CDTI SW II annual project technical report submitted to Technical Consultative Committee (TCC) : December 2004 to November 2005

RESERVED FOR PROJECT LOGO/HEADING i<: S ( i ORIGINAL : English Proiect Name: CDTI SW II ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TtrCHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSTON: To APoc Management by 31 Januarv for March rcc meeting To APOC Management by 31 July for September TCC meeting AFRICANPROGRAMME FOR NCHOCERCTASTS CONTROL (APOC) cEU Brl cs! bP ^H€gfo tu '.',,,,,igimcrllon -(cc-9+ 2 I A0llr 2000 H COUNTRY/NOTF CAMEROON Apnroval year: 1999 Launching year: APRIL 2OOO Reno Period: From: DECEMBER 2004 To November 2005 (Month/Year) Month/Year) Proiectvearof thisreport: (circleone) I Z 3 4 (5) 6 7 8 9 10 Date subm itted: DECEMBER 2OO5 NGDO partner: Sight Sovers fnternotionol r D\t I t- I I ! I I A, Aftlth I WHO/APOC, 24 November 2004 t v \ I :F, i ?. I E L r s E * = E *I iII tI $ $g EE it -; a .i ! A N N I IA I-, PROJECT TECHNICAL ITEPORT TO I t,( 't tN t('n t, CONSIILTATIVE COMM ITTEE (TCC) ITNDORSEMENT Irienr('c()rrl'irnr you have read this report by signing in the appropriate space. OFFICERS to sign the report: ('otuttry: CAMEROON Nrt(ioturl ( 'orlt'dinator Name: Dr. Ntep Marcelline Signature: . Date: ...3.0. .20.a 6 l'rovinoial Delegate Name: Dr. M, N e Martin Signature: .... Date erl4.9 N( ;lX) Representative Name qs"* Signature: .. Date 3, Sa- >-e- G l'rovincial Oncho Coordinator Name: Mr. Eb Signature: ..... Peter Oponde Date: t*" { r-4 I lris report has been prepared by Name: Mr. Ebongo peter oponde Designation: OPC SWII.. Signature: Date .-i,. trh P{ [' ll WHO/APOC, 24 November 2004 N. ""f I RES ERVED FOR PROJECT LO GO/HEADIIYG COUNTRY/NOTF: CAFJTEROCN ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TtrCHNICAL CONSULTATIVE COI\{MITTEtr (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAI\ PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) Proiect Name: CDTI SW II Arrproval Year: 1999 Launching year: APRIL 2OOO Renortin g Period : From: DECEMBER 2004 To November2005 (Month/Year) Month/Year) Proiectyearofthisreport: (circleone) 1 2 3 4 (5) 6 7 8 9 10 Date submitted: DECEMBER 2OO5 NGDO partner: Sight Sovers fnternationol WHO/APOC. 24 November 2004 TANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the approp riate space. OFFICERS to sign the report: Country: _CAMEROON National Coordinator Name: Dr. Ntep Marcelline Signature I i I I I I I I ! ! I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Provincial Delegate Name: Dr. Signature: Date: ...7 0. .?g.a ( Martin Date: . Name: t >.rfi gOI NGDO Representative b. ?'P:"* Signature: ... Date 3p Sa- >-e-- Q Provincial Oncho Coordinator Name: Mr. Eb Peter Oponde Signature Date: ,*, { .uol. ^, .-, / v' ,/l \l t, . \s.<. t. \)...... 'l'lris report has been prepared by Name: Mr. Ebongo peter oponde Designation: OPC SWII Signature: \ Date ',"Unl li. I ! I I I I I I I I I II WHO/APOC, 24 November 2004 Table of contents ACROI\rYMS V DEFINITIONS FOLLOW UP ON TCC RECOMJ\{ENDATIONS....... I EXECUTIVE SUMMARY.. 1 SECTION 1: BACKGROUND INFORMATION....... 1.1. GeNBnar. rNFoRMATroN............ 1.1.1 Desuiption of rhe project (brieJly)........... Location.. Manyu....... Lebiolem Kupe / Muanenguba l. l. 2. Partnership....... 1.2. PopularroN AND HEALTH sysrEM 1.2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI.....- 2.1. TrueLrNe oF ACTrvrrrES ........-... ....... 102.2. ADVocACy ......................122.3. MoylttzttloN, sENSITIZATIoN AND HEALTTi EDUCATToN oF AT RrsK coMMUNITIEs l22.4. Cotr,tt,rtxlry INVoLVEMENT........ ......142.5. Capacny BUTLDTNG.. ...... 162.6. TRearupNrs.............. .....1g2.6.1. Treatmentfigures.......... ........... Ig2.6.2 What are the causes of absenteeism? .......... .................222.6.3 What ore the reasons for refusals?................ ............... 222-6.4 Brie/ly describe all known andverified serious adverse events (SAEI) that...22 2.6.5. Trend of treatment acltievementfrom CDTI project inception to the current year24 2.7 . ORoeRrNc, sroRAGE AND DETIVERy oF IVERMECTIN .............. ...............252.8. covvuNtry sELF-MoNIToRTNG aNp SrarpHoLDERS Meetnrc ............262.9. SuppRvrsroN ............... ......................272.9.2. ll/hat were the main issues identified during superttision? .............................. 272.9.3. Was a supervision checklist used? ..... . ....2g2.9.4. What were the outcomes at eaclt level of CDTI implementation supervision? 282.9.5. Was feedbock given to the person or groups supervised?................................ ZA2.9-6. How was the feedback used to improve the overall pedormance of the project?)aLU SECTION 3: SUPPORT TO CDTI 28 VI 4 4 4 4 5 6 6 6 7 8 10 EqurrveNr FnqaNctal coNTRIBUTIoNS oF THE pARTNERS AND coMMLrNrrrES...... OrspR FoRMS oF coMMUNITy suppoRT.3.4. ExppNorruRE pER AcTrvrry SECTION 4: SUSTAINABILITY OF CDTI..... 4.I. INTCNNAI-; INDEPENDENTPARTICIPATORY MONITORINC; EVAIUATION...... 3.r 3.2 aaJ.J 28 T 1u WHO/APOC, 24 November 2004 4.1 .1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable). . .... . .--..-.---- 31 4.1.2. What were the recontmendations? ......-...--. 3l 4.1.3. How have they been implemented? ............. .................32 4.2. SusralNasrr-rry oF pRoiECTS: ILAN AND sET TARcETS (MANDAToRY AT.... ............32 Yn 3)......... .................32 4.2.1. Planning at all relevant 1eve1s......... ...........32 4.2.2. Funds....... ............... i2 4.2.3 Transport (replacement and maintenance) .... 32 4.2.4. Other resources ...... i2 4.2.5. To what extent has the plan been implemented............... ............... 32 4.3. INrecRarroN............ ......32 4.3.1. Ivermectin delivery mechanisms............... ................... i2 4.3.2. Training... ...............32 4.3.3. Joint supervision and monitoring with other progroms........... ...... 33 4.3.4. Release offundsfor project activities ........33 4.3.5. Is CDTI included in the PHC budger? .............. ........... 33 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................... 33 4.3.7. Describe others issues considered in the integration of CDTI. ..... 33 4.4. OppnarroNAl RESEARCH .....33 4.4.1. Summorize in not more than one half of q page the operational research undertaken in the project orea within the reporting period. ........ 33 4.4.2. How were the results applied in the project?............. ......-............. 