World Health Organization African Programme for Onchocerciasis Control

Assessment of the Sustainability of the Kano State CDTI project, Nigeria.

December 2003

VOL. 1 - MAIN REPORT

Prof. Celestine Onwuliri Prof. Jodi Mas Dr. Obal OtuDr. Yisa Saka Mr. Steven Orogwu Prof. Ekanem Ikpi Braide (Team Leader)

TABLE OF CONTENT

2

Acronyms……………………………………………………………………………………………3

Acknowledgement …………………………………………………………………………………4

A. Executive summary ………………………………………………………………………..5

B. Introduction …………………………………………………………………………………8

C. Methodology ………………………………………………………………………………...10

D. Evaluation Findings ………………………………………………………………………...14 1. State level 2. LGA Level 3. District/Health Facility level 4. Community level

E. Overall sustainability grading for the project …………………………………………….29

F. Recommendations ………………………………………………………………………….32

G. The way forward …………………………………………………………………………….36

H. Appendices …………………………………………………………………………………38

I. Time table for the evaluation of sustainability of Abia State CDTI project.

II. Agenda State level feedback/ planning meeting

III. Agenda LGA level feedback/planning meeting

IV. List of persons interviewed.

V. Participants at planning meeting.

VI. SWOT Analysis .

VI. List and contact address of evaluators.

3

ACRONYMS

APOC African Programme for Onchocerciasis Control

CDD Community Directed Distributor

CDTI Community Directed Treatment with Ivermectin

CHEW Community Health Extension Worker

CSM Community Self Monitoring

DHS District Health Supervisor

FLHF First Line Health Facility

HOD Head of Department

HSAM Health Education, Sensitisation, Advocacy and Mobilisation

IEC Information, Education and Communication

LGA Local Government Area

LOCT Local Onchocerciasis Control Team

MOH Ministry of Health

NGDO Non-Governmental Development Organisation

NOCP National Onchocerciasis Control Programme

NOTF National Onchocerciasis Task Force

PHC Primary Health Care

REMO Rapid Epidemiological Mapping for Onchocerciasis

SHM Stakeholders Meeting

SOCT State Onchocerciasis Control Team

SWOT Strength Weaknesses Opportunities and Threats

WHO World Health Organisation

WR World Health Organisation Country Representative

DPHC Director, Primary Healthcare

DB&P Director, Budget and Planning

CBM Christoffel BlindenMission

JICA Japanese International Cooperation Agency

VBDCU Vector Borne Disease Control Unit

4

ACKNOWLEDGEMENT

The team is grateful to the following persons who have contributed to the success of this

mission.

APOC management for the planning and funding of the mission.

The WR Lagos, and staff of WHO office in Kano for providing administrative support.

Officials of the Kano State Ministry of Health: The Hon. Commissioner for Health,

Permanent Secretary, Director of Public Health/PHC, Director of Budget/Planning, for

participating effectively in the evaluation and providing necessary logistic support to the

team.

The State CDTI Coordinator and the SOCT members for working tirelessly throughout

the duration of the exercise.

CBM project officer for providing logistic support and assisting in facilitating the planning

meetings.

Chairmen of LGA Caretaker Committees and other LGA officials for providing

information and documents relevant to the evaluation as well as participating in the

planning meetings.

Heads of Departments of health /Primary Health Care Coordinators, Oncho Focal

Persons members of LOCTs for facilitating visits to the First Line Health Facilities and

Communities, and also for participating in the workshop for production of the

sustainability plans.

Traditional Leaders and members of communities visited for cooperating maximally

during the exercise.

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A. EXECUTIVE SUMMARY

Kano State CDTI project has been funded by APOC for the past 5 years. The project is

implemented with the support of Christoffel BlindenMission (CBM) with headquarters in Jos.

Sustainability evaluation of the project was undertaken within the period Dec. 9 – 23, 2003 by a

team of scientists from Nigeria (5) and Spain (1).

The team was mandated by APOC to:

• Evaluate the sustainability of the project.

• Present and discuss the results of the evaluation with Government officials and CBM.

• Support State level, LGA and health area personnel in developing post APOC sustainability

plans using the guidelines for sustainability planning meeting developed by APOC and

pretest the guidelines

Before commencement of the exercise, Government and NGDO officials were briefed on the

purpose of, and procedure for, the evaluation. Appropriate permission was sought to carry out

the exercise. Interviews were conducted with policy makers and CDTI implementers at state,

Local Government Area Headquarters, First Line Health Facilities (FLHFs) and communities. In

addition, relevant documents specified in the guidelines were examined.

Using multistage sampling approach, LGAs, Districts and communities to be visited were

selected. Information was collected using four standardized instruments for sustainability

evaluation (one of each level). Findings were recorded, scored and analysed under Planning,

Monitoring/Supervision, Mectizan procurement/distribution, HSAM, integration of support

services, financial resources, other material resources, human resources and coverage. Each

indicator was scored for each level by each evaluator. The scores were discussed and an

average score recorded for each indicator at each level.

At the State level, the average score for all the indicators is 3.4. The existing plan for CDTI is

part of the overall annual PHC plan. Partners’ roles are clearly stated. There is a post APOC

plan which needs to be revised to indicate sources of resources outside APOC. Five skilled and

committed SOCT members implement the project at state level. Monitoring and supervision is

integrated and resources are cost-effectively used. Supervisory checklists are presently being

6

harmonized into one common checklist to further enhance integration. Officials at various levels

are empowered to solve problems through normal administrative channels and successes are

recognized and rewarded. Mectizan procurement, storage, distribution, stock control

documentation are as recommended for CDTI. Training is targeted and training materials are

adequate. Integration is being achieved impressingly: CDTI is implemented within the Vector

Borne Disease Control Unit alongside malaria, guinea worm, bilharziasis, cholera and filariasis

with State Oncho Coordinators in charge. Adequate provision has been made for CDTI in 3

budgets: – PHC budget, Donor funds budget and VBDCU budget. Funds disbursed are properly

managed. Equipment & vehicles are well maintained but project will need a new 4-wheel drive

vehicle, computers and photocopier. Coverage is good but there are indications that therapeutic

coverage is not properly calculated for some communities. The project was in the first four

years not well funded because of uncooperative attitude of immediate past Commissioner for

Health. However, the present policy makers in the Ministry have quickly repaired the damage

done to the programme during the past four years. CDTI in 2004 will draw from funds approved

for PHC & DC (50Million Naira), Counterpart funding in Donors funds (10Million Naira) and

VBDC unit (20Million Naira).

At LGA level, average score for all indicators is 3.6. Plans exist but do not have budget

estimates for CDTI. In most cases, the plans were not prepared in a participatory manner. The

HOD health and LOCT members take full charge of CDTI activities in the LGA. Supervision is

integrated and problems (mainly refusals) are adequately handled. There is no organized

system for rewarding success. Training, though targeted, is not integrated. HSAM is properly

planned and implemented with positive impact on release of funds for CDTI. Available transport

is used in an integrated manner but will not last for 5 – 10 years. Coverage is good but there is

need to restrain on calculation.

At Front Line Health Facility level, the average score on overall indicators is 3.3. This is the

weakest of all the levels. There are no written plans. The health officials in charge of the

facilities are knowledgeable and operate using weekly timetables. No budget is operated at this

level because FLHFs are outposts of the LGAs. LGA Councils and the communities supply all

funds and items required at this level. Supervisory checklists are not used but reports on

supervisory visits and follow up records are available in some of the facilities. Problems (mainly

7

refusals) are satisfactorily solved and Mectizan supply is adequate. HSAM is effectively carried

out with full participation of community leaders. More posters are needed at this level.

At Community level, the average score for all indicators is 3.7. This is the best performing level.

CDTI activities are planned and managed efficiently by CDDs and community leaders.

Community involvement is optimum, reported benefits are many and annual treatment is

accepted. Community leaders have dispelled the initial fear that mectizan is a contraceptive by

taking the lead in swallowing the tablets. Distribution is ongoing in some communities. The

CDDs are not given transport money for Mectizan collection because FLHFs are near the

communities. There is no central process of providing incentives to CDDs. Type and amount of

incentives given vary with communities and it is not a common practice to give monetary

incentives in the communities. The CDDs are satisfied and willing to continue serving. CDDs

are knowledgeable skilled, and committed but require more training on calculation. The CDD:

population ratio is not ideal and more CDDs are needed. However, this is not a major problem

since the CDDs are not overworked. The houses are close to each other and they do not have

to trek for long sessions.

During debriefing sessions/ planning workshops, findings were presented to policy makers,

SOCT members and LOCT members. Findings for each level were exhaustively discussed and

a SWOT analysis conducted. The participants were trained on planning and 3-year post APOC

sustainability plans prepared for each level.

Of the seven aspects of sustainability, integration and resources (financial) are moderately

helping sustainability, while attitude of staff; community ownership and effectiveness are

excellently helping sustainability. There are no major problems with regards to the critical

elements.

Based on the findings, the team assessed Kano State CDTI project as making progress

towards sustainability. However, the project will require national and project staff to take

recommended remedial actions on aspects of sustainability not completely fulfilled and

sustain achievements with regards to critical elements.

8

The team recommends that as way forward, the project should

Conclude -work on the post Apoc sustainability plans for all levels.

Sensitise all stakeholders at state, LGA, and community levels on the need for increased

and continued support of the project.

Ensure that CDTI continues to be budgeted for within PHC, VBDU, and Donor Projects

budgets.

Facilitate integration through joint trainings, monitoring and supervision.

Retrain members of LOCTs, staff of FLHFs and CDDs on calculation of coverage and

determination of quantity of tablets required.

Improve on CDD/ community population ratio.

Sustain- the present impressive leadership, good Mectizan

requisition/collection/distribution, and good maintenance culture.

