North West CDTI annual project technical report to technical consultative committee (TCC) January 2001 To December 2004

Republic of Cameroon Ministry of Public Health Si t Savers International COUNTRY/}IOTF: CAMEROON Prqiaat Nlaate: NORTH WEST CDTI PROJECT Approval vear: 2003 Launching year: 2003 Reporting Period: From: January 2001Toz December 2004(Month/Year) ( Month/Year) Proiect year of this report: ( I ) Date submitted: June 2005 NGDO SIGHT SAWRS I NTERNATIONAL ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) rErl-thn.est i.t)"[ [ Pu'rltert h r:;t r" "fi DEADLINE FOR STIBMISSION: / o5 To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR oNCHOCERCTASTS CONTROL (APOC) For io: C/.) For To, -)r t il,, Biiil Ar* lnir '1. I n l11 - as. t!'U y t{JU$ tq i .r,, i?- 2005 "*"1 WHO/APOC, 24 November 2004I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country Cameroon National Coordinator Name: )ru. ..tJ;.T{.Y..).1r" r ("tJ,[^< Signature Date: ....0.2 I [./u; Zonal Oncho Coordinator Name Signature: ...... Date NGDO Representative Name Signature: Date This report has been prepared by Name. \.- Aft'L. 4*),---' Designation: ?,:rr ffi- srr Signature ee: 1*** [ss(Date ll WHO/APOC, 24 November 2004 I Table of contents ACRONYMS FOLLOW UP ON TCC RECOMMENDATIONS .........1 SECTION 1: BACKGROUND INFORIVIATION....... ......................5 l.l. GeNeRar-INFoRMATIoN................ 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopulerroN....... SECTION 2: IMPLEMENTATION OF CDTI....... .....11 2.1 TtugltNp oF ACTIvITIES ..... 11 2.2. Aovocacv v 5 5 I 9 ...................... 13 MostI-tzerloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNtues 12 CouvurNrrynwoLVEMENT........ ...... 16 Clpncrrv BUTLDTNG.. ...... 18 TnrRrveurs........ 20 2.6.1. Treatmentfigures............ .........20 2.6.2 Wat are the causes of absenteeism?.......... ................. 21 2.6.3 What are the reasons for refusals?................ ............... 232.6.4 Briefly describe all lmown and verified serious adverse events (SAE{ that ... 23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year25 2.7. ORoeRrNc, sroRAGE AND DELIVERy oF TvERMECTTN ............... ..............26 2.8- CouuuNny sELF-MoNrroRrNG nNo SrnrrHoLDERS MeerrNc ....-.-..--.28 2.9. SuppRvrsroN ...................29 2.9.1. Provide aJlow chart of supervision hierarchy. ............29 2.9.2. What were the main issues identified during supervision? .............................. 29 2.9.3. Was a supervision checHist used? ............. 30 2.9.4. Whot were the outcomes at each level of CDTI implementation supervision? j0 2.9.5. Was feedback given to the person or groups supervised? .............. 302.9.6. How was the feedback used to improve the overall performance of the project? 30 SECTION 3: SUPPORT TO CDTI 2.3 2.4 2.5 2.6 3.1. 3.2. 3.3. 3.4. EqunueNr FnqeNctnl coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES. Ornpn FoRMS oF coMMUNIT suppoRT ............... ExprNorruRE PER ACTrvrrY . 31 31 32 32 33 SECTION 4: SUSTAINABILITY OF CDTI. ................34 4.1. IurenNel; TNDEeENDENT pARTrcrpAToRy MoNrroRrNc; Eve1uarroN....................34 4.1.I Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)........... ............34 4.1.2. Whatwere the recommendattons? ............. i4 4.1.3. How hove they been implemented? ............. ................. 34 llr WHO/APOC, 24 November 2004 4.2. SusrnNaerLlTy oF rRoJECTS: eLAN AND sET TARGETS (rra,a.NoeroRY AT...... ..-.......34 Yn 3) 4.2.1. Planning at all relevant levels.... ................ 34 4.2.2. Funds....... ............... 34 4.2.3 Transport (replacement and maintenance).............. .... 34 4.2.4. Other resources.. .... 34 4.2.5. To what extent has the plan been implemented...... ...... 34 4.3. INrecRerroN ..................34 4.3.1. Ivermectin delivery mechonisms............... ................... -t.I 4.3.2. Training.... .............. -rj 4.3.3. Joint supervision and monitoringwith other progroms...... ........... 35 4.3.4. Release offunds for project activities ........ 354.3.5. Is CDTI included in the PHC budget? .............. ........... -t5 4.3.6. Describe other health progrommes that are using the CDTI structure and how this was achieved. What hove been the achievements?............. .................... -3J 4.3.7. Describe others issues considered in the integration of CDTI. ..... 36 4.4. OppnarroNAl RESEARCH .....36 4.4.1 . Summarize in not more thon one half of a page the operational research undertalren in the project area within the reporting period. ........ 36 4.4.2. How were the results applied in the project?............. .................... 36 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTT/NITIES....... 36 SECTION 6: UNIQUE TEATURES OF THE PROJECT/OTHER MATTERS...........38 lv WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBAF CBH CBO CDD CDTI CMO CSM DMO LGA MOH / MoH NGDO NGO NOTF NW NWPSFH OPC PHC REA REMO SAE SHM SSI TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Chef of Bureau of Administration and Finance Chief of Bureau Health Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Chief Medical Officer Community Self-Monitoring District Medical Officer Local Government Area Ministry of Health Non-Govemmental Development Organization Non-Govemmental Organi zation National Onchocerciasis Task Force Northwest Northwest Provincial Special Fund for Health Onchocerciasis Project Co-ordinator Primary health care Rapid epidemiological assessment Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sight Savers International Technical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 Definitions (D 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 84o/o of the total population in meso/hyper- endemic communities in the project area. (i ii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesolhyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be 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) Geopraphical coverage: number of communities treated in a given year over the total number of meso/tryper-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, supervision 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-monitoring (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. vl WHO/APOC, 24 November 2OO4 FOLLOW UP ON TGG REGOTTE]IDATIO]IS 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 I Number of Recommendatio n h the Reoorl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY l13 - Report written in old format This report had been rewritten in the new format. - Inadequate resume The resume had been rewritten and beefed up as well. The former resume was brief and incomplete as it was just a partial report and activities were still ongoing and could not all be reported on. - Incoherent demographic data Data is now coherent. In the report in question, we were reporting on incomplete and partial data coming from the field. As activities were still going on in the field. The correct and complete data is what is found in this report. tt4 - No reason for distributing 58,331 Mectizan@ tablets in hypo endemic communities while tablets were short The figure of 58,331 Mectizan@ tablets being distributed to hypo endemic communities was just a partial figure as activities were still ongoing as already mentioned above. At the end ofthe year's CDTI activities a total of 349,541 tablets were distributed to hypo endemic communities, as shown on table l0 of page26. During trainings and at onset of activities we had advised that mass treatment be carried out only in hyper/meso communities. This was applied but there was so much pressure from the communities that were hypo endemic for oncho. They would not understand the meaning of hypo or meso/hyper endemicity and the prescribed treatment strategy. It was beginning to cause a big problem in the field. Also REA results were contested in some health districts; some communities that were reported as being hypo endemic turned out to be either meso or hyper when REA was redone. This happened in Bafut WHO/APOC, 24 November 2004 and Kumbo West health districts. Faced with this, the provincial delegate had to order that treatment be given to both hypo and mesolhyper endemic communities, but that side effects should be monitored scrupulously. Mectizan@ shortage that was mentioned in the partial report was taken care of by repartitioning of tablets within health districts and by a fresh stock of Mectizan@ that was sent by MDP in May as mentioned in page 26 of the report. - Information about the 469,012 Mectizan@ tablets missing Table l0 on page 26 details out Mectizan@ tablet inventory. A total of 253,422 tablets remained and were added up to this year's stock for distribution. It may be worth mentioning here that in Fundong health district a CDD's home got burnt with over 2,000 tablets that were meant for his community. lt5 - Missing information from report. 