World Health Organisation African Programme for onchocerciasis Control ',ri" ;,,Assessment of the Sustainability of the Anambra CDTI project, Anambra State Nigeria August 2003 Grace O. Adeoye Oladele B. Akogun - Team Leader Henrietta N. Ene-Obong Rehema Maggid Chris Ogoshi Joseph Okeibunor r, I ,"" tt..,.-,r I i'''t.,i, ( I !.. I I i I ---*{ r-,r' , ;-11 RECU -t,.;li-';;'.'- I I 6 SEP. 2003 APOC/DIR I I [ ,, I I i TABLE OF CONTENT TABLE OF CONTENT ABBREVIATIONS/ ACRONYMS ACKNOWLEDGEMENT: EXECUTIVE SUMMARY I.O INTRODUCTION 2.0 METHODOLOGY 2. I SAMPLING............. 2,2 SOURCE OF INFORMATION 2.3 ANALYSIS l0 3. EVALUATION FINDINGS................ 3.I SUSTAINABILTY - AT THE iiaTgil;E#i TSVEL, 3 3 su.i;ri,rA;ilii+ t+ i,ffi if,fr?'#i ,...............,... 3.4 SUSTAINABILITY AT COMilUMTY 22 LEVEL ...........27 , 4.0 coNCLUSroN...... rrru ovsnerr- ' ' iiot#H^c susiarr.lesi-irv or aNal,rnna c;ii 'o 4.2FEEDBACK/piAMm.rcrr,'e'rir.uci,.......................... .............30 4.3 THEWAYFORWARD.... ..................32 *-_... ...... ..................32 APPENDIX I. STATE LEVEL WORKSHOP PROGRAMME. APPENDIX 2: Feedback and Surtuir-uUiiity-ftunning Workshop...................................l: ABBREVIAT]ONS/ ACRONTYMS 4WD Four Wheel Drive APOC African Programme for Onchocerciasis Control CDD Community Directed Distributor (of ivermectin) CDTI Community Directed Treatment with lvermectin DPHC/DC Director of Primary Health Care/Disease Control FLHF First Line Health Facility FO Finance Officer GRBP Global 2000 River Blindness programme HOS Head of Service HSAM Health Education sensitisation Advocacy and Mobi r ization Km Kilometres LCIF Lions' Club International Foundation LG Local Government LGA Local Government Area LOCT Local Government Onchocerciasis Control Team LSC Local Government Service Commission MOH Ministry of Health NGDO Non-Governmental Development Organisation NOCP National Onchocerciasis Control proiramme NOTF National Onchocerciasis Task Force " PA Project Administrator PHC Primary Health Care SOCT State Onchocerciasis Control Team SPO State Programme Officer SSG Secretary to State Government wHo World Health Organisation 3 ACKNOWLEDGEMENT; we would like to express our appreciation.to the following people and organisations for their contributions and assistanii to*uras the succesrn i.irpr.tion of this assignment: ' The Director, Dr. A' seketeli and stafr at APoc rr""aqu".ters in ouagadougou for his confidence in the team and for providing irr.-n.r.rrary financial and logistic support for the success ofthis assignment. The ' wHo Represeatative, Lagos"and his staff especially Mrs Esther okonkwo, the Administrative Assistant and tt'e surveilru"u oml;'b. R. I. oyibo in the Anambra office for their kind assistan"".unJ professionaafi;;. Federal ' Ministry of Health Director oi. i.'iiyu the lJ.ocl, and his ream for facilitating smooth take offof tt e e*"rcir"in Nigeria Anambra State ' tvtinilnr of Health personnel at all levels provided assured environment. information and an for the assignment T!. ssc, ps, Directos pHC control as well as and Disease the state Progamme oflic". io. onchocerciasis especially helpful. control were ' country Representative, Global 2000,-Dr. Miri, and his staf[, Flealth community members workers and in Njikoka, Ihiala .ni o.ru. NJ.il, information and l-dAs provided contributed to th" surr"rs ofthe mission. ' Grobar 20oo Enugu, worked mrr*j:Iu, '^ tireressry in ensuring the success of 1.. 4 EXECUTTVE SUMMARY Introduction: The Anambra cDTI project was launched in 1998 and is therefore in its APoc funding' A team or.r,tutnJevaluarors fifth year of frr; il;.ria and Tanzania sustainability of the project u.t*u"n evaruated rhe August 4 ;d't'i, zool. The team results with the MoH authorities discussed the and NGbo pu*I, and ,rpponra ir,.'itate rever, and ;#ffi66' n uui I itv p r,, s i fiir"S","r:':l-, fl:'#fr:i;; #*ffi;; "'tui s, u n g th e Information was gathered'frorit. r.ui.w of rerevant were documents and reports. Interviews held with the MoH p.rronnlt, primary hr;ith;;; personner, FLHF communitv members in"ir-l-u"4".s. staff, cDDs, rieta at four levels (the FLHF and vilrage revers)"na prouiauJuoditionat statq LGA source"b;;;;,i., of information. Findings: All the LGAs that were. visited had geographical coverage per cent of r00%. However, onry 90 of the communities in the 16 apob coverage u*irtJiLa, in th. il.i;il therapeuric of 6s% or higher. communitd ;il;;i'wlringness treatment for as long to continue with as it is necessr.y a.g rr.r l"en heatth benefits *:l-"r Il. associated with a number of d::)";*iil ira i,,p.oiuJ-rigr,, A demanJ observed in some communities fb;, drug was thusinhancing.rriilfi;n ofthe communities have. t..n Rroject susrainablity. to pra] ; iil;; rore in communities have been informea"rpo*IIJ briri. io, oril,ei, il;r;r';;;.?ing cDDs "*r*pr", were well aware of their responsibiliti.s..uo*eu*,i'n.'