North West CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2005

'l t -t "-t _t Republic of Cameroon Ministry of Public Health S t Savers International ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) Northwest CDTI Project Year 1 DEADLI]\tE ST'BMISSION: / o5 To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting II ri For Agtion [o: For I To, r'lil I .r1 i I hr I 4 /rl - i.l. L- A itn 'r'rri'r6 \e , ' L "--i4 ^ - a -.1 L-.tllJ.li)--"1 t. \at!v J u AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I COUNTRYAI OTF: CAMEROON Proiect Name: NORTH WEST CDTI PROJECT Approval vear: 2003 Launching vear: 2003 Reoo rtins Period: From: January 2004 To: December 2004 (Month./Year) ( Month/Year) Proiect vea r of this renort: ( 1) Date submitted: June 2005 NGDO partner: S I GH T SAVER S I N TER N ATI O N AL fi F,# {J I 4 JU[{ 2005 Aroc/Drn WHO/APOC, 24 November 2004 1 _i ''! ] 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: Zonal Oncho Coordinator Name Signature: ..... Date NGDO Representative Name: ..... Signature Date This report has been prepared by Name Date: .. .0.2, I [ /O; . \. AfrL. -l'")r-r^, :,J lS*, srr Country: Cameroon National Coordinator S Signature Name: D.u. ..M.TE.Y...tt,* (&"-< ?*Designation: Date .ge: 1** &ss( ll WHO/APOC, 24 November 2004 I I ! 1 -l "I Table of contents ACRONryMS v 1 DEFINITIONS... VI FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY SECTION l: BACKGROUND INFORIVIATION....... l.l. GeNeRer. TNFoRMATToN 1.1.I Description of the project (briefly) 1.1.2. Partnership. 1.2. PopulerroN...... SECTION 2: IMPLEMENTATION OF CDTI....... .....11 I ,4 ,5 5 J I .9 TNter-rNp oF ACTrvrrrES ............ ....... 1l Aovocncy ....-................ 13 MosrI-zartoN, sENSrrrzATroN AND HEALTH EDUCATIoN oF AT RrsK coMMuNrrtrs 12 CovruuNrry nwoLVEMENT......... ..... 16 Cepacny BUILDrNG..... ........ l8 Tnserupurs. 20 Treatment figures ............ ......... 20 Wat are the causes of obsenteeism?.......... ................. 21 What ore the reasons for refusals?................ ............... 23 Brie/ly describe all lcnown andverified serious adverse events (SAEr) that... 23 Trend of treatment achievement from CDTI project inception to the current year 25 2.7. ORDERING, SToRAGE AND DELIVERY oF IVERMECTIN 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.8. 2.9. 2 2 2 2 2 2 3.1. 3.2. J.J. 3.4. 2.6.1 2.6.2 2.6.3 2.6.4 2.6.5 ................... 26 CouvruNrry sELF-MoNrroRrNG AND STAKEHoLDERS MpprrNc ..-...--....28 SuppRvrsroN............... ...-...--.-...-.......29 9.1. Provide aJlow chart of supervision hierarchy. ............ 29 9.2. What were the moin issues identified during supervision? .............................. 29 9.3. Was a supervision checklist used? ............. 30 9.4. What were the outcomes at each level of CDTI implementation supervision? 30 9.5. Was feedback gtven to the person or groups supervised?.-.............................. 309.6. How wos the feedback used to improve the overall performonce of the project? 30 SECTION 3: SUPPORT TO CDTI ..............31 EqurueNr FrueNcnr- coNTRIBUTToNS oF THE pARTNERS AND coMMLrNITrES....... OrHpR FoRMS oF coMMlrNrry suppoRT ............... ExpeuorrunE pER ACTIvtry ............ ........ 3 1 ........32 ........32 ........ JJ SECTION 4: SUSTAINABILITY OF CDTI. ................34 4.1. ItrenNar-; TNDEeENDENT pARTrctpAToRy MoNIToRTNc; EvaluerroN.......... ..........34 4.1. 1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........... 34 4.1.2. Vf/hat were the recommendations? ............. 34 4.1.3. How have they been implemented? ............. ................. 34 lu WHO/APOC, 24 November 2004 II I l -t 4.2. SusrentABILITy oF rRoJECTS: eLAN AND sET TARGETS (uaNoeroRy AT....... Yn 3)........ 4.2.1. Planning at all relevant levels.... 4.2.2. Funds....... 4.2.3 Transport (replacement and maintensnce) .............. 4.2.4. Otherresources.. 4.2.5. To what extent has the plan been implemented...... 4.3 INrpcRerroN ......... 34 34 34 34 34 34 34 34 35 35 35 35 35 -l 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. Iver mec tin de I iv ery me c hanis m.s ........ ....... Training.... Joint supervision and monitoring with other programs. Release offunds for project activities Is CDTI included in the PHC budget? .............. 4.3.6. Describe other health progrommes that are using the CDTI structure and how this was achteved. What have been the achievements?............. .................... 35 4.3.7. Describe others issues considered in the integration of CDTI. ..... 36 4.4. OpenerroNAl RESEARCH .....36 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. ........ 36 4.4.2. How were the results applied in the project?............. .................... 