Taraba CDTI Project
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World Health Organisation African Programme for Onchocerciasis Control Assessment of the self-sustainabitity of the Taraba CDTI project i:' : . ,,i,1, ::'ir May 2002 Oladele Akogun Yemi Fayomi Edith Nnoruka Joseph Okeibunor Chulcwu Okoronlrwo Detlef Prozesky i. Phittip Sanlrwai Index Abbreviations/ acronyms and acknowledgements J Executive summary 4 lntroduction and methodology 6 Findings and recommendations 1. State level 9 2. LGA level t4 3. Disrict/ health centre level 18 4. Village level 2l 5. Overall self-sustainability grading for the project 23 Advocacy activities and planning workshops 24 Appendix 1 State level workshop programme 27 Appendix 2 The SOCT and LGA workshop processes 29 Appendix 3 State level plan for self-sustainability 32 Appendix 4 LGA level workshop prograrnme 37 Appendix 5 LGA level plans for self-sustainability 40 Appendix 6 Detailed findings 56 1. State level 56 2. Health district/ LGA level 60 3. Sub-district/ first line health facility level 63 4. Communiw level 66 . Abbreviations/ acronyms APOC African Programme for Onchocerciasis Control CBIT Community Based Ivermectin Treatment CBM Christoffel Blindenmission . CDD Community Directed Distributor (of Ivermectin) CDTI Community Directed Treatment with Ivermectin CHEW Community Health Extension Worker - CHo Community Health Offrcer LG local government LGA Local Government Authority LOCT Local Government Onchocerciasis Control Team MITOSATH Mission to Save the Helpless MoH Ministry of Health NGDO Non-Governmental Development Organisation NGO Non-Governmental Organisation NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primary Health Care SOC State Onchocerciasis Co-ordinator SOCT State Onchocerciasis Control Team WHO World Health Organisation ZOC Zonal Onchocerciasis Co-ordinator UTG Ultimate Treatment Goal Acknowledgements - We would like to thank the following persons for their help: -r . The staffat APOC Headquarters in Ouagadougou: Dr S6kdteli, Dr Amazigo, Mr Aholou . StaIf of NOCP/ MoH in Lagos and Abuja, for undertaking all the arrangements - . Staffof the MoH in Bauchi and Taraba: Princess Ogbu-Pearce, Dr Apake and the SOCT . The CBM team: Mr Ogoshi and the Jalingo branch staff; the MITOSATH staff: Mrs Olamiju and her administrative assistant . Staffat the WHO offices in Lagos, Abuja and Taraba . Health workers and community members in the Takum, Yorro and Ardo Kola LGAs. 4 Executive summary The Taraba CDTI project has been supported by APOC for the past 4 years, and is in its last year of agreed funding from APOC. An evaluation of the self-sustainability of ttre project was carried out in ApiU May 2002, by a team of seven evaluators (six form Nigeria and one from South Africa). The evaluators were charged with three tasks: . Evaluating the self-sustainability of the project. ' Working with local stakeholders to plan for self-sustainability, based on the findings of the evaluation. ' Advocacy with local political and civil service leaders, regarding their future role in the self-sustainability of the project. The evaluation was carried out over a period of eleven days. Information was collected by document study, interview and observation, at sampled sites at four levels of the health service: State, LGA, district/ health centre, and village/ community. The overall judgement of the team is that the Kaduna CDTI project is not far from being sustainable. Regarding the six elements of sustainability, the situation is broadly as follows: ' Effectiveness: The project is effective at all levels (although some geographical areas are performing less well).. ' Effciency/financing: Many activities are not properly targeted, resulting in ineffrcient use of scarce resources. Lower levels (LGA and district/ health centre) are not yet fully empowered to carry out tasks at their level, and such tasks are often carried out by higher level staff. ' Simplicir): Routines are generally simple and easy to carry out (except the key area of village census). ' Integration:The programme is by now well integrated into the official health system. ' Attitude: Although stakeholders have accepted the project as part of their routine work, some key players have not yet accepted the fact that they will have to cope without outside resources in the near future. ' Resources: In this key area the project still relies too heavily on APOC. There are however cases were altemative sources are being used, but this is not yet the rule. Regarding the position of the different levels of the project, the CDTI activities of the most peripheral level (the village) appear to be sustainable, even now. The three higher levels however will have to sort out the key issues of planning, funding, transport, and delegation