I I I ,, I I UsJJTJ ji;t ir S, f lP IUJ 39 J ORIGINAL: Englislt COUNTRY /I.{OTF: I{IGERIA Proiect Namet Osun Stote CDTI Approval year: 1998 Launching year: 1998 Rerrortinq Period (Month/Year): October 2002 - September 2003 Date submitted: DECEMBER 2003 NGDO partner: UNICEF I I I I I I I I I I I I I I I I YEAR 5 ANNUAL PROJECT TECHNICAL REPORT I I I \ TO .!- Ey TECHNICAL CONSULTATIVE CONTuTITTEE (TCC) rl i .i t- t, I rl, l-, ri I I I AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) i w ,.*dh WFIO/APOC. 2(r Scptember' 2003 ANNTIAL PROJECT TECHNICAL REPORT TO TECHNICAL CON SULTATIVE 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. tiya. ,atl Signature i.i" ': Date .:. .. .. .i". k:-...,'.i*l Zonal Oncho Coordinator Name: Mn A. O. Jaiyeoba Signature Date This report has been prepared by Name . Mr. Matthew Lelaboye Designati on : State Coordinutor 2n$?1- Table of contents ............IV DEFINITIONS .......... V FOLLOW UP ON TCC RECOMMENDATIONS 1 EXECUTIVB SUMMARY 2 SECTION 1: BACKGROUND INFORMATION 3 1.1 . GsNuRal- INFoRMAlloN ............... J 1.2. PopuLettoN aNo HenlrH SYSTEM 6 SECTION 2: IMPLEMENTATION OF CDTI 8 2.1. PnnloooF'4CTIVITIES .............. .8 2.2. OIrotRtNc. sroRAGE AND DELIVERY ol'- IVEI{MECl'lN 10 2.3. AovocacY aNP SsNsl'rIZAl'loN l1 2.5. COUUUNITIES INVOLVEMENT IN DECISION-MAKING . 14 2.6. Cnpacttv BUILDING I6 2.6.1. Training..... l6 2.6.2. Equipnrcnt and human re,\otrces... 1B * CoNotroN oF TFIE EQUIPMENT PLSRSp srATE 18 2.7. TRcRrutuNrs................ 20 2.7.1. TreutmentJigures............ 20 'r't OROLU 2.7.3. Trend oJ'treotment ctchiet,ement from CDTI project inceplion to the currenl yeor25 * 3 LGAS (INE SOU'rrI, IIE NONT-U & EOP SOUTU) WE,RE I-ATER FOT-]ND TO BI] HYPO DNDI]MIC AND EXCLUDED FRoM MASS r)rsl'R.tBr.JTroN op MscttzaN IN ENDEMIC coMMt;Ntrtss..........25 2.8. SupsnvlsloN................ .................26 SECTION 3: SUPPORT TO CDTI.... 28 3.1. FINnNCtel CONTRIBUI'IONS OF' THE PARTNLIRS AND COMMUNITlllS...... .......28 3.2. OrNNN I-ORMS OF COMMUNITY SUPPOR-I .......28 3.3. Expt-NottunEPE,RAcl'lvlrY............. .......2e SECTION 4: SUSTAINABILITY OF CDTI .......30 4.1. INrpnNal-; INDDPENDENT PAR'IICIPATORY MONI'IORING; Evat.UnrlON........... .......30 RpcovnauNDnl'toNs nr LGA L9v11........ .......3 I REcovul,NDATIoNS a'l' FLHF LEvEI- .......33 REcovUnNDATIoNS Rr CouvuNITY LEVEL .......34 4.2. CoulauNtrY sEl.F-MoNIToRING aNn Strrrsllol.DE,l{s Mee'rtNc .......35 SusTRINnBILITY oF PROJEC.IS: PLAN AND SET TARGETS (MAND^TORY YR 3)... .......36 4.3. ^,I 4.4. INtrclrR'rtoN ............... .......38 4.5 Opnne ttoNAt. RESEARCI I .......39 SECTION 5: STRENGTHS, WEAKNBSSES AND CHALLENGES .......40 lll WHO/APOC', 26 Septernber' 2003 Acronyms APOC African Progratnme for Onchocerciasis Control ATO Annual Treatment Obj ective AtrO Annual Training Objective CBO Community-Based Organization CDD Comrn unity-Directed Distri butor CDTI Community-Directed Treatlnent with Ivermectin CSM Comrn unity Self-Monitoring FLHF First Line Health Facility FMOH Federal Ministry of Health GCCC Government Cash Counterpart Contribtrtion IFESH International Foundation fbr Education and Self Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NID National Ittrmunization DaY NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NPI National Programme on Immunization PHC Prirnary health care RE,MO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Tearn TCC 'fechnical Consultative Comtnittee (APOC scientiflc advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization tv WI IO/APOC. 26 Septcmber' 2003 Definitions (i) Total ation: the total population living in rneso/hyper-endemic commuttities within the project area (based on REMO and census taking) (ii) Eligible population: calculated as 84oh of the total population in rneso/hyper- endetnic comtnunities in the project area. (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in ineso/hyper-endemic areas that a CDTI project intends to treat with iverrnectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maxitnum 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 (norrnallythe project should be expected to reach the UTG at the end of the 3'o year ofthe project). (v) Therapeutic coverage: nutnber 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). WFIO/APOC. 26 Septernber 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 Number of TCC ACTIONS TAKEN FOR TCC/APOC MGT Recomntendoliott RECOMMENDATIONS BY THE PROJECT USE Ol'lLY in tlte Reporl (Plea,se atld tttore rotus if necessary) WI IO/APOC. 26 September' 2003 Executive Summary Osun State is one of the states in the South Western part of Nigeria and is located in the B HealthZone.It is a predominantly Yoruba State. Other ethnic groups like Hause, Ibo, Fulanis and Agatus horvever reside in all parts of the State.The State has a population of about 2.2rnillion (1991 census). However. 