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COUNTRY/|.IOTF : NI GERIA Proiect Name: NOTF/WHO APOC OYO STATE CDTI PROJECT.
Approval yearz 1999 Launching year: 1999 t Renortins Period (Month/Year): AUGUST 2002 TO JULY 2003
Date submitted: DECEMBBR2OO3 NGDO partner: UNICEF
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t FOURTH YEAR ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)
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i ,i Tac.rt co,:* u C SA I Lap I o 4 Cl r' "1 p\r(\ 4 1T\ edi*: )t.o^.ur AFRICAN PROGRAMME FOR Ton ;1t1 F." ONCHOCERCTASTS CONTROL (APOC) ; '{ I I i l@t{f,'r+
WHO/APOC. 26 September 1003 I
ANNUAL 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/LIBERIA
National Coordinator Name: Dr. J. Y. Jiya
Signature: ...
Date ,y
Zonal Oncho Coordinator Name: Mr. A. O. Jaiyeoba.
Signature:
Date: ......
This report has been prepared by Name : Mr. Akintunde Jayeoba
Designation : Project Coordinator a Signature : 1*1rr1g'*--=F-: r---ri-i 1 u Dare ... .*A... . J.*.v.r 20o+
ll WHO/APOC. 26 September 2003 Table of contents
ACRONYMS...... IV
DEFINITIONS ...... v
FOLLOW UP ON TCC RECOMMBNDATIONS I
EXBCUTIVE SUMMARY ...... 2
SECTION I : BACKGROUI\D INFORMATION 1.1. GsNeRalrNFoRMATroN...... 3 l. L l. Desuiption of the project (briefly)...... Error! Bookmark not defined. I . I .2. Partnership...... Error! Bookmark not defined. 1.2. Popularrou RNo HealrH sysrEM...... 5 SECTION 2: IMPLEMENTATION OF CDTI 2.1. PpRroo oF ACTrvrrrES 2.2 ORoERING, sroRAGE AND DELIVERy oF TvERMECTIN ...... 2.3 Aovocacy aNo SeNsrrrzATroN ...... l0 2.4. MostlrzarroN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES...... BooxnIaRx Nor DEFINED. 2.5. CouuuNIrrES TNVoLVEMENTIN DECrsroN-MAKING 12 2.6. CapacrryBUrLDrNG... 14 2.6.1. Training..... 14 2.6.2. Equipment and human resources t7 CoNotrroN oF THE EeutpMENT * PLeasg srATE ...... 17 2.7. TRealrasNrs...... Ennon! BooxmenrNorDEFrNED. 2.7.1. Treatmentfigures...... Error! Bookmark not defined. 2.7.3. Trend of treatment achievementfrom CDTI project inception to the current year2l 2.8. SupsnvrsroN...... 25 SECTION 3: SIIPPORT TO CDTI...... 26 3.1. FrNaNclel coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrrES ..26 3.2. Orusn FoRMS oF coMMUNrry suppoRT ..26 3.3. ExpsNorrunEpERACTIVITy...... 27 SECTION 4: SUSTAINABILITY OF CDTI ...... 27 4.1. INTERNaL; INDEIENDENT pARTrcrpAToRy MoNrroRrNG; Eva1uartoN...... 27 4.2. CovuuNrry sELF-MoNrroRrNG AND STAKEHoLDERS MperrNc ...... 28 4.3. SustRINastLITyoFIRoJECTS: eLANANDSETTARGETS(MANDAroRyAryR:1...... 28 , 4.4. INrpcnerroN...... BnnoR! BooxvraRx Nor DEFTNED. 4.5 OppnarroNAl RESEARCH 30 SECTION 5: STRENGTHS, WEAKNESSBS AI\D CHALLENGES ...... 30
lll WHO/APOC. 26 September 2003 Acronyms
APOC lAfrican Programme for Onchocerciasis Control ATO lAnnual Treatment Objective AtrO lAnnual Training Objective CBO lCommunity-Based Organization qDD lCommunity-Directed Distribuior unity-Directed Trqatment with Ivermectin SM Self-Monitoring LGA llocal Government Area MOH lMinistry of Health NGDO Non-Goyernmental Development Organization NGO Non-Governryental Organization NOTF Natio{ral Onchocerciasis Task Force PHC lPrimary Health Care REMO lRapid Epidemiological Mapping of OnchocerciasiJ SAE lSevere Adverse Event qUM lstakeholders Meeting TCC [echnical Consultative Committee (APO@ LOT firainer of trainers UNICEF lUniteA Nations Children's Fund UTG lUltimate Treatment Goal WHO lWorld Health Organization llnformation Educative anO Communication tr4ateriat IFESH llnternational Foundation fffi Help FHFS lFirst Line Health Facility NOCP National Onchocerciasis Control Programme URTW [National Union of Road Transpoft Workers
IV WHO/APOC. 26 September 2003 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 84Yo 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 3'd 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).
