I I I I I 7,TH YEAR ANNUAL TECHNICAL REPORT FOR COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN GDTD PROTECT IN NIGER STATE. I I ORIGINAL: English COUNTRYAIOTF: Nigeria Proiecl l\auqa: NGNIGS Approvalvear: 1999 Launchinq year: 2000 Reportine Period: From: January 2006 To: December 2006 IMoNTH/YEAR) ( MONTH/rEAR) Proiectvearofthisreport: (circleone) I 2 3 4 5 6 (7) I 9 10 Date submitted: 28th January 2007 NGDO partner: UNICEF A}INUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 JuIv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL ( i I "^. I r-' . ]-rctJs 1 -'- -"- - J l 21 rEv 2ri0; 16r c* AilE 6fo to e\uL) I , Ji( to Af/ttth
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
I
I
I
I
I
7,TH YEAR ANNUAL TECHNICAL REPORT FOR COMMUNITYDIRECTED TREATMENT WITH IVERMECTIN GDTD
PROTECT IN NIGER STATE.I
I
ORIGINAL: English
COUNTRYAIOTF: Nigeria Proiecl l\auqa: NGNIGS
Approvalvear: 1999 Launchinq year: 2000
Reportine Period: From: January 2006 To: December 2006
IMoNTH/YEAR) ( MONTH/rEAR)
Proiectvearofthisreport: (circleone) I 2 3 4 5 6 (7) I 9 10
Date submitted: 28th January 2007 NGDO partner: UNICEF
A}INUAL PROJECT TECHNICAL REPORTSUBMITTED TO
TECHNICAL CONSULTATIVE COMMITTEE (TCC)
DEADLINE FOR SUBMISSION:
To APOC Management by 31 Januarv for March TCC meeting
To APOC Management by 31 JuIv for September TCC meeting
AFRICAN PROGRAMME FORONCHOCERCTASTS CONTROL (
iI "^.I r-' .
]-rctJs1 -'- -"- -J
l
21 rEv 2ri0;16rc*AilE6foto
e\uL)
I
, Ji(toAf/ttth
I
ANNUAL PROJECT TECHMCAL REPORTTO
TECHMCAL CONSULTATIVE COMMITTEE (TCC)
ENDORSEMENT
Please confirm you have read this report by signing in theappropriate space.
OFFICERS to sign the report:
Country: MGERIA
National coordinator Name: Mrs. P. Ogbu Pearce
Signature4T)
...ff**-v...Q.<---..
Zonal Oncho coordinator Name: Dr. Fayomi
Signature
ItDate: .5.1. /.t.1. ?rn't I
aeps-
Date
This report has been prepared by Name : Hajiya Rakiya.Y.Datti
Designation : Onchocerciasis coordinator
Date
NGDO representative Name: Dr (Mrs) Catherine Gana
Signature€
>Z-lszl ca" "'1"'r'1"
sigrrutur"#t12:f
Dare .* b.l. eLl I
It
Toble of content
DEFINITIONS, w
FOLLOIY UP ON TCC RECOMMENDATIONS, I
DGCUTIYE SUMMARY 2
SECTION I: BACKGROUND INFORMA
l.L GzttgnuINFqRMATIqN.
l.l.l Description of the project (briefly)
2.1
2.2.
2.3.
2.4.
2.5.
2.6.
2.6.1.
2.6.2
2.6.3
2.6.4
2.6.5.
2.7.
2.8.
2.9.
2.9.1.
2.9.2.
2.9.3.
2.9.4.
2.9.5.
2.9.6.
3
1.1.2 PtnnNonsarp...
1.2 POPULATION...
SECTION 2: IMPLEMENTATION OF CDTI ........... .... 12
.....3
..3-6
7-8
9-t I
TIMELNEOFACTIVITIES ....... 12-13
Aovoc.tcv. ......14-15
MoBITIz,InoII, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISKCOMMUNITIES................,. 15
Couuuunv INVoLVEMENr................. ...16-18
C.tp,qcrcy nwtDrNG.......... .. 18-22
Tnnaruotns. .........22
Treatmentfigures............. ......25
ll'hot are the causes of absenteeism?........... ...............26
What ore the reasonsfor refusals? ................ .............26
Briefly describe all krnwn andverified serious adverse events (SAEI that .................26-27
Trend of treatment ochievementfrom CDTI project inception to the cunent year.............28
ORDENNG, SToRAGEAND DELIVERr oF IVERMECTIN ..29-31
CouuuNrcy sELF-MoNrroRrNG tuo SrexanotDERS MEETTNG .... 3l-33
Suponwstox ...-.....33
Provide a/low chart of supervision hierarchy. ........... 33
What were the main issues identified during supervision? .......33-33
llas a supervision checHist used? ......... .....................34
Vlhat were the outcomes at each level of CDTI implementation supervision?.............. 34-35
Was feedback given to the person or groups superuised? .............. -15
How was the feedback used to improve the overall performance of the project? ..........35-36
lll
SECTION 3: SUPPORT TO CDTI.. ------.------- 37
3.1. Egwrur,ur ......37-38
3.2. FtNtxcut coNTRtBWtoNS oF THE qARTNERS AND coMMtJNtruES.... 39-40
3.3. Orntn FqRMS oF coMMUNrry suppoRT.. ......................40
(i) Total population: the total population living in meso/hyper-endemic communities within theproject area (based on REMO and census taking).
