South West 1 CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2006 to December 2006

i NNSuIVED FoR PRaIECT LaGO/IIEADING COUNTRY/NOTF: CAMEROON Approval year: t9g8 Project Name: SOUTH WEST 1 CDTI PROJECT Launchins vear: IvIARCH 1999 Rebortine Period: From: January 2006 (MonthlYear) To: December 2006 ( MonthrYear) Proiectyearofthiereport:(circleone) 12 3 4 5 6 7(8) 910 Date eubmitted: January 2002 NGDO partner: Sishtsave rs Intemational I { APOC TECHNICAL REPORT ST]BMITTED TO TECHNICAL CONSI]LTATITre COMMITTEE (TCC) DEADLINE FOB SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL GPOC) ! I i I I I I I ! I ! : i I I I I I I I i ta ANINUAL PROJECT TECHNICAL REPORT TO TECHMCAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confrrm you have read this report by signing in the appropriate space. OFFICERS to sisn the rcport: Country: CAMEROON National Coordinator Name: Dr Ntep Marcelline Signature',rr r=r r=BW=: :. Date 1 . ..?.P.1 0..:110. Provincial Delegate Njie Martin PUUR I\. .U#-- \ ?p&*,l t.i, f4 or- Designation: 9 Signatursl ...... ri --{ 'dl ,L I T ?, NGDO Represent B Date: .+,5 c\-^^ >-=-=r\ Provincial Oncho Coordinator Name: Ms ecilia Signatursl ....... Date: 1q,- ..:2bD?t This report has been prepared by Name: Ms Mah Cecilia re t\- Dit I C Date ..1-q i il n'/ rrv 2n,l] -2 lTpble of contents ACROI\MvIS ............. DEFIMTIONS........ FOLLOW UP ON TCC RECOMMENDATIONS E)GCUTTVE SUMIvIARY SECTION 1 : BACKGROIJND INFORMATION.. . .. .. .. .. 1.1. GRxprutt, INFoRMATroN............. 1. 1. 1 Description of the prcject (brielly) 1.1.2. Partnership. ... L.2. Popu1auoN................ SECTION 2: IMPLEMEI{TATION OF CDTI.............. 2.1. TrunlrNn oF ACTIVrrrES............. 2.2. Anvocacy 2.3. Moutt tzAttoN, sI)NsITIZATIoN AND IIEALTH coMMtTNITIUS............. 2.4. CouuuNnyrNVoLVEMENT 2.5. CnpRcrry BUrLDrNc 2.6. TRri:n'rucvrs........................ 2.6.1. Treatment ligarcs...... .V VI 1 t 2.6.2 2.6.3 What arc the causes of absenteeism?. What are the reasons for refitsals?..... ........,....,.......2 .......,.2 .........2 .....,...6 ......8 .....................9 ..........9 ,rr.o,o* o. ^; ;ill ..,.,...12 ........ l4 ........ t6 ,.'',,..2o .,,..,,20 .,'.'..,.,,31 .......,.,32 ,.....,....,.32 . .. . .....33 ,.........33 ..........33 23 23 25 26 28 l0 30 31 31 2.6.4 BrieIIy desuibe all known aad veri.fred serious adverse events SAEil that.......... ......,.........23 2.6.5. Trcnd of trcatment achiewment fiom CDTI pmject ineption to the current year. 2.7 . Ottt>untNc, sroRAGt) AND DELIVERy oF IVERMECTIN ................ 2.A. COMMT)N)TY s}')I,F..MoNIToRING AND STAxEHoTDDRS MpUIINC., 2.9. Supr:RvrsroN......,......, 2.9.1. Prcvide a llow chart of superuision hierarchy. 2.9.2. What werc the main issues identified during supervision?......... 2.9.3. Was a superuision checklist used?........ 2.9.4. What werc the outcomes at each level of CDTI implementation 2.9.5. Was feedback gzven to the person or groups supervised?.................31 2.9.6. How was the feedback used to impmve the overall performance of the pruject?. SECTION 3: SUPPORT TO CDTI . Equreur:vr Fluauclel coNTRIBUTToNS oF THE pARTNERs AND coMMUNITIt)s Or:nnn FoRMs oF coMMUNrry suppoRT.............. ExpuNrnuRE puR AcTrvtry 3.1. 3.2. 3.3. 3.4. iii SECTION 4: SUSTAINABILITY oF CDTI.... 36 4.1. IN't'eRuel; TNDEpENDEI{T pARTICIpAlrlRy MoNIToRINc; EveluerroN.........354.1.1 Was Moaitoring/evaluation carried out during the rcportiagperiod? 4.1.2. 4.1.3. What were the recommendations?.. How have they been implemented? 35 354.2. SusralNestt,lTy oF pRoJECTs: pLAN AND sET TARGETS (MANDAT\IRy AT......35 Yn g) gs 4.2.1. Planning at all relevant levels... ..,.......36 4.2.2. Funds Errur! Bookmark not defined.4.2.3 Transport (rcplacement and maintenance)........ Enor! fuokmark not defined. 4.2.4. Other rcsources......... ......59 4.2.5. To what extent has the plan been implemented.......,,......................394.3. IxrncRerroN............. .............39 4.3.1. Ivermectin delivery mechanisms .........40 4.3.2. Training. ........40 4.3.3. Joiat superuision and monitoriag with otherpmgrams .......,40 4.3.4. Release of funds forprcject activities.. ............40 4,3.5. Is CDTI included in the PHC budget?...... .......404.3.6. Describe other health programmes that arc using the CDTI structure and how this was achieved. What have been t.he achievements?..40 4.3.7. Describe others issues considercd in the integration of CDTI. ........41 4.4. OpennuoNlL REsEARCH .....,.....4t 4.4.1. Summarize in not more than one half of a page the operational tesearch undertaken in the prcject atea within the rcportingperiod............41 4.4.2. How wete the rcsults applied in thepmject?............... ........41 a SECTION 6: STRENGTHS, WEAI(NESSES, OPPORTTIMTIES CHATIENGES, AND SECTION 6: UNIQUE FEATIIRES OF THE PROJECT/0THER IvIATTER.S ...44 42 iV Acronyms ANC APOC ATO ATrO CBO CDD CDTI CSM HESAM IT IWC LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo Ante Natal Clinic African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community'Directed Treatment with Ivermectin Community Self'Monitoring Health education sensitisation advocacy and mobilization Information technolo gy Infant Welfare Clinic Local Government Area Ministry of Health Non' Govemmental Develop ment Organization Non' Cove rnmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children s Fund Ultimate Treatment Goal World Health Organization v I Definitions Total population: the total population living in meso/hyperendemic communities within the project area (based on REMO/REA and census taking). (iil Elieible pooulation: calculated as 84o/o of the total population in meso/hyperendemic communities in the project area. (iiil Annual Treatment Objective: GTO): the estimated number of persons living in meso/hyperendemic areas that a CDTI project intends to treat *ith ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expee.te.d to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyperendemic communities as identilied by REMO in the proiect area (this should be expressed as a pen:entage). (viil Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for @taract, etc.) through CDTI (using the same systems, training, supervision and personneD in order to maximise cost'effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viiil Sustainability: CDTI activities in an area are sustainable when thcy continue to function effectively for the foreseeable future, with high treatment @veraBe, integrated into the available healthcare servitxr, with strong community ownerchip, using resour@s mobilised by the community and the government. (iil Community self'monitoring (CSM): The pro@ss by which the community is empowered to oversee and monitor the performance of CDTI (or any community'based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the communrff to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. (il l- I J I ''t I VI FOLLOW UP ONTCC RECOMMENDATIONS Using the table below, fitl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 23 South-West I CDTI Project (8,h year report) Number of Rmmmendatio o in the Repoil TCC RECOMMENDATION ACTIONS TAI{EN BY TIIE NOTF SECRETARIAT FOB TCAAPOCMGT USE ONLY t58 (Please add morc mws if necessary) I Exectrtive Summary l. Background on treatment and population data ' Totat communities, communities treated, total populiation, LnG, ATO and persons treated. CDTI Southwest 1 project was approved in 1998 but launched in 1999. It covers the health districts of Buea, Limbe, Tiko, Muyuka, Kumba, Konye, Nguti, Tombel and Bangem. A Ministerial text signed in 2004 created Mbonge as a heath district carving it out from Kumba health district. This makes a total of 10 health districts. These 10 districts are further broken down into 76 health aneas having a total of 478 meso and hlper endemic communities. From census update the project population in meso / hyper endemic communities was 363,550. This year the project has a geographical coverage of 100%.The ATO 236,308 and [J'IG 305,385. Persons treated were 268,499 giving a therapeutic coverage of 73.85% 2. Background on population movements. Population movement is only experienced in December around the fishing ports. The population movement don-t affect our CDTI population because they are found in the hypo endemic communities of Tiko and Limbe health Districts but if any, in Iv[bonge health district, they are always back from their Christmas feast before the start of Mectizan distribution. 