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 I IV WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SI{M TCC TOT UNiCEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Or ganization Community-Directed Distributor Commu nity-D irected Treatment with Ivermectin Community S elf-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization No n- Governm ental O r ganization 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 I WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in mesolhyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) @al (UTG). calculated as the maximum number of people to be treated annually in mesolhyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated, in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of cor4munities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage) (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supen'ision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitorine (CSM): The process 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 community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. V1 WHO/APOC, 24 November 2004 FOLLOW UP ON TGC REGOMTYIENDATIONS y#fr:T;:il",l.:|,o};#:i'Jjl'recommendations of the rast rcc on rhe project and describe TCC sessio , 1,,A I I Number of Recontmendaliott in the Report RECOTWI,TENDA?IONS TCC PROJECT ACTIONS TAKEN BY THE FOR TCC/APOC JIIGT USE ONLY 22.i the Mectizan tablets left over after the treatment round. P'rovi din foln rob 'ma tio o n The full boxes of mectizanthat 22.ii previous years as requested in table lI and an understandable table 72. Provi a mding pl figures for th e funds used in the The APOC FInance officer hastaken no te of this and the situatio nshall be ameliorated ln this report. 22.iii rWo ki rdhang to redu ce refusa as and bsen teeisrn intensification of HSAM -Planning with community on the convenient periods of Mectizan orstnbutron -U.ing door to door distribution strategy -Disp.elling rumours on dangers ofMectizan. on 22.iv ronger steps to CDTI into pHC. Taking st in tegra te PHC census/distribution fo CDTI rnto ISprogressively taking Iace.p Recently CareEye was intorntegrated CDTICDDs during fomecfizan also did visual acu ttyAPOC and SSI motor bikes are edus to outcarry EP1, LeprosyMCH and Roll Back Malarta activitie S IN n integrated mannerThe foscarcity INstaff the health cunrts om els Srp totaff do this; 'ISCotherw wouldthey not be able toco with,pe the workload. Due tolim ted resou rces the atstaff al WHO/APOC, 24 November 2004 been instructed on rntegration of activities levels has regularly 22.v utting into better use the 53 motor bikes. P mentioned above, the motorcycles are used for all health centre activities. Emphasis has been Iaid on better maintenance of the motorcycles by use of resources from different programmes and MOH. The use of Log sheets has also_been emphasized although this is taking Iong to sink as the culture of keeping log books is not so common especially with As already owned vehicles.22.vi Increasin Meetings g Advocacy commencement of Mectizan distribution this year. Opportunities were seized during National events to carry out advocacy. These were preceded by personal contacts with Admin Iigious districts Advo carrwas 'lecacy d out among strative Repersonnel, Leaders Chiefs and tn allMayors the health before the hi (Please add ntore rows if necessary) Executive Summ ary Prepare an Executive sumn,ry of the report in not ntore trtan one poge. 1. background on treatment and population data I:jffommunities, communities rreated, totar popuration, urc, ATo and persons southwest II CDTI project was approved in lggg but launched. in Apr.il 2000.At the beginning of the 3rd quarter of this yurr, t*o r"* health districts werecreated by a Ministerial order splitting r'""t"* and Mamfe Health Districts.The newly created districts u." Eyrroo:L"k ,oi wruune sprit from Mamfe andFontem respectively' The project now comprises of the following Health 2 \ WHO/APOC, 24 November 2004 Districts in alphabetical order: Akwaya, Ekondo Titi, Eyumojock, Fontem, Mamfe, Mundemba and Wabane. The project still consists of 40 health areas. The communities have however slightly increased from 452 last year to 504. This is because smaller communities in Akwaya and Fontem Health Districts that were merged during REA in 2002 and treated as such during Mectizan distribution are now being treated independently. The communities want to be identifred. Treatment this year would still be reported according the original 5 districts. This is because the new health districts were created after atl CDTI activities had taken pLace. Due to grievances from CDDs because of unpaid motivation of last year by government, one community was left untreated in Fontem Health District. This was discovered only at the end of the treatment period. Consequently, the geographjical coverage this year is 99.8%.The population in meso and hyper endemic communities in the project area is 213-988. The ultimate treatment goal was L79.750. The annual treatment objective of the project was 771.872. 155.911 persons were treated giving a therapeutic coverage of 72.9% as against 71.3% last year. 2. Background on population movements. Population movements were still noticed during the present distribution period as a result of farming. The organization of the National Immunization Days against Poliomyelitis during Mectizan distribution period (February to May 2005) again pushed the distribution way out of the distribution period. So it is difficult to say if tlle reason for high level of absenteeism can be blarned on population movements or not. As observed last year, some persons use the factthat distribution is carried out during farming season to stay away because those who are interested usually do everything to take their doses of Mectizan. However, HSAM has to continue to be intensified to solve this problem by targeting the communities concerned. 3. Training data - CDDS, health workers, Total population (community) per cDD trained. During the training in preparation for the 5th year, the recommendation (targeted training) of the midterm sustainability evaluation was not respected. All CDDs and health staff in the project area had to be trained on Eye care because this had to be integrated into CDTI. This explains why the ATO is far less than the actual number of persons trained. A total of 805 CDDs were trained as against 544 targeted for training. The ratio of CDDs per population therefore stood at ICDD/266 persons. A good number of CDDs continue to desert the activity as a result of no motivation from the community and delayed payment of government promised motivatio n of 25 francs per person treated. A lot of intervention from District team members and some community leaders to get some of the CDDs to do distribution and submit reports had to be made before some of them accepted to go in for training. It is foreseen that it will be a Herculean task to get the CDDs to work in2006 if government motivation for 2004 is not paid. 4. Challenges and horv they were overcome. The non-payment of CDD motivation