v for African World

r ^-l

World Health Organization

African Programme for Onchocerciasis Control

v

I ^{2 JAll.}

²⁰⁰⁵

Borno State CDTI Evaluation Report

Acknowledgemonts

We are grateful b ^{the fullowing persons and} organisatims fur tfieir ooperation, contrihrtlons

and a$tistance

towards the sumssftrl occr.rtion of this

assignment

. The Director, Dr. A.

Sekereli,

and stafr at

APOC

Headquarters in

Ouagadougou

fur

making available

tfie

necessary

financial and logistic

requirernents

fur the surcss of this asignment

. The WR

Lago6

and his staff prwiffi supportr who contributed b ^fie

^smooffr

functioning of the

Eraluation Team

. Dr Jondlan Jiya, ^National Orchoerciasis

Contnol Programme

Coordinabr, ard

his

team who

facilitated

the

smooffir take

otrof fie

exercise

. Dr.

Musa A. Z. Obadiah and his

team at

HKI

fur their

logistic

support

r Jfp Hon.

Cornmissiorrer

and Permaneilt Secrebry fior l-lealth,

Borno

StaE fur their support

. Ttte Dirstor of

Disease

Control and International t'lelth in the

Borno

StaE

Ministry

of Helth, and his l-leal$

Management

Team who prorided useful infurmation ard gale wonderfulsupport

. The local Go/emment Chairmor, the Supsvisory Corncillors fur H€l$ ⁱⁿ

^Askira

Uba, Gwoza

and Hawul

^LCrAs

vlsiEd and their l-lealfi

Management

Teams for their

cooperadon

. l-lealfir workers and ornmuniW members in the samded LGAs who ^protided imporbnt infurmation

and

onfihrEl b ^the

^suacess

^{of frte}

^mission

. _List brrt not

least

the team ogresses

immense graUtude

to *te drivers who filoEd

members

dthe Etaluation

Team

over sryeml

kilornetnes

of tough Errain.

lt-l<*t"*A

ru)qn'

llcsaS

evL{

7 B FI\i

⁷⁰⁰⁵

Borno Stote ('DTI Evaluafion Rep<trt

Borno State CDTI Evaluation Report

Ab

b

reviatio

ⁿ

slAcro nyms

APOG

-

^Afiican Programrne fur Onchocerciais Confrol CBIT

-

Community-Based lvennectin Treatnent CDD

-

Community-Directed Distibutor

CDTI

-

Community-Directed Treafinent with lvennectin DDC

-

Director, Disease Contol

DDC & lH

-

Director, Disease Confol ^& lnternational Heatth

DPHC-Direchrof

Primary Healtfi Care

DDPHC

-

^{Deputy Direchr} of Primary Heatfi Care EPI

-

^Expanded Prograntne on lmmunization FLHF

-

^{Frontine Line} Healft Fmility

GCC

-

Govemrnent Counterpat Coffibution

GCR-

Geographic Coverage Rate

HOD-Head

of

Deprtnent HIV-Human

lmmuneVirus

HKI-

Helen Keller lnternational HQs

-

Headquarters

HSAil -

^Healtr Education Sensi$salion Advocmy and Mobilizalion IEC

-

lnformation, Education & Communication

LGA

-

^Local GovernrnentArea

LOCT

-

Local Govemment Onchocerciasis Confol

Tean

Borno State (-DTI Evaluatton Report

Borno State CDTI Evaluation Regtrt

ilDP -

^Meclizan Donation Program Ml

-

Micronufient lniliative

ilITOSATH

-

^Mission

^h

^{Save the Helpless}

. . ilOH -

^{Ministy of HeaIdr}

ilou -

Mernorandum of Understanding

NGDO

-

Non-GovemnnnE| Developnrent Organisation

. .

NID

-

Nationat lmmunization Day

. . ^NOCP-

^Nationd Onchocerciasis Confol ^Programme

,,

^]{OTF

^-

^National 0nchocerciasis Task Force

ilPl -

^{Nationd Programme on} lmmunization PHC

-

^Primary

^Hedfi

^Care

PHCC

-

^{Primary Heann Care}

^Coordintur

STCPHG

-

Supervisory Councillor, Primary Health Care SilIOH

-

^{State Ministy of Healtt}

r

SOCT-StateOnchocerciasisConfolTeam TCR

-

Treafircnt Coveage

R#

VAS

-

^Vihmin A Supplementation WHO

-Wodd

^Heal& Organisation

U]{ICEF

-

United Nations Children's Fund

Ustof

figuresltables

FtWrc 1

-

^{Chart of findings at}

^$afe

^tevet

Fiyre

2

-

^{Chart of lindings at LGA level}

FrWre 3

-

^{Chart of findings at FLHF level}

Frgure 4

-

^{Chart of findings at Community level}

Ftgure

5-

Chaftof findings

atalllevels

FWre

6-

Cfarf

sf wingAnuhtive $ores

bylevel Table

1-

Sampledsiles ⁱⁿ Bomo Stafe

-

.

^{Tabb 2}

^{- Avary}

$tstainatillty

fuie

^of

fie

dlfrerwt

Grups

of

lndiatws

Borno State CDTI E',aluation Reytrt

Borno State CDTI Evaluation Report

Executive summary

Borno State of Nigeria is

loc#d

in

fre

norh eastem

pat

of the counfy. ^The tobil population is 3.5 million (projected fiom

fie

1991 Nationd Population Census resutts)

wih

over

8fr6

of

he

peopb living in

he

rural areas. The Shte ^is split into 27 LGAs

wift

¹² of

ftese

being endemic fur onchocercimis (5 hypo and 7 meso endemic).

Mectizan distibution ⁱⁿ the State started around 1993 ⁱⁿ 2 LGAS using

$e

Community Based

lvermctin Treatrent

^(CBIT)

4prorh.

CDTI comnrenced in

he

State in 1999 wiUt APOCs support

0fier ^pahers

ⁱⁿ

the projectare Helen Keller lntemalional ^(HKl),

tB

Shte Ministy of Heal$,

he

endemic LGAs and communities.

The Borno CDTI project

is

in its

fiffi

year

of mms Eednent

^{wifrt Mectizano under}

fie

five year funding

suppotftom

APOC and was evduated

brthe susbin$ility

perftrmance of

CDTIoprations

in

tn

^prcject

The fifth year evaluation of the pro,ect

wc

canied out between November and December 2004, by ^a team of evaluahrs from Nigaia and Uganda.

lnbrmation was gaheed ffom the

reviary

of

relevant

documenb and repoG,

inErviews

and

field observation of sampled sitss

d fie Sffi,

LGA, Front Line

Healh Frility

and communi$ levels. This

wr

Iabr

analyzed and

ftedbak

^{given to} proiect personnel at State and LGA levels. Thereafter workshops

br

the development of a

fire*yea

sushinability ^plans

bllored.

The overdlfindings of

he

barn are as bllows:

PLANNTNG

(r.8'

At both State and LGA level, there are same yearly tirxdines,

drarn

up at project level. The timeline contains dl

tre

aspecb of CDTI but does not prcvide

br trget rtivities.

