i NATIONAL ONCHOCERCIASIS TASK FORCE NIGERIA.

ORIGINAL: English

ANNUAL PROJECT TECHNICAL REPORTSUBMETTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

AFFICAN PROGRAMME FORONCHOCBRCTASTS CONTROL (APOC)

WHO/APOC, 24 November 2004;-).t ,

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C O UNTRY/I'{ O T E :NIGERI,4 Proiect Name: N,4 SARAWA

Approval vear:1997 Launchins yearz 1998

Reportine Period: From:l't June 2004 To:31.'t May 2005(Month/Year) (Month/Year)

Proi ect yes Lol ttritlepart : (circleone)1 2 3 4 5 (6)7 8 9 10

Date submitted: 23/8/2005 NGDO oartnerz Global 2 000

//.--- -- ,_.-_

ANNUAL PROJECT TECHNICAL REPORTTO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSEMENTPlease confirm you have read this report by signing in the

appropriate space.

OFICERS to sign the rePort:

County

,,b-iNational Coordinator N

Signature:

Zonal Oncho Coordinator Narte

Signature:

Date:.*1

\Date:

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ely"w:

NGDO Representattve N,ouJo#d 4, Sf'119?u

Signature

Date

This report has been prepared by Namei4

Designati

Signature

.A. (IMAR

Date: .Z44-_ o*- Ot

SPO

Table of Contents

ACRONYMS

DEFINITIONS

FOLLOW UP ON TCC RECOMMENDATIONS..

EXECUTIVE SUMMARY.......

SECTION I:BACKGROIIND INFORMATION......

vVI

I2

3

t.tt.t.t1.1.21.2

GENERAL INFORMATIONDescription of the project (brieJly)...Partnership..POPULATION.., ...

SECTION 2: IMPLEMENTATION OF CDTI2.1 TIMELINE OF ACTIVITIES......2.2 ADVOCACY2.3 MoBILIZATIoNS, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES

) 3-455

2.4

2.52.62.6.12.6.22.6.32.6.42.6.2.72.82.92.9.1

2.9.22.9.3

COMMUNITY INVOLVEMENT...CAPACITY BUILDING..TREATMENT.........Treatment figures... ...

llhat are the cases of absenteeism?......llhat are the reasons for refusal? ...

Briefly describe all known andverified serious adverse events (SAEs) that...........Trend of treatment achievementfrom CDTI project inception to the current year..ORDERING, STORAGE AND DELIVERY OF IVERMECTIN.........COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING. .. . . ...

SUPERVISION......Provide aJlow chart of supervision hierarclty...What were the main issues identified during supervision? ...

6677

8

9-10l0l0t0ilI t-12I t-t3l415

16

t6t6t6t6t616

3.1

3.23.33.4

t7t718

l8l9

Was a supervision checHist used? ...

2.9.4. What were the outcomes at each level of CDTI implementation supervision?...2.9.5 Was feedback given to the person or groups supervised?2.9.6 How was thefeedbock used to improve the overall performqnce of the project?

SECTION 3: SUPPORT TO CDTI.......EQUrPMENT............FINACIAL CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIESOTHERFORMS OF COMMUNITY SUPPORTEXPENDITURE PER ACTIVITY..

SECTION 4: SUSTAINABILITY OF CDTI.......

INTERNAL; INDEPENDENT PARTICIPATORY MONITORING; EVALUATIONWas Monitoring/evaluation carried out during the reporting period? (tick any of the

following which are applicable)...What were the recommendations?...How hqve they been implemented?

4.14.1.1

4.r.24.1.3

20

20

202020

WHO/APOC, 24 November 2004iii

4.2 SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT 20Yr 3)..

4.2.14.2.24.2.34.2.44.2.54.34.3.14.3.24.3.34.3.44.3.54.3.6

Planning at all relevant levelsFunds... ... ... ..

Transport (replacement and maintenance)... .. . . .

Other resources... ... ...

To what extent has plan been implemented... ... ..

INTEGRATION......Ivermec tin deliv ery mec hanis m...TrainingJoint supervision and monitoring with other programs..Release offunds for project activitiesIs CDTI included in the PHC budget?...Describe other health programmes that are using the CDTI structure and how thiswqs achieved. What have been the achievements? ... ... ...

Describe other issues considered in the integration of CDTIOPERATIONAL RESEARCH... ...

Summarize in not more than one holf of a page the operational research undertaken inthe project area within the reporting period...How were the results applied in the project?... ... ...

2020202020202l212t2t2121

4.3.74.44.4. t

21212t

4.4.22t2t

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SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.. 22

Section 6: Unique feature of the project/other matter

WHOiAPOC, 24 November 2004lv

Acronyms

APOCATOAtrOCBOCDDCDTICSMLGAMOHNGDONGONOTFPHCREMOSAESHMTCCTOTUNICEFwHoLFEPLFHSHFSMDPMEC/AC

African Programme for Onchocerciasis ControlAnnual Treatment ObjectiveAnnual Training ObjectivesCommunity-Based OrganizationCommunity-Directed DistributorCommunity-Directed Treatment with IvermectinCommunity Self-MonitoringLocal Government AreaMinistry of HealthNon-Governmental Development OrganizationNon-Governmental OrganizationNational Onchocerciasis Task ForcePrimary Health CareRapid Epidemiological mapping of OnchocerciasisSevere Adverse EventStakeholders meetingTechnical Consultative Committee (APOC scientific advisory group)Trainer of TrainersUnited Nations Children's FundWorld Health OrganizationLymphatic Filariasis Elimination ProgrammeFirst Line Health FacilityHealth Facility StaffMectizan Donation Program.