WHO/APOC, 26 September 2003 FOLLOW UP ON TGG REGOMMENDATIONS
Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session 16
Number of TCC ACTIONS TAKEN BY THE FORTCC/APOC Recommendotion RECOMMENDATIONS PROJECT MGT USE in tlte Report ONLY 64 ( I ) The need for project More new CDDs has been have more than 2 CDDs trained although the CDD to where the village population ratio is still far population is more than below the required standard. 250 people CDDs has been requested to take along a member of the community during distribution. The communities have been sensitized to the need to select more new hands to be trained as CDDs. 64 (2) To be more narrative This is taken care of in this in future reports report where the new reporting format had been utilized. 64 Concern about number of The number ofabsentees and absentees and refusals of refusals has reduced treatment substantially compared with that of last treatment cycle. This was due to the aggressive
mobi I ization and sensitization of the communities. More effort will be put to further reduce the rates.
(Please add ntore rows if necessary)
WHO/APOC, 26 September 2003 Executive Summary
Oyo State is one of the states in South Western part of Nigeria and is located in B Health Zone. The 2003 estimated population is 4,957,602. Yorubas are overwhelmingly the major ethnic group but individuals from other ethnic groups such Hausas, Fulanis, Igbos etc have migrated to the area. Population movements occur in migration from rural to urban areas in search of better livelihood or temporary relocation to farm areas during the cultivation and harvesting seasons.
2497 communities are endemic for onchocerciasis but 2455 communities were treated during the reporting period giving a98oh geographical coverage. The total population of all those living in the endemic communities is 1,768,245. Of this number, a total of one million one hundred and fifty thousand and forty seven (1,150,047) people were treated which gives a therapeutic coverage of 65%.
A total of one thousand one hundred and twenty ( 1 I 20) CDDs and one hundred and sixty (160) Health Workers were trained which show an achievement of 140o/o and 100% respectively as far as AtrOs is concerned. All the State Onchocerciasis Control Team members were trained specifically on record keeping, report writing, effective use of monitoring and supervising checklist, organising stakeholders meeting and community self monitoring.
The partners involved in project implementation within the project areaare LTNICEF/Nigeria, NOCP (National & the B - Zonal offices), the State Government, the various Local Governments and the endemic communities
The constraints/challenges are inadequate logistics particularly motorcycles and the late release of APOC funds. The major weakness is the lack of counterpart funding from the State Government despite series of advocacy visits.
However, the project has succeeded in creating a high level of community ownership. Several indicators such as number of communities selecting new CDDs, collecting their Mectizan from pick up centers, complying with treatments and conducting in meetings on CDTI show an appreciable level of community ownership. Many LGAs are giving counterpart contributions and there is active participation of some community-based groups in stakeholders meetings, CSM and in community mobilization
2 WHO/APOC. 26 September 2003 SEGTION 1: Background information
1.1. Genera! information 1.1.1 Description of the project(briefl y)
Geographical location, topography, climate Oyo State is located in the states in South Western part of Nigeria. It is bounded on the East by East by Ogun State, on the North by Kwara State and on the West by the Republic of Benin. The State lies within the forest belt of Nigeria and the vegetation is a combination of swampland, tropical forest and forest Savannah. The rainfall averages about 60 inches per year. Large areas of forest have been cleared for cultivation leaving a pattern of forest Savannah mosaic. The State has two distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June through September/October. Farming generally begins in April, most farm work is completed by October, after which the harvesting is carried out. The dry season begins in November and ends in mid-March.
Pop ulation: activities, culture, language The 2003 estimated population is 4,957,602. Yorubas are overwhelmingly the major ethnic group, but some lgbos, Hausas, Fulanis and Igbiras have migrated to the area where they cohabit peacefully with the indigenes. Although the State is highly urbanized a substantial proportion of the population still live in the rural areas and are farmers. The main crops grown are cocoa, yam. maize, cassava, rice, oranges, plantain, bananas, peppers and vegetables. Craft such as cloth weaving, cloth dying, blacksmithing, drum making, calabash carving are practiced.
Communicotion system (road,.,) The major roads in the state are tarred but access roads to most of the endemic communities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major means of communication among the communities. I.E.C. materials, electronic media and the use of community town crier, announcements in churches and mosque also form part of the communication system used.