There arc no vaiations since it is a timeline. No detailed plan of action

br

CDTI or

br

overall PHC activities exisb ^at any level. Al! parhers appear quite knowledgeable of

fteh

roles. Parhers and project leadership

re

clearly imare that APOC will devolrre at

tre

end of

$e

5

-

year period. There

ur6

an ffiempt ^at Stab level only to budget

br he

^post

-

APOC period, but

fiis

^{is not} dehiled or

clea.

At

he

community level, CDDs c-ltoose visiting

tinns

and routes that are convenientto ftem, which make

fie

^uyork less burdensome. They alrange

wih

community leaders

h

solve problems of refusals and any o&er one related to CDTI activities.

TNTEGRATTON OF SUPPORT ACTIVITIES

(23'

The CDTI sfucture is being used to do VAS. This

yea here

is an

dempt

to integrate Eye Care into

fie

Programrne. Ttrerc

are horever no

integrated plans. While

at the SEte

level,

visib h $e ^field

^are

Borno State ('DTI Et,aluation Regtrt

Borno State CDTI Evaluation Reytrt

monolihic, LGA stafi occasionally use supervisory

visib to do

rncbilization

of

community leadership to

select and

compensate CDDs,

or conduct heatft

education..

The

FLHFs

are not inrclved in

the implenrntation of CDTI.

LEADERSHTP (1.8)

Project leadership is fully conversantwith

fie

several prcblems and successes in

he

prolect

ltties

to delegate but a lot of work is dependent on

fie

^{presence of}

fie

Stab

Coordinffir

and

he

HKI Project officer. Quite a numberof SOCTs are notfully aware of allaspects of pnognarnme implemenhtion. The LGA stafi (LOCTs) initiate some activities such as mobilization and supervisbn,

buttaining

are planned and organized by

he

State in collaboration

wih fie

assisting NGDO. FLHFs have not been empowered

b

initiab key CDTI activtties like planning, nunibring/stperuision and faining, even when sorne FLHFs

shor

leadenship qualities in area of assisting in canying out CDTI ac{ivities. Aclivilies are planned by

fte

LOCTs, who sorptimes ^inrrolve

fie

FLHFs especially when

fieir

offces will ^{be venue}

br

faining. ^At the community level, leaders paticipate _{in CDTI} activites like mobilisation, giving of moral support

b

CDDs, eb. They

fy

to ensure

ftat

all eligible population are freated, and

heffit educ#

refusals.

MONTToRTNG/SUPERVTSToN

(r.8'

The Stab and LGA stafi routinely visit not only

fie

immediate lower level, but also

$e

communities.

Sorptines,

checklisb

ae

used

brtrcse

visib, dtrough

sorc

^of

he

checklisb ulere notproperly completed. Occasionally, supervisory rcports are made. Projectleadenship and LOCTs are

arare

of

fte

several problems consfaining CDTI implemenEtion, and make

eftrb

to address

fiese

^problens. There are howercr no conscious

efurb

to empower

he

appropriate levels to manage

fiese

problems. Only a

Ew

FLHF staff are involved ⁱⁿ supervision and

heir

level of involvenrent is minimd.

CDTI dah ^is fansmified firough

he

govemnrent sysbm, ^but most of

fie

resources used ⁱⁿ the tansmission of reporB are

eiher

^pensonal (at lower levels) or APOCNGDO; and in a

hw

cases with resources from the governnnnt At

he

community level, there is ^no fansport anangement

br he

CDD

b

go and deliver reporB

b

FLHFs where

he

^need aises.

MECTTZAN PROCUREMENT/DTSTRIBUTION (2.3'

The Mectizan procurcment and delivery sysbm ^is working well. RequesB

re

based on total populdions from &e community level, and delivery is made by

fie

higher level

h $e

one below. The rcsources

br tte

movernentof

tre

drugs are mainly fiom APOC. lnvenbry rccords exist at State and LGA levels

ftat

indicate

he

movementof

fie

^Meclizan,

butfie

LGA records appear notto be properly maintained. The FLHF is not significanty involved. Occasiondly, some Mectizan are leftwifrt FLHFs in case CDDs needed additional drugs. Mectizan tableb appear

suffcient

but atthe community level here were conplairtB

of

shorhges in a tsw places. This is occasioned by

he

time

fie hbleb

are made available to

fie

State by the assisting NGDO. No fansport anmgernent is made by

fie

community

h btch

mectizan. ln a Ew cases

fte

community leader mobilizes

tansportbr$e

CDD to distibute Meclizan to his peopb.

TRAINING AND HSAtvl

fr.8,

The State and LGA level taining is planned by

he

assisting NGDO. Alttough

he stff

at both levels are capable of organizing

$eirfaining

it has become an accepbd

prrtice b

waitfur directives on cascaded

taining

bebre distibution

sffi.

^HKI

^tains

the SOCTs and

he

LOCTs while

he

SOCTs

togetw

with the Borno State ('D'l'l Evaluation Report

Borno State CDTI Evaluation

Reprt

LOCTs tained some of

fie

health facility

sffi.

The LOCTs also

witt he

SOCT in charge of the LGA

tain

fire CDDs at

tre

diflbrent disfict levels. The faining sessions for some tirne now have focused on VAS and CDTI.

Project statr routinely inbrm policy makers of

fieir

activfies. There are planned advocay wukshops

refleffid

every year in the budget proposal submited and approrcd by APOC Managernent Policy makers appear knowledgeable about CDTI, and there are efurts

h

ensure release of counterpart funds

br $e

year. FLHF npmbers identify situations where community leadership lack inbrmation or arc not commitbd to CDTI, but due to lack of involverpnt

hey

are not able

b

inbrvene app'opriably. ln several

o$er

communities leadership do not provide

fie

required infurmation, obviously because

$ey

were not adequately mobilized.

FTNANCTAL

(r.8'

Attre

projectlevel, trere is an approved budgetproposalfom APOC. The proposalbllows

fie

usual brmat which specified line items

br

major activities. There were litUe variations in such budEet items as faining, HSA[, and supervision. At

fie

LGA level,

here

are no detailed CDTI budget plans. At

boh

levels funds for ac{ivilies are

sonntirns

approved,

buthere

is no assurance

fiatcounHpatontibutions

^will

conn in. Relemes are enatic. There have been

efurb

to sensfize polby makas on

he

^problem of

onchocerciasis, and in

sore

^cases

fiese

hare yielded rcsuFs leading ^to funds release. lssues of budgetary shorfalls are not given any consideration. Leadership at bofrr levels makes do wifrt whatever is arailable from APOC and HKI

brtrc

execution of

$e

crilicd ^CDTI

rtivfies.

Where releases

ae

made

4provds

bllow the established procedure. While govemnrcntorfficials have expressed confidence

hat

CDTI activities will be sushined with counbrpart contibutions post APOC, HKI has expressed iB readiness to continue support

br he

next

hw

^years, alfiough a neu, MoU is yet

b

^be developed and signed

wih he sttu.

There is no budget or release of funds

fom

LGA to

he

FLHF level

br

CDTI activities. At the community level, sone community members support CDDs in

diftrentbrms. Sore

community members do not compensate their CDDs because

fiey

said

fiey

^{were not}

arare.

Communities appreciab

fie

^{drugs and}

are willing to purchree registsns, pencils, biros, ^if requested to do so.