36 SECTION 5: STRENGTHS, WEAKI\IESSES, CHALLENGES, AltD OPPORTUNTTIES... ....................36 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........38 lv WHO/APOC, 24 November 2004 l l ,i -t 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 T'NICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatonent 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 S elf-Monitoring District Medical Offrcer 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 group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 I J 1 "l -r Definitions Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of 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. (i) --t vl WHO/APOC, 24 November 2004 I I -1 -l 1 ! I -1 FOLLOW UP ON TGG REGOTTENDATIO]IS Using the table below, fill in the recommendations of the last TCC on the project ond describe how they have been addressed. TCC session 20 I 1 Nunber of Recommendatio n in the Reoort 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 of the 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 "l I 1 -I and Kumbo West health districts. Faced with this, the provincial delegate had to order that treatment be given to both hypo and meso/hyper 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. 115 - Missing information from report. l. 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 1. Tables now have 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 2l and22. 3. The Annual Treatment Objective (421,633) is included in the report. See table 7, page 2t. 4. The report also has Annual Training Objective for health district staff(84), health centre staff(163), 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 I I -1 I -t 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 prograrnmes. 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 percentage 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 person /CDD ration per health district Heatth district Population of meso/hyper communitaes CDDs trained Ratio person / CDD BAFUT 35,615 172 207 BALI 16,729 87 192 BAMENDA 113,683 250 455 BATIBO 44,644 256 174 FUNDONG 94,170 241 391 KUMBO EAST 25,541 277 92 KUMBO WEST 44,951 214 210 MBENGWI 30,536 163 187 NDOP 41,619 132 315 NDU 27,619 141 196 NJIKWA 12,474 0 0 NKAMBE 53,358 318 168 SANTA 16,714 73 229 WUM 103,486 352 294 TOTAL 661,139 2,676 247 J WHO/APOC. 24 November 2004 l I "I -l Executive Summary/ Prepare an Executive summt ry of the report in not more than one page. 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, 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 same 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 Loaloa. 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 giving 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, heolthworkers, Total population (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 year: - lmplementation 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 finance 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 65%o of the population. This was also attained through a lot of health education sensitisation and a lot of monitoring and supervision of lield 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 "1 I -I -t SEGTION {: Background information 1.{. General information 1.1.1 Description of the project (briefiy) - Geographical location, topography, climate - Population: activities, cultures, language - Communication systems (roads...) - Administrationstructure - Heolth system & health care delivery (provide the number of health posts/centers in the project area if the informotion is available). - Number of health staffin project area and number of health staffinvolved in CDTI activities. A. Geographicalandadministrativearea(s) The Northwest project area will cover the entire North West Province, which lies longitude 9" 45' and 11" 10' east and latitude 5" 35' and 7" 10' 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 by Taraba State, Nigeria. It covers a surface area of 18,10O 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. Tabte i. Ad,minlstrqtlve unlts, Health districts qnd health area.s -! 5 Divisions / Sub-divisions HealthDistricts District population Health Areas Mezam Bamenda Santa Tubah Bali Bafut Bamenda I 13683 Azire 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 446M Batibo Guzang Tiben Laringi Kulabei Gwofon Widikum Bifang Ewai Ashong Olorunti Eka Mbengwi 30536 Andek Tezeh 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 I I I J 1 -t "t Ngoketundja Ndop Central Balikumbat Babessi Ndop 41619 Boyo Belo Njinikom Fundong Bum Fundong 94170 Menchum Wum Fur-Awa Fongun Menchum Valley Wum 103486 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 Kevu Nkum Kov Nkor Ngeptang Buh* Simon Kov Kuvlu Ichim Donga & Mantung Nkambe Central Ako Ndu Nwa Misaje Nkambe s3358 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,E29 !2[rrngo Babessi Bamali Bafanji Bamunkumbit Konene Mbessa Belo Mbengkas Baba Bamunka urban Bangolan Bamunka rural Balikumbat Bamessing Bambalang Mbissa-Mbaw Aduk Fundong Mentang Kiktuini w Anyajua Mejang Fuanantul Bu Yemge Weh Beba-Batomo Wum Urban Furu-Awa Bawuru Benakuma Kumfutu Befang Ise Abar Esu St Martin Modele Baftnen The 163 Health areas have been divided into 993 zones (communities) for better management. B. Topography, climate, eccess The bio climatic zone of the Northwest province is mainly Sudan savzrnnah 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 both 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 interrupted by falls all contributing to highly aerated waters which make a good habitat for Simulium, the vector of Onchocerca uotrulus. 