3. Training data CDDS, health workers, Totalpopulation (community) per CDD trained. Total number of CDDs trained was 915 in meso and hlper endemic communities. The number health workers implicated in CDTI activities both public and private was 178. With the total censured population being 363 550 persons, the CDD population ration was 1 CDD to 397 persons. This was very high and far above what we planned to have (t COO to 125 populatiod. This was as a result of the fact that recruiting new CDDs is a big problem as they do not want to work for free. Even the minimal financial motivation they receive from government comes very late. We also trained 271 CDDs in hypo endemic zones who assisted the health staff to mobilize the population for clinic based distribution and in helping to monitor for side effects. 4. Challenges and how they wene overoome Our greatest challenge is the motivation of CDDs. State funds for the motivation of CDDs are not always readily made available and the process to acquire them is very long and strenuous. This always leads to high CDD attrition rates yearly. Another challenge is securing adequate state funds for the implementation of project activities. There is sti[ to be a defined budget line for CDTI activities. 1 l-- SECTION 1: Background information 1.1. General information 1.1.1 Description of the project $rieny) C.eo graphical location, South West 1 is part of the South West Province of Cameroon. It Iies between 5"20 and 4'N and 8'45 E. CDTI SW 1 includes 3 administrative divisions.(Fako, Kupe Muanegouba, Meme). These divisions are made up of about 10 subdivisions. Buea in the Fako Division hosts the administrative headquarters of the SW Province .SWl is bordered to the North by the SW administrative divisions of l,ebialem and Manyu, to the South by the Atlantic Ocean, to the East by Litoral and West Provinces and to the West by the Republic of Nigeria. From the health point of view SWl is divided into 10 health districts (Buea, Limbe, Muyuka, Tiko, Bangem, Tombel, Nguti, Konye, Kumba, Mbonge) which are subdivided into 75 health areas. A Ministerial text was issued last year creating lvlbonge as a heath district from Kumba health district. Population The total area of CDTI SW 1 project zone is approximately 14300 km2 and the total population of the entire project zone (hyer, meso, h;'po communities) is estimated at 966,683 inhabitants following extrapolations frrm the 198? national population census. The number of communities in this project zone have increased from 375 to 478 meso/h5ryer endemic communities. This is because of the following: - During coding of communities last year we split up large villages into smaller communities for easy management. - We do not see any rational living out hypo endemic communities spotted in between meso/h1per endemic communities when they are all expose to the same ecological, geographical, entomological and sociological factors. We therefore included such communities as communities benefiting from mass treatment. - On request of some communities that were not having mass treatment REA was repeated in the health districts of Muyuka, Kumba, Mbonge and Konye. This showed that some of the communities earlier considered as being hypo were actually meso or hlper for oncho. This year so far the geographical coverage is 100%. Total population obtained from census update this year is 363 560 persons, Ultimate Treatment Goal 306 382 persons (gaX) Annual Treatment Objective for the project 236 308 persons (gSyi, Finally persons treated was 268 499 persons giving a therapeutic coverage of 73.85o/u. Mectizan@ distribution was carried out in all communities t I I I I a/. I ,i I I I I I Activities, The most important economic activity of the inhabitants of this project are is farming. The grow cash crops like Cocoa, Coffee and Oil Palms. Agro industrial institution in the project area the CDC and the Cameroon Tea Estate and Pamol Plantations Limited also grow rubber, tea, banana and oil palms most of which is for export. Subsistence farming is also done mainly foodstuff and fmits, for their livelihood and excesses are being sold to the local markets of neighbouring towns and Couptries. Cash crop farming is done mostly by males while the females are more engaged in food crop farming. We will wish to mention here that, most of our CDDs are engaged in faming activities, which explain the reasons for low participation of female CDDs, rapid drop out and replacement by communities is slow. Sometimes they abandon their activities duriug the peak of Mectizan@ distribution. A small population is engaged in administration (white collar jobs) and small scale trading. Cultures, The cultural setting is made of the Para mount chief who is the head of the tribe. He controls the sub or second class chiefs who are the heads of the clans that make up that tribe. These chiefs and their councillors make traditional laws, protect traditional believes, laws and taboos. Traditional ecremonies for example, marriageq deaths, festivals and births are celebrated according to the norms and standards of tbat tribe. They all have one belief in common, the pouring out of libation to appease the spirits and the ancestors to intervened for their wellbeing. Some of these cultures are a hindrance to a lot o f health intervention. l,angUagS The local dialects are widely spoken within the clans and tribes in the project area. The language commonly used during communication is Pidgin English. The literacy rate is very high many can express themselves in perfect English and French. Topography, climate, Access SW I features has a diversified landscape, the predominant vegetation is the Equatorial Rain Forest. Besides this main type of vegetation, there is mangrove vegetation on the coastal areas. The Rhumpi hills occupy the whole of Meme Divisiou. The altitude ranges from 0 metres on the coastal areas to 4095 metres in Buea with a multiplicity of small hills. The Cameroon Development Corporation (CDC), an agto-industrial unit has put its stamp in this region with its numerous large plantations of rubber, tea, palms and banana. CDTI SW I project area has a very rich network of drainage system most of which flows from high altitude and are interrupted by numerous cascades, rapids and waterfalls. These streams provide breeding sites to Simulium vectors which can be found on high altitude in the area. { i 1 .I{j 3 I ,i .J ] 1j -t 1 I '! I) l- I I 't I I J I ! I II 1 I \ I) II I Ij -l l l The rainy season starts from mid'March to mid'October with its peak around July and August. The dry season goes from mid'October to mid'March. Farming is practised all through the year, the highest activity being registered around March and April at the beginning of the rainy season. - Communication systems (roads...) The rpads in CDTI SW I project area ar€ mostly un'tarred. They are generally practicahle during the greater part of the year, with only about 3 months (July, August, and September) when they are difficult to ply. During this period of the year movement of Community Directed Treatment with Ivermectin personnel should be reduced and oriented towards areas where the roads are practicable, Despite every oaths with the use of four wheel drive car a person can still make a successful journey within the project zone. Telephoue, Fax, E'mail and Postal services. Communication services by telephone are well developed and cover 90% of the entire