TRANSPORTAND OTHER MATERIAL RESoURCES

(r.8'

At the State !eve!

here ae 4 (rnoe fian

enough)

pQect

vehicles which if well mdntained can last

br

sorrn reasonable lengh of tirne. Proiect logistics and equipment are mainbined and servbed when

fiey

break dovm

or fie

need

aises -

^subject

^to

availability

of

funds.

The

motorcycles at

the

LGAs

are

in relalively ^good condilion, but old, and given

he

^vast tenain of some of them, needs to be

eplmd

^and/or

complenented. There is no schedule

br he

mainbnance of

he

capital ibms. Mainbnanoe and

serviing

are done

wih

funds from APOC or as in

$e

LC"As fiom mainly personalresounces, augrnenbd minimdly and occasionally by funG fiom

he

governrnent and HKl. Govemnpnt officids have expressed confidence

that wih

counterpart funds

fiom gowmrnnt expecbd h

come

in

more rcgularly replacemenh and maintenance of logislics can be sustained and other needed mabrials provided. The management teams at State and LGA

bvels re ^ailarc

^of

fie

^need

b

replace and/or complement

he od$ing

logistics, and express

fie

hope

ftat

APOC or govemllrnts will provide.

Training and HSAtut materials are in very

shutsupply atallfie

LGAs visited.

Borno State CDTI Evaluation ReJnrt

Borno State CDTI Evaluation Reytrt

HUMAN RESOURCES (2.2)

There are enough human resources at

bo$

State and LGA level, and in fact may be a llUe bit high in

fie bnner

except

fiey are

used

hr oher

PHC duties. Most

of fie sttr

seen

at &ese tuo

levels

appea

commifred affirough level varies. They

ae

relatively skilled

in taining,

HSAIII and superuision but ^are deficient in planning, data managenpnt and computer literacy. Most of them are sbble. The ^FLHFs are not being utilized

br

CDTI implennntation.

At

he

community level, arerage ratio of number of people feated by one CDD

br dl

corumunities vbited stands at

I

CDD:I,500. Mostof

tre

CDDs are skilled on the job and some has been distibuting for about 3-5

yeas nor.

They however need improvement on census updaling and record keeping /repoting. All CDDs interviaved expressed willingness to conlinue serving

fieir

communities regardless of

sonp

problems encountered.

CoVERAGE

(2.5'

Geographic and therapeutic coverage

r#s

appear fair and good respectively, but there are corcems

hat

only eligibles are being registered. ^In a

hw

places some @rnmunities were

notfefrd

at

diftrenttinns

on account of CDD affition and lack of incentives. There is some confusion

ovs fte btal

number of

cornmunities that are being covered over time. A comprchensive listing of communities and @nsus update was hmever recenty done.

Using

tre

seven aspecb and five crilical elemenb of sustainability it became

clea

to

fie

evaluation

bam trat

only

3

aspecb

ae

helping sustainability and

of

the elemenB

2 ae ^pmitve

and dependable. The quantitative

smre of

1.92 supporb

he

qualitative decision

hat he

sustainability base

of he

^project is weak. ln line

wih fie

^guideline

br

^grading

he

whole proiect

$e

Evduation Tean condudes

hat he

Bomo State CDTI project

is

NOT lf,frKING SAIISFACIORVPROGRESS IOIUARDS SUSIATTUABTUTY.

!t is

clea

that the ^proiect

inpbnnntation

base and

sfrcture

need to

h

overhauled if sustainability is to

h

atained. The greatest

mist*e

made by

he

^{proiect perhaps} is the abandonnnnt of

he

FLHF level in

he

implernenbtion of CDTI in

orderh

maintain good covenage rates.

Borno State ('DTI Et,aluatron Report

Borno State CDTI Evaluation Reptrl

TABLE OF CONTENTS

lntroduction.. ^Enorl

Bookmark not defined.

Findings... ^Enorl

Bookmark not defined.

1.1 Background t0 the Borno Project

Evaluation..

^...9

3.0 EVALUATTON

F!ND|NGS...

...13

3.1 Sushinabitity at Project (State) Level

...

...13

3.2 Sustainability

attre

LGA

Level...

^...21

LCr,A

Recommendations. Enorl Bookmak

not defined. 3.4 Sushinability

athe

Community

1eve1...

...34

3.5 Comparalive Analysis of the Sushinability of

$e

Four

leve|s...

...38

4.1 Grading tre Overall Sustainability of Bomo State CDTI

Project. ^{Enorl Boohmrt}

not defined. 4.2 FeedbacklPlanning

Meetings:

...45

4.3 The Way

Fonrad

...45

I PROJECT LEVEL WORKSHOP

PROGRAirMElReport..

^....

^{Emrl Bookmsk} notdefined.

ll LGA LEVEL WORKSHOP

PROGMMMBReport.. ^{Enorl Bookmrrt} notdeftned.

lV Key Persons Met/lnbrvieryed ⁱⁿ

he

Borno Stats CDTI

Evduation

...24

v Ltsr 0F DocuMENrs oBSERVED

...29

VI.

ADDRESSES FOR EVALUATIONTEAI'

MEMBERS

...30

Bonto State ('DTI Etaluation ReJnrl

Borno State CDTI Evaluation Report

1.0

INTRODUCTION

1.1 Background

Bomo Shte of Nigeria is located in the north eastern

patof tte

counfy. ltshares international boundaries wifrr Niger and Tchad ⁱⁿ

fie

north and Caneroun in

fie

east Adamara SEte

bunds

iton

he

southeast Gombe in

tre

soutr and Yobe on

he west

The

hhl

^land

m*s

is 69,436 square ^Kms.

The State ^has two nohble vegehtional zones, grassland savannah ⁱⁿ

$e

soutt, and sahel (desert) ⁱⁿ

he

north. There are two se€Eons, ffre dry and wetsemons. The latter begins late May and ends

ealy

Octoben while tre fonner commencs mid May. Average rainfall in

fte

Stab is 760mm. The wettsst period is

between August and Sepbmber and

he

driest monhs are Januay

h

^March

wih

humidity as low as 12.

The totd population is 3.5 million (projected

fom fie

1991 National Population Census resutb) with over

8fi6

^of the peopb living in

he

rural arein. Language spoken include Kanuri, Hausa, Fulani and Bura. The people are predominanty fanrers and cafle rearers. The State is split

inb

27 LGAs

wih

12 of

fiese

being endemic

br onchocerciris

⁽⁵ hyper and 7 rneso endenic). The endemic LGAs have a

btd

population

of

about 1 million persons who are ^at risk of

fie

disease.

Mectizan distibulion ⁱⁿ

he

^State sbrted around 1993 in 2 LGAs using

fie

Community

Basd

lvennectin Treahrent (CBIT) approrch. CDTI comrnenced in

he

Stab in ^{1999 wi0t} APOCs support Offier panhers in

fte

project are Helen Keller lnternalbnal (HKl),

$e

State Minisfy of

Hedft,

the endemic LGAs and communities.

1.2 Evaluation Questions

1.

^How stshinable is the Borno CDTI project?

2.

^{What are}

he sfuctures

now

in

^place

to sushin

Bomo CDTI progranune as APOC pulls out iB supput

br

the implementation?