(ii) Eliqible populotion: calculated as 84%o of the total population in mesolhyper-endemiccommunities in the project area.
(ii i) Annual Treatment Obiective; (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) Utimate Treatment Goal (UTGI: calculated as the maximum number of people to be treatedannually in meso/hyper endemic areas within the project area, ultimately to be reached whenthe project has reached full geographic coverage (normally the project should be expected toreach the UTG at the end of the 3d year of the project).
(vi)
(v)
(vii)
(viii)
(ix)
Theraoeutic coverage: number of people treated in a given year over the total population (thisshould be expressed as a percentage).
Geographical coverage: number of communities treated in a given year over the total numberof meso/hyper-endemic communities as identified by REMO in the project area (this shouldbe expressed as a percentage).
Integration: delivering additional health interventions (i.e. vitamin A supplements,albendazole for LF, screening for cataract etc.) through CDTI (using the same systems,training, supervision and personnel) in order to maximise cost-effectiveness and empowercommunities to solve more of their health problems. This does not include activities orinterventions carried out by community distributors outside of CDTI.
Sustainabililv: CDTI activities in an area are sustainable when they continue to functioneffectively for the foreseeable future, with high treatment coverage, integrated into theavailable healthcare service, with strong community ownership, using resources mobilised bythe community and the govemment.
Community seV-monitoring (CSM\.' The process by which the community is empowered tooversee and monitor the performance of CDTI (or any community-based health interventionprogramme), with a view to ensuring that the programme is being executed in the wayintended. It encourages the community to take full responsibility of ivermectin distributionand make appropriate modifications when necessary.
vl
FOLLOW UP ON TCC RECOMMENDATIONS
Using the table below, fill in the recommendations of the last TCC on the project and describe howthey have been addressed.
TCC session I
Numberof
Recommendations in theReport
TCCRECOMMEN
DATIONS
ACTIONS TAKEN BY THE PROJECT FORTCC/APOCMGT USE
ONLY
(i) Focus on State andLGA financialcontributions.
Concerted effort was made both to the Ministry forLocal Government to obtain the proposed mandate forcentral deduction ofcounterpart contribution forthe 2lCDTI LGAs as well as to the Ministry of Finance forrelease ofUS$30,000 approved counterpart fund fortheState.
US$20,000 was released to the State but no mandatewas obtained for central deduction of LGAcontributions.
Only 2 LGAs released the sum of US$650 to theirLOCTs despite intense advocacy visits to all of the 2lLGAs
(ii) Replace and repairproject equipment.
Some project equipment were repaired and maintainedat State level, however, repair of LOCT motorcycles has
been difficult due to absence of counterpart funding atthat level.
(iii) Recruit more newfemale and maleCDDs.
Communities are continuously mobilized for inclusionof women as CDDs, but this is still difficult to achievebecause of religious and socio-cultural belief of thepeople especially the Moslems who happer to be themajority. There is a plan to collaborate with an islamicgroup known as FOMWAN, with the hope of improvingwomen participation. Absence of female CDDs does nothowever seem to have any negative effect on treatmentof females.
There is severe CDD attrition due to lack of motivation,and new ones are being selected both at ward level andalong family lines. CDDs are to be trained for integrateddisease surveillance and it is hoped that this wouldcreate opportunities for thern to be motivated alsothereby reducing threat of attrition.
(iv) Improvesupervision at alllevels.
There has been concerted effort by NOCP, UNICEF andthe SOCT to ensure that communities are adequatelysupervised, and these efforts have been quite revealing!The LOCT are highly dernoralized and hardlysupervised the lower level, therefore, drugs were notreleased to the communities on time and even whenreleased, distribution was not properly supervised anddata was not collated from the community register.
