AFRTCAN PROGRAMME, FOR ONCHOCERCIASIS CONTROL (APOC)

Year 3 Technical RePort for Community Directed Treatment with lvermectin (cDrI)

Birniwa

Sule Tankor Y w Guri Maduri Bosuna Garki Kaugamt Taura w Miga

Dutse

Birin Kudu I

J u,- For Acu*,,. l'o: \cc l* D'dFA cl. c Lv- I ( c.P B, rl-t fc September 2001- August 2002 B bciwio3 For lnformr:iion l'o, l- tC- AO

)l (.l.' {t 3t, r:Y.o3 f S Nigeria' The State has a total Jigawa state is situated in the Northern part of out of which seventeen number of twenty-seven (27) l-ocal Government areas onchocerciasis, Eight (17) of these Local Government Areas are endemic for KAIausa ' (g) L.GAs namely Birnin Kudq Birniwa Gwanam, ,

implementing CDTI' and Taura are meso endemic and are currently

hypo endemic, and the The remaining Nine (9) Local Government Areas are

in these areas state has been carrying out treatments in all the communities

The invermectin with the assistance from the supporting NGDO (C.B.M')'

immediately distribution programme (IDP) started in Jigawa State in 1996 Ministry of after the memorandum of understanding was signed between

health and Christoffel Blinden Mission (C.B.M.) of Germany

in 1996 to date' Below is the result of IDP exercise since from the inception

YEAR TREATMENT RESULT (8 1996 36,758 L.GAS) t997 37820 (8 L.GAS) (17 1998 124,744 L.GAS) t999 144324 (17 L.GAS) (17 2000 188,153 L.GAS)

2001 24600s (17 L.GAS) 2002 2662e8 (17 L.GAS)

2 programme state is in the 7th round of Ivermectin Distribution (rDp) in Jigawa in the year 2000 after an initial treatment, but CDTI strategy actually started

the project' The project has just approval was granted for APOC assistance to

completed its third year of CDTI implementation'

of community members During the year under review, targeted mobilization concept' In addition to was conducted to create awareness on the CDTI visits to all the endemic mobilization, the State officials carried out advocacy

on the need to support the Local Govemmdnt Areas to sensitize the executives their roles and prograrnme, ffid mobilize their subjects to honour

proce s s' re sponsibilitie s in the implementation

personnel was conducted Targeted training and retraining of CDTI progralnme

Jigawa state has 5 SOCTs at the state, LGA and community Levels. Presently, trained or 32 LOCTs 110 PHC workers, and 252 CDDs who were either partners have been of retrained in the State. The Nocp and the NGDO the state MOH assistance to the state in the training of SOCT, while and LGA Staff successfully carried out training and review for the LOCT,

conducted the training for the CDDs'

3 endemic and the Hypo endemic Treatment was carried out in both the Meso persons were treated with areas of the state. A Total number of 139,843

of a total of 266,298 persons mectizan form the eight Apoc assisted LGAs out treated in 17 LGAs lrr2002'

BACKGROUND INFOR]VIATION :

1991' The State falls Jigawa State was curved out of Kano State in September generatly flat or slightly in Sudan Savanna and Sahel zone. The Terrain is particularly the Southern undulating with few rock and hills in some places by some major part of the state bordering Bauchi State' The state is drained are largely rivers such River Hedejia, River chinyako and their tributaries

The flood plain of River seasonal, while the main rivers have water year round. the presence of Hadejia contains extensive wetland and swampy areas, and

sites for black flies' some man made dams in the states provides breeding

CDTI 1 1 COMMUNITIES IMPLEMENTING CDTI There are 105 Oncho endemic communities in the 8-targeted

a pattern of Local Govemment Areas in the state. The communities have

heads and nucleated settlements under recognized ward heads, village 2,500 paramount rulers. The average community size is approximately

4 have an average of 5-10 persons. The households in these communities

persons each but may have up to 20-30 members'

R EM

endemic Local Govemment The following are the treatrnent round for each area. TREATMENT piOUND S/NO LOCAL GOVRI\MENT AREAS 7 1 7 2 BIRNIWA 7 3 DUTSE 7 4 7 5 7 6 KAUGAMA 7 7 RINGIM 7 8 TAURA

also in the same rounds of The remaining Nine(l9) hypo endemic L .GAs are

treatrnent as above .

