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ORIGINAL: English

COUNTRY/NOTF: NIGERIA Proiect Name: FCT CDTIPROJECT

Approval vear: 1998 Launching ILear: 1998

Reportins Period (Month/Year): JANUARY -DECEMBER 2005

(circteon.) t 13 4 t-C[s s toProiect vear of this report:

bmitted: FEBRUARY 2006Date su NGDO partner: CBM

ANNUAL PROJECT TECHNICAL REPORTSUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

DEADLINE FOR SUBMISSION:

To APOC Management by 31 January for March TCC meeting

To APOC Management by 3l July for September TCC meeting

AFRICAN PROGRAMME FORONCHOCERCTASTS CONTROL (APOC)

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Table of contents

ACROIYYMS............... """""""v

DEFrNrrroNs......... """""""' vr

FOLLOW t]P ON TCC RECOMMEI\IDATIONS .......1

EXECUTTVE ST]MMARY ........2

SECTION 1: BACKGROUI\D INFORMATION...."""" """""""'4l.l. GBuenal INFoRMATIoN

1. 1.1 Description of tlrc project (briefly).....-...-

1.1.2. PartnershiP1.2. Poput-arrox

SECTION 2: IMPLEMENTATION OF CDTI........ """""""""""8.................... 82.1. TttuBr-wp oF ACTIvITIES ........-.

2.2. AovocacY ... l02.3. MOSTLZATION, SENSITZATION AND HEALTH EDUCATION OF AT RISK COMMI.JNITIES

ENNON! BOOKMARK NOT DEFINED.

2.4. CounauunY INvoLvEMENT.......'....2.5. CapecruY BUILDING

2.6. TRsarrrleNrs................2.6.1. Treatmentfigures...................2.6.2 What are the causes of absenteeism? --...-.----

2.6.3 What are the reasons for refusalsz ..'.............

2.6.4 Briefly describe all krnwn andverifud serious adverse events (SAEI) that....

2.6.5. Trend of treatment achievemenlfrom CDTI project irrception to the current year

How was the feedback used to improve tle overall pedonnonce of tlrc pmiect?

Enor! Bookmark not deftned

'20

2t2.7 - ORDERING, sroRAGE AND DELIVERY oF IvERMECTIN

2.8. CoutvruNny SELF-MONTTORTNG AND STAKEHOLDERS MeBrrNC ...........22

2.g. SuprnvtstoN """""""'222.g.1. Provide aflow chart of supervision hierarchy. ..Enor! Bookmarh not deftned

2.g.2. What weri the main issues ifuntified during supervision? .....Efior! Bookmark

not defined2.g.3. Was a supervision checHist used? ...Enor! Bookmark not deftned

2.g.4. What were the outcomes at eoch level of CDTI implementation supervision?

Enor! Bookmarh not deJined2.g.5. Wasfeedback given to tlrc person or groups supervised? Etor! Bookmark not

deJined2.9.6.

SECTION 3: SIJPPORT TO CDTI

3.1.3.2.3.3.3.4.

EeurpupNrFnqeNCIAI CONTRIBUTIONS OF THE PARTNERS AND COMMI.,NITIES........

Olupn FORMS OF COMMI.]NITY SUPPORT

E>oeNotruRE PER ACTIvITY ..........

23

23252525

SECTION 4: SUSTAINABILITY OF CDTI.. """"""'264-1. tNrenNAI-; INDEPENDENT PARTICIPATORY MONITOnTC; EvaI-UATION-..... ..............26

4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick aryof thefollowingwhich are applicable) ...........- """"26

lll WHO/APOC, 24 November 2fi)4

......Error! Bookmark not defined4

7

4.1.2. What were the recommendations?

4.1.3. How have they been implemented? """""""4.2. SuSTRNaSILITY oF PRoJECTS: PLAN AND SET TARGETS (MANDATORY AT""""""""Yn 3) ..

4.2.14.2.2

Planning at all relevont levels

Funds........4.2.3 Transport (replacement and maintenance)

4.2.4. Otherresources...4.2.5.

Bookmarh not defined4.4. OpENAUONAL RESEARCH..

