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Monitoring of the Implementation of CDTI Sustainabitity Plan in Plateau State, Nigeria

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Monitoring of the Implementation of CDTI Sustainabitity Plan in Plateau State, Nigeria Monitoring of the Implementation of CDTI SustainabititY Plan in Plateau State, Nigeria June 2005 Richard Ndyomugyenyi (Team Leader) Luc Mebenga Tamba Sunday Isiyaku @v (@ WORLD HEALTH AFRTCAN PROoRAMTAE FOR OR6ANIZATION ONCHOCERCIASI5 CONTROL I TABLE OF CONTENTS Abbreviations/acronyms and acknowledgments ...... ... 3 J Acknowledgements Executive Summary ..........4 Introduction and MethodologY .....6 .....6 l. Introduction . 2. Methodology ,.....6 Findings and Recommendations ....... ..... 8 ......8 l. State level l4 2. LGA level 3. FLHF..... 26 4. Village level ... 27 Debriefing 29 Overall Conclusion and Recommendations ...29 ... Appendix l: Summary table of problems and solutions 3l Appendix 2: List of people interviewed .......34 Appendix 3: List of monitors 35 2 Abbreviations/ acronYms APOCAfricanProgfttmmeforonchocerciasisControl CDD Community Directed Distributor CDTICommunityDirectedTreatmentwithlvermectin CHEWs Community Health Extension Workers FLHF First Line Health FacilitY GRBP Global 2000 River Blindness Programme HOD Head of DePartment HSAM Health Education, sensitisation, Advocacy and Mobilisation LF LYmPhatic Filariasis LGA Local Government Area LOCT Local Onchocerciasis Control Team MOH Ministry of Health NGDONon.GovernmentalDevelopmentorganisation NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NIDs National Immunisation DaYs PHC Primary Health Care RBM Roll Back Malaria SOCT State Onchocerciasis Control Team UNFPAUnitedNationFundsforPopulationActivities WHO World Health Organisation WR World Health Organisation Country Representative Acknowledgements assistance and support: We would li-t<e to thank the following persons for their Seketeli' Dr U' o The staff at headquarte., io Ouagadougou; the Director Dr A' for the mission' Amazigo purti"rfu.fy for their financlal and logistic support and other support' o The WR and his staffin Lagos and Jos for administrative Dr' E' I' Miri' Director of o The Country Representative of Global 2000lCarter Center, Dr Abel programme, foi ptut aulNassara*a and Deputy Country Representative' Mr' John Umaru and all Eigege, Programme Administrator for Plateaua{assarawa' kind support and facilities staff of Global 2000lcarter center Nigeria office for their theY the team members' Provide of Health, Dr. Staff of Plateau State Ministry of Health; The State Commissioner DabiyakDamulak,theDirectorofPHC,Mr.JohannaAtangs;thePlateauStateOncho contribution Coordinato;H.r.y Filda and his team for their moral assistance and their exercise' in providing information and guidance during the monitoring Kanke) in Plateau State o The LGA chairmen of selected LGAs (Bassa, Jos East and hospitality, availability and and their staff (Coordinators and Supervisors) for their information provided to the monitors' to receive the o The staff members of FLHFs of the sampled facilities who accepted teammemb,.,inspiteoftheirtransfersandlowmoralduetononpaymentofsalaries for manY months. for interviews' o The community leaders and the cDDs for their availability 3 Executive SummarY in March 2003 at the end of its fifth Plateau CDTI project was evaluated for sustainability were developed following the year of implementation. Thereafter, sustainability plans of the sustainability plans, evaluation recommendations. After two years of impiementation tasks: APOC management commissioned a team with the following particularly at the LGAg' FLHF and 1.0. To determine the extent to which program partners, in their sustainability plans community levels are implementing thI proposed activities of the sustainability plans and the 2.0. provide technicai ,upport for achiEvingthe objectives implementation of CDTI. Findings activities despite advocacy to policy At the state level, no funds have been released for cDTI as stakeholders and review meetings makers and for this reason, some planned activities such continue to be implemented and this could not be conducted. However, some GDTI activities malaria in a project initiated and has been possible iu.Jo int.gration of CDTI with LF and the state to LGA is not integrated in funded by the NGDO partner. Mectizan delivery from funds from Global 2000/Carter the drug delivery ryt,!. and its delivery is deiendent 9n project is highly dependent on extemal Center, the NGDO The implem"ntt ion of *," ;;;".. the policy makers with the funding (NGDO partner). High power delegation uOro*y to state to release funds for participation of epOC *unui",n"nt is urgJnt[ needed for the i"pf"ri""t"tion of CDTI activities as detailed in the sustainability plan' not used for implementatigl At the LGA level, CDTI sustainability plans are available but LGAs