ANNUAL NOTF SECRETARIAT TECHNICAL REPORT

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ORIGINAL

^{: English}

ANNUAL NOTF SECRETARIAT TECHNICAL ^REPORT

TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

tcc s3 To ApOC Management by 31 January ^for 14 ^{TCC meetin{}

i by 3l Julv for SSplember TCC meetin$

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To APOC ^Management

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AFRICAN PROGRAMME ^FORNF4*

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oNcHocERcrASIS ^{CONTROL (APOC)}

NOTF: ^Nryerda COUNTRY/z Nigeria

Approval vearz 1997

January - December 2005

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^ear

2 3 4 s 6 7 ⁽⁸⁾ 9 ¹⁰

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Proieet _{Year this rt:} ^(circle) I

July ²⁰⁰⁶

Date su bmitted:

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a

ANNUAL NOTF SECRETARIAT TECHNICAL ^REPORT

TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

ENDORSEMENT

Please confirm ^{you have read this} report by signing in the appropriate ^space.

OFFICERS ^{to sign the} report:

Country ^z NIGERIA

National Coordinator ^Name: Mrs. Patricia Oghu-Pearce Signature:

Date: June 20,2006.

NOTF Chair

Name: Dr. ^S. Sani Signature:

Date: June 20,2006.

This report has been prepared by Name: C. Okoronkwo'

Designati on:

Tech

nicol Oflicer/Data Manager Signature

Date: June 20,2006

I

t

WHO/APoC, 3 October 2004

TABLE OF CONTENTS

1.1.

GeNpRel- INFoRMATIoN...

1.2. PopulnrtoN

^AND

Hee.lru

sYSTEM...

SECTION 2: SUMMARY OF CDTI IMPLEMENTATION

2.1.

DtsrntsurtoNPERIoD

2.2. ^AovocncY

^e.No SeNsnlzATIoN

2.3.

INTORUETION, EDUCATION AND COMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT...

2.4. CouvuNtrles'

INvoIvEMENT lN DECISIoN-MAKING...

.... 1l 4 7 9 9

2.5.

2.6.

2.7.

2.8.

2.9.

Cnpncttv

^BUILDINC..

OnoeRrNG, sroRAGE ^{AND DELIVERY} oF IvERMECTIN ...

TRenTuENTS...

SupenvtsloN ...

ColluuNtry

sELF-MoNIToRING nNo StereHoLDERS

Meermc

r0

l4

15

l9 2l

29 .... 3 I

SECTION

3:

OTHER ACTMTIES ^{OF THE} NOTF..."""""" ""'

³⁴

SECTION 4:

^SUPPORT

TO CDTI """""""

³⁷

4.1 FrNeNctn

l

coNTRtBUTIoNS ^{oF THE PARTNERS} ...

4.2 OrHEn ^{FoRMS oF} coMMUNlrY suPPoRT...

4.3.

^Resounce MoBILIZATIoN EFFoRTS....

4.4.

ExpENotruRE ^PER

AcrlvlrY

BY THENOTF SECRETARIAT

""""""

4.5. ^EeulPunNr

SECTION

5:

EVALUATION ^FOR SUSTAINABILITY ^OF CDTI, INDEPENDENT MONITORING AND OTHER REVIEWS

59 62 63 63 64

5.1.

INoppeNoENTPARTICIPAToRY

MoNlToRlNc/evatuatloN....

5.2.

5.3.

SUSratNaglLlTY OF PROJECTS: PLAN AND SET TARGETS (MANDAronv er Yn 3)

INTecRnrtoN ...

66 66 69 70 5.4 OpenertoNAt- RESEARCH...

7l

SECTION

6:

STRENGTHS, WEAKNESSES, CHALLENGES ^AND OPPORTUNITIES

73

i t

Acronyms

APOC

ATO ATrO CBBI

CBO

CBM

CC CDD CDI

CDTI CM

CSM DHS DOTS FCT FLHF GCR GIS GRBP HFS HKT

HMM HSAM

HQs TDP TEF

IFESH

IT

African

Programme for Onchocerciasis Control Annual Treatment Objective

Annual Training Objective

Community Based Bamako

lnitiative

Community-Based Organization

Christoffel

Blinden Mission Carter Center

Community-Directed Distributor Community-Directed lntervention

Community-Directed ^Treatment

with

lvermectin Community Meeting

Community

Self-Monitoring District

Health

Staff

Directly

Observed Treatment Short-course Federal Capital

Territory

Front Line Health

Facility

Geographic Coverage Rate Geographic lnformation ^SYstem

Global 2000 River Blindness Programme Health

Facility Staff

Helen

Keller

lnternational Home Management

of

Malaria

Health Education, Sensitization, Advocacy

& Mobilization

Headquarters

Ivermectin

Distribution

Programme lntemational Eye Foundation

lnternational Foundation for Education

&

Self Help Information TechnologY

a

ITN

lnsecticide Treated Net

KAP

Knowledge,

Attitude &

Practice

LF

Lymphatic Filariasis

LGA

^{Local Govemment Area}

LOCT

^Local Government Onchocerciasis Control Team

MDP

Mectizan Donation Programme

MIS

Management lnformation System

MITOSATHMission

to Save the Helpless

MOH ^Ministry

^{of Health}

NEEDS

NationalEconomicEmpowermentDevelopmentStrategy

NGDO

Non-Govemmental Development Organization

NGO

Non-Governmental Organization

NOCP

^National Onchocerciasis Control Programme

NON

Newsletter on Onchocerciasis in Nigeria

ll

WHO/APOC,

¹⁰

April2003

I

NOTF

NPHCDA

NPT

o/R

PATHS PEC PHC REMO SAE SHM SMOH SOCT SSI

TBA

TCC TCR

TOT UN

UNICEF

UNIVA

UTG

VAS

wHo

ZOTF

National Onchocerciasis Task Force

National Primary Health Care Development Agency National Programme on

lmmunization

Operational Research

Partnership for Transformation

of

Health Systems Primary Eye Care

Primary health care

Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event

Stakeholders meeting State

Ministry of

Health

State Onchocerciasis Control Team Sight Savers lntemational

Traditional

Birth

Attendant

Technical Consultative Committee (APOC scientific advisory group) Therapeutic Coverage Rate