B. INTRODUCTION

Kano State is located in the Northern part of Nigeria and is bounded on the North East by

Jigawa State, North West by Katsina State, and South East by Bauchi State and Southwest by

Kaduna State. The population is 7.9 million (2003 projected population) made up of Hausas,

Fulanis and some migrants from Niger Republic. The state is administered in 44 local

Government areas.

The climate is characterized by two seasons i.e. rainy and dry seasons. Kano State falls within

the Sudan savannah and Sahel savannah zones. The terrain is generally flat or slightly

undulating with sandy soil and there are occasional rocky outcrops and granite inselbergs. The

region is drained by some rivers namely Rivers Kano, Zungur, Shimar, Challawa and their

tributaries. There is a large irrigation scheme in the project area (Kadawa Scheme), which is

marked by an extensive network of irrigation channels. Providing suitable breeding site for the

black fly.

Onchocerciasis endemic areas are located mainly in the Sudan savannah areas in the

Southern part of the State. Of the existing 44 LGAs, 18 are endemic for Onchocerciasis. These

9

are mainly meso endemic with a few hyper endemic foci. Ivermectin distribution programme

(IDP) Started in Kano in 1996. In January 1998, a proposal to for the control of Onchocerciasis

in Kano using the Community Directed Treatment with Ivermectin (CDTI) Strategy was

submitted to APOC. On approval, implementation of CDTI commenced in Jan 1999 with CBM

acting as the supporting NGDO. CDTI operates within the Vector Borne Diseases Control Unit

of the MOH.

The project is implemented by 6 SOCT members, 53 LOCT members, 354 Health Facility staff,

and 1850 CDDs, with the support of policy makers at all levels. All CDTI activities i.e. health

education, sensitization, advocacy, mobilization, mectizan procurement/distribution, monitoring

and supervision, are being implemented. The average ratio of CDDs to registered population is

1 CDD to 267 persons. In 2002, the 4th year of CDTI implementation, targeted trainings on

Stakeholders meetings and Community Self Monitoring were conducted in a cascading manner,

facilitated by CBM (NGDO) and NOCP. Mobilization activities have been quite satisfactory and

have resulted in acceptance of responsibility and ownership of the project. In the 2002

treatment round, out of a registered population of 494, 473 in 779 meso endemic communities,

412, 623 persons were treated using 1,067,452 tablets. Geographical coverage of 100% was

recorded for the year and therapeutic coverage of over 65% was recorded for each of the CDTI

communities.

During the last (2002) treatment round, partners made the following contributions:

State Government N700, 000

Local Government N1, 876,000

Communities Support for CDDs mainly in kind

NGDO Logistic support for collection of Mectizan and training.

10

There is a high degree of structural integration of CDTI into all health programs and there is a

move to produce a single supervisory checklist.

Constraints encountered by the project include

• Lack of support to CDDs in some communities.

• Negative effect of payment of monetary rewards to local guides who participate in

other community based activities like polio vaccination.

C. METHODOLOGY

• Evaluation question……..How sustainable is the Kano State CDTI project ?

• Design……………………..Cross sectional, participatory and descriptive.

• Population………………. Kano State project, including its SOCT, its NGDO partner;

It’s LGAs with their LOCTs, the project communities,

project villages and their CDDs

• Sampling………………... Details of the sampled districts and villages are contained in

Table 1 below.

Sampling

The sampling for the evaluation was purposively done, based on the primary criteria of

coverage (geographical & therapeutic). Secondary criteria for sampling were the following:

• Endemicity level (the sample contained both hyper and meso endemic areas).

• Geographical spread: sampled villages were from different areas of the project area.

• Accessibility/convenience: sampled villages were selected taking into account

accessibility and convenience to ensure that the state is covered within the limited period

of the evaluation.

There are eighteen endemic LGAs out of which three were sample from each of the three

geographical zones of the State. A 100% geographical coverage has been achieved in all

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endemic LGAs during 2003 distribution except in Danbatta LGA, where 30 communities out of

42 (71.4%) had been treated by the time the evaluation team arrived. The three LGAs sampled

include Garum Mallam (89%) with highest therapeutic coverage rate, Takai (89%) medium level

coverage and Danbatta (75%) as the LGA with the least coverage.

For each LGA, communities were first aggregated under the various health facilities, each

under a First Line Health Facility staff as direct supervisor. Two health facilities (one with good

coverage and the other with the least coverage) were sampled. From each of the health

facilities selected, two communities (one with high coverage and another with lower coverage)

were selected. A total of three LGAs, six First Line Health Facilities and twelve communities

were selected as shown in Table 1.

Table 1: Distribution of sampled LGAs, health districts & villages

S/N LGA Therapeutic Coverage

Endemicity Health Area(Therapeutic Coverage)

Community/Villages (Therapeutic Coverage)

1 Garum Mallam

89% Meso Yadakwari (86%)

1. Dakasoyi (86%)

2. Mudawa (87%) Kadawa (93.5%)

1. Kadawa qtrs. (94%)

2.Kadawa Liki (93%)

2. Takai 85.7% Meso Faruruwa (92%) 1. Jigawa (91%)

2. Tarandai (95%) Falali (85%) 1. Fita (78%)

2. Falali village (85%)

3. Dambata 75% Meso Ruwantsa (82%)

1. Ruwantsa (84%)

2. Takuya (85%) Dukawa (85%) 1. Unguwa Bali (72%)

2. Dukawa ciki gari (85%)

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Sources of information

Information was collected at State LGAs, FLHF and community levels from the following

sources:

• Verbal reports

• Documents

• Interviews

State level ……………... SOCT leader, SOCT team members, policy-makers and

management staff of the Ministry of Health.

LGA level……………..… CDTI Focal person, LOCT members, policy makers, and

management staff.

FLHF Level ……… ……. Health staff.

Community level ………. Community leaders, CDDs and community members.

Procedure

Information was recorded on the following evaluation instruments

Instrument 1 for state level

Instrument 2 for LGA level

Instrument 3 for FLHF level

Instrument 4 for community level

Each indicator on each instrument was scored independently by each evaluator. Details of

indicators scored at each level are shown in Table 2.

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Table 2 Indicators scored at each level Category Indicator State LGA FLHF Community

Activities & Progress which support CDTI

Planning

Leadership X

Supervision

Mectizan supply

Training and HSAM Integration X X X

Resource provided Funding (financial)

Other resources (Transport etc)

X

Human resources

Results achieved Coverage

= Scored X = Not scored

Based on the information collected, each indicator was graded on a scale of 0 – 4, in terms of

its contribution to sustainability. Members of the evaluation team exhaustively discussed

findings and average score for each of the indicators at each level was calculated.

A two-day feedback/-planning meeting was conducted in two batches for implementers and

policy makers from endemic LGAs. Participants from Makoda, Gwarzo, Ajingi, Tundun Wada,

Madobi, Garum Mallam, Takai, Dawakin Tofa, and Bebeji LGAs attended on days 1 and 2 while

participants from Dandatta, Kabo, Gaya, Doguwa, Kura, Kiru, Sumaila, Rogo, and Karaye LGAs

attended on Days 3 and 4. Thereafter, a one-day planning/ feedback meeting was held for

members of the SOCT and principal officers of the State Ministry of Health. During each of the

meetings, findings at each level were presented by the evaluators and exhaustively discussed

by the participants. Problems were identified and solutions to the problems proffered.

A SWOT analysis, facilitated by the NGDO representative and evaluation team members, was

conducted. Participants at LGA level later worked in LGA groups to produce three year post-

APOC sustainability plans for the LGA while the State team worked as a group to develop the

State level sustainability plan.

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D. EVALUATION FINDINGS

1. Findings at the State level

STATE OVERALL SCORES

33.2

3.5 3.4

3.1 3.1

3.6

3.9 4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Planning Monitoring &

supervision

Mectizan Training &

HSAM

Integration Financing Transport &

other

resources

Human

Resources

Coverage

INDICATORS

SC

OR

ES

15

Planning (3.0, highly)

There is an existing plan for onchocerciasis activities and it is part of the overall annual plan of

the Department of Public Health and Primary Health Care. Key CDTI activities are provided for

within activities budget lines. The 2003 plan is an improvement of the previous years and not a

re-write. While the previous years plans had as objective to establish sustainable CDTI in 98

endemic communities, objectives in the 2004 plan were specific on sustainability issues such as

advocacy on policy makers, mobilization of stakeholders, training/retraining, review/appraisal of

activities, evaluation, and community participation, attainment of adequate coverage, ensuring

adequate and timely Mectizan supply, maintenance of existing vehicles and replacement of

unserviceable vehicles. This plan needs to be revised to indicate sources of funding outside

APOC.

The main partners i.e. Ministry of Health (State Oncho Coordinator, Chief planning officer),

representative of CBM (NGDO), and Zonal Coordinator (NOCP) participated in the preparation

of 2003 and 2004 plans. The plan was discussed during NOTF/NGDO review meetings.

However, no minutes of these meetings were available. There was no indication that plans for

previous years were drawn in a participatory manner.

Monitoring/supervision (3.2 Highly):

The CDTI team is made up of 5 SOCT members at the state level. Each SOCT member is

responsible for monitoring and supervision of particular LGAs, with at least one visit per year.

They routinely supervise and monitor CDTI activities at the LGA headquarters level and do not

go to the FLHFs and communities except when there is a problem beyond the control of the

LGAs staff. Staff members at lower levels are properly empowered to monitor and supervise

levels under their charge. Ministry of health policy makers participate in monitoring when there

is need for them to do so. The Zonal Coordinator and the NGDO officer carry out overall

supervision. A CDTI Monitoring and supervision checklist is used and a common checklist is

being proposed for better integration. Once in every two months, the SOCT holds a review

meeting at the State capital with LOCT members. Minutes of some of these meetings were

seen.