WHO/APOC. 24 November 2fi)6
Executive Sunnury
Niger State has 25 administrative divisions known as Local Government Areas (LGAs), out ofwhich 2l arc approved by APOC for implementation of CDTI. The population of the State is 3.9
million based on the recent (2006) national census. There are 2,872 affected communities with aregistered population of 1,774,333 people at risk of infection and blindness from Onchocerciasis.
At the time of submission of this report l,l53,3ll people were treated in 2,069 endemic
communities, representing65Yo therapeutic and72o/o geographic coverage respectively. Four LGAs
did not give any feedback while five of them submitted only partial reports. The Ultimate Treatnent
Goal (UTG) forthe project is 1,490,440, therefore UTG coveragewasTTYo.
The population in over 40%o of the project area is highly migratory because the State shares
boundary with several others in all directions, as well as Benin republic on its' western border.
Commonest among the migrant ethnic groups are Gwaris, Kambaris and nomadic Fulanis. Due tothe socio-cultural beliefs and practices of the aforementioned, they migrate annually both within and
outside the State in search of virgin (fertile) land for growing cash crops such as yams, guinea corn,
matze and millef, while the nomadic Fulani migrate in the dry season in search of water and fresh
fodder for their animals. The above phenomenon is responsible for the nucleated and highlydispersed settlement pattem, as well as highly dynamic community and population figure thatprevails in over 60% of the State. Niger is the largest of the 36 States in Nigeria, occupying l}Yo ofthe total area.
5,356 CDDs were trained/retrained out of an ATrO of 14,263 representing 3802, while 702 healthpersonnel were trained/retrained to increase capacity for supervision of CDTI. This achievementrepresents l22o/o cov erage.
The challenge the project experienced within the period of report was achieving its'ATO of1,490,440 people in spite of very poor funding at LGA level. Only two LGAs released funds to the
LOCT, therefore most of the teams were demoralized and commitment declined. Because ofinability of most LGAs to collect lvermectin from the State, it had to be conveyed to them, either by
the SOCT or during distribution of vaccines for mass immunization. In order to ensure that drugs
were released to all eligible communities, a comprehensive list of these communities, and their drug
allocation was compiled by the SOCT and then distributed to the LGAs as a guide. The acceptance
of Mectizan, and its' popularity, together with opportunity provided by the NIDs, helped to integrate
CDTI in PHC at all levels, while the commitment of some of the LOCT and frontline health facilitystaffensured training/retraining of CDDs as well as supervision of treatment. Intensive advocacy and
mobilization visits werc made to LGAs by the SOCT and supervision was intensified to ensure
adequate ooverage.
Frequent transfer of the heads of the PHC department at LGA level was a major set back to ensuringtimely reporting from the LGAs, despite the effort of the SOCT. UMCEFS' renewed commitment tothe programme provides a ray of hope and its' funding for focused intervention in Borgu LGA(November/December 2006) holds promise for improved coverage at the border with Beninrepublic.
) WHO/APOC. 24 November 2006
SECTION I: Backgruund information
LL General information
1.1.1 Description of the project (brielb)
- Geographical location, topography, climate
- Population: activities, cultures, language
- Communication systems (roads...)
- Administrationstructure
- Health system & health care delivery (provide the number of health posts/centers in the
project area if the information is available).
- Number of health staff in project area and number of health staff involved in CDTI activities
l.l.l. Descriotion of oroiect
Niger State is geographically located within the middle belt of Nigeria and it lies between latitude 3
20' East and longitude ll" 3' North. It is borderedby Zamfaru State on the North, Kebbi State on
the North Wesf Kogi State on the South, Kwara State on the South West Kaduna and Federal
Capital Territory of Abuja at the North East and South East respectively. The State shares a common
boundary with the Republic of Benin on the westem border i.e. at Babanna district of Borgu Local
Govemment Area. The location of the State gives rise to common inter-border trade with it in all
directions.
The topography of the State is highly undulating, while the land is traversed by several fast flowing
rivers such as Niger, Oli, Kaduna, Kontagora, Gurara and several tributaries that flow into them. As
a result of the topography, the major rivers of Niger and Kaduna have been dammed for production
of electricity, therefore, the State houses the largest number (3) of hydro electric power stations in
the country thus earning itself the title, 'Power State'. Prominent among the dams are Kainji, across
river Niger at New Bussa in Borgu LGA, and Shiroro, across river Kaduna at Shiroro LGA. Despite
its' meso endemicity, the State is surrounded by hyper endemic foci on its' northeas! southeas!
south and southwest. These foci are in Kadun4 the FCT, Kogi and Kwara States respectively.