Trainer of trainers United Nations

United Nations Children's Fund University

Village

Association Ultimate Treatment Goal

Vitamin A

Supplementation

World

Health Organization Zonal Onchocerciasis Task Force

lll

WHO/APOC,

10

April2003

t

Definitions

(i)

Total population: the total population

living

in meso/hyper-endemic communities within the project area (based on REMO and census taking).

(ii) Eligible

population: calculated as 84o/o

of the total

population

in

meso/hyper- endemic communities in the project area.

(iii)

Annual Treatment Objective:

(ATO):

the estimated number

of

^persons

living

in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a

given year.

(iv)

Ultimate Treatment Goa[ (UTG): calculated as the maximum number of people to

be treated annually in

meso/hyper endemic areas

within the project

area,

ultimately to

be reached when the project has reached

full

geographic coverage (normally the project should be expected

to

reach the UTG at the end

of

the 3'd

year

ofthe

project).

(v)

Therapeutic coverage: number

of

people treated

in a

given year over the total population (this should be expressed as a percentage).

(vi)

Geographical coverage: number

of

communities treated

in

a given year over the total number

of

meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).

(vii)

Integration:

The

bringing together

of two or

more health programs, removing barriers between/among them, in order to maximise cost-effectiveness and permit free and equal association. For example 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 empower communities to solve more

of

their health problems. This does not include activities

or

interventions carried out by community distributors outside of CDTI.

(viii)

Sustainability:

CDTI

activities

in

an area are sustainable when they continue to

function effectively for the

foreseeable

future, with high

treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government.

lv WHO/APOC,

10

April2003

FOLLOW UP ON TCG REGOMMENDATIONS

Using the table below,

fill in

the recommendations

of

the last TCC on the project and describe how they have been addressed.

TCC session

21

(Please add more rows

if

necessary)

I

Number

of

Recommend ation in lhe Report

TCC

RECOMMENDATIO N

ACTIONS TAKEN BY THE NOTF SECRETARIAT

FOR TCC/APOC MGT USE

ONLY 4

(i)

continue

advocatingfor

Federal

government, state and LGA cash

contribution

This is being done

with

tremendous help from APOC Mangement, some members

of

TCC, members of the Steering Committee, and NGDO partners. We have seen

Ekiti,

Oyo and Nassarawa giving some counterpart funds for the first time for

CDTI

activities.

Delta State during the reporting period increased its counterpart contribution significantly

4

(ii)

encourage

training

of many CDDs in every community

The NOTF is encouraging this. Ebonyi State has applied for support from APOC

Mgt for

selection and training

of

more CDDs along kindred lines. Their proposal has been approved, and implementation is expected to commence from 2006. The NOCP intends to submit ^a special proposal for selection and training of CDDs in selected States.

4

(iii)

where women are accepted, should encourage

their

selection as CDDs

This is the stand of the NOTF. However, some States complain of lack

of

funds

for

proper mobilization, and even where new CDDs, including female CDDs, are selected the funds ^are not there to do ^a thorough training.

a

(iv)

where ^a

project

has more than one state, information

for

each state should be

provided

This has been done in the current report.

WHO/APOC,

10

April

2003

Executive Summary

Nigeria is made up

of

36 States and the Federal Capital Territory

with

a population of over 120

million p...onr.

Total population at risk for Onchocerciasis is about 28

million

^persons.

In 2005 treatments increased

slightly with

^{a total of 21,} 166,922 persons being treated. This represented aTS%otherapeutic

"ou"rug.

rate, and achievements

of

90% of both the

ATO

and

uic _-

slight reductionJover what was achieved in 2004.

overall,

the national therapeutic coverage lias been over 65Yosince 1999. Details of treatments show

that27

States (8a%)

of

the

totil

32 States and FCT covered

(a3%

increase over 2004 figures) achieved

>65%

therapeutic coverage rate. 31,883 communities were treated out

of

a total

of

36,162

communities targeted, representing an 88 % geographic coverage rate. Projects

like

Kebbi, Kwara, Niger, Gombe

andZamfa*

^huu. experienced coverage fluctuations on account

of

CDD attrition, inadequate number of CDDs, poor census update, inadequate supervision, late supply of Mectizan through the LGAs to the communities and lack

of follow

up on treatments due to dearth

of

funds. Poior performing States in the last two to three years in terms

of

coverage have been Benue,

6yo,

Imo and Abia. Reasons for this include withdrawal

of

extemal support, poor counterpart funding, poor managerial skills by State teams, inadequate commitmeni by h-ealth workers and improper mobilization of communities.

During the reporting period ^a total

of

10,601 health workers and 59,642 CDDs were trained or

re-traiied, r.fr.r.niing

achievements

of

81% and 78% of their ATrOs respectively. These represent slight increaies over numbers trained/retrained in 2004. The CDD/population ratio stands at about ¹

CDD:

472 _Persons.

Extent

of

integration

of CDTI

into PHC varies from one project to another, and from State level to the

fiUF

^level. Generally, Mectizan ^processes and funding are

within

the

govemment system. Joint monitoring/supervision ^and

joint utilization of

logistics/transport

6."u.

more

aithe

peripheral level than ^at the project or national levels.