Administrat ive str uct ure The state is made up of 33 Local Government Areas with the Chief administrative officer being the Chairman. A legislative arm made up of selected councillors from various ward supports him. At the State levelthe Executive Governor is the head of administration supporled by an elected legislative arm and the judiciary. The capital of the state is located in Ibadan.
Health system & health care delivery There is an official PHC system and it is implemented in the project area. It is a system where health care services are taken to the doorsteps of the rural populace. It is a system where community participation forms the mainstay and thrust of health care delivery with support from the UN agencies, the State and Local Governments. Levels of functionality however vary across the state. Health facilities such as Primary Health Clinics, health posts and Hospitals can be found through out the State.
I.I.2 PARTNERSHIP
The partners involved in project implementation within the project area are LrNICEFAIigeria, NOCP (National & the B - Zonal offices), the State Government, the various Local
3 WHO/APOC. 26 September 2003 Governments and the endemic communities. An internationalNGDO, IFESH is a partner in one LGA where it oversees mectizan distribution. The State and LGAs through their various units are involved in training of field personnel, community mobilization & health education, management of side reactions, planning and management of project implementation, supervision and monitoring, and Mectizan procurement and delivery. UNICEF is involved in supervisory, advocacy and training roles and assists in logistics provision. The Zonal and national offices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities paly such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution and recording and reporting of treatments. Some Local NGOs and CBOs such as Man O War, Civil Defense, Boys Scout, Lydia Group, Youth group have been identified and will soon be mobilized to support CDTI implementation.
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Ordering, storage and delivery of ivermectin Mectizan@ ordered/a lied for by - Qtlease tick the appropriate answer) MO wHo tr UNICEF E NGDO E Other (please specify) Mectizan@ delivered by - Qtlease tick the oppropriate answer) r/uon n wHo E uNrcEF n NGDO E Other (please speci fy): Please describe how Meclizan@ is ordered and how it gets to the communities *uOH * ---> NOCP FMH Lca First line Health Facilities -> Communities Mectizan@ add more rows State/District/ Number of Mectizan@ tablets LGA Requested Received Used Lost Waste Expired l. Ibarapa 70,000 70,000 68993 7 Central 2.lbarapa 140,000 140,00 North 140,000 3. Atiba 420,000 420,000 419,974 6 4. Oyo East 105,000 105,000 105,000 5. Oyo West 140,000 140,000 140,000 105,00 6. Ido 105,000 105,000 7. Kajola 175,000 175,000 174,994 6 70,000 70 000 8. Iwaiowa 70,000 ) 105,000 105,000 9. Lagelu 105,000 210,000 209,993 10. Itesiwaiu 2l 0,000 7 350,000 I l.lseyin 350,000 349,985 5 420,000 419,990 l2.Atisbo 420,000 20 175,000 174,995 I 3. Orire 175,000 5 245,000 244,990 l4.Irepo 245,000 10 l5.Saki East 280,000 280,000 279,985 15 l6.Saki West 175,000 175,000 174,990 l0 3,185,000 3,185,000 3,184,909 9t 9 WHO/APOC, 26 September 2003 State octivities under lvermectin delivery that are being caruied out by health care personnel in the project area. The health staff in the project picked up their Mectizan supplies and delivered them to the collection centers. Then they mobilized the communities to collect their mectizan requirements. They also monitored and supervised mectizan distribution and sent returns to the appropriate authority. 2.3.Advocacy and Sensitization State the number of policy/decision makers mobilized ut each relevant level during the current yeor; tlte reosons for the sensitization and outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. Advocacy visits were paid to the policy makers at the State Ministry of Health, State Planning Commission and Ministry of Local Government and Chieftaincy Affairs. The Honourable Commissioner for Health, The Honourable Commissioner for Local Government and Chietaincy Affairs, The Permanent Secretary Ministry of Health and the Executive Secretary for Planning Commission were mobilized by the NOTF and APOC delegates on counterpart fund for CDTL The SOCU Team also mobilized sixty-four decision makers at the Local Government level. These include the Chairmen, Political Secretaries, Directors of Personnel, Directors of Finance and Admin., PHC Coordinators and Supervisors for Health. They were sensitized on the need to continue to support CDTI implementation through counterpaft fund contribution. The visits to the LGAs yielded fruit because nearly all the sensitized LGAs contributed various amount totaling:N:785,776 for CDTI implementation activities in their respective Local Government Areas. It is expected that the State will soon approve some amount as counterpart funds for CDTI implementation. 