RESERVED FOR PROJECT LOGO/IIEADING ORIGINAL : English Ptoi-".t Na-*: CDTI Northwest -couNrnvmorr, -1""".n "gf"*:2003Approval vear: 2003 ileportiosP"tioq(}lqo-Lhry"nttt ffiosDEcEMBERoS s678910 NGDO nartner: SSI.CAMERQqNDate submitted: I I I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICALC0NSULTATIVECOMMITTEE(TCC) NORTH WEST PROJECT YEARII DEADLINE FOR SUBMISSION: ToAPoCManagementby3lJanuarvforMarchTCCmeeting ToAPOCManagementby3lJulvforSeptemberTCCmeeting set- AFRICANPROGRAMME FOR ONCH0CERCIASTS CONTROL (APOC) For llifdit'Bstio' ro,\fuh- ,in ,,-l L,' I ",|ir|ti .'"q- IIXI.'',i; \- iL I -i i, i. Ii ,,:il,::::**,-#,.:*,;;[:*., rl : ENDORSEMENT i i pl"u.. confirm you have read this report by signing in the appropriate s1 : orrlcrns to tierrth' : Country: National Coordinator Name: Dr' Ntep Marcelline Signatu Provincial Delegate NGDO Representative i^ I Provincial Oncho Coordinator Name: Mr' Akiumbeni\r i fnit report has been prepared by Name: Mr' Tangwa Patrick l\if* /lah 6cnor I\[rMr. Geh Oscar, Mr. Tekwe T!5fnas tion: oPC il'l [r*;{r1 WHO/APOC. 24 November 2004 Date: ..o.V.l.?.?-/.?..6.... Name: Dr. $',ldiforchu !j Table of contents AcronYms v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive SummarY 2Gli6ts*m:mm::' i-: 3 t.t.t Description of the proiect (briefty) """""""' 3 I.t-2. Partnership "" ""i**t Bookmark not fufined' ......................7 1.2. PoPul-nuoN *,1'l'*#Hffi"??,$::l: : e 2.2. APvocecY ""'12 2.3.MOBILIZATION,SENSITIZATIoNANDIIEALTHEDUCATIoNoFATRISKCOMMI.]NITIES12 2.4. Col'nutn'rnY INVoLVEMENT """""""' 14 2.5. CepecnvBtrILDING """"' 16 2.6. TREATMENTS"""""""' ""' 19 2.6.1- Treatmentfigures """","" """"" 19 2.6.2 Wat are ih' "*'u' oiabsenteeism? """""'"'""'no"'! Bookmnrk not defined 2.6.i What are the reasons fii refusak? :"':"""" """""""' 22 2.6.4 Briefly describe ou *no*n"ana verified serious adverse events (sAEi that"" 23 2.6.5. Trend if treatment achievemerii"* tOn p'"i"ct inception to the current yeat 24 2.7.onopnuc,STORAGEeNnopt.twnyoFIVERMECTIN.............................25 2.8. ColvnurnmY *ELF-M.NTT.RINGaNp SrarsHol-oeRsMeE,ThrG...'.......... ... , ....,.26 2.g. Sr-PsRvIsroN """"""""""27 2.g.1. Provide aflow chart o7*i"*oio1t \iy1cW" """"':""^ """"""27 2.g.2. whatwere the main i!*riiiinned during ipervision? """"""27 2.g-3- Was a supervision checklist u'ud?""""':':""' """"""" 28 2.g.4. whatwere tn, ortconirr" oiii"i t"r"t ,tcii implementation rupervision? 28 2.g.5.Wasfeedbackgiventothepersono,g,*p,supervised!..............28 2.9.6. How was the feedbac;";;"i;" i^prt;" *{"-ou[r"u performance of the proiect?28 *fl-1';#ffiffi:'"'l 28 - 28 3.2. FD.TANCIALCOhITRIBUTIONSoFTTIEPARTNERSANDCOMMUNITIES"""""""""""""30 3.3. OrrmnronusoFCoMMuNITY suPPoRT """""""30 3.4. DGENDTT]REPERACTIVITY """""" """""""""'30 t"fr'-X*lST^1lffilJS:3ililr,.,roro*'MoNTToRTNG; EveLuauoN 3r 4.1.1 [{as Monitoring/eroiuirron carried out during the reporting period? (tick any of thefoltowingwhich are applicabte) """""'-"""""""" """"' """""""" 31 4-1.2. Whatwere th"'commeidntions? """"""" 32 4.1-3- How hwe thev been'iiii"i"n"d? ""-:'-"" """"""""' s3 4.2. SUSTATNABILTTY oF r*orsari' PLAN AND SET TARGETS (rraeNoeroRY AT """""""'33 Yn3) """"'33 4.2-1. Platming at all relevant levels """""""""" 33 4.2-2. Funds """' """""""" J-3 4.2.3Transport(replacementandmaintetance)..................3J 4-2.4. Other resources" """ 34 4.2.5. To what extent h", ;i;; pb, irrn i:-ptrmented ""' """' 34 4.3. I\mGRArIoN """""" """'34 4.3-1. Ivermectin delivery mechanistns"""""""' """""""""' 34 4.3.3. Joint supervision and monitoring with other programs """""""' ":"""""""' 34 4.3.4.Releaseoffundsforprojectactivities..........."Error!Bookmatknotdefined 4.j.5.IsCDTIincludedinthePHCbudget?...............8rror!Bookmorknotdcfined 4.3.6. Describe other health progro**zs that arlusing the GDTI -structure ond how thiswas achieved. Wat hwe br"n7h" achievements?""' Enor! Bookmark not defined 4.3-7. Describe others issues considered in the integration of cDTI'Error! Bookmark not dcJined ........35 4.4. OPERATIONAL RESEARCH 4.4.1. su**ii in not *or, ,ho, one half of a wge the operatiotal research undertaken in the proiect areawithrii the r"p*i"s-ptioa """" 35 4.4.2. Howweretheresults"ppiti*innp*i*t?"""""""' """"""""' 35 SECTION 5: StrenShS, *.ut r"tt"s, challenges, and opport,nities 35 SBCTION6:Uniquefeaturesoftheproject/othermatters36 Acronyms APOCAfricanProgrammeforonchocerciasisControl ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTICommunity-DirectedTreatmentwithlvermectin CSM CommunitY Self-Monitoring LGA Local Government Area MoPH Ministry ofPublic Health NGDoNon-GovernmentalDevelopmentorganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force NWPSFH North west Provincial Special Fund for Health PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SSI Sight Savers International TCCTechnicalConsultativeCommittee(APOCscientificadvisorygroup) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization DOT Direct Observation theraPY Definitions (D Total population: the total population living in meso/hyper-endemic communities\/*itrrl.rtrr"p.oj""tarea(basedonREMOandcensustaklng) (iD Eligible population: calculated asS4Yoof the total population in meso/hyper-endemic communities in the Project area' (iii) Annual Treatment objectiv:e: (ATO): the estimated number of persons living in meso/h1per-"ra"-l"E* that a CDTI project intends to treat with ivermectin in a given year. (iv) Illtimate Treatment Goal (UTG): calculated as the marimum number of people to be treated *ro@mic areas within the project area ultimately to be reached #* the projlit has reached firll geographic coverage (normally the project should be expected to reach the UTG at thi end of the 3d year of the project)' (,) Therapeutic coveraSe: number of people treated in a given year over the total\'/ p"p"ffi"(thrs;troutO be expressed as apercentage)' (.rr) Geographical coverage: number of communities treated in a given yeal over the total number or rioolt-w-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' (-r) Integration: delivering additional health interventions (i.e- vitamin A supplements' albendazole for LF, screerung for cataract, etc.) through CDTI (using the same systems, training, supervision *d p"rro*el)^in order to maximise cost-effectiveness and empower cimmunities to solve more of their health problems This does not include activities or interventions carried out by community distributors outside of CDTI. (riii) Sustainability: CDTI ltilties- in an area are sustainable rryhen they continue to function effictirely for the foreseeable future, with high treafrnent coverage' integrated into the available healthcare service, with strong community ownership' usingresourcesmobilisedbythecommunityandthegovernment. (r*) Communitv self-monitoriqg (CSN{,): The process by which the community is "-porr"rrd to *"" and-monitoithe performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is b"rrg "*".rrt.d in the way-rntend"a. It encourages the community to take full responsibili y of *",.