CDTI

^{has been used as}

a vehicle for

VAS,

PE'C, schisto and LF control programmes to the benefit

of

all the programmmes.

In the course of the year, the NOTF conducted advocacy campaigns, participated in targeted training of programme staff, coordinated procurement

of

Mectizan and capital items, organiied

*p.-*irory

^and monitoring visits to selected projects, and overseen transfers

of eiOC fundJto projetts while

ensuring that expenditures are

in

line

with

approved budgets.

The NOTF ^tras atso conducted routine programme review meetings and sensitizationl mobilization of target populations.

Strengths

of

the programme

in-country

^include increasing

level of

integration

of CDTI

into

the pHC

structure,

-p..r"r,."

of trainid staff at all levels of CDTI

implementation, ^good commitment

by healih staff

especially

at

the State

level to the CDTI

process, and effective coordination, networking ^and collaboration at national and State levels. Moreover, ^mectizan processes, apart

from

procurement, are

well

established

within the

^{govemment system, and} are

working

perfectly. The

CDTI

^structure

^is

^{also being} used as a vehicle

for

the delivery

of

other health

"*.

p.og.ummes such ^as

VAS.

^{This has} strengthened the

CDTI

structure.

Weaknesses

are

absence

of

appropriate

skills at national level for the mobilization of

resources

for CDTI

implementation

in the

country,

poor

coordination

of

research activities

resulting in ineffective utilization of

^outcomes

in

^projects,

^poor

supervision

at all

levels, inadeqtilte involvement

of

the

FLHF

staff

in

the

CDTI

process,

low CDD

to population ratio and inadequate record keeping at the

LGA

and FLHF levels.

2

WHO/APOC, l0 APril

2003

t

Opportunities for

strengthening

the CDTI

process abound.

These include availability of human resources for ^COtt lmplementation at atl levels, increasing recognition

^by

stakeholders

of CDTI

as a vehicle

for

the effective delivery

of

varied health interventions at

the community level, early receipt of Mectizan

consignments

at the national level,

^and

increasing involvement

of

local NGOs, CBOs and associations in the

CDTI

process.

Mass and indiscriminate transfers

of

health staff; the creation

of

the

Ministry of

Environment

in the

south westem States and subsequent deployment

of

environmental health

officers

to that

Ministry;

inadequate counterpart

funding for

^project

activities at

State and

LGA

kevel;

weak levels

of community owneiship in

some

of the

projects; and payment

of

community based workers

by

other programmes constitute some

of the

threats

to effective

programme implementation

in

the country.

Additionally,

^there

is

a general

feeling of well

being among some target populations resulting in non-compliance to Mectizan treatments.

To

address the chalenges and threats the

NOTF

embarked

on

advocacy visits/campiagns to

policy

makers,

.r,ru..J the

reconstitution and

training of

^teams

^{at State/LGA}

^{levels, and}

inititia

moves

for

the

mobilization of

resources

from

the

public

and private sector

for

CDTI.

It

also encouraged projects to request inclusion

of

CDDs

in

incentive

-

paying programmes at the community

levil, Lnru..

selection

of

more CDDs along

kinship or

ward lines and have ^a rethink of IEC strategies to deal

with

non-compliance to annual treatments.

J

WHO/APOC, l0 April2003

\

SEGTION {: Background information {.'1. General lnformatlon

l.l.l. Description of

^the

country ^program -CDTI

^and

vector elimination (briefly)

Status

of

National

ptan

implementation,

population at

risk,

number

of proiects being

impleminted, othei relevant

activities,

infrastructure

^{(eg. Adequate}

healthfacilities,

^is system decentraliZed

or

not, etc), logistics, administrative structure.

Nigeria is made up

of

36 States and the Federal Capitat

Territory with

^a population

of ovir

120

million

persons. Nigeria operates a federal system. There is ^a central

govemment

withihe

president at the top, supported by executive, legislative and

judicial

ipparatus. Each Statohas its own govemment

with

the Governor ^as the chief executive.

fi. ^ir

"o.plemented

^{by the same type of} structures at the federal level but on a ^State basis. The State consists of a number of LGAs

with

each

LGA

being administered by the Executive Chairman supported by its miniature legislative and executive structures.

The country is divided into six geo-political zones. There are however 4 health ^zones for the onchocerciasis control programme. Each health zone comprises eight to ten States and has a Coordinator for the Onchocerciais Control Programme.

Latest

information on PHC facilities

indicates that

there

are 22,895

different

types

of facilities in

the country.

Of

the

number

14,203 are

public

health

facilities while

8,692

are privately owned. lg, ^{745 are} PHC facilities white ^2,970 are

secondary health

facilities.

The remaining 33

facilities

are

of

tertiary level. The

total

number health ^care

facilities is still considired

^grossly inadequate and accessibility (physical access and economic access) is ^a big

p.obl.*. A

majority of the rural populace is emasculated from adequate health care.

presently

Nigeria

has

28

projects

(27

CDTI projects covering

33

States, including the Federal

-Capital

Territory, and the National

Headquarters Support

Project. About

²⁸

mitlion

persons are at risk of the disease.

Heatth system

&

heatth care delivery

$tate

^any problems related to health ^system

that

imp e de p ro g

ram

imP le me ntation).

primary Health Care (PHC) is the

strategic

policy, central function and ^focus of Nigeria's national health

system, and

to this is tied the overall social

^{and economic}

development of ^the communities. This ^{policy, according} to the document

on

Revitalization of primary Health

Care

in Nigeria - ^{A Blue Print,}

recognizes that the physical,

biological

and social environment

of

a community constitutes the cesspool in

which

diseases=thrive and

from

where they can be

effectively

controlled

or

eradicated.