2.4 Mobilization and health education of at risk communities Provide information on: Media Used Mobilization The communities were mobilized through jingles on Local Radio stations i.e. Radio Nigeria & Broadcasting Service of Oyo State. Town criers, Public address systems mounted on moving vans, IEC materials like posters, handbills; and village meetings were also used to mobilize the endemic communities. Mobilization Health Education of Women And Youth Minorities ln the State there is an active participation of female members of the community at mobilization and health education meetings. However in core Muslim areas participation of women is limited and this explains why public address systems mounted on vans are used to reach thern in their households. To further enhance women participation a participatory method was used during health talks on onchocerciasis control during meetings organized for the market women in some selected LGAs. During the meetings they were sensitized them on the need to be more actively involved in CDTI activities. l0 WHO/APOC, 26 September 2003 Response of target communities/villages 98% of the 2497 communities/villages mobilized responded 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. There is more awareness of ivermectin benefits, more involvement in decision making and villagers make more efforts to encourage potential refusals to take ivermectin. Accomplishments (l) More community involvement in decision making (2) Increased levels of awareness of ivermectin benefit (3) Villagers make more efforts to encourage potential refusals to take ivermectin (4) Communities came forward to collect their drugs. (5) Less demand that government should provide incentive to CDDs. Weaknesses/Constrai nts The major constraint is the inadequacy of motorcycles for district supervisors and First line health facility staff so that their mobilization visits would be easy and less time consuming. How Mobilization of Target Communities can be Improved (l) Equipping LocalNGOs, Market Women, Religious leaders, Road Transport Workers and other community based organization with necessary mobilization skills will help a great deal in improving mobilization of the communities. (2) There should be regular meeting with the community leaders. (3) First line health Facility staff should organize stakeholders meeting with communities under them periodically. l1 WHO/APOC. 26 September 2003 c.t (.) -o E (.) o. a I aa u N '= \J \o \o O o\ o\ \o o\ 6\ \o \o 0 s ( .o o\ \o o\ o\ o trc (rl ca co $ oo o\ 6\ co lr) o\ tr) oo o\ .i- N od o LE *?q I e.5 6 9o *b.E EX trao =eE z zn i'i o\ It- c,- aa c.1 co ca o\ c..l ca F- c.l F- o F c.) oo co \o (/'l tr) \o ca s oo oo \o \o o\ t-- c.] o\ tr) I-* @ ca $ O co N c.] a.l c..l N c9=> a2 A? 9o€6 v'E tr o\ r.n t-- 9E t-- ca c.l co ca t-- o\ -Otr c.l co t-- N c.l z=9 uA 2u c..l .f,oo t-r o\ a.) 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".; -l $ v i\ a.l x o! \- -o S ()E o- s- x, o q a qJ EJ q?) r) c-.t S.h \o vl9 o\ -o 5\ s o\ g\ t-- N r?E o rr) \C) I On c) 'Us-() o .s e2 x!.) c l6 o\ aa o\ 6 o. N (.t $o) L .3'; -(.) \tr \o ao \o \o E.E oo c! F- \)(H c\ ra So \) 0.) 'stri5 q ta) Ore o. ca o\ 'S- o. N .I g ;EbO_ V'rd \ :g \o >. f x rr .t' ci o c- aO ca $ F- c.l o\ A^SrS lg \o (a w-.-P .= boo = \o o\ NSS^.C)€ Eu e s aa o\ .I ss tr > o dE E\. .E H S EF srS €H s $ :; ra) s s I ia .E.:u ^, =-cB- !s ;i0) -o Fr €ts ng c.l o\ Sa' l-* \o t $ ta) I-* N =q SS\EL.- E-B !e^.- \o u.S 3r o\ o\ o\ s t-- a- q S'S g I o, O co o\ (\ \o *id.ErV \R O E h$-,^= S il e ri't=q #E \o o iaa{ !TS E3 co (a rsE E9 :v!*ar! \: i,* S!s E; r- .\s s k o) \o \ S'{ (F -o r- $ F* s'.t s o tr oo t-- =f I TE€ E H (h c/) 0) :€ s.s €-e trJ $ S UE E E a- C) -v(n !(! U) E L S\s It -\J U) c/) CE \) r r -CFF -C + ar; I 3 2.6. Gapacity building 2.6.1. Training Targeted training on record keeping, report writing, effective use of monitoring and supervising checklist, organising stakeholders meeting and community self monitoring were conducted for 5 State Oncho ControlTeam members and 160 LOCTs. A total of one thousand, one hundred and twenty (1,120) CDDs were trained. 