by government risks killing the project. CDDs have sworn not to carry out distribution in 2006 if nothing is done to solve this problem. The authorities concerned have been informed. Community leaders rvere called upon during 3 I WHO/APOC, 24 November 2004 appraisal meetings to motivate their CDDs and appealed to them to be patient with government. Govemment contribution in cash is still not palpable, as no line has been created in the budget for CDTI. However the Vote Holders at different levels have been called upon to provide pooled funds for CDTI activities and document them so that govemment contribution can be rnade palpable. The replacements of the present APOC motorbikes which are depreciating because of age and over use remain a major problem. The District and Health Areas have applied to APOC for replacement of the rnotorbikes. For other equipment, the districts are abeady maintaining them and will be able to use the same resources they used to obtain them to ensure their replacement in future. SECTION {: Background information 1.1. General information 1.1.1 Description of the pro.iect (briefly) Geographical location, topography, climate Population: activities, cultures, language Administration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. Location Thc South West Two (SW II) Project Area is made up of three aCministrative divisions (Ndian, Manyu and Lebialem) of the South West Province of the Republic of Cameroon. It now covers seven health districts (Mundemba, trkondo Titi, Fontem, Mamfe, Akwaya, Eyumojock and Wabane). The last two health districts were recently created by a Ministerial Order. Most of this project area is characterised by dense and luxuriant equatorial forest except for part of Akwaya Health District especially towards the border with Njikwa in the North West Province and the border with the Republic of Nigeria, which has Savannah vegetation. SW II has a very harsh topography with many rolling hills and valieys. This renders the terrain very rough making accessibility difficult. In most of these valleys run fast flowing streams, providing good breeding grounds for the black fly, simulium. This area has two seasons; the hot dry and the wet rainy seasons. The rainy seasons are usua-lly long (April to mid November) during rvhich the streams get flooded. The road network is very poor rvith all roads being earth roads. These roads get very slippery and muddy during the rainy season making work in the fieId difficult even with a four-wheel drive vehicle. To get to Akwaya one has 4 WHO/APOC, 24 November 2004 to go through the Republic of Nigeria and drive across large streams with no bridges and rough mountainous terrain. The main economic activity in this area is farming. Males are more concerned with cash crops, planting cocoa, coffee, and oil palms. The common food crops include plantains, cocoyams, cassava, yarns, groundnuts, maize and a rich variety of fruits and vegetable grown mostly by women. Tablel.l: Showing administratiue units, health districts and health areas, Division SubdivisionlDistrict Health District Health Area Ndian Mundemba Isangelle Kombo Itindi Kombo Abedimo Idabato Toko Mundemba Mundemba Lipenja Madie Ngolo Isangelle Kombo Itindi Pamol Kombo Abedimo* Idabato* Ekondo Titi Bamusso Dikome Balue** Ekondo Titi Ekondo Titi Kumbe Balue Bamusso Bafaka Bissoro Bekumu Lobe Bekora Illor Manyu Mamfe Upper Banyang tryumojock Mamfe Eyumojock Bachou Akagbe Kajifu Kembong Kendem lvlamfe Tali Bachuo-Akagbe Afap Ekok Eyumojock Ogurang*** Akwaya Akwaya Akrva Akwaya Amassi Bagundu 5 WHO/APOC, 24 November 2004 Lebialem AIou Fontem Wabane Fontem Wabane Fontem Azi Essoh Attah Fonjumetaw Fotabong Menji Takwai Bamumbu Bechati Fotang Kupe Muanenguba Nguti Mbetta**** Njungo**** *Kombo Abedimo and Idabato are health areas that are really non-functional as the areas are found in disputed Bakassi area and occupied only by soldiers. No civilian activity goes on there. **Dikume Balue is under Kumba Health District in South West 1 Project Area. ***Ogurang health area is the only health area without a functional health unit in Mamfe health district. It has no roads. Only trekking inside dense equatorial forest across large streams accesses the whole area. Health interventions in this area are done only through outreach from the district health service at irregular intervals. ****For the purpose of proximity and accessibility,-Mbetta and Njungo health areas in KupeMuanenguba division are administered by Fontem Health District in Lebialem riivision. SW II is situated between latitude 5o 12'and 6o 30'north and. longitude 8o B0' and 9o 45' east. As mentioned above this proje ct area spans in three administrative divisions, consists of 7 health districts and 40 functional health areas. The health districts do not strictly follow the administrative units such that a heaithdistrict or health area can cover more than one division or subdivision. The adrninistrative headquarters of the province is Buea, situated in South West One(SW I) Project Area SW Il shares boundaries in the west with Nigeria, in particular Cross River, Taraba and Benue States. In the north it shares boundaries with the North WestProvince; in the east with the West Province; in the southeast with SW I and is bordered in the south by the Atlantic Ocean. 1.1.2. Partnership Partners involved in the implementation of South West II CDTI project arethe Government of Cameroon (Ministry of Public Health [MOH]), AfricanProgramme for Onchocerciasis Control (APOC), Sight Saveis internationa-l(SSI) and the Community. These partners ail work in harmony for the smooth running of project activities. Planning is done with the full participation of the MoH, ssl and the community. They together also carry out supervision and mobilisation and monitoring of side effects during Mectizan@ distribution. Advocacy is usually reserved for personnel of MOH and SSI. Plans of action are usuallydrawn specifying which of these partners does what and at what time. 6 WHO/APOC, 24 November 2004 1.2. Population and health system The surface area covered by SW 2 is approximately 10,610 sq. Km. Registration update this year revealed a total population of 213.988 an increase of S.4OB inhabitants. This year data processing was much better and census updates were done together with treatment in most of the communities. The table below shows the population change since the onset of the project. Table shouts Variation in yearly population Year of activity Total Population l't Year, 2007 185,874 2"dYear,2002 172,956 3'd Year, 2003 L83,756 4th Year, 2004 542,596 5th Year 2005 213,gBg Table 1: Number of health staff involved in CDTI (Please add more rows lf necessary) HEALTHDISTRICTS Number of health staff involvet in CDTI activities- Total Number of health staff in the entire project area Br lNumber of health lstaff involved inCDTI B2 Percentage B3=B2lB1 *100 AKWAYA 28 13 46.43% EKONDO TITI 62 i6 260A IIoNTBI\{ MAI\{FE 64 17 73.40/, 36 28 I\IUNDEI\{BA 67 23 34Yo Total 257 127 49.4"A 7 I WHO/APOC, 24 November 2004 $ O CI () -o q) o z N O op. - A e, o 0)q U) 0)o t< o U) trod. o o o(, I I I I I I I I I I (n C)/ c-.E o ! 