persons' resident in The main goal of the project is treat a total of 250,000

disease' This task has been communities that are known to be endemic of the

consolidate on this effort to achieved in the year 2002 and we now hope to Conscious effort will retreat community members yearly in all the 17 LGAs' effective and be made by the state, LGAs and communities to establish owned by the people sustainable Community Directed Treatment prograrnme

support' through participation and effective implementation and

5 2OO1 AUGUST CDTI IMPLEMENTATION YEAR 3 SEPTEMBER' - 2002 couuuxntrs NO.OF -x6.or CDDS IN CASH OR IN KIND COMMUNITIES COMMUNITIES THAT COLI.ECTED COMMUNTTIES COMMUNITIES/vlL COMMUNITIES THAT DECIDES WTTH TRAINED -noor DRUGS DECIOES ON LAGES THAT SE[E TED ON THE CDDS CDDS I **rr* I I DISTRIBUTION METHOD OF I DISTRIBUTI ON I 36 39 39 39 u 1 BIRN 39

KUDU 5 4 5 5 4 BIRNIWA 5 5 l2 8 5 8 6 7 DUTSE I I 22 15 22 21 20 GWARAM 22 22 4 o I I I 5 KAFIN I I

HAUSA 3 7 7 8 KAUGAMA 8 8 I 11 5 11 I 10 7 RINGIM 11 11 I 3 3 3 I TAURA 3 3 3 95 105 57 105 105 105 93

is difficutt because of Getting to know the sort of support that cDDs receive members' Our conflicting claims between the CDDs and the community

concern themselves with the suggestion is that project implementers should not members during support issue, but should only encourage community

mobilization activitie s.

6 C OF F AFF o

IMPLEMENTATION

2.1. Training Objectives/Achievement of 417 The annual training objective was to train at total number using CDTI personnel for the ivermection distribution prograrnme

these 399 programme approach in the 8 APOC supported LGAs. Out of

workers were trained.

TABLi 1A ANNUAL TRAINING OBJECTIVES COVERAGE S/NO CATEGORY OF TARGET ACTUAL o/, PERSONNEL

5 5 t00% 1 SOCT 100% 2 LOCT 32 32 a 110 95% J TIEALTH WORKERS 115 (PHC STAFF) 95% 4 CDDS 265 252 TOTALS 4t7 399 9s%

2.2 Developed Training Material Used'

Training being an integral part of the CDTI process was given due

developed consideration during the period under review. Materials were

in line with the NOTF instmctions. Little modification were made in

7 the posters and the T- shirts to some of the materials produced such as the customs and have some Arabic writings which is in tine with brochure has been believes of the people, currently the English cDD

ffanslatedintoHausalanguageandproduced.Thisistomake

comprehension better.

2.3 Performance of CDDs was goods, but in The perforrrumce of the CDDs during the exercise number of CDDs some communities, it is difficult to have required distribution thereby increasing the work - load of the few during of the activities. Many of them have demonstrated a good understanding were properly CDTI Concept during training and mobiluation Records

kept by most of the cDDs, with mectizan drugs well managed.

2.4 Improving the Quatity of Training workers have The quahty of training has improved since more health Hausa been trained to assist the LOCT in this task. The traditional during training' Language has been the main means of communication from The Health education and training flip chart have been translated

increasing Engtish to Hausa Language. This wilt go a long way in

8 trainers order to understanding. TOT has been condUcted for in strengthen their abilities during training'

devolve training As the projects starts activities for year fotrr, we hope to putting responsibilities to the LGAs without compromising standard,

the confidence more emphasis only on the new CDDs. This will increase level of the LGA PHC workers involved in the pnogralnme'

9 TABLE II INVOLVED IN TRAINING OF DIFFERENT LEVELS OF STAFF

CDTI IMPLEMENTATION.