project zone except for Konye and Nguti health districts. ' Administration stmcture The Governor is the head of the Administration in the South West Province. The Senior Divisional Officer is the head of Administration in the Division. The Divisional oflicer is the head of Administration in the Sub Division Traditionally the Paramount chiefs are heads of the tribes made up of clans. The chief and his traditional councillors administer in the communities. Health system & health care delivery (provide the number of health posts/centres in the project area if the information is available). Health System Administrative Health Care Delivery Intermediary level Provincial Delegation Public health Buea of 1 Provincial Hospital Limbe. Provincial Annex Buea 1 I Peripheral level Health District Services 10 plstryict Hospitals (PuUtic) o Private Horyitals 72 Centres M6dicaux d'Arrondissement (CMA) 6 Health Areas 75 Health Centres (puUtic) 72 Communities meso/hlmer 478 Health Ceutres Private 37 4 : i Number of health staff in project area and number of health staff involved in CDTI activities. Table 1: Number of health staff involved in CDTI (Please add more rows if necessaty) loistricut GA, Number of hedth stafiinvolved in CDII activitio. Total Number oI health stafi in the entire project area Public Br Total Number of health stafi in the entire project area Private Br Number Percentage Br *100 BA\IGEM 48 0 L4 29o/o BUEA r29 61 40 3r% KONITE 19 0 8 42o/o KIJMBA 88 58 30 34o/o LIMBE r98 91 32 16% MBONGE 25 14 10 40o/o MIJYUI(A 91 18 15 160/o NGIJTI 18 t21 13 72o/o TIKO 84 68 30 360/o TOMBEL 23 35 t7 74o/o PROVINCIAL DELEGATION 35 0 5 l4o/o TOTAL 768 466 214 28o/o NB: The private health sector is made up of staff from Catholic, Baptist, and Presbyterian confessional health unites as well as those Cameroon Development Co operation (CDC). They arc trained in Primary Health care prcgrammes and are even responsible for some health areas as leading health units. 1 I 5 I : I I -1 I .tJ t I .: I L.L.z Partnership Indicate the partners involved in project implementation at all levels IMoH, NGD Os ha tional/interna tional), comm u nities, local organiza tions, etc. l Describe overall workiag relationship ayong partners, clearly indicating specific aneas of prcject activities (planning supervision, advocacy, mobillsation, etd where all partners are involved. African Pro$am for Onchocerciasis Control GPOC) APOC desigued the project and supported the project for the first five years as per the project proposal. It provided most of the equipment (vehicles, IT materials and other logistics) which are still currently being used for project implementation. This year it provided funds just for HESAM. Me ctizan@. Donation Program, Provision of Mectizan@ free of charge to the CDTI Project Sightsavers International Sightsavers is the supporting Non Governmental Developmcntal Organisation in the Province. They supported the CDTI S\tr I Project withi - Losistics (purchase of car insurance, car and motorbikes tyres) - Financing activities like training of nurses and CDDs, supervision, evaluation meetings and HESAIT{ at the prrcvincial, districts and health area levels. - Ensuring good resources management and reporting by supporting training, supervision, monitoring and evaluation. - Integration of eye care program into the CUII project Ministry of Public Health The Ministry of Public Health is the main coordinating and implementing body of the project from top down. - Provides personnel in the field at all levels, i.e. province, districts and health areas and support the community in implementing the prrcgram. - Organises traiuing of health personnel and CDDs - Motivation of CDDs - Financing of activities at the provincial, districts and health area levels - Contributed to the repairs and maintenance of equipment at all levels. - Organise advocacy at all levels. - Planning, mobilising, sensitising and supervising activities at all levels - Monitoring, Supervision and Evaluation of the project - Produce IEC materials - Management of Mectizan@ stock through the essential drugprogram. 6 Endemic Communities These are the affected commuuities. They are the priucipal partuers of MOH as the implementation of treatmeut with Ivermectin and its sustainability depend entirely on them. - Select Community Directed Distributors and send for training. - Take decision on the mode of distribution (Central point distribution method) - Plan for distribution. - Accept registration update. - Mobilise and sensitize the communities to take Mectizan. - Supervise and monitor Mectizan distribution within the communities. - Contribute in the identifying and referring cases of adverse reaction within T days of Mectizan treatment to the health unit. The Community Directed Distributors (CDDs): Ensure storage and safety of Mectizan@ within the communities. Collect Mectizan@ from the Health centre. Distribute Mectizan to their communities. Carry out registration update of their communities. Assist the nurse to summarise treatment reports at the front line health facility. State plaas, if any, to mobilize the statelrregion/disrricUlcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI imFlementation. At the moment there are Do plans to mobilize more NGDOs, NGOs, CBOs to assist in CDTI implementation h SW I project zone. 7 I co s$ ao o?Er, 6l 6l(o o)o D- Co <{ (o O) @ cr) ctloo CTJ 6l @(o rO C-l $ ao$ CD c\ @d) rOo CO (o(o cr3 F. o)@ F{ c\ @ crl $ crf roo o) tt ll(o A r"E9N x- c) rEE EE6 o)(o tr- @ o6I cr) co F{ c\ @ cfJlo$ o) tr- ts-t-o F{ l(io cr) t-- @o(o Io IO r- <t rO <{ l{:o cr)t- c\ 6I(o O)$ @$F(o o ro rO ot(o ot o)(o o) r{ c\ co Fl lI) lo(o(o $ c\o$ $ o) 3 is $EtE- lo F- rr)$ o)lr) C{6l o)(o o)F- co ca6 cr) tr-lO oF- @ F{ @ o) tr- t-{ rO Ct? cg @ O) F{ o EIo d a aoA ,.o .X .EE'- oooct-r1E.l 6O€ hg$ESE o)r$ F{ @o c': <l c- CO o)(no r{) 11?6Itr- r() @o @ CO$ c\oo(o c\ o, rO6lN tr- c\ CN$ FIo$ co C.l {t I tq) aha Ee H5 tr.9 -ts'dqr,t -9trFO c\:lCD co .$to CDo (o CO@ LO$ $@ rOri O@ 6E-$ (rf c!{ o .gd Eo616aO 8.I H h, , .-E ,h5E '{Na @ (o cr) 6t@ (o c\t rO lo @ a o k oE E 2 $6t c\CD o c\$ t-$ C.l ,. 0) .x -oE-oo6)4-ll.I.H €Oe ils$ ERE, c\ l1? @ $ <t Oro Io @ffJt- C\ c\ cOo$ Fl co$t- CD o ro rO cr) CO CO o'E s €6H EE:E OJ(ot- @ O c\I cY) co 6I @ co rO$ o tr- tr-t-o lo O) cot- (oo(ololr) f- <t rO$ I HoH 9ts1l .g 3.8 io EE{.H * sESEH EoH ED14 H co z J ld k Fr! z o M E< r.1 frlI o E< aH oz tq Bra taE e S) tsq E c! E N d o li o)q ho H s L{ og c) Ll oE +) bo H ,r a +) o H k o fd o (! o)ti +l q) f{d >t(Ds +, kq) +)oA B d o) d () o 'a f.re c)t{ H o) 0)E H ,!o t{ +)d tr o P(! q oq € trd U)q) H E Eo C) ort ,l -otdlFI tro {J crl aor "i f'lo zo E I I a I i LllM = calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the prujut arca, ultimately to be reached when the project has rcrched full googaphic ooyorage (normally the project should be exputed to reach the UTG at the end of thc 9d year of the projecD. Was a census for the proiect done during the r€porting period? Yes If No, what is the source of the data in the table above? * Source: National census CDD: Yes Other source, specify: Year : -2006- If you are using the term community or village, define what mnstitutes the community or village. This will help understand the profrle of the project area. The village or a @mmunity is made of people of the same tribe living as a group in a given setting. The number of persons in a village can be as small as 52 persons to more than 450 Persons. In some health areas, the number of persons cpvered by one CDD is considered to make up one community while in others the culturally structured unit has been retained as the communitY. Is there any other infotmation of interest about the population in the prcject arca? If so, include it here. Considering the fact that, not everybody living in the hypo areas was born and breed in these communities and coupled with high rate of community urban migration in search of better living standards, smployment and commercial activities. Mectizan treatment was also carried out in all the hypo areas of CDTI SWI project r,one. A total number of 98 509 persons was treated in the hypo areas. SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fitl in table 3, timeline of actiuities for arcas trcated in cunent yea.r; indicating when the key activities were implemented by the month they began and the month they ended. 