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, maize groundnuts vegetables and beans are planted all through the year, in swarnpy 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 l 1 t -t t Of the 329I km 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 povert5l. The communities of the Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and highly respected. Each clan I 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 8th 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 1: Number of heabh staff involved in CDTI 7 Health District Number of health stalf involved in CI/[I activities. Total Ifumber of hcalth strffin the cntirc project area Br Itlumbcr of heelth steffiavolvcd in CDTI Bz Percentage Bs=Bzl Br *lOO BAFUT 39 15 38o/o BALI 35 18 5Lo/o BAMENDA 139 34 24o/o BATIBO 7l 25 35o/o FUNDONG 524 36 7%;o KUMBO EAST 37 t2 32Yo KUMBO WEST 358 50 I4o/o MBENGWI 7l 28 39o/o NDOP 63 20 32o/o NDU 29 l4 48o/o NJIKWA 22 o 0 NKAMBE 49 2l 43o/o SANTA 29 18 620/o WUM 53 24 45o/o Provincial delegation* 49 5 IOo/o TOTAL 11568 32U^ 2l.Lo/o WHO/APOC, 24 November 2004 -! {"l .l 1.1.2. Partnership * The Provincial delegation has health staff that do not fall under any healttr area. These health sta-ff some of these health staff are involved in CDTI and other health programmes. Indicate the portners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc. J Describe overall working relattonship among partners, clearly indicating speciJic areas of project activittes (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, ,f ,ny, to mobilize the state/region/district/LGA dectsion-makers, 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]), the 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 communit5r. The communit5r's opinion was sought on programming activities. These dates were however changed when the various health areas delayed in conducting REA and registration. National lmmunization 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 sta-ff. Advocacy was reserved for personnel of MoH and SSI. Community members did the registration. 8 WHO/APOC, 24 November 2004 -t -, -I .f, O N F o) -o E 6) o z$ c..l LJ op. o o\ o o d g o er I () Fp oi :6- :qc! E xOpE r- q o\ cil C.il ra)o .+ s o\d^ r o\ o rar r-- c.} co o\t-- sras C{ o\ tr- Fi c.t orrt\o \a) N o\oq t c.) o c.l cn(\ @ c- -d. Nco +s o$ -f, 6 c.tq \o € F- ra ra rnio ra +> I b .6)iE -oo .= o.N .BE.-!\Ei E€ r \o \ co o\ c.lr- \o cn&\o ca $s\o^ v$ or- $ o\ $ tr)N r o\ +$ \o cntr} ca o\ \o $ o\ .o^ F-(\ $t-q c.l oo rl.. co catr) $ r- \o \o €$ aa o\(a \o\o . ..8 Ei'=e6tE.E;;>,'r, o) cr -E E I'FNa ca o\ c.l t* o\ oo .f o\o co € \o \o ca oo\$ a.l ol r\ ca t-r* c{ r- la) € ral t t-- F- oo oo €6 o\ t-.@ crl \o ca ooo r- ca rn t--\o € s c.to- \o oto- ra6cl 'Egs ^9= HFisgsi o6$ \o (\ c.t oo $r- co r cO eno- o\ or*$^ o\\o o\ oor- c.{ tr-\o t- c.l lr) o\ tr) c.lOq C\ ca car- r- r- € o^ \o rn r-. ol \o o\ coo od c.l\o$ € ca o\ o\o F-F.(a tr pr) €) ba cl (r) 6) trl A o(.) o tr o)! E z +_ il t (l) o. -. :F8.9 6c) otr F-$ rnco o\oo a-oo $rat oN \o.f, \o $(\ c'lc.l a-c.l ooo €C\ ca\o ot€\0 .etsE'F *a =-.69E Etl€6oE >ro ,!r E N +ct -f, .+ €\o lr) c7) cilc.l cOca s s o c.l\o € \oco 6ra(Y) q) 'EgB Er h tr .= !:t?orUo Et'=$si ca c.l (\ fr1F- o\ o\c?| f- $oil r*C! o(\ € t-- r- o r-c.l t =(a =€€!EEf; iA-x .-X \o c..l oo od c7) ra) r- s^ o\ cl\o\r! o\o o o\lr) *d ra) \o ca sa $ cilo ca oo $ € <+ c.) C.il o\ €r- o\ ca $\o oq r- € ra) o €r-c'l c.l c.l c.l \o !f c.l o\s ca \o oo \o c.l (ainia(a € f;.BE =rq)8.E'F-H-$i{l3 a9F€ g EARE l/a q) H fri o Fl m ozfrl o oo F o (, zo oz Dh Fa 14 o ez D M Fa II] oo D M ozfrlo z Ao oz D oz E z F] ta V z Fz a zD 6lo I-{ { a\ AJ\ 0o $\ q) ,s 0O \ o \q) \) qJ It A. -s q) ,s \)s B a) B () q) s' \q) a) a)s *( € ?1 o El a.S-\\ B EajOE?s -i =RC _ogr (\l . o'lN5t . cllFFI t- t* I L L_ t' t- $O ol I C,) -o (u o z$ c.l U o o. oH B O E tBus &T;::EB FiEE*Esria.Bt s Ef € E H#H;;:EE5E 9E 9o I *!:E3:H3Egg ETS? HE .c, 9 i B E P'0 o t HHs€eHt ; *Ei g;t c5 b.9 g.:* Ee i8EsE;rH E: H H E fl $Ei,.ui! 3 P": g6Pf =JH a.E"-E HE EBE HE a o re! I8 Ee*g,H r* ; Hfif I E g gE #tsEEHsSfr o'<J o=_dt P o E E HFEss=;8tubE9s €5.s*:g.H I E Efs!.EEEB'i a EIl;rgqEOl=o*i SH.Eu_9otp.a$E:e eE EE I H:oi8 .! 5 d:?9 HE c.,5 tEgIEEEEE EEEIEIE$g H o.o:-9;el cd h E5eE gEt *E E!L{A+J (Dle Ef= g '=S Eco .E#B E€$ EBfi EHE E$e 5:'ts EEE EfiT Es8. -H3 3ffr $,^ .H s st i$t *s Eg€fI$II I;g;aggflI i If,I f,ie ge sggllgitlit *'q fi*uu *: tIliEIIiEE s$IEE{EEflE *E$f,I{iEBi q) \- o' a) \_ t\ q) \ v q) sq) Va l-r q; ho(J L o I q) U2q) s ?) o c) s : \) \\\)'\ q) bo B \o b o() L s) q) bo laF eq) Pb(3r -c)s'i H\ q B uq) L q) q) a q) B\)\ q) .a \) .s _, sd$6'$Lh\ 'q) .[.:. \E I$9 I 's-,tr\ I I .:.n I ^es I i.: IbO'ISr IL\I$s)ss Z tEsP xr L\q)u a$ qr .q) Dt N.ss \\U .sts'iq)$\ s-'tsS h;TS .S-sg F\e $SS L -1. S q):'o "SP-S \i; s Et s *$BrS \{F rss \\.s y =$H{FPP q)E$ *:4 T\sv q -\: q\3S 3 :si- Ssry q)$uR\00R- .4 *x s>\Sil's' ssttr (t\q) I I.l 1 i -1 SEGTION 2: lmplementation of GDTI 2.1- Timeline of activities 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) staff visited all the referral hospitals in the province to access what equipment was available for the eventual management of side effects. Trainings then started in July and went on right to December 2OO3. 