1. Totals on tables 2. Geographic and therapeutic coverages 3. Annual treatment objective 4. Annual training objective. 5. How to address absenteeism. 6. Adequacy of health staff l. Tables nowhave totals as need be. 2. Geographic coverage (93.8%) as well as therapeutic coverage (66.4%) have all been calculated and included in the report. See pages 21 and22. 3. The Annual Treatment Objective (421,633) is included in the report. See table 7, page 21. 4. The report also has Annual Training Objective for health district staff(84), health centre staff ( I 63), other trainers of trainees (6) and CDDs (2,952). See table 5 on page 19. 5. In page 23 section2.6.2 absenteeism was said to be caused by treatment in the farming season due to the two intemrptions caused by the national anti poliomyelitis immunization campaign. This year treatment was started well ahead of the farming period and it is almost going through. We hope that there will be less absenteeism this year. 6. Generally, the health sector especially the government facilities are poorly staffed. Good enough staffthat work for 2 WHO/APOC. 24 November 2004 7. Male/female CDD ratio, Percentage of communities with female CDDs, person/CDD ratio. CDTI are the same that work for all the other health programmes. Also CDTI is a seasonal programme whose peak activities are in just about three to four months ayear, giving time for the health staff to concentrated in other programmes. Though the number of staffwe have is few, they adequately carry out their CDTI activities. 7. Table 4 on page 15 shows the number of male and female CDDs district by district. It also shows percentege of communities with female CDDs. The ratio of number of CDDs to the population was not requested in the format but the table bellow details this health district by health district. Table showing percon /CDD ration per health district Health district Population of mesorhyper communities CDDs trained Ratio penson, CDD BAFUT 35,615 172 207 BALl 16,729 87 192 BAMENDA 113,683 250 455 BAT!BO 44,W 256 174 FUNDONG 94,170 241 391 KUMBO EAST 25,541 277 92 KUMBO WEST 44,951 214 210 MBENGW! 30,536 163 187 NDOP 41,619 132 315 NDU 27,619 141 196 NJrl( /A 12,474 0 0 NKAMBE 53,358 318 168 SANTA 16,714 73 229 WUM 103,486 352 294 TOTAL 66{,139 2,676 247 5 WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summory of the report in not more than one page. l. Background on treatment and population data - Total communities, communities treated, total population, WG, ATO andpersons treated. The Northwest CDTI project has completed its first round of activities. The project was approved in 2003 and started in June of the sarne year even before APOC funding. The project area has a total censured population of 682,829 inhabitants spread over a surface area of 18,10OKm2. It is made up of 14 health districts that comprise of 163 health areas. The project area has a total of 993 communities. CDTI did not take place in the whole Province. Njikwa health district and part of Wum health district were left out due to poor accessibility and the presence of Loa loa. The meso lhyper endemic zones that did CDTI had a censured population of 648,665 inhabitants. Our treatment objective (65% of meso/hyper population) for the year as well as ultimate treatment goal l84o/o of meso/hyper population) was 409,906 and 555,357 persons respectively. A total of 430,436 persons were treated grving a therapeutic coverage rate of 66.40/o. 2. Background on population movements. There is constant migration to the urban towns by the youths in search for better jobs. During the farming season people also leave their villages and temporarily migrate to their farm houses. The province also has cattle rearers that migrate with their cattle following seasonal changes, looking for green pastures. 3. Training data - CDDS, healthworkers, Total populotion (community) per CDD trained. Trainings started in July 2OO3 in most of the project area. These trainings were in cascade starting for the provincial level right through to the community level. 322 health workers were trained in all. A total of 2,676 CDDs were trained. The population: CDD ration was 247 persons : 1 CDD. 4. Challenges and how they were overcome. The following are some of the challenges encountered by the project this ye€rr: - Implementation of the project with little funds available after massive budget cuts that APOC had made. To overcome this the following were done amongst others; a lot of sensitisation had to be made in order to convince the communities to linance the registration exercise themselves, the planned provincial launching of Mectizan@ distribution was cancelled and replaced by low-keyed district launchings, Sight Savers International had to financed REA and supplement for other activities. - To attain the treatment objective of at least 650/o of the population. This was a-lso attained through a lot of health education sensitisation and a lot of monitoring and supervision of field activities. - To improve on the transport situation of the health sector of the province. A four-wheel-drive vehicle and 27 motorcycles were provided to the project by APOC and SSI. 4 WHO/APOC, 24 November 2004 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Ge o gr aphi cql I o c at i on, t opo gr aphy, cl imate Population: activities, cultures, language Communication systems (roads ... ) Admi ni s tr at ion s truc tur e 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. A. Geographical and administrative area(s) The Northwest project area will cover the entire North West Province, which lies longitude 9" +5' and 11" 10' east and latitude 5" 35' and 7" 1O' north. It is bordered in the south by the Akwaya and Mamfe health districts of the South West Province, in east by the West Province and in the north and west byTaraba State, Nigeria. It covers a surface area of 18,100 km2. It has a total population of 682,829 inhabitants in meso and hyper endemic communities. The NW province is made up of seven administrative divisions, which are divided into 14 health districts with 163 health areas. Tdble t. Admlntsttzttue unlts, Health dlstrtcts and health aneq,s 5 Divisions / SuFdivisions HealthDistricts District population Health Areas Mezam Bamenda Santa Tubah Bali Bafut Bamenda l 13683 Azke Nkwen Urban Nkwen Rural Mankon Nkwen Baptist Mendankwe Bambui Ntamulung Alabukam Bambili Mbachongwa Ntambag Atuakom Mulang Alakuma Kediom Keku Kediom Ketinguh Santa 16714 Mbu Menka Akum Ndapang Buchi Baligham Pinyin Santa Urban Awing Bafut 35615 Manji Nsem Mbakong Mambu Mforya Buwe-Burari Mundum Akofunguba Mankanikong Bali 16729 Bali urban Gungong Bossa Bawock Catholic mission Wosing Momo Batibo Mbengwi Njikwa Ngie Widikum Batibo 44644 Batibo Guzang Tiben Laringi Kulabei Gwofon Widikum Bifang Ewai Ashong Olorunti Eka Mbengwi 30536 Andek Tezph Abebung Njah-Etu Bome Njidom Mbengwi Ajei Nkon-Mengom Tinechung Acha-Tugi Munam Nryen-Mbo Njikwa 12474 Njikwa Bassa Kuttin Konda Oshie Akanunku WHO/APOC. 24 November 2004 Ngoketundja Ndop Central Balikumbat Babessi Ndop 41619 Babungo Baba Bamunka urban Babessi Bangolan Bamunka rural Bamali Balikumbat Bamessing Bafanji Bambalang Mbissa-Mbaw Bamunkumbit Mighang-Mbaw Boyo Belo Njinikom Fundong Bum Fundong 94170 Konene Mbessa Belo Mbengkas Aduk Fundong Mentang Kiktuini Anyajua Mejang Fuanantul Menchum Wum Fur-Awa Fongun Menchum Valley Wum t03486 Furu-Awa Bawuru Benakuma Kumfutu Befang Ise Abar Esu St Martin Modele Bafrnen Bu Yemge Weh Beba-Batomo Wum Urban Bui Kumbo Jakiri Oku Mbiame Noni Kumbo East 25541 Mbah Wasi Ber Vekovi Mbam Dzeng Kwanso Mbokam Tatum Mbiame Ngorin Shisong Jakiri Sop Mbonso Wvem Kumbo West 66641 Kumbo Elak-Oku Jikijem Kikaikom Melim BBH Djottin Kew Nkum Kov Nkor Ngeptang Buh* Simon Kov Kuvlu Ichim Donga & Mantung Nkambe Central Ako Ndu Nwa Misaje Nkambe 53358 Nkambe urban Fonfuka Dumbu Kom Abongshie Misaje Binka Kuta Lus Berabe Ako Tabenken Buabua Mbot Ndu 27619 Luh Ntumbaw Ngu Mbongong Ndu Gom Nwa CBC Mangu Ntem Ntong CTE TOTAL 682,829 The 163 Health areas have been divided into 993 zones (communities) for better management. B. Topogrephy, climete, lccess The bio climatic zorre of the Northwest province is mainly Sudan sav€rnnah grassland, with plains, rolling / steep hills and valleys. It makes up most of the Western highlands and is one of the minor watersheds contributing to botJl the Niger and Atlantic basins. These valleys form beds for swift running streams especially in the rainy season, which are dispersed through out the province. The rivers beds are frequently rocky and sometime intermpted by falls all contributing to highly aerated waters which make a good habitat for Simulium, tJre vector of Oncln@rca uouulus. The rains begin in March and are very heavy in August through October, followed by a short dry season. The roads, mainly dirt roads become impracticable during this period. Farming is year round, rrlai".e groundnuts vegetables and beans are planted all through the year, in swampy areas during the dry season and in the main land in March and August. These are harvested three to four month later. The intensity of farming is low or moderate only during the months of December and January. The men farm the cash crops while the women farm the foodstuff. 