrrers especially APOC management. The is yet to be addressed. Additional comments APOC management to please release all outstanding funds allocated to the project from its inception to date. Our NGDO (CBM) usually assists the project always with vehicles during mobilization, distribution and supervision. MOH releases counterpart contribution excluding Personnel cost. The Local NGOs are the CBOs like Damagum Development Association, Fune Development Association both in Fune LGA, Bubaram Gakoko in Potiskum & others newly identified that released the amount above in temrs of Mobilizatioq Supervision and paying stipends to the CDDs 26 IIII^ /lDn^ ar lr--,^_L^-nnn, 3.3. Other forms of communi$r support The communities support to CDDs in kind by giving them some measures (mudu) of grains or units of other farm products in appreciation of their work is still encouraged. During farming some communities assist their CDDs by mobilizing some members to work on their farms. Some of the communities simply pray for the CDDs and wish them well. Some assist them with loans for their private business or enterprises. Some communities support the CDDs in running for political positions e.g. councillorship. Some communities make available transport (bicycles or motorcycles) to CDDs to enable him pick Mectizan, attend training in a nearby community or submit reports of treafrnents. Some others provide refreshments during CDD training. Few LGAs stil do employ some CDDs as a means of motivation to others n rl[rn /aDn^ ai l]^-,^-L^-ann, 34. Expenditure per activiQl Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here l$ US : N128. Table 14: 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 cenhal collection point of 15,000 MOH,LGA,CB community ;M 14,000 MOH,LGA/ Mobilization and health education of communities ,CBM 3,000 Training of CDDs .MOH 38,0+l Training of health staff a! all levels MOH, APOC to,ooo Supervising CDDs and distribution _MOH,!9.1 10,000 COMMUNITIE Internal monitoring of CDTI activities S 35,000 _Advocacy visits to health and political authorities (SHM &_CSM) MOII,APOC 8,000 IEC materials MOH 1,000 Summary (reporting) forms for treatrnent MOH/CBM 7,000 Vehicles/ Motorcycles/ bicycles maintenance MOW LGA 1,000 Office Equipment (e.g computers, printers etc) MOH Others 0 TOTAL 142047 Total number of persons treated 465,110 The project is spending close to N2 million to take Mectizan from Lagos to the communities This could be due to over expenses on part of the state and LGA. There is a plan for the integration of drugs delivery into PHC. 28 IIIIn /ADn^ a' \r^-,^-L^-ann, SEGTION 4: SustainabiliQr of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting pcriod? (tick any of the followingwhich are applicable) _Not applicable _Year I Participatory Independent monitoring _Not applicable_ Mid Term Sustainability Evaluation Not applicable_ 5 year Sustainability Evaluation Not applicable_ Internal Monitoring by NOTF Not applicable _ _ Other Evaluation by other partners 4.1.2. What were the recommendations? Not applicable 4.2. Sustainability of proiects: plan and sct targets (mandatory at Yr 3) Was the project evaluated during the reporting period?_No_ Was a sustainability plan written? When was the sustainability plan submitted?_last four What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels The 3 year sustainability plans developed based on basic CDTI activity earlier are still being followed up. The plans were fine tuned and draft submitted to the policy'makers and was used in the execution of the 2006 CDTI activity. 4.2.2. Funds The State & L.G.As have accepted firlly their roles in CDTI and have demonstrated this in the release of counterpart funding. To enhance continuous release and improve the level of funding at the LGA level there is a policy to centrally deduct funds from Ministry of LGA Affairs for CDTI implementation. Meanwhile the State counterpart contribution has been on the increase since inception of the project. The State released the sum of 3.2Million for its counterpart funding. 29 Il[rnla nM a, \r^.,--L^- ann, 4.2.3 Transport(replacementandmaintenance) Funds from the Counterpart contributiomr are still used for maintenance of equipment as has been highlighted in previous sections. However, as stated earlier the project expects APOC to arange for the collection of new capital equipments allocated to the project.. The state received approved phase II budget from APOC but replacement of Vehicle still not done. 4.2.4. Other resources other resources like motorcycles belonging to other programmes in the PHC department, were used during mectizan distribution. 4.2.5. To what extent has the plan been implemented About 85% of the planned activities of the reporting year has been implemented. 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Mectizan is being delivered through the normal Health centers. Also mectizan is delivered through other PHC activity e.g. routine immunization and distribution of Vitamin A supplementation has been a good means of Mectizan delivery to some LGAs and communities. 4.3.2. Training Targeted training was done in all the LGAs however, few commturities were targeted. Health Staff do give some on the job training during their supervisory roles on other PHC activities e.g. Immunization. This is not fully integrated. At the course of CDTI training, some components of PHC are also discuss. 4.3.3. Joint supervision and monitoring with other programs CDTI activities were also supervised by other health offrcers from within the PHC deparfrnent of the ministry during other health activities. 30 llnrn ra DM a, \r^-,^_L^- ann, SEGTION 5: Strengths, weaknesses, challenges, and opportunities STRENGTHS o Yobe State Government has been financially committed to the Programme a The Project has dedicated SOCT members implementing the Programme. a The Project has enjoyed tremendous support of the assisting NGDO and NOCP. Their back seat support system to the State is highly appreciated as it makes the Project to take full ownership of the programme right from the onset. a Acceptance of Programme by Communities is a success indicator. a The project in collaboration with her counterpart parbrer was able to conduct free cataract surgery to people that are cataract blinded (400 eyes were operated). WEAKNESSES . Lack of constant and regular funding from partners o Untimely financial support from APOC management. o Poor supervision by LOCTs at community level due to lack of adequate frrnding. o Unable to meet the dateline for the submission of result and annual report for TCC meeting. CHALLENGES . High ratio of CDD to population o Non participation of female in CDTI activities CHALLENGES ADDRESSED o Continuous health education mobilization. rrITn /l nnn lr^.,^_L^- ann / 3',1 ^, SEGTION 6: Unique features of the proiecUother matters Dedicated and commlftcd staff at statc level. Gontlnuous support from the government and other partners. Abillty to talntaln the Profcet vchlcle for ovcr the 6 ycarr. This needs urgent replacement for smooth runnlng of the profect. THANK YOU FOR TAKilG YOUR TITE TO READ. 3L IIII^ /A nM a' \I^-,^-L^- ann,