Currently,

Health

Care

Delivery is

the responsibility

of all

three

tiers of

government,

with

each

tier

taking care

of its

level. Ideally, at the

LGA

level PHC is the

first

level

of

contact

of the community

^members

with the health

service,

and

referrals are made upwards from that level.

Problems:

roles and responsibilities

of

the State and the Federal are not clearly spelt out.

minimum ^health

^{care package}

to citizens of the country. Policy

^{makers and} programme managers

within the

health sector has

faited to

agree

on or

work

4 ^{WHO/APOC, l0 APril2003}

towards an integrated

minimum

package

of

PHC services, preferring rather the execution

of ^gigantic

and expensive

vertical

programmes

for

each component without commensurate impact.

economically inaccessible to the rural populations and the poor.

by inadequate logistic support and poor communication.

or institutional

support

for community participation

and

co -

management in PHC.

little or

nothing

for

capital development, drugs

or

supplies.

[n

some areas, there

is a problem with the

payment

of

^salaries

of health workers

leading

to low

morale and abandoffnent

of

work for other means

of

livelihood.

Provide map

locating

all projects

(CDTI and

Vector

Control, tf

any)

within

country,

Yobe

Kano Bomo

lGduna

FCT Niger

Taaba Benue

Shaded areas indicate the combined projects

1.1.2.

Partnership

Indicate

the

partners

involved in

project

implementation at

all

levels

(MoH,

NGDOs

- national,

inte rnatio

nal)

5

Name

of CDTI Project Partners

Adamawa

HKI,

NOCP, State MOH, endemic LGAs, target communities,

CBBI

committees.

Akwa Ibom

HKI,

NOCP, State MOH, endemic LGAs, target communities, Bauchi UNICEF, NOCP, State

MOH,

endemic LGAs, target

communities,

Benue UNICEF, NOCP, State

MOH,

St. Monica's Hospital Adikpo,

WHO/APOC,

10

April2003

rr'ffi

ri ', t"r

-) ta

)

endemic LGAs, target communities,

Borno

HKI,

NOCP, State MOH, endemic LGAs, target communities, Cross River LINICEF, NOCP, State

MOH,

South Eastern Nigeria Outreach

Eyecare Services (SENOES), Ogoja Catholic Eyecare Services, Cross River National Park, Cross River Forestry Commission,

Tulsi

Chanrai Foundation, Great Friends of Obudu, Pacesetters

Klub

Exclusive of Calabar, Calabar Leo Club, Catholic Nurses Guild, endemic LGAs, target communities, Youth Care, Opthalmology Dept of University of Calabar, Cross River University

of

Calabar.

Edo Global 2000lCarter Center, Lions Club International District 404, NOCP, State MOH, endemic LGAs, target communities,

Delta Global 2000/Carter Center, Lions Club Intemational District 404, NOCP, State MOH, endemic LGAs, target communities,

Ekiri

UNICEF, NOCP, State

MOH,

endemic LGAs, target communities,

Enugu Global 2000/Carter Center, Lions Club lnternational District ^404, NOCP, State

MOH,

PATHS, endemic LGAs, target communities, Anambra Global 2000/Carter Center, Lions Club International District 404,

NOCP, State

MOH,

endemic LGAs, target communities,

Ebonyi Global 2000/Carter Center, Lions Club Intemational District ^404, NOCP, State MOH, endemic LGAs, target communities,

FCT

CBM,

Dept

of

Health, Area Councils, target communities Gombe UNICEF, NOCP, State

MOH,

endemic LGAs, target

communities,

lmo Global 2000lCarter Center, NOCP, State

MOH,

endemic LGAs, target communities,

Abia

Global 2000lCater Center, NOCP, State

MOH,

endemic LGAs, target communities,

Jigawa

CBM,

NOCP, State

MOH,

endemic LGAs, target communities, Kaduna SSI, NOCP, State MOH, endemic LGAs, target communities, Kano

CBM,

NOCP, State MOH, endemic LGAs, target communities, Kebbi SSI, NOCP, State MOH, endemic LGAs, target communities,

Kogi

SSI, NOCP, State MOH, endemic LGAs, target communities, Kwara SSI, NOCP, State

MOH,

endemic LGAs, target communities, Niger UNICEF, NOCP, State

MOH,

endemic LGAs,

Agric.

Cooperative

Groups, Trade Unions, Age Grades, target communities,

Ogun

IFESHruNIVA,

NOCP, State

MOH,

the Baptist Church, Anglican Church, endemic LGAs, target communities,

Ondo UNICEF, NOCP, State

MOH,

Progressive Club, Elite Club, Cordat Club, Union of Friends, endemic LGAs, target communities,

Osun UNICEF, NOCP, State

MOH,

endemic LGAs, target communities,

oyo

UNICEF, IFESH, NOCP, State

MOH,

endemic LGAs, Boys'Scout, Girls Guilds, Lydia Groups, Man O War Groups, target communities,

Plateau/ Global 2000lCarter Center, NOCP, State

MOH,

endemic LGAs, target communities,

Nassarawa Global 2000lCarrer Center, NOCP, State

MOH,

endemic LGAs, target communities,

Taraba

CBM; MITOSATH,

NOCP, State

MOH,

endemic LGAs, target 6

WHO/APOC,

10

April2003

communities,

Yobe

CBM,

^{NOCP, State}

MOH,

^DAMAgUN Development Association, Fune Development Association, Bubaram Gakoko, endemic LGAs,

Zamfara ^SSI, NOCP State endemic

LGAs

Describe overall working relationship ^among partners, clearly indicating

^speciJic

areas of project activities where all partners are involved (planning,

supervision,

advocaiy,

resources

mobilization,

endemicity mapping

/

assessment, development

of

IEC

materials, studies or surveys etc).