Mectizan Expert Committee I Albendazole Co-ordination.

vWHO/APOC, 24 November 2004

Definitions(D Total population: the total population living in REMO/hyper-endemic

communities within the project area (based on REMO and census taking).

(iD Eligible population: calculated as 84Yo of the total population inmesoAryper-endemic communities in the project area.

(iii) Annual Treatment Objective: (ATO): the estimated number of personsliving in meso/tryper-endemic areas that a CDTI project intends to treatwith Ivermectin a given year.

(iv) Ultimate Treatment Goal (UTG): calculated as the maximum number ofpeople to be treated annually in meso/hyper-endemic areas within theproject area, ultimately to be reached when the project has reached fullgeographic coverage (normally the project should be expected to reach theUTG at the end of the 3'd year of the project).

(v) Therapeutic coverage: number of people treated in a given year over thetotal population (this should be expressed as a percentage).

(vi) Geographical coverage: number of communities treated in a givenyear over the total number of meso/tryper-endemic communities as

identified by REMO in the project area (this should be expressed as apercentage).

(vii) Integration: delivering additional health interventions (i.e. vitamin Asupplements, albendazole for LF, screening for cataract, e.t.c) throughCDTI (using the same systems, training, supervision and personnel) inorder to maximize cost-effectiveness and empower communities to solvemore of their health problems. This does not include activities orinterventions carried out by community distributors outside of CDTI.

(viii) Sustainabilitv: CDTI activities in an area are sustainable when theycontinue to function effectively for the foreseeable future, with hightreatment coverage, integrated into the available healthcare service, withstrong community ownership, using resources mobilized by thecommunity and the government.

(ix) Community self-monitorins (CSM): The process by which thecommunity is empowered to oversee and monitor the performance ofCDTI (or any community-based health intervention programme), with a

view to ensuring that the programme is being executed in the wayintended. It encourages the community to take full responsibility ofIvermectin distribution and make appropriate modifications whennecessary.

Vi

WHO/APOC, 24 November 2004

FOLLOW UP ON TCC RECOMMENDATIONS

The recommendations ofthe last TCC on the project and how they have been addressed.

TCC session_l R

Number ofRecommendation inthe Report 120:

TCC RECOMMENDATION ACTIONS TAKEN BY THE PROJECT FORTCC/APOCMGT ASEONLY

120: i Intensifu advocacy for release offunds by State/LGA

Advocacy has been intensified but State couldnot releasefundsonlylGAtoreleaseN I 96,000($1,468.16) for CDTI activities..

120:ii Used new format in subsequentreport

The new format has been used during currentreport writing.

120:iii Increase the number of CDD The number of CDD has been increased from1808 to 2851.

720:iv Provide missing informationManagement of SEAUTG

Special advocacy workshop.

Revised ATO of 6 LGAs

Monitory/supervision

Ordering,storage and delivery ofivermectin

Plan for integration.

Serious advert events was not recorded.

The project is matured and has attained 100%geographical coverage.

Special advocacy workshop was carried outby Dr. K. Korve in 2001 and the report wassent to APOC Head quarters through NOCPNigeria. We do not have a copy now.

The 6 LGAs from Nasarawa state are beinghandled by LF. Being hyper endemic for LFand hypo-sporadically endemic for Oncho.

Monitory/supervision has been carried out bySPO, SOCTs, LOCTs, HFS and communityleaders.

Ordering storage and delivery of ivermatin iscarried out systematically from community toLGA-state and the NGDO.

Health workers (State/LGA) are beinginducted on CDTI.Integration is being carried out in the projectinvolving Oncho, LF, Schisto, RBM and NPI.

Structures and staff for CDTI are used orinvolved in LF/Schisto/RBM simultaneouslyor whenever scheduled. Similarly none CDTIstaff and facilities are involved in CDTIactivities

I

D(ECUTIVE SUMMARY

The implementation of CDTI in Nasarawa State started, when APOC' letter of agreement wassigned in April 1998. Presently the project is in its 6th year of APOC assistance (June 2004-May200s).

CDTI is being carried out in seven LGAs in Nasarawa State, Akwanga, Kokona, Karu, NasarawaEggon, Lafra, Toto and Wamba. The total population of the 589 at risk villages was 988,161during the period under review.

The state project office carried out village mobilizationAlealth Education in all the 589 villages.

Most villages came out in mass to take Mectizan during distribution June 2004 -May 2005,communities are voluntarily putting efforts to contribute and support their CDDs. A total of 584vi0llages supported 1338 CDDs within the period.