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Monitoring and supervision in CDTI is integrated within the Vector Borne Disease Control Unit

(Guinea worm, Malaria, Schistosomiasis, Polio and Immunization programmes) to maximise the

use of resources, especially vehicles. Problems identified during supervisory visits are

managed through normal administrative channels. Successes are recognized and broadcast in

State and National media. Certificates of recognition are also awarded. A certificate presented

to the Director of PHC during the Civil Service award in July 2003 as a State Prize for Excellent

Service was seen. A sample of certificates presented as prizes to best performing LGA focal

persons was seen.

Mectizan procurement and distribution (3.5 Highly):

Mectizan allocation for the state is cleared by UNICEF along with the general consignment for

Nigeria. Once the State is notified of the availability of Mectizan, CBM assists in moving the

consignment from Lagos to Kano. The drug is stored in the Vector Borne Disease Control Unit

store with other supplies for the unit. The SOCT then invites the LGAs to collect their allocation.

From the LGAs, Mectizan is sent to the FLHFs from where the CDDs pick up the drug for their

communities. There is a Mectizan order and control stock documentation.

Training and HSAM (3.4 Highly):

SOCT members train the LOCT members who in turn train the CDDs. Training materials seen

included manuals, posters, flipcharts, reporting forms, tally sheets. Training is targeted at

specific aspects of the CDTI and last training was done on Sustainability Stakeholders Meetings

(SHM) and Community Self Monitoring (CSM). There is a policy on integrated training and the

PHC Department has plans to organize such trainings in the future.

SOCT members effectively carry out HSAM during briefings and routine sensitization as well as

through the mass media. Radio Kano and other media outfits in the state are used to promote

CDTI projects. The Honourable Commissioner participates in advocacy for the CDTI to LGAs.

17

Integration of support activities (3.1 Highly):

Support activities are planned and executed in an integrated manner. The Vector Borne

Disease Control Unit integrates CDTI activities for efficient monitoring/supervision. Staff

members in this unit are also involved in the control of guinea worm, malaria, cholera, and

schistosomiasis as well as immunization.

Financial (3.1 Highly):

During the first 4 years of implementation, CDTI was not adequately funded because the

Commissioner for Health was not cooperative. There is no record of funds released by State

Government for CDTI for the years 1999 and 2000. In 2001, N700.000 was released while in

2002 there was no release of funds. In 2003, N250.000 was spent on maintenance of vehicles.

The 2003 CDTI plan has budget lines for advocacy, mobilization, training, census, Mectizan

supply, transport, I.E.C., facilitators, LOCT guide, register, household card, Mectizan allocation

form, and supervisory checklist. This is subsumed in the overall PHC budget. The Vector Borne

Disease Control plan has budget lines for mobilization, training, equipment/supplies, community

empowerment, documentation, verification and evaluation. The present policy makers of MOH

have already made provisions in the 2004 budget for sustainability of CDTI activities after

APOC withdraws.

The budget for 2004 has made provision for N150 million for PHC and Diseases Control and 10

m for counterpart funding of all donor programs and 20 Million for control of Vector Borne

Diseases. CDTI is provided for within each of the three budgets under activity budget lines.

Funding of CDTI is guaranteed because of this nature of the budgeting, which provides funding

for activities and not for programmes within PHC system. The policy makers of MOH have

given assurance that CDTI activities will be funded adequately. There is proper management of

the funds disbursed for this project. The normal administrative procedure is adopted in the

approval of expenditure with requests going from the State Oncho Coordinator to the PHC/PHC

to Permanent Secretary and finally to the Honourable Commissioner who approves.

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Transport and other material resources (3.6 Highly):

The following transport and materials are available

Item Number Provider Condition

4x4 WD vehicle 1 APOC functional

1 JICA “

Motorcycle 1 APOC “

Bicycle 0 APOC -

Computer 1 APOC “

Printer 1 APOC “

Projector 1 APOC “

TV 1 APOC “

Video machine 1 APOC “

Fax machine 1 APOC “

Air conditioner 1 APOC “

Generator 1 APOC “

Magnetic board 1 APOC “

CBM provides additional vehicles when needed. The computer, printer and photocopier will

need to be replaced soon. There is also a need to replace the vehicles presently in use. The

Ministry plans to purchase 20 utility vehicles one or two of which will be assigned to CDTI.

Though CDTI trips are authorized, conventional logbooks are not used. The vehicles and other

material resources are well maintained by MOH. A total of N250.000 was spent on vehicle

maintenance in 2003 and the source of funds for maintenance is dependable.

Human resources (3.9 Highly):

Project officials at the state level are academically sound, professionally competent, well trained

in CDTI, adequately motivated and committed. In spite of lack of support during the first 4

years of the project, SOCT members have remained committed to the job. There are 5 SOCT

members and 1 computer operator/data manager who is shared with the UNDP assisted

programme

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Skill number

Planning 6

Report writing 6

Training and HSAM 6

Monitoring/supervision 6

Data management 1

Computer skills 6

Mectizan ordering/distribution 6

These SOCT members are stable, have been on the job for 6 years and have the potential of

passing on their skills if transferred out.

9. Coverage (4 Fully):

All endemic LGAs have attained 100% geographical coverage and at least 65% therapeutic

coverage has been achieved in all communities eligible for treatment. However, there is need to

retrain all implementers on calculation of coverage.

Fig. 2. LGA OVERALL SCORES

3.4

4

3.1

3.6

3.1

3.4

3.7 3.84

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Planning Leadership Monitoring &

Supervision

Mectizan Training &

HSAM

Financing Transport &

other

resources

Human

resources

Coverage

INDICATORS

SC

OR

ES

20

2. Findings at LGA level

Planning (3.4, highly).

Plans for Onchocerciasis control activities exist in all the endemic LGAs visited namely, Garum

Mallam, Takai and Danbatta. The plans were drawn up in a participatory manner in some

instances. The team sighted plans for 2001, 2002 and 2003 but could not see the 1999 and

2000 plans. CDTI activities appear under Disease Control (subheads 10 and 13) in the PHC

section of the overall LGA plan. However, no budget estimates are provided for CDTI.

Leadership (4.0, fully).

The PHC Oncho Coordinator (HOD Health) takes full responsibility of CDTI activities. He/She

also oversees all other PHC programmes. A focal person (equivalent of Oncho Coordinator in

other CDTI projects) in each LGA is in charge of CDTI activities. In each LGA, there are 4

LOCT members who initiate CDTI activities at this level. These officials have been adequately

trained on various components of CDTI, are knowledgeable and are committed. Leadership at

this level is sound and dependable.

Monitoring/Supervision (3.1, Highly).

Reports concerning CDTI activities are processed and disseminated through routine

government system. Reports go from the communities to the health officers at the FLHFs who

pass these on to the LOCT. Copies of the reports are sent to the State Oncho Coordinator and

finally to the State Ministry of Health with copies to the DPHC and DPRS. The team saw reports

in all LGAs visited.

In Takai and Garum Mallam LGAs, the focal persons supervise only the FLHF staff but in

Danbatta LGA, the focal person often supervises the communities working with the FLHF staff.

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Though there is some degree of integrated supervision with other programs like malaria, polio,

scabies, guinea worm etc, no shared checklists are used.

As soon as problems are identified, they are handled by the LOCTs who go with FLHF staff to

communities to solve the problems. The problems are mainly refusals due to culture and

religion. Most often, problems are referred to District Heads who are very powerful in control of

community members. One of such District Heads is Dr. Alhaji Muktar Abanan, the Sarkin Bai

of Kano and District Head of Danbatta whom the team met and interacted with. The District

Heads are very knowledgeable about CDTI and the role of the communities. They participate

fully in HSAM and support the project materially. This explains why the quality of

implementation of CDTI below the State level remained high even during the first 4 years when

support from state Government was minimal.

There is no organized system for rewarding success at the LGA levels. However, the team

ways told that verbal commendations are usually given and in some cases T-shirts, food and

prayers are offered to deserving LOCT members and FLHF staff.

Mectizan Procurement and Distribution (3.6, Highly).

Sufficient quantities of mectizan are requested for and provided to LGAs. Mectizan supply is

timely with no shortages and wastages. Backup allocations are provided when necessary.

Mectizan consignments are collected and stored in central drug stores. The team saw, in most

LGAs, impressive stores with good power supply. The system of Mectizan procurement and

distribution is effective, uncomplicated and simple. The LGAs collect mectizan from the State

CDTI office utilizing transport /transport fares provided by the LGA Council. The drug is

controlled within the existing government drug procurement and distribution system.

Training and HSAM (3.1, Highly)

LOCTs train health facility staff and FLHF staff train CDDs. Training materials like tally sheets,

measuring sticks, posters etc were seen. Resource materials for training and IEC have been

translated into Hausa. Though Training is targeted, there is no integrated training at the

22

moment. HSAM activities are properly planned and executed. The LGAs have positively used

HSAM to solve problems of refusal. HSAM activities targeted at policy members have led to

prompt releases of funds for fuel, workshop attendance, Mectizan collection and others needs.

Financial (3.4, Highly)

CDTI activities are budgeted for adequately under PHC. Additionally, the Councils meet costs

of transport, feeding and accommodation of CDTI staff attending meetings and workshops. A

monthly allowance of N3, 000 is paid to each focal person (within salaries) for fueling and

motorcycle maintenance. Vouchers for the various payments were shown to the team. Details

of the funds budgeted/ spent on CDTI in the LGAs visited are shown below:

GARUM MALLAM

2000 - N96, 000

2001 - N96, 000

2002 - N96, 000

TOTAL N288, 000

TAKAI

2001 - N225, 000

2002 - N318, 000

2003 - N340, 000

TOTAL N983, 000

DANBATTA

2002 - N195, 000

2003 - N200, 000

TOTAL N395, 000

These exclude monthly allowances paid to focal persons in their salaries.