337 were new ones while 783 were refreshers from identified problem areas. The CDDs understood their roles and responsibilities more than before, the conducive environment provided by the various communities for training and field guides provided for the CDDs were of immense value to them. 4+ WHO/APOC, 26 September 2003 C.l o F .o r O N o E r € r r r CJ o o a0) U a< N O o N € a c.l I N N (, () o o r 6 r 6 o N N r r z d N N F O O O o O O O O O O o F 6 N N N N N N N N N N N N N N ! .=a LL N N N al N N al v; U ! Vj z !o N N N N N N N N N N N N N N N q) o\ \ F > q) o o q OE \) q a a s ue l :. : a N \ o (d N N d N ! = o L E z 6) k- @ o. E q 6 F o O o o O o O O O O O O O O F L ! = O € o q a r a r r a € r a r C) J I L -a N ko N N N .o (L: oL C) F z o O O I O o O O O I O O (d = = oo E o (n (.) L z o F o o a , - t! E o o 6 ,iir € a o a E o d - I ! ! ! C) o v o J a q -od J F o N N € r o an o -o a 6 oE o. a0) a a.l o r r d N n o o O €r O r 6 o N o n d bo a o \o d a N \o o € d €o\ Oi a I r I N E s 6 d : o G o O o = \ N \p o c O a o \ o F ! e € ; Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) Trainees Other Health Community Workers members e.g (frontline Type Community health MOH staff Political Others Of training CDDs supervisors facilities) or Other Leaders (speci&) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis { Report writing Others (specifo) - Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rows if necessary) APOC MOH DISTRICT/L NGDO Others Condition of Source GA Equipments Type of Equipment Condition of the equipment * Please state l. Vehicle I Functional 2. Motor cycle t9 4 2lFunctional 2 not functional 3. Computers I Functional 4. Printers I Functional 5. Fax Machines I Functional 6. Others Functional a) Photo copier I Functional b) r.v I Functional c) VCR I Functional d) Public Address System 2 Functional E Air Condition 2 Functional F) Generator I Functional *Condition of the equipment (Functional, Currently non-functional but repairable. Written off). WHO/APOC. 26 September 2003 47 How does the project intend to maintain and replace existing equipment and other materials? I The maintenance section of the ministry has been fully intimated of all these equipments and they have been helping to repair and service some of our equipment. The Local Government also gave imprest every month for the maintenance of;he project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of all equipment. On the issue of replacement the project intends to request APOC to replace the project vehicle and other capital items supplied earlier while efforts continue to get government or UNICEF to replace them on the long run. Meanwhile UNICEF has given four motorcycles to LGAs to replace the ones written off. Some of the motorcycles given for NPI activities may also be used for Oncho control activities. - Describe the adequocy of ovoilable knowledgeoble manpower ot oll levels. There is abundant knowledgeable manpower at every levelof CDTI implementation in the State. Although 19.90% out of the 1,767 Health Workers in l6 LGA were CDTI is being implemented are actively involved in CDTI activities effort will still be put to have more of them involved. Whenever new staff was employed or when trained staff was transferred, training was usually organized for those that replaced them or the newly employed one. l8 WHO/APOC. 26 September 2003 ?E E =i-lisza*e,^o^^ .= EE ESEE€ N z=ou-L--- * f e o. 9rI] (J =4 o z=a o. r 6 N r N c N r r N T EO z6 n I€ r r r r r r € :€g- a N r @ r l- 6 d :[E5IEEE Uo 6 o\ 6\ 6\ 6\ 6\ o\ qL 6\ o\ 6\ 6\ 6\ 6\ O r N N N d N O I N 6 m L a r r N N € @ o @ o € F a r 6 r r N o b_ N € r 6 a N 6 r LE9 N. 6" O^ d1 o) r 6- r- E 9o: o^ d r 6 6 oi 6 N r N N a o Eto e z= ei € € € € N € a a a @ r a r N r @" r- dl o\ r v1 o\ o\ i o O a' 6 N : r N 6 € r o r ;ES o. € N a 6 r € o r O r 6 6 N r a o I 6 N rH r v. d} r" +" r r^ 6- 6 *" N € oi 6' r O O 6 :YL a a O r a oi r € 5 o -€ r 6 o r E.= = XL>=J E --9@ F 6\ o\ o\ 6\ o\ s o\ 6\ o\ o\ o\ I 6 o O o O o o O O O O O a O u 6 9 I 9 O I O o 6 O O o O 6 = uL o Io 't- 6 r € r a r o, r r r o n u r N r a r r r n !>e o= N N N -N F= zE#=EP^ o 8= N a r I r N r r N € r a 6 r N r € o N I r o .i N N N 9 f N :.E, U gf <= N \o r a r N r r N a r \oo 6 d r a O 6 a r 6 O- J 6 N I N N r L O= i o ! iE.= *i N = q.5.