3.

^Has

$e

CDTI process becorne

prtof

the routine processes of

hed$

delivery in

he

Shte?

4.

How integrated are the support activites of CDTI into the heal$ systems?

5.

^How

arc$e

^Mectizan procurementand delivery mechanisms perbrming?

6.

What is the financing mechanism put in place

to

ensure

tte

arailability of

bcal

and dependable source of funding of Borno CDTI proiectwhen APOC pulls

ou8

7.

^{What is}

he

level of preparedness of

tE

State and Local Govemmenb

h

maintain, replace and ensurc

tre

availability of

fanqort

and capihl equipment

br fie

continued delivery of Mectizan@ to the people

br

long term

fe*nent?

8.

^How commitbd are

$e

human resources

br

CDTI implementation in Bonp CDTI prcject?

Borno State ('DTI Evaluation Report

9

Borno State CDTI Evaluation

Reptrt l0

9.

^{What are}

fie

^{results of the CDTI pQect in}

^&e

^last

^hree

years of implernentation of the project?

a.

^{Are all} cornmunities ident'fied by REM0 fur treatnent receiving

featnent?

b.

^ls

feffnentcoverage

> 65 percent?

c.

^{What are}

^he

^{bends in} botr geogr4hical ^and herapeuth coveage

r&s?

2.3 Evaluation Obiec{ives

The

genaal

objeciives fur the evaluation exercise urere

to

determine

fte

sustainability potentials

of fie

Bomo CDT! project by its

fitrr yea

of operation and

rsist

in developing a ^plan

br

susbining

he

^proiect

post-APOC

The specific objeclives

fierebre

are:

a)

^{To assess}

^tre

perbrmance of

fte diftrent

groups of indicators of sushinability of CDTI projecb in the Borno CDTI project

b)

To idenlify

tte

facbrs

fiat

may block or help

fie

sustainability of the project

c)

^Discuss

^{fie ouborns}

^of

^fie

^{evaludion exercise}

^{wih fie}

relevant stakeholders in

fie

Bomo CDTI project

d)

Develop plans

br

sustaining

$e

Bomo CDTI pnoject post APOC

Borno State ('DTI Evaluation Report

Borno State CDTI Evaluatron Report

2.0

METHODOLOGY

2.1 Design

The crosssectional des$iptive design

wai

employed in the evaluation of the sustainability of Borno CDTI

project

lnbrmation was collected at

fte

various levels of the

p$ect ftrough

interviews, examination of reconds and observations with respect to

he

evduation objectives. Data collecbd were

fien cd#d

^and

analyzed.

2.2 Population

The

population

br ^the

evalualion

in the

Borno

Stab

CDTI project includes

the

State Orrchocerciasis

Confol

Team ^(SOCT) members, policy makers/hedh managenent stafi at

Stfr

and LGA levels, Local Govemment Onchocerciasis

ConfolTeam

(LOCT) rnembers, heat& facihty in

-

^{charges and}

^fie

^project

communities, their leadership, nrembens and CDDs, as well as

$e

projects NGDO

patner

(Helen Keller lntemational).

2.3 Sampling

A list of all the LGAs in the project was lisbd. A random sample (by bdloting) of

firee

of

hese

LGAs

wm

taken. Table 1 shorvs

fie

LGAs selected,

For each LGA sampled, a list of all

$e

cornmunities was drann up wi&

&e

assisEnce of project staff. Then the scouttook a random sample of

tlo

communities fur each heatth facility. Then

he

^healt'lt fmility closest to

fie

communities sampled was selected.

ll

Borno State ('DTl Evaluation Regtrl

Borno State CDTI Evaluation Reptrt

Table

l:

Sampled Sites in Borno State (LGAs, ^FLHF and Communi0es):

S'N LGA Health

Facili$

Communities

1 Askira Uba Leho Leho

Kilaroal

Tampul Tampul

DauraTamol

2, Gwoza Bita

Bih

Sasara

Gava Gava

Amudal"A"

3.

Harul

Kwajafia Kwajafia

Ghuno

Sakwa Sakwa

Kuburdukre 2.4 Sources of lnfiormation

lnbrmation was collected from interviews, verbal

reporb

and

docunenb.

Various categories

of

^people were interviewed

in tire Shte.

These included

fie

Commissioner, Permanent Secretary and Director Disease Contol in

tre

Stab Minisfy of Healh; ^Director of Primary Health

Cae

and Permanent Secrebry

in tre Sffi ^{Minisfy of Local}

^Govemment

^and

Chieftaincy

Afiairs; some

members

of he Stfr

Onchocerciasis

ContolTeam

(SOCT) including

$e

^Project Coordinatoc a

proffi

oficer of

fie

supporting NGDO ^(HKl). At

fte

LGA level,

he

Local Onchocercimis Confol Teams and

fie

^{LGA Policy} Md<en and Health

ManagernntSffiwere

intervieued.

Ofier

^pensons interviewed were

athe

Fronfline Healh Facility (FLHF) staffand rnembers of

trc

sampled communities ^(leadens, CDDs, and members).

2.5Analysis

Based on the informalion collected, each indicator was ^graded on a scale of G4 ^(worst

b

best), in terms

of

its pobntial contibution to sustainability. The average 'susbinability

score'br erh

group of

indicturs

was calculated,

br

each level, and a ^graph was plotbd. Summary statistics fur

he

scores werc calculated fur each level, and

br

each ^group of indicatots, and Ebles and Eaphics of

fiese

results were presented at feedback

wukshop.

The ^quality of the overall poject was also

asessed tsing $e diftrent

aspecb and crithaldenrenB of susEinability presentin

fie

^proiect

The five critical

denenb

and

he

seven aspecb of sushinability in

fie

^{project were} qualitatively discussed and

resulb

agreed

to

by

he

team

in

open debate.

The

project was graded using

fiese aspecb

and elemenb in accord wifir APOC guidelines. Thus judgment

abouthe

sustainability

pobnlids

of the ^proiect was

bced

on

&e

quantitative assessrcnt of

he

average sustainability scores of

fie

groups of

indic&rs

as well as the qualihtive assessmentof

fie criticalelerpnb

and aspecb of sushinability of

fte

^project

t2

Borno State (.DTI Evaluation Report

IJ

T1 Borno State CDTI Evaluation Report

3.0

EVALUATION FINDINGS

3.1 Sustainability at Project (State) Level Figure 1

-

^Chart

^of

^{findings af Stafe level}

State Level Findings

PLANNTNG (2.3,,

There is a yearly timeline, drawn up by the State Coordinator & NGDO (HKl). The timeline contains all the aspects of CDTI but does not provide for target activities. There are no variations since it is a timeline. No detailed plan of action exists, However, there are annual budget proposals listing several CDTI activities that are routinely submitted to APOC Management. No plan for the health service (or for the Disease Control Department) was seen. A budget for 2005 for the SMOH in which onchocerciasis control was reflected was observed.

r_-l

f-'

l

r-l

r1

t- _.)

r-t

l

l.]

i-'

I l

rl

{_-

il

r1

-

ll !

t-r

ItJ

n

l

ir

L

t-'

rl

U

Ir

I

T1

I

ar

r:

r-

[]

l3

'*de .-'"." '"c ."t-"

"'"^.."."-o *d.,"/ ^"/

lJortto ,ltute ('l)'l'I livo|utttion lleport

Borno State CDTI Evaluation Report

The timelines and CDTI budget propocals

submihd

to APOC are developed by the State Coordinator wi$t HKI representative.