6 WHO/APOC, 24 November 2004 Of the 3291km of road network in the province only 187 km are tarred the rest is made of dirt road, which becomes impassable during heavy rains in the months of August through October. Some of the villages are only accessible by trekking. The people of the Northwest Province are mainly dispersed living in family groups surrounded by their farmland, scattered throughout the area. Among them are Fulani cattle rearers who are nomads. The rural communities are mostly homogenous while the semi-urban and urban communities are heterogeneous. There are some Fulanis, nomads dotted all over the project area. There is constant migration to the urban towns by the youths in search for better jobs leading to increase urban poverty. The communities of the Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and highly respected. Each clan / family has a family I clan head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the communit5r. The main occupation in the rural communities is farming, animal rearing and petty trade. Most communities have a week of 8 days and the Str day is observed as the traditional Sunday. In most communities this is the market day. Everybody is in the village on that day since no one goes to the farm. Also the dry season is reserved for funeral celebrations and other traditional feasts. Table l: Number of heakh staffinvolved in CDTI 7 Health District Number of health stelf invotved in CIIII activities. Totel lfumber of herlth strlf in the entlre proJect rrce Br Ifumbcr of heelth strfrinvolvcd in clyu B2 Percentage 36=D2l Br *1(X) BAFUT 39 15 38o/o BALI 35 18 5Lo/o BAMENDA 139 34 24o/o BATIBO 7t 25 35o/o FUNDONG 524 36 7o/o KUMBO EAST 37 t2 32o/o KUMBO WEST 358 50 L4Yo MBENGWI 7t 28 39Yo NDOP 63 20 32o/o NDU 29 L4 48o/o NJIKWA 22 o o NKAMBE 49 2L 43o/o SANTA 29 18 620/o WUM 53 24 45o/o Provincial delegation* 49 5 lOo/o TOTAL 1,568 32o- 2L.Lo/o WHO/APOC, 24 November 2004 1.1.2. Partnership * The Provincial delegation has health staJf that do not fall under any health area. These health stalf some of these health staJf are involved in CDTI and other health progr€unmes. Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nat i o nal/ i nt er nat io nal), c ommunit i e s, I o c al or ganiz at i o ns, e t c. J Describe overall working relationship among partners, clearly indicating specific oreas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are iruvolved. State plans, ,f ony, to mobilize the stote/region/district/LGA decision-mol(ers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Partners involved in the implementation of Northwest CDTI Project are the Government of Cameroon (Ministry of Public Health [MoH]), t]re African Programme for Onchocerciasis Control (APOC), Sight Savers International (SSI) and the Community. These partners all work together for the smooth running of project activities. Planning was done with the full participation of the MoH, SSI and the community. The community's opinion was sought on programming activities. These dates were however changed when the various health areas delayed in conducting REA and registration. National Immunization Days (NIDs) against poliomyelitis that were not originally planned for also affected the dates originally agreed upon for CDTI activities. These partners together carried out mobilisation. Health education was mosfly done by the health staff. Advocacy was reserved for personnel of MoH and SSI. Communit5r members did the registration. 8 WHO/APOC, 24 November 2004 -is a ! oE E -Dt -ot l-l la)td l6- lxr s S $v, S ! .S! S. S aa a\ E.F Ii G G \G! ,S Go S\GF e =.G si G\ s a S\G\GS G srl o \ \r Oa s G sS\ Oe !Grr SF H o l0 ez a z -l zX z ED frj z =X zU\- zU otu z EUfrjz o = X ? EU o rna -l X ED o rn a *.1 41c z, U oz o EU -J ED o Ed tr,zU EU r{ ED FrJ Ca o EJaE r. \l r.s =P d 5'- .iE 8Fr ".E. r'F(D +ESrii 6 OJ ( UI(r) N) o\ oo o\ UJ5\o t)5 o\ tJ t)tJ UJ{@ o L'I @{ N) o\5 (,)\o \t @\o N)(r) 5@5 @ u) "o N5 o5 UJ o\ L,I _6Ur\oo o\I(l1 o\ N) \o "5{(,T lJ) -6 €tJo\ = EE € *E= IgrE8EE (, 55 l.J{ o { { @ tJo t\){ tJs \) u)\o \o {L,I N) N)(r) :sFE. It ogtDa x ='Ei rH P z =EE(! 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' o\ o\ (,\o o UJ 56 o\ o\{ 5 (,r (JJ u)(,r oo tJ 5\t5 tJ J-J o\ \o s o\ \o u)o r.h u)6 55 \o(n t) tn 5 \o5 {o 5F o\55 lr) o\ oou) o\ -)t)\o (,(n o\ l/t *3 'lH e.3;-.=t9 Nro ='o(Dr H7 q il \ + ( UTUt t(, -t €I\otJ € 5 a5a 5i oot) P5 -I@ N)tr) NJoa t,5 "\o o\o N)(/l "o\(,o UJ{{(n\o tJ 5(,t5 {\o o(, (,){ (.alo \o(, "s \o5 5 a(/t t\) NJ\o \o{ o8 =O!]EEE iPO eFl o \o A o FU o _o i.Js z o (D o(DI tJoos (\\ S\ sciRilts\= 0a\(\S 8N^ €e x.s Rs x$\ i-:-sshs(\= S': Sg .=\ +.\6\sR\E x.a- ets 3x'Xc,rsBR(\ii $s NNRR.s-.= Sg' (\S S(\c]hso *\ GN -(\ ciss* sS R'a'(tQ Rd ,oh cs vsdGS\q*. =.d(!^\\ -t (tQ.FRs F G = o s G\(! aG G\ s G G\\ (\ o b 6\s s a(\ V) V1 o'\ (!\\ .o(\ a $ (\ \\ h (\\ .(\\ o\ h\(\\ o\ '\) (D 2 IX zo \s TEqs Qil(\-FU 0q (\ (!\ c) o € \ sh(\ ^ .(\ (\ s ao V) (! V) (\ cJ o q \ Sh(\ \){ :r. = (\t- s :! S \ (\\\ .o\+. G .o G it*ig[Igg* [E Bgffi B[fi $ *z Sret E:+ S F[$[}flgBEEr$ efixi alx i ;t'Irgrtas B$EIF[iri[g frgH E;i IHn f;E1 Eg# $ il* !qf i€ *&s' f38 $8 H'FF tti '*Z $i gq$ fr,r'^{ EilE E+$ flgr rS $frEIBE5' eEH 1B='E eqs f;g I'B' :t 5d oE'(+ali ts is*i$*$gB € Fr,.rs6-1o.o E E Hs[3H n Xs BEfi i*rfi f iiEi*;E$$ HeB*$I5E+g:rBfIriI EfiE+H3f E;ilcfg$[$+i E g H E:H5'$S }EIFSEEl tE$sE;E * BT EE*tnn $$BrFrEB g:E, rE 3E r E'ts A i E'3'o at[[g gf r x iss aEe E [efi[argr E$ry[34* ++ag[[$r t=fEsirIE silg+'I O otru o _o t.Js z o (D d(DI N) o5 SEGTIOI| 2: lmplementation of GDTI 2.1. Timeline of actMties Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended As shown on table 3 below, activities all started in February 2OO3 while still waiting for funding from APOC. Activities started with advocacy visits to administrative and traditional authorities of the province. This was then followed by community mobilisation. During this period NGDO (Sight Savers International) stalf visited all the referral hospitals in the province to access what equipment was available for the eventual m€rnagement of side effects. Trainings then started in July and went on right to December 2003. These trainings consisted of the following; training of the staff of the provincial delegation, training of district medical officers and chiefs of bureau health of all health districts, training of the district and provincial finance officers, trainings of doctors and nurses of referral hospitals, training of laboratory technicians on the calibrated smear for diagnosis of Loa loa, training of health centre nurses and training of CDDs. As can be imagined these trainings took place at different levels (provincial delegation of health, health district services, health centres and within the communities). Community mobilisation was an ongoing activity. It went on right through Mectizan@ distribution itseH and even after. It was done by the health staff, the community members themselves (CDDs) and the NGDO staff. During and even after Mectizan@ distribution community mobilisation was geared more towards the early detection and management of side effects, especially after the first case of severe side effects occurred in Fundong health district. Mectizan@ distribution was postponed thrice. It was originally scheduled for October 2OO3. Registration (census) and REA was not completed so it was pushed to November. Still registration was not complete. The new distribution date was January 2OO4. This time national immunisation days against poliomyelitis which were not planned for carne up, further pushing Mectizan@ distribution to February 2OO4. This distribution went on till early April when the stock of Mectizan@ (1,5OO,0OO tablets) got finished. A supplementar5r stock of 3OO,O0O tablets was sent by MDP and distribution resumed in June. This distribution continued till L,ate July 2OO4 in some health districts. Supervision was done for each level of activities; from community mobiliz,atton right through Mectizan@ distribution and appraisal meetings. Every level above supervised the level directly below it. 11 WHO/APOC, 24 November 2004 e7 (A z -l 2. X z EU rn z =n z UC zU oFU 7 EU rnz o = Xe? EU o frla -l X ? ED o rrl (t) -l Frl z U oz o @ -.1 @ o tr 7 tnz U Ed - EU 41 C -l rl(D D It U (r) rt (l o, N)oo G) Il, Noo G) o, 