-ecti, disttibution and make- appropriate modifications when necessary. FOLLOW UP O]I TGG REGOTTENDATIOilS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 20 All issues raised at the TCC session 20, were addressed and a new report was submitted to APOC management in April 2005. (Please add more rows if necessary) Number of Reconmendilion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR rcC/APIOC MGT ASE ONLY WHO/APOC,24November2004 I Executive Summaly Prqtare an Exccutive sumrrutry of the report in not more than one page. 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. This is year two of CDTI NW Project. The project was approved in 2OO3 Activities began before APOC came in with funds. It has a total censured population of 1.199.014 inhabitants occupying a surface area of 18,lOosq.km. 705237 Inhabitants are found in the hyper/Meso-endemic communities .It is made-up of 14 Health Districts .Within the year, three new health districts were created. Hence in year III the project will be operating in 17 Health Districts. It has 179 Health Areas and 1073 Communities. 776 communities are h5rper/meso. TWo health areas in Wum health district did not treat this year. Screening for Loa Loa was undertaken in Njikwa Health District and the eligible Persons with a high Micro-filaria load were treated at the district hospital. Our annual treatment objective was set at 65 "/o (444,1a8) while the UTG set at 84 %(550,3221. We treated in 763 Communities scoring a geographical coverage of 98.7o/o (.472371) persons were treated scoring a therapeutic coverage of 67.0%o. Out of 2,348,O61 Mectizarn tablets received by districts ,1,835,460 Tablets have been distributed,8,323 tablets have been declared wasted 2,499lost .413,5O0 tablets have been transferred from the Districts to the North West Provincial Special Fund Health against year III. 2. Background on population movements. There is constant rural exodus for job opportunities in urban areas.There are also population movements for agricultural reasons and transhuma.nces during the dry season; 3. Training data - CDDS, health workers, Total population (community) per CDD trained. Training started in Nov O4 with a refresher course on financial management for fourteen Chiefs of bureaus administration/Finance and four OPC s This coincided with the visit of the chief executive officer of SSI from England. In March 05 69 district staff and 293 health center staff were trained/ retrained. In April 2005, 3131 CDDs were also trained and retrained. The CDD ratio finally stood at l:224 persons treated per CDD. 4. Challenges and how they were overcome. 1.) Inhabitants migrated to new settlements (transhumancef farrners). To overcome the situation and improve on coverage, CDDs moved to their new settlements and treated the eligible population. - 2l Initial high refusal rate. To overcome this, community mobilization/sensitization was intensified, many refusals convinced and the refusal rate dropped. WHO/APOC, 24 November 2OO4 2 3) CDDs were reluctant to work due to no palrment of the state promised motivation; To overcome this, Health workers and communitSr ieaders convinced them that it was a community project, instituted ways like exoneration of CDDs from communit5r work, gave them some food and drinks during distribution. During other PHC activities like National Immunization Days ihey are incorporated as vaccinators and social mobilizers, at such they become more performant. 4l Inadequate means of transport. To overcome this, some communit5z members gave bicycles to accelerate monitoring of side effect and distribution. SECTION l: Background information 1-1. General information 1.1.1 Description of the project (brielly) A". Geographical locations and administrative area(s) - Population: activities, cultures, language - Communication systems (roads...) - Administrationstructure - Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). - Number of health staffin project area and number of health staffinvolved in CDTI activities. - Describe overall working relationship dmong partners, clearly indicating specific dreas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - Snte plans ,f arry to rnobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The CDTI NW project a-rea covers the entire North West province. It lies between longitude 9" 45'and 11' 10' E and latitude 5" 35' and7" 10'N. It has a total censured population of 1,199,014 inhabitants. Spread over a surface a-rea of 18,100km2.A Population of 688,857 inhabitants is found in the meso and hyper endemic communities. It is bordered in the south by the health districts of Akwaya and Mamfe in the South West province, in the East by the west province and in the North and West by the Federal Republic of Nigeria. The North West Province is made of seven administrative units (divisions) Thirty one subdivisions. This is further divided into seventeen health districts (Ako, Benakuma and Tuba have just been approved, hence they will function independently in year iii.) and one hundred and sevent5r-nine health areas. WHO/APOC. 24 November 2004 3 Census update was also done during this period. Advocacy was resetved for personnel of MoH, SSI and communit5r members. Plans to mobilise local NGDOs, NGOs and CBOs to assist CDTI implementation are rudimentary in the project area. Table 1: Number of health staffinvolved in CDTI @lease add more rows if necessary) DistricULGA Number of health staffinvolved in CDTI activities Total Number