Target, 2851 CDDs: (1043 kindred and 1808 existing)

CDDs trained: 2851 : 100o/o: Kindred 1043 or 100%Old CDDs 1808 or 100%

Target:LOCTs: 2I Trained: 18 : 85.7%Front Line health workers trained is 150 out of I75 or 85.7%

TREATMENT:- Treatment activities were carried out in the 7 APOC assisted LGAs. A total of 753,227

persons out of 988161 were treated representing 76.2oh therapeutic coverage in 589villages representin g I00% geographical coverageThe ration of CDDs to the population is one CDD to 347 people.

Drugs: The project received a total of 3,257 ,842 tablets of mectizan and used 2,315,906 forOncho and 669,549 for LF. Treatment Balance of the drugs in the field is 272,387 .

LGAs contributed N196, 000. ($1,468.16), Lafia LGA N31, 000. (5232.21), Kokona LGAN65, 000. (S486.89), Wamba N20, 000. ($149.81). Nasarawa Eggon N20, 000 ($149.81),ToTo N20, 000, ($149.81), Karu N20, 000, ($149.81), and Akwanga N20, 000, ($149.81).

Communities contributed N562, 445, ($4,213.07) to support CDTI activities in the State

Constraints.' -There was poor counterpart fund from both the state and the LGAs.

Advocacy visit was carried out by the Country Representative Dr. E.S Miri, National DirectorOncho/LF/Schisto in company of Project Administrator and State Oncho Co-coordinator to theCommissioner for Health and Commissioner for Local Government and Chieftaincy Affairs ontheir responsibility for effective control of Onchocerciasis by contributing their quarter ofcounterpart funds in both state and the Local Government.

2

Section 1:

1.1 General information

INTRODUCTION (BACKGROUND INFORMATIOI\N

LOCATION:

Nasarawa State lies between lat.70 and 90 degree North, longitude 7 and 100 degree east. It is bordered onthe North by Kaduna/Plateau State, on the South by Taraba State and on the East by Plateau State and onthe West. The State has an area of 27116.8 sq. km. It lies territory (FCT) Abuja to the South and Benueand Kogi to the West

POPULATION:

Nasarawa State has a total census population of about 2.3 million (based on 1991 census projections). Itis estimated that approximately 900,000 thousand people are at risk of Onchocerciasis and about 446,859thousand are infected with over 1,200 persons visually impaired in the State.

CLIMATE:

Situated in the tropical zone, the climate of Nasarawa State is both hot and cold. The state lies wholly inthe tropics with and pleasant climate and a mean temperature of 600rand 800r (maximum). Annual rainfallvaries from 13l.75cm in some places to l45cm in others. The 3 months in the year, December, Januaryand February are cold and known as the Harmatan season.

PEOPLE:

The state is inhabited by over 24 ethnic groups with common historical and cultural affiliation with nosingle group large enough to either dominate or claim majority position. The people are both hospitableand accommodating and have almost similar cultural and traditional ways of life. People from other partsof Nigeria Co-exist peacefully with the indigenes of the state.

The 24 major tribes found in the state include: - Alago, Agatu, Ake, Arum, , Afor, Eloyi, Bassa, Chessu,Egbura, Egorma, Eggon, Fulani, Gade, Gbagyi, Gwandara, Hausa/Fulani, Kamberi/I(anuri, Kantana,Kwarra, Mada, Mama, Migilli, Rindre, Tiv and Yeskwa. The name of the ethnic groups goes with theirlanguage, 80% of the people live in rural communities with agriculture as their main occupation, 20oh arein urban areas practicing small and large businesses.

CULTURE:

The importance of culture can not be over emphasized considering the rich culture of the state. Theseplay an important role in the lives of the people of Nasarawa state in showcasing its rich culture annuallythrough culture festivals. Amongst them are the famous and annual Oganni cultural and fishing festival atUmaisha of panda Chiefdom in Toto LGA, salt festival in Keana, the Omadege in Nasarawa, Odu inDoma etc.

COMMT]ITIICATION SYSTEM (ROADS) :

Nasarawa State has very good networks running across the state and other neighbouring states of Benue,Plateau and the Federal Capital Territory. Local Government Headquarters are also linked with goodroads to facilitate transportation of human and material resources. The state has and estimated populationof 2.3 people with 70%o of them in rural areas practicing agriculture. Rural settlement are either clustered

J

or scattered with a minimum population of 250 people per settlement30%o of the population live in urbanareas.

HEALTH SYSTEM STRUCTURE:

Nasarawa State Health System is well structured such that Oncho Control unit is under thedirectory of PHC/DC, which is headed by the SPO who is answerable to the Director PHC/DC ofthe Ministry of Health. All communication are passed through the Director PHC/DC up to theHon. Commissioner.At the LGA level, each has five Primary Health Care district referred to as referrer centres headedby District Head Supervisor. In each health district there are health posts or first line healthfacilities (FLHF) headed by health facilities staff (HFS) who over see the activities of CDDswithin their catchments areas.(See table 2 on population of CDTI LGAs)

A Primary Health Care Director who supervises all Health activities in the LGA is the head ofeach LGA health department. The State Ministry Health developed policies and sends them theLGA for implementation. Each LGA has 33 staff that are involved in CDTI activities. At thestate level, there are 7 personnel who carry out Onchocerciasis Control activities. They include:The SPO, 4 SOCTs , I Data Clerk, and I Driver. The programme is integrated in to the PHCsystem at both the state and local government levels.