9 ai ) I't I 'l ! I tro o L(D0 o tro 'E o EE 6E (oao c\ rO @oo c\ rn @ooNb (oooN lo (ooo c.l ltt (o ooN r/! (oooN rO @oo C\t ltt (o ooN lo (ooo c\ rO b0 .A.a EE c/)Et (o oo6l N (o oo c\ N (o ooN c\ (o aoN N (o oo c\ N (o oo c\ 6.I (o o c\ N (ooo c\r N CO P c{ N (ooo c{ N tro 'tr aE k o u0 li a o €aEF EE()EI @ 8s$ (o 8 c{ $ @I c.I$ (oIN n4 (ot c{ Io (otN .s (oI c\ s @IN <r @ 8N$ @I c.l co bD .E.a EEOH @oo C.l co (D oo 6.1 N @ooc{ cY) CO o 6.t (Y) @oo C.l + @ooN co @ o 6.1 co @ooc\ N @ o C\t cr) @ooN N o +)dEa) cA 01 H 0)() q o *n EE 6E @ooNt @oo 6.I <i (o ooC! (o o 6t <{ COooN rl. @oo6l .$ (o ooN <{ @ooN (o aoN + (o aoN 60 bD .t.a EEc2H co 86l CD @ o cil 6l @oo e.t d) @o N (D @oo cil $ cOo N cr) @o N (D @IN 6l @ 8N 6Y, @oo eil 6t hI c ts d!F E6 q) 5E EN N IoN ert IoN co (DooN 6a CD 8N N .Do N N cDo N N @ooN 6I @ooN 6l CD oN N u0 .1a H8(,)H (oo C! N (OI c\l R (D C)o eN (ooo c\l c\ (D o c\l N (O 8 C{ N (o 8N N (o 8 c! (D 8$N (o 8N N sOx(D E.ts(!dN;{ EE >8 o do 6) AGEE 6H @ N $ (O ao6I (Y) @ 8N Cn (o 8N cO @oo6t rO @ooN co (o oo c\t $ @ oN rrC (o oN N (o ooN N h0 .A.s EEoEl (o oo c.l N (o e 6! N (o oo C.l c,) (o ooN co (o ooN N (o oo c! N (o o c\ N (o o 6t N (ooo c\ N (o oo 6T N o ']>() ir o o z trI(5 z cq frl Eq fr] 2 o M e 6 frl E J H(J z IJ E nD h F) z E) o z o M E d Ez o E- o 'd, Ho E Eo ? ?\\' H(,5Iq)q!. p R Poq \\ql E(Il *s ,<d o)x +) q) frk C) o)s+, H q) tJ(d q) f{ a(6 (D ,d o)E+t tr € q Q) +) (.)(! o o) tr (l) E F mt .lHI -ol(6l FI 2.2. Advocacy State the number ofpolicy/decision makers mobilized at each relevant level during the eurrent War; the rcasonb) for undertaking the advocacy and the outcome. Describe difficu]ties/constraints being faced and suggestions on how to improve advocacy. Funds for HESAIvI given by APOC this year boosted the health education, sensitization, advocacy and social mobilization of endemic communities in the entire project zone. T'shirts were made by Sightsavers and MOH and given to the all the CDDs and health staff who actively participated in the Mectizan@ distribution activities this year 2006. This gesture helped maintain some of those disgmntled CDDs who were to abandon distributiou for late financial motivation from the government.. Advocacy was ensured by the DMOs to some policy makers withiu their districts. This included the three Senior Divisional Offrcers of Fako,Meme and Kupe maneguaba, the ten Sub'Divisional officers of each district, the two Govemment Delegates of Urban Council, the Mayors of rural council and Parliamentarians within the Districts. At Health Area level the Heads of leading Health Units carried out advocacy in the various Health Areas by meeting quarter heads, block heads and village chiefs. During ANC and IWC clinics as well as during individual consultations sensitization vras carried out. These policy uakers were mobilized during the launching of Local immunization days, the international day of the wornan and Youth day (11,t February), as well as before the start of the distribution of Mectizan@ and during the luuchiug of Mectizan@ distribution in each District. It was [mperative to get these policy makers and community members as a whole involved and fully sensitized. This was to make them have a clear insight iDto the CDTI programme and to involve them as front-line advocates for the CDTI project, mindful of the fact that the project is in its 8th year. The outcome for this advocacy and sensitization was quite positive since we observed less refusal of Mectizan@ which has also accounted for an increase in therapeutic coverage. The following difficulties/constraints were faced during the advocacy and sensitization exercise : Difficulty to get in touch with policy makers due to their very tight schedule of activities, Some of the policy makers invited during advocacy meetings were expecting money for fuel at the end of the meeting. Lack of IEC material for distribution. Imp ro veme n t on ad voca cy.. - We intend to improve on advocacy by applyrng the following: I I ) t I \ i I ri I ) \ 1l I- Ensure that, besides sending letters inviting these policy makers to meeting, more time will be allocated to ensure a higher level of personal contact. - Do all in our power to get more IEC materials. - Ensure that the policy makers accept ownership of the project, - Request for zupport funds from our partners. 2.3. Mobilization, sensitization and health education of at risk communities Prcuide information on: The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities Response of targe t comm u nities/uiilages Accomplishments Suggest ways to impruve mobilizhtion and sensitization of the target communities. Mobilization and Health education was ensured on the mass'media by the Provincial Delegation of Public Health Buea, (OPC SW I ). tne Lake Side Lpcal Radio station in Kumba was greatly used for community mobilisation and sensitization. The radio programs were just timely because Konye, Mbonge and Kumba have just started Mectizan distribution whose communities were our main target on problems of refusal, absenteeism and CDD attrition. Our radio messages were focus on - . Importance of Mectizan tablets . Need of takiug Mectizan continuously for 15 year- . Role of endemic communities as main partners. . Management of side effects ' Mectizan distribution and eye care. These messages were recorded in both English and Pidgin English and were rebroadcast three times a week continuously for one month, through out distribution period. We also developed a spot on Mectizan which also went on air continuously for one month. t2 \Town criers using whistles, Iocal tongue translators and other means of traditional communication such as the use of talking drums were used to educate and mobilize trromen and minorities. The content of the messages on this subject matter was as follows: * The disease * The drug * The rationale for mass treatment t Those to take the drug .:. Those not to take the drug{. Treatment is free of charge .:. Importance for being treated.{. The number of tablets to be taken according to height{. How to swallow the tablets. * Possible side effect with management taken care of by the project with 7 days after mectizan is swallowed. The reason aud usefuIness of census update. The H5per and Meso communities/villages were the major target for mobilization and health education. The response from these communities was satisfactory. This e:<plains the reduction in the number of persons afraid to take Mectizan and an increase in therapeutic coverage. The following weaknesses/constraints were obsenred: Lack of adequate IEC materials for mobilization and health educatioq very few dialogue structures members were involved in the mobilisation of their communities. There was inadequate health staff commitment to project activities. Below are ways to improve mobilization of the target communities: - Supply of adequate IEC materials for mobilization and health education. - Reinforcement and following up of mobilization and health education sessions. - Ensure full implication and involvement of dialogue structures at all levels. - Hierarchy needs to address the issue of health staff commitment to the CDTI proBram. ! ) I 13 A B o o!oql E @ o ! ct E 6 8 tra -o r.Olo EEac Z19 E rqME o bo6 +)c p oa \oo\ O \o o\ co \oo\ c- \oo\ c\6t \oo\ 60 @ \6o\o crf \o6\ co t-{ \oo\ a c\ \oo\ <o(o \oo\q <o s cl?(o o cq oii E E8 ".EBPIoii Et ; E5 o .<f .<ti eo6l II) oC\ (o c\ ori $ @t- .6 o z a oo s a E E 8 oA € c a Aao o L -t E z o ca +fi A ql 6F @rt) Nrt? o)@ (o @ ct:@ O r{ o)D- O)@ co(o o ro O) d tn €5 ro6l @N o o(D eor.