.r,i" a, ,roo respondents very high orcnns'ii poputation and the communiii.g uijr.o tr,.t tt. nuril., is could adequately support' *nr, ,n", Further irorr, apart from the "iciini"rlpr.Lfil method of treatmeni' tr'" ptti"J selection of cDDs or drugs' over ,ortty l"pendent on ilr" *"labirity"na "hoi", which rac-k-contror"fLginls commulil^yl*hip of strong' It was "orrurities of the programme is obvious, from the meetings r"ioi, practical steps have been .held wiih comrlunities, that put in-pi.r" to ensure"r"t sustainability of the GDTI at the The Evatiation f;* conctudes :##::ii"tevet. ni iort or the commanitlt tevet is Funding for GDTI by government (at the state and LGA payment of salaries, levels)-very poor and mainry provision oi stationerie. Ei,;;ent -n.r.. -iJeased for funds for the runnini hes any of cDTI alttroush these rru"u worse sti[, r-rageted for end are approved. the nuag;ins d.;;.;;;Jriom z 2003. The mnitui i,iioor and 2002 to l mirion explanatlion fl" tfri, O"llne, according in rhat wherea,'tr,u to r previouc ,pp."r"q wenc ,##,rf.J,["r..rl reducing the amount il""utjf#lf, tunding 1 gor;;;;; to fund ,m for GDTI imprement.iion" ","{li-sutting lr-to;;;.ri'-i'ur.rr, "Jiues. Major Grobat 2ooo. rn the.r"'t,'i.. jzo91-,i^iqij;erbc specificaly Apoc and technical vl*' and-Grobai io6oprovided and financiar-supplirr ussroz,iza: APoc has provided "il"r1 and N6,3 53,22g.In addition .rJ inciuding cruiser vehicrg motorcycrer,"ehiciJs ".pj"r "qrrpr"ii one 4wD Toyota Land t;;";;i;r, among others in the past Dependence on externti to*.Ir ;i il,rdtrg-computer, s years. ffiffi;:*ntee projecr sustainabirity. 5 The previous poor funding was blamed on the position provision, of the past government to service which was not peculiar to CDTI. There is high-level political .on,ritr"nt as evidenced of the involvement of the Ministry of Health. an! gther policy State makers in the borr programme. The departmentar heads.in the different Ministlry are knowredg;di;uiout the programme. The personnel display high level'oi.orritr."ni;h; un teamwork' This .rriroiment of supervisory is shown during the.briefirg, ur were present Dir;;rs from other units of the MoH and participated actively. Theii understandi"g ;iih;';bd;.gramme impressive and thiir inclusivener. is i, There are enough carry out activities but "*"rptary.'from financial resources to these are mostly Apoc- funds. This considered to be seriously would have been blocking sustainability f";; fifth year project environment project, but taking the into consid..urtion, impiemerrt.rion more' could not have done much It is generar knowledge that trre.a^nam-u;-d;;;;';"vernment^the form of svstemic diapause;, system was in some th. 0.":, p* y";.-l-6s are counterpart funding being pranned to secure from governr"nt in the sixttr year in the top uling tt"op;#;r; of a change hierarchv of goierril;. A meeting orit.-"raru;r;;ililiJ State Governmenf (ssc) tea i.'"r.,u.y to the to assurance of financial support. The informed (during the worlsh"pl tr,"ittt. team was later rmmediate c"r;;;-;;; of the situation, had ordered rerease of the sum'of N98,000 an ,;;;;;;gi.,nr". The Locar Government ai.po'"a to f,"il:.i:S#i';ffi[#JllffiIrv e;ttils ?he rcas to .,r.u,. counterpart Regarding transport and Mectizan supply, there are no plans vehicle and for the replacement of motorcvcles in tr,. n tui.'b;;;r;; il" plrl"trehicres well' The current Mectizan a.. stili-t nctioning yppry tvrtem is poo. t, ,ustainabirity socr collects the of the project. The State *tig;;'.ni'of Mectiiu" i, rou. cost of CDTI imprementation]rmie installments. This increases the ir u gooJ *.noii'o*r.rrt ip of the the local lever esoeciaily the ,omrr,,rritylcorrrniti-., programme at Mectizan requirement, ,ponror cDDs to corect their fro* a"rGr.[a i,"rri ,p"r*r their areas using tt"."o*,nuffi'Irrrtop."nr-"J.'nitt".,"rJ treatment-rerated activities in communities were well und town councirs. The mobili'ea roi orunirship uy ttre nontline played the most visjble a"iliiatlng health facilities, which rl" in tr," in was made possible by Anambra. This in turn a non-put.o"niring socT"rttJp.ogr".me or the team r-dbTit is worth rnent]""irg here observed ttrlt 6ertrap; that ;";;" of lack ornrnas at_the LGA and FLHF personnel were unencumbered State revers) the overbearing SOCT and LOCT. tot of initiatives and carrie; ci,iilI "n*ith They used a bureaucracy ;d-;;iiar dependr;;'on upper but heavy reliance ""on tt, communities tt. this and their structures. The personnel levet show an adepr una.rri*Jils p.opr.-;;i at ensure that ;;;i'ffi #"r,yrlanding the communities as I unii strlouru*".qtr,.