Table 1: Number of health staff involved in CDTI

District/LGA Number of health staff involved in CDTI activities

Total Number ofpercentagehealth Staff n theentire project area

B1

Br:BzlB/*100

Number of health

staff involved inCDTI

B2

AKWANGA 301 33 t0.9%

KARU 329 33 t0%

KOKONA 218 33 15.t%

LAFIA 342 33 t4%

NAS/EGGON 256 33 12.8%

TOTO 216 33 15.2%

WAMBA 207 33 15.9%

Total 1,869 231 12.3o/o

4

1.1.2 Partnership (role of each partner) state, LGA/Communities

The state is the implementing agency and her major roles included planning, staffing, manpowerdevelopment, advocacy, counterpart funding, Mobilization/Health education and supervision/distribution.NGDOs are found mostly in cities and state headquarters. They provide cash and logistics to CDTIimplementation, provides technical assistance to the project, advocacy to high government functionaries,procurement of Ivermectin tablets from MSD and development of Health education materials, while MSdprovides mectizan tables, though WHO, Nigeria.

The roles of Local Governments include Planning, Staffing, Training, Distribution, Supervision,Mobilization and Health Education.

The roles of the communities include collection of mectizan, selection of CDDs, provision of registrationbooks and incentive to CDDs.

CBOsz These are philanthropic and religions organizations based in urban communities. They providesupport to CDTI implementation such as providing transportation to CDDs during training, mobilizationand supervision.

Policy makers: Budget and release of funds for CDTI implementation and give technical advice forsmooth running of CDTI activities.

I.2 POPULATION:Table 2: Communities and population at risk in the entire project area whether they are treated or notduring the reporting period.

Number of Communities/Villages in Population of

CDTIDistrict/LGAsin the entireproject area

Totalpopulation in theentireproject

area

Meso-endemic zonein the project

area

Ar

Hyper-endemic zonein the project

area

A2

Total inmeso/hyper-

endemiczone

Ar=A/+Ar

Meso-endemic zonein the

projectareaAI

Hyper-endemic

zone in theproject

areaA5

Total inmeso-hyper-

endemiczone

Ac=A/+As

Ultimatetreatment

Goal

(UTG)AKWANGA r45676 102 102 145676 145676 I I 8943

KARU 168622 99 99 168622 168622 152941

KOKONA 71629 47 47 71629 71629 64347

LAFIA 262079 72 72 262079 262079 228608

N/EGGON 144587 82 85 144587 144587 134186

TOTO 88007 99 99 88007 88007 83291

WAMBA 107s61 85 85 107561 107561 95400

Total 988161 388 201 589 754478 233683 988161 877716

5

I

WG: calculated as the maximum number to be treated annually in meso/hyper endemic areas within theproject area, Ultimately to be reached when the project has reachedfull geographic coverage (normallythe project should be expected to reach the UTG at the end of 3'd year ofthe project).

The seven CDTI endemic LGAs have a population of 988161 and732067 eligible population.Source ofdata on the table above arel. CDDs2. HFS3. DHS4. LOCts

SECTION 2: Implementation of CDTI

2.1 Timeline of activities

The project year for CDTI implementation is from June 2004 to may 2005 (One year). Majority of CDTI

activities especially training, distribution, supervision and collection of mectizan etc. are done during the

dry season period when people have less to do in their farms. High peak period of activities falls between

January and July (See table 3,). However, this call spills over to December.

Table 3: Timeline of activities June 2004 - May 2005

llB: All activities are targeted with occasional spot-checking and co-ordination of supply.

6

DiSULGA

Mobilization ofCommunities

Treining July 2004to May 05

Census/Update August2004-March 2005

Drug distributionAugust 2004 - May

2005

Supcrvision Aug.2004

- May 2005

Startingmonth

Completionmonth

Startingmonth

Completionmonth

Startingmonth

Completionmonth

Startingmonth

Completionmonth

Startingmonth

Completionmonth

Akwanga June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Karu June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Kokona June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Lafta June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Nas/Eggon June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Toto June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

Wamba June 04 May 05 July 04 May 05 Aug.04 March 05 Aug.04 May 05 Aug.04 May 05

2.2 Advocacy

Advocacy visit was carried out to Commissioner for Health, Permanent Secretary Minishy for LocalGovernment and Chieftaincy Affairs and the LGA Chairmen and Community leaders of the sevenendemic LGAs on sustainability of the CDTI activities: by NGDOs Country Representative, PA./OnchoCoordinator and Director LF, Schisto and Oncho.

The main issues discussed were on sustaining the programme through counterpart contribution. Promiseswere made by State and local Government for the contribution of their counterpart fund. However, LGAsgave N196,000 ($1,468.16) for the collection of the additional APOC donated equipments; and to supportCDTI activities.

