I rll I _. _-,__,__. -._ -_,- .---_ -- --,,t ORIGINAL: English COUNTRY/NOTFz Nigeria Proiect Nanqez Benue State CDTI Proiect Approval year: 1999 Launching year: 1999 Reporting Period (Month/Year) z October, 2000 - September, 2001 Date Re-submitted: January 2004 NGDO partner: UNICEF YEAR 2 PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) t-.-_ .) I CL ! l3 I C,oorb I r5L I CEv CDf Bth BEt RECU --l I lt , t, 2 6 FFV. 2004 tc, \tR. i A\i APOC/DIR I i ( AFRICAN PROGRAMME FOR CONTROL (APOC) ff,iaM ONCHOCERCTASTS I i i ,i WI-lO/APOC. 26 September 2003 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 Same: Dr. J. Y. Jiya t/r,,rnurur" \ /e Date: Zonal Oncho Coordinator Name: Dr. U. E. Udofo Signature Date: ... This report has been prepared by Name '. Mrs. Betty Jande Designation : Proiect Coo rdi nator Signature Date 2 WIIO/APOC. 26 September 2003 Table of contents Acronyms..... .1 Definitions..... ..5 FOLLOW UP ON TCC RECON|MENDATIONS I 2 Execut ive Sum mary....... SECTION l: Background information J l.l. GeNsRalINFoRMATIoN............... .3 .3 I . I .l. Desuiption of the project (brieJly) l. 1.2. P artnership........ ,4 1.2. POPULATION AND HEALTH SYSTEM....... .5 SECTION 2: lmplementation of CDT|...... .6 2.1. Psntoo oF ACTIVITIES .............. ,6 2.2. ORopRtNc, sroRAGE AND DELIVERY oF IVERMECTIN ....'...' .8 2.3. AovocRcv AND SENSITIZATIoN l0 2.4. MOSILtzRttON AND HEALTH EDUCATION OF AT RISK COMMUNITIES..... ll 2.5. CoTUvuNtltESINVoLVEMENTINDECISIoN-MAKING l4 2.6. CRpactrv BUILDING 16 2.6.1. Training..... 16 2.6.2. Equipment and human resources..- I9 CoNotrtoN oF THE EQUIPMENT * PLeesg srATE 19 2.8. SupsRvrstoN................ 25 SECTION 3 Support to CDT|....... 26 3.1 . FtNRNCtaL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES............. 26 3.3. ExpgNottuRE PER AcrlvlrY 27 +Lxpenditure included under IEC materials.. ......... 27 SECTION 1: Sustainability of CDTI.. 27 4.1. INTpRNR1; INDEPENDENT PARTICIPATORY MONITORING; EvalUarlON...... 27 4.2. CouuuutrY sELF-MoNIToRING AND STAKEHoLDERS MpertNc 30 4.4. INrpcRRuoN 3l 4.5 OppnaloNAl RESEARCH 32 SECTION 5 Strengths, weaknesses and challenges.. JJ 3 WHO/APOC. 26 September 2003 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obj ecti ve ATrO Annual Training Objective CBO Community-Based Organ ization CDD Commun ity-Directed Di stributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring DHS District Health Staff HFS Health Facility Staff LGA Local Government Area LG Local Government LOCT Local Onchocerciasis Control Team M&E Monitoring and Evaluation MDP Mectizan Donation Program MOH Ministry of Health NID National Immunization Day NGDO Non-Governmental Development Organization NGO Non-Governmental Organ ization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers TV Television UNICEF United Nations Children's Fund UTG U ltimate Treatment Goal VDC Village Development Committee VHC Village Health Committee wHo World Health Organization 4 WHO/APOC, 26 September 2003 Definitions (i) Total population: the total population living in mesoihyper-endemic communities within the project area (based on REMO and census taking)' (ii) Elieible 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 Iiving 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 (normallythe project should be expected to reach the UTG at the end of the 3'o 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 numUer of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). 2003 5 WHO/APOC. 26 September FOLLOW UP ON TCC RECOMMENDATIONS The table below shows a follow up of the recommendations to the project made at the last TCC meeting. TCC session 13 Number of TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR Recommendot TCC/APOC ion in the MGT USE Report ONLY 34 (i) Conflicting information on annual This is clarified in Table l0 treatment obiective 34 (ii) Complete infonnation on Table 3 Cost per treatment could not be ofthe report calculated. There was no community where CDD is a health worker. The health workers supervised all the distributors in the communities. 