4.3. INrecReuoN .'............."ERRoR! BooxrumxNorDEFINED'4.3.1. Ivermectin delivery mechanisms -.....0nor! Boohmark not deftned

4.3.2. Training.... ..Efior! Bookmark not deJined

4.3.3. Joint supervision and monitoringwith other programs--. Enor! Bookmark not

deJined4.3.4. Release offundsfor project activities................Error! Bookmark not deJined

4.3.5. Is CDTI irrcluded tnine pUC budget? ...............Error! Boohmarh not defined.

4.3.6. Describe other heatth progrommes that are using the CDTI structure and lnw

this was achieved. What have bienttrc achievements? .....Enor! Bookmark nol deftned

4.3.7. Describe others issues considered in the integration of CDTI. Enor!

............. EnnoR! BooKMARK Nor DEFII\IED-

4.4.1. Summarize in not more than orc half of apage tlrc operdional rcsearch

undertaken in the proiect area within the reporting period.."""""' Enot! Bookmark not

dejined4.4.2. How were the resulrs applied in the project? .....Enor! Bookmarh not deftned

SECTION 5: STRENGTHS, WEAKIYESSES, CHALLENGES' AI\DOPPORTTJNITIES....... .....ERROR! BOOKMARK NOT DEFINED.

SECTION 6: LMQUE FEATT RES OF TIIE PROJECT/OTHER MATTERS.------....30

IV WHO/APOC, 24 November 2004

Acronyms

APOC

ATOATrOCBO

CDD

CDTICSM

LGAMOHNGDO

NGO

NOTF

PHC

REMO

SAE

SHM

TCC

TOT

UNICEF

UTG

wHo

African Programme for Onchocerciasis Control

Annual Treatnent Obj ective

Annual Training Objective

Com munity-Based Organization

Community-Directed Dishibutor

Community-Directed Treatment with Ivermectin

Community Self-Monitoring

Local Government Area

Ministry of Health

Non-Governmental Development Organization

Non-Governmental Organization

National Onchocerciasis Task Force

Primary health care

Rapid Epidemiological Mapping of Onchocerciasis

Severe adverse event

Stakeholders meeting

Technical Consultative Committee (APOC scientific advisory goup)

Trainer of trainers

United Nations Children's Fund

Ultimate Treatment Goal

World Health Organization

v WHO/APOC, 24 November 2004

Definitions(i) Total population: the total population living in mesolhyper-endemic communities

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

(ii) Eligible population: calculated as 84%o of the total population in mesoftryper-

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/tryper 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 tt e end of the 3d

year ofthe project).

(v) Therapeutic coverage: number of people heated 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 ntrmber of meso/hyper-endemic communities as identified by REMO in the

project area (this should be expressed as a percentage)-

(vii) lntegration: delivering additional health interventions (i.e. vitamin A supplements,

albendazole for I-F, screening for cataract, etc.) through CDTI (using the same

systems, training, supervision and personnel) in order to maximise cost-

effectiveness and empower communities to solve more of their health problems.

This does not include activities or interventions carried otrt by community

distributors outside of CDTI.

(viii)

(ix)

Sustainability: CDTI activities in an area are sustainable when they continue to

function effectively for the foreseeable future, with high treaffnent coverage'

integrated into the available healthcare service, with strong community ownership,

using resources mobilised by the community and the government.

Communiff self-monitorine (CSM): The p(rcess by which the community isempowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme

is being executed in the way intended. It encourages the community to take fullresponsibility of ivermectin distribution and make appropriate modifications when

necessary.

vl WHO/APOC, 24 November 2004

FOLLOW UP Oil TGG REGOTTE]IDATIOIIS

Using the table below, fill in the recommendations of the last TCC on the project and describe

how they have been addressed.

TCC session 19

I

Number ofRecommendationin the Report

TCCRECOMMENDATIONS

ACNONS TAKENBY THE PROJECT

FORTCC/APOC MGTASE ONLY

I Project to performoperational research on

incentive options for CDDS

So far we areconsulting withNOCP and

Sociologist to drawup aproposal forthisstudy

2 Assess Onchocerciasisendemicity in FCT satellite

communities.

A research group willbe submitting aproposal to determinethe transmissionpotential in the FCTsatellite communitiessoon.

J Continue !o increasenumber of CDDs

We plan onincreasing thenumber of CDDs as

part of our trainingproposal to APOC

4 Train MOH staffat alllevels on management of

SAEs

Already we have aplan to conducttraining and retraining of all theworkers in theprogramme.

5 Strive to reduce the numberof refusals and absentees

The project isworking hard atsensitizing thecommunity membersto comply withtreatment and forCDDs to be morecommitted to theirduties of getting thecommunity memberstreated.

6 Integrate program activitiesinto PHC and into other

health programs for the sake

of sustainability.

Yes there is alreadyemphasis on this as

conscious effort to re-train all the PHC staffon CDTI and usingthis level effectively.