Generally, the relationship among

^partners

is cordial though there are

^occasional

frictions

over the extent

of

roles being played

by

some partners. The NGDOs assist in

resource mobilization, advocacy, endemicity

assessment,

Mectizan

procurement,

monitoring

and development

of IEC

Materials.

The

State and

Local

Governments ^are engaged in mobilization, plaruring, supervision, Mectizan delivery, and training.

NOCP's role includes advocacy, training, supervision/monitoring, ffid

^technical

support.

The

communities select

their

distributors, determine

type of

incentive

to

be

givin to such distributors, decide

mode/period

of distribution, fund local

^costs

of

distribution,

and supervise the distribution programme. Where operational local NGOs and CBOs assist

in

community health education and

mobilization,

supervise and part

-

fund the

CDTI

^process.

State

plans d

^{any to solve}

any

^issues

arising

as regards

CDTI

implementation.

There are no plans to ^{solve any issue as} it ^relates to partnership in ^CDTI

implementation, as none is outstanding.

1.2. Populatlon and Health system

Table 1: Projects and population at risk in the

entire country

whether they are treated or not during the reporting period. ^(Please add more rows

if

necessary)

7 Name of

CDTI ^{Project Total}

communities

in

meso/hyper- endemic zone

Total population in

meso/hyper-endemic

zone

Ultimate Treatment Goal (UTG) by 2010

Adamawa 2,784 ^{1,178,45 1 989,899}

Akwa lbom ^{13 17,682 14,853}

Bauchi 675 914,000 767,760

Benue 3,473 2,957,600 2,484,384

Borno 1,429 745,109 625,892

Cross River 930 1,008,897 847,474

Edo 530 687,029 577,104

Delta 470 562,439 472,449

Ekiti

^{344 1,091,000}

9r6,440

WHO/APOC,

¹⁰

April2003

Enugu 1,373 922,475 774,879

Anambra 1,062 735,153 617,529

Ebonyi 973 594,000 498,960

FCT 559 297,491 249,892

Gombe 966 1,617,452 1,358,660

lmo 1,940 955,208 802,375

Abia

684 522,920 439,253

Jigawa ¹⁵⁸ 352,832 296,379

Kaduna 2,597 1,283,274 1,077,950

Kano 977 600,738 504,620

Kebbi 287 241,415 202789

Kogi

^{2,544 1,572,168 1,320,621}

Kwara I_,109 973,054 817,365

Niger 2,745 1,632,079 1,370,946

Ogun 881 300,274 252,230

Ondo 579 1,212,406 1,018,421

Osun 997 814,030 683,785

oyo

^{2,269 r,244,463 1,045,349}

Plateau 296 354,799 298,031

Nassarawa 589 868,751 729,751

Taraba 1,533 l,ogg,823 923,851

Yobe 247 594,486 499,368

Zamfara 134 160,231 134,594

TOTAL

36,162 28,L56,752 23,651,672

Source: From Oncho Project reports: National census: Other source,

speci Year source:

UTG: Calculated as the maximum number of people to ^be treated annually in meso/hyper endemic areas

within the project

area,

ultimately to ^be

^reached

^{when the project}

^{has reached full}

geographic coverage (normally the project should ^be expected to reach the UTG at the end of the 3'd year of the project).

8

WHO/APOC, l0 April2003

SEGTION 2: Summary of GDTI lmplementation 2.1. Distribution ^period

Chart the actual distribution period for each

CDTI

Project in the country in the table below.

Overview of distribution undertaken rows as

BrieJly note any problems/issues (one paragraph).

Quite ^a number of projects

still

distribute Mectizan during the rainy season. This is at variance

with

the NOTF

policy

that distribution should take place in the dry season. It has however been noted that several reasons account for this development, and these include late delivery

of

Mectizan to projects/LGAs, non-provision

of

logistics by LGAs for drug

collection, unwillingness by some CDDs to distribute due to lack

of

incentives, poor commitment of health staff, community decision on time

of

treatment and late release

of

funds.

9

Distribution Period Project

Name Jan Feb

Mar Apr

May Jun Jul

Aug

Sep Oct

Nov

Dec

Adamawa

{ { {

Akwa Ibom ./ ./ ./

Bauchi ./ ./

{

^{./ ./}

Benue

{

^./

{ { { { {

^{./ ./}

{

^{./ ./}

Borno ^,v

{ {

Cross River

{

^./

{ { { { { {

^{./ ./ ./}

{

Edo

{ { { { {

^{./ ./ ./}

^.i

Delta ./

{ { { { {

^{./ ./}

Ekiti {

^{./ .J}

\i \i

Enugu ./ ./ ./ ./

{ {

Anambra ./

{

^./

{

^./

{

^{./ ./}

{

Ebonyi

{ \i \i { {

^{./ ./ ./ ./}

^.i

FCT

{ {

Gombe ./ ./

{

^./

{ { { {

lmo ^./

{

_^/ ^{./ ./}

{

^./

{ {

^{./ ./}

Abia

^./

{ { { { { {

^{./ ./ ./}

{

Jigawa ./

{

^./

{

^{./ ./}

Kaduna ./ ./ ./ ./

{

Kano

{ \i

^./

.i { ^.i { ^\i {

Kebbi

{ { { {

Kogi \i { { { { { {

Kwara ^,v

\i { { {

^./

Niger ./ ^,v ./

.i

./

{

^./

Ogun ./

{

Ondo ./

^/ ./

{

^./

{ { { {

Osun

{

^./

{

^./

{ { { {

ovo { {

^./

{

^./

{

^./

{ {

Plateau

{ { { { { { {

^{./ ./}

{

^./

Nassarawa ./

{

^./

{

^./

{ { {

Taraba

{

^{./ ./ ./ ./}

Yobe

{ ^.i

^{./ ./}

Zamfara

\i { {

WHO/APOC, 26 September 2003

2.2. Advocacy and Sensitization

a)

State

the number and

type

of policy /

decision makers

mobilized at the national

and

lower

(state and

district

level)

during

the current

year;

the reasons

for

^the sensitization and outcome.

b)

State progress _made towards

internal

resource mobilization.