1\)oo(1, I c(o t\,oo(l) o, Noo G) =o) N)oo CD 'Tl oo N)ooG' C ro Noo G) C-c Noo o, o) N)oo CD 0) Nooq) o, t\,ooq) (- C, fo t\,oo(r) AE =te =.isE' (D3ooEq ESEo. (DP Vt) l^{i (- c N)oos (- C N)oos C-c Noos o =.Noo5 C-c Noo5 (- c l\)oos LC N)oos C-c N)oo5 HE5ci C-c Noo5 (- c N)oo5 C-c Noo5 Lc Noos o E39o i+6 o Lc Noo G) Lc Noo G) C-c Noo G) oo l\)oo(.) C-c Noo(}) C-C N)oo(r) C-c t\,oo Cr) Lc l\)ooq) C-c N)oo CD C-c Noo Cr, (- c Noo(r) Lc Noo CD oo Noo G) -a =r95* =E HFtp E E' CE ooo N)oo Ca) ooo Nooq, ooo N)oo Cr) I ooo N'ooG' (- o =Noos Uoo Noo(/) 0) Noos (- o,f Noos 'n oo Noo5 ooo Noo o) ooo Noo CD 0oo N)oo Cr) 11 oo Noo5 ooBE o; a+(D o (n oo l\)ooq) (n oo t\)ooG' U,oo N)oo G) I cio Noo(^) 0, Noo CJ (n oo N)oo o) co N)oo CJ @oo Noo Cr) c to Noo CD @oo Noo G) aoo N)oo(l) U,oo t9oo(r) U)oo l\)oo CD -Qn =!9l, .i FE' o t,D E ao (, r5oD (D (- C N)oo5 (- c Noo5 (- c fo NooA I o _-. Noos o, Noo5 (- c N)oos (- c fo t9oo5 (- c =(D NooG' .TI oo N)ooA C-c N)oos C-c l\)oo5 C-c Noo5 (- c f(D Noo5 o 3EOa o 'Tt o cr Noos 'Tl oct Noo5 'Tl oct Noos I 'Tl oo N)oos 'Tt oo Noos .TI oo Noos -TI oq Noos 'Tl o cr Noos 'Tl (D o Noo5 'Tl (D o Noos .TI oo Noos 'Tt oo N)oos -Tt o cr Noos -a =t05ei :iE UFt F ,a E o rt 5 o (- E Noos (- c N)oo5 (- c l\)oo5 o =.l\)oos ts<o0,sa J Lc Noo5 C-c f(D Noo5 C-c =o Noos E' =.Noo5 (- c Noo5 (- c Noo5 (- C l\)oo5 Lc =o Noos ooE= o 0, o o) I oo o CD ll) o o) o, oG' (- c o G) (- c o Cr, (- c o(r) =ll, o G) 0) oG) o) o Ca) Lc o G) -(n =t05.i +E atE(D{ ar) oIt Etoc @ os c(o c <,, os coE(tt os I ctcc a, os E roE Vt os coco o5 C-c f(D Noo5 c-c Noo5 =It, Noo5 coc(D o5 c tf,C(tt os ctcc(t, os c(o c at, os oo3E oi i+(D oE l*l l!otd ltDl- ;:ei G G ,S trf) G v) S'I F G e(! Sb GS G\ si G .) G \< l! Erl I o s(\ t\ all i$Pt55'Ha.6 sO oi'p)o o!t(,(D zF)<=qii(Do- +a'(DFr iJc) 4A$a)o.(D(DiJ d?<6 +{os)o: LJ A) -FlvH. Q. o- 5.EiJa+0a ar a5 :jp Ncl a)eiJC)t8)O AP =6Y(D goPts doEt(r) c) o E() trI(D =, { A) 5 o. U) ,-t dt o ; (D d(Dso' r-t o Ft !D @ U) N) o E o _o N)s zo (D d(DI t'J os I I I Njikwa is a very enclaved health district. Most of the communities in the district can only be accessed by trekking. No CDTI activities were carried out there this year. The plan was that after treatment in the other 13 health areas of the health districts resources would all be centred on Njikwa; the whole provincial and NGDO teams were to be totally deployed to the health district and treatment as well as monitoring of side effects done jointly. This however did not work because of the unexpected sessions of poliomyelitis immunization campaign that took place shifting the distribution period in tJle rest of the health districts even beyond the year of the project area. We hope tJlat in the second year things would be smoother and treatment would take place in this health district. 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 dfficulties/constraints beingfaced and suggestions on how to improve advocacy. In April of 2OO3 an advocacy visit was made by the NGDO staff to the provincial delegate of health for the province. Discussion on the program and plans toward the starting of the project were made during a meeting that including the whole team of the provincial delegation. This being the first year of CDTI activities in tlre Northwest province, a.n advocary visit to the Governor of the province was also planned. This visit also took place in April 2OO3. It involved the SSI country representative and the provincial delegate of health meeting the governor and educating him on the whole programme. The governor had already been informed about the CDTI project and how it had succeeded of other provinces of the countqr. He was in accordance of the fact that registration as well as the other activities of the programme be carried out in the province. In March 2OO4 the West Africa Regional Director of Sight Savers International also made an advocacy visit to the Provincial delegate of health for the province and the local administrative head of Tlrbah (Bamenda health district). This visit took the Regional director right to one of the referral hospital treating the cases of severe adverse events the occurred. He also visited health staff and communities in Bamenda and Ndop health districts. Prior to the commencement of CDTI activities within each health district, there was an advocacy visit of the district medical health team to the local administrative head. This local administrative head was a Senior Divisional Officer, a Divisional Officer or a District Head. Village chiefs and quarter heads were also seen. These administrative heads and traditional rulers were all educated on programme. They were grven brochures and fliers on Onchocerciasis control through CDTI. 13 WHO/APOC, 24 November 2004 2.!. tobilization, sensitization and health education of at risk communities Provide information on : The use of media and/or other local systems to disseminote information Mobilization and health education of communities includingwomen and minorities Re spons e of tar ge t communitie s/vil I age s Accomplishments Suggest ways to improve mobilization and sensitizotion of the torget communities. Journalists of the Northwest Provincial Radio Station of the Cameroon radio television in Bamenda as well as those of the private radio stations were trained on the type of messages that needed to go on the air. These journalists consisted of those producing and presenting English, French, Pidgin English and vernacular languages. Within the health areas the health personnel targeted social, cultural and religious groups for health education. Some of these groups were women and youth groups. When ever people were called for health education within the communities, the response was not always satisfactory. Very few people usually turned up. This poor response was noted most in large heterogeneous communities. In future the village chiefs and not health personnel should be made to summon such meetings. Dialogue structures members and trained social mobilisers used for EPI should also be used more. In some health districts, the health district stafl particularly the DMO was not very implicated. Their full implication will give more weight to the programme as they have greater regard within the communities than the health centre staff. t4 WHO/APOC, 24 November 2OO4 \t5 NtI o o 3 3 E3 It t o? o =Jo3t lFl ls>'lct ltD l+ $ (! v, !Srf (:t'E S si(! S lralt-i ,, o F, F FU Ft o s U(D o@ o) o C7 a z -l 2.X 7 tr E] z N z. UC zU oFU z EU rnz o X( z ED o rna -l ne7 TD o ti (r) -l Fr1 z U oz o EU -J t! o Ed tr,zU ED t- EU 41 C -l ('DD q o @\) o o\lJ) N)@ @o N){ N)N) N)5 o\o 5o\ tJO (,5 @{ oo\o u)L'I 5{ ao+E d3t -tro P.E. i E ao= D=, otEO zE g (D o ao (') o q1 E6i(D:.o31 ai+ o o ETo o ts o o o o o o o o o o o o o o o o o aZ z ?=E lE?"TT ;.5 z?rDS-x39o q- o o o o o o o o o o o o o o o o o o Fg(t o 19 0e(t EE{_ EE EE *ll eo Hq) H + o I I N){@ o Aoo J A J J A J @(o I J{N J(,l{ A(,(,I o)N (o(o z D o o U Ua EE z g(t o ol,U t, EL (! o I (t a o Oo 55 H o I I 5o o N(rl NJ otN so) t o)@ (l)N @{ N)(rl 5@ OFUEUtDo6. EE N olo -l o o)No {(, o)A@ o JN(,r JG)N JCD(r) N)Js N{{ N)so J @(o NNl\) @\t Js{ Bo E IE I EE + IE N @o o I I I o { (o N(o N)o) Ao) 6)o CDN @o) N(rl No) ao!tr2 DE=F6-=.* o i^=.Gl-:o r y =.:1 z q o o e9 tD5 u8 Dlxl(t o{ 5ts s o I I I (l) N) s (^) @ s 5@s (Dos o)(rl s (rl o)s G){ s (o{ s { s (,l(,l s tE (D G 19 0eo F Fs+ll o o\ t= 'do _o Ns z o o doI tJoo(r) ttllro v $$$$$$$s.o%=s-Q"8X\S;: u! ='PilFt*$S >.il sE Ns=ksSIrQS-ro{!tDs\ ssEIE' \e\\-{=-xb s *.SJ.ota S..ci H \x3-3S sB s: t .s5:. [S E\ $ 6'S\o ss *E S€\ * S'R .u-E *N\-\ S Rvs* (!a\ SR\?' Al :Sti SHJao;S \ -Ai- \U ,KSa s.- s.$Sv2(\ I,G\\)q A ! s € SF. =qe+ sdse.5(t\= -\, (\(\\ -qa q +\(\ d oN\./LJ\.i :\.qt,{(\ 4 A\(\ Ar(! h\s{.q a _ U) a.j(! Oa :\NsG SS.A- -as Bg5qtsts *ra0p o(, Fl F+t ,J(D4H-gqB H H8Ho |v.-$€$0qIloa-o6' -tH-t5d I.o^o ".lou E Bah55S.?D do o-E E sOb-.*5b Itg)5 9.5- g1@ O) rJ r{ 'aO- 6 HE .:(2d -o)B !)hA)oxH$.*p 6EHdE && sH'i+ 0) Pt+gIr ootro-t) ')rDt-aor+ 0) 5' b.pr9 oP r+H s.5trtoog.?5 oa 1C,.{6(DFr qts{8 8s oH.<o oP.iO ilo ts8pA) Tfr pA558.,70 0 BtsH 6 g.i E'ol 5 3 e3.?p.(Da5e-E v+$$*g,fi $. ilraFrt 8 *fH I'P E 3U =-9tsdJlE =:E.Pr+tso5'hP)oEi e H i's a6 f r-.o HPC't o:E@ =5{Ho oPO)FIo Foe_$< [+€ a'6 5'r+o) <I. ti- o 'B8 fip- ,HqP oO BE5o>d?)H-t E* tsE oedo =aEEr+ l.-1- FE -l 5't*d5' a'0q p oo o. o H) p a p) P -l'p p)9. {d ts) op -l') p. o -tFt o -fU) p.p -to op -t)o oo xoa ori o U U a{p a) o -f o o oor|oo z o p 0qo rJp o p o o 5 tstp tso Bdo5p o p U)t r3 o T a oFt IrJo^.i. o-5o.Q.HP5' lJJs88*P6 o55CDJp 0) h' 6tJOa$r at *ro ut8 G* otdSe -adooo CDa.