Thaa

are

raiut

meefings, af

ffe

Stafe and wifrt ffie NGDO. Whenevq I

an

arwnd I usedto

$airfiremeetings.'(DDC).

Somelimes

fieyinvltemefoJos,

anduresddown

witrfiun.'(&ate

Caorlinator).

We enwrqe fiem

as

muci

as possble to

dm*

up frrclr ^plan.

HK

hpiks at ^lt,

'

_to gtkle.

fie projd

based on

tp resqnms fiatwill b

^{availabb from}

^HK

^{and APOC, 'to make fr} rcalis0c'. (HKl ^Rep).

All parfrrers appea quite knowledgeable of

fieir

roles. The MoU HKI signed

wih fie

SEte has expired and a new one is expected

b

^{be signed.}

Partners and project leadership ^are clearly EMre thatAPOC will devolve

atfie

end of

$e

5

-

year period.

There was an attempt

b

budget for

he

^post

-

APOC period, but

ttis

^{is not} dehiled or clear. Most of the funds are expected

b

^{corne from}

he Sffi

^and

fte

LGAs,

buthere

is no evidence

$athis

^{will be}

guaanbed.

However, policy

m*ers athe Sffi

^level

m eryhath $atthey

will supporthe ^programrne at devolution .

We

arc gorhg fo

wstain

the

prqnmme

arcn

if

APOC

wihdrarc."

(Permanant

*r.retary,

$ate

Mhisfry

of

Heatth),

We

^can take

owr

fron where

W ^stoppd.' (@mnixionef $afe

Ministy

of

Heafrh). As partof

eftrts h

sustain

he

programrne, the Comnilssioner is looking

atfie

possibility of

approrhing l-ledh

Systems FunG and inbEating

he

ptogftilnme into

it

TNTEGRATTON OF SUPPORT ACTTVITIES (3.0'

The CDTI stucture is being used

b

^do VAS. This year there is an afremptto integrate Eye Care

inb he

Programrre.

Whilefiestafiknowhatbofi gobgefier,

and

inffisometimesfundsbrVAS

are

usedbr

CDTI, trere is no integrated plan. SOCTs go

d diftrent

tirnss

br

mobilizatiorUadvocacy, faining, supervision and collection of reporb.

SOCIs are also used on an adhoc basis

br

^Malaria confol, immunizations and campaign fur HlV.

Therc

are times

w

^invdve

fiem in

oher PHC

prognmmx.

T}tis

is

adhrc

aN _Wiodb.'

^(DDC). Though Programme stafi say they ulilize occasions ^of their outings fur

hese

adhoc activfies fur CDTI,

here

is no indication

ftathis

^is

tue.

LEADERSHTP

(Lo)

Projectleadenship are fully convensantwift

fte

several problems and successes in

fie

project ReporB ale available

br

each period, but

$e

^sth year report is ^yet

b

^be finalized. There are problens of late reporting from the LGA levels and SOCTs routinely ^visit fields

b

collect rcporb

Project leadership

ties

to delegate but a lot of work is dependent on

fie

^{presence of}

fie

State Coordinator and

$e

HKI Project offcer. Quite a number of SOCTs are notfully iruarc of all aspech of programme impbmentation.

MONTToRTNG/SUPERVTS|ON

fr.8'

Treatnent and financid records arist as well as an inventory ^of equipnentsupplbd. The records are

neat-

sonre typed outwhile

ofiers

are handunifren. l'lowever,

fiere re

^concerns aboutUrc qudily of

he

data concemed. There were variations in sorne of

he

feafinent and population data seen

atfie

lower levels vis

-

^a

-

^viz

^ftose

^at

^fie

^Shte level. Population figures do

rct

appear

fustworfiy

as

here

^are therapeutic coverage

r#s

of more

fian

85% fur

sercrd

areas.

t4

Borno State CDTI Evaluatron Report

Borno State CDTI Evaluahon Reytrt

SOCTs and HKI Project offcer routinely visit not only

he

^{LGA level but also}

fie

communities. There are oher visi6 to the LGA at

diftrenttimes.

Erch of

$e

visits las8 tur 5

-

7 days per ^LGA.

There are chec*lisb used by sorne of

fie

SOCTS, alhough some of the checkllsb were notproperly completed.

Occrionally,

superuisory repoG are made and submitbd

b fie Sffi Coordin&r.

i'lo checklisb and superuisory reports ^u,ere seen

br

^2003.

Project leadenship is

arae

of

fie

several poblems constaining CDTI implenenbtion, and ^md<e

eftrb

to address

fiese

problems. There appeas houcver ^no conscious

eftrtto

empourerthe LOCTs

b

^manage

these problems. As a resuttSOCTs conlinually go dourn to

fie

community levelto address

fie

same problems in

dlfie

endemic LGAs. Pro,iectleadership is aware

hatsome

of

trc

LOCTs as well as some communities and CDDs

ae

doing well. To motivate hem

$e

project has produced T-shirE, face caps and certificates

h

^{be given}

b

all pmject sEfi ^at

fie diftrent

levels.

Reason whv suoervision is inefficient

The LOCTS, parliculaly

fie

LOCT leaders, can cany ^out

fie

supeMsion at

$eir

next lower level which is FLHFs but since

$ere

are funds for superuision, lt

hm

becorne an

mepbd

^practice

br

LOCTs to supeMse activtties

athe

Community level. There are

ffiempb

to terch personnel targeted supervision ⁱⁿ

fte

last faining session. 0n the conshnt supervision 0te HKI Proiect

fficer

reprsenling the County Represenffive stated:

Thefirquqrf

wsils (i.e.

bytrc HK prciedoficer)

nrere

oeasiondbyl*kof

rcsuflb. Some decisims

rm nd

impHnented oncr ure lefr ffie Sate ^{Dack fo} Jos. This

warufid trc

fieqtentfrips to ffie

$ate

and LGAs.' (HKl

futnty

^Rep).

MECTTZAN PRoCUREMENflDTSTRTBLTfl ON (3.0'

The SEte Coordinator on completion of a

featnent

cycle submits data to HKl. Based on

fte

^population

data available, HKI processes

he

application

br

Mectizan and procures

it

HKI brings

fie

drugs to

he

Stab. The drugs are kept in

he

project store from where

hey

are moved to

$e

^LCr,As

br

distibution

b

CDDs during

he

faining. The rcsources

br he

movenrnt of

he

drugs from

he Sffi b fte

LGA level are mainly ftom APOC. lnvenhry records exist that indicate

fie

^{movement of}

fie

^Meclizan.

Mectizan tableb appea sufficient ^{but at}

he

community level

fiere

were cornplainb of shotages in a few places. Therc were also complainE of delivery of Mectizan at

tinns

not convenient

h

community

rnmbers.

This

4pers

occasioned by

fte

time

fte hbleb

are made available to

he

Shte by the assisting NGDO.