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). Cornmunity mobilisation was an ongoing activity. It went on right through Mectizan@ distribution itself 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@ (1,5O0,OO0 tablets) got finished. A supplementar5r stock of 300,000 tablets was sent by MDP and distribution resumed in June. This distribution continued till Late July 2OO4 in some health districts. Supervision was done for each level of activities; from community mobilizatton right through Mectizan@ distribution and appraisal meetings. Every level above supervised the level directly below it. ll WHO/APOC, 24 November 2004 $O c\.l Lo ,.o Eo oz .+ c.l L, o A{ ts C\ an o{) tr (dtr (l) Lr -o(ai iD .o tr(l) oio) -o L (n E 6J >. Itr(l) til< otro C) U)lr()p H-ox oi!r# AA HI o Qt)otr icdIN GI:9E >ra .ooo +.r E7./o= E'13Q.a 'trA L-tdno- (€o)3€9>. a4 -otr o.)(l)E ocd a* Oa l<6) €q2 : l-r +.! Oi) (d- O") -co(1)6 (ti hor) *Ex!rEL -csUP)1 A q) o(-) I B s) q)L\ (.) q) ,st \qr Bq.rL v, Elq) B q) *t .o 14\) () B S' q) q) ;\Fr ..ir 6)l .oldtFI a o t)t(l) o a E o 6)e EEo-() rt o of o) = so o :, o:f $o of o) = \to of o)f soo C.,l (U sC)o c\l = - rtoo C\l oCf - rl| o ofof $o of ol = $o o =(,) = I to o f o) = !t o of o) = $o o =of -E"s1iE 6= c.)o f - c.)o (U (f,o o (o o (U = (f)o .>Ja (f,o =? (f)o f - (f)o o = (oo o = (Y) o oo (Y) o (U = (f)o (I, = (f, o (E Eo E lr an ua L a o o.6EEo'- U ttooN oc f 'a $oo c\l fa $oo C\I = - \too6t l - sooN o. \tooN oc)a $oo C\l oEf -a tooN = - E9soo >R !tooN L o. too c\l f - too c\I fa $ooN = - EO .E .tj c 6: aE \too C! -oo]L rtooN -oolL soo6t oo LL soo c\I -o(l) LL $ooN -o(l) lL soo c\l -oolL soo c! -o G) LL soo c{ -oo TL $oo C\I -cloLr $oo6l oo TL soo(\I -o(l) Lr sooN oo TL soo(\l -oolL q) GIEe EA TA EIq) U tr o q6 EEo(J $ooC! oC = - trfoo c\t ='a $oo N f - $oo C\l f - $oo c\t -ootr (f, oo(\t oc = - \tooC! oc = - $oo c\l = - stoo c\l o = \too GI L o. rt ooN oc = - sooN ) - $oo N f - .E',s!iE d= aE (o oo c{ o.o(n (f,oo C\l ooa (aooC! oo U) (f,ooN o.oa (f,oo c\l o) (f,oo6t o. o U) (f) oo C\t (,) a Cf)oo c\T ooa (ooo C\l o (f) oo C\l C,)f (f)oo6l o. o U) (f)oo6l o(l) ct) (oooN o.o U) botr tr clL Fr o q6 EEo'- U \rooN -oo]L (f)ooN oq) o (f)oo C-{ ooo (f) oo C\l o o)o sooN -o o) TL soo C\I co - soo c\t o (f,ooN o oo soo c\I C(I, - (f,oo c.,l oq) o (9 ooN() q) o (f)ooN o(l) o (f)ooN o o)o Enr ?E c:d;E (o ooN oo (f,ooN = - (f)oo c\t ->) - (ooo N f - (f)oo c\l fa (f,ooN ->f - (9ooN =-? (f, oo N f - (f,ooN ='a (f,ooN oo I (f)oo c\I - (o oo c\l = - (r)ooC! J - tlr oqD rO €'E s= EtrooEr c)a tr o a6 EEI \tooN =, - .(roo c\I .> f ") soo c\l a - !tooN .>J -a 5o SR !too N fa too c! f - $ooN -> = -) vooN a - $oo c{ L o. \too c! -=J - sooN a - $oo N f - En. '!i tr d: (f) oo c\t o)c f - (ooo6l (U (ooo c\l (U (f)ooN o (f)oo 6l fa (ooo(\l o) = (o ooN -oo LL cf)oo c{ o (r)oo c! (I, (f)ooN(,, = cr)ooN o (9oo c\l o (f)ooN o = () L aD a 5 clq) F) Ir{ @ -l cq zfrl z o oo F ca o zo oz frr Fa II] oo a V Fa rrl B o Fq z r) M o zo FA z Or o o z D o z E z IJ]o z V z F z a z I I I .I l 1 t *I "t Njilowa 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 tl e 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 the rest of the health districts even beyond tJre year of the project a-rea. We hope that in tfre 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 relevont level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints betngfaced and suggestions on how to tmprove 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 the Northwest province, an advocacy visit to the Governor of the province was also planned. This visit also took place in April 2003. It involved the SSI country representative and the provincial delegate of health meeting the governor and educating him on the whole progrzrmme. The governor had already been informed about the CDTI project and how it had succeeded of other provinces of the country. 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 loca,l administrative head of Tubah (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 heatth 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 given brochures and fliers on Onchocerciasis control through CDTI. l3 WHOiAPOC, 24 November 2004 1 I -1 I ! 2.3. tobilization, sensitization and health education of at risk communities - The use of media and/or other local systems to disseminate information - Mobilization and health education of communtties includingwomen and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitizqtion of the target communities. Journalists of ttre Northwest Provincial Radio Station of ttre 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 staff, particularly the DMO was not very implicated. Their full implication will give more weight to the prograrnme as they have greater regard within the communities than the health centre staff. Provide information on: t4 WHO/APOC, 24 November 2004 ,15 co N k(l) -o (1) o z$(\ U o Or o > \o o a) a0ql qd 5H '= \J 5gtr6 6eo o Q) ! E z oo ll* ,ii ri () a06 Eo a) Cr slolo s F sF. o, s F-(f, s(olo slo(o solo s @$ s @(o s(\I(o I I I t o s r-lt -'E X L OFc.5U o €'E.d =3.>cEa E-o oo (o c\t lo C! (o @ N(r) o(f) (f) (f)N C"c\l o, F- o I I I o o @ ol q o I oo o E ql ooU o !oE z te +Fe il rq cB oti t-$ I.-@ NNN o,@ r o$N NF-N $ N (f)(o N(o loN o @(o (f) F- oN(f, o FotoN e 2- €a EOflu @t toc{ r-@ (\l(o @@ I Ce)$ Ntr) N loN o os I I o F{tt tr 6 ao L)g c! 2 o, ct N(o lo(r) r-lo Nt- I CD@ r r oo o @t-N I I o t t{ Co Fl c LoE E o E tr E o 'o o06 o E oo o c! E az oo ll * lalq tq o606 coq o 9r o o o o o o o o o o o o o o o o 7o -D oIE: iE3 .E.s E rEia2Ee o o o o o o o o o o o o o o o o o O6 !lo9L cd -1.