7 Submit 3 year post APOCsustainability plan to APOC

management as soon as

The project hadsubmitted this

WHO/APOC, 24 November 2004

possible. proposal on twooccasions, but have

been recentlyintimated that such

has not been found.We are re-submittingit again to APOC.

l0 No expenditures were

described for the availableAPOC tunds.

It was an oversight.The table presented

was meant for APOCand CBM and notMOH.

Executive Summa4Y

The Federal capital territory GCT) was created from the gerographical centre of Nigeria to

serve as the new capital of the Nation. The area occupies about 8, 000 sqkm and divided into

6 administrative Area councils.

prior to the creation of Abuja as the new Federal Capital Territory in 1976 the whole area was

infested with black flies vector of Onchocerca SPP.

The results of Rapid Epidemiological mapping of Onchocerciasis (REMO) Conducted in 1995

in the area demostrated hyperendemicity.

Mectizan distribution was started in 1995 in collaboration with christofell Blinden Mission

(CBM), an NGDO supporting Onchocerciasis control in FCT A total of 56, 083 people were

treated in 178 endemic communities during the period.

African programme for Onchocerciasis control programme (APOC) approved proposal sent

by FCT in 1998 for 5 -years support (1995-2002). The FCT has assumed full responsibility

oisustaining the programme by providing the enabling enviroment. Under APOC support, the

treatment coverage has increased from 56,083 to 234,895 and from 178 to 559 endemic

communities.

Training was conducted in a targeted manner for all categories of staff involved in the

programme. The local Oncho control Team (LOCT) identified priority needs of the personal

it tfie first line Health Facility (FLHF) and the community Directed Distributors (CDD) who

were trained. A total of 860 programme workers were trained.

Health Education and Mobilization was also carried out in the communities in a targeted

manner. Advocacy visit to politically electoral Chairmen of the Area councils was also carried

out to solicit for support.

2 WHO/APOC, 24 November 2004

capital Equipment and counterpart funds provided by FCThry been of tremendous assistance

to it "

COff project in the implementation of the scheduled activities. FCT has released 5

million last year and again 5 million this current year 2005'

During the year under review, the project has treated 261, 728 people in 559 communities'

thus achiev ing r7%.Therapeutic and I 00% Geographical coverage' s.

Major challenges remained the population explosion of the satetlite and urban centres as well

u, ior*opolitan nature of the residents. This issue is addressed in the sustainability plan.


SEGTTON {: Background informdion

1.1. General inf,ormation

1.1.1 Description of the project (briefly)Geograp hical location, topography, clirMetheieteral Capital Terriiof lies-in the centre of Nigeria, just north of the hot and humid

low lands of the Niger/Benul Trough, but south of the drier areas to the north. It lies north

of the wide alluvial plains formed by the confluence of the Niger and Benue Rilers- The

Jama'a Platfornu a continuation of the Jos Plateau, extends well into the middle of the FCT'

It comprises 8,000 square kilometers. Four major rivers flow through the area, all of them

flowing roughiy from north to south, and draining into the River Niger. The rivers often

now siitt/tfriough rocky gorges, providing an ideal habitat for the Simulium fly. The

FCT itself ;onsists of a tilted plain, rising from an elevation of 300 fe€t in the south-west' to

above 2,000 feet at the North-East corner. Rising out of this plain are numerous rocky

outcrops and inselbergs. The predominant vegetation type is park savannah. River banks are

typicaily heavily foreited wiitr tatt trees and thickets, and there are occasional patches ofrain forest r*t"r"d throughout the FCT. Rainfall averages l622mm annually- The rainy

s&ason begins in April and ends in mid October. The dry season lasts from late October to

March.

Pop ulotion: activities, cultures, lang utgeBefore the construction of Abuja the capital city, the estimated population of the area

comprising the FCT was about j00,000. With the construction, populations have exploded

in ait thJ settlements. The indigenous ethnic groups in the FCT include the Gbagi,

Gwandar4 Gade, Koro, Ganagana, Bassa, tgbirr4 Fulani and Hausa. With the influx ofpeople into the capital tenitory almost all major ethnic groups have representatives in the

tommunities. Therefore, most settlements are muhi-ethnic, and many are multi-lingual.

Most rural communities depend on farming andlar pastoralism. Other occupations include

farming, fishing and pastoralism. Traditionally many crafts are practiced, including iron

smelting, pottet making, etc. Setlements may be either nucleated or dispersed. There are

also numerous nomadii Fulani settlements, which may be either seasonal or semi-

permanent.

C o mm unic dio n sy stem (road.. )There is a good network of roads leading to the major towns, particularly Area Council

headquarters. In the past few years there have been considerable improvement in road

construction, and some communities with poor road network have had their access roads

improved considerably. However, some roads to the smaller settlements are at best

rudimentary. A few of these rmds are not accessible during the rainy season.