But NGDO says it is notentirely

ib hult

^'lf

fie

Sfale does nof respond in goodtime fo MDP's ingurires ftere is

frltnd

to 0e some

delap.

Sometimes lt is &termined by when

he

drug

ffncs

^{into ffie} oounty for

colMbn atU

flCEFb

waehwscinLags.Thaearemanyfacfors fiatofien

carse

trcthlaytotrc Sate.'(HKl

CauntyRep)

TRATNTNGAND

HSAi' (23'

The State levelfaining is planned by HKI and

he

Shte infunred ⁱⁿ writing. The letbr specified daEs, venues and parthipanb (categories and numbers).

HKlfains

the SOCTs and

&e

LOCTs while

fie

SOCTs together wtUr

he

LOCTs

tains

sorne of

he

healh fmility staff.

Tle

LOCTs dso wiUr

fie

SOCT in charge of the

LGAfain he

CDDs

atfie diftrentdistictlevels.

15

Borno State CDTI Evaluation

Reprt

Borno State CDTI Evaluation

Reprt

The faining of SOCTs and LOCTs bcused on VAS and CDTI. There was a taining for Eye Care

br

Shte and selected LGAs in 2004.

Project staff routinely inform policy makers of

$eir

activities, especially as project leadership

ha h

take permissbn for

fie

severd activites to be canied

out

HKI

fficials

also pay

afuoc*y

visiB

b

policy makers wheneverfiey

te

around. Every ^year,

fie

DDC,

&e

State Coordinator and

he

HKI Project Officer

undertake advocacy visib

h

the LGAs. There are planned advocacy wortshops reflected

evuy

year in the budget proposal submitled and approved by APOC Managennnt Policy makels appear knowledgeable about CDTI, and

fiere

ale

eftrb

to ensure

releae

of counterprt funds

br fie

^year.

Reason whv tainino ^is inefficient

Altrough

he

LOCTs are capable of organizing their faining it has beconB an accepted practice to waitfor directives on cascaded taining bebre distibution shrts. Houtever, in rccentfaining sessions

fte

^need

br

each

levelh

emporer lower levels

b fain

was highlighted.

FTNANCTAL (28,|

At me p@ect level, there is an approved budget proposal ftom APOC. The proposa! bllows

he

^usual

brmat which specifies line ibms

br

^major activfies. There were liffie variations in such budget items as faining, HSAI, and supeMsion.

Atfie Stfu

level,

abtalof

=N=5 million has been approved,

buthere

are no specifications nor detailed planned of activities wiflr cost implications as to ^how

he

amount will be utilized, alfiough

ftere

is

&e

MoH component in

fte

budget proposal submitbd

b

APOC.

While the ^arnount ftom APOC could be reasonably guananteed, there is no assurance

$at

Shte contibulions will come in, hough govemnrnt ^is expecbd

b

make provision for counterpat funding

br

every elGmally assisEd progranme. While no

relere

has been made fur 2004 =N=500,M)

wa

released in 2003 fur vehicle insurance. !n 2002 a total sum of =N=2 million was released.

'ftrn6

release is enatic. tloney is rcleased 0ased on cirutmstanes.' ^(DOC).

There

haw

been

efurb

to sensilize ^policy makes on the problem of onchocerciasis. Thus

fie

Executive

@vemor approved

$e

deductions of =N=250,000 ^at source fur

he

¹² endemic LGAs, and

fiere

arc great expechtions

fiathe

approved =N=5 million will ^be released as SEte counterpart contibution, which may be used fur activilies in 2005.

No detailed plan of activities exisb and project

ties

to make do wifrr whabver is available

fom

APOC and HKI

br he

execution of

he

cri0cal CDTI activilies. lssues of budgetay shortfalls are therebrc ^{not given} any serious consideration.

While governmentoffcials have expressed confidence

fiatCDT|

activilies will be sushined wifir

counterpartconfibutions

postAP@,

HKI has expressed its readiness to continue

supprtfurfie

nextftur years, al$ough a new MoU is yetto be

Gvdoped

and $gned

wih

the State

.'HKr,s

readyto

supprtheir

praiect Sfafes (postAPOC).'(HKl Reprasentahre). FundsftomAPOC

sourcesbr

HKI/Nigeriawill decrease draslically as

amunb br

owrheads will be much less, and

he

funding fur severd

rtivities

including personnel emolurnenb will likely cease.

Butttis br

HKI is not a source of concern. "HK is

expding

a0ott

far trun&d fiwsad

^U.S. Oolars fiom

he Nippn

foundalbn for a firee

yeu _WriN of

prognmme implementalion in

fie lun

Safes ^of

Adamwa

and Bomo. Secondly,

fie

agency

is eryeding

moremoneyfrom

drcrsouruassuci

as heChevron C;omparyandMlforVilamin

Awfiidtisverymudt

intqraimd

intohe milo corrffi adiwlix.

Thercwill

M prory

intqration of

h*e ^pagrunm*

^after

Borno State CDI'I F-t,aluation Report

L6

Borno State CDTI Evaluation Report

APAC

andro.tld

benefitfrom each otherfinanciaff and mateially.

Atfundingfo

ftre

$afe

witt tikely rhcrease to moderately to parlially

mmmodate fie

shoilfall trrd witl arise from

AP}C's

dnsticalty

rctued

tunding.' (HKl

fuutty

^Rep).

Meanwhile,

$e St&

Commissionerof Healtr is trinking of approaching Healtr Sysbms FunG (a World Bank

-

assisted project) to integrate CDTI activities poetAPOC.

Though $ere

wa

sorne budgetary estimates for postAPOC

tratwere

developed by

tre

State, no serious consideration appeam to have been given

h

what will happen on devolution. There was however an expechtion

ftatfie

govemmentwill provide counterpatfunds to sustain basic CDTI activities. Given

fie

contibutions in the pastyears

fiis

expectation is notentirely misplaced.

Project leadership knorrs

hat

some aspecb of

tre

programnre implenrentalion will be

trcted if

govemrnnt _{funds do} not

m#rialize,

but it is basically not

arale

of

he

size of

tre

shortfall. Thus it makes do

witr

whatever is anilable ftom APOC and

tre

assisting NGDO.

Approvals bllow

fie

established prccess and allocations of expenditures

br

APOC funds are in line wiur

fte

WHO imprestsystem.

TRANSPoRTAND oTHER MATERTAL RESOURCES (2.S'

Pdect

has more than enough vehicles

whhh

if well maintained can

lmt

for sorne

reaonable

lengtr of tirne.

P0ect

logistics and

equiprcnt

are mainhined and seruiced when

trey

bred< down

or the

need Emses

-

^subject

^b

availability

of

funds. While

fte

vehicles, paticularly

trose

supplied by APOC, are periodically serviced,

fiere is

no schedule

br $e

maintenance

of o$er capihl

items. Maintenarce and servicing

are

done

wih

funds

fom

APOC, augrnenbd minimally and occasiondly by

funG

from

&e

Minisfy and HKl.

Project

sff

^{make do wiflt public} fansport on

he

severd occasions where project logistics

re

not available, or where

fte

funds are not

fiere

to fuel them.