The vegetation of the State is mainly of the guinea savanna type with forest mosaic savanna
especially in the south and south-western parts. The climate is of distinct dry and wet season with
rainfall ranging between l,l00mm in the North and l,600mm in the south. The wet sqxon ranges
from l50days or more in the northern part to 210 days or more in the southern part. The dry season
commences in October and humidity could be as low as 140'between December and February.
1 WHOiAPOC. 24 November 2006
Temperatures rise as much as 90T betrveen March and June, with the lowest minimal temperatures
usually in December and January.
Most of the Onchocerciasis endemic communities are located within the abundant flood plains of the
rivers that traverse the lan{ thus the population is agrarian in over 80% of the State. Among the
large ethnic groups, the Gwaris', Kambaris' and nomadic Fulani have a socio-cultural habit of
moving from place to place in search of virgin land for their crops, and in the case of the Fulanis, for
water and fresh fodder for their animals. Common cash crops produced by the farming groups
include yams, rice,maize, millet and guinea corn. Nupes' are one of the major ethnic groups in the
State, and they are more stable in settlement forming very large clustered populations that reside
within the marshy alluvial rich valleys, which abound in the State. The Nupes grow mainly rice as
both food and cash crop while they are also very good fishermen.
While the settlement pattern in 4OYo of the State is dense and clustered, over 60% is sparsely
populated and highly nucleated with distances of up to 40 kilometers between some communities.
Niger is in fact the largest State in Nigeri4 occupying about 12 million hectares of land, which
represents about one tenth of the total land area of the country.
There is a fairly good road network in about 40%o of the areq however, due to the riverine nature,
about 40%o of movement is by water, using local tug boats, engine boats, and ferry for movement ofgoods, vehicles and humans across the rivers, especially between communities and from the State to
neighboring Kebbi State. Heavy flooding, as a result of overflow of the hydroelectric power dams
especially after the rains, is a major threat to communities that reside along the large rivers of the
State, therefore several communities are often either submerged, dispersed or are displaced.
The administrative structure is typical of what obtains all over the country, i.e. with a politically
elected executive Governor at the State level and 25 local administrative councils headed also by
politically elected LGA chairmen. The peculiarity here is that the administrative councils are further
suMivided into 43 units with 18 ofthem known as developmental area councils each with a separate
leadership which makes coordination of activities quite difficult especially where there is poor
collaboration between the adjoining LOCT coordinators. There are several traditional institutions
headed by Emirs and chiefs of various hierarchies, who oversee the districts and communities while
the kingdoms are grouped as emirate councils. The communities within the emirates are headed by
traditional rulers who pay allegiance to the top hierarchy as is typical of the ancient feudal system ofgovernment, while all Emirs are accountable to the Executive Governor. The State government
basically comprises ofthree arms i.e., the executive, legislative and judiciary.
4 WHO/APOC. 24 November 2006
The heatth care delivery system comprises of three levels i.e. Primary, Secondary and Tertiary, all of
which are quite well interlinked. The PHC system has been put fairly well in place, and is becoming
more functional. There are over 1,400 health posts/health centers in the State out of which about
1,000 exist within the CDTI project area. There are 3,239 PHC staff, out of which, 796 are
participating in CDTI.
Out of 2l CDTI LGAs, 17 are old (i.e. have implemented CDTI for at least 4 years), while four,
namely, Suleja Tafa, Gurara and Agwara (which came about as a result of the REMO
update/approval of year 2004) have implemented CDTI for three years now. Western Borgu shares
border with Benin Republic at Babanna district and was also approved for CDTI in year 2004. It was
only in year 2006 however ,that concerted effort was made to ensure total coverage of over 200
communities in that sector.
5 WHO/APOC. 24 November 2fi)6
Table 1: Number of heahh staffinvolved in CDTI
District/LGA
Number of health staffinvolved in CDTI activities.
Total Number ofhealth staffin the
entire project areaBr
Number of health staffinvolved in CDTI
B,
Percentage
BrBzlBr *100
Kontagora 150 l3 9
Rrjau 123 50 4t
Magama 216 36 17
Mariga 202 34 17
Mashegu t14 27 24
Agaie 132 23 t7
Lapai 137 67 49
Mokwa 182 48 26
Rafi 185 6t 33
Wushishi 150 50 33
Borgu l13 69 6l
Lavun 185 23 t2
Shiroro 120 60 50
Gbako 69 2t 30
Katcha 65 45 69
Munya 194 l8 9
Bosso230 36 t6
Suleja 166 2t 13
Gurara 187 37 20
Agwara 164 24 l5
Tafa l5s 33 2t
TOTAL 3,239 796 25
('l WHO/APOC. 24 November 2fi)6
1.1.2 Portnerchip
- Indicate the partners involved in project implementation at all levels MOH, NGDOs
(national/international), communities, local organizations, etc.]