The LGA also spend some money monthly for drugs for the FLHFs. A fixed amount of N1

million is released each month for drugs and supplies for FLHF in Danbatta. Though these

drugs are not specifically for CDTI, the initiative is an indication that LGAs have the potential of

providing regular financial support for CDTI. Generally government at all levels made

disbursements of funds for CDTI activities. However, the team could not ascertain if the

disbursements were directly from the budgets. The Chairmen of LGAs visited by the team

corroborated these assurances earlier given the team by the Permanent Secretary and the

Hon. Commissioner for Health; those CDTI activities will be adequately funded whenever

APOC withdraws. The team noted that funds are allocated against specific activities/items and

23

approval for each item of expenditure is given. Though there is judicious management of funds,

monitoring budget line balances is not done specifically because CDTI is budgeted for within

PHC under activities budget lines. This is an advantage for CDTI because the project can

always draw from PHC budget as long as there is money in the budget line relevant to the

activities for which funding is required. This, incidentally, is the case in most LGAs where CDTI

is the most ‘active’ health project.

Transport and other Materials (3.7, Highly).

There are 18 functional motorcycles available for CDTI in all the LGAs implementing the

project. These motorcycles are also used for other health activities. In Danbatta, there is an NPI

Land cruiser (donated by UNICEF), which is used for CDTI and other health activities. Other

vehicles are available in the LGA vehicle pool, for CDTI activities. However, some of these may

not be functional in the next 5 – 10 years and therefore need to be adequately maintained

and/or replaced as the case may be. In Danbatta LGA, N20, 000 is released monthly for fueling

and maintenance of vehicles and in all LGAs N3, 000 is paid to focal persons for motorcycle

fueling and maintenance. Some LGAs are willing to buy new vehicles and provisions have been

made accordingly in their 2004 budgets.

Human Resources (3.8, Highly).

Staff members involved in CDTI activities possess adequate skills for the job and are satisfied

with their job. In each LGA there are 4 LOCTs and a focal person. The staff are stable

competent and committed to the project. The staff members are highly motivated with salaries,

wages and incentives paid to them regularly and as when due.

Coverage (4.0, Fully).

than 65% therapeutic coverage rates as follows: GARUM MALLAM 89% TAKAI 85.7% DANBATTA 75%

24

3. Findings at FLHF level

Planning (2.0 Moderately)

There are no written plans at this level. The officials operate using weekly timetables and meet

each day to discuss activities to be carried out. Staff members here are not empowered to

prepare comprehensive plans because FLHFs are extensions (outstations) of the LGAs. FLHFs

are not self-accounting and therefore make no plans and control no budget. They are however

very knowledge about CDTI activities and implement CDTI at this and timing for distribution.

Fig. 3 FLHF OVERALL SCORES

2

3.6 3.5

3.8 3.7

2.4 2.4

4 4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Planning Leadership Monitoring &

SDupervision

Mectizan Training &

HSAM

Financing Transport &

other

resources

Human

resources

Coverage

INDICATORS

SC

OR

ES

25

Leadership (3.6 Highly)

FLHF officials take full responsibility at this level. They are very knowledgeable about key CDTI

activities such as training CDD, HSAM, Monitoring and Supervision, Mectizan ordering and

distribution. Political heads are well informed about CDTI and participate in the programs.

Monitoring/Supervision (3.5 Highly)

Reports are transmitted through routine but effective government system. FLHF officials collect

reports from the CDDs and send them to focal persons in the LGAs. Treatment records for

2000, 2001 and 2002 were seen. Supervisory checklists were seen in only one of the FLHFS.

Problems (mainly refusals and adverse reactions) identified in the communities are referred to

FLHF staff by the CDDs. Officials at this level provide technical advice to the communities.

They initiate approaches for solving problems and inform LGA if problem persists. Reports of

supervisory visit and follow ups were seen in some of the FLHFs. Reward of success is not

formalized. However, food, items of clothing, and prayers are offered to officials of the FLHFs

by communities from time to time.

Mectizan® Procurement and Distribution (3.0 highly)

Mectizan is usually ordered in good time and distributed in an effective, uncomplicated, and

simple manner. There have been no major shortages and no wastages. Mectizan is stored in a

drug cupboard containing all drugs administered at this level and allocation from this level to the

communities is quickly done and inventory properly kept.

Training and HSAM (3.7 highly)

Communities select CDDs who are trained annually by FLHF staff. The trainings are conducted

in venues close to the communities. Content of training is based on current needs. Training

materials, such as, posters, measuring sticks, register, etc are available. CDDs are also often

trained and used as guides for other projects/programs e.g., NPI. HSAM is conducted at this

level with the assistance of community leaders who often participate actively in all CDTI

26

activities. This has had positive impact on coverage in spite of problem of refusals. The team

found the need for more training of CDDs on determination of quantity of Mectizan to be

ordered for each treatment round as well as on calculation of coverage.

Financial (2,4 Moderately)

FLHFs do not prepare and operate any budget and do not administer any funds. The LGA PHC

unit provides supplies needed for FLHF activities. In Dambatta, the LGA provides N1 Million for

drugs for all 30 FLHFs, which exist in the LGA. One of these FLHFs is a general hospital while

29 are health centers/posts (one in each of the 29 communities in the LGA). It is not clear why

cash is not provided to officials at this level but indications are that this is not the routine

practice. This is good for sustainability as it makes the communities take on more responsibility

for healthcare activities. The team noted that, in one instance, the FLHF was built and

maintained by the community, which also funds fueling, and maintenance of the motorcycle

used by the FLHF staff. Most communities give assorted incentives to staff of FLHF.

Transport and other Material Resources (2.4 moderately)

LGAs provide some bicycles and motorcycles for FLHFs. Some FLHF use personal bicycles

and motorcycles to move to villages for CDTI activities. Some communities assist FLHF in

bicycle and motorcycle maintenance and are willing to replace existing bicycles and also

provide HSAM materials for CDTI if need be. However, an official of one of the FLHFs

complained that he spends personal funds to maintain his bicycle. Though there is integrated

use of the bicycles and motorcycles, no logbooks are used.

Human Resources (4,0 Fully)

All the officials are skilled and knowledgeable about CDTI.

27

Coverage (4.0 Fully)

In 2003 almost 100% geographical coverage was achieved. About 10 communities are yet to

be covered and distribution is still going on. Geographical coverage was 100% in 2001 and

2002.

4. Findings at community level

Planning and Management (4.0)

CDTI activities are planned and managed efficiently by CDDs and community leaders.

Communities decide on method of distribution (house to house or central). CDDs choose their

distribution routes and, in conjunction with community members, the time most appropriate for

distribution. The CDDs update their registers during each distribution cycle.

Fig. 4 COMMUNITY LEVEL SCORES

4 4 4

3.5

4

3 3

4

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Planning Leadership Monitoring Mectizan HSAM Financing Human resources Coverage

INDICATORS

SC

OR

ES

28

Leadership and ownership (4.0)

Community leaders are responsible for arranging for announcing the arrival of Mectizan. The

CDDs are selected by community leaders and members, who also exert their authority in

changing any non performing CDD. Communities determine the time and method of

distribution. Treatment period is either morning or evening depending on community decision.

In most communities, it has been decided that married women should be treated in the evening

hours when their husbands are back from farm. Community members understand and

appreciate the benefits of Mectizan and enumerated several benefits of the drug to include

improved sight, generally health improvement and passage of worms. Generally, communities

now understand that Mectizan is not a contraceptive and are willing to continue to take

Mectizan for as long as necessary.

Monitoring (4.0)

CDDs send their report to FLHF on time for collation and transmission to the LGA. CDDs are

not provided with funds for transportation because the health facilities are close to the

communities.

Mectizan® Procurement and Distribution (3.5)

Mectizan is collected by CDDs from FLHF staff. In most instances, two or more visits are made

by CDDs to collect drug. This is because of population dynamics; it is often difficult to

accurately determine quantity of tablets required. In most cases, quantity of Mectizan required

is based on previous years allocation/use. In two communities visited, community members

expressed desire to have more drugs as there have been shortages recorded during

distribution. These two communities are among those listed for mop-up distribution, which is

scheduled to take place before the end of the year. CDDs, and at times community leaders,

collect Mectizan from the nearest health Facility. There is no need for transport fare to be

provided for CDDs because the communities are close to the health facilities.

29

Training and HSAM (4.0)

Community members and CDDs take on the responsibility of community mobilization and

information dissemination. They encourage compliance by tracking down absentees and

convincing those who initially refuse to take the drug to comply. Community leaders take the

lead in taking the drug to encourage others.

Financing (3.0)

Communities in many instances do not have a central process of providing incentive to CDDs.

Food items, soup ingredients, and prayers are offered. Individuals at times provide token gifts in

either cash or kind to CDDs. In this part of Nigeria, provision of monetary incentives for

community service is not commonly practiced. CDDs are content and willing to continue their

job.

Human Resources (3.0)

The ratio, CDD: population is about 1:500. Though this is not the recommended ideal ratio,

communities feel they do not need more CDDs since they live in clusters and CDDs do not

have to travel long distances between households. However, in spite of this explanation, the

team felt that, communities should be encouraged to increase the number of CDDs.

CDDs are knowledgeable and skilled and have repeatedly been trained on various aspects of

the programme. Community leaders have plan to replace CDDs if need be. The CDDs enjoy

CDTI activities and are willing to continue on the job. They see their participation in the

programme as their contribution to the development of their communities. Only a few CDDs

have dropped out.

Coverage (4.0)

All the households have been treated. All communities visited had therapeutic coverage rate ranging from 72% to 95%. All the communities had not less than 65% therapeutic coverage,

30

E. OVERALL SUSTAINABILITY GRADING OF KANO STATE CDTI PROJECT.

With respect to the seven aspects of sustainability, efficiency, effectives, simplicity, attitude of

staff, community ownership are found to be very much helping sustainability, while resources

(particularly financial and integration are moderating helping sustainability)

• Integration

Integration of CDTI into PHC is just moderate at all levels.