There is a multiplicity of channels of communication. The most commonly used in

governmental circles is through the traditional political and community leaders, council of

"tO".r, religious leaders, youth and social groups. Town criers are often used at the

community level to communicate information to the public. Radio (and TV where

available) is also effective.

A dministrot io n str ucl ur eThe FCT is treated as one of the Federal Minishies, under the coordination and supervision

of a Minister appointed by the President and ratified by the National assembly. The Minister

is assisted by Directors who oversee different departments. The FCT is divided into six

administrative areas (Area Councils), under the leadership of an elected Chairman.


Health system & health care delivery @rovide the number of health posts/centers in theproject area if the information is available).R Frimary Health Care System is in place within the project are4 although the level offunctionality differs from place to place. This system of health care services ensures

community participation as the mainstay with the support of the local govemment/area

council. In this regard, some health care activities have been hansferred to local

govemmenVarea councils for adequate sustainability.

Table l: Number of health staffinvolved in CDTI @lease add more rows f necessary)

District/LGA

Numbcr of hcrlth strff involvcd in CDTI rctivitics

Totrl Numbcr ofhcrhh strfr in thccntirc project rrcr

Br

Numbcr of hcrlthstefr involvcd in

CDTI

B,

Pcrccntegc

B3=B2l 81 *lfi)

AMAC 50 25 50o/o

ABAJI 30 25 83%

BWARI 35 25 7lo/o

KWALI 37 25 680/o

KUJE 45 25 68%

GWAGWALADA 46 25 62%

Total237 150 630/"

1.1.2. PartnershipIndicale lhe parlners involved in project implementation at all levels (MoH, NGDOs -nat io nal, inter notio nal)The FCT project is a partnership involving APOC, NOCB CBM, State Government, the

Area Councils, and the endemic communities.

Describe overall worhing relationship omong partnerc, clearly indicating specilic oreas ofproject activitics @lnnntng, supervision, advococlt, planning, mobilizfiion, etc) where allpartnerc are involvedAPOC provides financial and logistic assistance, and conducts monitoring/evaluation of the

project activities. NOCP coordinates the control efforts and provides guidelines. It also

supervises and monitors implementation of programme activities, advocates for support and

provides technical assistance through the Zonal Office. The State and Local Governments

through the SOCT and LOCTs conduct training of all levels of personnel involved inprogramme implernentation, collects and deliver mectizan to endemic communities, collects

and collates reports/data on CDTI, mobilization and health education of communities, and

supervision/monitoring of CDTI activities. The community selects its distributors, decides

on mode and period of distribution, and provides support for dnrg dishibution, census

update, and recording and reporting of treafinent activities. The assisting NGDO - CBM -assists in advocacy, provides technical assistance and logistic support. It also assists inprovision of tEC materials and funds for various CDTI activities.

5 WHO/APOC, 24 November 2fi)4

Overall relationship among partners has been cordial.

State plans tf any to mobilize the state/region/district/LGA decision-makers, NGDOs'

NGOs, CBOs, to assist in CDTI implementation.As a routine SOCTs and LOCTs Carry out advocacy visits to policy makers at State and

Area Council level before the commencement of the dishibution exercise. This becomes all

the more necessary in view of the fact that elections into the area councils are expected to

hold by March 2004 andnew policy makers will be in place-


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SEGTIOII 2: tmPlementation of GDTI

2.1. Timeline of activities

Insert Plan of action indicating activities by month, which were implemented'

SAI Activities Time ImplementedI J' 2005

2 Review January 2005

3 February 2005

4 Mectizan February 2005

5 of PHC Staff February 2005

6 Mobilization February - March 2005

7 of CDDs - March 2005

8 Census U March - 2005

9 Mectizan Distribution April - May 2005

10 May - June 2005

1l Treatrnents June 2005

t2 collection & Collation June 2005

l3 Feedback Workshop 2005


Advocacy

Monitoring & Supervision

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State the number of poticy/decision mokerc mobilized at each relevant level during the

current year; tie- ,iô^ for the sensitizltion and outcomc' Descrtbe

dilliculfie;/constraints beingfaced and suggestions on how to improve advocacy'

At the State level the Hon. Minister, Permanent Secretary, Director Health Service, Deputy

Director Public Health, Director of Finance were sensitized. At the LGA level the Hon'

Chairmen, Council Secretaries, Council Treasures (CT), HODs Chieftaincy Affairs, and

HODs Health of the six area councils were sensitized. This was done to ensure political

commitment to the programme, release of counterpart funds, and logistic support' With the

advocacy and sensitLatlon approval was secured for the released of funds. This was followed

up with ihe actuat releases aiCouncil levels. To achieve this there was need for repeated visits

and fottow up as politicians could be very diflicult to deal with.