- o 6I o a<r (oti F.-c{ F co 6 o o c) o cl a eogrt .$ c\ O)@ (06l o Ft o co 1Il O)@ Oc\ roco .+ v(o E E fe EB BH a rE >r .ft JE oo I d ,li e o boq,D Eo 2 o0{ o o o o o o o o o o o d 63'Es E r.'E ts E EHIF o o o o o o o o o o o cq 8.5.8 tDElQO65Pd6 =loaE B P E* B c\e6 e') <.ro oao (0 COCO lo\f <t6 lot-{ o<o Ob- ril sBt) .E b a E trIo z ca rlp ca E] D,o M cq ED(,/ tr1tr t< Fl trl oz o cql-ia M5 b'.r E EiD(5 z o M Er Flf'l Fq a oF Cd o E{ v A G H() q) .E H 5E R I E E(! q) t') sq) E t{ a(J oA{J tr co .E +r Gldgo'EEEOH >(E 'dg >02:. 0) .H'6 E'a EE EE EC)O -i,t orl{€l ar Hl I I a I ) I .i I Comments on: Attcadaace of female memberc of the community at health education meetiags Very poor, female members were most often found in their social groups aufl churches. Few of them attended big groupings mobilized in the villages. Majority of women are involve in farm work and therefore paid little or no attention to meetings. In general, how do you rate the participation of female members of the community meetings when CDTI issues are beirg discussed Gttendance, pafiicipation ia the discussion etc). Generally, their participation was poor. We could. only reach out to them during their social group meetings. Incentives prouided by coamunities for the CDDs Commuuity mutuality and voluntary senrices ofrered to CDDs is not a commoD practice and this makes it very difficult for community members to assist CDDs in kind or cash to carryout their task. Attuition of CDDs, Is attrition a problem for the project? If yes, how is it addressed? Attrition was common in Kumba, Konye, and Mbonge health districts where some CDDs refused. to distribute or even abandoned distribution midway because of the late payment of state motivation for last year. Others who did not aband.on withheld their treatment reports for the sayne reason. Otherissues. I -1 15 2.5 Capacity building Describe the adequacy of available knowledgeable manpower at all levels. fhere was adequacy of available knowledgeable manpower at all levels. Ttris was the 8u year of Mectizan distribution in this project and all health staff are already used to the program already. Whdre frequeat fuansfers of tained staff occur, state what the project is doing, or intends to do, to remedy the situation. 0:he most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). T\ansfer of health staff was not an issue. Very few transfers in and out of the project zone took place. The few transfers that tpok place, the health staff were quickly accepted during the targeted trarning on the program. fraining carried out consisted of the following. 2-5.1 Tlaining ftaining s/ss painly targeted. It was orgaanzed. by the districts for both health persounel and CDD. 2-5.1.1 Refresher course for Chiefs of Post A total of.75 chiefs of post were retrained in the entire project zone at the level of each district. 2-5.2 Training of CDDs and other Health stafffor CDTI2006 Total number of CDDs trained was 915 in meso and hyper endemic communities. Ihis gave a population ration of I CDD to 397. IL.e number health workers train fut CDTI activities both public and private. We also trained 27L CDDs in hlryo endemic zones who assist the health staff to mobilise the population for dinic base distribution. A the Disease . Aetiology Oefi"ition) . Mode of transmission and vector . Complication if not treated . Socio'economic impact of the Disease. B the lteahent . The ilrug mectizan ( height range / number of tablets) . Non'eligibles . Possible side effects ) _t 16 ) t 1 a . Management of side effects, . Possible side effect with management taken care of by the project with 7 days after mectizan is swallowed. C Reporting . The registers . Recording . Census up dating o Nurtbering of Houses o ReBistration of treatment o House Hold cards . Community treatment forms, community self monitoring forms, Health Area treatment forms, census and mectizan Distribution summary forms, Adverse reaction forms, fi.nancial justification, etc. D Importance of intergrated surveillance of Disease and notification of Disease under surveillance. t7 il. cu6 stI aq !{ B s I ts tr t(t a)(r)(! *s Ho 's C! E 6) H o) a ll H a() +{o a o o +) tro F{ -o TH € oE +) €(g bD EI d dkH ior orl ..ol(El t-l € o A 6t{ o a a rJ o l.roE E z 3r a C) + o HE \ *d 6 L6 o La 6l rI} c-t r.o o @ (D CD Fl (D @ r-{ @ @ H 1- o)r- C)@ @ o co(c co F{o : O ll) 3 lt) o) O \oo\oo {J o Eo o CJ s co t49 co r.(} (}r r.o c)@ (c co F{ @ o Fl I\ ao coI ot-{ rle o) o U)lr 0) a (g ,.{ .J oo)E E-{ OSJ c+{ FOv HOo(l)E0) E.E ,c!ZE o gJ!3 Es $E o o o o o a O O o O o o a O o o o o O O o o O o so tro Eo o E CJ s o Ei. o O O o o o o dxoXE'H tr EJ?s o o) b€ €gEI {.?cat<l)Ac) 3rI tq $ t rQ t\ tr- O rn llf o a o Pl o l.a C\I r.(] c\l 6l t-l l.O rlf O r.o an 6l H o '-{ c)N ^l o O) c) O @t- (o rJ) 6I6\ \o oO-o o Eo o A c) \oo\ o & a(-) t-: iO o rO6l N l6 r6 O)it O) r-t- lH c! o o o Fl a c) h lt) a o trOEQ0)td 56ZE E otFO() t € (3 I * $ ao a6 o o o ao o $ O $ o ro co sn co N soo do Eo o € s o! F{ C) e|,) (c r+ an .+ lo(1: H c) Eo a t{A Ho z cq fr] D !q ri 2o\) EA aDk frl ca r=lA J ri o z o FA A $5 h FDo z o\,4 E J rn @ a o E Fl Ho t-{ co 'jt- c\ @o tro N oa >'E E 6 tr(U tO o) c) E o)6 Ho ,.roo >rE 6 Hd o tl) a) E tr '15q) EI CIlH +.) cn a a C) +io HoP E H (6 +)o E-,' m z ii .t I 8 *I € oq .t \ ,s I $ E 6! a i oq Table 6: Tyrye of training undertaken. (Tic* the boxes wherc specific training was caried out during the reporting period) Any other comments Trainings were targeted; CDDs were trained on just what was required of them (health educatiorl census update, filling of registers, Mectizan@ distribution, detection of side effects and community self monitoring). Only health workers were trained on programme management and data analysis. Trainees Type Of training CDD'S Other Community members e.B Community supervisors Health Workers (frontline health facilities) MOH stafl or Other Political [,eaders Others(spec iry) Program management x x x IIow to conduct Health education x x x x Manaqement of SAEg x x x x CSM x x SHM x x Data collection x x x x Data analysis x x Report writing x x x x Primary Eye care ServroeS x x x x Visual acuity x x x x Others (speci&) x x x x l9 o o o o o o o o o o o B nsa;iE fii gEt+ t-z p !t R e ei E\\ CE +)(( q cd c)l{ c( -d H oJ +)() k +)(n .t, U) trl ct) d FId H o) E(g o E{F o) +) CUt{ (D bodti o) o C) q)E +) lr o (D bodt{ o) oo o +, o)a({t{ o) +) \o6\ r() @ o EAaEE .d- pEl- -dA EE <ufi Esdg Sed:h;iB;,c)H ='6UP 'aa :H E'.ELi^ b.o -oo)oE bD +r -o'dO\ ,<ge ,-r (4 uoid6 'ad 6e4q E HI!*, or ,$tE$OU) EI .HQs trogE 3 E 8 E gE .E- TESrEEfiX= E Co c.i ol hoiHaa AO o o o O o O o O o o o I{ 0)A E a z o o o) o 6 E!6 @ CO(o t- @ rO o(o 6l $t-lO CD N crt ct6t @ co$ co rOo G\ c\ o) CO6\ (ot-lo cr) Io E- ao iE B E E**tre r()cr,o) lo(olo (o <rr- G\l6\E- (o ro ro lO ct)o$ lO o)F- @ (Y)t- CE o) c- crJ o o)lO t- c\ o o.6k 0)AF 0 o) bD6Lq) oo s o6 Idil- na (o u? @ (a -q Co € (o6 C; c- OJo Co(o (ot- cj(o t-lo 6i c- @q @ @ ol(o c- 6$ t.- c- r$, € lO @ c,rj c- d .E rtEEts ,xozL! AI l() c- c! lo CO$ 6!(o (ot- c- cY) O)s <t Io lO(oo @(o 6(o co @O 6t CDolo @(D l() C\l B{@(o 6l EiratD c\lr*l{o =Egzi B E g5.<t-O oo D'- rO CD rJ)(D @ coo <{o6l ro u)ooF- E-o 00!r \D 1I) tr)o <r tD u) u) O) c\ I CDt- IDt\lF-o cr) tD tDv6! tro d aoA rO co CDt- 6-e e\l tD o)v d co$r- CD o u) rI)(D(o c7) ts& . b$o o* a h-=6 llea7 EE E A8 g; d O)(o r- @ o c\t cr) CD c! @ ct) rI?$ o)t-t-r-O r-.1 ro o) CDt- TDo(o r{)lo t.-$ rO$ 5o soo soo xoo .:s Efr HDfa 5^ cItE oo t olt- no \c6\oo soo soo soo soo so soo @t- <rd o.o r'i Etp 5 hD.O!d6C) E H=I e 5t s NcfJ CD $lo CDo (o (o(o rO$ <r6 Io oCO d rE :1-q BEP E,,<E--O C.Icr) (D riro crlo (o (o(o ro$ <rco lo o(o @t-$ o o)h!(6 E U)q) {J tr E E o c) cot-!$ ts q,.E LlEo q+gH" E.g E Ef "HE rd 8t€ E I E15 c\CO CD -rillO CDo Co (o(o rO$ $6 IO o(o H r5 zo g g D tsr) A 5 o z o 14 F 11 frl H o E '1 E-t o F{ c) 't -,6dE€ A rr z ca r{ Eq E o t4 c0 V H B J r.l \ ett Gt h G{ E a. $ c,!