• Resources (Human, financial and material)

Government financial contribution was poor during the first 4 years of CDTI implementation in

the state. There are evidences of guaranteed government support to CDTI at all levels following

the advent of a new political dispensation in the state.

• Efficiency

There is high level efficiency exhibited by the managers of CDTI activities at all levels.

• Simplicity

The procedures adopted for achieving the objectives of DTI are simple and uncomplicated.

• Attitude of Staff

The staff members are all very skilled, dedicated and willing to continue with the CDTI project at

all levels.

• Community Ownership

CDTI in Kano is fully owned by the community with community leaders participating actively in

all CDTI activities. As a result problems in CDTI related to religion and culture are easily solved.

• Effectiveness

Coverage rates (geographical and therapeutic) have been excellent as a result of effective

procedures adopted in distribution, supervision and management of resources.

Aspect Judgment: to what extent is this aspect helping or blocking sustainability in this

project?

Integration Moderately helping

Resources Moderately helping (financial)

Efficiency Very much helping

Simplicity Excellently helping

Attitude of staff Excellently helping

31

Community ownership

Excellently helping

Effectiveness Excellently helping

There are no significant problems with any of the critical elements of sustainability.

Money: Is there sufficient money available to undertake strictly necessary tasks, which have been carefully thought through and planned? (Absolute minimum residual activities). YES

Transport: Has provision been made for the replacement and repair of vehicles? Is there a reasonable assurance that vehicles will continue to be available for minimum essential activities? (Note that ‘vehicle’ does not necessarily imply ‘4x4’ or even ‘car’). YES

Supervision: Has provision been made for continued targeted supportive supervision? (The project will not be sustained without it). YES

Mectizan supply: Is the supply system dependable? (The bottom line is that enough drugs must arrive in villages at the time selected by the villagers). YES

Political commitment: Effectively demonstrated by awareness of the CDTI process among policy makers (resulting in tangible support); and a sense of community ownership of the programme. YES

Grouping the indicators under this categories, activities, resources, and results, the project

has achieved good results. Average scores (all levels) are 3.5 for activities, 3.3 for resources

and 4 for results.

Ranking of the levels in terms of performance of indicators is Community (3.7), LGA (3.6),

State (3.4), and FLHF 3.3). This indication that the strength of CDTI in this state is at the

community level, is good for sustainability of the project.

32

TABLE 3 Scoring under categories of indicators

Category Indicators Scores

State LGA FLHF Community

Activities and processes

which support CDTI

Average overall score for

category at all level is

(3.5)

Planning 3 3.4 2 4

Leadership X 4 3.6 4

Supervision & Monitoring 3.2 3.1 3.5 4

Mectizan supply 3.5 3.6 3.8 3.5

Training & HSAM 3.4 3.1 3.7 4

Integration 3.1 X X X

Resources provided

Average overall score for

category at all level is (3.3)

Funding 3.1 3.4 2.4 3

Transport & Other resources 3.6 3.7 2.4 X

Human Resources 3.9 3.8 4 3

Results achieved

Average overall score for

category at all level is

(4)

Coverage

4 4 4 4

Average score

3.5

3.4 3.6 3.3 3.7

33

G. RECOMMENDATIONS

1. State Level Recommendations

Indicator Recommendation Priority Rating

Who to take action Deadline for action

1 Planning Post Apoc Plan should be completed

High SOCT, MOH policy makers, CBM, NOCP (Zonal)

March 2004

2 Monitoring and Supervision

Complete common checklist for supervision

High SOCT, MOH policy makers, CBM, NOCP (Zone)

April 2004

3 Mectizan supply

Maintain efficient mectizan requisition, distribution and inventory

High SOCT, CBM NOCP (Zone)

Always

4 Training and HSAM

Retraining of LOCTs on calculation coverage.

High SOCT February 2004

5 Integration Begin to integrate content of training to cover CDTI and other PHC programmes

Medium SOCT, DPHC&DC, Managers of PHC programs/projects

August 2004

6 Funding Specify budget lines for CDTI within PHC budget

High MOH officials, DPHC&DC, DB &P and SOCT

March 2004

7 Other resources

Purchase 2 new vehicles for CDTI

Use Logbook and maintenance book for vehicles.

Medium MOH policy makers Jan 2005

8 Hurman resources

Do not transfer SOCT members frequently

High MOH policy makers Always

9 Coverage Maintain 100% geographical coverage and Above 65% therapeutic coverage

High SOCT, CBM, NOCP (Zonal)

Always

34

2. LGA Level Recommendation

S/no Indicator Recommendation Priority Rating

Who to take action

Deadline for Action

1. Planning Undertake integrated training of staff on planning

High LOCT, HOD, focal person

March 2004

2. Leadership Maintain the impressive leadership status of the programmed.

High LOCT, HOD and other programmes

Always

3. Monitoring and Supervision

Put in place effective integrated monitoring and supervision.

High LOCT Always

4. Mectizan procurement and Distribution

Maintain good Mectizan requisition practice and collection.

High HOD, LOCT Always

5. Training and HSAM

Commence integrated training

Medium HOD, LOCT and all staff of LGA Health staff.

August 2004

6. Financial Ensure CDTI has its own budget line within the overall PHC budget.

High LGA Chairman, HOD, Treasurer LGA, LOCT

March 2004

7. Transport Sustain maintenance of existing motorcycles

High HOD, LGA Chairman, Treasurer, LOCT

Always

8. Coverage Retrain LOCT and CDDs on calculation of coverage

High HOD, LOCT March 2004

9. Human resources Sustain prompt payment of salaries and wages.

High LGA Chairman HOD

Always

35

3. FLHF Level Recommendations

S/No Indicator Recommendation Priority Rating

Who to take action

Deadline for action

1 Planning Produce a written plan containing CTI activities.

High FLHF staff LGA/ LOCT

March 2004

2 Leadership Intensify HSAM targeting politicians on the need for own CDT.

High FLHF staff CDD LGA/ LOCT

March 2004

3 Monitoring and Supervision

Produce adequate quantity of Checklists.

Prepare formal process for rewarding success.

High LGA/LOCT HOD FLHF

March 2004

4 Mectizan Train FLHF staff on calculation of tablets of Mectizan required.

High LGA/ LOCT March 2004

5 Training & HSAM

Integrate CDTI training with training in other health programs.

Medium FLHF staff LGA/ LOCT

August 2004

6 Financial Release adequate funds for CDTI activities.

High LGA Council, Always

7 Transport and other resources

Sustain provision of funds for motorcycle maintenance and fuelling.

Replace unserviceable motorcycles.

High Chairmen/ Caretaker LGA HOD health

Always

December 2004

8 Human resources

Provide incentives for FLHF staff.

Sustain regular payment of salaries.

High LGA Council HOD health

Always

9 Coverage Maintain good coverage

Retrain CDDs on calculation of coverage.

High FLHF/ LOCT HOD health

Always

February 2004

36

4. Community Level

S/n Indicator Recommendation Priority Rating

Who to take action

Deadline for action

1. Planning Discuss and prepare plan to sustain CDTI post APOC

High Community leaders, community members, LOCT members and FLHF staff

Always

2. Leadership ownership &

Maintain good leadership High SOCTs, LOCTs Always

3. Monitoring Commence Community Self monitoring.

High LOCTs, FLHFs March 2004

4. Mectizan Train FLHF staff and CDDs on determination of required Mectizan tablets.

High SOCTs, LOCTs, FLHFs, CDDs

March, 2004

5. HSAM Intensify HSAM to community leaders and members.

Medium FLHFs April 2004

6. Financial Sustain provision of non monetary incentives to CDDs.

Medium SOCTs, LOCTs, FLHFs

Always 2004

6. Human resources

Improve on CDD/ community population ratio.

High SOCTs, LOCTs, FLHFs

March 2004

7. Coverage Retrain CDDs on coverage calculation.

High SOCTs, LOCTs, FLHFs

March 2004

37

H. THE WAY FORWARDAs way forward the team recommends that the following priority actions be taken.

Conclude -work on the post Apoc sustainability plans for all levels.

Sensitise all stakeholders at state, LGA, and community levels on the need for increased

and continued support of the project.

Ensure that CDTI continues to be budgeted for within PHC, VBDU, and Donor Projects

budgets.

Facilitate integration through joint trainings, monitoring and supervision.

Retrain members of LOCTs, staff of FLHFs and CDDs on calculation of coverage and

determination of required tablets.

Improve on CDD/ community population ratio.

Sustain- the present impressive leadership, good Mectizan

requisition/collection/distribution, and good maintenance culture.

I. APPENDICES

Appendix I. Time table for the evaluation of sustainability of Kano CDTI Project EVALUATION OF KANO STATE CDTI PROJECT

PROVISIONAL TIME TABLE

DATE TIME ALL MEMBERS Monday 8

th Dec. 03 Arrival of External and internal evaluators to Kano

city the Kano state capital. Tuesday 9

th Dec. 03 8.00-10am Orientation of members on the instrument and

review of the provisional timetable. 10.00-4.00pm Meeting with the state Onchocerciasis control team

members (SOCT)/finalization of the workshop timetable.

4.00-5.00pm Evaluators review strategies for the evaluation in preparation for the assignment.

Wednesday 10th Dec. 03 8.30-9.30am Courtesy call on the Ministry of Health Official

9.30am-5pm Data collection at the MOH project HQ conduct interview for the CBM project administrators & project accountant.

Wednesday 10th Dec. 03

Thursday 11th Dec. 03

Friday 12th Dec. 03

Saturday 13th Dec. 03

Visits to LGAs, FLHFs and communities

38

Appendix II. Agenda – LGA level “feedback”/planning meeting

EVALUATION OF KANO LGAs CDTI PROJECT DECEMBER 9-22, 2003. FEEDBACK/PLANNING MEETING FOR LGAs.