2.3. tobilizdion, scnsitizati.rn ard healllr Gducatiorl of at riskGlommunitiea

Provide information on :

The use of media and/or other local systems to disseminde informalion

FCT being the seat of the federal government as well as the HQs of most companies it isdifficult to utilize the mass media without adequate funding. The project therefore could not

make use of the mass media for mobilization and health education of, communities, as it is

expensive. The traditional systems employed for mobilization include:

Direct contact with the community members.

Use of town criersServices of information unit of LGA/Area Councils with vehicles mounted with public

address system.Utilization of the departnent of chieftaincy affairs of LGA/Area Councils to mobilize

officially community leaders and opinion leaders who then mobilized their communities.

Mobiliztfion and heahh education of women and minorities - method and response

The FCT being inhabited by peooni from diverse cultural and religious backgrounds which

provides the Jnabling "nri**ent for easy mix of men and women when the occasion

iemands. During treatttr education and mobilization women do not find it difficult toparticipate with ihe men and to make contibutions. There are however families that are

Muslims who do not allow their women to freely mix. For such families a female health

worker is usually assigned to health educate and mobilize them. As a result of womert

participation **, "ori*unities

have female CDDs who had been found to honest and

io-.itt"d to the work. However, women do not participate in the decision-making apparatus

of the communities. Most decision-making meetings take place at an elder's forum at the

chiefls palace. Women are conspicuously absent at such palace meetings. It is at such

meetings that community decisions on time and mode of treatment are usually taken.

Response of target communitiestTillogesfne Uenefiiof tiking Mectizan in previous years has made communities to respond positively

to health education messages and created a high demand for the drug. However, most

communities are still reluctant in supporting CDDs.

2.2 AdvocacY

Accomplishmerds

l0 WHOiAPOC, 24 November 2004

All communities have been health educated and mobilized. They have accepted CDTI as theirown although there are problems of giving incentives to CDDs.

ll'ea k nes s e s/C o nst r ai ntsThe FCT is a commercial center and seat of power of govemment. Several things are

monetized, and people expect benefits in monetary terms. Communities ane being encouraged

to do what they can for their CDDs. There is however need for gleater interaction with the

communities.

Suggest wuys to improve mobilization of the target communities.At the moment the communities in FCT require general mobilization and sensitization. Thiswill be useful to discuss compliance, community participation and support to the programme.

rherorrowinswavsy",;Hff '"J,li'f, 3'ffi lH#it*rHffi f,ff ::.T#'il:"lna"-i"

communities.o Mobilizing the entire communities at the villageso Talking to the people in the churches and mosques.

: i*:"'il: i:flffiil';Ti#:,'H"HI*unity Serr Monitoring(csM)

l1 WHO/APOC, 24 November 2004

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The project intend to train within the year 8 SOCTs, 3l LOCTs, 150 PHC staff and 720

CDDs. At the close, the project was able to train 8 SOCTs ,24LOCTs 120 PHC staffand720 CDDs.

t4 WHO/APOC, 24 November 2003

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Table 6: Type of training undertaken(Tick the boxei where spectfic training was carried out during the reporting period)

Any other comments

2.6. Treatm,ents

Total Population 297, 491

Number Treated 261,728Mectizan Used 733,474Coverage 88%o

Total communities - 559Number of communities Treated - 559

Geographical Coverage- 100%

Trainees

Typeof training CDDs

OtherCommunitymembers e.g

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PoliticalLeaders Others(speci$)

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2.6.2 What are the causes of absenteeism?

Temporary relocation by farmers to virgin areas

Movement back to schools"Travel outside the community during distribution

Employment in the citY

2.6.4

N/A

In case the project did not have any cases of serious adverse events (SAE) during this

reporting period, please tick in the box.

No SAE case to rePort

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2.6.3 What are the reasons for refusals?

The number of people refusing to take the drugs is almost non existing, but what

we have at the moment is absenteeism due mainly farming activities population

movement and lack of CDD motivation.

Briefly describe all known and verified serious adverse events (SAEs) that

occuried during the reporting period and provide (in table 8) the required

information when available.