no. or coos OF OF s,No NO. TRAINED DSTRICT STAFF FACTLITY STAFF UNDERTAKEN TRAII{ED TRAINED TRAINED

4 30 78 I IRNIN KU 3(LOCTHMORKERS & 2 CDDS 16 2 4 7 2 BIRNIWA 3( & CDDS 26 2 4 10 3 DUTSE & CDDS 56 2 4 25 4 GWARAM 3( & CDDS 28 2 4 12 5 KAFIN HAUSA 3( & CDDS 16 & 2 4 I 6 KAUGAMA CDDS 22 2 4 13 7 RINGIM sfl-ocrHrwoRKERS & CDDS 10 & 2 4 5 B TAURA CDDS 110 252 TOTAL 16 32

l0 TABLE III COMMT]NITIES MOBILIZATION AND EDUCATION OF TARGET

OF NGDO NO.OF NO. OF MOH STAFF NO. NO.OF COMMUNITIES NO.OF I sruo L.G.A INVOLVED IN STAFF ADVOCACY VISIT COMMUNITIES THAT RECEIVES INVOLVED MOBILIZED MOBILIZED H/EDUCATION ABOUT TO STATE OR THE IMPORTANCE OF REGIONAL EXTENDED DIRECTORS OF TREATMENT HEALTH. 39 5 1 BIRNIN KUDU 39 1 2 5 5 2 BIRNIWA 5 1 2 I DUTSE I 1 2 22 5 4 GWARAM 22 1 2 I 5 KAFIN HAUSA I 1 2 8 5 b KAUGAMA I 2 11 5 7 RINGIM 1 1 1 2 3 5 I TAURA 3 5 1 TOTAL 105 2 105

they were The team visited selected communities to ensure that

mobilized in readiness for the Third Year CDTI implementation

exerclse.

2.2.0 Advocacv Visit

review to State Advocacy visit was ca:ried out during the period under before and and Local Government Areas p.G.A) Chief Executives

able to carry out during the take - off of the project. The state has been

this exercise jointly with other opinion leaders, and programme

n well as Ministry for Local supervisors in the State Ministry of Health as

Government and Chieftaincy Affairs'

2.2.1 The Use of Media in to the success of Utilizing the media for mobilization is very important to the project most the programme. Radio Jigawa has been of gteat help ,,Lafiya programme that especially during Jarri" programme a Hausa on the usually interviews programme coordinators (oncho inclusive)

disease paffern and the control strategies'

of communities were mobilized using the following channels

communication.

* Traditional/Religious Leaders

* Face-to-Face discussion with community members

* Town criers.

2.2.2 Result of Mobilization Effort

The mobilization effort carried out by the groups outlined above has

greatly increased peoples' awareness on the need to take drugs

are continuously for the next 10-15 years. The community members as it increasingly becoming aware of their roles and responsibilities

t2 the involvement concerns CDTI implementation. They also appreciated

process' of the cOmmunity members in the ptanning and implementation

2.2.4 ResPonse of the CommunitY the The various communities have demonstrated their commitment to

the implementation of CDTI. However, what remains contentious is

level of support to cDDs, which bears different definitions and CDDs who interpretation on the part of the community members and the

the dre the recipients. To one gouP, they have done enough, and to to APOC other, not much has been done. The project wishes to suggest

the to de-emphasise the issue of support and leave the rnatter to

commrurities. Keen interest should be paid to coverage, and

participation.

2.2.5 Sugsestio ns, to, Improve, ryIo,bil4atioq

The quality of information that gets down to women in purdah is of

serious concern in predominantly Muslim pommgnities. The project

intends to address this problem by getting female members to be part of

the teams at both the local govenrment and the State levels to open up

better and easier ways of interacting with this important group of people'

l3 The project shall also ttry to identify female community based people to take their organuations to assist in educating these souP of

drugs yearly.

them on the The project intends to also target the Men too to educate

as need to have the women to be involved in the programrne either given to them distributors or as mobilizers. The quality of information to take will be necessary and will encourage participation and the need

the drugs over the years by all without breaking the cycle.

TABLE IV TREATMENT FOR JIGAWA STATE SEPTEMBER 2OO1 AUGUST 2A02.

COST PER 1lo.oF ito. oF ilO. oF ro. oF TRFAIED PERSOlI }IO.OFTARGET ELGIBT.E PEOPLES Etlo L.G.A COilTMLL vllLAGERS TREATED coiltt ilInES poPuLATlot{ TNEATED D6TffBUNO ll AGE IN wml sr,rP$nasED w}ilCHGDOS SUXTARY BY }EAITH ARE FORIE IK)roGR H'rcRKERS X BIRNIN 63160 1 0 39 1 39 64109 0 5 X 2 KUDU 5 413/ 3853 1 BIRNIWA 0 8 X 3 DUTSE I 8805 8116 1 0 22 X 4 GWARAM n 25058 23il2 1 1 0 I X 5 KAFIN I 14614 14324 HAUSA 0 8 X 6 KAUGAMA I 8805 7919 1 0 11 x 7 RINGIM 11 15350 14142 1 0 3 X 8 TAURA 3 5840 4787 1 105 x 105 1tl6,tl66 139843 1 0

l4 SECTION III :87o/o 3.1 Treatment Cov! 139843 x 100

159,958 1

distribution The treatment coverage for the Jigawa State during the last

is gTYotherapeutic while 100% geographical coverage

3.2 Total Census PoPulation

The total censes population of treated communities was 159'958

persons.