The projectwishes to requestthe assistance of NOCP and Global 2000 The Carter Centerto assist inthearea of advocacy to the executives at both state and local government levels to facilitate the release offunds for project activities.

2.3 Mobilization, Sensitization and health education of at risk communities.The objective ofthe project was to reach and mobilize 589 communities concerning CDTIactivities through: -

The use of Town announcer or town criers, posters, videos, radio jungles etc

Health education of Women and Minority groups is done through Women Leaders, Religionsleaders, Market Women Union, Youth Leaders etc.

- The response of target communities/villages: they accepted the CDTI and promised to giveincentive to CDDs in kind or in cash, as the programme belong to them.

The outcome of the mobilization/health education was impressive at the community levels, all589were mobilized of their roles and responsibilities in CDTI. This is indicated by a therapeutic coverageof not less than 76.2% and 100%o geographical coverage.

7

District/LGA Number of communities/villages w withcommunity members rs supervisors

Number of CDDs and thecommunities involved

Number ofcommunities/villeges with

femalc CDDsTotal

no,Communitiesin theentireproject

area

B4

Number withcommunitymembers as

superyisors

Bs

Percentage

Be:Bs,/B.* 100

MaleCDDs

B7

FemCDDs

Bs

Total

Bs=Bu*Br

Number ofcommunitie

s withfemaleCDDs

Bto

Percentage

Brr=Bro/B{*100

AKWANGA 102 t02 t00% 321 65 386 t6 16.8%

KARU 99 99 100% 326 134 460 34 29.r%

KOKONA 47 47 100% 196 69 265 17 26.0%

LAFIA 72 72 100% 447 144 591 36 24.3%

NAS/EGGON 85 85 100% 442 123 565 3l 21.7%

TOTO 99 99 100% 216 66 282 l8 23.4%

WAMBA 85 85 100% 289 r3 302 5 4.3%

Total s89 589 100% 2237 605 2851 157 21.2o/o

2.4 Community involvement

Table 4: Communities participation in the CDTI

Comment on:

I

Comments on females performance on CDTI activities:-

The attendance of female members of the Community at health education is notencouraging, as men are not giving that opportunity to women. In all endemic communitiesfemale CDDs are selected based on socio cultural and region believes.

In all the endemic communities female CDDs are selected based on socio cultural andreligious beliefs.

2

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Trainees

Type of trainingCDDs

Othercommunitymembers e.gcommunitysupervisors

HealthWorkers(Frontlinehealthfacilities)

MOH staff orOther

Politicalleaders

Others (specify)

ProgrammmanagementHow to conductHealth educationManagement ofSAEsCSM I ISHM IData collection IData analysis I IReport writing I IOthers (specify)

Table 6: Type of Training undertaken

Training caruied out during the reporting period)

2.6 Treatments

2.6.1 Treatmentfigures:

Total census populationEligible populationTreated populationTherapeutic coverageGeographic coverage

988,1618777t7753,22776.2%100%

2.6.2 Causes of absenteeism:Absenteeism reported during the distribution period were 6608 persons or 0.75yo of the total eligiblepopulation.

REASONS:(1) Not treated at the time community needed/selected(2) Out for farming during raining season(3) Out for other businesses during treatment

l0

-_]

(l)(2)(3)

2.6.3 Reasons for refusal:

Reaction during treatmentNot willing to give incentive to the CDDsFeel they don't have any infection to take the drug

ln case the project did not have any cases of serious adverse events (SAE) during this reportingperiod, please tick in the box

2.6.4

No SEA case to reportI

Table 7: Treatment and SAEs by district/LGA in all areas at risk (June 2004-may 2005)

District/LGA Communitics/Villages Population NO. ofper.ref.

treat

Numberoof

rbscntism

NO.of

SAEs

NO. ofseriousadverscevents(SAEs)

rcf.

post/hosp

Total #ofcom.lvill. in

themeso/hyp

er-cndemic

orcls

D,

AnnualTreated

Objective

D:

No, ofcomm-unitics/villagc

s

trcated

D3

Geogcoveragc

(%)

IFDs/Dr*100

Totrl pop.of the

meso/hyper-endcmic

erers

D.

Anu.Trc-ated

Objective

Dr

No.r ofpcrstrc

etcd

D7

Thera-peuticcov.(%)

AKWANGA 102 93898 102 100 145676 I I 8943 I I 8943 8l 6% 0 0 0 0

KARU 99 144949 99 100 168622 15294t I 52000 9O.1o/o N/A 376 0 0

KOKONA 47 157313 47 100 7 t629 64347 s8200 8t 2% 2459 0 0

LAFIA 72 149249 '7) 100 262079 228608 150997 57 60/o 0 0 0

NAS/EC,C,ON 85 I 361 46 85 100 144s87 134186 129500 89.5o/o 1874 0

TOTO 99 80349 99 100 88007 83291 78542 592% I 899 0 0

WAMBA 85 70644 85 100 I 0756 I 95400 6s045 60 5% 0 0 0

Total 5E9 732067 s89 100 9E8l6l E77716 753227 76.2Vo N/A 0

ll

S/N Age Sex Villegcof

ongrn

Datcmectizrn

was teken

Drtc l"sympts

appeared

Sympt Healthstrtusbcforeteking

mcctizan

Drtcofedm in

healthfaci.