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2.7. Ordering, storage and dclivery of ivcrmectin

Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer)

./uon tr Btro uflcnrNGDOOther (please speciff)

Mectizan@ delivered by - Qtlease tick the appropriate answer)

MOH tr WHOtr T]NICEFtr {NcoCOther (please specifu)

Please describe how Mectizan@ is ordered and how it gets to the communities

Information generated from census update by the CDDs is used to estimate the number of

Mectizan tablets that would be needed for the next treaffnent cycle. This information is made

available to CBM by the FCT team who applies to Merck, Sharpe & Dohme (MSD)' Once the

drug is made availa-ble through the NOTF itore to CBM, the FCT Team is contacted to fetch

thei requirements. The SOCT on collection requests the LOCTs to pick up their

consignments for their respective area councils. The LOCTs present the consignments to the

Area Council Chairmen tosignal the commencement of the distribution exercise. The LOCTs

asks the FLHF staff to pick irp their drug needg and these make the tablets required for the

communities to the CDDs.

Table l0: Mectizan@ Inventory (Please add more rows if necessary)

Sfate activities under tvermectin delivery lhat are being carried out by heolth care

personnel in the proiect areuThe Health Care Personnel uses the data generated by CDDs through Census update to

apply for Ivermectin based on the population figures-

The health staffs collect the supply of Ivermectin from the appropriate point, (the State

from CBM, the Area Council stafffrom the State and the Health facility staffcollects from

Area Council).The health staffalso store Mectizartfor safety at all levels.

Mectizan inventory are also kept by health Staffat all levels for record purposes and

ensure accountability. Monitoring and supervision /Health Education at community level.

State/District/LGANumbcrin stock

Rcqucstcd Rcccivcd Uscd Used/Pcrsontrcetcd

Lost Westcd Erpircd Rcmeining

AMAC 0 250,000 203,000 2r1239 77122

ABAJI 0 97,000 106,000 101840 36 166

BWARI 0 I10,000 106,000 103,744 35 140

KWALI 0 100,000106,000

106,339 37 902

KUJE 0 I14,000 132,000 123,265 44534

GWAGWALADA 0 98,000 90,000 87047 30 864

TOTAL 770,fl)O 743,4m 733474 261 728

2l WHO/APOC, 24 November 2fi)4

Number of tablets

- Any other comment

2.8. GommuniQT self-monitoring and $takeholdenr illeeting

Has any training (of trainerc)for community self-monitoring been done in the proiect

area?No training has been done, but we are requesting that APOC fund this activity to enable us

introduce the concePt in 2006.

Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed)

Describe how the results of the community self- monitoring and stakeholders meetings have

affected project implementation or how they would be utilized during the next treatment

cycle.

2.9. Supervision2.7 .l Provide a flow chart of su hierarchy

1.8.1 What were the main issues identified during supervision.

Issues identified in the process of supervision include:

District/ LGA Total # of communitieVvillagesin the entire project area

No of Communities thatcarried out self

monitoring (CSM)

No of Communities thatconducted stakeholders

meeting (SIIfvD

rln00flI

TOTAL N--

DD/PH

COORDINATOR

SOCTs

LOCTs

DHS

FLHF STAFF

CDDs/Comm unities


. Poor record keeping

' Lack of logistics at lower level

' Non support of CDDs by communities

. Low involvement of FLHF staff

' Delay in funds release to LOCTs

. Lack of documentation of supervisory visits

. Few health staffhanding several PHC activities

SEGTION 3: Support to GDTI

3.{. Equipmert

Table 12: Status of equipment (Please add more rows if necessary)

*Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable,

WO:Written off;.

IIow does the project intend to maintain and replace existing equipment and othermaterials?

Funds have been set aside for the maintenance of vehicles motorcycles from the counterpart

funds made available by the Government. It is expected that this will continue. The project

will be requesting APOC management to replace existing transport and other capital

equipment.

For other materials the assisting NGDO is willing to assist, and efforts will be made to get

other groups to support. Meanwhile efforts will continue to get government to fund the

replacement of these materials when necessary.

Describe the adequncy of available hnowledgeable manpower at all levels.

Source

Type ofequipment

APOC MOH DISTRICT/LGA

NGDO Others

No Condrtion No Condition No. Condition No. Condition No. Condition

l. Vehicle I F I CNFR2. Motor cycle(s) 20 CNFR 5 wo 3 F

3. Computer(s) 1 CNFR4. Printer(s) I CNFR5. Photocopier (s) I F

6. Fax Machine(s)7. Othersa) Generator I F

b) Television I CNFRc) Video I wo


Manpower though few compared to overall population of FCT are adequate for CDTI

implementation if all that are trained will be committed.