0)o' .b0 -c) ']:0 LAo'x o- cJ()r<=(Jd Pc)bo -( !H 'd(d o(dtrrooo) 'O .'! oq<0)o 'a c) ti<)0.!c.,7 .-A r<() .o .q a u-) 2E6€o* d ch .o *(cA ,2 t:.i =!?o5 ad -L(6_Cpi.tr OB .> ch €(C o)9EE dt< AP )Zo oB8 ()(d t< li '= bo q<H o li i d_) dL.l bO += trbo o=PH o (.) 9U, .eb -Yu) l< .E9 ,-qn ': o)LJL ;< (!rso 0.)4aH() cbo6cd I o.l 26!fiOi8(g q-.i ._A Al< .i OP tacx(Jd .vtrl >, q< o-oH QU) iI o-ila * o.ivk QO OJ{)fi Prh aO oxa*d0)=5oOa()s; --C E< ^H .6 .,O ._ .. 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IL() o o() ro N EO 6O Fo) (n c)L o c) .<f o\ta .+ ra o €\ v V) € ao !+(-l rao\ cl \f,r- r-ca ra \o \c .<r c-l.+ \o aa ra .EE e!! aQ= Ir -9?= .gts *ar 9' !^-^ co(.l er- co rr) .+ r-- lr1 r- rn g; \c) ra lj-) t? r- r- N o\ o\ ro e.l \O)ehdO v UDHO t-l (, C)ti+ L -A r|1 ! cJ -vUF] U E z frl Fr =a t-l Frz r-l a r-a z r-l z z I F F w o N L 0) ,-o o o z$ cq O o o. o\ E :O E55 .o .= ;5Fo' = A--o.=!=csdt+ -d q.< o6r-qoo; 'u -*.= r*E E tsE9 ^v)ae(dq$<<-1o g 8SE;=(d.=oc)\H-i{(d€o o 9ic.,E 'E ,Ei<(.13 E HiE: v B'fr;E 8, bf;;ino=E 8 &ETtr t :-6 > = n'd d# E EE: 'q 6 rHg =qP'5 .!J o E-o2 E' g[F -c '=tr g Hgtse ,; c =-oE-:;o '5o .= P-t 9'S .S 'E o.lEEl = o E,='= EF A E€g$i g 6ezz = bo U) ().= bo =Oqi=idCE b -.5 30'E d9N.P\ef5 -g sEs€o q< h O o -(I o .j h'H.s € I BEEE3 o., 'dI E c ^L!eLa = Qo E Ip!.<-L '-Pori-:q-i4 o, E.EU o-r3 E ;EgEi 3 IsrScd () Q= O?-.r -d.H!U.<YT, E EgEg ' qr =Ly'=H o -, d"s HI5 *.€ &EEt € ilu e€;€b ;E =5f p('J;U).:: (, a o2 ==E o-= ,-o- o(Hb s3 EIiH >. d d F.= o 6 .= tr oO E.-uv)C-trE^(n -L._.-Ve,\ = o > q<'o o XE € S o c'I tr5 gE sfi#;gd '; d iiq.E o.l€tr (-) (n E O= C ^i Sg reEI;E EE =F.gEE; 5.E EI.=SEBtr=-ia-Ee()OZ, gE 63EE,Ec I >.8 o 5o?n)4<f)?-1+;.=L<E Es :i€5u -lFdp ^=trcr:dvd-94>,d o d = I ='= 5!H <3 strilE3 I SEGTION 2: lmplementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treoted in current year, indicating when the key activities were implemented by the month they began and the month they ended. l0 WHO/APOC, 24 November 2004 N o -o () z wN r') A. (H o d o !()Ed o^ d tr)>\ v(u RE l' o->(9d H*z- ,-(Js E Ex(g'--.! t d o-p -q .rt'tr\9 eJ ^trdh3, 6/) (g -ll-7,36E.o ot r-'! C) U) 0-)I rr. 3'F -otr!E ., '- () (-) A V - tt o o-a o'N*t 9-\vi ^^60:ts = bo_c =.= L(-- () -d o' >! z:^oH }. h o-> uA-5 b(9H E > zdd:& ^ \E.;5.e9Nz;Li'F o'5 :E*oi-' ;1 >a (gHEHc.> ,o b X.qE';E* .i.-..j-6-< -d SFEd 1 tri ';j.9 --dn E bb.g .iz * 3 > c-r - I.-r.5€,5 u ,A-\v!9 + QE O =()!lco 26 aP.d-E qE o* F3s E e hvit!d0): ^PtsUtr36E OAO.H(d(H.- -o(d9(J E 3' >.tj aP-a =dNbo(drru5ot bO -^ O .Q rzl ia -q e aJ 4.IF } U< l-- C) J-itYioo.l cii 'H rr a .- - O.- 'IJo>9 A-*ijtrrg .n.E c0 n .\ U -aL;\trA>\ a OF-.{ LJ.H '<;i d € *vP,! o co E'EO O.; P!E >.s.= .c.2 or!dts()C'-F- - -rtp (n 0) oO I B 01 V)q) U\) 4 n \ q) L "d c q) b q) Lr-\: ! 0) (.) F =O o -d() ()k (n cO c-) L cO() Lo an() o (H o o 0) F ."it ol7t =tFI V) P c) a o () OOUE o \c coO coO \c) O \o -f, O EO r<E6O(nE Oc.tO O N O coO r)9 c.)o o coo o U) tr o o,+ OOUE rl O O co o ca \oO r)o vO bo LE cEo ac o c.) O ca o rl w O coO o OO \JE bo Ltr((o AE v) U) oU o o coO r)O w O caO o co ra) coOs O co o F () OOUE O a.lO r)O c\O r)o c.lo O .i- o o c\O bo LE(!o atr (\O O C\ o C\ O NOO q< o t:: q aO (la N= €. <) o c)OUE o NO c.)O OO O+ b! LEGo aa o c\ o NO c\l o ca raF <F .-i (/l v F F o zo H EA z rrl a z Z, E]IL a z rl.]F z ot\ FI F F 2.2. Advocacy State the number of policy/decision makers mobilized at eachrelevant level during the curent year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Advocacy was done to policy/decision makers such as Senior Divisional Officers, Divisional officers, Mayors, Chiefs of Services, Paramount Chiefs, Parlamentarians, all in an effort to re-sensitize them to be involved in the CDTI project in order to step up community participation. In Akwaya 31, Ekondo Titi 100, Fontem 96??? Of the above personnel were contacted. Increased community participation would mean that rrrore people take Mectizan, destructive rumours are dispelled, refusals reduced and CDDs are motivated. The outcome was more or less impressive. In Ekondo Titi and Mundemba Health Districts for example, the therapeutic coverage went above 650/o whichthey have never attained since the inception of the project 5 years ago. Fontem also increased its therapeutic coverage although Mamfe and Akwaya slightly dropped. Sonre difficulties faced were: l. Lack of funcis: MOH contribution was difflrcult to come by- because credits were disbursed only around the end of March 2005. Numerous bottle necks in liquidating the funds accompanied with the gross reduction in credit allocation compounded the iituation. APOC funds were also very late to come, in fact after most of the activities had taken place. SSI funds came early but small to cope with the numerous activities that had to be undertaken. 2. Community participation: In spite of the sensitization and health education given at all levels, traditional rulers have a very poor attitude torvards CDTI and all other health programs in general. They strongly believe that these programs have a lot of money and so they do not see any need why they sl-rould support their CDDs. In fact some request for payment to carry out an activity in their own community. To improve on the difhculties, all partners are requested to respect their engagements and on time. HSAM has to be intensified and continuous as it is not easy to change a people,s mentality over a short period. Although APOC funding stops at the end of the 5th year, we would be grateful if she can fund HSAM as this activity is very important for the life of the projecl. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information In Mamfe Health District a local radio station was used to disseminate messages to thepopulation in both vernacular and "pidgin" English; a commonly used languagi by bothilliterate and literate, indigenes and non indigenes alike. In Health Districts were radio I 12 WHO/APOC, 24 November 2004 signals are not received, megaphones and Town Criers were used. The Town Criers usedgongs and whistles to alert people and then pass on the required information. Announcements were made in schools and school children made to inform their parents. Mobilization and health education of communities including women and minorities Health persorurel and CDDs organized, themselves to meet different populations in clrurches, social groupings, national celebration points, e.g. Nation alDay,Vouth Ouy,Womens' Day which all fall within the distribution p-eriod.