of responsibility, if they are to be self-sustaining. Detailed recommendations were drawn up, based on the findings of the evaluation at the four levels. The recommendations were prioritised, and indicators and deadlines were suggested for each. The most important recommendations concern: ' Determining the exact funding that will be available, and mobilising additional sources of funding if necessary. ' Tailoring activities (mainly training and supervision) to fit the budget. ' Empowering the LOCTs and district level staffto take full charge of activities at their levels - all in all, rationalising activities to achieve maximal efficiency. Advocacy activities were carried out at the level of the State (Deputy Govemor, Commissioner for Health and other senior MoH civil servants) and LGAs. Particular attention was paid to the State Onchocerciasis Co-ordinator, Ers a key player in future remedial action. Three feedback/ planning workshops were held - one for the SOCT, and two for teams from each LGA/ LOCT (six such teams attending each workshop). In each case the evaluation team gave feedback on its findings, which were discussed in depth. The evaluators and other facilitators then guided the participants to draw up realistic'Plans for self-sustainability' for their respective areas of operation. The workshop process worked well and considerable enthusiasm was generated. There is considerable agreement between the plans produced in this way, and the recommendations that the evaluators have made in this report. However most of the plans still need to be refined, and possibly adapted, in the light ofthe evaluators' recommendations. Finally, the plans need to be meticulously implemented, if the self-sustainability of the Taraba project is to be assured. National, zonal and State level staffhave ayear in which to work with local stakeholders, to take the necessary action. Introduction and methodology l. Introduction The African Programme for Onchocerciasis Conhol (APOC) approved the Taraba State Project for funding of CDTI implementation in July 1997. The project has however been distributing Mectizan since 1994, using the mobile system and later the Community Based Ivermectin Treatnent (CBIT) shategy. When APOC funding for the project was agreed, the Community Directed Treatment with Ivermectin (CDTI) strategy was finally adopted. Treatments have risen from a few thousands to over 880,000 persons by 2001 with the Ultimate Treatment Goal (UTG) currently put at 980,000. The State contains hyper endemic foci with high prevalence of blindness. The project was initially supported by A&icare, and after its withdrawal by CBM and a local NGDO, MITOSATH. The two supporting organisations have an exciting relationship, in which the intemational NGDO mentors the local one and agrees to transfer certain responsibilities to the indigenous NGDO within a given timeframe - as a way of promoting progftlmme sustainability. This has resulted in the devolution of support for three LGAs by CBM to MITOSATH during 2001, and will later result to the transfer of support for the entire project area to the local NGO. As part of its plan to achieve sustainability of programme operations APOC management commissioned a team of consultants to develop an instrument to assess the self-sustainability of projects. This having been completed, it was decided that all projects in or about to enter their fifth year of APOC funding should be assessed, to find out their levels of self- sustainability. Hence the current assessment of the self-sustainability of the Taraba project. 2. Methodology 2.1 The'John the Baptist'visit Building on the Kaduna experience where the instruments were field tested and revised, a 'John the Baptist' was sent to the Taraba Project a few days to the commencement of the exercise to: . [ntroduce the instrument to the Project team . Negotiate times and dates for all interviews with government offrcials . Plan initial planning and feedback meeting with all relevant staff . Sample sites for the evaluation . Ensure that all necessary documentation are made available to the team . Select local team members 2.2 Sampling Sample sites were chosen according to the guidelines using coverage rates and where needed accessibility as parameters. Three LGAs were selected (one with high coverage, another having medium coverage and the third with low coverage). Two health facilities were selected for each L.G.A (one with high coverage, one with low coverage) and two communities were selected for each health facility chosen (one with high coverage, one with low coverage). This resulted in the selection of the following: S/no. LGA Health facilitv Communitv I Yono (high Lankaviri Lankaviri'E' coverage) Napu'B' Kajong Kaione Shompah'B' 2. Ardokola Tau Answan Sauda (medium