= * > .EEPiE"= E a F @l ot O z E a o d i a e FI o o I! s o ti..l -94L,; ! o o a o o a d a o ! D a o ; . o o J o q a L N N € r 6 I Formula for computing therapeutic and geographical coverages Therapeutic coverage rate = Number of people treated x 100 (%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate Number of communities/villages treated x 100 (%) Total number of meso4ryper-endemic communities as identified by REMO in the project area ATO coverage rate Number of people treated x 100 (%) Annual Treatment Objective % UTG achieved Number of people treated x 100 Total number of people to be treated in meso,/hyper-endemic areas within the project area (UTG) ATO = The estimated number of persons living in meso/hyper-endemic areas thar a CDTI projecl intends to trcot witl, ivermeclin in a given yeor. UTG = The maximum number of people lo be lreated in meso/hyper-endemic areas wilhin the projecl area, ullimately lo be reached when lhe proiect has reached full geographical coverage (normally lhe project shoitd i" uperi"a b reach the UTG at the end of lhe !'t year of the project). - If the proiect is not achieving 100% geographical coverage and minimum of 65% therapeuticol coverage rate or coverage rate is lluctuating, state reosons and ploni Ontrg mode to remedy this. The reason for not achieving 100% geographical coverage was that some communities refused to select new CDDs to replace the ones that dropped out hence defaulting in drug collection for the treatment year. To remedy this in the next treatment cycle the Firstline health facility staff nearest to these communities has been empowered tirrough capacity building on SHM/CSM to organize stakeholders meeting with community mimbers. We hope that with periodic stakeholders meeting with the community members there would be quick response and active community participation of allthe communities in the project area. 2.7.2 llthat ure the couses of absenteeism? (l) Rural urban migration in search of greener pasture (2) Occurrence of flood disasters, temporarily causing some families to relocate. (3) Re-settlement to other areas. 2t WHO/APOC, l0 April2003 2.7.3. BrieJly describe all known and veri/ied serious adverse events (SAEO and provide in table 9 the required information when available, 2.7.4. In case the proiect has no case ofserious adverse event (SAE) during this reporting period, please tick in the box. No case to report L/ 22 WHO/APOC. 26 September 2003 o()< -E2L lJ>! N <.= b L o- Lq @-"-oo() I 6oo () 6 !i= r! 5'5 o J Ca q4 sa a,) U \-, o o- q) S q : eO9o \o a3^^o L o.: () U o.c c t I q) Fd c1 oq -n AJ F.= I [i I E HU9!q o c L _ o-c o v@o!A o- ), o'= o= bo O H.EE oL o. C) .a L cO c.l () € !, oo.N :=^Lir- bo i;.83> L E E o) o L L o. E o o a I o _ E! a 0i !+o Ho6 a v1 C) =0) (,) .N'6 () gH; (t) L I I o o>; I cn o lqr o a OOa o =o0 k r'o \) a0) I I I (H I o () a \ v) AJ C) -a (!th (.) () 00 o.r I o)l ! _ol \ dt A) + 4 FI a I o ca -o .o .o o\ \o o\ 6\ cl\ c\l UD o9 tr) |r) o\ ai G ^ -q o co o t- r- tr- ,o l9c\ t-- \o trr r- 6l r 6- tro; oE I 5 .-: a6) .o \o \o \o 6l ,; o o\ o\ o\ o\ OV c] ..1 N -EO 9 n =q n o\ oo aa oo C\! aa tn c'l o\ oo L0) o Ei G 9E .o \o \o \o o o\ o\ o\ o\ o\ o\ o(=o! o\ + 09 O r- o\ ca o o -; o ..li N co ca c.j \o o o- \o )Y o-> E9 (BP Fe o! .F 0) t'- \o N ca (\ tr- o o, 00 $ N -1- 6Jtr o6 N C\ (o t- r- .o \o oo s o.l O o5 o\ r- r) c..l LO 2. N N + o- x.9 z?=O 3 o.r I- cd O o o O o o o O (D^ O O O E.z O o O O itsE O o .-=co " tr) O co qz. a'9E () rrl E o-r F€ La o\ $ o i* \o F- \o ..l € \o oo- O t-- c 9E + q c* OLo- S'E o ca aa ol oo oo LO }..i O ca \o aO- € + €:'E r- F- o- O t-- :c) L ' cn G a ?e N N $ e 90, c.l -o co o\ o\ o\ o\ o\ o\ o\ ld= F',a oo N ra) € 00 N ca o t-.- @ o\ o\ q 00 e F o6\ F- 00 o\ o\ o\ I {: o.) o\ lo.r I F^cl-6 -o .o a*, d) EO o\ o\ o\ o\ o\ o\ o\ o. oo @ q @ @ N (o EoE^'U *'- 9 o\ o\ oo;i o o\-c $ oo 6 + $ \o o\ o\ 36 o\ fc-.1 - o6 EeX O9 \o cn \o .Q t- tr) dE3 I.E I,q s \o \o CO + o\ (a) .2on ,o I 6.: (\ N ca t- + = at al N N o) 2.8.1. Provide aJlow chart of supervision hierarchy. T STATE NOCP NOCP QUARTERLY MONITORING ZONE STATE, LGAS AND COMMUNITIES + ZONAL N.O.CP ZONAL OFFICE _ MONITORING AND IBADAN SUPERVISION OF STATE LGAS/AND/ MUNITIES I STATE ONCHOCERCIASIS STATE - ROUTINE MONITORING CONTROL TEAM (SOCT) AND SUPERVISION OF LGAS AND I I SPORT CHECK ON COMM. NEEDS V LOCAL GOVERNMENT LGA - ROUTINE ONCHOCERCIASIS MONITORING AND SUPERVISION CONTROL TEAM (LOCT) OF COMMLINITIES - CDDS + COMMUNITIES - COMMUNITY COMMUNITY - CDDS LEADERS AND COMMUNITY BASED ORGANISATION 2.8.2. lYhat were the moin issues identffied cluring supervision. o Some communities were not giving incentive to their CDDs. tr Inadequate logistics for monitoring and supervision at the LGA level tr There was no thorough supervision in some communities. 