\i'5ao o. x' r+(DhlHPnt 5'o.H'* 0a i.D Ou)5$ o+Uo Fl H, -s,t) o 13Fl o io p a. o o 0ap '+o o +l -firo A '!O ro oFt(n o t) o{oFt)f r) oq p r+) o { { o t= o _o l..J5 z o (D cro N)oos 2.5. GapaciQl building - Describe the adequacy of available lcnowledgeable manpower at all levels - Were frequent transfers of trained staffoccur, 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 enough knowledgeoble manpower was available or dstaf arefrequently transferred duringthe course of the campaign). As mentioned on table 3 above trainings started in July 2OO3 in most of the heatth districts and went on right through May 2OO4 in some health districts. Prior to trainings at the different health districts, all the district teams and the provincial team were all by the staff from the NGDO, NOTF secretariat and MDP/Centre Pasteur. This training took place at the provincial delegation of health in Bamenda. The different health districts then proceeded with trainings within their different areas with the level above training just the level below it. This being the first year of activities the NGDO staff co-facilitated the trainings at district levels. CDD trainings at health area level were co-facilitated by both the health area nurses and the health district staff. In some districts like Ndop however, the health district carried out CDD trainings in the presence of the health area staff. This was in order pass on the sarne information down to the CDDs. It was also considered as part of the training of the health area nurses, as the district thought the health area nurses were not capable enough to train the CDDs by themselves. As you will notice on table 5 below, only the column of "new" is filled. This is because this is a new project and all trainees are being trained for the lirst time. Due to the vastness of t]:e health areas and remoteness of most of the rural communities of the Northwest Province, and we planned and budgeted for the training of 2 nurses per health centre (health area). Most of the health centre nurses are just nurse aids and training more than one per health centre is good as they will complement one another during CDD training and other project activities within their health areas. To the tables 4 and 5, we added a row to in pick up data of the sta-ff of the provincial delegation, who do not fall under €rny health district. This consists of persons like provincial delegate himself, the provincial chief of service of community health, the provincial chief of service of administration and finance, the provincial chief of service of pharmacy, an ophthalmologist, the GTZ representative, the person in charge of health information mErnagement system, and four project co-ordinators. 18 WHO/APOC, 24 November 2003 zX ? -Ed Ial z er X{ z z oFU ?It EE lr,z o{ Xezn Ed o{ lr,aFl XezL EU o FI (r) Fl E z U z o EU Fl -EE o ED z -trjz EE F Eg E H (! D J U O .) Fl o tr Ft o (D (D 0q D o E' { ?It (r) za o\ o\ o\ o\ o\ o\ o\ o\ o\ o\ o o €5 O o\ €\ o\ o\ s f) E (D (D (D tt hJ 6Ut 6UI e € € o\ o\ -t o -I (, (, Ut (, o\ o\ { { 5 5 o { -t o { { -l -I € 6 5 e 5 o\ o\ n b.G:+, o G- ;tE z 5ort o rt(D ED Et3tD,og (r, Et .) ID o 19 B o\(, o o\ \0 5 o\ N) (, (, 5 5 { o\ 6 o ao-oo\ t? G (D (D 5 Ut hJ\J\o hJ hJ\o { -t UI (,I o\ o\ hJ hJ \o \o \o \o \J hJ \J hJ -t -I hJ UT hJUI € € hJ o\ hJ o\ e \o \0 hJ \J o a b\ o + o il Do G- a(D =z(Dr' <E EF, 0OAE;inE *8p= oE b.) h.) o\ o\ e s, Io os aIt G (D E t'D (,(, te 6 6 6 O € o e c e e o o o o e e 53 sq o + -'oF"'- z THD?i 8o'@t ':o E-! YrrHEI -r' o -tO o },J \o UI hJ (,) UI hJ 6 5\o\o { -r (, UTo\ o\ o\(, 5 \o \J{{ }.JUIo\ bJUI 65 {hJ O.J-6s t) (D G (D E \o P{ h,J o\ e hJ o\{ o\ \t o\ o e (, UrtJ (, UI bJ {(, {(, (, 6 (, O 5 5 (, h.) (.}) t\) o\(, o o\(, b,J 5 hJ 5 hJ{ -l hJ -I -I hJ5 bJ5 o hJUl o\ e hJUI €\ b.) Ur e hJUI € -l o €{ -lhJ {\J OB(€ sq F^-r + J-',O .)ll z .^ z Eorl o oU E) rt !, Ito a s G (\ G v, S\I\i b \l' q s o b F\ o o ^i\ ,a o a ; ci d o o $ o qa \o o 'U ^ "f) t)5 z o (D doI tJ o Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others (Journalists) Program management { { How to conduct Health education ./ ./ ./ { ./ Management of SAEs ./ ^/ { CSM ./ { { { SHM { ./ { Data collection { { ./ Data analysis ./ ./ Report writing ./ { Others (Mectizan@ distribution) { { ./ Program management { ./ Table 6: Type of training undertaken (Iick the boxes where specific training was carried out during the reporting period) comments Trainings were targeted; persons were trained depending on what is expected of them as far as CDTI implementation was concerned. Health workers who are actually directing the programme received the most deta.iled training as can be seen from the table. Also there were no community supervisors. In all the health districts those who supervised CDTI activities were health staff. 2.6. Treatnents 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650% therapeutic coverage or the coverage rate is Jluctuating, state the reasons and the plans being made to remedy this. This is the f,nst year of treafrnent in this project. Therapeutic coverage rate was 66.4%. Geographic coverage was93.8%o. The challenge is not just to maintain these coverages but to increase them. 20 WHO/APOC, 24 November 2003 l-l ls l(D l-r : GS G S h\ lqY) .+ =a. Y, -(: R N R S e\GS v, S \ Y, * Fl o s z a z .J z X z Ed rn zrf X zU e z UoFO ? ED frJz o s g7deiDzF., EE o frl ,(>e(r') >ETS ,EO o 41 C 2, U o zo TD .J TD o Ed ? ln zU EE F Ed E1 rl (D p) R U I o o)oN o\(+) N)@ @o t\){ tJN) NJs Oro 5o\ NJO L,T5 @{ @\o U)(, s{ 3 r 5.R "$ggEf,B! 5 il o(l L! O(D 6oiPoar'o\ oo 2L5 (D v)t p) 0a(D tt) 5(oo s(,r N)J O)o o J{ J@ 5(,l (,s J(rl 5J o)(rt {o N(,t (/)s Fdrc=E?'s eLo= o)5o o)o t\)@ @o o N)N) N5 o,o (r){ No (,tJ @{ @(o o)(rl 5{ oOd +(5e(D =5 cPoci- E.E T.E o !l- (o 9" @ s (oI{s oos Joos os Aoos Joos Joos @oLs Joo s (o PN s Joos Joo s Joos Aoos oR8 ^:qesEs 60 E'o6' EL t il q_ -+ eO o)5 -oo) o) Ol Jo -(r)5@ o) J -o){ Js (rl -(r)(r)(rl @ o N{ b, J(o s J b, J(o (r) -o(rl o) o, s +(o(,r I N -(,l(rls A (o -5{o 55 -o, s5 J -cD o,@ G) J .P{N(o C,J srt o) I(rl J8p I8r ^ sts e:iE6'9 +EHE'i89 r' =' U FU odt D) o 5N -ol (., G' o)\t i\) o) o) J -o@ o)s (,5 -o, @(.r) o I _{(o(,l N N -{o(JrN J -(o@s@ N) -(oN) J @ A -o) o)o N) o, A iu J J N -(oo A(o { -o)@(os J -o@{s N) -(,J cno /'\ -l;E >E.E = o3= ='o Po= 5 G,' -o5(., o) { J .N @(rt JNL(o N o) -(l)(os o) o N -oJ{l\) q) -o)s(r) o) NN I -(rt (o N J -lJ(rl A -o)(r) o,o cn -@@o o) N -9o@o(,l { o) -{o@ J Ju I o)o N -{(,(o @ 2. +'O caE3t;5t o) o) 5s o)P(o s {I{ s o)!, o)s { CD s @f(,l s { lu o, s s 90(, s (rl N(r) s ct)NL s (,r s,(, s o) :.1(rl s { l\){ s {P(o s -lo=O@ 6.8t00oagog.' o s t E-Yt N -(o5 o,o NT ss@ sNct -(rlJo C^) o J'o@ o) (o @N @o o) J "N C')s NL ct)(o -(rl{{s _(r){s J !u(])so (l){N CD(rl{ H$-EI o -ot -(o(,r(rls JLo J -(rl{N(,l o -(r)@(oo Jr) o){(o -so,(r)(,l -(rl J @{ -(r){ J N J -o)(o @(, J J o J5 A -o{ o)(o Juo J(, -q)N o,(o &2.6oE g -E' (.t o o o o J o o o o N o o o o az a= H* C., o o o o o o o o N o o o o zc !Jdo o o o "E AgO i$.; 3a H a E € H39fi6rg N) 'tr -o N)5 zo (D tsdoI N)o s NOTE CDTI activities have just finished but evaluation meetings are still ongoing. Data submitted in this report is not final. The final report which will be submitted as soon as the evaluation meetings is over will have more the complete data. Formula for comoutine and seosraohical coverases Therapeutic coverage rate (%) Number of people treated x 100 Total population living in meso/hyper-endemic communities within the project area 66.4% Number of communities/villages treated x 100 Total number of meso/hyper-endemic communities as identified by REMO in the project area 640 X 100 682 93.8% Number of people treated x 100 Annual Treatment Obj ective 430.436 X 100 648,665 Geographical coverage rate (%) ATO coverage rate (%) 430.436 X 100 421,633 102.r% %UTG achieved Number of people treated x 100 Total number of people to be fieated in meso4ryper-endemic areas within the project area (UTG) 430.436 X 100 544,879 79% ATO = The qfimacd number olpenons living in neso/hyper-endemic areas thal a CDTI project intends lo trcd with ivermcclin in a given yeat UTG : The noxiruut ntmber of people to be treoted in mao/hyper-endenic areos within the projecl areo, uhinady n be reached when the pmjecl has rcachedfuL gcographicol coveragc (normolly the prujeo shouU bc cryeded to ?each the (lTG a the ead ofthe f year ofthe projed). 22 WHO/APOC, 24 November 2004 Table 7 bis: Numher of persons treated per health district in hypo-ende mic communities Health District Number treated in hypo endemic communities BAFUT 2,269 BALI 2,401 BAMENDA 2,424 BATIBO 5,977 FUNDONG 3,698 KUMBO EAST 38,352 KUMBO WEST 30,159 MBENGWI 5,909 NDOP 25,824 NDU 2,195 NJIKWA 0 NKAMBE 16,437 SANTA 5,790 WUM 12,661 Total 154,096 2.6.2 What are the causes of absenteeism? The main causes of absenteeism were as follows: - The two treatment intermptions pushed treatment into the farming period and people did not want Mectizan@ side effects to trouble them during farming. 