(February to May). SomeHealth Staff and CDDs used the person to person healih education stiategy in drinkingplaces. Various communities were also seniitized during National Immtirization DayI against Poliomyelitis which were quite many this year. Posters although few were pasted at community halls, churches, drinking places, schools etc. Response of target communities/villages It was not easy as usual to mobilize people in the village in order to give health educationin this project area- However the auendance in the g-roups mentioned above was betterbccause they were met during their meeting period. Iiformation delivered in these smallgroups was usually taken kindly and appreciated. Pcoplc rcsponded by asking questions for clarification and even expressed that they u,derstood l.hings better even if they ended up refusing the drug. Accomplishments Treatment reports of this year have improved? andthe refusai? rate has also reduced. Suggestwaystoimprovemobilizationandsensitizationofthetargetcommunities. The use of outsiders i.e. District Management Teams, Provincial Team to conduct sensitization in difficult or areas were coverage has continued to be low. people tend tolisten to outsiders than those they are used to. Because of the late arrival of APoC funds, mobilization was carried out timidly due toinsufficient funds- Consequently, funcis would have to be mobilized on time for effective rnobilization and sensitization to take place. 'fhc I)rovince has plamed to assist Ekondo Titi and Mundemba Health Districts forscnsitization because of their continuous lagging behind- I l3 WHO/APOC, 24 November 2004 2,4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance of female members of the community at health education meetings Fcmale members were most often found in their social groups and churches. Few of them attended big groupings mobilized in the villages. Ilorvcvcr, in Fontem Health District it was reported that women attended such meeting in thcir numbcrs although they refuse to take responsibilities. In tlic rest of the Health Districts, women were said to be busy with farm work and thcrcfore paid little attention to such gatherings. - In gcncral, how do you rate the participation of female members of the community mectings when CDTI issues are being discussed ^ (attendancc, participation in the discussion etc). Generally, tlieir participation was low. As already mentioned above, they are better reached intheir respective social groupings. Here they discuss freely and ark questions. Theirinvolvement in farming activities for the most part makes it diffrcult for them io take part fullyin meetings of any sort. - Incentives provided by communities for the CDDs The insensitivity to motivate CDDs is still very alive. The communities feel that sincegoverrunent is motivating CDDs, there was no need for them to further motivate them. Even lvhen goverrlment was not motivating the CDDs, the situation prevailed. Nonetheless, a few communities in the project area continue to give incentives to theirCDDs in the form of food, drinks and sometimes money. \ HEALTH DISTRICT Number of communities/villages with community members as supervisors mber of CDDs and the communi Number of communities /villages with female CDDs Total no. of communities in the entire project area B4 Number with community mem bers as supervisors Bs Percentage B; By'B1 *100 Male CDDs B7 lFemale ICDDs Br lTotat Be= 87+81 lNumber of communities with female CDDs Bro Percentage Brr= Bro/B4*100 AKWAYA t0t 7t 70.30h tt7 9 126 8 1.9,4 EKONDO TITI 40 0 0o/. 4t 5 46 5 12.50h I;ON1'I]M 139 6 4,30 320 49 369 40 25.9o/o MN I\4FII M(,INDIIMI]A 134 0 0.4 r50 l3 r63 t2 9% 90 0 0 87 1t 98 ll 12.2y. Total s04 77 15.'/" 715 87 802 76 15.0o/. 1,4 WHO/APOC, 24 Novemb er 2003 The number of CDDs per population in the whole project area was ??. During the District Appraisal meetings, the heads of health areas planned to retrain/train 1CDDjl25 persons or less. Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition was common this year especially in Fontem health district where some CDDs refused to distribute or abandoned distribution midway because govemment has not yet paid CDDs' motivation for last year. Others who did not abandon withheld their treatment reports for the same reason until the village administration intervened. Most CDDs in the project area have sworn not to carry out distribution of Mectizan in 2006 until they are paid. in order to address this situation, the community representatives were informed during appraisal meetings of measures being taken by government to pay CDDs. Thatgovernment action is slow but sure. The role of the community in CDTI and other healthprogrammes were reiterated. In Mamfe Health District, the District Chairperson proposed lhat llic Provincial Delegate of Public Health shouid write on this issue appealing on all comnrunilies to motivate their CDDs. He strongly feit that this action frtm above will convince some if not all the traditional councils to do something to the CDDs. This action sliall be taken at the beginning of the distribution period for 2006. Other issues 15 WHO/APOC, 24 November 2004 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. All the health districts have adequately trained staff on CDTI at all levels. Each year staff are refreshed and this year in particular all of them were trained because of the introduction of Eye Care. The big problem is shortage of staff. Some health centers have only one staff that caters for all the activities. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not encugh knowledgeable manpower was available or if staff arefrequently transferred during the course of the campaign). Transfers have not occurred in the project area recently except in the newly created District of Wabane. Contract staff transferred to the project area two years were trained at the beginning o('this ycar's activities. Plans are underway to get the new District Medical Officer transferred [o Wabane trained in CDTI in the forth coming training sessions. I t6 WHO/APOC, 24 November 2003 ca O c.l L() .o 0) o z$N o P. o f > t-- ?aCJ .H EF 'o 9.)o=gdgo o-h -d u.] -chl< lr H5\J(d oo .u= ().e do B'.9 dzoYl-i(gH Lrr dC)(gr{ ,ooP oo2PPtJ v)*v)(doH >-o 9?aut)1() o(H kio(d!(J': b a o'7frr Et'r: .ooN?.r=95s?' c)(.).crHH:F *A ^ ,;A A 'd at d,9.b *- gBtrb '1 xaE K.- .-.'i 5() o-* o,r .)I qr(/] O'=1 (dde '3 ,E go 0J.ir (oPa!0)/PbO- -Lv(5sHz()dE S.!d I p-399;g)28 5 ,?'i thY v)bo.S5 EE Reo: (B0) 9.E E -dH'=a^ -n_f ..H ?EU}l-'O= t/) E 3E:co.xox\J-q o gb o a o o s){ B{ C o ! o $\ o B\o \ o L\ s € B s\ o -: st\ Lt' ts = q) an Q o trq) z !