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Diffusion of Innovations: Evaluation of the Sustainability of the Community Directed Treatment with Ivermectin Programme (CDTI) In Adamawa State, Nigeria
Abstract
The Adamawa State, Nigeria CDTI project was approved by APOC in 1998, commenced implementation in 1999, concluded its fifth year of APOC support on 30th November 2004, and was evaluated for sustainability by evaluators appointed by APOC from Nigeria and Kenya in December 2004. The terms of reference of that team were to evaluate the sustainability of the project; discuss the findings of feedback/planning meetings with the State, LGA and community authorities and assist them to develop post-APOC sustainability plans and analyze the data collected and present a report, NOTF and APOC management. Thereafter, the Country Office of Helen Keller International (HKI) instituted a separate, independent, and
autonomous evaluation of the Adamawa State CDTI project, of which this is the evaluation report. That evaluation was conducted on the basis of the APOC guidelines and procedures for sample selection and other field activities, as well as the instruments designed by APOC for that purpose. The present evaluation team (also, HKI evaluators) worked at the State level and in 3 local government areas (LGAs), 6 health centres and 12 communities. The team carried out review of documents and interviews of health personnel at these various levels and also met with community representatives at the LGA, district and community levels. The team found that 17 LGAs are endemic but treatment took place in 19 in 2004. Two LGAs were treated on the basis of REMO refined. Reported therapeutic coverage is high (the lowest TCR is 73 percent), but CDD motivation is low and turnover high (fifty percent in Ganye LGA) and this is viewed in this report as a serious threat to programme sustainability. Viewed as a new innovation in community health care delivery system. An understanding of the diffusion and adoption pattern of the CDTI is collorary significance to the sustainability question.
autonomous evaluation of the Adamawa State CDTI project, of which this is the evaluation report. That evaluation was conducted on the basis of the APOC guidelines and procedures for sample selection and other field activities, as well as the instruments designed by APOC for that purpose. The present evaluation team (also, HKI evaluators) worked at the State level and in 3 local government areas (LGAs), 6 health centres and 12 communities. The team carried out review of documents and interviews of health personnel at these various levels and also met with community representatives at the LGA, district and community levels. The team found that 17 LGAs are endemic but treatment took place in 19 in 2004. Two LGAs were treated on the basis of REMO refined. Reported therapeutic coverage is high (the lowest TCR is 73 percent), but CDD motivation is low and turnover high (fifty percent in Ganye LGA) and this is viewed in this report as a serious threat to programme sustainability. Viewed as a new innovation in community health care delivery system. An understanding of the diffusion and adoption pattern of the CDTI is collorary significance to the sustainability question.