Date ofdismissal fromhealthfacilitv

Results oftests (thick

blood smear

Outcomc of

prognosis

Extenuating orcomplicatingcircumstances

No serious adverse events were experience/reported

Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period

2.6 Trend of treatment achievement from CDTI project inception to the current yearSince treatment started in 1998 - May 2005 there has been a progressive increase in the number ofpersons treated each year.

t2

Year Communities/villages PopulationTotal # ofcom/villagesin themcso/hypcr-cndemicareas

Er

AnnualTrcatedObjcctives

Ez

Numbcrofcommunities/villagcs treated

Er

Geogcov.(o/o)

ErE!Er *100

ATOcov.(%)

Es=EJE2*100

Totalpop.ofthemeso/hyper-endemic areasE6

AnnuelTrcatcdObjectives

E7

Numbcrofpen.treatcd

Er

Thcrapeuticcovcrage(o/o)

Eg=EE/E

6

100

ATOcoverlge (o/o)

Ero-Er/E:*100

UTGcovcrlgc(o/o)

t998t99 589 42E000 589 100 100 1,3217

64

685,000 657211 49.7

%

96% 765

199912000 s89 43s930 589 100 100 1,289,8

3

l0l 3 160 8335 l 0 64.6

%

82.2% 79 6%

2000/2001 589 538400 589 100 100 894013 756258 717881 80.2

%

94.9o/o 94.9%

2001n002 589 538400 589 100 100 113447

7

1 03398 I 943897 83.2

o/o

9t.2% 91.2o/o

2002t2003 589 785085 589 100 100 974608 911278 1046578 106

7

fi42 106.7

2003D00,4 589 732067 589 98 9o/o 98.9% 872768 860768 7 12702 8l.6

%

82 Jo/o 82.8%

200412005 589 '132067 589 t00% 100% 988161 877716 7s3227 762

%

85.8% 85 8%

Table 9: Treatments and coverage for June 04 - May 05 by calendar year for entire project area.

UTG for the project area: 877,716 persons

l3

2,7 Ordering, Storage and delivery otlvermectin

MOHMectizanI ordered/applied for by -

wHo tr T'NICEF tr NGDO

UI\ICEF tr NGDO

Other (Please speciry): MOH

Mslfflivered bv - (Ptease tick the appropriate answer)r

Other (Please specifu)

Before the procurement of mectizan is done by NGDo, each CDD calculates his or her mectizanrequirement based on the eligible population registered and multiply by average of three tablets.Together with FLHFS they arrived at their requirement for each village who send to the focalpersons at the LGA (LOCT) to the DHS then to the SOCTs. The SOCTs/SPO compile allrequirements for the seven LGAs and send to the NGDO for procurement. When mectizan arrivesin the country, WHO clears from the Customs and stores it in their ware house. The NGDOs thencollects the drugs to her store. The state project officer put up requisition for each LGA.

When mectizan is supplied to the SPO by NGDO, SOCTs collect for their respective LGAs anddeliver to the LOCT team leaders at the LGA levels. The team leader then hand over the drugs to

The five DHS for allocation to the five FLHF or collection centers where CDDs come to collectfor their respective communities.

Table 10: Mectizan Status

State/Dist/LGA

Number of Mectizan tablets

Requested Received Used Lost Wasted Expired balance

Oncho LF

AKWANGA 451,344 451,344 281980 166020 3344

KARU 773,008 773,008 613882 103625 s5501

KOKONA 328,034 328,034 I 84389 2300 141345

LAFIA 675,758 675,758 253258 397604 25096

N/EGGON 597705 597705 597705

TOTO 249,442 249,442 203157 46285

WAMBA 182,351 182,351 181535 816-

STORE

Total 3257842 3257842 2315906 669549 272387

t4

2.8 Community self-monitoring and stakeholders meeting not carried out during period

Table 11: Community self-monitoring and stakeholders meeting not carried out

District/LGA Total # ofcommunities/villagesin the entire project

area

No of communitiesthat carried out selfmonitoring (CSIvf)

No of communitiesthat conducted

stakeholders meeting(sHIvr)

AKWANGA 102 0 0

KARU 99 0 0

LAFIA 72 0 0

KOKONA 47 0 0

N/EGGON 85 0 0

TOTO 99 0 0

WAMBA 85 0 0

TOTAL 589 0 0

l5

2.9 Supervision

Flow chart of supervision hierarchy2.9.1

ZONAL COORDINATOR

NGDO (Dir./PA) STATE

sPo/socT

LGA

LOCT/DHS

CLINIC

HFS

COMMUNITY COMM.LEADERS/CDDs

L------------

2.9.22 What were the main issues identified during supervision?

Some CDDs do not use durable registers like hard cover note booksSome communities give incentive to their CDDs while others don'tInadequate logistic for supervision at LGA levelslnadequate IEC materials.