2.8.3. ll/as supervision checklist used ? Supervision checklist was used during the supervision exercise. 2-8.4. What were the outcomes at each tevel of CDTI implementotion supervisecl The supervisory visits have helped the project to correct the attitude of some communities in the area of giving incentive to the CDDs. The four motorcycles given by UNICEF to the project has been allocated to needy LGAs and this has improved their monitoring and supervision activities. More is however still needed. 25 WHO/APOC, l0 April 2003 SEGTION 3: Support to GDTI 3.1. Financia! contributions of the partners and communities Table I l: Financial contributions by all partners for the last three years. (excluding staff salary for the MOH and Local Government component). Aug. 2000 - July 2001 Aug. 2001 - July 2002 {tug.2002 - July 2003 Year 2 ('provide the Year3 ('provide the Year 4('provide the period') pertod') period') TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Budgeted Released Budgeted Released Budgeted Released Contributor (us$) (us$) (us$) (us$) (us$) (us$) Ministry of Health (MOH) 37,313 \il 25,000 \rl 23.000 I LocalNGDO(s) ( if any) NGDO partner(s) 18.450 879 t8.450 Nil 18,450 Nil District/LGA I 0,000 t0,079 14,300 5,864 24,340 5,864 Others a) b) c) Communities APOC Trust Fund 87,470 81,65 3 78,300 72,325 55,845 30.000 TOTAL 153,233 92,611 136,050 78,189 l2l,635 35,678 If there are problems with release of counterpart funcls, how were they addressed? At the State level there are problems with release of counterpart funds and memos have been written to government. Several advocacy visits were paid by TCC representatives, UNICEF and NOTF members. At the LGA level, due to the several advocacy visits a total of :N:785,776 Naira were released by all the l6 LGA implementing CDTI. - Comments 3.2. 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. 26 WHO/APOC. 26 Seprember 2003 3.3. Expenditure per activity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table l2: Indicate how much the project spent for each activity listed below during the reporting period Expenditure Source(s) of US fund Drug delivery from NOTF HQ area to central collection point of commun 200 APOC Mobilization and health education of communities 420 APOC of CDDs 4,800 APOC Trainin of health staff at all levels 6,835.2 APOC/LGA CDDs and distribution 600 APOC Internalmon of CDTI activities 3,840 APOC/LGA Ad visits to health and itical authorities 720 APOC IEC materials NIL N.A S re n forms for treatment Nil N.A Vehicles/ Motorcycles/ bicycles maintenance 4929.6 APOC Office Equipment (e.g computers, printers etc) 424 APOC Others 12,909.2 APOC/LGA TOTAL $3s 78 Total number of treated 1,150,047 total A of $35,678 was released for the fourth year with the exchange rate of 125 Naira to a dollar. SEGTION 4: Sustainabitity of GDTI 4.1. lnternall independent participatory monitoringl Evaluation 4.1.1 ll/as Monitoring/evaluation carried out durtng the reporting period? (tick where applicable) None was conducted Year I participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF ------Other Evaluation by other par-tners 27 WHO/APOC. 26 September 2003 4.1.2 l(hat were the recommendations? Not applicable 4.1.3 How have they been implemented? Not applicable 4-2- Gommunity self-monitoring and stakeholders Meeting Table l3: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) DistricV LGA Total # of communities/villages No of Communities that No of Communities that in the entire project area carried out self conducted stakeholders monitoring (CSM) meeting (SHM) 5 Irepo 47 5 Iwajowa 86 5 Saki East 562 5 Orire 72 5 Atisbo 215 5 Total 987 5 25 Describe how the results of the community self- monitoring ancl stakeholders meetings have offected project implementation or how they would be utilized during the next treatment cycle. The results of the community self-monitoring and stakeholders meetings have brought about increase in community participation. The success story will be extended to 5 additional LGAs and communities while those that have started would further be encouraged to forge ahead. 