-e e E'3co- trtr9 E9otrqO t--$ ratco o\€ r-€ $la) Oc.l \o.t \o $N c.lc.l tr-N O€ @c.l co\o o Noo L a ql o F)tu @ r.l EA nzH a EA o ca F o U zo oz tu Fa rrl oo z D M Fa E] ca z J M z rQ ca z o.o oz oz g i- z frl ca z V z Fz a z o cB bI)(l) (.) o iotr o. FI t{ o t t-i B q) * flbE:E.So 'is .: .*c.9 EqiE\ a.s .S f'E1s -tESEq$t .olrElr (glNFI to c.l Lo -o o) oz$ct O oA E tr- o J-{ +J L{ bo l< JL o B a Li oak og' O,$ o J-{ +J (ff o L{ o +J Cd boq) 0)t cd o L{ o t< P. o a4d *J- r*i Fon HOcd_ +J L{ao obo €.E! 5.E3 9E 'f O+J k .yE91 aal+rr>dH-ad g8 cd o$2 ,iFa x^(U cdsh obJ BrE 9oo ot-E .EOP-h .9N .n E '';8,*r: =+J(6tr otr5 -q.9? 9Hcu tbo'0J L.,d lY q.r -q ,.lJHo o';u0 'i.:d .Eo -frd vHfr.r vdLz ,!o t o +)o o oO +) o tr od B a o o C) (ff o a o xoa o +J c o oPdro a +J o li +Ja 15 'li{-J (U o .( E 5 B E c Cd cdP cda H (ff o EHs H F E oo.e6H EN, .oe '5 I o, rOY 'H o) -to> .Hr n H *s .-c .;i ..58B Ug -. L- l+.HH ci oi - ) o-oHE ,i9 .tA o tr;i .Ea'bo .='ata ,-iHES d EHE EEc9 Uo -t'-=.9 .H trqE ETniE E€f =-c ';-i 5HE.E hE;d. '? (u +-)I,o >€i €E HE: rse IEI E H 3 t enI a F g's.n 3E fr E B E';; ts .E.E s? EIE EEEr.t'6 t= Io o',i ? d " EE H g3f € H E €#XE gE ! gots ,3 E a #.+;E5E €3 H T E H g:€ EP.€ .,tsHE ; HT ;E.E tlod qidq :$* :8; qt() t q) Eg 4 a)q -6 U .j\ bo q) .a L oaq) sV) .3\ F,t aU q) 1 a \)$ (\.-S+i :dFo) .E v')sp3"s N E\V \AS$xq)vh s$'*i\_s : A\-\) 'cv\ hh v i. hgS -s) * -a .'\dS \ -q)\ ESi\\\Se 3tu R -\\vo,E.s . \ sB 3"s\s U,-N.S qr€.NE Ss'8.$ \S ^. .: w- -a*i t ".'9 * R9:E S .ls)uSu9 H - \ F$t i ssSS36LX*uuhS;Sqe\sq, Q .$ "o'{: E€*N" .tl r s'i XbIS I R U . .. I x'E x\'S : t s sr s r RS TE NSNS \\ \\ \\J o Urrrrr Jl I -1 2.5. GapaciQr building - Describe the adequacy of available lmowledgeable 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 rfleasilr.s were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or dstaf arefrequently transferred during the course of the campoign). As mentioned on table 3 above trainings started in July 2OO3 in most of the health 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 tJ:e 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 frlled. This is because this is a new project and all trainees are being trained for the first time. Due to the vastness of the 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 (heatth 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 staff of the provincial delegation, who do not fall under any 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, tlr.e GTZ representative, the person in charge of health information management system, and four project co-ordinators. 18 WHO/APOC, 24 November 2003 !?[U o -= +ts ",i .L qv ir *o Nrr (\lt- r-6 t- € o rat\l eto al \o tO6l \c)ia ot sol t ol o t-r-t\ F-t-(\t o =f cl t N o (ri\o (o\0 GI ?al cl ra = tf, 6(t) 6 (a o ra r-. rar- at ra(.) N\a(a \ot-\o GI \or-\o N o GI ro o e(J o Lq)E z GIF- t6 laN \o ra(\l r--r-N e o\ t (n\o \o \oia m F-F- o\ o\ = € (\I ra ra olia o\ N r- o\ E(l) (l) o) q) sQoLF O o o € 6 6 o 6 Glll, Ii\J: .( +go is *G e e e e e o o qr)trq) .=66l tr!b r- Fr6): pa,) oo)k9 r- Glc)L!- z Q oLF o e o e \o \o trq) Eq) o (, s a(?) ra I Itr U (-) + Q tJ .L a< sD GI N o\ o\ \oN \oN € 6 ia(\I ra N t- F- GI(\l o N6l o\ o\ o\ o\ (\l N \o \o la ra N 6t t- r- e o\N6t o\olN e o -4 gts =s -rE tr.-- z-c q) g) U 6 \o r- $ t (.) ra (\l \o $ o\ \o O (f)\o r,o tI q) q) €) (.) -o .\ q oz E.r?F-(j t t F.- e Fr t-- o r-- t-- t-- t t tr- r-- \o \o ia ra (f) ?a F- t- \o \o € a ia6 ra6 !H 6l rn an a L ah liE d6tOli L o z Q o LF \o \o \o \o € \o € \o \o \o \o \o \o \o \o \o \o \o $6 L q n 6q) Fr f= tr Fl FE l-{z rd =a c o Fq F{ FA z o ez f= Era f-I o EAr=a 11 Fa ri B o FEts{t4p 11 B Uzri tq ETa o nz z F v l- z trl Fq z vz t-rz O =a o cl a0q) o) L G o Fr N tr(l) EI(D o E c) s co O(\ L{)p o oz$ c{ O o o\ gb o a o o B :i p s i. o ll o \ o\ p o i o\ d € o s .B ,a F * !\l\ B L I q) q)s lS I1 E -'t Table 6: Type of training undertaken (Iick the boxes where specific trainingwas 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 detailed 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. Treatments 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 first year of treatment in this project. Therapeutic coverage rate was 66.4%o. Geographic coverage was 93.8%. The challenge is not just to maintain these coverages but to increase them. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political [,eaders Others (Journalists) Program management ./ ./ How to conduct Health education ^/ { ^/ { ./ Management of SAEs ./ ./ ./ CSM ^/ ./ ./ ./ SHM ./ { { Data collection ./ ./ ./ Data analysis .i { Report writing ./ ./ Others (Mectizan@ distribution) { ri ^/ Program management ./ { 20 WHO/APOC, 24 November 2003 I too c.l l<o .