2.9.32 Was a supervision checklist used?a. Supervision checklist is used during supervision by each level of health staffinvolved in CDTI activities.

2.9.4: What were the outcomes at each level of CDTI supervision?- SOCts are involved in mobilization, training, and supervision at the LGA level

while LOCts and DHS mobilize, train, monitor and supervise health facility staffand CDDs at community level.

I2

3

4

16

SECTION 3: SUPPORT TO CDTI

3.1. Equipment

Table 12: Status of equipment

Condition of the equipment (F - functional, CNFR - Currently non functional but repairable, WO Writtenoff) NA NOT AVAILABLE.

s/N TYPEOF

EQUIPMENT

APOC MOH DISTRICT/LGA NGDO/GLOBAL2000

OTHERS

No Condition No Condition No Condition No Condition No Condition

I Vehicle I 1t|/O Nil Nil Nil Nil2 Motor-

cycle14 4WO

10FNil Nil 12 WO S IrO Nil

J Comp. 2 IFII4/O Nil Nil Nil Nil4 Printer 2 IFIWO Nil Nil Nil Nil5 Photo-

copierI I CNFR Nil Nil Nil Nil

6 Tele-vision

I IF Nil Nil Nil Nil

7 Video I 1F Nil Nil Nil Nil8 Generat

orI IF Nil Nil Nil Nil

9 Stabilizer

I 1 CNFR Nil Nil I CNFRI Nil

10 Phone Nil Nil Nil Nil I F Nilt1 Standin

c-fan

Nil Nil Nil Nil I F Nil

t2 Refri-Rerator

Nil Nil I F Nil Nil Nil

t3 Tables Nil Nil 6 F Nil NA 7 F Nil14 Chairs Nil Nil 6 F Nil NA 3 F Nil15 cup-

boardNil Nil Nil Nil Nil Nil

16 File -cabinet

Nil Nil Nil Nil 2 F Nil

t7 P,Asystem

Nil Nil Nil Nil Nil Nil

t8 Bicycles 35 2tF9 CNFR5WO

Nil Nil t6 13F3WO

NIL

19 Officesafe

Nil Nil Nil Nil Nil Nil

t7

Contributor Year I (2003) Year 2 Q004) Year 3 (2005)Totalbudgeted

Grs$)

Totalreleased(us$)

Totalbudgeted(us$)

Totalreleasedrus$)

Totalbudgeted(US$)

Totalreleased(us$)

The Ministry of

Health (MOH)

I 498.1 Nil 1498.1 Nil I 498. I 1498.1

DistricVLGA 112.3 112.3 973.7 973.7 1468.16 I 468.16

The Local NGDO (S) Nil Nil Nil Nil Nil Nil

The NGDO partner(s) r27828.58 97750.233 95099.333 9298r.653 231s07.11 231507.11

Others Nil Nil Nil Nit Nil Nil

Communities 1303.3 1303.3 1746.6 1746.6 422 6522.6

APOC Trust Fund 49622.57 49622.57 29542.91 29542.91 31500 3r500

Total 180364.85 148788.403 128860.643 125244.863 266395.37 272495.97

3.2 Financial contribution by all partners for the last three years

Table 13: (N133.50 : us$1.0

If there are problems with the release of counterpart funds. How were they addressed?Advocacy visits were made to the relevant policy makers.Additional Comments;High-level advocacy to the various government levels by NGDO, APOC, and NOCP is solicited

3.3 OTHER FORMS OF COMMUNITY SUPPORT:In Nasarawa State most of the incentive for CDDs are in cash and the food items such as yams,rice, g/corn etc.

Indicate in table 14 the amount expended during the reporting period for each activity listed.

Write the amount expended in US$ using the current united nation exchange rate to local currencyIndicate exchange used here N133.5 = US$1.000

l8

S/N ACTIVITIESNGDO APOC SMOH LGA

Akwanga Karu Kohona LaJiya N/eggon Toto Wamba

I Drugs delivery NA Nil Nil

2 Mobilizahon 34,125.00 Nil Nil

3 Training of CDDs 47,600.00 Nil Nil 486.80

4 Training of FIFs all

level

32,041.66 Nil Nrl

5 Supervising 168,223.33 Nil Nil 232.20

6 Intemal monitoring

of CDTI activities Nil Nil Nil

7 Advocacy visits to

health and politrcal

authonties

7291.66 Nil Nil

8 IEC materials Nil Nil Nil

9 Summary (reporting)

forms for treatment Nil NilNrl

t0 Vehicles/lvlotorcycles

/Bicycles

maintenance 90,650 00 28,000 Nil r49.90 149.90 149.90 149.90 149.90

1l Office equipment

(e.g computers,

printers etc) 2,333.33 3,500 Nil

t2 Side reaction

drugs/stationerres

39,974.66 Nrl Nrl

Total $2551.6 31,500 Nrl 149.90 149.90 486.80 232.20 149.90 149.90 149.90

3.4 EXPENDITURE PER ACTIWTY

Table 14: Project expenditure June2004 - May 2005N135.5 (us$1.0)

. Most activities were sustained by NGDO funding and the good will from the communitieso Expenditure per activities by Communities was not given.

t9

SECTION 4: Sustainability of CDTI

4.1. Internal; independent participatory monitoring; Evaluation

4.1.1 Was Monitoring/evaluation was carried out during the reporting period. NOYear I Participatory Independent monitoring

Mid Term Sustainabi lity Evaluation

5 year Sustainability Evaluation

_Internal Monitoring by NOTF

4.1.2. What were the recommendations?

4.1.3. How have they been implemented?

4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3)

Wastheprojectevaluatedduringthereportingperiod?-zo-

Was a sustainability plan written?

