t EDO IDELTA CDTI PROJEGT {f, ORIGINAL : English OUNTR NIGERIA Proiect Name: EDOIDELTA CDTI PROJECT Approval Yearz 1999 Launchingtgar: 1999 Reportins Period From: DECEMBER 2003 To: NOVEMBER 2004 ear) ( Month/Year) Proiect Year of this renort: (circleone) I 2 3 4 Q,S 678910 Date submitted: NGDO nartner: DECEMBER 2OO4 GLOBAL 2OOO/THE CARTER CENTER NIGERIA ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) a DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) ? ' rr,; ?fir}l I I WHO/APOC, 24 November 2004 t ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGEzuA National Coordinator Name: DR. J. Y. JIYA Signature: ... Date o Zonal Oncho Coordinator Name: OMOBA A. JAIYEOBA Signature Date NGDO Representative Name: MR. J. O. EGUAGIE Signature: .... Date This report has been prepared by Name : PAUL UGBADAMU Designation : Project Secretary Signature Date a ll WHO/APOC, 24 November 2004 Table of contents SECTION 1: BACKGROUND INFORMATION 4 1.1. GBNenel INFoRMATIoN............. 4 1.1.1 Description of the project (brie/ly)...... 4 1.1.2. Partnership 7 1.2. Popu1erroN............... 8 SECTION 2: IMPLEMENTATION OF CDTI....... .....10 2.L TrvpI-nn oF AcTIVITIES ............ ....... l0 2.2. Apvocecv ... 13 2.3. Moerr-rzetloN, sENSrrrzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNtrms 13 Wevs ro IMpRovE MoBILIZATIoN oF THE TARGET vILLAGES:................. ...........14 2.4. CouuuNtrY INVoLVEMENT...... 2.5. CnpecrrvBUILDING.. 2.6. TRpervBNTS.............. r't 2.6.1. Treatmentfigures............ .........20 2.6.2 What are the causes of absenteeism?.......... .................23 2.6.3 What are the reasons for refusals?................ ...'........... 23 2.6.4 Brie/ly describe all htown and verified serious adverse events (SAEs) that ... 23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curent year26 2.7 ORtERrNc, sroRAGE AND DELIVERY oF IvERMECTIN............ .,...,.27 2.8 CouvuNrry sELF-MoNIToRING AND STAKEHoLDERS MpPrrNc .......29 2.9 SuppRvrsroN........ .......30 2.9.1. Provide aflow chart of supervision hierarchy. -........... 30 2.9.2. W'hat were the main issues identified during supervision? .............................. 31 2.9.3. Was a supervision checklist used? Yes............ ............ 31 2.9.4. W'hat were the outcomes at each level of CDTI implementation supervision? 3l 2.9.5. Was feedback given to the person or groups supervised?................................ 31 2.9.6. How was the feedback used to improve the overall performance of the project? 32 SECTION 3: SUPPORT TO CDTI ..............32 3.1. EqurueNr 32 3.2. FrNeNcnl coNTRIBUTIoNS oF THE PARTNERS AND coMMLINITIES...... 34 3.3. Orgen FoRMS oF coMMUNITY suPPoRT............. 34 3.4. ExpeNo[uRE PER ACTIVITY 36 SECTION 4: SUSTAINABILITY OF CDTI....... ..........37 4.I. INTERNaI; INDEIENDENT PARTICIPAToRY MoNIToRING; EvALUATIoN.......... ..........37 4.1 .l Was Monitoring/evaluation carried out during the reporting period? ............ 37 4.1.2. What were the recommendations? ............. 37 WHO/APOC, 24 November 2004 4.1.3. How have they been implemented? ....... 37 4.2. SUSTIINaeILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT............ 37 Yn 3) 37 4.2, 1. Planning at all relevant levels.... 4.2, 2. Funds....... 38 4.2, 3 Transport (replacement and maintenance) .i8 4.2, 4. Other resoltrces 38 4.2, 5. To what extent has the plan been implemented................ ...38 4.3. INrpcRartoN....... 38 4.3.1. Ivermectin delivery mechanisms .. 38 4.3.2. Training.... ....... i9 with other programs.. .......39 4.i.3. Joint supervision and monitoring j9 4.3.4. Release offunds for proiect activities ..,.,., 4.3.5. Is CDTI included in the PHC budget? Yes..... ....... 39 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved?. 39 4.3.7. Describe others issues considered in the integration of CDTI. 39 4.4. OpBnnrIoNAL RESEARCH. 40 4.4.1. Summarize in not more than one hatf of a page the operational research undertaken in the project area within the reporting period. ,.,40 4.4.2. How were the results applied in the proiect?..........." ...40 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AND OPPORTUNITIES.... 40 FEATURES OF THE PROJECT/OTHER MATTERS...........41 SECTION 6: UNIQUE a lv WHO/APOC, 24 November 2004 Acronyms wHo World Health Organization APOC African Programme for Onchocerciasis Control UNICEF United Nations Children's Fund MOH Ministry of Health FMOH Federal Ministry of Health LGA Local Govemment Area NGDO Non-Govemmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force NOCP National Onchocerciasis Control Programme RBF River Blindness Foundation G2000 Global 2000 lThe Carter Center LCIF Lions Clubs Intemational Foundation LCI Lions Clubs lnternational, District 404 Nigeria CDTI Community-Directed Treatment with Ivermectin CDD Community-Directed Distributor HFS Health facility staff DHS District Health Supervisor CDHS Community Directed Health Supervisor ATO Annual Treatment Objective ATrO Annual Training Obj ective a UTG Ultimate Treatment Goal CBO Community-Based Organization CSM Community Self-Monitoring SHM Stakeholders meeting PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers NPI National Programme on Immuni zation DSN Disease Surveillance Notifi cation SPIC State Programme Implementation Committee PMRC Project Management & Review Committee v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/h1per-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84o/o 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/h1per endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverag-e (normally the project should be expected to reach the UTG at the end of the 3'" year ofthe project). (") Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coveraqe: 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). additional health interventions (i.e. vitamin A supplements, (vii) Integration: delivering a albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The plocess by which the community is .-p"*.r.d to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the proglamme is being executed in the way intended. It encourages the community to take full ,..pon.ibility of ivermectin distribution and make appropriate modifications when necessary. ! 2004 v1 WHO/APOC, 24 Novembet 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 15TH Number of TCC ACTIONS TAKEN FOR TCC/APOC MGT Recommendation RECOMMENDATIONS BY THE PROJECT USE ONLY in the Report 78 The issue of incentive A research fellow to CDD and an at the University examination of rate is currently of refusal and handling the absenteeism over proposal. time in relation to the statement that "it may be due to post- honeymoon effect". a (Please add more rows if necessary) 1 WHO/APOC, 24 November 2004 Executive Summary 1. Background on treatment and population data Sponiorship of 2l endemic LGAs out of 43 LGAs in Edo and Delta States started in June 1999. The hyper / meso endemic LGAs are2l LGAs (12 LGAs in Edo State and 9 LGAs in Delta State). Treatments have consistently been carried out in the 2l endemic LGAs since 1999, while passive treatment is under the sponsorship of Global 2000 lThe Carter Center. 2. During the period being reported on, a total of 965,149 persons were successfully treated with 2189,719 tablets of Mectizan in 991 endemic villages of 21 LGAs. The total population of the 2l LGAs stands at 1,374,785 persons. The ATO was 937,873 p.rronr. See details in section 2.6.1. This active treatment respectively gave geographic coverage