2.6.3 What are the reasons for refusals? Some people refused treatment because of the following reasons: - General fear of side effects, especially as there had been two deaths from side effects in the province already - In Ndop health district some persons left their homes and travelled out of their villages during distribution period just to escape treatment. 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 when available. A total of three cases of severe adverse events were reported this first year. Unfortunately two of them died. They were all managed in referral hospitals that were well equipped and whose staff had been trained on the management of such cases. One of these patients who died was even transferred from District Hospital Ndu to the intensive care unit of the Provincial Hospital in Bamenda. Both of the cases of SAEs that died developed bed sores. The four cases of side effects that occurred are described in table 8 below 23 WHO/APOC, 24 November 2004 UJ N) V) * <5 a- ktJils <o\;(^ @(D 9:.(D z o) o 3 D) o (t) (D x z D)d A) ID A) 3 oao XFp 5 9<J. r.00= -.N!J dao oFn l'J Ho(,OE5.,1 od b.J -o t.JOE5i.1 (D d N-oooa5EJ od f,EF rN :,P t.J -O-rOEsE' (D d NJ- o b.J sE od t.J -oN)OE5E od N@-EE HR€ (DHE-* o.!Ja +f; Ho(D^. E g* I EEf; E6'iD (D A B" s;g H-8 E}TgTE FB.FgtrD)!d6AFJ ii - !I@39'-A)dt@ U) ! o 3 'rJ (D \1 E'o FrJ 3o Ft$gES'd6e-g A)5 l.J -o\oot +. ,fj (D d NJ-o(,ogsE (D d I.J -O tJ) og5Er od PH'BV ===.o € EB o - -.-o =' N)HFlosY.ot(Do<3 EE ESAd E'c . o- N) - l-'lONY.os(Ds-gSop)5 o B"+gUiaO@t! -.1 5 (a5=6'o -38-', 3 EO\F) N) x-O gB do 5' olo o. E5FrOx-O g8 do 5'ar og EN)f+, 5 ar 9rg CO aol o o- @ A 3 !' tDI [e -dq X F+)[6 o o (D o. F(D o o ot(Do U() o. EO €E HB a.(Dq ED(Dg q o (D o TE(Dg ooI(D @ 9. Q rrj EE 6 @a)o SB.E. HEE zo o) oo o z o D) o o o z o ol c) o o = 5'> e a5 aEr lsls. lR- lo" (\ S.uGvt .S aa G S V) a a. (s a(\ G(\ * alaA Itj .Y, s.S s()(: \(\\\ Oa s G Es Oe\GI S\ * 14 G\ (\\ (\ (\ tJs E o 'go _o N)s z o (D cr(Dt N)o s No o Noo\o h..)oo oo t.)oo -l t)oo o\ h..J o(^ Noos tJoo(]) lfj F o\ 00 N) oo@55I e eE e P t "v +h + HE e'3qE,' =p oq oo ts - (D @t p 0a(!q 5\oo /1 -l .E6 P(DHq9EE ='c fD o* F' o\5o ()!@oZ+>3E s =31Efi E I*E ao ora F' \o UJ i,o s FroO irs g g€ =da! UJI o\ s oo- ^< D\oo Je# cj o E' c_ E tr, *ll oo o\s@b o\Ut g-rc, ri5 ob'g 9 :fo-=E,E=.>iipo .o€oEFEq 5 -ST oa- rtr o Itr o) o;, s N) o\(,)(,) --lte > oB=g3E ='o E!G= F' 5(+) s lJ) o\ foflzOF5!: a= so po6E o- ttl o\ o\ s s .lo=O@ o-P a)o0qc(! tr'.o .o o\ F' EF' *ll e O !'.) \o o\ o ^g >\o@ Lrt-E o o FT a_ xt! *il o {\o s o Sd -reE ci 0q(D FU l-'lFlsDILA I'Dgrex *ThtlGg,Stst fR3N EFSc.GDo('''! xi -Sea\dAYFd3 H '(\+.D3fE'66:E(\X3lY= -gI*E :liE r3:E $IlloleEllsls=I sEl=,-oti.l116tG6lrI.te.HtG6L R.g'a' s ='3t= .lFF I l.u2 ii, =r(DOe rt ILFt rl(DFt DCroi 3 .r.Hg AFt (,D co E -c' t? oFt D Fl a oo (D El D 0q(D aD +t E s.o ? N)(, FU \J -o tJ5 z o o d(D Noo5 2.7. Ordering, storage and delivery of ivennectin Mectizan@ ordered/applied for by - Qilease tick the appropriate answer) MoH fl wHo tr UNICEF fl NGDOtr / Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH tr/ wHotr UNICEFE NGDOf] Please describe how Mectizqn@ ls ordered and how it gets to the communities Mectizan tables were ordered by the NGDO. This order was done with the aim of treating 5O0,O0O persons, following the recommendations of Mectizan@ donation programme. A total of 1,8OO,OOO tablets were received for the project; 1,5OO,OOO at the onset of the distribution and 3OO,OOO in May when the initial stock got finished. For easy clearance Mectizan@ from the port, WHO Cameroon was the consignee. When these drugs were cleared by WHO, they were handed to the Ministry of Public Health in Yaounde (NOTF secretariat). The NOTF secretariat then handed the drugs to the NGDO, Sight Savers International who transported them the Northwest Provincial Special Fund for Health (Drug Programme), at the provincial delegation of public health Bamenda. The drugs were transported to the Northwest province during one of the routine trips to the project site. Table l0: Mecfiztn@ Inventory Health District Number of Mectizant tablets Requested Received Used Lost Wasted Erpired Remaining Meso/hypcr hyoo Bafut 0 95000 71746 5469 s36 412 0 t6837 Bali 0 50000 33926 6353 0 t79 0 9s42 Bamenda 0 202000 186444 573t 0 1327 0 5578 Batibo 0 96000 58400 t6/.tS 0 709 0 20473 Fundong 0 186500 147936 7687 2097 777 0 28003 Kumbo East 0 134000 35942 85321 0 505 0 12232 Kumbo West 0 145000 5661 I 73897 0 66 0 tM92 Mbengwi 0 83000 57',756 128',19 0 l34t 0 9790 Ndop 0 r 32000 91346 38336 0 216 0 2102 Ndu 0 r20500 59161 7036 0 375 0 s3928 Njikwa 0 0 0 0 0 0 0 0 Nkambe 0 190000 117096 44728 0 480 0 22s20 Santa 0 70000 33732 t97M 0 57 0 r6507 Wum 0 250000 169923 25982 0 996 0 41418 TOTAL 0 r754000 r120019 349541 2633 7UO 0 253422 26 WHO/APOC, 24 November 2004 This being the first year, health district staff did not know how to request for the stock of Mectizan@ tablets needed by districts. The onchocerciasis project coordinators at the provincial level had to then use registration figures to allocate drugs to every health district, taking into consideration that only 1,50O,0OO tablets were available. This resulted in drug shortages in almost every health district. The various district medical off,rcers then collected their stock of Mectizan@ from the drug programme during a routine coordination meeting they had at the provincial delegation. Mectizan stock m€rnagement data collected from some health districts was not complete for an example of tJ:is is the case of Ntumbaw health area of Ndu health district where data on tablet m€rnagement could not be got because the nurse who implemented activities retired mid way in the programme year and left the place without adequately handing over. In Fundong health area (Fundong health district) a CDD's home got burnt and all tablets in his keeping (2,206 tablets) were all lost in the fire incident. This accounts for the high number of tablets lost. - How are the remaining ivermectin tablets collected and where are they kept? After Mectizan@ distribution, all left over tablets with CDDs were forurarded to the health centre nurses who made and inventory of what they had left at the health are level and in turn returned this stock to the health district. A few tablets were signed out and kept at the district level for passive treatment and the rest returned to the essential drug programme (NWPSFH) at the Provincial Delegation of Public Health in Bamenda. - List and brieJly describe the activities under ivermectin delivery that are being caruied out by health care personnel in the project area. As soon as ivermectin got to the drug programme at the provincial delegation of health in Bamenda, it was stored and managed with the provincial stock of essential drugs. From there it was collected by the health districts. From the health districts the various health centres collected their stock. There is need for these drugs to be transported to he health districts by the drug programme as they do for other drugs within their essential drug programme. This will not only help develop the spirit of ownership of the programme but also reduce cost if programme implementation as transporting Mectizan@ to the needy areas will not entail any additional cost. - Any other comments Now that active distribution is over, remaining drugs within the health districts is being returned to the drug programme. This is such that the actual stock of Mectizan@ left should be known. This information is needed for requests of year 2 to be made. 27 WHO/APOC, 24 November 2004 2.E. GommuniQl self+ronitoring and Stakeholdenr teeting Has any training (of trainers) for community self-monitoring been done in the proiect area? If so, when? Training of trainers that took place at the onset of the program in May - June 2OO4 included training them in community self monitoring as well. APOC organiz*d a training session on this activity mid way in the years CDTI implementation cycle during which a representative from this project was trained. It is planned that during retraining for year 2 activities, more emphasis would be laid on CSM. Provincial supervisors and health district teams will atso be properly trained so that tJrey can in turn train the health centre nurses who woutd be the key actors in supervising the activity on the field. It would not be wrong to say that no community self monitoring was not carried out this year in this project. In some health areas the health staff single handedly did the monitoring and filled the CSM form. In others the activity was well started but ended half way complete. Some health area staff referred to community and health area evaluation meetings as community self monitoring. Others regarded CSM as a separate activity and not an integral part of CDTI implementation and were expecting extra I additional funds for the