All

tips

oubide

$e

State are approved in writing by

tre

^policy makerc. Whateverwe are

bing w pt

in

Wrg

^{and hey}

afirofize.

lf

yut

tnvel

qi wifitwt Wrmixiwt W

^{may eam a}

qury.'(Safe fuilinatoy

Fortavels

wihin

fie

SEte

fie

DDC is infumed, but usually not in wriling.

Proiect leadership is fully awarc that replacemenb will be needed, and has gone ahead to request and secure a neu,

Topta

Hilux from APOC

b

complenrentilte old one. Govemment offcials have expressed confidene

fiatwift

counterpartfunds from governrentexpected

b

conre in rnore regularly replacemenb and maintenance of logistics can be done and

ofier

needed materials provided.

There

ae

enough T-Shirts and face

c4s

^produced to be given as incentircs

b

CDDs and

hedtr

workers.

Quite a number of

faining

manuds and reporting furms were seen, but posters appetr

b

be in very short supply. These were produced fiom oubide resources (APOC/F|KI).

HUMAN RESOURCES

(20

There is a totalof

I

SOCTs (including State Coordinator) available. For a

projectwih

12 endemic LGAs

$is

might be a liffie bit high except if they are used for

ofier

PHC drnies. Most of the SOCTs appear

Borno State CDTI Evaluotron Rep<trt

L7

Borno State CDTI Evaluation Report

commtfied altrough level varies. The SOCTs are relatively skilled ⁱⁿ faining, HSAI\,| and supervision but are deficient in planning, data managenrcnt and compubr literrcy.

There are @ncerns

thatfie

lack of skills is much more ^due to

ffirdinal

^patbrns

han

lack of faining while

abwmaybeduehlackofknowledge. ?Deliegentvbds

^(of

^HK Sfalftofie$ate ndLGAs),rere

occasioned by ^{lad< of} resufis wbnted puticipation of some members of

he

team who

wght

not to be incfu&d butthe

qency

has not

rrlrnr

fo ask fortheir rqlacemenf as we

de

not in

fie

Sfate

lo Nicc

ffiem butuyukwifrr

whreverfie

Safe fias assfined toffie

prognmne.' (HK Canty

Rep) All

fte

SOCTs have been in

fieir

present positions

br

the last 6 years.

covERAGE (20,l

-

.

Geographic and

her4eutic

coverage rates appear tair and good respectively, and

$ere

are concems

ftat

only eligibles are being reglstered. ln a

ftw

^plmes some @mmunities were

notteated

at

diftrentlimes

on account of CDD

ffiition

and lack of incentives. There is sonre confusion over

he

total number

of

communities

ftat

are being coveled over tirne. A cornprchensive listing of communities and census

upd#

was however recenty done.

Recommendatons

hr

the Ptoiec't Leuel

Recommendation lmplementation

Planning

t

Tentative Sustainability plans dercloped should be fine-tuned and incorporated into

he

overall healft budgetfor emh ^year.

o

The Sustainability Plans should

reflectfie

activities of

o$er

health interventions that have been added

t

The possibility of integrating CDTI into on. the Healtt Sysbms Fund as a means of alternative funding should be followed up.

.

^{There is need} for a new MoU to be signed between

fie

Shte and

HKlturthe

^{postAPOC period.}

Prrorrtv; HIGH

lndicaton ofsrrccess;

o

Existence of integrated action plan endorsed by all partners

o

Sushinatlility plans reflected in healtt budget

o

^{Minutes of} planning meeting

o

^CDTI inbgrated in Heath Systems Fund activities.

o

Existence of MoU siqned by HKI& State

Wtototslkeaclion:

Directr

PHC/SEIe Coordinator

I)cadlim

for completion:

Februarv 2005

I ntegration of Support Ac{ivitiee

o

^{One lield} visit by SOCTs needs

b

^{be used for}

several CDTI activities for cost eficiency.

o

Since the CDTI sfucture is being used forVAS and Eye Care, an integrated supervisory plan or schedule should be developed and utilized

brfield

visiB.

ffionlv:

HIGH

lndkators ofsuccess;

o

Existence of superuisory/field reports showing various aclivities canied out in a single

tip.

l

^An integrated supeMsory ^plan or schedule available and in use

Whototake rction:

Director PHC/Stab

Cmrdinabr

t)cadlline for completion:

ADril2005

l8

Borno State ('DTI Evoluatrcn Report

Borno State CDTI Evaluation Rep<trt 19

Leadership

I

The State Team should be reorganized and

fie

number reduced,

excepthe

rnembers are made to perform

o$er

PHC duties.

.

There is need for greater delegation of duties to ^a re- organized SOCT membership. This willresultto a greabr sense of ownership, and work

o@ut

will not be dependenton the preserce of

eifterfte

Coordintur ^or

fie

^HKI project officer.

ftioritv:

^HIGH

lndicators

ofsuccess;

o

^SOCT

^bam

reorganised and ^no of members possibly redtrced

o

SOCTs eflbctively performing CDTI&

ofier

PHC rctivities.

o

^{Existence of} work schedule & Minubs of olannino rneetino

Whototake

action:

Direcbr ^PHC

Deadline

for

completion : Februarv 2005

ilonibring

and Supervision

t

SOCTs and HKI staff should visit roulinely only

he

LGA levelwhile empowering the imnrediate lower Ievel to conduct supervision at lower levels. The Project

st#can

pay targeted superuisory visits to communities

wih

specific problems or as partof its 'spot checks'.

o ^Trednent

data should be utilized to monitor areas with low coverage.

o

Integrated

checklisbfurhe

programmes using the CDTI sfucture should be developed and utilized for

allvisib

to the field.

i

^{The LOCTs need to be empowered}

^b

^manage

problems of CDTI implenrentation atthe lower levels.

Ptiotily.

Medium

ldicatorc ofsuccess:

.

^{Existence of} superuisory schedule$

reporB indicaling targeted visits

m

specified on

fie

left

o

Evidence of specific action hken to address

lowmvcage

in idenffied areas.

t

No of SOCTs using integrabd checklist

t

^{Reports arailable} at State and LGA levels showing actions taken by LOCTs on oroblems identified.

Wrtototake

aclion=

Director PHC/Stab Coordinator I)re,adline for completion:

End of next distibution Mec{izan Prccu remenUDisfi

ibution

o

Each level should be encouraged

b

^{pick up}

heir

Mectizan requiremenb from

fie

^{imnediate higher}

level using resources

hat

are dependable, preferably

fiatof

^govemment

o

^{Mectizan need to be} procured early enough

b

ensure

ftat

it is available

atfie

community level at perioG _{that are} convenientto rnembers.

Pr'plritv: Medium lndicators

ofsuccess;

.

^No of LGAs collecting

fteir

Meclizan

needsfromhe

State

.

Availability of Mectizan atconvenient

lims furhe

communities.

Whototake rclion:

Direcbr ^PHC/State Coordinator/l'lKl Deadlirc for complelion

:

ADril2005 Training & HSAM

i

Each level should be lefi and appropriately empowered to organize ^its faining ^programmes based on paceived needs.

t ^Afaining

need assessment need to be undertaken by the project

Ptiorrrv

HIGH

lndicators of success:

o

^{Exisbnce of} faining reporb/ schedules indicating organization ^of

taining

by each level

o

Reoort of assessment available

Wtototake

action:

Shte Coordinator

Borno State CDTI Evaluation Report

t-.