-o E(l) o z$N U oA s E B ": e€E E a*?I=gZ HE E o o o o N o o o o r o o o o G' O rr) E3 AO o o o o N o o o o o o o o G) -3CU 5"Hz€ o)(o c\l (f) l.r, r o_ N C"(o N o $ o_ r (Y) @ O) @ r N r l'- (f, F-@ ro lo ct)(o rf CDt-(f)- (f) @ o) @-(a o loNF- rr) $to rr)_ ct ro @ ts- -3; "E E:r EEr'€E I-lf,(o c{ F-(r) o$(f) c.i rsI-(o $F-F- lo o,(o $_ N s(o c\l r (oo@ N@ CD (o @ o-(o o (oo ro (o Nlf @$$- N o(o !t_ o,N tr o cl p o Or o II a o!o3 0l)tD ctasbs oo ,EoH s CD(o F* sN c.ir- sq t- @ s (f) c.i rr) s s N(o s (f) c.i ro s (f) cts sq Nr- s ro F. @ s(r)t- I sq(a(o st- .tt* s CD ct(o s a(o(0 o ts -_gH€ H59 = o-z @ CD(Y) F*N o(o F c.i @ o- N(o F- looo (f) N (f)o@ @ ro o(o (f) (., r ro \ r N C" rr)- Nc! (o (f)$-(o c4) Nr- oN o (f)$ Ct_ C{'(Y) N CD s_(\l - rO @ ry rr- (0(r:' t_ o cl)tf Eo d o-=2E6E E.S < g€'Fr(J o ro (", N sF-@ o $ o) @^ (f) N CD o o,N No(o- (o @ N o,N @$@ o, Nloo It-N Nlo o)- N o (r) @(o_ $(f, s(o @ o r (o(o N l-(o (9 G'q N!t a .=_rdE Eg = o 9(li€ -?.g o:OE = - E€: EtroF ro @- rO(f) ct)N\(o r (f, @(o- (f, r $s(o dlif or- r s o) r$ro ro N rlo o, $t (o (f) r.() o(o o, (o_ rt o, (o_ r-N o @lo(r) (olo s t-(o (o @i: (f)o lo(o(0 odrt(o c) C) o0 c, cn(.) I H F{ oO ll rdd\o E .9o;MErd!n6bo<83 soo soo soo soo sNd o) soo s .q oo soo soo soo so soo soo st- @ o) so(r ct) E.9 .- -3 5 $.Htr C= o =c>rz6o F-$ ro(f) o,@ I-@ rO oN r-(f) o(o sN GIc\I o o@ @CN o(o o$(o a :oE b.Z =E5TE5 t(f, |f)c\I ot- lo(o r$ lr) s(f) r(,$ @ t- o o(o N los oCDt \Oqod,rGq Ot X o --e d ae1 E'; F.g x S E gE E - . 8E E E r- *ir rarco o\@ t'*€ $trl ON \o$ \o $(\ c\C.l c-(\ oo @C\ ca\o (\to(o o L a o (6 o) Flr F tri cq rl m n zH z Fq o Eq F FA o zo o z t\ ca-\<tsAAD<Mrq o tQ r- >,4 -r trl *9 E o z EIo a Ao o z D o z B v l- z rr.l ca z v z F z a z GI F c{ *a V1 13q.l\lJ B dN\() \ ,s' rri\r ra \l s q) BqJi r-f o-, I -oldlFI 1 I --t i ITOTE 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. Forrnula for computing therapeutic and geographical coverages Therapeutic coverage rate (%) 430.436 X 100 648,665 Geographical coverage rate (%) ATO coverage rate (%) Number of people treated x 100 Total population living in meso/tryper-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 100 421,633 102.1% %UTG achieved Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) 430,436 X 10Q 79% 544,879 ATO = The atinated number of penons living in meso/hyper-endemic arcas lhal a CDTI projeci inlends to trcut with ivermectin in a given year. (|TG : The moxinam number of people to be treated in meso/hyper-endemic areos within the projed area, ultimalely lo be rcachedwhen the project has reachedfull geographical aovetage (normally the projea should be eryeded to reach the I\TG at the end ofthe f year ofthe projecr). 22 WHO/APOC, 24 November 2004 .J 'l I -1 Table 7 bis: Number of persons treated per health district in hypo-endemic 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 Z) WHO/APOC, 24 November 2004 -t soo c.l l<(u -o o oz .+ c.l -aJ A o .+(\ a) \ q) Lq) "a N r.q * \so q)\ OO S $' q) .s Oo \\q) L q q) s t3 .s f\isrl $ q) q) f x B 4) s q) u, S' aa) a) % -s\) ool slSI st =EP.EE b <.E E otoOo Ad o ,qoo 6 o z o oo d o z ;P8 E€E6toi, @ ;,J ,EEH q(l)ko o @ a o)lro ! c) ca qr oq).9 EO9Egs 6E -o (1) o d !(l) lro oo 6)d !() ! q o .9! +.Q qb ^ .! v'r'it (dir.= lU(.)-C tr *va € o ,t -9o-oE!oe o€ sqf(\1 t o o-9o-oEt oqldl E o c.9o-oEIJ= (\ ({> \Ol. **E-O.9Etr o c E=9HH'i(doooA€,Ee o EctO<! ozso€o ':NOL.l - c.r ! 3 E.'-HEEit >n U.lL ebor< o4to€oE=R .; oq'; \e qEu' v;i- A€gE .o c)trr <-50 c.l Oic{ -oofr. <. raor c.l ,o o)trr <.50O\OH c.l d €-gqp.E EEEEg C)q t! otr Iri q) fr< E o o. E >.a r(ud -iE oo8 - P daO(D E-(dcct,= t 6n !a tts Q'E6 € -H,.8 dc3a .e3€ E>\s - triI C) (t.9f b'a H A AE€ B ^ho €E pdcr6 E b: ,9iElrr o (S Otrt;=o -.ts1: o =iD! F.eHo(g -oit)trr <-50NOHN !() trr <- C.l O -(\ .oIt)lrr <-EOr-O *(\ HS? .Nt 9!2-A: E -oofrr <-5Ooorc{ soo C.l -o() frr tN o boq d m $ C.l -oo frr C, -o cd z o oo0d6.t - bI) ?o qi .v M C) (d zxoa o) d z () d a (l) h0 frE\o >. .r' Ec.l >, ^qsf, >' * a c.I co $ooNk(.) -o o o z$ c.l Q or o qn o cl C) G!I(l) bo cltrq) o C) (J F CB e Lo GI o c) e) en cl o)L a0 an o ah tr) c'l cloL cl Iq) 'e La (l) L € Fp q) q) 6lq) tr q) eh 6l o) Fr L clo c)LL (J ()E oecltrp EE(l)q) :'$ .=L;\EP Es HSa\(.) e,ETOa)tr >. :hlFtl Eil f5l:sES +.:6lvP\ o& E! FilS 'S) ": t\o ..i o,l()l _ol(dt FI o bI) P $s/o O -oo\ o\ r-. tro Gt oo Or eili ri Er t{ o9Sati oo\ -o o s c.iO oe ll r Id frl f-l \o o 'j5 o = bI)od *b oo5()F s n\o\o r.l ,r. Iodg9) oj52-Etr50Ab q \o cOd cot r.l Eod o.= EH.g < g4'F'J co c.t\o^ N$ ! rfi - x sES'E o ho " .o dE='ElI] ' 6. 3gO E: o. E6 lat\o \o^ € =f\o o c) bI) GI () trtr o(J lL *^ l-l t-l ri o9ffa - oo\< e-o -o5\\q c.t o.bo=!q- F-il LFs gda*i OoEI \o o\ oq co o\ l-l aOoE 3_ E 5 SE 'tr ts=;;EEi.: >Oa $\o l.l Io d o.= E E.g < 9P'FL' o\$ oOd =qti g IE rt o:E }'_-: d'=.=-\ cEt e 3 q€ tro oo C.I oo\o & rrl cooO c.l {o c.l ooN \o oN r-o c'l oo N o\oo c.l O o c-t t2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate answer) MoIr D wHon U111CEFI NGDON / Mectizan@ delivered by - Qtlease tick the appropriate answer) MoH tr/ wHotr UNTCEFII NGDO D Please describe how Mectizan@ ts ordered and how it gets to the communities Mectizan tables were ordered by the NGDO. This order was done with the aim of treating 5OO,O0O persons, following the recommendations of Mectizan@ donation programme. A total of 1,8O0,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 10: Mectizan@ Inventory -! Health District X"-ter of Mectizaro tablets Requested Received Used Lost Wasted Expired Remaining Meso/hyper hypo Bafut 0 95000 71746 5469 536 412 0 16837 Bali 0 50000 33926 6353 0 179 0 9542 Bamenda 0 202000 186444 5731 0 1327 0 5578 Batibo 0 96000 58400 16418 0 709 0 20473 Fundong 