Partners are making more efforts to encourage State and Local Government

policy

makers to provide counterpart

funding for CDTI

activities. Given the changes taking place at the

LGA

level several State projects have tried to get approval

for

the deduction

of

LGAs contributions before allocation. These have met

with

varying successes. There

is

an increasing number

of

Level No

& Type of Policy

makers

mobilized

Reason

for

Sensitization Outcome

of Mobilization

National

17 ^(Minister,

Permanent

Secretary, Director, Public Health, some

policy makers

at

State level -

^PHC

Directors,

Commissioners for

Local

Government

&

Chieftaincy

Affairs); 13

senior

officers in

^the

FMOH and

other federal ministries.

a

Enablement of senior policy makers, national coordinators

of

community-based programs, the NGDOs and donor agencies supporting or financing control programmes

in

Nigeria, to dialogue on different programme- designed support and sustainable approaches;

o

lntegration of approaches and analysis of factors that constitute barriers or promote integration

of

community-based interventions;

a

Sensitization on the benefits of the community-Directed lntervention

(CDI)

approach

a

Increase knowledge on

CDTI

and the

sustainability process

The

Onchocerciasis control

programme has

^been

incorporated into

^the

NEEDS

document, and the

presidency has given

a

positive nod to

^increased

funding of

communicable diseases.

It is

expected that

in the coming year

more

funds will be

^made

available

to

the programme for direct control activities.

State 160

(Commissioners

for

Health, Permanent Secretaries,

Directors

for

Health, Members

of

the House

of

Assembly

(in

Kaduna State)

Nassarawa State

^has

released

5.5 million

naira

deducted from

^LGAs

allocations for CDTI.

This

is the first time

the State is

making funds

available

for CDTI

implementation. Oyo State released over 400,000

naira for CDTI. Again

this

is the first time this

is

taking place. Delta

^State

increased significantly

its counterpart contribution.

LGA

1,213

(LGA

Chairmen, PHC Directors,

councilors, other

policy

makers at this level)

lncreased

recognition of

the need

for

sustained

control of the onchocerciasis

disease,

and increased

^financial

support for CDTI.

A number of ^LGAs

^are

supporting CDTI

^even

though levels

differ. In

Oyo

State nearly all LGAs

are

giving monthly imprest

to

the

Onchocerciasis Coordinators.

l0 WHO/APOC, l0 April

2003

States where

the direct

deduction

is

being effected.

As

stated above, Nassarawa State was among those

that joined this group.

Projects

are also being

encouraged

to identifu

and

mobilize local

CBOs,

NGOs,

socio

- ^cultural

groups and

religious

organizations

at

various

levels to contribute to the CDTI

^process.

Meanwhile, the NOTF has set up an

ad-hoc committee

to

come

with

proposals

on

private sector

participation in the

implementation

of CDTI

in the country.

c) Describe any policy-related constraints

being

faced by any particular project and

describe

what

was done

to

cssrsf the

project (outcome). Explain

any

plans on

how to improve advocacy.

Incessant transfer of health workers at

LGA

level has been a recurring factor, particularly in the south western States. State Coordinators in collaboration

with

Zonal Coordinators and NGDO partners have made appeals that

CDTI

staff be retained in their positions or

transferred to

CDTI LGAs.

Some States have given heed to this appeal while others are yet to respond favourably. The creation of the

Ministry

of Environment, again in most South

westem States, and the transfer of all environmental health officers, most

of

whom make up the LOCTs and SOCTs, have also been a source of great concem. In Oyo State, the entire SOCT members, being environmental health officers were transferred out, and

it

took the intervention of the national and zonal offices for them to be reinstated.

To improve advocacy, the

NOTF

in collaboration

with

APOC Management intends to send high

-

powered teams to selected projects, targeting the chief executives

of

such States. States being targeted are

Ekiti,

Oyo, Plateau and Nassarawa in the interim. Other States that are yet to release counterpart funding are being targeted in the nearest future. In addition, the NOTF is

still

looking at modalities of having national and zonal

goodwill

ambassadors for the control of onchocerciasis. This is yet to be conclusively discussed.

2.3. lnformation, Educatlon and communication strategy and matertals development

Briefly

describe the

IEC strategt

being used

in

the

countryfor CDTI.

At the

inception

of CDTI in

the country, the

NOTF

raised

a

sub

-

^committee

^{on [EC.}

^Its'

main mandate was to come up

with

prototype IEC materials and possibly coordinate the mass production

of

such materials

for

projects

in

order to maximize economies

of

scale. The sub

-

committee came

out with

several prototype _materials ranging

from

treatment registers, CDD brochure and

different

posters.

The NOTF initially

assisted projects

to

produce

what

they needed,

but ^{later projects} were allowed to produce, and develop others on their

own sometimes

with

assistance

from other

partners.

Currently, it is the policy of the NOTF

to

allow

projects

to

develop and produce

their

own

IEC

materials relevant

to their

needs. They

are

advised

to utilize existing local

channels

of

communication

for the

dissemination

of

information on CDTI. However, in

recent

times the NOTF is

requesting

the

^projects to

develop materials that

emphasize

sustainability and long term compliance to

Mectizan treatment even in the absence/ regression of the disease manifestations.