of health staffin the entine project area B, Number of health staffinvolved in CDTI B, Percentage BeB,/Br *lfi) BAFT]T 74 34 460/o BALI 35 18 52V" BAMENDA/TUBAII 206 tt7 57 o/o BATIBO 9l 34 38 Yo FT]NDONG 316 36 12Yo KI]MBOEAST 58 2l 36.2 o/o KUMBOWEST 228 36 16Yo MBENGWI 82 52 63 o/o NDOP 29 2t '72.40/o NDU 54 l8 34Vo NJIKWA 23 23 l00o/o NKAMBEi AKO 81 39 49Yo SANTA 5l 35 69Yo WI]M/BENAKUMA 67 50 75 Yo TOTAL 996 382 38 "/o WHO/APOC, 24 November 2OO4 6 1.2. Population Table 2: Communities and population at risk in the entire project area whether they are treated or not during the reporting period. lease add more rows CDTI Districts/ LGAs in the entire project area Total population in the entire project area Number of communities/villaees in Population of Meso-endemic zone in the project area Ar Hyper-endemic zone in the project area At Total in meso/hyper- endemic zone 4. = 211* Ar Meso-endemic zone in the project area N IIyper- endemic zone in the project area As Total in meso/hyper- endemic zone Aa= Aq*As Ultimate treatment Goal (urG) BAFUT 39449 25 25 50 t5634 2t582 372t6 31262 BALI 23033 25 15 40 11832 4887 t6719 t4044 BAMENDA 144664 75 t4 89 50209 t6tt2 66321 55710 BATIBO 60970 13 58 7t 9033 366t1 45644 38341 FUNDONG 107308 39 22 61 82608 24700 107308 90139 KUMBO EAST 98633 40 3 43 29867 5t2t 34988 29390 KUMBO WEST 137527 l9 Z3 42 33494 30280 66774 53570 MBENGWI 39789 40 33 73 15951 14585 30536 25650 NDOP 209262 2T J 24 24595 2616 27211 22857 NDU 77177 9 t6 25 18058 2tT30 39188 32918 NJIKWA t7647 6 )) 28 5755 11892 17647 t4824 NKAMBE/Ako t28270 37 47 84 2720t 2710t 54302 456t4 SA}{TA 628t7 14 t7 31 8039 8675 t6714 14040 WUM t13957 45 70 115 38637 58940 97577 8196s TOTAL 1199014 408 368 776 370913 284232 658145 550322 WHO/APOC, 24 November 2004 7 y) rcdchedit geogqhlc cotcruge (non@lly the Wject sltould he eryected to rcadt the UIO dt the end of the 3d yat olrhe W|ect). Was a census for the project done during the reporting period? Yes, Census up date was done No If No, what is the source of the data in the table above? x Source: CDDs Other source, specify: Year : 2005 If you are using the t€rm community or village, deflne what constitutes the community or vitlage. This will help undqstard the profi1e ofthe project area. Is there any other information of interest about the population in the ploje{t area? If so, include it here. WHO/APOC, 24 November 2004 8 SEGTIOil 2: lmplementation of GDTI 2.1- Timeline of activities Fill in table 3, timeline of activitiesfor areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. WHO/APOC, 24 November 2OO4 9 District/LGA Mobilization of communities Training Census/Undate Drus distribution Supervision Starting month Completion month Starling month Completion month Stafting month Completion month Starting month Completion month Starting month Completion month BAFUT MAR05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 ocr 05 MAR05 ocr 0s BALI MAR 05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 ocr 05 BAMENDA MAR 05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 BATBO MAR05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 FI.INDONG MAR05 APRIL 05 NOV004 MAR 05 APRIL 05 AUG 05 APRIL 05 ocr 05 MAR05 OCT 05 KUMBO EAST MAR05 APRIL 05 NOV004 MAR05 APRIL 05 AUG 05 APRIL 05 ocr 0s MAR05 OCT 05 KUMBO WEST MAR05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 ocr 0s MAR05 OCT 05 MBENGWI MAR05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 NDOP MAR05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 ocr 0s MAR05 OCT 05 NDU MAR05 APRIL 05 NOV 004 MAR 05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 NJIKWA MAR05 APRIL 05 NOV 004 MAR 05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 NKAMBE/AKO MAR 05 APRIL 05 NOV 004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 ocr 05 SANTA MAR05 APRIL 05 NOV004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 ocr 0s WIJM MAR05 APRIL 05 NOV004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 OCT 05 TOTAL MAR05 APRIL 05 NOV004 MAR05 APRIL 05 AUG 05 APRIL 05 OCT 05 MAR05 ocr 05 Table 3: Timeline of activities for the areas treated in the current year (Please add more rows ilnecessary) -Please indicate if all activities were undertaken as planned, and if not, please explain. WHO/APOC,24 November 2004 19 As shown on table 3 activities started on the 4th November, 04 with the trsining ofCBHs / CBAIS /OPCs on financial managemed, This coincided th€ visit ofthe ChiefExecutive of SSI from England. This was foltowed with 8 s€rics of activities in 2005 thus: l) Training ofhealth persomel... It was dorc in Malch 05. Participants included; District Medical officers, Chiefs ofBuresu healtl/health centers. Chief Medical Olficers of Disbicl Hospitals / Medioalised }lealth Centres, who managed side €fects. A few Provincial superviso$ were incorporatedh the training that was organized at Bamenda Health District 8nd CDDS. . A1l the trainings w€re done at the distlict lwel for health staff 8nd within the community for CDDS Even though DMOs / CBHS /Chiefs ofhealth cen$es were participants, the DMOS took part ir the facilitation ofthe training at the lower level in preparatior for their taking over this role in the future. They were assisted by the zonal OPCs, St&tr ofthe NGDO (SSD. 2)MOBILIZATION OF COMMUNITIES: Sponsored mobilization started in March 05 and ended in Aprit 05 As an ongoing aotivity it contiNed though out the Mectizan distribution Period .It was done by health staE colnmunity distdbutom, afld NGDO staff 3) Census Updates: This was done tom tle beginning ofdistribution (April05) tothe end ofdistribution(Ootober 05) 4)DRUG DISTRIBUTION: It went on simultaneously in all the commudties in ertire project area from Apdl 05 to October 05 o.oept two communities in Wum health District,, Distributioo did not tske place there thus keeping the Geographical Coverage of the province ai99.73yo 5) SUPERVISION: There were four levels of supervision: i)Plovincial level: This was undertaken by the Provincial D€legate (PD) and the zonal OPCs Salient aspects -Further comEent! supervised included training , mobiliz&tion, census updates, monitoring of side effects urd appraisal Meetings. ii)District Level: DMO8 / CBHd CBAF$/ some competetrt melIlbem of the Dfutdc't