Where frequent transfers of trained staff occur, state what project is doing or intends to

do to ."."dy the situation' (the most important issues is what measures were taken to

ensure adequite CDTI implementation where not enough knowledgeable manpower was

available or staffoften transferred during the course of the campaign)-

Efforts are made to train new staff whenever transfers occur. But the transfers can be quite

rapid, and sometimes there are delays in re-orienting the new ones. The solutions in the near

future is to consider the training of all PHC workers which could be expensive.


Contributor

Ye* I ('provde theperiod')

Yerr 2 ('provde thepernd')

Ycat 3 ('provide theperiod')

TOTALAMOUNT

(cASH)Budgeted

(us$)

TOTALCASH

Released(us$)

TOTALAMOUNT

(cASH)Budgeted

(us$)

TOTALCASH

Released(us$)

TOTALAMOUNT

(cASH)Budgeted

(US$)

TOTALCASH

Released(us$)

MOH (Central + ProvinciaUstate) 50,000.00 0 5s,000.00 50,000.00 s5,000.00 50,000.00

MOH @istrict/LGA) 31,000.00 8,000.00 3s,000.00 t 2,000.00 36,000.00 14,000.00

Local NGDO(s) ( if any)

NGDO partner(s) 34,000.00 I1,000.00 20,000.00 10,000.00 35,000.00 21,000.00

Others

a)

b)

APOC Trust Fund 0 0 0 0 0 0

TOTAL 84,000.00 19.000.00 l 10, 000.00 72,000.00 126,000.00 85,000.00

3.2. FINA}[CIAL CONTRIBUTIONS OF TIIE PARTIYERS AND COMMT'NITMS

Table 13: Financial contributions by all partners for the last three years

If there are problems with release of counterpart funds, how were they addressed?

Before the current administration headed by Matlam El- Rufai, release ofcounterpart fund was a big problem, but with continuous advocacy and

sensitization, budgetary allocation has been considered yearly for the project

for CDTI and Blindness Prevention Programme of the FCT. This is a

welcome development and is highly commendable.

3,3. ()ther forms of community support

- Describe (indicate forms of in-kind contributions of communities if any)

Different communities have one form of support or the other which can be considered

relative to the people of the area.

3.4. Expenditurc pcr activitY

- Indicate in table 14,the amount expended during the reporting period for each activity

listed. Write the amount expended in US dollars using the current United Nations

exchange rateto local currency. lndicate exchange rate used here


Expenditure($ us)

Source(s) offunding

Drug delivery from NOTF HQ area to central collection point ofcommunity

Mobilization and health education of communities

Training of CDDs

Training of health staffat all levels

Supervising CDDs and distribution

Internal monitoring of CDTI activities

Advocacy visits to health and political authorities

IEC materials

Summary (reporting) forms for treatment

Vehicles/ Motorcycles/ bicycles maintenance

Office Equipment (e.g computers, printers etc)

Others

4,200

7861

5,100

3,221

3,000

3,891

6,971

10,473

6,921

6,411

CBM/MOH

MOH

CBI\4/MOH

MOH

MOH

CBM/MOH

MOH

MOH

CBM/MOH

CBM/MOH

TOTAL50,000

Total number of persons treated 261,728

Table 14: Indicate how much the project spent for each activity listed below during the

reporting period.

Any comments or explanations?

SEGTIOII + Sustainabilitt/ of GDTI

4.,1. Internall independent pailicipatory monitoring; Evaluation

4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tickany of the following which are applicable) N/A

Year I Participatory Independent monitoring

Mid Term Sustainability Evaluation

5 year Sustainability Evaluation

Internal Monitoring by NOTF


Activitv

Other Evaluation by other partners

4.1.2. What were the recommendations?

4.1.3. How have they been implemented?

&2. Sustainability of proiectsl plan and set targets (mandatory atYr 3)

Was the project evaluated during the reporting period (NO)

Was a sustainability plan written (YES)When was the sustainabiliry plan submitted (YES)What arrangements have been made to sustain CDTI after APOC funding ceases in terms of,

4.2.1. Planning at all relevant levelsRepresentatives from the state and Area Councils have developed realistic 3 years

sustainability plans based on basic CDTI activities and recommendations made by the

evaluators.

4.2.2 Funds:

In the past 5 years of CDTI implementation, the Government released funds for 3

years. As a result of continuous advocacy and the adding on of the Primary Eye Care

Programme, the FCT authority has released 5m Naira for 2005 activities. At the Area

Council level there was release each year, although the levels were fluctuating. The

project intends to build on this release to continue advocating for continuous funding

of CDTI activities. The project will also approach philanthropic organizations such as

Rotary Club to fund aspects of the project. In the meantime the assisting NGDO has

expressed readiness to minimally support CDTI but in an integrated manner with PEC

activities.