SCHOOL OF HEALTH TECHNOLOGY, KANO CITY KANO

FIRST BATCH DECEMBER 15 AND 16,2003 SECOND BATCH DECEMBER 17 AND 18,2003

PROVISIONAL AGENDA

Day one

S/No Activity Time Resource person Facilitator

1. Registration/Administration matters 08:30-10:00hrs SOCT 2. Introductions 10:00-10:30hrs All 3. Welcome Address and update on Kano CDTI

project. 10:30-11:00hrs State Coordinator

4. Objective of sustainability evaluation. 11:00-11:30hrs Braide Coffee Break 11:30-12:00hrs

5. Evaluation methodology 12:00-12:30hrs Braide 7. Presentations of main findings

State level LGA level FLHF level Community level

General Discussions

12:30-13:30hrs Otu and Mas Onwuliri Saka Orogwu

8. Lunch break 13:30-14:30hrs 9. SWOT analysis…...LGA level 14:30-15:30hrs Ogoshi/SOCT10. Guidelines for preparation sustainability plan 15:30-16:00hrs Pearce/Mas 11. Coffee break 16:00-16:15hrs

Work in LGA groups on sustainability plans 16:45-18:00hrs LGA groups and SOCT

DAY 2

S/No Activity Time Facilitator

1. Work in LGA groups on sustainability plans 08:30-11:00hrs LGA groups and SOCT

2. Coffee Break 11:00-11:15hrs

3 Work in LGA groups on sustainability plans 11:15-13:30hrs LGA groups and SOCT

4. Lunch 13:30-14:30hrs 5. Presentation of LGA plans 14:30-16:30hrs H.O.Ds. Health 6. General discussions on “way forward” 16:30-17:00hrs All 7. Administrative matters and Closing 17:00-18:30hrs SOCT

Recorders for days one and two ……….2 SOCT members to be appointed by State Coordinator. Each LGA should submit an endorsed plan (and diskette) by Friday December 20.

39

Appendix III. Agenda – LGA level “feedback”/planning meeting…Kano CDTI Project

EVALUATION OF KANO STATE CDTI PROJECT DECEMBER 9- 22, 2003

FEEDBACK/PLANNING MEETING FOR STATE LEVEL SCHOOL OF HEALTH TECHNOLOGY, KANO CITY KANO

DECEMBER 19, 2003

TENTATIVE AGENDA

S/No Activity Time Facilitator

1. Registration/Administration matters 08:00-8.300hrs SOCT members Introduction 10:00-10:15hrs All

2. Welcome address and update on Kano CDTI project

10:15-10:30hrs State Coordinator

4. Objective of sustainability evaluation 10:30-10:45hrs Braide Coffee Break 10:45-11:00hrs

6. Evaluation methodology 11.00-11:30hrs Braide7. Presentations of main findings

State level LGA level FLHF level Community level

11:30-12:30hrs Otu and Mas Onwuliri Saka Orogwu

8. SWOT analysis…State level 12:30-13:30hrs Ogoshi 9. Lunch Break 13:00-14:00hrs 10. Work on sustainability plan 14:00 -16:30hrs SOCT ,Government officials

and partners Tea Break 16:30-16:45hrs

15. Presentation of plan 16:45-17:15hrs State Coordinator16. General discussions on “way forward” 17.15-17.45hrs All 17. Administrative matters and Closing 17.45-18.00hrs SOCT members

40

Appendix IV. List of persons met/ interviewed

NAMES DESIGNATION LOCATIONDr. Sanda Muhammad Hon. Comm. For Heath Kano City Engr. Abdulahi Idris Permanent Secretary Kano City Alh. Ubale Rano Director Planning Kano City Dr. D. Muhammad Director PHC and DC Kano CityMr. Tukur Makama Getso State Oncho Coordinator Kano city Hojarami Lawan SOCT supervising Gwaozo,

Kabo, Rogo and Karaye. Kano City

Binta A. Sarki SOCT supervising Gaya, Sumaila, Ajinji and Takai

Kano City

Shehu Umar SOCT supervising Kura, Kuru, Madobi and Garum Mallam.

Kano City

Danladi Tanko SOCT supervising Dawakin Tofa, Makodi and Danbatta

Kano City

Yusuf Haruna SOCT supervising Doguwa, Bebeji and Tudun wada

Kano City

Sabiu Hamisu Focal person Garum Malam head quarters Sabiu Musa LOCT Garum Malam head quarters Jafaru I. Chiromawa LOCT Garum Malam head quarters Ja’afaru Y. Madaki LOCT Garum Malam head quarters Haruna Abdulkadir NPI manager Garum Malam head quarters Idris Ahmad G/Malam LOCT Garum Malam head quarters Ahmad Muhammad Panda D.P.M Garum Malam head quarters Isyaku Umar Jobawa Vice Chairman Garum Malam head quarters Adamu Mohd. Sha Yadakwari H/F Garum Malam head quarters Muhammad Daniya Ibrahim V. Head Yadakwari Garum Malam head quarters Wakili Tambai W/ head Dakasoyi Garum Malam head quarters Mohammad Sani Yadakwari Garum Malam head quarters Haladu Musa W/ head Damaji Garum Malam head quarters Mohammad Tasiu Ibrahim W/ head Mudawa Garum Malam head quarters Usaini Alasan Yadakwari Garum Malam head quarters Daiyabu Munkaila Mudawa Garum Malam head quarters Hudu Danladi Dakasoye Garum Malam head quarters Sammauna Usman Dakasoye Garum Malam head quarters Dantala Nayaya Dakasoye Garum Malam head quarters Farouk Garba Village head Fita village, Takai LGA Shehu Muhammad Suleman CDD Fita village Ya’u Wanzan Community member Fita village Haruna Sabo Community member Fita village Musa Bako Community member Fita village Lurwan Rabiu Community member Fita village Muhd. Abbani Takai Chairman Takai LGA, head quarters Muhd. B. Kachako Councilor medical Takai LGA, head quarters Alhaji Baba Kanu Community Dev. Takai LGA, head quarters Yakubu Nadu Sarki APHCC H/ Edu. Takai LGA, head quarters Abdulrazak I. Usman Focal person Takai LGA, head quarters Iliyasu Ahmed Village head (Jigawa &

Tarandai) Takai LGA, head quarters

Sule Abba Ward head Jigawa & Taranda Takai LGA, head quarters Dauda Alhassan CDD (Taranda Comm. Takai LGA, head quarters

41

Usaini Adamu Ward Head “ Takai LGA, head quarters Usman Mohammad Mai unguwa Jigawa Takai LGA, head quarters Usaini Mohammad Bello Falali ward head Takai LGA, head quarters Abdullahi Ismaila CDD Falali Comm. Falali village Sani Ahmed CDD Falali Falali village Ahmed Isa CDD Falali Falali village Adamu Sale Health/F Dispen. Falali village Isa Ismaila Falali Falali village Amadu Mohammed Falali Falali village Yusuf Musa Falali Falali village Shehu A. Ibrahim Falali Falali village Dan’Azumi Garba Falali Falali village Umaru Mohammed Falali Falali village Adamu Umaru CDD falali Falali village Basiru Ali CDD Unguwar Bai village, Danbatta LGA Adamu Umaru Comm. Member Unguwar Bai village Bashari Lawan Comm. Member Unguwar Bai village Magaji Ibrahim Comm. Member Unguwar Bai village Dahiru Haruna Comm. Member Unguwar Bai village Idi Amadu Comm. Member Unguwar Bai village Ya’u Idris Comm. Member Unguwar Bai village Inusa Garba Comm. Member Unguwar Bai village Dalladi Amadu Comm. Member Unguwar Bai village Lawan Inusa Comm. Member Unguwar Bai village Wada Musa Comm. Member Unguwar Bai village Haladu Mohammad Mai Unguwa Dukawa ciki gari, Danbatta LGA Usman Mohammad Member Dukawa ciki gari village Yusif Musa CDD Dukawa ciki gari village Umar Isah Community member Dukawa ciki gari village Yusif Ladan Community member Dukawa ciki gari village Yusif Abubakar Community member Dukawa ciki gari village Shu’aibu Garba T.V. operator Dukawa ciki gari village Ibrahim Mohd. Community member Dukawa ciki gari village M. Yahaya Isyaku Community member Dukawa ciki gari village Jibrin Musa Community member Dukawa ciki gari village Salihu Yusif Community member Dukawa ciki gari village Nura Ibrahim CDD Dukawa ciki gari village Daha Isyaku Community member Dukawa ciki gari village Abubakar Yusif Community member Dukawa ciki gari village Abdulazizu Safiyanu Community member Dukawa ciki gari village Gambo Safiyanu Community member Dukawa ciki gari village Mohd. Musa Community member Dukawa ciki gari village Mohd. Yusif Community member Dukawa ciki gari village Mohd. Isah Community member Dukawa ciki gari village Tijjani Ibrahim Community member Dukawa ciki gari village Basiru S. Arewa Community member Dukawa ciki gari village Lawan Umar Community member Dukawa ciki gari village Abdullahi Umar Community member Dukawa ciki gari village Sani Ibrahim Community member Dukawa ciki gari village M. Ya’u Ibrahim Community member Dukawa ciki gari village Abdullahi Ibrahim Community member Dukawa ciki gari village Mohammad Sale Community member Dukawa ciki gari village Abubakar Ado Community member Dukawa ciki gari village Sabi’u Isyaku Community member Dukawa ciki gari village Bahari Isah Community member Dukawa ciki gari village Alasan Yaro Student Mudawa village, G/Malam LGA