(-) 5lt+ FUL) o Ed +. q t : lr) o\ \o .<l r,t+ o\\o : 6 el r- @r- @ @ o\ @ o\ ln co \c t- o\ o\ l---- q) 6) I a \oo\ r-{ot- \ool \o .<f rnco o\ @ 00 o\ .f .<l la) ol-q) (! t- LqJ^ E0eti E- b3!() z! (J €'t*=FO(J +.eo UI !c o.r C.l Lo rO e.l t'- = re o \o co o\ c.l c- () c) o a \oo\t @(J LF .<l rn al e.r o o\ L tiF -d a oL^ 6L aG) 2a q q '-1q a q AP Q +(J U U :ll FU +. z € !+ ar t-- !+ .c .+ cl ra) \o (.r c- cO .+t- rO .<l o\ el o o C) <) o\ ar o\(, o LF lr) c.l \co.l al a:l@ (J :ll +F(,U ri }Itol q \o lr) ro \c rO N fo rO a.l(..l r- ra) o o o (J o\\o lr) o\ o LF v \o t-) .<l cOel tr< F F.] -<F .-i rD V tr F o az V a F z(J tr frlfr a. a a a z a Fl 3 F< -l a-l a) La q)(J q) V) o\ q) o \ v q) U) B AJ U o a) 0) 0. F t-.,1(J qi o ch c) o o H 6)G(H (_) cd bo (d!F ,iir ,l7l =tFI \ !f, (, .1- O N 0) -o o o z vN (J(a tu4 o >Ji oo or' H'.= ^O -tr(d(H aO cd (H o- * o-> ojjoc):-UDV tro7) u) -o(dokLrQC) ()e t< c) 'o . af) a_ -C 'uo .9'o t<kL(0- <) qZ): qr >F -u >r d (tlEo.(n*hoo Ep .aa(c() o.o (.) .!L a? 6)k dx!-o-o.- 5c d.= ?Fe6 >o do anP ai rYl .= <tbcr(d (H -, 0) ETEoE+Q2 *u) c\J Z= o -o !>. L2U(r)og boi adtr FO \ Table 6: Type of training undertaken (Iick the boxes where specific training was carried out during the reporting period) Any other comments 2.6, Treatments 2.6.1. Trcatmcnt figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type of training CDDs Other Community members e.g Communiry supervisors Health Workers (frontline health facilities) MOH staff Other or Political Leaders Others(specifii) Prograrr management X X How conduct Health education to X x X X Management of SAEs x x X X CSM \/' -a\ X X SJI IM I )lr l:r co llccliorr X x x Data arralysis x x Report rvriting X X x X Others (specifu) \ t9 WHO/APOC, 24 November 2003 OO c.l Lo -o q) z$N O p< rJ. a.l rts] F (g oL(! (_)() '= s o\ 9g a .= 'a >.: b.=d :'r()6(ds os) -'ils d^ ocIUH\o\gs 46!t\ o;OE -!$Er. ds .o\ .r * dFrOI 9 Rol - \J *l o e xl -o : -l - :9l +: =lll n' 6sli s!l 3 Fol o. -x ol(# \9l o tUILol() iql € {ol H :u .t -(Dl c rs' -ol \ Hl 6b =l : !-tatAtts .i bo ll s\ \J tr.\o'\ ,a Uou\ 0-, : :o- gOEFuDo .o t'. o\\ OI -t lo)xl > El 3dl '- El6()l : Q{(.) 8t -Eo+6(Hl 9)olr: Ll ' PIE =ldzl< d C)I 63 o 0) 'a kq 0) o z E] p ! C) I C) 'o <h c6 rh C) o o 6) 'IJ o I t< 0) o. >. -E o @() q< o L() -o (n oF C) k 0) bo(tq 0) oo o- .E 9\. d b0 o 0) r >'l olOI *t d 0)l eldt()l ;l o[ -l -l -ilol a)I :El =t EIg :l HI EI -I zl (d otr(d o(-) 'a Lq o q 0) o o G) 'o 0) I!() x o an o E bo o (d o o. F o x c/) a) o{(! rr o O () o o()0(H o L() -o) zl o L() bo ex oo F () cd Lr o bo cdL c) oo()^ OJ (nk C) r- ltll o 0)bI cC o )) 0)t CUk() oO r< € cd l. l ot r!l a ^oOh€ rll= =(o .= F,*aZX ^QtroocL=>;549*33Aocaoi=O. T# E,;2z o LOOO E6 1q2e (\l \c c'l ro € o\ € + cO\o .a o o\ o\ m o\\ c{ !o LC o2Eo .c!oE Eqo-=23.;Eg v co €\o n alr- o\ ra \o € o\ .I o.l .i \o\o @ .+ o cd o c. il- QA o fo 9? bo Loo--^ c i'.o \o r- a.;r- \o €\o \oo\ ol t-r- -oo\ e \c c\ rar- sq al a- H o : c! =oo 2 LE r-o rr) t- al r- \c vv a rl^i oo -q c\ .<l r'l\o @ t.i q ra ra Eo * 9.2dE: =EUE gF<Fo co rn 00 oi c.l € nv \cq rO rr) ro F- r-tn \o t) F- (.l r-T t- a EOOE 6d =j-oox63 5.g \F dYo .oq 9 EFoEo fO at nr- t) ra) .<l r- ln r- rn G\c .+ .+ n r- r- e.l 66q (-) cl o a H II qo.^ o>-c d"o!ao n:=.E & E! o 2..9EE$;E o:J o: t-o>Eo E .9 ;o =Ui:6 oDh o:\o .9 .: eC = tr ooo i o= IAA>E c9 ::3 = o'= <Fo U)O rr) 0) Or) o\ c\ o\ c\c.l o\ o\ o\ \o e\ @ c\ os o\ ro rO rO o f.lr) *o .tr o\ rO v ro O1 tf, ta) s o\ rA ttr-) o\ t rn O .Ea s v L-,) a z vhHF 2HFz A a co aI!Itz z F]4 F< F :\. v) v) q) U V) + o;- a)\ o I u q)q sq) L) a li (,(n oLd (c oJ o ri(, -o u) r! cn o C)l<F Sr rl7l?t r<l $OO c.l L() 0) o zsN() \JA o N u_.M:' e-95l.Y da. U ^\ e)YE\ 9o hh. \ q) TL tl!$a\ b \i a. -tr c' tr\: .o o I cE e e u(t .\N a. \So\ s .3->d sd\s e{\ S. U .a S*{=s!\ o' s\ -Q lJs':r ia. .=! --l\$ ils at- I 2.6.2 What are the causes of absenteeism? Generally, those who are absent can be considered as refusals because they go to their farms on days of Mectizan distribution to evade the exercise. The few who are actually absent are those who travel out of their villages or communities for one reason or the other. 2.6.3 What are the reasons for refusals? -Fear of Side Effects - Fear of death. There are rumours that Mectizan kills especially witches and wizards -Fear thatMectizan provokes other illnesses -Resistance to abstain from alcohol consumption even for a day. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information rvhen available. In casc tl-re project did not have any cases of serious aCverse events (SAE) during this rcporting period, please tick in the box. I 22 WHO/APOC, 24 November 2004 .i- c.l ! 0) C) o zs(\ \Jp. o+ > caN qJ a) o' r_q) .a !\q) V) J( o _E-6ooF>c E7 qr2;o <.= E o @ bosS '-:d ccoi, 4,4 tC^LiD ==TFg Lr.l o o o ot .2 Cq o;gEo =9(, cL o o -o \J, .9U Y !._ v doaE -- r: F= 600 €,Eqq l o o>\qEu J!YO cs -c C: @ q q) o Od(* o O 6 o q o 0) o € - s., oo.NFE€.= 3F; j: c>'= =>, a,-O :: Z 6 E o o. a U) id 5sr No=o :H o- ^AUl-!oad -tr =o .N* oi- ,YoiljJ9 cJo> =(H o () OOaG.; =.gr ,2o o a o oo * L a ?\ s bq q)() a) q: p o F qJ V) Al L\ v o L(-) o, bo Lo O.o l< o bo t< 'd okL oo o rn r! (/) U) C) C) o c/)L C) cd (/) ! o U) (H o <t o U)d(-) ool 0)I EI I () bD(t rt ()Y )aF O\o)()9 al F-!f, ro o\ rn ro el F-r- |r) F- o\r- o (d o-o P. o 11 l'I rI1ra o ho ci -btr iG< u5 \a F- la) \o o\ .+ \o o\ o\ rn o\ c\t'- Or o E]lt\ f:l fd o )a 92 bo 6LLO = ^\o - 9v s a.l t-r ra \o e co \oo\\o rn\o \Q c\ n F- sq(.l r- o -o o 6o 3e -o: E@ :o/- o- rr}o c: a\o ra6 l/i Lo o rn o.l t- co .<l o\ V;lr) G] -O6> 6a- =e6E 9E<Fo @ co o cl elt ol rO =R6 !\ot'l \o ro alr- o? r- O6 J.3do: ^ O-'- .= >O d+.c dJYU : *o YiEt:;€ E bd .+ r- 00 l/i co \o rr}q olr- \c) m\to6 00lr, cl a coq t) ol 0) bo(d 0) E E O EJlt- o bo oE^ k 3- \Q Vi o\ \o e o\ o\ \c \oo\ \o co o\ o\ '=o =ooi:d+ :3oGlU= iGll-;O U 5e)r.lr:l o\ ra) Or o\ e o\c\ s o 6\ 00 Or o\ tI] O -'a 3o :J bI)_. € ES; = E.- 6 z 6> E fo co .<l rn rr) .+ cl rn = ci rn .+ ro rn -O :Lo =Eo = 'F <Fo 6O rn 6 r..)t altn r$ c.l rn .<l v rn ! oooe dt = +f rU .EctsEc'- Xo -F^! .oE-9E=F o o E: ot4 @ ra) @ rr) = el rr) ! ar rn .<l !to lf) & H c- € o\ o\ O(\ ON N O c! coOON $O N oo c.t ON r- al 6o C\ o\ c.l O N <1- OO o] L o 6) o z c.l (-) o a. ts -f, ol - q 4 o ./9 )o o e) u0 tiq) o() I t-{) C! tc' .i\ x9 -->.6 VH\.r F =EC:OUELq)\qr'uUso) ='lq;\cs!tr-qiLi -u t- J<)=bo o)dr.=\ v U J.: Gc)HC.)oL- 9!rO.!l olol oq)l IHI YIrl oc. I .gel o.=l L!c.trl ol t4d)l :._EIl-lPIUrl QYIE!l (ottd)l !lC(FEI EiEl c(031 Ea (gI cr()Ol .- \l Vi5t: ebo= 6iI!FOJl- !O(r5 o rr LU .HAb -Y.i o) 'udtr6t9tro - -iid-(-)Q tar E .- v c.i o\l ';91 2 ^l !r ':t c.)