activity, especially as it came up have way during the implementation cycle. Evaluation meetings that held at the various levels brought together all the stake holders of the project at that leveI. and Stakeholderc,! relJ Health District Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) BAFUT BALI BAMENDA BATIBO FUNDONG KUMBO EAST KUMBO WEST MBENGWI NDOP NDU NJIKWA NKAMBE SANTA WUM 54 42 120 92 6l 80 95 80 98 67 47 r65 25 62 54 42 t20 87 55 80 86 80 98 62 0 165 0 55 TOTAL 1088 9U 28 WHO/APOC, 24 November 2004 Describe how the results of the community self- monitoring and stakeholders meetings hove 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. Provincial team/OPC Health area team 2.9.2. What were the main issues identified during supervision? - In many places CDDs made mistakes in filling of registers and household cards. - Some health staff had told CDDs that they were to be paid for their job. As pa5rment did not come forth, some CDDs in certain areas decided to withhold keep treatment data pending pa5rment for the work tJ:ey had done. - Time line of activities was not respected in most of the health districts. - Funds for activities were found to be mismanaged in Kumbo East Health District where the DMO was found to have disbursed less funds to the health areas that was supposed to for supervision of Mectizan@ distribution. He was called to order by both the staff of the provincial delegation and SSI and the situation corrected with appropriate funds as budged disbursed to the health areas and appropriate justifications made. - Many health staff at health area and a few at district level still did not see the reason why treatment stratery was based on the endemicity on onchocerciasis. This was particularly felt in Kumbo East, Kumbo West and Ndu health districts where the health personnel did not see why persons in hypo endemic communities should be treated differently from those in meso / hyper endemic communities. District team/OPC CDDs 29 WHO/APOC, 24 November 2004 2.9.3. Was a supervision checklist used? In most of the health districts supervision checklists were used systematically during supervision. The provincial Onchocerciasis Project Co- ordinators also used supervision check lists for supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Generally, good performance was commended while e(Tors were corrected on the spot. Also, subsequent supervision trips focussed more on problems identified during earlier supervisions. 2.9.5. Was feedback given to the person or groups superuised? Just as during supervision of other health activities, feedback was always given to the supervised. This was used as bases for improvement of performance. At the end the supervisee also wrote a supervision report that was forwarded to hierarchy. Sometimes, for these reports to be written and submitted, the supervisee had to be pushed. 2.9.6. How was the feedback used to improve the overall performance of the project? Just as mentioned in "2.9.4" above issues identified in previous supervision trips served as starting point for the subsequent superwision visit. The supervisee always made it a point of duty that the points raised were fully addressed by the supervised. This ideal situation did not however occur in all places. In Kumbo East Health district for instance the DMO did very little supervision. Neither did he facilitate the process of any other district staff carrying out supervision. This not withstanding, most of the health areas in this district supervised their CDDs. 30 WHO/APOC, 24 November 2004 SEGTIOII 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment *Condition of the equipment (F:Functional, CNFR{urrently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? During this early phase of the project, the equipment will be maintainedjointly by the Ministry of Public Health, APOC and Sight Savers International as spelled out in tJre approved budget. As APOC funding starts reducing the Ministry of Health will gradually take over maintenance till the Sft year which is APOC's last funding year. After this time, the Ministry is expected to take over this maintenance. Replacement of the equipment will be made by the Ministry of Public Healthjust as it does for its other equipment within the province. This however does not yet future in their budgets. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 1 F 7 I F CNFR 10 F 2. Motor cycle(s) t2 F t5 F l4 F 3. Computer(s) I F 20 F 4. Printer(s) I F 20 F 5. Photocopier (s) I F t7 F 6. Fax Machine(s) I F 1 F 7. Others a) Overhead Projector I F I F b) Flip chart stand I F c) Power point point proiector 3t WHO/APOC, 24 November 2004 Contributor Year I ('provide the period') Year 2 ('provide the penod') Year 3 ('provide the oeriod') TOTAL Budgeted (us$) TOTAL Released (US$) TOTAL Budgete d (us$) TOTAL Released (us$) TOTAL Budgete d (us$) TOTAL Released (US$) Ministry of Health (MOH) 187 050 163 139.00 Local NGDO(s) (if any) NGDO partner(s) 84 843 149 456.16 District/LGA Others a) Communities APOC Trust Fund 238 7t8 144 398 TOTAL 510 611 427 852.83 3.2. Financial contributions of the paltnerrr and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpartfunds, how were they addressed? Additional comments APOC funds for Capital Equipment were not transferred. However the equipments were bought by WHO Cameroon and handed to the project through the NGDO. The Ministry of Public Health's did not transfer any funds to the project ofr its contribution to the project. The contribution is mainly through already existing infrastructure, import duties and staff salary. 3.3. Other forms of communitt/ suppott - Describe (indicate forms of in-kind contributions of communities ,f ony) The community members carried out registration without any financial support from the Ministry of Public Health, APOC or the NGDO. They provided the exercise books in which registration data was recorded. During Mectizan@ distribution, most of tle CDDs were not given any support from their communities. However a few were given food, drinks and kola nuts as they went on their activities. [n one community on Bangolan health area of Ndop health district a CDD was provided with a bicycle to facilitate his movement from house to house as he went about his 32 WHO/APOC, 24 November 2004 distribution. In Djotin and Ngeptang health areas of Kumbo West health district, the communities organised themselves such that each family contributed 50 CFA frs (in Djotin) and 1OO CFA frs (in Ngeptang) to a fund and this was given to the CDDs as compensation for their work. 3.4. Expenditure per actMQt Indicate in table 14, the amount expended during the reporting periodfor each activity listed. Write the omount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here l$ US:600 CFA Table 14: Indicate how much the project spentfor each acfivity listed below during the Erpenditure ($ US) Source(s) of fundingActivity MoPHAPOC SSISource t2 735.67 20 069.7r 30 488.51 2 579.76 s238.r 911.43 8820,1 3 3038,27 1092.3 8202.33 7366.06 8457.9 548.6 1742.51 1709.9 13 600.00 Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all level Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment - Registers - Household cards - Treatment summary form Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g computers, printers etc) - Others - Supplies | 247.54 2327.8 Personnel 121s2.38 666.11 74139.00 1871.53 r35.66- General Assembly - Communication 761.68 5202.37 - Appraisal and planning 28 088.86 r0 214.37 2 590.39 7 400.00- Other operating expenses 2514.28- Launching of Mectizan Distribution - Side Effect Management 6 404.19 3450.29- REA 9159t.27 68 000- Capital cost(bikes) TOTAL 132 763.75 149 456.16 163 139.00 Total number of persons treated Any comments or explanations? 33 WHO/APOC, 24 November 2004 SEGTIOII 4= SustainabiliQr of GDTI 4.1. lnternal; independent particlpatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the followingwhich are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustainabality of proiects: plan and set targets (mandatoly at Yr 3) Was the project evaluated during the reporting Was a sustainobility plan written?_ Whenwas the sustainability plan submitted? What arrangements hqve been made to sustain CDTI after APOCfunding ceases in terms of. 