{ $I .S o) {: HtP G$' It$ {t$S(\' .s SS $ii l$sfi E-S r$$l il-$ i$ slE il t{ ^'- t tt& tt! r$h 6!t iE $E$ s ${ q t$ rXg/F)v C6 0)trd € I o 'a u g 0) A € H .d AP .t B a cd o)fr6 v .d E o HIt{ 0)F A CD(D H .a 4 0)!(( et futI J( -- Nl.Z r:l ool-ilr Hec'jl 5l Edl ol q*l El:rrrl 8l ;ql 3E =t ol H{l lrl 5 El8 3l: sl8 El s RIR il€ 3 -tl a,xl.i €li fitBglo el o ol tr BHol€ fig r.l 'Elt:la oEl E\ Ett cBotr c! ts o) 'a ta oE .aJ tr .l o H rd h! A E € .d +) tr 0) ,9 .; cd ao .- .H Ht) alE:l s xl 8H.: HI gda)Lld!(x rol X6)li6rl t{ cdl o dl x :sr *l<El 85c',il 'El gF'-l =l ,*.ill El oOI EI Eol ol =fl tst E EIB EI:$lHEls RIH Elf \Cl €\l 8l :lol *l6l F-l!+l (! ot{ c! liv o 'a ti 9. 3 +J H .tAA .ts B o .9 +) .s tr 7 E EoO O ./ E o)dc oLo E tr BE6l -[E>l xt-9l tl.IUl a\l -l .!51 bDsl El! .ql q= Fl €l sB 8IE8 .ot*b4 El 6. 'dl 'rl odl eladl 4-t *jl q,l El SEI EI zIEl'at iDl !tH ' :l 6dl 'il tiltsl9llirl tlHl $fi sl Ei$ .Et Et b El;t3al qil '5 ^El *l ilEbI EIE6l til (D sl €l E o) q) Eo(d o E-{ s o) Cdtr o bo cElra6) ro>9U t< il 0)rJ(d 0) ho(d}r 0) oO (6 c) 'Aa ^o\ CTtr bo 0)o il c.lGI o E(l)C, .Eo H€(D.Fl OE BE .cEtrol-.{ C) d a 66 ,9 o Aot o o. o tr 3 E a2 00 1o @ ln 6l $t- $IG @ri O co aoN$ O $ @I.a o .+ g) or-O ro F] O tr +)t) a !{aH z ca frl F) m f-l 2o\.1 4 m aat) rn ca E .] f'l(5 z cq z V l H z t) F 11 frl Fq A Ei .FI floH o; HoN () o 'a F{q B U) Ft a C) U) +r ar)o F{ Ho q tsa(! ok oP ,,h p tr- o Ed E{ 2.6.2 What are the causes of absenteeism? Some members of the community migrated to farms and fishing ports (Boa Balondo, Konye, Bangem and Kumba health districts) 2.6.3 What are the reasons for refusals? It is strange that some people still complain of fear of sided effects ir the 86 year of the project live. We however think these people are just refusing treatment and are hangrng on the side effects as the cause. 2.6.4 Briefly describe all known and verified. serious adverse events 6ans) that occurred during the reporting period and provide Gn table g) the required. infomation when available. There were no cases of severe side effects In case the project diil not have any casies of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report I I ) I l { 23 <r crl H N(!q e) N \ ba E q $ '!i ,3 * 1\h (! Ord ai$q) -tr\ B R P(J Ht(! oq sq) Q ,C, o .E (l)A hD H '{r r{oa(t) ,. q)E bo FI 'd .d 'd o)Ht{ C)() o +r(!E ct) rI] !a o{J trl d) o) (D(nkq) t(! U) o .E o cA o a G)o Cd() cor ol .al c6l E{l Iqo adtrX>rr oo-lt>: <.8 b obD bo 9i € EEE stsE EEo H5{rtra)X .. 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O) s lO 1ll rO 6I ts- crt cn ts-F- c\ Oao r$ ts-6l lo F-v O) co co C-{ m$ 1Il rli m o lO .tt co cr) oo b06 t l,) o A a E oO g I El EE o bD6 obie8 so soo oo o\o C) soo soo dp- IEts"i .$: HslrE soo soo soo sao soo soo r{ ts.E rr{trtDI a atn ; EE e rOr-co rOt-(it rOF-co rI:ts-co cots-s ar-$ kl EeG E5zr B E P3 <E O ll! r- cr) rf:t- lOF. co r{: F. crj @ r.- .$ @F-$ E H.3 *' * "t ' [3 -e < E E E$EE,' lr)r.-co ll)F-co rlats- lOF-co cot- r+ @t- <. d rI) @ o)o o)o o) H oa c{ t-{ao6l 6loo c! cooo c\ lOoo C.l (o oo c.l F.oo c\ @oo c{ O)oo c.t o oN ra)N oIo! -.!s8ts \dPb $aRo oE*tD "'!?EE E ESE H^E EBS E o.9EdIl € (l)i .i3 cd ol .t+r! E gE EEE .EHtD BEItr .sr 5 .9P'g€qtj orH-O E.Eq() H..I E g.Q ,E a[T, e-r 'dl 6 E{lEoal L) .E .et 3 € E"i(! H' o.r{i tr -dtr 9'+J H 3..E EEHEfl; 'd oil EEs438 efrE xrr il Et.u E-'.1 tu $ooN 2-7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (glease tick the appropriate answer) MOH D .'/ WHOD I]MCETD NGDOtr Other (please speci&): Mectizan@ delivered by - (glease tick the apprcpilate answet) MOH n ./ WHOtr UMCEFfI NGDON Other (please specifir): Please ilesgribe how Mectizan@ is ord.ered and how it gets to the communities. fhis year's Mectizan@ for the project was jointly ord.ered by the NGDO and Southwest Provincial Special Fund for Health following the requests from the ten health districts of the project. Mectizan@ was ordered through WHO office in Yaounde. The drugs were collected from WHO by the NOTF and handed to the NGDO who latter on transferred the dn gs to the Southwest Provincial Special Fund for Health. From there the drugs wefe distributed it to the various health distric'ts through the regular drug delivery system. The Nurses in charge of each health area collected Mectizan@ from the districts according to the request by the CDD's of each community. This year drugs were delivered on time and in sufEcient quantity. Stock management of the drugs was good at all levels. I(umba, Tomble, Timbe and Muyuka had a balance of 131 894 tablets of Mectizan stock in the district before the start of distribution 2006. 26 t) {Jo Ed +r o c(6 N 'tr oo fH o ,{o € E z h0 tr GI E 0)tr tda C6t+ cr: co co F-g\ o)606I F- o o o) c\lli co co o I6lo co co O) co c.l o $o co .6 0)t{ B frl o o o o o o o o O o o .6 o t) .6 E s 6t 6lN s!r <oco o) c\ c\ o) t- cqoc\ .6 0) CEotr F{ tr oo r<oA oll:F ro cr: o)o ro 6A (o !d. c\ 6!A oOI6Io t-!r co @ CD rJ) ll: ott CDo ro @O 6t r- co .+ r-c\ @r- lO(o .S$r-@ c\ -l d) op Io lr)(o ro 6I ct)o ort!6l6 c6 o)N$ cot-6l 6t(o <i ao 6l CO!il c\o F{ oo o AI €F.t- r() colrla ts-o !S C] colJ)q) I c{ 60 ca asgE EoIo Ec! 8ra)lt) O) E 5 aPIt- 8o CO 60 ooo co{ Eco CO E ooo rr: o) ooll)o6)o d 0) o3sItXoo F4 pa Eo rJ: oooi 8lI)rl!o oatp a!i : o 8 co co E co .+ Eco(o o 8 o8lr)o 8 !.(!Io {J c.) t{{ja o -g<t!o(a< frl(J z pq f:I m fEI D o M ca aD M rn cn E rl frl(5 z o ea g E t- D C5 z o E J frl Eo E Fl HoH f-6t _a'\ l"' N 016q)(Jq) ^q\ h E R I H E N q) ta(! -a)q xHo Ho H @ H(d N 'd (.) 0)k!{a iir ol -ol c6l E{l How are the remaining Ivemectin tablets collected and where are they kept? The remaining Ivennectin tablets are collected through the same channel in a reverse manneri from CDDs to health centre chief of post, through the district to the central dnrg store of the essential dmg programme at the province for storage. This year the 81104 tablets are in the districts and health areas. State activities under Ivemectin delivery that are being carried out by health car,e personnel in the project area. fhe health care personnel carried out the following activities under Ivermectin delivery. 1. Mectizan requests 2. Tbansportation of Mectizan@ from the province to the health districts and to the health areas. 3. Monitor and supenrise the distribution of Mectizan@ to cDDs. 4. Storage and. stock Eanagement of Mectizan@ ie Reporting on Mectizan@ Any other comrnenf,q Non 28 t I a 1 i t i I 2.8. Community self-monitoring and Stakeholders Meeting E[as any fraining 6f trainers) for commuaity self'monitoring been doae in the project area? Yes. Lf so When? During flaining on CDTI in SW I project zone. Table 11: Community self'monitoring and Stakehold.ers Meeting Lqaa rows if needed) Describe how the results of the community self' monitoring and. stakehold.ers meetings have affected project implementation or how they would be utilized during the next treatment cyde. Though TOT Has taken place on CSM, as of now, communities are yet to carry out this activity, probably because there is no specific fundiog for this important activity as CSM monitors demand. compensation just Iike what is given to CDDs. No community self monitoring sessions were carried out this year. Di-stricU LGA Total # of comruunities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting(sHIvI) lsANcpt\,r I I nttur IiC,ME irnrl,rn-r_ _ I,IMBE IURpN(]E _ruLI_tEl__ N(;I.ITI TIKO T(-)\IBEL B2 l:l 54 0 0 0 0 0 0 10;l 6 0 0 0 0 6G 45 0 0 0 0 84 0 0 15 0 0 GO 0 0 TOTAL 478 0 0 29 t i a 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Central Level - NOTF - NGDO Health Area Level - Health Centre nurse Intennediar-v' level - Provincial delegate - Provincial Chief of Service of Community Health - Oncho Pro.iect Coordinator - Finance Officer - District Medical Officer - Chief of Bureau Health - Chief of Bureau of Administration and Finance - ChietMedicalO{Iicer of Distric( Hospital PeripheralLevel CDD Dialogue structure members Conununity members C 30 2.9.2. What were the main issues identified during supenision? Full integration of eye care into CDTI is still on going. 