4.3. sustainability of projects: plan and set targets (mandatory at Yr 3) 4.3.1. Planning at all levels Although the State project is yet to be evaluated the State is in the process of preparing a 3 - year sustainability plan which will be incorporated into the State health budget. The project also intends to facilitate a workshop for the LGAs where they will be taught on the preparation of sustainability plans. Advocacy visits will follow to the LGAs to ensure the incorporation of such plans into LGA health budget. in the meantime the project intends to maintain geographic coverage at l00o/o, increase therapeutic coverage from the present 650% to 80% within the next three years. A need assessment will be conducted for health workers in the 5th year so that training nieds will be identified and appropriately planned for. 28 WHO/APOC, 26 September 2003 4.3.2. Funds This is a crucial issue. At the State level there has been little or no counterpart contributions since the inception of the project. With the visit of the advocacy team from APOC Management it is hoped that the State will start giving counterpart funds. In the meantime advocacy visits will continue to ensure that LGAs will keep on releasing at least minimal amounts for CDTI implementation. The project has also been guaranteed some level of funding from UNICEF till at least 2007. Funding for 2004 is up to, but not exceeding $15,000, and amounts will go down over the next 4 years. By then government contribution is expected to have reached a level that will sustain CDTI operations. 4.3.3. Transport (replacement and maintenance) As stated in the earlier sections of the report the project expects APOC to replace transport before it finally withdraws funding. This applies also to other capital items such as computers, printer, generating set and TV monitor. Given the state of the economy and the allocations from the federal government there is no expectation whatsoever that government will procure a 4 wheel drive in the next 3 - 4 years. at the LGA level the National Primary Health Care Development Agency which is supported by several international NGDOs occasionally procures motorcycles for NIDs which are distributed to the LGAs. These are and can be used for CDTI activities. With respect to maintenance it has already been highlighted that LGAs release minimal amounts for the periodic maintenance of the motorcycles. We hope this continues. In the meantime a system of strict control of transport has been put in place. Every trip and every expenditure on (fuel, tyres and repair) a log books and monthly conciliation of trip authorization and log book entries has been institutionalized. 4.3.4. Other resources Addressed in 4.3.3 4.3.5. Please provide a written plan with set targets and achievements for so far. See 4.3.1. Meanwhile a 5th year plan is attached. 4.3.6. To what extent has the plan been implemented 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectindeliverymechanisms Ivermectin 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. 4.4.2. Training Some health personnel has been trained on early detection and report of Guineaworm and other diseases during training sessions on CDTI. 29 WHO/APOC, 26 September 2003 4.4.3. Joint supervision and monitoring with other programs The project is still working modalities on joint supervision and monitoring with other programmes using a joint supervisory checklist. 4.4.4. Release of funds Release of fund CDTI activities has been integrated into the existing PHC structure. Budgets are prepared and funds released within the overall pHC framework. 4.4.5. Is CDTI included in the PHC budget? At the State level there is a line item for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. 4.4-6. Describe other health progrommes that are using the CDTI structure und how this was achieved. llthat hove been the achievements? None at the moment 4.4.7. Describe others issues considered in the integrotion of cDTI. 4.5 Operational research There was no operational research carried out within the reporting period. sEGTloN 5: strengths, weaknesses and challenges Strengths o High levelof community ownership: Several indicators such as number of communities selecting new CDDs, collecting their Mectizan from pick up centers, complying with treatments and conducting in meetings on CDTI show an appreciable level of community ownership. o Availability of highly committed Health workers to GDTI activities o Counterpart fund contributions by most of the LGAs where CDTI project is being implemented o Active participation of some community based groups in stakeholders meetings, CSM and in community mobilization Weakness tr Lack of counterpart funding from the State Government despite series of advocacy visits Challenges o Inadequate logistics particularlymotorcycles. o Late release and non release of APOC funds. 30 WHO/APOC, 26 September 2003 o U o z o o Fl Z fri Frq trr o Fr rq a Qil D o (J a o o.{ E.! 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