Borno State CDTI Evaluation Reptrt 20

Deadline

for completiwr:

Mav 2005 Financial Resources

o

^Detailed Sushinability plans should be heeded in

&e

utilization of all funds ftom all sources.

o

Where shorffalls occur, perhaps occasioned by late release of govemmentfunds, efurts should be made to

renedyfiem.

i

^Aclear understanding should be reached by all stakeholders on

$e

disbunsementand utilization of LGA fu nds deducted at source.

I

A high- powered advocrcy needs to visitthe

Executive Govemorto

furfier

advocate for release

of

counterpartfunds on a regula basis.

Prioritv:

HIGH

lndic ators of success.'

t

Expenditure profile in line wi$r detailed plan of action

a

Evidence of actions taken

h

rerredy shortfalls

I

Minutes of meeting available

.

Existenceofreportof advocacy

o

Funds released

Wn to

tslke

*{ipm:

Director PHC/Shte Coordinator Deadllirc for

complelion:

Auqust 2005 Transport & CIher illatedal Resources

o

A maintenance schedule for project capihl items needs to be developed.

.

Appropriate plans forthe replacernentof some capital items such as the computer and procurernent of a generating setshould be made and

implernented.

HiorW:

HIGH lndicatorc

ofsuocess;

I

Existence of maintenance schedule

t

^Plans for orocurenrent available

Whototake *lion:

Director PHC

Deadlirc

for

completion:

February 2005 Human Resources

I

SOCTs should be fained on data management, resource managenrcnt and planning. They need to be

expced

to some computer appreciation.

Prioritv:

HIGH

lndicatorc

ofsuocess;

o

^{No of SOCTs tained on areas of}

deficiency

ideffied

on

fie

left

JUhototake rcliwr:

Director PHC/State Coordinator Deadlturc for completion

:

February 2005

Goverage

.

^Using

^fte

updated REMO Map for Nigeria,

fte

Project should validate fi e comprehensive census updab recenty done and clearly define

he

number of endemic communities needing

fefrnents

and their populations.

Pioritrr:

HIGH

ldicators ofsuocess:

t

Reliable data based on REMO

inbrmation indicating number of

hrget

communities and oooulations available

Wrntotake rctiur:

Director PHC

Deadlirc for completion:

End of nextdistibution oeriod

Borno Stale CDTI Evaluatrcn Reytrt

Borno State CDTI Evaluation Report

3.2 Sustainability at the LGA Level Figure 2

-

^Chart

^of

^findings

^at

^{LGA level}

0

LGA Level Findings

l

t.J

!

T

t'

!

T

ti lt

il

L]

! II

f')

I

;

!

T

I

r-J

!

t-,

l

r-l

ll

L

f-' L

tr

t-l

L

l-r 21,

..C ,-c """c ."""- -d^"..."$'s ,*d"/ _"/

PLANNTNG (0.0)

There is no overall written ^plan for PHC. "We dlscuss generallt' (Ag PHC hordinator, Gwoza LGA).

There are annual LGA budgetary estimates, in which CDTI is not reflected. The CDTI plan seen is a generic timeline prepared by the State and circulated to all the LGAs, This timeline is same for each year, and specifies when broad activities will be carried out.

Whv CDTI or PHC activities are not olanned.

There is no culture for ^planning for activities, moreso when it does not form a basis for release of funds.

LOCTs also say that they were not informed that a CDTI plan should be part of the overall PHC plan.

TNTEGRATTON 0F SUPPORT ACTIVTTIES (3.0'

No written work plans exist. LOCTs deliver Mectizan when training CDDs. They also use supervisory visits to do mobilization of community leadership to select and compensate CDDs, or conduct health education

Rorno ,Slale

('l)'l'l

livaluqtion lleport

Borno State CDTI Evaluation Report

Sonn LOCT Ieaders are in chargg of other PHC activities such ^as essentia! drugs while the other LOCT members do

all$e

otrer duties expected ^of them as the in/charges of

tre

heatth fmilities.

We

ched< how

the CDDs are distihtting

fie

^{drug. We also dterf. ouf how fltos e in}

^darge

^of sanitation are doing.' (GYnza LGAOncho

Codinatar)

LEADERSHTP (2.0)

LOCTs initiate some activities srch as mobilization ^and supervision,

butfaining

are planned and organized by the State in collaboration ^wi0r

tre

assisting NGD0.

'Ea$ ^ye9rre

^llrcf do the mobilizalion

arwnd

February

or

MarchDefore the

tniningof

CDDs.' (@roza ^LGA 0ncho Coordinator).

There is a coordinator

br

CDTI activities (LOCT Leader/Oncho Coordinator) who is

asisted

by 4

ofier

dispensary

stfrwho

senre also as distictsupervisors. These persons

hgeher

^{make up}

he

Local Govemnrent Onchocerciasis Confol Team (LOCT).

Reason whv leadershio is

notinitdino

some

rtivities

@CDDfainingandMectizandisfibutionaredependentonfteState,because

this has been

fie

system and both State and LGA partners hare

mepted ttis

^as the standard practice.

MoNTTORTNG/SUPERVISIoN

(20'

Treatnent data flows

fom

the community through

fie

supervisors to

tre

LGA Coordinator who collates these summaries ^into the ^LGA

featnent

summary

brm

which he submib to the State Coordinator. The S9CTs usually go round

tre

LGAs to collect reports. Training data are collected ^by

he

State personnel (SOCTs) sinc6

trey

are present and

dively

participate during CDD taining. Most of the resouroes used in the

fanimission

of reports are either personal ^(at lower levels) or APOCNGDO; and in a Ew cases with resources from ffie governnent

Sffi

^at this level superuises CDTI activities ^at

tre

community level constanty and routinely.

'l

visit ditrerent comnunilies 2

-

^{4 imes in}

^{a montf ,}

depnding on ^financial reswrc,es available.

(@nza

LGA

Ondp

Coordinator).

otrer

LoCTs being nearer ^to the communities (being ^at

tre

dispensaies/clinics) supervise more frequenty. There is no atGmpt to empower the dispensay staff (front line heglth facility staff) to conductsupervision. However, sonre

ofier

^prcgramme offcers are being involved ⁱⁿ the supervisory process, but this not widespread.

Problems identified during supervisory visib

ae

dealtwiilr ^by ttre LOCTs. Communities

hat

are giving some incentives to ttreir CDDs have their efiorts appreciated and encouraged

h

^continue.

^Yle

^{usedto go}

and ffiank hem, (and tetthem that) ^{atl of}

us

are helping

wr

^{people notto go} blind.' (GY'nza LGA Oncho Coodinator)

Reason whv suoervision is inefficient

to understand the conceptof targeted and integrab_d superuision, especiatiy its sorrn funds are made available fiom State, HKI and occmionally from

fie

^LG Courrils

br

supervisibn. However,

attre lasttaining

programnre paticipanb whbh include LOCTs were

taughthe

concept of hrgeted and integrated supervision.

Borno State CDTI Evaluatron Rep<trt