team, this is evident in Ndop, Kumbo East and Bamende heslth distdctB. All espeots as seen in the table above were also supervised. iii) Health area lwel: CDDS within their respective communities, community's representatives within their resp€clive zones. And chiefs ofcenters had to irtersiry all the aspects ofsupervision as seen above. In general, despite the level ofs.rpervision everybody was particulfily very involved in monitodng and managiry side efects. WHO/APOC,24 November 2004 | | 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficultieVconstraints being faced and suggestions on how to improve advocacy. This is the second year of the NW CDTI project on initiation of the project a number of advocacies were held at the Provincia), divisional and district level. In November 2004, the chief executive of SSI from England paid a cutesy visit to the governor of the North West province. This coincided with the training of district chief of bureau administration and linance and Oncho Project Coordinators. Other forms of advocacy were undertaken by the district and health center teams to the Senior Divisional Officers, Divisional Officers, mayors, opinion leaders, religious and traditional authorities and municipal counselors. 2.3. tobilization, sensitization and health education of at risk eommunities Provide information on: - The use of media andlor other local systems to disseminate information - Types of IEC materials used - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. Journalists of the North West province radio stations, televisions based in Bamenda gave important message through their media on CDTI. These messages were delivered in English, French, Pidgin English and vernacular language. Within the health areas, health personnel, CDDs and social mobilisers of other programs targeted social, cultural and religious groups for health education. These included women groups, youth groups and church organizations like Christian Men Fellowship, Christian Women Fellowship Catholic Women Association and Catholic Men Association among others. During these sessions, those that were organized at health center levels were highly attended by women who came for other PHC activities. Within the community, the male attendance was higher than those of the female. In future, dialogue structures, CDDs, traditional rulers, religious authorities and opinion leaders be updated to carr5r out this activity. This full implication will give more Weight to the program and improve attendance at either the health center level or within the community WHO/APOC, 24 November 20O4 12
2.4. GommuniQr involvement :Communities ipation in the CDTI (Please add more rows DistricI/IJGA Number of communities/villages with community members as supervisors Number of CDDs Number of communifies /villages with female CDDs Total no. communities in the entire project area Ba Number with community members as superuisors B5 Percentage B6 By'B4 *100 Male CDDs B7 X'emale CDDs B8* Total BpB.tB" Number of communities with female CDDs Bro Percentage Btt= BrdBr*100 BAT'UT 50 0 0 106 39 166 31 53.4Vo BALI 40 0 0 65 19 90 25 69.4o/o BAMENDA/ TUBAH 89 0 0 135 141 276 86 8t% BATBO 71 0 0 179 33 220 32 78% FUNDONG 61 0 0 299 68 357 30 47.60/o KUMBO EAST 43 0 0 77 53 130 27 29o/o KUMBO WEST 42 0 0 92 40 248 28 25.60/o MBENGWI 73 0 0 tt2 6t 210 29 34.9o/o NDOP 24 0 0 43 l0 157 l9 16.l%o NDU 25 0 0 92 3l 281 t7 260/o NIIKWA 28 0 0 71 8 80 6 22.2% NKAMBE / AKO 84 0 0 248 53 420 33 24.3% SANTA 31 0 0 86 40 138 25 59.5% WUM / BENEKUMA 115 0 0 281 55 358 31 32.3o/o Total 776 0 0 1886 551 3131 419 39.1o/o t4 WHO/APOC, 24 November 2003 cDDs tained in hypo -srdernic oommunities Comment orl: - Attendance offemale members ofthe community at health education meetings - In general, how do you rat€ the paflicipation offemale members ofthe community meetings when CDTI issues are being discusses (attendanc€, participation in the disoussion etc), - Incentives Fovided by communities for the CDDs - Attrition of CDDs. Is attrition a problem for the projecf Ifyes, how is it addressed? - Displacement. To solve the problem , the cormunities selected new CDDS - Other issues WHO/APOC,24 November 2004 15 2.5. GapaciQr building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation. (The most important issae to describe is what measures were taken to ensure adequate CDTI implementationwhere not enough lcnowledgeable manpower wqs available or if staffarefrequently transferred during the course of the campaign). l6 WHO/APOC, 24 November 2003 Table 5: Training atthe different levels of CDTI implementation (Please add more rows dnecessary) District/LGA Number of Districts/LGAs staff trained Number of Health center/post staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO Cr New C, R"fr C, Total Cr= Ca* Cr ATrO c. New C^ Refr Ct Totsl Cr Crf Cr ATrO Cc New Cru Refr Ctr Total Cp= C16-f C1 ATI{) C'. New Cu Refr Cr Total Crr Cu* Crs BAFUT 5 I 4 5 22 8 11 t9 0 0 0 0 t7I 34 136 170 BALI 6 0 4 4 6 6 8 t4 0 0 0 0 96 19 70 89 BAMENDA t2 0 6 6 78 26 76 102 0 0 0 0 276 l1 250 261 BATBO 6 0 6 6 18 1 13 20 0 0 0 0 256 6 244 250 FUNDONG 6 0 6 6 1l I1 2l 32 0 0 0 0 275 67 184 251 KUMBO EAST 7 0 7 7 58 24 34 58 0 0 0 0 382 t87 195 382 KUMBOWES T 6 0 6 6 L6 20 18 38 0 0 0 0 300 t34 142 276 MBENGWI 6 0 6 6 40 5 35 40 0 0 0 0 210 43 t32 t75 NDOP 7 0 8 8 29 4 25 29 0 0 0 0 ll5 42 44 86 NDU 7 I 4 26 8 18 26 0 0 0 0 353 25 2r0 235 NJIKWA 5 5 0 5 23 18 0 18 0 0 0 0 80 79 0 79 NKAMBE/AK o 7 0 5 5 20 5 26 3l 0 0 0 0 420 160 260 420 SANTA 7 0 5 5 2l 1 t4 15 0 0 0 0 149 77 69 t46 WUM 5 0 5 5 47 15 31 46 0 0 0 0 424 tt4 256 370 TOTAL 90 13 69 82 258 93 200 293 0 0 0 0 2747 601 1892 2606 %o Achievement 9t,to/o 7o Achievement ll4o/o 7o Achievement 0o/o 7o Achievement 9sVo t7 WHO/APOC, 24 November 2003 . N.e , Rfr : tf.htdl nor @oibbt , pwde ttc @tdp6a,atutaluv.Mol<. 