2.9.2. Was a supenrision checklist used? There was effective supervision in most of the health districts, and well developed supervision checklists in the districts were used. 2.9.4. What were the outcomes at each level of CDTI implementation supenrision? Poor record keeping. Health centre staffs are overloaded with a lot of activities. CDD were disgruntled for late and low financial motivation 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback ugEd 1q imFrove the overall performance of the project? High level commitment from the few health staffs and CDDs who were willing to work. 3l I I SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipmett (Please add more rows if necessaty) tCondition of the equipment F=Functional, CNFR=Currently non'functional but rcpairable, Wo=Written off) How does the project iatend to aaintain and rcplace existing equipment and other materials? The equipments are used also for other proBTams and the cost of maintenance is shared with other projects. The project will request from its partners to replace existing equipment and other materials. ,l I Source Type of equipment APOC MOH DISTRICT /LGA NGDO Others No Conditio n No. Conditio n No. Conditio n No. Conditio n No. Condition 1. Vehicle 2 Good 2 Good 2 Good 2. Motor cycle(s) 30 L7 20 6 3, Computer(s) 2 10 L2 1 4. Printer(s) 1 10 t2 t 6. Photocopier (s) 1 1 10 1 6. Fax Machine(s) I 7. Others d Flip chart stand 1 3 b) Overhead Proiector 1 c) 32 : II 1j 3.2. Financial contributions of the partners and comrnunities Table l3: Financial contributions by all partners for the last three years If there are problems rrith release of counterpart funds, how were they addressed? There were no problems in releasing counterpart funds. Adfitional comments. 3.3. Other for:ms of community support Describe Gndicate forms of in'kind contributions of communities if any) 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount e:rpend.ed in US dollars using the cunent United Nations exchange rate to local currency. Indicate exchange rate, lUS dollar was 525 Contributor Yeer5 (2(M) Yerr7O(XXi) YqrS (2N6') TOTAL Cash Budgrtcd (US$) TOTAL Cash Rcleastd (us$) TOTAL Cash Budgvted (us$) TOTAL Cash Rslcasld (US$) TOTAL Cash Budgvtcd (us$) TOTAL Cash Rclcased (us$) MOH (Central + ProvinciaUState) 50885 0 0 0 50885 50885 MOH (District/LcA) 0 0 0 0 0 9600 Locsl NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partne(s) 53126 39558 44363 27665 34280 14378 Others 0 0 0 0 0 0 Communities 0 0 0 0 0 0 APOC Trust Fund 62022 50857 33863 0 15000 17353 ITOTAL 166033 90415 78226 27665 100165 92216 33 II 'l .) Table 14: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditur e ($ US) Source(s) of fundine Drug delivery from NOTF HQ area to central collection point of community 67 SSI Side effects m4pa6e.1trqBt_ . Mobilization and health education of communities CDDs lT_qqining of health staff at qll leyels l$usrvtsi+e CDDs and distribution CDDs Motivation Dis tric t Sup ervisioLald !qa,_4-]to 1!ng .of C DI' I a ctivitie s Advocqqcy visits t9_!.9g-!!h -q4q political authorities IEC materials E"ep__a:ry_09p"oTt&d_fqryB9_f9_{"t-rsqtgq! Vehicles/_Mgtorcy_cle5/li_cyc_les maintenance Office Equipment (e.g computers, printers etc) Others District Temporal Staff 789 9554 6370 L429 la zeg I 600 t0 482 1590 2L62 ssl APOC APOC APOC MOH MOH $!r wHo ssr Provincial Supewision 300 MOH Comrnunicatiou 95 SSI Planning Evaluation meetings 10 883 SSI staff cost 5639 ssr Launching Insurance of Bikes and Vehicle 3202 SSI External Monitoring TOTAL L7 353 33 319 28 169 APOC ssr MOH Total number ofpersons treated MesolH5per ommunities HyIo communities Total 268 499 158 709 427 208 Any comments or explanations? 34 of SECIION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period?(tick any of the following which are applicable) o_ Year 1 Participatory Independent monitoring o_ Mid Term Sustainability Evaluation _Not applicable 5 year Sustainability Evaluation o Intemal Monitoring by NOTF Other Evaluation by other partners At t^he e.nd of the year there were bealth area, health district and a joint Southwest 1 and Southwest 2 provincial evaluation at the proviucial delegation o{health in Buea. these evaluation meetings brought together actors at the various levels. One of the mai'issues that carne out of this meeting was that for Vit&miB A supplementation to be made alongside CDTI as Vitarnin A capsules ald needed resources need to arrive the.provin@ on t'me. 4.1-2- What xrere the recommendations? Given the reduced funding from external sources, the health districts should completely integrated CDTI activities in to the PHC. Resources needed for integration of Vitamin A into CDTI should be made available well ahead of time so as to jointly carry out CDTI and Vitamin A supplementation. 4.1.3. How have they been implemented? These can only be implemented in 2007 4-2. Sustainability of projects: plan and set targets Gmandatory at Yr B) Was the project evaluated during the reporting period? -NO-The project was evaluated for sustainability in 2003 and sustainability plans for 2004,2005 and 2006 were submitted. Was a sustainability plan written? - Not applicable When was the sustainability plan submitted? -Not applicable What arrangements have been made to sustain CDTI after APOC fundi"g ceases in terms: I 1 I 35 I I I I !I I 4.2.L. Planning at all relevant levels RECOMMENDATIONS FOR THE PROVINCIAL LEVEL RECOMMENDATIONS LE\TEL OF IMPLEMENTATION A}.ID INITEGRATION 'p[aaning' 1. The roles of each partner in planning and other CDTI activities should be clearly defined and adhered to based on their project prcposal. 2. All parties should be involved in the financial planning. 3. Specific 3 year plans for sustainability should be made and followed up iumediately by a 5 or 10 year plan. A schedule/document issued as a reminder to all partners on their roles and responsibility was distributed by the PDPH. A detailed integrated Sustainability Health plan containing all CDTI activities is available at all levels. Specific 3 year plans for sustainability was drawn in 2003 at all levels. 36 Monitorin g/Sup ervision' 1. Supervisory visits should be planned, targeted and integrated with other PHC progTammes. 2. Supervisory check lists should be a 'shared tlpe' or integrated checklist, so that it could be used for most PHC activities carried out at this Ievel. 3. AII Health programmes should be involved in CDTI activities. 4. Fuuds from dependable sources available for these activities, especially governments own. Supervisory visits are planned, targeted and integrated with other PHC programmes at all levels. Reports indicating planned & targeted Monitoring/Supervision, Performance this treatment cycle has been greatly improved. Integrated checklists are available at all levels, Government funds for activities were provided at all levels. Mectizan pr(nrrement ard Distribution' 1. Mectizan ordering, procurement and storage should entirely be the responsibility of the Province through the Essential DruB Programme. 2. SSI should empower the province to enable them take up this task. 3. NOCP should ensures that the right quantity of mectizan gets to the projects well ahead of time for distribution to the communities Mectizan onder/ inventory forms at the Provincial Essential drug Pharmacy, Reports reflecting timely arrival and distribution of Mectizan are available. The concern respected these recommendations, ' fpainingllIESAI\{' 1. Training should be more focused to needs. 2. Training should be integrated with other PHC activities. 2. HESAIVI activities should be properly planned and effectively implemented. 3. Appropriate HESAM materials should be available for use. Districts carried out integrated and targeted lrqlqr4g. Commitment of the various stake holders and ownership of pnogram is greatly improved especially the endemic communities. The results reflect their performance. 