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plansfor complete integration: 34 WHO/APOC, 24 November 2004 This has just been the first year of project implementation. Much advocacy has been done with regards integrating CDTI into the other existing health projects. This has already started in some areas: 4.3.1. Ivermectindelivelymechanisms This first year ivermectin was transferred from the NOTF in Yaounde to the NWPSF in Bamenda were it was stored and managed togetJrer with the other drugs of the provincial essential drug programme. Health districts all made their requests, which were studied and approved by the OPCs. Only after approval by the OPCs could the districts then collect their drugs from the NWPSFH. The districts had to collect their stock of Mectizan@ from the NWPSFH themselves instead of it being brought to them because Mectizan@ arrived the province after the normal drug distribution period. However, drugs for side effect management as well as materials for management of Sever Adverse Events (SAEs) that were in the province much earlier were all transported to the districts and health areas. 4.3.2. Training Trainings were not integrated. Trainings this first year were long and tiring. Integrating them would have made grasping or the material difficult, especially to the health area nurses who are mostly nurse aids and assistant nurses. However during CDTI training announcements and distribution of materials for other health programmes were usually made. 4.3.3. Joint supervision and monitoring with other programs In most places (especially provincial and district level) supervisions and monitoring of CDTI was made jointly with that of other health progr€rmmes. Such supervisions were more resource management efficient. 43.4. Release of funds for project activities CDTI funding from APOC and SSI is different from funding for other health projects. However government funds meant for the running of the health facilities were pooled and equally used for CDTI activities. This however may be difficult to evaluate. 4.3.5. Is CDTI included in the PHC budgetr There is no budget line yet for CDTI activities at provincial, district or health area level. This is what we still need to advocate for greatly. However, the government plans to motivate CDDs by payrng them 25 CFA Frs per person treated. The Ministry of Public Health also provided some stationary to 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? All community health progra.mmes at all levels of the health structure are making use of the transport facilities provided by CDTI. These progr€rmmes include; National Poliomyelitis Control Programme, Expanded Programme on Immunization, Ttrberculosis control 35 WHO/APOC, 24 November 2004 programme, Leprosy control programme as well as supervision of routing health activities at district and health area levels. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operational nesearch 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out this year. RAPLOA was however carried out before the onset of the project. 4.4.2. How were the results applied in the project? The results of RAPLOA were applied in determining which villages were to have mass treatment. Health district staff were provided with these RAPOLOA results and advised to stricfly adhere to the MEC I TCC recommendations when treating in communities at high risk for SAEs. SEGTIOX 5: $trengths, weaknesses, challenges' and oppoilunities List the strengths and wealmesses of CDTI implementation process. a) Strengths - CDTI progr€rmme has created awareness on filariasis within the communities. The progr€unme has made the community members involved in the project implementation to become closer to the population and the health services. The community now has a better idea of what the exact population of their communities are. Through the programme the provincial delegation has been provided a vehicle and 27 motorcycles motorcycles. These transport facilities are not only used for the CDTI project but also for the implementation of all the other health programmes. Due to the provision of free Mectizan@ by the project, the utilization of some health centres in Ndu health district has increased. This is as a result of the fact that the population now has developed more confidence in their health centres. In most communities people are happy with the programme as tJrey admit that it has helped treat not only onchocerciasis but also intestinal worms, body lice, jiggers and bed bugs. 36 WHO/APOC, 24 November 2004 With the coming of CDTI in the Northwest province, there has been improved integration of primary health care activities within the health districts. b)Weaknesses Sensitisation and community mobilization was poorly done such that most CDDs saw their jobs as employment for which they expect pay. Some even say if they are not compensated financially they would not work next year. Also persons in hypo endemic communities did not feel happy with the fact that they did not have mass treatment in their communities. ln some health areas with no health units some persons who had side effects bought treatment with their personal funds and felt cheated when they learnt that treatment for side effects was completely free in other places. Funds for training of CDDs were inadequate in most of the health areas. As a result few CDDs had to be trained thus making the work load hea'ry on the CDDs. Those who worked in nomadic communities like in Mentang health area of Fundong health district had to walk long distances to treat cattle rearers up in the hills. Some health districts have non-functional health areas i.e. health areas without health centres. Such health areas lacked health staff for programme implementation. Also making drugs for management of side effects available to communities in such areas was difficult. The district had to arrange for drugs from the district hospital pharmacy to be dispatched to such health areas. This did not always work out well. In Mbessa health area (Fundong health district), a Baptist health centre (CBC Akeh health centre) distributed expired Mectizan@ (545 tablets) from their old stock along side with Mectizan@ received from the CDTI programme. Transport facilities are inadequate in most of the province. Most of the health areas have not got any means of transport. Some health area staff complain of not being adequately trained in CDTI. List the challenges and indicate how they were addressed Below are a list of challenges that this project has: - Successful implementation of tJ:e project after massive budget cuts by APOC. To overcome this, a lot of sensitisation had to be done to convince the communities about the need of their support. They bought registration books for their communities and finance the registration exercise themselves; the planned grand provincial launching of Mectizan@ distribution was cancelled and replaced by low-keyed 37 WHO/APOC, 24 November 2004 district launchings; Sight Savers International had to single-handedly finance certain activities like REA as well as supplement financing of other activities like appraisal meetings. To make treatment available the very remote areas of the province like Njikwa health district, parts of Wum health district. We did not succeed to carry out treatment in these remote areas due to their poor access; tJre prevalence of Loa loa artd charged progr€rmme of the health sector. To effectively manage persons having SAEs that may occur in future. Three persons developed SAEs. They were promptly taken to referral hospitals with trained staff in the m€rnagement of these side effects. Unfortunately two of them did not survive. To be able to provide sufficient means of transport to needy health areas. A four-wheel-drive vehicle and 27 motorcycles were provided to the project by APOC and SSI. To attain the treatment objective of at least 650/o of the population. This was also attained through a lot of health education sensitisation and a lot of monitoring and supervision of field activities. We now need to ensure that every community that is meso or hyper endemic for onchocerciasis attains this coverage and maintain, if not increase it to the ultimate treatment goal (84o/o). SEGTIOII 6: Unique features of the proiecUother matters The main ethnic groups in the Northwest are; Widikum, Fulani, Tikari, Bali, Ngemba, Aku, Essimbi, Beba, Aghem, Njkwa and Nso. The communities of the Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and very highly respected honoured. Each clan I family has a clan / family head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the community. This traditional administrative set up has been very helpful in the successful implementation of CDTI. As soon as the traditional rulers or chiefs (called Fons) and their councillors are well sensitised and buy an idea, it is very easily abided by by the whole community or clan. Within the communities information emanates from the chief and is sent down to the population through town criers. Information is also passed down through church authorities, through existing health dialogue structures and in the case of agricultural information, through agricultural extension workers. Information can be passed on in the church, and announced in the market place through local radios and newspapers. 38 WHO/APOC, 24 November 2004