I D E D u D 0 I _) ORIGINAL: English COUNTRY/NOTF : Nigeria Proi Name: Benae Stote CDTI Project Approval year: 1999 Launching year: 1999 Reportins Period (Month/Year): October, 2001 - September, 2002 Date Re-submitted z Jonuary 2004 NGDO partner: UNICEF YBAR 3 PROJECT TECHNICAL REPORT TO I?"-, TECHNICAL CONSULTATIVE COMMITTEE (TCC) f, -l,CC lf RS C5D CE{ t-o" Brrl i sib i ',!-- RECU ! r 2 6 FEV. 2004 brt APOC/DIR AO t ( AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOci WI-lOiAPOC. 26 September 2003 ANNUAL PROJECT TECHNICAL REPORT Y 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 NIGERIAILIBERIA National Coordinator amu Dr. J. Y. Jiya Signature: .. fut"@ Date: Zonal Oncho Coordinator Name: Dr. U. E. Udofo Signature Date This report has been prepared by Name : Mrs. Betty Jqnde Designation : Proiect Coordinstor Signature E+*ee Date 2 WHO/APOC, 26 September 2003 Table of contents Acronyns ..4 Definitions.......... 5 FOLLOW UP ON TCC RECOMMENDTITIONS... ...... .. .t Executive Sum mary....... .3 t SECTION l. Backgt'ound information.,. I l.l. GeNeRalrNFoRMATroN............... ..4 l.l.l. Description of the project (brieJly) ..4 I . l . 2. Partnership........ ..5 1.2. POPULATION AND HEALTH SYSTEM ..6 SECTION 2: Intplementalion of CDT|...... ..7 2.1. Penroo oF ACTIvrrrES .............. ..7 2.2. ORoe RtNc, sroRAGE AND DELIvERy oF rvERMECTrN......... ..9 2.3, ADVoCACY AND SENSITIZATIoN II 2.4. MosrlrzaloN AND HEALTH EDUCATToN oF AT RrsK coMMUNITIES.............. l3 2.5. CovvUNITIESINVoLVEMENTINDECISIoN-MAKING 16 2.6. CRpaclryBUrLDrNG... l8 2.6.1. Training..... t8 2.6.2. Equipment and human resources... 2t CoNorrtoN oF THE EeutpMENT * PLeesg srATE 21 2.8. SupsRvrsroN................ 28 SECTION 3 Support to CDTI .... 29 3.I . FtNRNcral coNTRIBUTToNS oF THE pARTNERS AND coMMUNrrrEs.............. 29 3.3. ExpsNorruRE pER AcTrvrry ............. 30 SECTION 4. Sustainabiliry of CDTl.... Jt 4.1. INrenNal; TNDEIENDENT pARTrcrpAToRy MoNrroRrNG; EvRLuarroN................... 3l 4.2. CouvruNrry sELF-MoNrroRtNGAND STAKEHoLDERSMspTTNc 32 4.4. IxrncRalou 33 4.5 OpenarroNAl RESEARCH 34 SECTION 5: Strengths, weaknesses and challenges. .31 J WHO/APOC. 26 September 2003 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Comm unity-Based Organ ization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Comrnun ity 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 N on-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 Vil lage 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 meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%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/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3,d year ofthe project). (v) Therapeutic coverase: 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 number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). 5 WHO/APOC. 26 September 2003 FOLLOW UP ON TGG REGOMMENDATIONS The table below shows a follow up of the recommendations to the project made at the last I TCC meeting. TCC session 16 Number of TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR Recommendat TCC/APOC ion in llrc MGT USE Report ONLY 65 Inadequate comtnitment by State, The State and Local Government SOCT & LGAs authorities are being sensitized. An advocacy workshop for policy makers at State and LGA levels was held but attendance was poor. Information with the project indicates that a total of :N:405,000 ($3,I90) was given by the LGAs in 2002. At State level the government released only N73,000. Advocacy visits were paid by NOCP and UNICEF officials. To yield the required results advocacy visits is requested from the highest level. 67 iii Evidence of implementation of The project has done the following with the recommendations of the respect to recommendations: independent monitoring undertaken in August 2001 has been brought to the attention of the different stakeholders in the State. more attention is given to LGAs that are not performing well. million tablets) has been collected and distributed to the LGAs for treatrnents in the communities. More could have been procured from NOCP but the project was faced with tirne constraints and wanted to ensure that huge balances are not carried over to the next treatment cycle. mobilized in all the treated LGAs, and most of them went back to mobilize their communities. stakeholders meeting at the community level was initiated in 30 communities in 3 LGAs. These were carried out with UNICEF funds and in collaboration with NOCP. been to address record WHO/APOC. 26 Septernber 2003 keeping at the community level. guides have been produced to enhance CDD training. produced with the sum of :N:220,000 as part of efforts to address poor health education. They were then distributed to the various LGAs. LOCTs was held to assess implementation of activities/ recommendations. from NOCP for use during visits to the communities. 67 vii Provide the UTG Although the project has some tentative data on target population for all the areas it is treating, a good population update is yet to be done. A general population census update is being planned. Once this is done the project shall be able to provide the UTG. 67 viii Collate outstanding treatment All treatment data for the year has been data and complete and provide collected and collated. They are presented UTG in the report. The issue of UTG has already been highlighted. 67 ix Subrnit a Year 2 technical report A technical report using the old format had been submitted at the tirne it was demanded for, and forwarded to APOC Management. Efforts has been made to prepare and submit a revised Year 2 report using the new repofting format. A lot ofgaps are apparent as data was not collected for some indicators. 2 WI-tO/APOC. 26 September 2003 Executive Summary I 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 3.9 million. The major ethnic groups are the Tiv and ldoma. 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 1,374,276. All communities were reported to have been covered but total number of persons treated stands at 824,271 thus achieving a 60%o therapeutic coverage. Eleven (l l) SOCTs and 180 LOCTs, were formally trained on CDTI. The same number of SOCTs and LOCTs in 3 LGAs were trained on CSM and SHM. Though 540 health facility stafl 540 others and 3,000 CDDs were planned to be trained, these could not be done due to lack of funds. However, 186 CDDs were trained by various LOCTs at their own initiative. A total of 234 district chiefs participated in advocacy workshops organized by the project. An advocacy workshop was also held for policy makers at State and LGA levels. The outcome of these includes the release of bicycles by some LGAs forCDDs as a form of encouragement. Some community leaders who had disallowed their communities from taking Mectizan on account of side reactions were encouraged not only to allow its distribution but also to support the programme. This followed testimonies from satisfied users at the meeting. This facilitated compliance within the project area. The project has succeeded to some degree in empowering communities to consider and determine their own health needs. There are committed staff at LGA and State levels. A reasonable level of awareness of the magnitude of the Onchocerciasis problem exists at various levels. The major challenges facing the project include inadequate understanding of communities of their roles under CDTI, inadequate commitment of some health staff due to non - payment of salary arrears, frequent change of policy makers, obtaining an authentic and reliable estimate of the total population of endemic communities and ensuring proper record keeping at all levels and getting the State and LGAs to release counterpart funds.