- Describe overall working relationship among par0lers, clearly indicating specific areas of project
activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are
involved.
- State plans, if any, to mobilize the State/region/district/LcA decision-makers, NGDOs, NGOs,
CBOS, to assist in CDTI implementation.
Partners involved in project implementation are:-
- The National Onchocerciasis Control Programme, of the Federal Ministry of Health,
- The State Ministry of Health and LGA/PHC departments
- UNICEF, APOC, WHO
- 2,872 Onchocerciasis endemic communities with their CBOs. These CBOs are mainly agricultural
cooperative groups and trade unions for both men and women, as well as various youth (age
grade) associations, which also often double as agricultural cooperative groups.
The overall working relationship among the partners is quite cordial and encouraging. Generally, all
are involved in HSAM at various levels. LINICEF has renewed its' commitment and is involved in
planning for conduct of CDTI activities like planning, training, HSAM and supervision/monitoring.
The focused intervention at Borgu LGA (December) was an outcome of the internal
advocacy/monitoring visit paid to the State by the new UNICEF consultant in October in company
of NOTF officials. Two review meetings for the 9 assisted States were also sponsored by UNICEF
in the year under report.
The Ministry of health solicited for piece-meal release of funds from the US$23,809 approved and
was successful in acquiring US$15,873 which was utilized for HSAM, supervision and monitoring
{rmong several other activities.
7 WHO/APOC. 24 November 2006
Various groups like media organizations, the Nigerian Red Cross society, Jama'atu- Nasril-Islam
(JNI) the predominant muslim organization, as well as National Union of Road Transport Workers
also pledged to continue to assist with HSAM activities.
There would be a new democratic government in 2007, and there is a plan for high level advocacy
visit involving UNICEF, NOCP and possibly APOC to the State in the middle of year 2007 to
advocate for bulk release of funds (for 3 years) from the newly elected democratic govemment.
Advocacy visit would be paid to the 2l new LGA councils by the SOCT to also solicit support for
long term release of funds for LOCT/CDTI activities.
A comprehensive list of active local NGOs and CBOs is being compiled for sensitization and
collaboration in the on-coming year, of special interest is the Federation of Muslim Women
Association Of Nigeria (FOMWAN) which would be engaged for collaboration to mobilize women
for active participation in CDTI at community level.
Table 11: Cotttnunily self-monitoring and Staheholden Meeting
Describe how the results of the community self- monitoring and stakeholders meetings have
affected project implementation or how they would be utilized during the nert treatment
cycle.
Pilot CSM and SHMs conducted in these LGAs revealed that some CDDs were discontented
about not being paid incentives by their communities, while members of communities who had
never served as CDDs were incorporated into programmes like polio+radication and guinea
worn surveillance. This informed the decision to work towards formulating a PHC directive such
that, wherever committed CDDs were pr€sent, they were also integrated into other PHC
7) WHO/APOC. 24 November 2fi)6
programmes, especially where financial or material rewards would be derived, in order to
encourage CDD retention. This action is already being applied in at least 5 LGAs and the benefits
are obvious since the treafinent coverage is quite good and there is very good CDD retention.
These LGAs are Magama, Kontagora, Agaie, Lapai and Gbako.
Information from some SHMs revealed that the communities had preference of a treatrnent
period, which did not conform with the period when drugs were usually released to them, and this
information helped to plan for Mectizan delivery at preferred treatment periods.
In the Kambari settlements (camps) there is distrust in a CDD from the same community
administering drugs to its' members, so the CDD from the main village is relied upon to visit the
neighboring wards (settlements) to administer drugs and this causes a lot of delay in completion
of treatment and reporting. These CDDs have to travel over distances of sometimes 20 to 30
kilometers apart and require assistance with bicycles from APOC.
2.9. Supervision
2.9.l.Provide aflow chart of supentision hierarchy.
2.9.2. jYhat were the moin issues identiJied during supervision?
The main issues identified include :-
(l)Drugs were being allowed to expire.
(2) There was no documentation on treatnent of some communities (especially those that are far
and hard to reach) for example, those at the border with Benin republic.