(9t(.1( .t -t 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate onswer) MOH Other (please specify) wHo UNICEF Mectizan@ delivered by - Qtlease tick the appropriate answer) wHo UNICEF NGDO NGDOMOH Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan is applied for by the Manager of the Drug Programme in the Province assisted by the NGDO for the main time. When it is supplied, the Manager dispatches someone to collect it lrom the port of entry and it is stored like any other drug. The Health Districts then make thcir rcquisitions and they are supplied through the Essential Drug Programme distribution systcttt. 'l'his system is responsible to supplying all drugs to all public and some private health trttits in theprovince. Mectizan is deposited in the respective pharmacies of the Health l)is(r'icls rvltcrc heads of Health Areas collect them following theii requisitions. CDDs then crrllccl lionr thcir heads of health areas Mectizan needs just a few diys before distribution llr:girrs. Tablc I0: Mectizan@ Inventory (Please add more rows tf necessary) Horv are the remaining ivermectin tablets collected and u,here are they kept? The full boxes of the remaining mectizan tablets are returned to the drug progrurnrn. for safe keeping rvhile loose tablets remain in the district to treat those who "o*. later on withOnchocerciasis provided they are not expired or over stayed the required period after opening the tins. It should be noted that 487.000 tablets were received from Merck plus a balance of 24.866 tablets after the 2004 mectizan distribution. This brought the total number of tablets available for 2005 mectizan distribution period to 511 .866. \ State/District/LGA Number of N{ectizano tablets Requested Received Used Lost Wasted Expired Remaining AKWAYA 77.866 71.866 73.460 123 66 800 3,4t7 EKONDO TITI 45.000 45.000 33.225 20 10 0 r 1.685 FONTEM 146.000 146.000 129.27A 374 0 0 16.356 MAI\4FE 144.000 144.000 132.4s8 27 707 0 i 0.808 MUNDEMBA 54.000 60.000 46.342 ZJ5 0 0 13.425 Balance Programrre ln Drug 0 0 0 0 0 0 39.000 TOTAL 466.866 472.866 414.755 777 843 800 94.691Total reccived Drug Programme by 487.000 + 24.866 (2004 balance) 5r 1.866 25 WHO/APOC, 24 November 2004 List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. 1. Drug Programme: Collects from the Port and stores it. Delivers to Health Districts following their requisitions via the pharmacy at the district level. 2. Health Districts: They request the quantity of Mectizan they need and forward to Drug programme. When Ivfectizan is received at district level, the Health Areas are informed. 3. Health Areas collect from the district pharmacies and inform their CDDs on the availability of Mectizan. 4. CDDs: These collect from the Health Areas as soon as they are ready to start distribution. Any other comments 2.A. Gommunity self-monitoring and Stakeholders Meeting I l:rs lny lririnirrg (o1'traincrs) for community self-monitoring been done in the project area? II'so, Whcn? Table 1 Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project irnplementation or how they would be utilized during the next treatment cycle. Communities are not enthusiastic about monitoring CDTI activities because they want to be paid. It is commonly believed that there is funds for those activities but health personnel want them to work for nothing. Some are of the opinion that the work done by the CDDs is reliable enough to be challenged. District/ LGA Total # of communitiesivillages in the entire project area No of Communities that carried out self monitoring (CSI!f) No of Communities that conducted stakeholders meeting (SHM) AKWAYA proNno IITI FONTI]M 101 40 139 0 0 0 0 0 MAMFD 134 0 0 N4UNDE,MBA 90 0 0 TOTAL 504 I 26 WHO/APOC, 24 November 2004 2.!', Supervision Zq.l- Providc u.flou, chart of supenti.yion hiercu.chy Central level - NOTF - NGDO Provincial level - Provincial deiegate - Provincial Chief of Service of Community Health - Oncho Project Coordinator - Finance Officer I.lcalth District Level - District Medicai Officer - Cheif of Bureah Health - Chief of Burea of Adrrinistration and Finance - Chief Medical Officer of District Hospital Health Area Level - Health Centre nurse C'onrnr rrn it1, - ('t)l) - ( orr)rttrrrtit,t, rttctullcrs 2.9-2- what rvere the main issues identified during supervision? Main issues identified rvere: Census update rvas poorly done. In Akrvaya Health district for instance, only eligible members of the family were updated. 27 WHO/APOC,24 November 2004 I I + I Checking of visual acuity rvas poorly done by CDDs CDDs were unhappy because of unpaid motivation for 2004 by government and their communities to assist them. Absence of drugs for the treatment of mild side effects in some communities Absenteeism was observed in communities The principle of CSM has not yet been well grasped by some supervisors, so that facilitation of a community to carry out monitoring of the CDTI activities leaves much to be desired. Most communities in the project area are reluctant to carry out CSM. Late submission of reports and financial justifications. 2.9.3. Was a supervision checklist used? The Health Districts used supervision check lists 2.9.4. What were the outcomes at each level of CDTI implementation superwision? The District Teams resolved to lay more emphasis in the areas where serious dcliciencies were identified during training at all levels in2006. 2.9.5. Was fccdback givcn to the person or groups supervised? Irccdback was given on the spot to the person or group of persons concerned to correct inadequacics. 2.9.6. Horv rvas the feedback used to improve the overall performance of the project? There was improvement in therapeutic coverage of health districts like Ekondo Titi and Mundemba. Fontem Health District registered an increase in its therapeutic coverage. The entire project area has registered an improvement in its therapeutic coverage?? SEGTION 3r Support to CDTI 3.