760,988 is estirnated to be living in 1,131 communities in the 14 endemic LGAs in the state. Population movetnents occttr due to the following reasons: population displacements / The movernent of the Agatus into the State during the farming season, and return to their ancestral places thereafter. Of the total population of 760,988, 531,361 people were treated during the period with 1,300,568 tablets. This represented a 70o/otherapeutic coverage. Targeted trainings were conducted in the 5th year of the project. Only 678 CDDs and 543 Health workers were trained/retrained. These represented an achievetnent of 97%o and 95oh respectively as far as AtrOs are concerned. Strengths of the project include existence of Sustainability plans based on realistic budgeting rvhich can be bLrilt on for an effective and efficient progratnme implementation. increasing support by LGAs for CDTI irnplernntation, integration of CDTI activities into other PHC activities, particularly at the LGA level, and appointrnent of sorne CDDs as top political functionaries in some assisted LGAs in the State. Greater slrpport is therefore anticipated from such LGAs, if they continue in office. The rnajor challenges that faced the project are the strike action by the entire r,vork lorce in Osun State for a period of 3 months which disrupted implernentation of planned activities. lirnited involvement of Health Centre/Post staff in CDTI activities, inadequate Irotivation of CDDs by the cornrnunities and lack of adequate census update. To address these challenges the project tried to carry out activities on a limited scale during the strike period; efforts were rnade to train more health facility staff and communities have been re - rnobilized to contribute rnore to the CDTI process especially with regards to incentives to CDDs. A censtts update with assistance fiom UNICEF is being planned lbr February 2004. 2 WIIO/APOC, 26 Scptember 2003 SECTION {: Background information 1.1. General information 1.1.1 Description of the project(briefl y) Geographical locatiott, topography, clinnte Osun State is one of the states in the South Western part of Nigeria and is located in B Health Zone. lt is boLrnded by Kwara State to the North, Ekiti and Ondo States to the East, Ogun State to the South and Oyo State to the West. The State has a land mass of about 8,572 sqLrare kilometers. 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. Population: uctivities, culture, longuage Osun State has a population of about2.2million (1991 census). Yorubas constitute the major ethnic group, although some minorities such as the Igbos, Hausas, Fr.rlanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian state with about 7\ohof its population engaged in one form of agriculture orthe other. In addition, it is a State that is internationally recognized for its rich cultural and tourism potentials. Com mu n icati o rt systern (roa d...) The major roads in the state are tarred but access roads to most of the endemic cornmunities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major lneans of comtnunication among the comtnunities. I.E.C. rnaterials, electronic media and the use of cornmunity torvn crier, announcements in churches and rnosque also fortn part of the communication system used. A dnti tti st r ul iv e sl r uct ure The state is rnade up of 30 Local Government Areas with the Chief adrninistrative officer being the Chainnan. A legislative arm made up of selected councillors from various ward suppofts hirn. At the State level the Executive Governor is the head of adrninistration supported by an elected legislative ann and the judiciary.