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Dan larai Malam Pharm. Tech. Mudawa village Dan’asabe Amadu Pharm. Tech. Mudawa village Hamisu Sanda Student Mudawa village Isyaku Abdu Student Mudawa village Ibrahim Sani Community member Mudawa village Hassan Saidu Community member Mudawa village A. Abdu Mudawa Community member Mudawa village Sule Direba Community member Mudawa village Mamuda A. Adamu Community member Mudawa village Shehu Umar Community member Mudawa village A. Suraja Muhammadu Community member Takuya village Dambatta LGA Shu’aibu Garba Focal person Takuya village Abdullahi Mohd. Community member Takuya village Jibrin Mohd. Community member Takuya village Hamza Mohd Community member Takuya village Isah Amadu Community member Takuya village Ya’u Mohd Community member Takuya village Ayuba Amadu Community member Takuya village Bala A. Garba CDD Takuya village Usaini Ibrahim Community member Takuya village Abba Labaran Community member Takuya villageIbrahim Mohd. Community member Takuya village Hambali Garba Community member Takuya village Adamu Hassan Community member Takuya village Dauda Musas Community member Takuya village Haruna Abdu Community member Takuya village Aminu Mohd. PHC Coordinator Kura LGA head quarters Shu’aibu Garba Focal person Kura LGA head quarters A. Lawan Garba Councilor Kura LGA head quarters Mohammad Yusuf Treasurer Kura LGA head quarters Yawale Ahmed Supervisor Kura LGA head quarters Alh. Inusa Mohd. Community member Ruwantsa village, Danbatta LGA Ali Usman Community member Ruwantsa village Biniya Yakubu Community member Ruwantsa village Abdulsalam Isyaku Community member Ruwantsa village Muktari Ibrahim Community member Ruwantsa village Auwalu Mohd. Community member Ruwantsa village Umar Yunusa Community member Ruwantsa village Sani Mohd. Community member Ruwantsa village Isah Sani Community member Ruwantsa village Sallau M. Ya’u Community member Ruwantsa village Nasiru Waziri Community member Ruwantsa village Ya’u Sani Community member Ruwantsa village Amadu Abdullahi Community member Ruwantsa village Kabiru Magaji Community member Ruwantsa village Abdullah Mohd. Community member Ruwantsa village Aminu Usman Community member Ruwantsa village Abdulrahim Shu’aibu Community member Ruwantsa village Sa’adu Garba Community member Ruwantsa village Maharazu Mohd. Community member Ruwantsa village Babangida Magaji Ward head Ruwantsa village Haruna Mohd. Community member Ruwantsa village Shu’aibu Magaji Community member Ruwantsa village Abbas Magaji Community member Ruwantsa village Gambo S/Fawa Community member Ruwantsa village Auwalu Garba Community member Ruwantsa village

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Barau Mohd. Community member Ruwantsa village Mohd Umar Community member Ruwantsa village Hamza Abdullahi Community member Ruwantsa village Manzo Hadi Community member Ruwantsa village Yusif Magaji Community member Ruwantsa village

V. Participants at planning meeting

Day one

S/N Name Designation Address1. Makama Wada PHC T/Wada 2. Dalha Baba Doka Focal Person Mokoda 3. Bilya K. Sule Focal Person Dawakin Tofa 4. Muhd. Bashir T/Wada5. Murtala A. Ajingi Treasurer T/Wada6. Ahmed A. Rufai PHCC Takai 7. Sani Nasiru Focal Person T/Wada8. Saidu Mu’azu Focal Person Ajingi 9. Hajara A. Lawan SOCT VBDC 10. Binta Abdu Sarki SOCT VBDC 11. Abdulrazak I. Usman Focal Person Takai 12. Shehu Umar SOCT VBDC 13. Danladi Tanko SOCT VBDC 17. Hassan Adam School Health Dawakin Tofa 18. Adama Shehu DPHCC Dawakin Tofa 19. Sabiu Hamisu Focal person Garun Malam 20. Alh. Mohd. Garba PHCC Makoda 21. Yusuf Haruna SOCT VBDC 22. Uwani Bala umar PHCC Madobi 23. Abdullahi Sha’aibu Medical T/Wada 24. Muhammadu Hamza PHCC Garun Malam 25. Chris Ogoshi Coordinator CBM 26. Tukur Makama Getso Kano Coordinator MOH 27. Yahya A. Danbala Treasurer Makoda 28. A. Abdu Abdullahi C/ Health Makoda 29. Lawan Yahaya Focal person Gwarzo 30. Isah Yusuf Focal person Madobi 31. Haladu Omar Doguwa PHCC Bebeji 32. Ya’u Uba Councillor Bebeji 33. Adu Musa Yako PHCC Gwarzo 34. Suleman Adamu Focal person Bebeji 35. Alh. Bala Yabuku Councillor Gwarzo 36. Ibrahim Jibril Comm. Member Takai 37. Jamilu Garba D/Iya Data Analysts MOH 38. Usman Tijjani VBDC 39. Salisu Inuwa VBDC

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Day two

S/N Name Designation Address1. Makama Wada PHC T/Wada 2. Dalha Baba Doka Focal Person Mokoda 3. Bilya K. Sule Focal Person Dawakin Tofa 4. Muhd. Bashir T/Wada5. Ahmed A. Rufai PHCC Takai 6. Sani Nasiru Focal Person T/Wada7. Saidu Mu’azu Focal Person Ajingi 8. Hajara A. Lawan SOCT VBDC 9. Binta Abdu Sarki SOCT VBDC 10. Abdulrazak I. Usman Focal Person Takai 11. Shehu Umar SOCT VBDC 12. Danladi Tanko SOCT VBDC 16. Hassan Adam School Health Dawakin Tofa 17. Adama Shehu DPHCC Dawakin Tofa 18. Sabiu Hamisu Kura Focal person Garun Malam 19. Alh. Mohd. Garba PHCC Makoda 20. Yusuf Haruna SOCT VBDC 21. Uwani Bala umar PHCC Madobi 22. Abdullahi Sha’aibu Medical T/Wada 23. Muhammadu Hamza PHCC Garun Malam 24. Chris Ogoshi Coordinator CBM 25. Tukur Makama Getso Kano Coordinator MOH 27. Yahya A. Danbala Treasurer Makoda 28. A. Abdu Abdullahi C/ Health Makoda 29. Lawan Yahaya Focal person Gwarzo 30. Isah Yusuf Focal person Madobi 31. Haladu Omar Dogua PHCC Bebeji 32. Ya’u Uba Councillor Bebeji 33. Ado Musa Yako PHCC Gwarzo 34. Alh. Bala Yabuku Councillor Gwarzo 35. Ibrahim Jibril Comm. Member Takai 36. Sirajo Usman PHC Madobi 37. Dahiru Mustapha PHCC Ajingi 38. Ya ‘afar Y. Madaki SCH Garun Malam 39. Ibrahim Tijjani Dawaki Treasurer Bedeji 40. Abdu Yusuf 41. Fatihu Mohd. 42. Sani Ali 43. Nura Uba 44. Ammani Ibrahim 45. Jamilu Garba D/Iya Data Analysts MOH 46 Usman Tijjani VBDC 47. Salisu Inuwa VBDC

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Day three

S/N Name Designation Address1. Usaini Hamza S/ Councillor Rogo 2. Suleiman Dahiru PHCC Rogo 3. Abubakar Shehu Focal person Rogo 4. Ibrahim Suleman PHCC Kabo 5. Haruna Mohd. Usman Focal person Kabo 6. Abdu Tsoho Focal person Doguwa 7. Nasiru Ibrahim Focal person Gaya 8. Umaru Garba Councillor Danbatta 9. Aminu Garba PHCC Danbatta 10. Sha’aibu Garba Focal person Danbatta 11. Maitama Y. Nadabo Councillor Karaye 12. Jubril M. Usman Councillor Kura 13. Idris S. Usman Focal person Kiru 14. Usaini K. Mohd. Oncho. Coordinator Kura 15. Haruna A. Mustapha PHCC Karaye 16. Rabiu Mamuda Focal person Karaye 17. Sagir Mohd. Sharif C/Health Kado 18. Ibrahim Garba C/Health Doguwa 19. Sadiya Mohd. Sharif C/Health Kiru 20. Abubakar S. Abubakar Focal person Rogo 21. Mansur Abdulkadir Oncho Coordinator Sumaila 22. Jamilu Ibrahim Focal person Sumaila 23. Falalu Sani Councillor Sumaila 24. Shehu Umar Councillor Kabo 25. Shazali Uba Focal person 26. Binta Jubril PHCC Kura 27. Manya Yahaya PHCC Sumaila 28. Bashir Bala PHCC Kiru 29. Zakari Ahmed Focal person Kura 30. Umaru Iliyasu Coordinator Karaye 31. Haruna Sani Coordinator Rogo 32. Ladan Mohd. C/ Health Rogo 33. Isa Yahaya Treasurer Kabo 34. Chris Ogoshi Coordinator CBM 35. Tukur Makama Getso Kano Coordinator MOH 37. Shehu Umar SOCT VBDC 38. Danladi Tanko SOCT VBDC 40. Binta Abdu Sarki SOCT VBDC 41. Hajara A. Lawan 44. Yusuf Haruna SOCT VBDC 45. Jamilu Garba D/Iya Data Analysts MOH 46. Usman Tijjani VBDC 47. Salisu Inuwa VBDC