When was the sustainability plan submitted? April 2003

4.2.1. Planning at all relevant levels

Arrangement put on ground to sustain and implement CDTI activities in the state and LGAs

a. Planning, will be carried out at both state and LGA

b. The funds for running of CDTI implementation will be sourced from state government,

local government, communities and philanthropic organizations (CBOs)

4.2.2. Transport (replacement and maintenance)

Maintenance of project vehicle is carried out by GRBP and APOC. State Ministry of Health and

the LGA are yet to address this issue, but hopefully when their financial standing improves they

will embark on it soon.

4.2.3. Other resources - will be sourced from philanthropic organizations and CBOs.

4.2.4. To what extent has the plan been implemented:-

The recommendation of sustainability evaluation from GRBP stated thus-

a. Non release of counterpart funds

b. Non usage of measuring sticks by few CDDs

c. No incentive for CDDs in some communities

20

4.3.1

4.3.2

4.3.3

4.3.4

4.3

4.3.5

4.3.6

4.3.7

d. Few CDDs do not know how to calculate their drug requirement during the evaluation.

i. Counterpart funds issue has been addressed through the release of 5.4 million naira by

Nasarawa State.

ii. CDDs now use measuring sticks during treatment.

iii. Communities now give incentive to their CDDs to an extent.

iv. Retraining of CDDs by health facility staff has addressed the issue of drug requirement by

CDDs.

Integration

Integration of CDTI into PHC structure and the plans for complete integration:

Ivermectin delivery mechanisms - Donor, Federal, National, State, LGA, Community

Training - Training for CDTI activities are integrated with LF/Schisto and RBM training

simultaneously.

Joint supervision and monitoring with other programs- LF, Malaria, Schisto

Release of funds for project activities - release of fund by Ministry of Health is not forth coming.

Money was budgeted in 2002 but not released. However, 5.4 million has been budgeted and

released in 2005.

Is CDTI included in the PHC budget?

CDTI is included in the Ministry of Health budget for the year 2005.

Health programmes that are using the CDTI structure. LF, NPI and RBM Programmes.

Issues considered in the integration of CDTI- this is in the pipe line in the Ministry of Health and

Ministry for Local Government and Chieftaincy Affairs.

Operational researchTo summarize in not more than one half of a page the operational research under taking areawithin the reporting period? Yet to commence operational research.

4.44.4

4.4.2 How were the results applied in the project? The result will be used during distribution andtreatment period if carried out.

I

2l

SECTION 5: Strength, Weakness, Challenges and opportunities

Strength;

* High coverage geographical/therapeutic.* Time of treatment has been reduced because of more hands in the job.* More awareness by community on self-ownership.* Training of Oncho Team on CDTI activities is now a targeted training.* Collection centers are now nearer to the community making things easier for the CDDs

Weakness:

.t Drugs passing through many hands before reaching the community causes delay on treatment.* No adequate incentive to the CDDs by the communities.* No adequate counterpart funds by the State and Local Government.* Some CDDs left their job without handing over the registration books to their village heads* Clashes in some of the LGAs e.g. Toto LGA.* Strike in some LGAs.

Challenges:

1. Poor counterpart fund from state and local government

2. Poor incentive to CDDs by some communities

Recom m endations/Opportu nities :

* Overallbudget for State and LocalGovernment should include CDTI activities* Community should intensifu giving incentive to the CDDs.':' All hands should be on deck for all tiers of govemment and community for the sustarnabrlity of the CDTI actruties.

Section 6: Unique feature of the project/other matters

The project operations were integrated where the same staff at the State, Local and Community level wereinvolved in CDTI, LF elimination programme, Schistosomiasis control and roll back malaria activities

The project had the following achievements during the period under this reporting period in addition toCDTI:

NASARAWA ADD _ ON ACTIVITIES TO CDTI IN NASARAWA.

o *The ATO was based on gestimation of urban populations thus under estimated.o Entomological studies of Black flies and Mosquitoes were also ongoing to monitor impact on Lymphatic

Filaririasis and Onchocerciasis,

SAi PROGRAMME VILLAGES POPULATION

ATO COVERED ATO Vo ATO PERSONSTREATED

ATOVo

I Lymphatic Filaria 4 4 100% 786,641* 249,615 133.7%

2 Schistosomiasis 101 97 96Yo 56,910 55,107 96.\Yo

J RBM-ITNs

Distribution 103 99 96.1 28,983 24,872 85.8%

22