NOCP
SOCT
LOCT
DS
CDDsFLHFCSMs, Communilies,
Wllage heads
?1 WHOiAPOC. 24 November 2006
(3) Geographical coverage was low and therapeutic coverage for some LGAs like Borgu, Bosso
and Wushishi were far below 65%. Drugs released to some LGAs were also not adequately
accounted for.
(5) Late submission of treatnent reports to the State.
(6) Inconsistency in Mectizan inventory records at different levels / Poor census.
2.93. Was a supentision checklist used?
Yes. One was developed by the SOCT to address specific issues of concern while the standard
checklist was utilized by the combined team of NOCP and UNICEF.
2.9.4. What were the outcomes at each level of CDTI implementdion supervision?
State level
(l) The outcome of NOCPAJNICEF supervision indicated that there is need for adequate
supervision of the LOCT by the SOCT since drugs released for 6 months had not been
distributed in some LGAs, while year 2005 treatment report indicated that some LGAs had
very low coverage.
(2) Absence of counterpart funds at LGA level was having a severe effect on conduct of CDTIactivities.
LGA level
(l) High CDD athitior/Some CDDs wer€ not adequately trained and data entry was poorly done.
HeighVdosage calibration was also inaccurate. In one of the communities, drugs were
received by the CDD, but not distributed.
(3) Highly demoralized LOCT. There was hardly any release of counterpart funds at the LGA
level and the health statr (LOCT) did not supervise the FLHF staff in most of the LGAs.
Records were poorly kept at all levels and there was no duplication of those forwarded to
higher levels.
(4) There was frequent transfer of trained health staff leading to lack of supervision of some
communities.
(5) The directors PHC were not giving the necessary moral support to the LGA coordinators.
74 WHO/APOC. 24 November 2006
Conmunitv level
(l) Treatment fatigue was observed to be the problem with many of the communities. There was
a feeling of good health and the communities no longer had the urge to comply with
treatment.
(2)The health staff were not adequately communicating with the traditional leaders, therefore the
leaders were not aware of release of Mectizan to the CDDs.
3) Mectizan was not released to the communities by the FLHF staffand when they requested they
were informed that there were no drugs because the programme had come to an end.
(4) Opposing political parties were exploiting the issue of payment of incentives to CDDs as a
tool against the incumbent government, by insisting that the payment should be done by
government rather than the people since healthcare is a social service that is their right.
2.9.5. Wasfeedboch gtven to the penon or groups supemised?
Yes, feedback was given at all levels.
2.9.6. How was thefeedbach used to improve lhe overall petforrnonce of the pmjea?
(l) Reminders were written to both the State Ministry of Finance and the Ministry of Local
Govemment in request of release of counterpart funds. Advocacy visits were also made to
both Ministries to sensitize the leaders on need to release funds. LGA policy makers were
sensitized on the urgent need to release funds to the LOCT, and pledges were made to support
with funds. That promise was not actualized in most LGAs but is still viable and could be
redeemed. Meetings were also held with traditional leaders in Wushishi, Borgu, Bosso and
Gurara among several other LGAs and pledges were made for improvement.
(2) The State Ministry of Health released the sum of U.S.$15,873 for HSAM, supervision, as well
as for retrieval of outstanding treatment reports and drug balances that were not submitted.
(3) Meetings were held with the LGA authorities to inform them on the poor attitude of some
health workers, and action was taken to ensure that drugs were immediately released to the
benefiting communities and treatment commenced immediately. This was particularly so for
Bosso,Borgu, Wushishi,Mashegu, Mokwa ,Agwar4Lapai, and Agaie LGAs.
15 WHO/APOC. 24 November 2006
(a) In order to ensure 100% geographic and at least 84% therapeutic coverage of communities,
the SOCT compiled a comprehensive list of endemic communities and their projected
population and released Mectizan accordingly to the LGAs. This effort also helped to control
wastage.
(5) Adequate capacity was provided (for supervision of CDDs) through training and retraining of
health staff and other community supervisors like teachers (in Borgu LGA) where long
distance between communities makes supervision very difficult.
(6)The SOCT supported the LOCT to mobilize the communities for better compliance with CDTI
objectives and especially the need to sustain yearly treatment through both moral and
financial support to the CDDs.
(7) Communities were mobilized to select new CDDs i.e. where attrition had affected distribution
and all were trained, by the FLHFs and LOCT and treatment followed immediately even
though some as late as in December.
(8) Communities that had never been treated were mobilized for participation and treatment is
ongoing. There is promise of 1007o geographical md 84Yo therapeutic coverage in year 2007.