0 186500 r47936 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 14492 Mbengwi 0 83000 57756 12879 0 1341 0 g'.t90 Ndop 0 132000 91346 38336 0 216 0 2102 Ndu 0 120500 59161 7036 0 375 0 s3928 Njikwa 0 0 0 0 0 0 0 0 Nkambe 0 r90000 117096 44728 0 480 0 22520 Santa 0 70000 33732 19704 0 57 0 16507 41418Wum 0 250000 169923 25982 0 996 0 TOTAL 0 r754000 tt200t9 349541 2633 7440 0 2s3422 26 WHO/APOC, 24 November 2004 "I r -I -t 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 1,5OO,OO0 tablets were available. This resulted in drug shortages in almost every health district. The various district medical officers then collected their stock of Mectizan@ from the drug programme during a routine coordination meeting they had at the provincial delegation. Mectizan stock management data collected from some health districts was not complete for arr example of this is the case of Ntumbaw health area of Ndu health district where data on tablet mzuragernent 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 andwhere are they kept? After Mectizan@ distribution, all left over tablets with CDDs were forwarded 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 briefly describe the activities under ivermectin delivery that qre betng cqrried out by health cqre 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 prograrnme. This is such that the actua-l 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 -t I _t -I 2.8. GommuniQr self-monitoring and Stakeholder:s teeting Has any training (of trainers) for community self-monitoring been done in the proier.'; 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 organiznd 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 supenrisors and health district teams will also be properly trained so that they can in turn train the health centre nurses who would 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. [n some health areas the health staff single handedly did the monitoring and Iilled the CSM form. In others the activity was well started but ended hatf way complete. Some health area staff referred to community and health area evaluation meetings as community self monitoring. Others regarded CSM as a separate activit5r and not an integral part of CDTI implementation and were expecting extra f 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 level. and Stakehold.ers Health District Total # of communitieVvillages in the entire project area No of Communities that carried out self monitoring (CSlt) No of Communities that conducted stakeholders meeting (Slil/t) BAFUT BALI BAMENDA BATIBO I IFI]NDONG I l KTJMBO EAST KUMBO WEST MBENGW] NDOP NDU NJIKWA NKAMBE SANTA WUM 54 42 )20 92 6 1 8_0 9s 80 98 67 47 165 25 62 54 42 120 87 55 80 86 80 98 62 0 165 0 55 TOTAL 1088 984 28 WHO/APOC, 24 November 2004 I i JI "1 _i -l Describe how the results of the community self- monitoring and stakeholders meetings have afficted project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 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 payment did not come forth, some CDDs in certain areas decided to withhold keep treatment data pending payment for the work they 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 wittr 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 strategr 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 I 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 supenrision checklists were used systematically during supervision. The provincial Onchocerciasis Project Co- ordinators also used superwision check lists for supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Generally, good performance was commended while errors 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 supervised? Just as during supervision of other health activities, feedback was always grven 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. flow 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 supervision 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 occnr 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 6tI -l -l SEGTION 3: Support to CDTI 3.{. Equipment Table l2: Status of equipment tCondition 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 moterials? During this early phase of the project, the equipment will be maintainedjointly by the Ministry of Public HeaItJr, APOC and Sight Savers International as spelled out in the approved budget. As APOC funding starts reducing the Ministry of Health will gradually take over maintenance till the 5ft 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 quipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition L Vehicle I F 7 I F CNFR l0 F 2. Motor cycle(s) t2 F l5 F t4 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 3l WHO/APOC, 24 Novemb er 2004 -! -I 3.2. Financia! contributions of the partnerc and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, 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 communiQl support - Describe (indicateforms of in-kind contributions of communities f ary) 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 the 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. In 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 Contributor Yelrr I ('provide the period') Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgete d (us$) TOTAL Released rus$) TOTAL Budgete d rus$) TOTAL Released (US$) Ministry of Health (MOH) 187 050 163 139.00 Local NGDO(s) (if any) NGDO partner(s) 84 843 149 456.16 DistricULGA Others a) Communities APOC Trust Fund 238 718 r44 398 TOTAL srO 611 427 852.83 )Z WHO/APOC, 24 November 2004 -I I *l 1 't --t I distribution. In Djotin and Ngeptang health areas of Kumbo West health district, the communities organised themselves such that each family contributed 50 CFA frs (in Djotin) and 1O0 CFA frs (in Ngeptang) to a fund and this was given to the CDDs as compensation for their work. !.4. Expenditure per activiQr Indicate in table 14, the amount expended during the reporting periodfor each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here 1$ US:600 CFA Table 14: Indicate how much the project spentfor each activity listed below during the -'t -1 Activity Expenditure ($ US) Source(s) of funding Source APOC SSI MoPH Drug delivery from NOTF HQ area to central co ! lqc_li 94 point o{ coryngryty Mobilization and health education of communities Training of CDDs flqipln_g_gfhealth slaff at all level Supervising CDDs anlaiitribution Alygcqcy v_isits to lreallh qqd poliliq4 authorities IEC materials Su44qry _(r9p_orting) foryl for treatment - Rggls_te19 - Household cards summary form Molo1cygles/ bicycles maintenance O!{cq Eqg_ipment (e- g computers, printers etc) - Others - Treatment Vehicles/ Internal moni of CDTI activities t2 735.67 20 069.71 30 488.51 2 579.76 5238.1 911.43 8820,1 3 3038,27 t092.3 8202.33 7366.06 8457.9 548.6 1742.51 1709.9 13 600.00 Supplies 1247.54 2327.8 Personnel 12 152.38 666.11 74139.00 - General Assembly I 871.53 r35.66 - Communication 76r.68 5202.37 - Appraisal and planning 28 088.86 - Other operating expenses t0 214.37 2 s90.39 7 400.00 - Launching of Mectizan Distribution 2514.28 - Side Effect Management 6 404.r9 - REA 3450.29 - Capital cost(bikes) 9159t.27 68 000 TOTAL 132 763.75 149 456.16 163 139.00 Total number of persons treated Any comments or explanations? 33 WHOiAPOC, 24 November 2004 II *I E i t SEGTTON 4: SustainabiliQr of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 \ilas Monitoring/evaluation carried out during the reporting period? (tick any of the following which 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. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan writlen? _ Wen was the sustainability plan submitted? Wat arrangements hove been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementand maintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: "I 34 WHO/APOC, 24 November 2004 1 t _i -t 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. Ivermectin delivery mechanisms This frrst year ivermectin was transferred from the NOTF in Yaounde to the NWPSF in Bamenda were it was stored and managed together 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 marragement 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 a-reas. 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 progr€rmmes 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 programmes. Such supervisions were more resource management efficient. 4.3.4. 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 greafly. 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? A11 community health programmes at all levels of the health structure are making use of the transport facilities provided by CDTI. These programmes include; National Poliomyelitis Control Programme, Expanded Programme on Immunization, T\.rberculosis control ] 35 WHO/APOC, 24 November 2004 programme, Leprosy control programme as well as supenrision 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 research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No 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 strictly adhere to the MEC I TCC recommendations when treating in communities at high risk for SAEs. SEGTIOil 5: Strengths, weaknessesr challenges, and opportunities List the strengths and wealcnesses of CDTI implementation process. a) Strengths - CDTI programme has created awareness on filariasis within the communities. The programme 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 h.ppy with the programme as they 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 I i "II I -t -t _i --f 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 mobilizatson 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. In 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 heary 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 a-reas 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 expiredMectizan@ (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 the 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 hnance the registration exercise themselves; the planned grand provincial launching of Mectizan@ distribution was cancelled and replaced by low-keyed t a 37 WHO/APOC, 24 November 2004 -l "l I .I -'t 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 tlreir poor access; the 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 management 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/ol. SEGTION 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 ctan I 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. l 38 WHO/APOC, 24 November 2004 I t