'rtu harh.re a tu ddbt4 @nnB. If "other traitren oftrrinccs" wcre traitrcd, pleare erphitr vho th€y arc &trd thcir role in CDTL No other trainer oftrsirces w€re tained WHO/APOC, 24 November 2004 13 Table 6: Type oftraining undertaken (Tick the boxes where specific trainingwas carried out during the reporting period) - Any other comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving l00Yo geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Trainees Type oftainine CDDs Other Community members e.g Community suDervisors Healttr Workers (frontline health facilities) MOH staffor Other Political kaders Others(soecifr) Program manaqement Howto ./ conduct Health education ^/ .l ^/ ./ Management of SAEs ^/ ^/ ^l ^/ ./ CSM ^/ ^/ ^/ ^/SHM { .l ./ ^/Drta collection ^/ ./ ^/ Data analysis ^/ ./ ./ Report writing { { ^/Others (snecifr) ./ ^/ t9 WHO/AFOC, 24 November 2003 TableT Treatment and SAEs by district/LGA in all areas at risk (Please addmore rows dnecessary)NW2}11 District iLGA Communities/Villages Population Number of persons who refused the treatnent Number of absentees Nurnber of SAEs Number of adverse e (SAEs) ref the her post/hos Total # of communitieJ villages in the meso/hyper- endemic areas Dr Annua I Treat ment Object ive IL Number of communitieV villages treated Ds Geographical coverage ('/o) Dl= DJ Drrlfi) Total population of the meso/hyper- endemic areas Ds Annual Treatnent Objective Dc Number of persons treated Dt Therapeutic coverage (%) De= Drl Dsrlfi) BAFUT 50 50 50 100 372t6 2419r 2s376 70.2% 1878 44t7 0 0 BALI 40 40 40 100 2t7tt 141 13 14861 68.50/o 352 3028 0 0 BAMENDA 89 89 89 100 66321 43t09 48945 74.0% 2948 8560 0 0 BATBO 7t 7t 69 97.2 45644 29669 38380 68.t% 4108 8460 0 0 FUNDONG 6t 6l 61 100 tt2582 6975t 56982 53.IYo 1 1654 24729 0 0 KIJMBO EAST 43 43 43 100 34988 22742 26104 74.8% 1043 5201 0 0 KUMBO WEST 42 42 42 100 63774 4t454 41208 64.6% 1988 5681 0 0 MBENGWI 73 73 73 100 3t227 20298 232t4 74.3% 1983 5646 0 0 NDOP 24 24 24 100 2121t 17688 207t2 76% 468 ll20 0 0 NDU 25 25 25 100 37391 24304 24690 66.0% 4427 5038 0 0 NIIKWA 28 28 28 100 17647 tL47l t2406 70.0o/o 658 2033 0 0 NKAMBE/AK o 84 84 84 100 54302 35297 37811 69.80 2283 54',79 0 0 SANTA 31 31 31 100 4t266 26828 26313 63.8% 831 5342 0 0 20 WHO/APOC, 24 November 2004 Formula for computing therapeutic and geographical coverages Therapeutic coverage rate (%) Geographical coverage rate(n ATO coverage rate (%) Number of people treated x 100 Total population living in meso/hyper-endemic communities within the project area : 4723711705237*100=67.lYo Number of communities/villages treated x 100 Total number of meso/hyper-endemic communities as identified by REMO in the project arcr7631776*100=98.33% Number of people treated x 100 4723711444148+100:106.36% Annual Treatment Obj ective Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG)=4723711550322*100:86%o ATO =Ih.tu dtd@ olpoprc blrqhnadltrya-arbnb @NM ocDTI pnj.dit akh bt dt hiwatut,1ti|stilg.re@. UNi=Ih. dn r,,,t,,,,r' qpq&,o b.nqdinnao/htpa-.rubb ,,c,r$iiti,th. pqid oa nd&bberdd*znrh. Wi.d h6 tehdthAS.ogq cd@Erqe(nor@ dE paj.d sW bc atddfb |r,frh,*. ATG d*c erd ofrte 3 r.o dth, Wi.q WHO/APOC, 24 November 2004 )l TREATMENT FIGURES IN THE HYPO- ENDEMIC COMMUNITIES S/no. DISTRICTS FIGURES I BAFUT 1972 2 BALI 736 3 BAMENDA/TUBA s6708 4 BATIBO 3211 5 FUNDONG 0 6 KUMBO EAST 42721 7 KUMBO WEST 58896 8 MBENGWI 1888 9 NDOP 59180 IO NDU I 1567 II NJIKWA 0 I2 NKAMBilAKO 25850 t3 SANTA 9739 I4 WAM 0 TOTAL 252468 267. What are the causes of absenteeism,? 1.) Farming season, families usually change residence during this period 2.1 Migration especially the Fulani that practice transhumance during the dry season. 3) Commercial activities, some people move to neighboring countries for business ventures 4l Non residence was censured. What are the reasons for refusals? 1).Fear of side effects that will disturb their pre- occupation (examination periods) 2) Rumor of death from other provinces 3i Religious Fanatics evident in Jehovah witnesses, Apostolic and Full gospel Christians. 4y mt..rrption of drinking habits .some persons did not want to miss alcohol for a day 22 WHO/AFOC, 24 November 20O4 r In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box.@tr 2,6,4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the repofting period and provide (in table 8) the required Information when available. No SAE case to report Table 8: Cases of serious adverse events (SAEs) that occurred during the repofting period @lease add more rwvs d necessary) SA.I* Age Sex Village of origm Date Mectizan was taken Date 1" symptom s appeared Symptoms Health status before taking Mectizan Date of admission in health facility Date of dismissal from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involveme nt or not * Serial number of the patient 23 WHO/APOC, 24 November 2OO4 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage by calendar year for the entire project area. (Pleaseftll in the required data) Please indicate the UTG for the project area: .(use this figure as the denominator in all UTG coverage calculations.) YEAR Communities/Villages Population Total # of communitieVvillag es in the meso/hyper- endemic areas F:,, fumual Treatment Objective F:. Number of communitie s/vi11ages heated f,"" Geographi cal coverage (o/o) El= x",/ F..*100 ATO coverage (o/o) Bs= tr""/ F^*too Total population of the meso/hyper- endemic areas E. Annual Treatment Objective Ez Number of persons treated n. Therapeutic coverage (o/o) Er= E"/ E.*100 ATO coverage (%) L10- F:,J F:,"*100 UTG Coverage va 2001 2002 2003 2004 682 490 640 93.8 130.6 648665 42r633 430436 66.4yo l02.lo/o 79.0 2005 776 505 763 99.73 149.0 705237 444t48 472371 67.j%o t06% 85.84. 2006 2007 2008 2009 2010 WHO/APOC, 24 November 2004 ){ 2.7. Ordering, storage and deliycqy of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH n/ WHO fI UTIICEF E NGDO / OthEr tr (please specify): Mectizan@ delivered by - (please tick the appropriate answer) tr MOH fl wHOtr UNICEF NGDO Other (please speciff): Please describe how Mectizan@ is ordered and how it gets to the communities 2,000,5 OOtablets of medtzan3mg wasordered from the Mectizan Donation progrilmme. In the course of distributiorq there was reported shortage. With o drugs at the NWPSFI! 