?(t WHO/APOC. 24 November 2006
SECTION 3: Srryport to CDTI
3.1. Equipment
Toble 12: Stotus of equipment
*Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable,
WO:Wriffen off).
How does the project intend to maintain and replace eristing equipment and othermaterials?
This will be done through the normal government system, i.e through the vehicle maintenance
pool. Furthennore, the project intends to intensiff request for monthly standing imprest (running
cost) from the State approved budget line for recurrent expenditure which if provided, would
serve as a source of funds for equipment maintenance as well as for maintenance of other items.
The budget line for overhead i.e. State counterpart fund would also be intensely exploited for
ensuring sustained funding of project activities by government.
Even though funding at LGA level is currently very poor, there will be sustained mobilization of
the relevant authorities for the necessary fund release, the LGA coordinators have been
responsible for maintenance of project motorcycles attached to them and will continue since this
APOC MOH DISTRICT/LGA
NGDO OthersSource
Type ofequipment
No. Condrton No. Conditon No Condrtion No. Condition No. Condition
l. Vehicle I F I wo I wo2. Motor cycle(s) 22 l0F
6CNFR6WO
l6 wo
3. Computer(s) 2 lwolF4. Printe(s) 2 lwolF5. Photocopier (s) I CNFR6. Fax Machine(s) I F7. Others
a)Megaphones l0 Fb)Writing board I Fc)Overheadproiector
I F
Video player I FBicycles 65 20wo 50 woT.V. set I F
Manual typwriter 2 F
In-focus proiector I F
UPS I wo
IIIIIIIIIIIIIIIIIITIIIIIIITIIIIIIITIIIII
IIII
?7 WHO/APOC. 24 November 2006
is the usual practice over here. LGA administrators will also be encouraged to purchase
motorcycles and bicycles for the programme i.e where ever the need arises. Furthermore, efforts
will be made to ensure integration of the CDTI with viable projects like HIV/AIDS control, NPI,
malaria control etc. so that there would be central maintenance of all participating PHC vehicles.
APOC management has also been requested to replace some capital equipment before its'f,rnal
disengagement.
JR WHOiAPOC. 24 November 2006
lsslR' \tF E'irt:s't=r:riasss.+;t.sR.\;sg!
SR$ESslF(s=:t 'rr.q2 la
ESqSs=ts- R.
3E'sG(!\<Gic,jtaFSSI
:ht\).g\
(JJ\o
'!otJ5zoE6(D
t\)o5
rlortF
-l>: r-oao;oo
ooj3c3.
o2EAo6 xHr V\'9,
z.--iO
H8.
C?b6>E
a<b)uo* s<
Ee
\o6-Io
t\)6\o5
UJ
5
t)Foo o
tJ-N-INJo EEsE
r
oD
toce(,Ia\o(.4
oooo
oo
5(j
--I
N)
@
(,6
t\)l.J{t'J(,
-r0O-lEFB9
t.D-o
t\)5-IUl -Joo
(,6@
tJso
5\o
eEEEo
oI
NFo
UI5\o(,r
5N)5O
6o\*-I
2,EAaEre9
otsEL
\oc5t\l
o\ tJ5O
o(f){
5
O CEsEB
(DE(ra
nooeo\\oo\
(,(,
O
5o,
-ootJ@
{tJ6-a
:c!oaa Fegla>(!F
\co5t\)o
o\t.)
hJo
z NJs zt-
5UJ
OE!OB
EEAE(Dt,5to
-(ra\o€tJ€(,l
{o UJ(,) NJJ.lt,5o\
-Jo5erEO.lEFgF
(D-aL
\o6(,o\(,
UJ
o
NJ
NJtJ
o\{tJo
(J)
o\oo
alEO-l^E E Fr
gE-i t'Dtg
(,l
t\)o5-It,
t,{(,a -O O.N)3"8;
8aE -
N)'t.l1..)
;3E E E FT"Hg" g€- '""'9;.
OFi-P h ?"o.3>5K{{{N)
)1AaHFA9
6HOL
Oo\
o(n
5o\o{
I O zt tJ
N)@o\
N)tJNN)N)
oEsol
EEAE i;<40 t!-rr=o\trN)+t-rn(,t
(.)l,o\e
Hc) (D-H
- 9 a. h,"oFS rod {b3 x E '''L@ AJa o sg-+o\*
zt 9G&ta (,-oPq
562!O'lEFAS
OFA-o\
UT6I.)-tt\)
o\t)6
5N)
z (})\oo,6
l.J
6\o
aEO,i
EEAE d<60t9
t:ilPrtEs9o\
(ra\0
EDH+FE TBEe+-; a56gg
'4(Ita
-9ItJNNJ
zt-
9Gs(a-6vo €{ =rUO-lEFES(l-
I
(2) If there are problems with release of counterpart funds, how were they addressed?