34 (iii) Provision of a plan of action for The present leadership did not meet any expansion Year 2 Plan of Action in the files, but it is aware that treatments were expanded from the l4 LGAs originally approved to l8 (with the addition of 4 new LGAs namely:Tarka, Obi, Ohimini & Logo. 34 (iv) NOCP to ensure adequate The national office is trying its best to monitoring of CDTI monitor the activities of the project implementation 34 (v) Treatment figures should be Complete summary treatment figures provided from January to provided in Table l0 December 2000 and not only for January to September 2000. WHO/APOC. 26 September 2003 Executive Summary Benue State is located in the central part of Nigeria. The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. Estimated population of the State is put at 3,802,500 persons. The major ethnic groups are the Tiv and Idoma. Settlement pattern is largely dispersed. Movement of whole communities or large numbers of persons is common due to inter ethnic clashes or fear of reprisals from the army authorities. Roads between major cities are in good condition, but access roads to most of the endemic communities are in poor shape. The State consists of 23 local government areas but CDTI is currently being implemented in 2049 communities in l8 LGAs. Target population is 1,243,525. All communities were reported to have been covered but total number of persons treated stands at 696,460 thus achieving a 56%o therapeutic coverage. During the course of the year I I SOCTs, 72 LOCTs 180 other LGA health staff, 540 health facility staff and 3,451 CDDs were trained on CDTI. One SOCT underwent computer training. These represent achievements of 33% for LGA staff, 60% for health facility staff and 345% for CDDs with regards to AtrOs. A total of 1390 community leaders, 221 opinion leaders and 584 primary school teachers were mobilized to support CDTI. The policy makers at State and LGA levels were visited to solicit for financial support to the project and to enlighten them on their roles. This has resulted in some communities forming Mectizan distribution monitoring committees. Moreover, in some LGAs drama groups are being formed to further highlight the socio - econmic importance of the disease using the local dialects. Some schools have formed health clubs. These have resulted in increased awareness of the communities of the benefit of Mectizan, and the need for its continual intake over a long period of time. The project has succeeded in creating awareness in communities that the programme belongs to them. It has tried to some extent in empowering communities to consider and determine their own health needs. There are committed staff at LGA and State levels. The major challenges facing the project are: communities and ensuring proper record keeping at all levels. State and LGA levels 2 WHO/APOC, 26 September 2003 SECTION 1: Background information 1.1. General information 1.1.1. Description ofthe project (briefly) Geographical location, topography, climate Benue State is located in the central part of Nigeria. The State lies between longitude 6030' and 8020' East and latitude 7080' and 9035' North. It is bounded on the North by Nasarawa State, North West by Plateau State, Enugu State on the South, Kogi State on the Southwest, and Cross River State on the east. The vegetation is forest to the south, with forest - savannah mosaic and mixed savannah grassland in the northern areas. The terrain comprises undulating hills which occasionally reach 4,000 feet above sea level, to bare flat plains along the Benue River, with an altitude above sea level ofabout 300 feet. In the eastern part ofthe project area there are steep hills, cut by swift flowing streams whose banks are densely forested. The rainy season begins in March and ends in October while the dry season lasts from November to February. The State has an annual rainfall of 1200 - 9800mm. Population: activities, cultures, language Estimated population of the State is put at 3,802,500 persons. The major ethnic groups are the Tiv and ldoma. There are other smaller groups such as Etulo, Offiah and Jukun, who live in Tiv areas; while the Igede and Agatu live in areas inhabited by the Idoma. The major languages spoken are Tiv, Idoma and Hausa. The major occupation of the population is farming, including growing of yams/cassava and cultivation of cotton and beniseed. Fishing alongthe riverine areas is widespread. Crafts such as blacksmithing, weaving of cloth etc are practised. Some also keep domestic animals. Settlement pattern is largely dispersed. Movement of whole communities or large numbers of persons is common due to inter ethnic clashes or fear of reprisals from the army authorities.