70,000 tablets were gotten from SWI. Of the 190,532 tablets which were in the districts at the end of the distribution cycle in the first year, 133,532 was still at the district level as indicated in Table 10. The shortage turned out to be artificial. Ofthe 465,748 tablets remaining, the 70,000 borrowed from the Southwest province has been returned, 343,500 have been returned to the NWPSFH, while 52,248 tablets are still at the district level. Table l0: Mectizan@ Inventory (Please add more rows if necessary) District Number of Mectizan- tablets Number in District Requeste d Received Used Lost \Yasted Expir ed Remaining BAFUT 0 97,OOO 97,000 71,487 196 1,993 0 23,324 BALI 7,5N 50,000 50,000 52,007 0 0 0 5,493 BAMENDA 0 400,000 400,000 257,502 0 1,656 0 140,842 BATIBO 10,500 150,000 135,000 105,005 0 787 0 39,708 FLINDONG 3,1 16 170,0m 170,000 151,537 349 0 0 21,230 KIJMBOEAST to,t74 270,000 259,000 t80,429 331 9 0 88,405 KUMBO WEST 24,992 190,000 188,500 198,237 37 2to 0 15,00E MBENGWI 0 80,000 80000 71,372 500 212 0 7,916 NDOP 2,1o2 178,000 178000 t77,238 0 0 0 2,864 NDU 0 I15,000 115,000 92275 728 971 0 21,026 NJIKWA 0 50,000 50,000 27,818 0 115 0 22,067 NKAMBUAko 31,62r 155000 155,000 162515 358 872 0 22,876 SANTA 2,527 100,0m 100,000 97,340 0 380 0 4,807 WI.JM 41,000 209,000 209,000 198,7m 0 lll8 0 50,182 TOTAL 133,532 22,14,0OO 2,186,500 1,843462 2Age 8"323 0 465,748 25 WHO/APOC, 24 November 2OO4 - How are the remaining ivermectin tablets collected and where are they kept Districts collect the remaining mectiz-an; constitutes into tins of 50O tablets. These are sent to the Northwest Provincial Special Fund for Health for storage against yetr 3. However some Districts are still keeping some tablets as seen above (table 10) - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. When the drugs got to the NWPSFH at the Provincial Delegation of Puhlic Health Bamenda, the request of the District was distributed as seen above. The districts in turn distributed to the health areas through chiefs of health centers. CDDs collected their requested stock from the leading health unit in the health area. The CDDs finally gave the drugs to the eligible population. - Any other comments 2.8. Gommunityr self-monitoring and Stakeholderc tleeting Has any training (of trainers) for community sellmonitoring been done in the project area? If so, When? Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSI/D No of Communities ttrat participated in stakeholder meetings (SHM) held at health area level. BAFUT 50 40 50 BALI 40 40 40 BAMENDA 89 89 89 BATIBO 7l 69 71 FT.]NDONG 61 61 6t KUMBO EAST 43 43 43 KUMBO WEST 42 20 42 MBENGWI 73 55 73 NDOP 24 24 24 NDU 25 16 25 NJIKWA 28 28 28 NKAMBE/AK o 84 80 84 SANTA 31 31 3t WHO/APOC, 24 November 2OO4 )g WUM 115 6l 115 TOTAL 776 657 776 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supewision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identitied during supervision? i) Direct obsenration treatment was not practiced in some communities. ii) Some CDDs took money from the communities iii) Some CDDs kept drugs for their families and friends iv) Rumour of sterilization/death loomed in some communities v) CDDs reluctantly did their due to non pa5rnent of 2OO4 motivation Provincial team / OPC Health area team WHO/APOC, 24 November 2004 )'l vi) Conflicting roles of some CBHs/CBAFs notice in Santa. vii) Generalized Poor handling of management tools viii) Late justification of funds 2.9.3. Was a supervision checklist used? They were used at all levels community / health area /Districts /province. These were used by Health center staffs, District Technical staffs, OPCs and Provincial team. 2.9.4. What were the outcomes at each level of CDTI implementation\supervision? i) On the spot rectification ofjustifications /written reports. ii.) Correction of the filling of data collecting tools.(registers/household cards) iii) CDDs were convinced to carry on distribution iv) Supervision checklist were supplied to some areas that formerly did not have them v) The conflicting roles of CBHs/CBAFs were clarified. This was evident in Santa Health District. Their performance improved thereafter as seen in their overall results. 2.9.5. Was feedback given to the person or groups superoised? YES During active superuision, management of minor side effects, CSM, and a-ll the appraisals immediate feedback on the main issues identified were grven at various levels. Substantial improvement was recorded by the supervisee this was seen in the quality of various written reports to hierarchy. 2.9.6. How was the feedback used to improve the overall performance of the project? i) Improvement in filling the management tools. ii) Early and proper justification of funds iii) Intensive search for severe adverse events iv) Proper management of minor side effects SECTION 3: Support to CDTI 3.{. Equipment Table 12. Status of equipment @lease addmore rows if necessary) Source Tlpe of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Conditim l. Vehicle I F 2. Motor cycle(s) t2 F 2t F 3. Computer(s) I F WHO/APOC, 24 November 2004 Zg 4. Printer(s) I F 5. Photocopier (s) I F 6. Fa:r Machine(s) I F 7. Others a)overhead oroi. I F b)Flip chart stand 3 F c)Powemoint I F *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? WHO/APOC, 24 November 2OO4 29 Contributor Yezr I ('provide the nerid') Year 2 ('prwide the neritl') Year3 ('prwide the nerid') TOTAL CASH Budgeted rus$) TOTAL CASH Released rus$) TOTAL CASH Budgeted rus$) TOTAL CASH Released rus$) TOTAL CASH Budgeted russ) TOTAL CASH Released rus$) MOH (Central + ProvinciaUState) 234522 234522 MOH (DistrictilGA) Local NGDO(s) ( if any) NGDO partner(s) 53,928 34,730 99,087 105,910 100,925 87467 Otherc a) b) APOC Trust Fund** 238718 238718 129099 129099 TOTAL 3.2. Financial contributions of the partneis and communities Table 13: Financial contributions by all partners for the last three years * This is exclusively project cost no NGDO personnel cost is included. ** APOC funding started year goes across the calendar year. - If there are problems with release of counterpart funds, how were they addressed? - Additional comments 3-3. Other forms of conrmunity support - Describe (indicate forms of in-kind contributions of communities if any) Some communities motivated the CDDs with food and drinks, exoneration from community work and sometimes financial assistance. 