While the State released funds, there were indeed severe problems with release of counterpart
funds at LGA level. All effort made to ensure release at LGA level was futile.
- Additional comments
It is recommended that advocacy visit be made to the newly elected government between June
and July 2007 by a high powered team of APOC,LINICEF and NOCP to solicit for bulk release
of funds, possibly for 4 years duration.
33. Aherforms of communtty support
(3) Describe (indicate forms of in-kind conhibutions of communities if any)
In-kind conffibutions by communities include assistance with farm work, prayers, supervision by
village heads and CBOs, support with community mobilization, giving of food stuff to CDDs,
provision of transport or transport fare to collect Mectizan@ from agreed points, nomination of
CDDs into politically elected posts such as local councillors or LGA council chairmen,
employment into government paid jobs, and recommendation for inclusion of CDDs for other
incentive giving social services like polio eradication and guinea wonn surveillance.
3.4. Eryenditure per acttvtty
(4) Indicate in table 14, the amount expended during the reporting period for each activity
listed. Write the amount erpended in US dollars using the current United Nations
exchange rate to local currency. Indicate exchange rate used here US 1.00 to#126.
Tahle 14: Indicate how much the project spentfor each activily listed below during the reportingperiod
ActivityExpenditure
($ us)Source(s) of
fundinsDrug delivery from NOTF HQ area to central collectionpoint of community
2,000Gov't
Mobilization and health education of communities 5,000 Gov't/UnicefTraining of CDDs 6,000 Gov't/UnicefTraining of health staffat all levels I1,000 Gov't/APOCfunicefSupervising CDDs and distribution 4,500 Gov'VAPOC/UnicefInternal monitoring of CDTI activities ? Gov't/UnicefAdvocacy visits to health and political authorities 6,000 Gov'UAPOC/Unicef
IEC materials
Summary (reporting) forms for treatment
40 WHO/APOC. 24 November 2004
(2) If there are problems with release of counterpart funds, how were they addressed?
While the State released funds, there were indeed severe problems with release of counterpart
funds at LGA level. All effort made to ensure release at LGA level was futile.
- Additional comments
It is recommended that advocacy visit be made to the newly elected government between June
and July 2007 by a high powered team of APOC,UNICEF and NOCP to solicit for bulk release
of funds, possibly for 4 years duration.
3.3. Otherforms of communtty support
(3) Describe (indicate forms of in-kind contributions of communities if any)
In-kind contributions by communities include assistance with farm work, prayers, supervision by
village heads and CBOs, support with community mobilization, giving of food stuff to CDDs,
provision of transport or tmnsport fare to collect Mectizan@ from agteed points, nomination of
CDDs into politically elected posts such as local councillors or LGA council chairmen,
employment into government paid jobs, and recommendation for inclusion of CDDs for other
incentive giving social services like polio eradication and guinea wonn surveillance.
3.1. Eryenditure per acttvtty
(4) Indicate in table 14, the amount erpended during the reporting period for each activity
listed. Write the amount expended in US dollars using the current United Nations
exchange rate to local currency. Indicate erchange rate used here US$1.00 to#126.
Table 14: Indicate how much the project spenlfor each acttvity listed below during lhe reportingperiod
ActivitvExpenditure
(s us)Source(s) of
fundinsDrug delivery from NOTF HQ area to central collectionpoint ofcommunity
2,000Gov't
Mobilization and health education of communities 5,000 Gov't/Unicef
Training of CDDs 6,000 Gov't/UnicefTraining of health staffat all levels I1,000 Gov'VAPOCfunicef
Supervising CDDs and distribution 4,500 Gov't/APOCfunicef
Internal monitoring of CDTI activities ? Gov't/UnicefAdvocacy visits to health and political authorities 6,000 Gov'VAPOCAJnicef
IEC materials
Summary (reporting) forms for treatment
40 WHO/APOC- 24 November 2fi)4
Vehicles/ maintenance 1,587 Gov't
Office e. etc 100 Gov't
Others to 2,500 Gov'VUnicef
TOTAL 38,687
Total number of persons treated I,153,311
(5) Any comrnents or qlnnotions?
The support for field activities from UNICEF was for focused attention to Borgu LGA in view of
consistent low coverage and the need to address cross border concerns with Benin republic. This was
an outcome of the monitoring visit by both UNICEF and NOCP to the State in October.