37 We intensifred HESAM at all levels. We had HESAI\d NOCP. some stock of materials from Integration of support activities.' 1. Integration of CDTI into other PHC activities like EPI, HIV-AIDs, etc at this level. Provincial Schedules of integrated support activities with CDTTI in PHC programs are drawn each year during planning meetings and strictly respected within each vear. 4.2.2. Funds 'Finance' 1. Appropriate financial planning and budgeting of CDTI activities should be carried out at this level and should be reflected in the yearly Estimates of Recurrent expenditure for the delegation. 2. NOCP should ensure that Government commitment for all pmjects in Camerouni towards CDTI sustainability is maintained. 3. Contributions of the various partners/stake holders at this level should be clearly spelt out. 4. The project accountant should move down to Beau from Yaounde, or the Provincial Chief of Service for Admin and Finance should take up the task of accounting for all aspects of CDTI at this level. 6. Delegate and SSI should put in place a process that is sustainable, more realistic and less complicated for fund management. We respected these recommendations 3E I , I , 4.2.3 Transport (replacement and maintenance) 4.2.4. Other resources 'Human Resources' 1. The Provincial Oncho Task force team should become more involved with CDTI activities as weII as the operational running of the SWI project. At the beginning of each year an operational plan is drawn Scheduling aad assigning each person on their activities. Micro integrated plan of action 'Coverage' 1. Therapeutic coverage should be improved upon. 2. The issue of treatment in Hypo' endemic areas should be addressed bv NOCP /MoPH Therapeutic coverage has rapidly improved after post APOC period. NOCPi MoPH has no objection distributing in the hypo zones. 4.2.5. To what extent has the plan been implemented We covered the three year sustainability plan submitted in 2003; integration of CDTI activities into the minimum package of aII health care programs is currently ongoing. However, the state has not fully assumed total responsibility of funding CDTI activities. At the end of this yeay's evaluation meeting, the province and all districts of CDTI SW 1 werc nequested to submit other three year sustainability plans from 2007, 2008, and 2009. ' TrottsporUother Resources' 1. Maintenance and fuelling of project vehicle/motorbikes should be properly planned with Provincial funding. 2. Realistic plans for the replacement of vehicles should be made. 3. As the project is in its 5th year, and the fact that the vehicle has been efiiciently managed even after the motor accident last year. Replacement by APOC is strongly recommended. The Provincial Delegate of Health has taken full responsibilities in Maintenance and fuelling of project vehicles/motorbikes APOC has replaced the project car as strongly recommended by the external evaluators in 2003. We havejust received a 4x4 HILUX from WHO CR in Cameroon. 4..3. Integration 39 a aOutline the extent of integration of CDTI into the PHC structure and the plans for comp lete in tegra tion : 4.3. 1. Ivernectin delivery mechanisms, This activity was integrated into the drug supply system of the MOH through the essential drug proBram. The South west Special fund for health is in charge of storage and delivery of Mectizan in the districts. 4.3.2. Training To minimize cost, all the district trainings are integrated. This year Eye Care was carried out during CDTI training. Information on other health programs such as Routine Immunization, RoIl Back Malaria, Leprosy and Tuberculosis are usually carried out simultaneously. Coordination meetings at District and Provincial Ievels ensure that issues concerning all programs are discussed. 4.3.2. Joint supewision and monitoring with other progrrms During supervision of CDTI activities for instance, some time is allocated to supervise other pro8rrms as already enumerated above.It must however be stated that sometimes time and financial constraints make it difficult for effective supervision of other activities. Provincial and especially District and Health area staff are so polyvalent that they implement all activities at their level. The transport means available are used for the implementation of all health programs. 4.3.3. Release of funds for project activities MoH contribution in cash is coming on very slowly; the MoH is still to allocate budget line for CDTI activities. Sightsavers supports activities at all level with funds. 4.3.5. Is CDTI included in the PHC budgetr The district and health areas state budget carries a specific line on supervision of health activities. CDTI is part of the health programs they run, Hence this budget line is used for CDTI and a[ health programs. There is no particular budget line for just CDTI. Not all the health areas have state budgetsi some are run private t confessional bodies and hence have no funding from state budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. what have been the achievements? t 40 I I The Expanded Program of Immunization (EPI), Roll Back Maria, Leprosy, Tuberculosis have benefited from the use of motorbikes at health area level as well as Onchocerciasis project vehicle at provincial level for supervision of their activities. CDDs trained through CDTI initiative have become the link between the communities and health stmctures and are therefore used by all health prcgrams to reach the community. Now they have been trained to do visual acuity and most of them carried out the activity. They are also used by EPI to register children newly born in the community so as to recruit them for vaccination. 4.3.7. Describe others issues considered in the integration of CDTI Currently the eye care program is being integrated into CDTI program at all level. Roll back malaria, TB, HIV/AIDS, Leprosy and Brulli ulcer control programs are using CDDs at the level of the community to implement their programs. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No research carried out. 4.4.2. How were the results applied in the project? Not applicable. I a 4t t zfrl M H zo H C) ts3,,; 8FE cdX :ET: HEEur=E t+a td H- E b,'E 3I t'atotl tr "? E3< 8.E E{ nO t € (n o +J 's Hg €Letd5q)ho c) *{kcdoHF E EE$#; EE gi *E E iEE= r *ET H:E f,E HE;E E rd.J o H3 H.tr qtuo ',{ 1. 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(l) o+J 5 Hfi g ?i $E5.86s xolr .E .E E o* E €.8 " qE Ie Et.dEE;a .r{o'H'.,8fl€ H# +) H o)d 6 ot{ oo f.t fr{ E-t() fElAa Ho +) oal EEE9(!HF{ 6)bDtsor+F{ ctA.H d >rO+) .d HCU5gH'6 EEocdOp{ q{ o o €.s 8s J , cl\r ui cD(I)ItA tr .9 "dHEEBOtd6 .EE 3e .=o *,FEr()€ tsa cnooE9'ogH _u.9 'd r5otrFE EHd (,1o)o -q boB6 EEJr .qo<) ooAA oo FI Fl u)o c lroqq o6dd oto h0 c(l) c6A c) a; oo CN o -q Cd o F ot B tro Ea to zo E-tO Ha .L xE', EEE :HsfiEErrdavodrEg, oq)!€ tsqI .i +)r{d r3E EE A ,{ 8d o t ood cr.9 EE a -6(!(l) E.q aA -.kcl(l)op{E o(aa 85 .9, FI .dE+,at 3s €9{ o9{r tj b88€o;{ >cSdq) <Iq .1 a HE HEo)trg: s'E rc 0)o'(,OHHo) oO 'i O. g -e'9 o.r fi +) ?-EE o hDEH E- eE$u)9riE^,U Qc) !jjg'E ag H E B-< fi EsH .d'r5qtr E.o QdPO Ftg^3 6.IJ E <l) nE# ett or uoe! d{J .dL sa ,8aooEE -E T Hgcq 36 Ex.sE EHEii s5I HEEd*3 a Bo{(D6i €.c; ho.E .9q- ((! nE c6!)+jE B.g -cl(l)ko HSH:fie.q trB1 "B E g EgBS e $r r f =ai ,da 6€.s Ets 0)6 o q dN +,(J o) E EE5() Pfidq) A4bDtrEd HE EEt{ o)4...5"E fr5* o)r{o){P =OE*E=gHE --8 r'E 5 .eE I q ttc € o'.=Eo xa esE 9?uo .9 -:5fE E H€ H EU EEE;€EE^HE E€E.iEE E+ IE aei l E B"q'E EE6 EF lo'-d'6 rl - .H .i (D t! aEbEEH/-H , H.H '-l E E E, H.,Ah E-8. f, E ste e tD(Dt:C)ft-t .E 3 TEE"Ht g Ef s6 sE E 80s: H* -ia(D€(DO(/) E E B be B 3 ES 3 E": E E-aE$*E a,- tr - (D ! -x:Jo(D>ooT H€€ 8€€ o(D € ;'6(l)ErB Efi H -or. o(l) ",dfiqE E b3 .l= +)d x .!tr €trcdot'5(l)LdllAE.; EE E EEC).iJE EE=tsE Eg EE' iuHsE# fi3,Ecs EEAS iD-a aiac! crt Xt{ f{ Eluo o r)o(D +j ..rho .= otoh0.o hD(d c\ (d >e tr CrJ r{ 8 tn tr-{ O(- C)- (h o) +) <;H HdoIdHtrori() o .J t cnq) tr t7)$ J SECTION 6: Unique features of the projecUother matters ? { o 44