3.4 Expenditure per activiry - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here. WHO/APOC, 24 November 2OO4 fQ 4qqyity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 0 Mobilization and health education of communities 4015.2 APOC IELry4g !rcqDs 9908.6 APOC/SSI Training of health staffat all levels 17630.5 APOC Superviqi4g CDDs and distribution 11560.00 APOC/SSI t"te1qql *gg{q4gof CDTI activities 37261.90 APOC/SSVMoPH Advocacy visits to health and political authorities 26878.81 APOCiIvIoPH IEC materials r785.00 MoPH Summary (reporting) forms for treatment 19.05 APOC Vehicles/ MotorcycleV bicycles maintenance 39055.1 I APOC/SSVIVIoPH Qfiice Equipment (e.g computers, printers etc) 867.62 APOC Others 14162.88 APOC/]VIOPH Supplies 13222.47 APOCiSSUIIoPH Personnel 132255.42 APOC/SSUMoPH G"rqryl Assembly meeting 0 Communication 4900.00 APOC/MoPH Other office operating cost 23302.61 APOC/SSI/Ir4oPH REA 0 TOTAL 336825.t7 Total number of persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period. - Any comments or explanations? The contribution from the ministry of public health was in terms of personnel and minimal out station allowances from NOTF to opCs. SEGTIOII 4: Sustainabitity of GDTI 41. lnternal; independent participatory rnonitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) {--Vear I Participatory Independent monitoring NO Mid Term Sustainability Evaluation NO_ 5 year Sustainability Evaluation WHO/APOC, 24 November 2004 31 Internal Monitoring by NOTF .YES_ Other Evaluation by other partners 4.1.2. What were the recommendations? The independent participatory monitoring recommended as follows: 1.) Increase involvement of communi$, especially the women in deciding the period and method of mectizan distribution. ii.) Plan health education for periods convenient for women like during clinics, women groups meetings and hjangi'houses. iii.) Communities to be sensitized to motivate CDDs iv.) Identify minorit5r groups like herdsmen and use special strategies to treat them. v.) All communities should be trained and retrained and encouraged to carr5rout community self monitoring. vi) Health Districts /Areas should be trained and retrained and encouraged to request for their stock of mectizan. vii.) Training group should be made smaller to promote good group interaction. viii.) Avoid selecting students and people likely to get other employment as CDDs. ix.) Take measures to avoid late supplies and shortage of mectizan. x.) Make efforts to get local NGOs and CBOs involved in CDTI. xi.] Dance groups should be used during sensitization and mobilization. xii.) People should be made to give testimonies during mobilization and sensitization. Xii Advocacy visits be intensified at levels xiii) CDDs should be provided with aprons, T-shirts or caps for identification. Xiv Financial incentives owed CDDs should be paid. 4.1.3. How have they been implemented? The following of the above recommendations have been implemented thus: a. About 4OYo of CDDs are women. b. Most health education, mobilization and sensitization are done during situations where women are involved like clinics, women groups and njangi houses. c. Communities played an important role in motivating CDDs like exonerating them from community work, weeding their farms, giving them foods when distributing mectiz,an and give even financial motivation. When other remunerative health programmes comes up they are consider first. d. The state through the Ministry of health allocated 14.000.000 francs to motivate CDDS Year 1 distribution. WHO/APOC, 24 November 2O04 32 e. There was no mectiz,an shortage this time, ALL request came from below and according to their target populations and taking into consideration of an average of 3 tablets per eligible person. f. Testimonies were given in many Districts particularly on the merits of mectizan. g. Out of 776 meso/hyper communities, 657 undertook communit5r self monitoring and all held stake holders meetings However, the following recommendations are yet to be implemented; i) 500 T-shirts provided bt NOTF for CDDs could not go round so T- shirts are yet to be provided to CDDs and other actors. ii) The number of participant per training /retranning sessions is still large because of the size of the project and to encourage group interaction and d5mamism. iii) Advocacy visits are still timid even-though the population is quite responsive. iv) Dance groups were used during the first year launching in 13 districts. This year there was no launching hence this method of sensitization was virtually absence. This calls for funds to do Launching in Njikwa and the province. This activity is pending at these two levels. 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: 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 plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: During the Frovincial Appraisal meeting of The 17ft to 18ft ,November,2OO5 , the Executive secretarlr of the National Ochocerciasis Task force Cameroon gave an elaborate expose on how sustainability can be achieved in Cameroon and added that: 4.2.1. Plaaai-g at dl relevant levels - integration with other programs 4.2.2. Frrnds - composite budgeting 4.2.3 Ttansport lreplacement and maintenancef use of state allocation and donor agencies to replace or maintain vehicles as the need arises. WHO/APOC, 24 November2004 Jj 4.2.4. Other resources cost recovery and revenue set aside , part if it will be allocated to CDTI. 4.2.5. To what extent has the plan been implemented During coordination meetings, issues concerning CDTI are currently been discussed awaiting the integrated sustainability plan. 43. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. fvermectindeliverymechanisms Ivermectin was transfered from NOTF Yaounde under the watchful eyes of SSI to the drug Fund(NWPSFH) by the North West Provincial delegation of Fublic Health. At the request of the District Chiefs of services for Public Health and endorsed by the provincial delegate of health each District received a stock directly from the fund and eventually distributed it to the health areas on request. The health a.reas in turn distributed their stock to the CDDs following the request originally submitted by the z,olee concern. The CDDs finally gave the drugs to the eligible population .However, drugs for managing side effects were kept only in community Pharmacies owned by the fund. 4.3.2. Training Training is not yet integrated. This 2.d year training was held in the Districts. Some Districts with easy accessibilit5r were grouped into one training centre, while those with difficult terrain like Njikwa had independent training. 