Note if ony

neu,

IEC materials

were developed

or

revised,

the type of the material,

the message and target audience, and where they were distributed.

We are not aware of any new IEC materials developed or revised during the reporting period.

- How

were the

IEC

materials developed ?

N/A

ll ^{WHO/APOC, l0 April}

²⁰⁰³

a

- Are the materials reviewed to address upcoming

issues

(like decreasing

refusals,

s ustainab il ity, maintain

ing

co mp liance to lo ng-term treatme nt, SAEs) ?

N/A

-

^Report

_d

^{any KAP} surveys have been done and how

their

results were used?

At the

inception

of CDTI

some projects conducted

KAP

surveys

but the

results were not shared

with the NOTF

Secretariat,

neither was it

^aware

of how the

results were used to translate

existing IEC

materials

or

develop new ones. The

NOTF is not

aware

of

any recent surveys.

S ummarize info rmatio

n

o n

:

- The

use

of appropriate and innovative media and/or other

strategies

to

disseminate

information

among the

projects;

To

disseminate

information

among the various projects, the

following

strategies/channels

of

communication were utilized:

o

Radio and televison messages/programmes

.

Posters/Handbills

t Bill

boards

o

Community meetings

a

Announcements in churches and mosques

o

Health workers sensitization meetings

o

Local Town criers

o

^National HQs newsletter, NOly'

a NGDOs'Newletters

To

disseminate

information TO the various

projects,

the following

strategies/channels

of

communication were utilized:

Onchocerciasis in Nigeria (NOIU).

but for the past two years

it

has been made annual.

per zone)

- Mobilization

and

health

education

of

women and

minorities -

^method and response Different approaches are being used

in

various projects, particularly in the northern part of the country where involvement

of

women and minorities constitute an issue.

[n

some States

like

Zatnfara and

Kebbi Muslim

teachers are used

in

reaching women. Projects

like

Yobe make use

of local NGOs.

Generally

where women are in

seclusion,

the

public-address system, female health workers,

traditional birth

attendants

(TBAs)

_and

family

heads constitute means

of

health educating and

mobilizing

them. [n some other projects especially those

in

the south- western

part of the

country, trade women associations and faith-based women societies are effective means

of

reaching

the

female

folk. In

the southem part

of Nigeria,

involvement

of

women and

minorities in

the

CDTI

process is not much

of

an issue. They are part and parcel

of the community that is mobilized and health

educated

by health workers and

CDDs.

Response

in

most projects is quite encouraging. Where the women participate, particularly in

the

south,

they

make

vital contributions

and some are selected as

CDDs. [n

some south- eastem States

like Imo

and

Abia,

there are as many female

CDDs

as there are male CDDs;

and sometimes more.

In

the north, participation

to

such a degree is

still

not existent. There is

t2 WHO/APOC,

10

April

2003

however an increase in the level

of

awareness of women in

CDTI

issues. In a few of the States

like

Yobe, Adamawa and Gombe there ^are attempts to select females as CDDs.

- Majoraccomplishmentsl

The major accomplishments include:

State some women groups have taken

it

upon themselves

to

give incentives to CDDs selected.

even though overall amount being made available tend to fluctuate

in

the

CDTI

process.

As

earlier stated,

in

some projects a good percentage

of

existing CDDs are females.

CDTI. [n

some parts

of

the north,

VAS

coverage is higher when distributed by

CDDs than when distributed by health workers during the

immunization campaigns.

Additionally, in

some communities where

oral polio

was rejected

when

administered

by health workers or other

vaccinators,

it

has become accepted

if

the

CDD

is seen to be participating.

Weaknesses/Constraints

I

implementation is cumbersome.

health workers, and develop appropriate IEC materials education of target communities by health staff.

signals

to

communities

that CDTI is only for men. This further

constrains mobilization

of

female members of the community.

members do not ^possess the means to move around.

Suggest ways to improve

mobilization

of the target communities among projects.

I

.

Selection

of

more CDDs along kindred lines and

utilization of

same to mobilize the populations.

2.

lnvolvement

of

communities and CDDs in planning and implementation of other health-intervention ^pro grammes.

3.

^Greater involvement

of

existing frontline health workers particularly in community mobilization.

4.

^Greater interaction

of

knowledgeable implementers

with

communities. When

CDTI

was initiated, sufficient time, and maybe funds, was not devoted to this activity.

5.

^Targeted training of health workers in the implementation

of

CSM

6.

Identification and mobilization of more local NGOs, CBOs, ^age grades, religious/

cultural groups, women groups etc for community mobilization.

A

situation where there is some form of competition among several community based groups in the

CDTI

process

will

dramatically improve not only community mobilization and health education but also ultimately enhance community participation and ownership.

t

l3 WHO/APOC, l0 April2003

a

7. Mobilization

of community representatives at the

LGA

level to identifu more

with

the programme and assist in the mobilization of their constituencies.

8.

Increased emphasis and efforts towards integration of health care delivery

programmes, particularly at the lower levels. This

will

translate in part to an integrated approach to community mobilization.

9.

Capacity building on mobilization skills for health workers.

10. Review

of

IEC materials to address emerging issues from the community level.

2.4. Gommunitiest involvement

^an

decision.making

Comment on community

participation

making comparisons among proiects

Community participation has been

limited to

selection

of

distributors, collection

of

Mectizan

from

designated

points and

announcements

of times of treatment (following anival of

Mectizan).

This

occurs

in all

the projects. However,

only in

some projects

do

communities

determine period and mode of treatment, mobilize

resources

for CDTI at that

level, compensate

CDDs,

conduct

self - monitoring

and

follow up on

refusals. Cross

River

State

Project remains an outstanding example. [n this project community

enthusiasm

in

the implementation process

is

legendary (maybe except

in

Akamkpa

LGA). Most

communities are so

well

mobilized that they are even prepared to be collecting their Mectizan and returning reports directly to the State capital even though

for

some communities this could as

well

take

a whole

day's

joumey.