{. Equiprnent Table l2: Status of equipment (Please qdd more rows if necessary) \ Source Type of equ ipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No Condition No. Condrtion No Condition l. Vehicle I F 2 F I CNFR 0 0 0 0 2. Motor cycle(s) 20 F 1 CNFR 15 10F 5 CNFR ll CNFR 3. Computer(s) 2 F 6 F 5 F 0 0 0 0 4. Printer(s) 2 F 5 F 5 F 0 0 0 0 5. Photocopier (s) 2 lWO 2 CNFR 5 2 CNFR 0 0 0 0 6. Fax Machine S 1 wo 1 F 0 0 I CNFR 0 0 7. Others a) Lab-top I F 0 0 0 0 0 0 0 0 b) c) 28 WHO/APOC, 24 November 2004 *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The Health Districts and Health Areas are beginning to realize that maintenance of existing equipment is their responsibility and are doing so already. Emphasis for them to use all available resources to maintain equipment seems to be sinking. Regarding replacement of equipment, no clear-cut policy has been put in place. However, apart from motorbikes, the rest of equipment and materials are replaced and maintained from government-supplied credits. Because of the inadequacy of these funds, the Health Districts have applied to APOC for the replacement of the present motorbikes supplied 5 years ago by APOC. The motorbikes are wearing down very fast because of the bad tenain and numerous activities for which they are engaged. As indicated on the table above, the Health Districts grossly lack means of transport. Apart li'oltt l]ontcm I-lealth District, no other health district has a vehicle to carry out its numerous lrc livi(ics. 3.2. Financial contributions of the partners and communities l;inrrncial contribulions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) I Contributor Year 3 Apnl 2002 March2003) Year ('Dec 2003 - Nov 2004) Year 5 (May 2005 - April 2006) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOIJ (Central + Provincial/State) 47 387 50 885 MOII (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 4t 288 45 486 46953 26 770 Others a) b) Communities APOC Trust Fund 92 499 59 2t3 62 022 50 857 48 183 t7 t42 TOTAL 29 WHO/APOC, 24 November 2004 Apart from the motivation of CDDs by some communities in Akwaya, Fontem and Mamfe Health Districts in the form of food and drinks there has not been any other contributions reported on. 3,4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the cunent United Naticns exchange rate to local currency. Indicate exchange rate used here 525FCFA: lUS$ 30 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SEGTIOH 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the follorving rvhich are applicable) Monitoring/Evaluation was not carried out during the reportingyear. Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What rvere the recommendations? I Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 99q4q!!itv Mobilization and health education of communities Jre,li-qe of CDDs f.qif'!g ot health staffat all levels Supcrvising CDDs and distribution lntcrnal monitoring of CDTI activities Arlvocrrr:y visits to be lll(' rrrirlcrilrls alth and litical authorities Srrrrrrrrrrr'.y (r'cportirrg) forms for treatment Vc I r ic lcs/ Motorcycl cs/ bicycles maintenance ( )l'licc I itluiprncrrt (c.g colnputers ters etc Othcrs( I nsurancc of motobike 'fo'r'AL t22 6808 SSI SSI 1 835 SSI 8060 SSI JJJ 5398 SSI SSI 1s00 SSI 1039 SSI 2s09s Total number of persons treated 3t WHO/APOC, 24 November 2004 4.1.3. Ilory havc they been implemented? 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? When was the sustainability pian submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant Ievels Planning is now done at all levels, Health Area, District and Provincial Levels 4.2.2. F unds Efforts are still being made to get the MOH to take total control of the funding of CDTI activities. Health Districts have begun to pool funds from various sources to funci CDTI activities. The problem is documenting the amounts so used. 4.2.3 Transport (replacement and maintenance) No replacement policy has been put in place for transport yet. However, government provides motorbikes from time to time although the number is very limited. Last year one Jialing motorbike was supplied to Akwaya District. 4.2.4. Other resources 4.2.5. To rvhat extent has the plan been implemented Except for the weaknesses already mentioned above, the sustainability plan is being implemented progressively according to available means. In spite of financial constraints, all the activities this year were carried out. 4.3, lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms This activity is integrated into the drug supply system of the MOH. 4.3.2. Training All the Districts integrate training. This year Eye Care was carried out during CDTI training. Information on other health programmes such as Routine Immunization, Roll Back Malaria, Leprosy, Tuberculosis etc are usually carried out simultaneously. Coordination rneetings at District and Provincial level ensure that issues concerning all programmes are discussed. I 32 WHO/APOC, 24 November 2004 I4.3.3. .Ioint supcrvision and monitoring rvith other programs l)uring CDTI activities for instance, some time is allocated to supervise other programmes as alrcady enumerated above. It must however be stated that sometimes time and financial constrainLs nrake it difficult for effective supervision of other activities. Provincial and especially District and Health staff are so pollvalent that they implement all activities at their level. The transport means available are used for the implementation of all health programmes. 4.3.4. Releasc of funds for project activities Apart from counter part funds, MOH ccntribution in cash is corning on very slowly. This year, the project experienced difficulties implementing its activities because of delay in release of funds by APOC. 4.3.5. Is CDTI includcd in the PHC budgetz The budget does not specifically cany a line on CDTI. The Vote holders however use lines like miscellaneous to fund some CDTI activities. The introduction of a line for CDTI can only be done at Central level. 4.3.6. Describe other health programmes that are using the CDTI structure and how this ryas achieved. What have been the achievements? The Expanded Programme of Immunization @PI), Roll Back Maria, Leprosy, Tuberculosis have benefited from the use of motorbikes at health area levels for supervision of those activities and the vehicle at provincial level. CDDs trained through CDTI initiative have become the link between the communities and health structures and are therefore used by all health progreammes to reach the community. Recently they were 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. 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 rvithin the reporting period. No operational research was carried out. 4.4.2. Horv ryere the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of GDTI implementation process. STR]]NGTHS Use of APoC vehicle and motorbikes to carry out other health activities. It is casier to reach the communities through CDDs trained by the project Awarcness of the population on CDTI is increasing 1'hc therapeutic coverage is improving year by year. More and more people come up to request for mectizan after the treatment period. 33 WHO/APOC, 24 November 2004 I Eye Carc is using tlrc CDTI structurc to enter the community The refusal ratc is climinishing Craw-craw is hzrd to llnd now WEAKNESSES Lack of community sup1rort and delay of government motivation to CDDs Late arrival of APOC Iturds Lack of community involvcment List the challenges a-nd indicate how they were addressed. The main challenges remain MOH contribution in cash and replacement of means of transport. These have already been addressed above. SECTIOilI 6: Unique features of the project/other matter-c 34 WHO/APOC, 24 November 2004