released some funds for GDTI due to delayed and inadequate funding. ehhough all the effective implementation of the activities in 2004,the funds released are still i-nadequate for this has enabled CDTI planned activities. CDTI is integrated with I-f and malaria and based on annual activities to continue. Treatment coverage is high but it is calculated -calculated total population like in other treatment objective. coverage should be based on Advocacy to policy makers by APOC supported projects for easy comparison across projects' and adequate release of funds for SOCT and NGDO pi.tn", shouli continue to ensure timity also be integrated timely implementaiion of the planned activities. CDTI activities should LF and malaria in NGDO with other programmes in the ministry of health in addition to partner funded Project. in an integrated manner with LF At the FLHF level, health workers are implementing CDTI has disrupted timely and malaria control. However, massive iransfer of health workers need for LGAs to train implementation of CDTI activities in some LGAs. There is an urgent train all health workers in the all the new health workers on CDTI. It is also important to LGAs on CDTI so that when ever there are transfers; there is always somebody knowledgeable to continue with CDTI implementation' is being implemented At the community level, health education and mobilization on CDTI nets (ITNs) for malaria and integrateo wiitr LF and the distribution of insecticide treated in some communities' control. However, ivermectin collection from the FLHF is delayed 4 reasons for These communities need to be followed up by the health workers to establish exercise books, some delayed collection and solutions worked out. Registers are in form of LGAs together with which are in a poor state and difficult to use to calculate coverage. The page for each ApOC and the NGDO partner need to print standardized registers with a recorded at each household and the number of tablets received by each household member round of treatment. This will help in monitoring individual long-term compliance' lack The overall conclusion Thekey CDTI activities continue to be implemented, despite This has been of funding from the State and inadequate and delayed funding at LGA level. partner funded project' possible d-r. to integration of CDTI *itn tf and malaria in the NGDO CDTI is However, its sustainability is doubtful if the NGDO partner funded projects where high-powered currently being integrated comes to an end. APOC .anug"."nt should send a and state delegatiln thaiwoui<l aim at reaching the highest level of-g,overnment at the national Nigeria levels to advocate for government support.-The national level is important because level will go a long has many ApOC suppoied CDTI projltts and government support at this way in btosting sustainability of all the cDTI projects in Nigeria. 5 1.0. Introduction plateau state is located in the Middle -Belt of Nigeria and it is bounded to the South West by Nasarawa state, while to the North West and North East are Kaduna and Bauchi states respectively with Taraba state to the South. The state has an estimated population of 3.2 miilion people and is divided into l7 political Local Government Areas (LGAs) The Plateau State Ministry of Health is structured in line with the Nigerian health structure which is based on the concept of the Alma Ata declaration of 1978 which states: "Primary health care as essential health care based on practical, scientifically sound and socially acceptable methods and technologt made universally accessible to inqividuols and their participation and at a cost that the community -andfamiliis in tie community through full country can afford to maintain at every stage of their development in the spirit of self reliance and self determination". Based on the above the national health care delivery system is structured into primary, secondary and tertiary levels. Health Care is the responsibility of the lo-cal, state and federal gor"*-Lnts. The Piateau State Ministry of Health is responsible for the provision of Lcondary health care and supervises LGAs to provide primary health care services to its population. The FLHF which are also known as the PHC centres are manned by trained tommunity health extension workers (CHEWs) and are located in the communities with each PHC centie serving/providing services to communities within a radius of 5 kilometres. The staff centres superviie and implement health care activities in the communities under them and this is where CDTI is supervised. The activities of the Ministry and health services provided are funded from budgetary allocation from the state government. CDTI is being implemented in five LGAs namely Bassa, Bokkos, Jos East and Pankshin, CDTI implem-entaiion in the state started in 1998 with APOC financial assistance and the 2000lCater Center
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