Projects such as Taraba,

Kogi,

Kaduna,

Ebonyi,

Ondo, Ogun and

Yobe are making

great

efforts to

ensure adequate

mobilization of their

communities and increasing

level of community participation. However, self - monitoring, follow up

on refusals and

mobilizationof

resources

still

appear to be weak in these States. The FCT project appears

the

weakest

with

respect

to community

involvement and

mobilization. This is

not

entirely surprising given such confounding variables as the urbanization of ^the

^local

communities

with

the attendant heterogeneity

of

the populations and the constant interaction

with

the seat

of

government that has monetized

all

issues and gradually eroded time-honoured

community principles and morals. In

Plateau and Nassarawa States,

the problem of low

community participation is an offshoot

of

inadequate attention given to the programme by the health staff, a development arising

from low

morale due to non payment

of

staff salaries and allowances. The

low level of

community participation

in

other projects

is mainly

more

of

^a result

of

inadequate interaction

by

health

staff with

the communities, occasioned

mainly

by dearth

of

funds and poor commitment.

Participation of female ^and youth

members

of the community at health

education meetings;

This varies

from

one part

of

the country

to

another. In the southem part

of

the country (most sections) females and youth have the freedom

to

attend health education sessions

with

other community members.

In

some

of

these parts they can be more vocal than the men. However,

in

some sections

of

the southem eastern part

of

the country, the youths, though free to attend and participate, do not attend as they ^see the programme as belonging to the adults. Moreover,

the

youths believe

they will be

more rewarded

for their time if they

are engaged

in

some

activity that will bring

ready cash.

[n

the

middle belt,

they can be present

but

deference is given

to

the men

with

respect

to

participation.

In

most

of

the northern parts

of

^the country, women are never

allowed to

attend

with

the men any gathering,

including

health education sessions. The male youths may be allowed. However,

in

some communities the women can be

organized separately for health education

sessions

by appropriate persons, and

their participation in such sessions are uninhibited.

a

t4 WHO/APOC, l0 April

2003

t

,

In

general, how do

you

rate the

participation

of

minority

groups

andfemale

members

in

community meetings, decision-making, (attendance,

participation in

the discussion etc,)

other

issues.

See comments above. Suffice

it

to reiterate that in most communities across the country (except Benue State where females can become traditional rulers, or hold high traditional positions), women are not part of the decision

-

making apparatus

of

the community.

However, as in the south they can contribute but the final decisions

lie with

the men. There have been no reports

of

marginalization of minority groups. In most parts they become assimilated into the host community and play the roles expected

of all

community members.

2.5. GapaciQl bulldlng

Training of national, district

level

staff in CDTI

and general management

skills (computer applications, project planning,

etc.)

Brietly

describe

any training done by the NOTF for ^{specilic CDTI} or Vector Control

Projects ^(O bjectives, partic ipants, o utco mes, any

follow-up

^needed).

Officers

of

the

NOTF

at national and zonal levels have been

involved in

training

of

project

staff, but no training

programme was organized

on

a national basis

by

the

NOTF.

One

of

such

training activities in which NOCP officers

partook

in

was a targeted

training of

some SOCTs

of

UNICEF-assisted States

in

technical report

writing

and organization

of

CSM. This was

followed

up

with

a one-day training

of LOCT

leaders

in

the UNICEF-assisted States on CSM.

There was

a

capacity

building

^workshop

on

operational research proposal

writing for

key

project staff in FCT,

Taraba, Plateau

&

Nassarawa States.

This workshop,

organized in collaboration,

with APOC

Management, was sequel

to

^proposals submitted

on

usage

of

^the

kindred system for

CDD

selection to be carried out in the affected States.

The objectives

of

workshop were:

o To

strengthen

the

capacity

of

participants

in

conducting community research that

will

enhance

CDTI

implementation.

o To improve the

capacity

of

participants

to

design

and write good

research proposals through clear problem identification, development

of

research tools,

data collection, analysis and the use of

^research

results for ^program

^re-

orientation.

o To

enhance

the participants'

use

of community

meetings

for

development

work

related to

CDTI

activities.

o

To revise and finalise an Operational Research proposal submitted to TCC.

This training covered the

following

topics:

methods, data collection, handling/entry, analysis and interpretation);

activities; and how

it

relates statistical trends

l5 WHO/APOC, l0 April2003

t,

The

O/R

proposal was

finalized,

submitted

to TCC,

approved and funds released. However, the study is yet to be concluded due to late release of funds.

Table 3: Type of training undertaken at national level by the GTNOAtrOTF

(tick

the boxes where specific

training

was carried out during the reporting period)

Type of training Project staff

MOH staff Opinion Leaders

Others(speci!) Program

management ^/

How to conduct Health education Management

of

SAEs

CSM

./ ./

SHM

Data collection Data analysis ^/

Report writing Others ^/

(Operational Research)

{

^/

Briefly

describe any technical assistance provided to the CDTI projects.

Technical assistance has been extended to projects in the

following

areas:

o

Preparation

of

technical reports using the revised reporting format

o

Preparation and production

of

sustainability plans

o

Rendition

of

accurate

financial

returns.

This is

applicable

to

projects that have new accountants

or have problems in

usage

of the WHO imprest

system. Such States include Kwara, Gombe,

Akwa

[bom, and

Ekiti.

o Definition of 'definite' CDTI

areas using the health mapper software

o

Review of technical reports, progress reports and budgets

Fill

in table 4 on the next page.

l6 WHO/APOC,

10

April2003