4.2.3 Transport @eplacement and Maintenance):

The available transport has been in the Area Council for the pastT years and require at

the moment replacemeng while the existing ones can be maintained to complement.

The FCT project has in the light submitted proposal to APOC for replacement of

existing capital equipments.


4.2.4 OthersResources:

There is presently renewed commitment in the additional PEC programme recently

introduced which is also attracting support from both the CBM and the government.

This is a welcome idea as it will greatly support the monitoring and supervision of

CDTI.

4.25. To what extent has the plan been implemented?The plan was implemented from 2004, and extent of implementation reported in this

technical report.

Integration:

Outline the &ent of integration of CDTI into the PHC structure and the plans for

complete integration

CDTI is part and parcel of PHC structure but exist as vertical programme because of

its strategies and technicalities. As long as the health worker are involved, its indeed

an integrated programmme.

4.3

4.3.1 Ivermectin Delivery Mechanisms:

The LGA focal persons who are part of PHC deparfinent normally come to collect the

ivermectin whenever they come to collect NPI vaccine or other PHC logistics for their

area councils. Also at Council level Mectizan collection is within PHC structure

because LOCTs and first line health facility staffare all within PHC deparftnent.

4.3.2 Training:

CDTI training has not been integrated with any other training activity or other

programmes. This activity is being carried out in a targeted manner, but reasons

suggest that the quality is reducing, requiring full scale training and re-training

activities for all programme workers in 2006.

4.3.3 Joint Supervision And Monitoring With Other Programs:

There is joint supervision and monitoring since the LOCT and FLHF staffs are

charged with different activities to execute.

4.3.4 Release of Funds:

Release of funds pass through the same channels within the PHC structure. At LGA

level some impress is made available to PHC Coordinator and from here some


amounts are given to the LOCT leader for routine supervision. Funds are not

combined and release for two different programmes at a time.

4.3.5 Is CDTI included in the PHC budget?

CDTI activities are included in PHC budget.

4.3.6 Described other health programmes that are using the CDTI structure. What has been

the achievement?

The newly introduced Primary Eye Care programme is utilizing the CDTI structure.

So far, some LOCT and CDDS have been trained in PEC.

4.3.7 Describe other issues considered in the integration of CDTI.

CDTI can be utilized for programme like malari4 guinea worrn, polio etc.

4.4 OperationalResearch

4.4-l Summarize in not more than one half of a page the operation research undertaken in

the project area within the reporting period.

Presently the Kinship study is being undertaken, as preliminary data has been

collected already.

4.4.2 How were the results applied in the project?

N/A

SECTION 5: Strengths, Weakness, Challenges and Opportunities.

- List the strength andweakness of CDTI implementation process

- List the challenge. "Andindicate how they are addressed".

STRE,NGTHS:

* The release of counter part fund forthe year 2005

t?. Availability of Mectizan and its wide acceptability

* Continuous release of counterpart funds by most Area Councils

{. Availability of some, CDD that are dedicated to the programme

* Introduction ofthe Primary Eye Care Programme.


WEAKNESS:

.3. Declining morale of some LOCTs/FLHF staff due to irregular or lack of

support from Area Council executives-

* Delay in release of counterpart funds by Area councils

* Most communities do not support the CDDs Leading to CDD athition

* Massive transfer of trained health staffat the Council level

{. Unstable FCT population particularly at the satellite towns due to urbanization

CHALLENGES:

* Need to redefine satellite towns in FCT where the disease is endemic, and

where treatments can continue

* Nonchalant attitude of the health staffparticularly at the LGA and FLHF level

* Demand of some CDDs for incentives before carrying out CDTI activities in

their communities

* Sustained and regular, release of counterpart funds from state and LGAs

* Replacement of old vehicle(s) and motorcycle

* Sourcing of funds other government in case of shortfall or non release of

counterpart funds.

To address the challenges faced the project has done the following:

.E Re-organized the LOCTs and tried to ensure that committed FLHF staff ate

appointed to handle the programme

* Sensitized communities to select persons that are really willing to work for

them

{. Continued advocacy with policy makers to ensure sustained and early release

ofcounterpart funds

{. Plans are being made to approach relevant organizations to support CDTI

within the project area.

SEGTIOII 6: Unique featutes of the proieeUothermatters

This unique feature of the project is that it is a very fast growing city, that is fast diluting the

original endemic communities' around the capital city.

30 WHO/APOC, 24 November 2fi)4

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