AFRTCAN PROGRAMME, FOR ONCHOCERCIASIS CONTROL (APOC)
Year 3 Technical RePort for Community Directed Treatment with lvermectin (cDrI)
Birniwa
Sule Tankor Kazaure Y w Guri Maduri Babura Bosuna Gumel Hadejia Garki Kaugamt Taura w Miga Jahun
Dutse
Birin Kudu I
J u,- For Acu*,,. l'o: \cc l* Jigawa State D'dFA cl. Nigeria 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 Kaugama' (g) L.GAs namely Birnin Kudq Birniwa Gwanam, Dutse,
implementing CDTI' Ringim 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 BIRNIN KUDU 7 2 BIRNIWA 7 3 DUTSE 7 4 GWARAM 7 5 KAFIN HAUSA 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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