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Day four

S/N Name Designation Address1. Haruna A. Mustapha PHCC Karaye 2. Abdu Tsoho Focal person Doguwa 3. Abubakar S. Abubakar Focal person Rogo 4. Usaini Hamza S/ Councillor Rogo 5. Jubril M. Usman Councillor Kura 6. H. Binta Jubril PHCC Kura 7. Suleiman Dahiru PHCC Rogo 8. Haruna Mohd. Usman Focal person Kabo 9. Idris S. Usman Focal person Kiru 10. Ibrahim Suleman PHCC Kabo 11. Aminu Mohd. PHCC Danbatta 12. Umaru Garba Councillor Danbatta 13. Sha’aibu Garba Focal person Danbatta 14. Nasiru Ibrahim Focal person Gaya 15. Maitama Y. Nadabo Councillor Karaye 16. Rabiu Mamuda Focal person Karaye 17. Usaini K. Mohd. Oncho. Coordinator Kura 18. Sagir Mohd. Sharif C/Health Kado 19. Ibrahim Garba C/Health Doguwa 20. Sadiya Mohd. Sharif C/Health Kiru 21. Mansur Abdulkadir Oncho Coordinator Sumaila 22. Binta Jubril PHCC Kura 23. Mariya Yahaya PHCC Sumaila 24. Shehu Umar Councillor Kabo 25. Jamilu Ibrahim Focal person Sumaila 26. Falalu Sani Councillor Sumaila 27. Shazali Uba Focal person 28. Umaru Iliyasu Coordinator Karaye 29. Bashir Bala PHCC Kiru 30. Zakari Ahmed Focal person Kura 31. Sabiu Musa Councillor Bebeji 32. Haruna Sani Coordinator Rogo 33. Ladan Mohd. C/ Health Rogo 34. Isa Yahaya Treasurer Kado 35. Abdu Ibrahim Treasurer Sumaila 36. Habib Tijjani Treasurer Danbatta 37. Mohammed Sani Coordinator Doguwa 38. Chris Ogoshi Coordinator CBM 39. Tukur Makama Getso Kano Coordinator MOH 41. Shehu Umar SOCT VBDC 42. Danladi Tanko SOCT VBDC 44. Binta Abdu Sarki SOCT VBDC 45. Hajara A. Lawan SOCT VBDC 48. Yusuf Haruna SOCT VBDC 49. Jamilu Garba D/Iya Data Analysts MOH 50. Usman Tijjani VBDC 51. Salisu Inuwa VBDC

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Day 5

Engr. Abdulahi Idris Permanent Secretary MOH Kano City Alh. Ubale Rano Director Planning MOH Kano City Dr. D. Muhammad Director PHC and DC MOH Kano CityMr. Makama Getso State Oncho Coordinator Kano city Hojarami Lawan SOCT supervising Gwaozo,

Kabo, Rogo and Karaye. Kano City

Binta A. Sarki SOCT supervising Gaya, Sumaila, Ajinji and Takai

Kano City

Shehu Umar SOCT supervising Kura, Kuru, Madobi and Garum Mallam.

Kano City

Danladi Tanko SOCT supervising Dawakin Tofa, Makodi and Danbatta

Kano City

Yusuf Haruna SOCT supervising Doguwa, Bebeji and Tudun wada

Kano City

VI. SWOT ANALYSIS FOR EVALUATION OF SUSTAINABILITY OF CDTI PROJECT IN KANO

SWOT ANALYSIS…………STATE LEVEL Indicators Strength Weakness Opportunities Threats

1 Planning Plan exists

Integrated

Management accepts ownership

No specific budget for CDTI project

Partners met

Plan exist for 2004

Should not include APOC budget

2 MonitoringAnd Supervision

MOH participates in all activities Support activities integrated

SOCTs routinely supervise assigned LGAs

System in place to solve problems

Not fully integrated with other health programmes

Common checklist proposed for better integration

none

3 Mectizan Procurement & Distribution

Drug system within the normal government procedure

None Enhancement of integration

None

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Timely and regular delivery

Stored in VBDCU

Order and control documentation

4 Training and HSAM

Integrated training policy

Oncho staff academically and professionally competent

HSAM carried out at all levels

Integrated training yet to be fully implemented

Media used to promote CDTI

None

5 Integration of Support Services

VBDCU integrates CDTI

None Integration provides practical integration of CDTI with other health programmes

None

6 Financial Funding provided for activities within PHC System

Specific budget for CDTI not spelt out

Policy makers made provision in 2004 budget for CDTI sustainability

NGDO participation

Level of support may change when present regime leaves

7 Transport & other Material Resources

Transport appropriately managed and used

Routine maintenance provided by MOH and NGDO

Funds available for vehicle maintenance

Computer will need replacement

No maintenance book

State Government is purchasing 1-2 vehicles for Oncho Programme

NGDO provides vehicle when needed

More vehicles will be needed

8 Human Resources

Skilled, dedicated and stable staff

None Staff have a potential of passing their

None

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skills if they move away

9 Coverage 100% geographical coverage achieved

Therapeutic coverage above 65%

Coverage calculated using eligible population in some communities

The need to retrain all implementers on calculation of coverage is an opportunity to review other aspects of CDTI

None

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SWOT ANALYSIS - LGA LEVEL

Indicators Strength Weakness Opportunities Threats

1 Planning Plans exists

Plans done in a participatory manner

Plan for 3 years exists

Plans were not integrated.

Plans are not based on schedules.

Plans do not tally with distribution time.

Political commitment.

Enlightened communities.

Integrated roles of PHC workers.

Availability of materials

Political differences.

Poor attitude to work.

2 Leadership PHC coordinator takes full responsibility of CDTI.

Focal person for each LGA. LOCT initiate activities

None Support of communities and staff.

Regime of rewards.

Frequent change of regime/ transfer.

Political antagonism.

3 Mectizan Procurement & Distribution

Reports available in all LGAs.

Monitoring & supervision in cascading pattern.

Integrated monitoring & supervision.

Shared checklist not used.

No written reports in some LGAs.

No follow ups in some LGAs.

Availability of needed materials.

Integrated use of resources (HFM)

Bad roads.

Frequent breakdown of vehicles.

Lack of incentives in some LGAs

4 Training and HSAM

HSAM is properly planned and executed.

LGA use HSAM to solve refusal problems.

Funds and incentives released as a result of HSAM in decision making

Training has not been integrated.

Poor attendance to organized trainings.

Integrate with training of other health programs

None

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5 Financial Sufficient quantity of Mectizan supplied.

Back up provided when need arises.

Drugs collected and stored in central (govt.) stores. Effective, uncomplicated & simple system.

LGA collects Mectizan from state coordinator.

Wrong estimate of Mectizan requirement.

Delay in collection of supplies by LGAs. Some LGAs supply directly to communities

Use Mectizan supply system for new health programs.

Population movement affects project.

6 Transport & other material Resources

Availability of motorcycles & vehicles.

UNICEF other logistics also available.

Use of transport is integrated.

LGAs are willing to buy new motorcycles in 2004 budget.

Proper management of transport.

Frequent breakdown.

Inadequate fueling & maintenance allowances.

Political commitment to replace with new ones.

Bad roads

7 Human Resources

Adequate staff at LGA level.

Focal person for each LGA.

LOCT are committed and willing to continue.

Workers salaries paid

None Additional knowledge & skills through training

Transfer.

Lack of imprest.

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regularly. 8 Coverage 100%

Geographical coverage.

Above 65%therapeutic coverage.

Problems of calculation

Use same distribution system for other health programs

Population movement.

Bad roads.

SWOT ANALYSIS - FLHF LEVEL

Indicators Strength Weakness Opportunities Threats1 Planning Some have written

time table with CDTI activities

Some do not have written plan for CDTI activities

Now have to learn how to write plan and plan for CDTI activities

No plan

2 Leadership Leadership quality present. Effectively and efficiently implement activities

None To let politician know about CDTI

None

3 Monitoring & Supervision

Integrated monitoring/ supervision.

Checklist seen in some FLHFs.

Solve problems within set up.

Supervise CDD effectively.

Some FLHF do not know how to calculate.

No checklist seen in some FLHFs.

Rewarding success is a form of incentive

Absence of checklist in some facilities

4 Mectizan Keep good record of Mectizan.

Have ability to request for Mectizan requirement. Inventory form present.

Store Mectizan in cupboard.

Good inventory

Wrong calculation of amount of tablets required in some FLHFs

Use same system for other health programmes

Shortage and surplus

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No shortages. No surpluses

5 Training and HSAM

Communities select CDD.

Effective training of CDDs.

HSAM used to solve problems.

None CDD used as guide for other programs e.g. NPI.

None

6 Financial Communities give incentives, fund activities such as monitoring/ supervision. HSAM, & Training.

No budget. LGA do not fund FLHF

Increased support by communities

None

7 Transport & other Material Resources

Community support. repair and maintain transport.

Plan to replace by community/ LGA. Community built FLHF.

Integrated use of bicycle/ motorcycle

No bicycles in some FLHFs

Some communities can purchase bicycles

Overwork of CDDs without bicycles

8 Human Resources

Well trained/ skilled staff members stay long enough on job. No unnecessary transfer.

None Integrate all PHC activities

None

9 Coverage 100% geographical coverage.

Poor calculation ability in some FLHF

Use same system in other health programmes

None

Appendix VI. List of evaluators

S/N Name Full contact address1. Prof. Ekanem Ikpi Braide Department of Zoology,

University of Calabar, Calabar. Cross River State, Nigeria. Tel: 234 8033416842 E mail: ekanem_b@hotmail.com

2. Prof. Celestine Onwuliri(Professor of Parasitology and Infectious diseases)

Department of Zoology University of Jos, Jos, Plateau State, Nigeria P. M. B. 2084, Jos. Tel: 234 8037225385 E-mail: onwuliri@yahoo.com

onwuliri@uninjos.edu.ng

3. Prof. Jodi Mas Department de Microbiologia; Parasitologia Sanitaries, Facultay de Medicina University de Barcelona C/Casanova 143 08036 Barcelona, Spain. Tel: (34) 932275522 Fax: (34) 932279372 e-mail: jordimas1@ub.edu

4. Dr. Obal Otu Adi Specialist Clinic 7a Otop Abasi street P. O. Box 1636,Calabar. Cross River State, Nigeria Tel:234 87231973 234 8023536817 e-mail: drobalotu@yahoo.co.uk

5. Dr.Yisa Saka NOCP Federal ministry of Health Federal secretariat (Second phase) Ikoyi ,Lagos, Nigeria. Tel: 234 8033029387 e-mail:yisaasaka@yahoo.com

6. Mr. Steven Orogwu Ebonyi State CDTI project Ministry of Health Abakaliki – Nigeria Tel:234 433220332 234 8046102402 Fax: 234 43221657 e-mail: stevenorogwu@yahoo.com