3.3 Total Elisible PoPulation

Total eligible population of treated communities was 146,466

3.4 Total Absentees /Refusals

Total population of absentees and refusals is 6,623.

3.5 Some Reasons for Absentees /Refusals (l) The people of Jigawa State are predominantly farmers and

nomadic herdsmen who sometimes move away from their towns

and villages to other areas during raining seasons' Some of them

l5 takine them away again are involved in dry Season farming,

during distribution activities' localities outside (2) Rural - Urban migration or movement to other implemented, in where treatment with Mec tzan or GDTI is being the previous year, search of greener pasture, especially when in yield bumper there was no adequate rain fall for the crops to

harvest.

season, it (3) whenever, treatment period spitls over to the farming This though has tends to affect treatment coverage to some extent'

for subsequent been given a serious consideration in our planning the lives of years to ensure that we avoid such active period in

farmers

3.6 Plans to reduce Number of Absentees

1. Intensive CommunityMobilisation Leaders 2. Advocacy visit to Emirs/district heads and Religious roles and 3. Advocacy meeting with L.G.A. chief executives on

responsibilities as proj ect partners' by 4. Treating communities at the most appropriate time required

them.

for communities with 5 Organisation of mop up treatment activities

low treatment coverage.

l6 3.7 of the of Health of Jigawa State The fotlowings are the contributions of the government

to the project.

funding was approved as cash 1 2.5 million as counter part this report, contribution to the project. As at the time of writing

the release has not yet been done, but there was strong

pleased with commitment on the part of the government who are for the CDTI implementation in the state to release the money

activities soonest.

2. One electric tYPewriter.

3. Purchase of office equiPment's'

STRENGTHSTWEAKNEESES.ANDSUGGESTIONS

STRENG

to the programme in the area 1 very high govemment commitnent

of release of counter pafi funding to the project'

participation due 2 A reasonably good community commitment and

to good mobilization.

t7 and other logistics to the 3 prompt delivery of Ivermectin supplies

communtties to them 4. Training of cDD at their communities or centers close

has reduced the burden of travelling distances, and this watch training development has enabled community members to

events and gain more knowledge of the CDTI strategies'

5. The prograrnme enjoyed the senrices of dedicated and the

committed SOCT and PHC staff'

WEAKNESSES/ CONSTRAINTS:- too is quite 1. Inadequate support to cDDs by the communities' ffis

controversial and relative to the village in question.

2. Low level of supervision by the LocT /Flealth workers due

mainly to the culent political situation where almost all the

LGAs are complaining about the zero allocation from the federal

account, making it almost impossible for them to sponsor the

LOCT during supervision activities'

3. Payment of incentives to vitlage workers by other programmes

has greatly affected CDTI. Examples National Immunization

programme, which seemed to have federal government

commitment for the eradication of polio at the expenses of other

control Prograrnmes.

l8 is still not 4 participation of women goup in the CDTI programme belief of encouraging. This has to do with the culttre and religious

the peoPle.

SUGGESTIONS: Ministty 1. Advocacy meeting with L.G.A. sxecutives should be held at for Local Government Atrairs. This is necessary because of the

importanc.e that LGAs attach to that office that supervisor them'

2. Community members, influential people and interest groups should be get mobilized to support CDDs. The women group shall be targeted to

them particiPate more.

3. LOCT/Health workers should participate fully in all the stages of

implementation. This we intend to do by continuous devolvement of

responsibilities to them, and encourage them through workshops on the

need to change their attitude.

to stop 4. The project appreciates moves at the highest level of govemrnent

the payment of all workers at the level of communiu. In the near future.

This will help CDTI implementation, as there will be no longer basis for

comparison. If this however faits, then beneficiaries should be the

CDDs.

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