4.3.3. Joint supervision and monitoring with other programs At the Provincial and District levels supervision and monitoring of CDTI activities was made jointly with other PHC programmes .These supervision were more resource management efficient. At the health area CDDs went out only for CDTI activities. This was linked to the fact that their remunerations will be compromised if activities are jointly done. 4.3.4. Release of funds for project activities Funds are released from all the partners. These include APOC / SSI / STATE / community. The part from the state is difficult to evaluate entirely. However some state paid employees (OPCs) work fulltime with CDTI., government funds meant for the running of health facilities are pooled together and equally used for CDTI activities . Members of the communities release funds in kind. Even though the partners release fund they often do that quite late. 4.3.5. Is CDTI included in the PHC budgetr There is no budget line yet for CDTI activities at any level (Provincial, District or health area.). This is what we still need to advocate for vehemently from the state. However in Year 1 the State released over fourteen million francs to motivate the CDDs at a rate of 25frs per person WHO/APOC, 24 November2004 34 treated. The Ministry of Public Health provided IEC materials and stationeries to reinforce the project. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? A11 community health programmes make use of all CDTI implanted facilities namely; i) Vehicle used for integrated supervision ii) motorrycles used for integrated supervision also. iii) CDDs who are used either as social mobilizers, vaccinators or carriers during programmes like EPI, National Immunization Days, Malaria / TB control. 4.3.7. Ilescribe others issues considered in the integration. 4.4. Operational research Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research has been undertaken in the entire project area. All the actors were initiated into this during the provincial appraisal meeting that was held to evaluate year l1 activities. The District Chief of service for Fublic Bamenda has been select for a similar to this effect. This might be the kickoff point for operational research in the project a-rea after his training. 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. Not yet applicable in CDTI NW project. 4.4.2. How were the results applied in the project? Not yet applicable in CDTI NW project. SEGTIOil 5: Strengths, weaknesses, challenges, and oppoilunities - List the strengths and weaknesses of CDTI implementation process - A)STRENGTHS: 1) No SAEs registered in the entire project area in year1l the acceptance rate increased 2) High acceptability of mectizan due to intensified community mobilization 3) Donation of eight more motorcycles by SSI to re in enforce CDTI/PHC in the Province. 4) Increased utilization of health facilities dues to the benefits of mectizan viz; - Improved eyesight - Improved skin turgor WHO/APOC, 24 November 2OO4 35 - Expelling intestinal parasites - Regularized menses - lmproved sexual performance in men - flexible joints - treated body lice/jiggers / bed bugs 5) There is increased community participation as CDDs are incorporated into other PHC programmes. This is serve as a form of motivation .to them 6) Communities participated in stakeholders meetings conducted at the level of the health areas. - B) WEAr(NESSES 1.) Timing was not generally convenient in the entire project a-rea 2.) CDDs worked agitating due to the pending MOH motivation of yearl(2oo4l 3.) Some emerging health problems during distribution were attributed to Mectizan administration. 4.) The actors had so many management tools to fill 5.) Few districts filled the APOC technical report before the district appraisal meetings. 6.) Timid written reports on community self monitoring. 7.) No advocacy visits undertaken by OPCs 9.) Late / wrong/ improperjustifications 10.) Very limited time for OPCs to do supervision of CDTI activities. List the challenges and indicate how they were addressed. 1.) Inhabitants migrated to new settlements (transhumance/farmers). To overcome the situation and improve on coverage, CDDs moved to their new settlements and treated the eligible population. - 2l Initia-l high refusal rate. To overcome this, community mobilization/sensitization was intensified, many refusals convinced and the refusal rate dropped. 3) CDDs reluctaat to work due to no pa5rment of the state promised motivation; To overcome this, Health workers and community leaders convinced them that it was a communify project, instituted ways like exoneration of CDDs from community work , gave them some food and drinks during distribution. During other PHC activities like National Immunization Days they are used as vaccinators, social mobilizers , at such they become more performant. 4) Inadequate means of transport: To overcome this challenge, some community members provided bicycles and motorcycles to CDDs and health personnel to accelerate distribution. SEGTIOII 6: U mattens nique fieatures of the proiecUother The unique features of the North West includes: 1) The Province is predominantly English speaking WHO/APOC, 24 November 2004 36 2) Traditional authority is highly respected: any mobilization that emanates from their end is acclaimed; 3) The drug delivery mechanism is highly developed, hence the delivery oi mectizarr through the NWPSFH is an advantage when sustainability become a reality. T[e dialogue structures a.re a major partner of this fund. 4) The main ethnic groups in the North West Province include; -The Widikum occupies Momo,part of Mezam and part of Menchum Divisions. -The Tikaris Occupies part of Mezam,Ngoketunjia and Bui Divisions. -The wimbums/Yembas occupies Part of Bui Donga/Mantung -The Aghems occupies most of Menchum- - The Koms occuPies all of BoYo - The Lamnso occuPies BUI> -The Fulanis are dotted all over the entire project area. It should be noted that to arrive at the different Divisional head quarters you must pass through Bameda the provincia-l headquarter of the province. WHO/APOC, 24 November 2004 J7