South West 1 CDTI project technical report submitted to Technical Consultative Committee (TCC): September 2002 to August 2003

MINISTRY OF PUBLIC HEALTH SIGHT SAVERS I]\TERNATIONAL CAMEROON I ) { I I ri, 'I it SOUTHWEST 1 sTH YEAR ANNUAL PROJECT TECTTNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL [ri uri, qt -^.k-4*o-- 11,::' r 'r () i lcc t8 t-_ F-L'.V trP 5rn igrr iAL -,. -.. .i I ,tl ( [or ', ' .i Tr), \tP- A<-) COUNTRYAIOTF: Cameroon Proieet Name: CDTI Southwest I Project Approval vear: August 1998 Launchins vear:ffi.n leee Reoortine Period (Month/Year) : September 2002 to August 2003 De!q@: @: Sieht Savers International wHo/APoc, zs eJgustaool Table of contents Acronyms ii Definitions iii FOLLOW UP ON TCC RECOMMENDATIONS iv Executive Summary v SECTION 1. Background information I 1. 1. GSNERAL rNFoRMATroN............. 1.1.1. Introduction and new developments in the project (briefly) . l.1.2. Partnership 1.2, PopUI.aUoNANDHEALTHSYSTEM SECTION 2: Implementation of CDTI 4 2.1. PgnroooF AcrrvITIES........... 2.2. ORoER_hic, sroRAGE ANDDELIVERy oF MERMECTIN.......... 2.3. AovocacynNo SpNsirzATroN..... 2,4. MogTLzeTIoN AND FIEALTH EDUCATIoN oF AT zuSK CoMMUMTIES........... 2.5. CotvrururuuEs INVoLVEMENT IN DECISIoN-MAKING...... 2.6. Cepecrry Br.rrLDrNG 2.6.1. Training i I 2 3 4 6 7 7 2.6.2. Equipment and human resources.. CoNorrtoN oF TrrE EeLTTrMENT * PLgess srATE 2.7. TRremmvrs................,. 2.7.1. Treatmentfigures... ..ll .,,|2 ...12 ...14 ...14 ... 15 ,..15 2.7.3. Trend of treatment achievement from CDTI project inception to the current year 202.8. SuppRvrsroN ................21 SECTION 3: Support to CDTI Zl 3.1. FwaNcrar coNTRtsurIoNS oF TIIE pARTNERS ANDCoMMUMTTES ..., ............21 3 .2. Orrmn FoRMS oF CoMMLNITY SUPPoRT ...,,,..,,., ,.223.3. ErcrNprunrpERAcTrvrry......... ......................22 SECTION 4: Sustainability of CDTI23 4.1. hmnNar; INDEeENDENTIARTTCIrATORv MONTTORTNG; EVerUetrON ........23 4.2. COtrnvfU.UrY SELF-MOMTORINGaUO SIeXcHOLDERS MfgrnrC... ..........32 4.3 . SusreNasILITY oF PROJECTS: PLAN AND sET TARGETS (rrleNoaroRy ar yR 3) .. ,.. ,......3 34.4. IxrpcnarroN ... . . ....... 33 4.5 OpenaTToNALRESEARCH .,..........34 SECTION 5: Strengths, weaknesses and challenges34 WHO/APOC, 29 August 2003 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT LINICEF UTG wHo DTS African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government fuea Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization District Temporary Staff ll WHO/APOC, 29 August 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iD Eligible population: calculated as 84Yo 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. (iu) Illtimate Treatment Goal (UTG): calculated as the ma<imum 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). (") Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("t) Geographical coverage: number of communities treated in a given year over the total number of mesoftryper-endemic communities as identified by REMO in the project area (this should be expressed as apercentage). lll WHO/APOC, 29 August 2003 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 16 (Please add more rows if necessary) *Please indicate the number of the paragraph (agenda line item) in the TCC report relating to the recommendation of the TCC being addressed *Number of paragraph in TCC Report TCC RECOMMENDANONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT USE ONLY 37i Distribution should be undertaken during the period preferred by the community and the project should work with other health programmes to make this possible The campaign strategy used liberated all the staff at the same period and this made it possible for increased health education and community mobilisation. The period of distribution proposed by the communities was respected. 37 ii The project needs to increage health education and community mobilization. Advocacy, health education and sensitization was intensifi ed. There was effective participation of the health stafl During this distribution, SSI made face caps, calendars and posters with health education images. 1V WHO/APOC, 29 August 2003 Executive Summary Prepare an Executive summary of the report in not more than one.page l. Background on treatment and population data - Total communities, communities' treated, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, healthworkers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. The 5th round of Mectizan distribution in the SWI project began in January with a consultation meeting of the stakeholders to determine ways of achieving a better coverage for the province. It was agreed that CDTI activities should be grouped together and carried out with a defined period with all health staffin the project area actively participating. This was termed as carrying out distribution as a campaign As indicated in the plan above, all resources were provided to the provincial, district and health area teams in January. Training was immediately followed by health education and sensitization of the community and distribution followed without any gaps in between activities. Training was done by the district staffand the health centre chief of post 144 nurses, 5 DTS and 1107 CDDs of whom 89 were females were trained The launching of the program at each health district during the youth day celebrations in some instances was also a plus in creating awareness This way the awareness created in the communities was still at its peak when distribution was carried out and the participation of the population is reflected in the coverage Supervision and monitoring for side effects was effective, the nurses visited the communities taking along drugs for side eft'ects thus there was better management of mild side effects Cases necessitating hospital care were quickly referred to the hospitals Because of the lifting of cost recovery, more persons took Mectizan, for a population of 265,384 in the hyper / meso communities, a total of 304,098 persons of whom 126,432 were from hypo endemic communities This led to the shortage of Mectizan The community was please with the distribution taking place during the period they had requested and would Iike it to be carried out in the same manner next year Given the context under which Mectizan is distributed in Cameroon in general the campaign method in the most effective method to be used. The project will appreciate the replacement of its vehicle by APOC WHO/APOC, 29 August 2003 SECTION 1: Backgnound information 1.1. General information 1.1.1. lntroduction and new developments in the project (briefly) - Provide information on any new, important development(s) in the project characteristics (e.g area covered, change in management leadership, cha'nge in administrative and/or political structure). Location South West I (SWI) is part of the South West (SW) Province of Cameroon. It lies between 5o20 and 4oN and 8o45 E. SWI includes 3 administrative divisions. (Fako, Kupe Manengouba, Memr:) These divisions are made up of about 10 subdivisions. Buea in the Fako Division hosts the administrative headquarters of the SW Province.SWl is bordered to the North by the SW administrative divisions of Lebialem and Manyu, to the South by the Atlantic Ocean, to the East by Litoral and West Provinces and to the West by the Republic of Nigeria. From the health point of view SW1 is divided into t health districts (Buea, Limbe, Muyuka, Tiko, Bangem, Tombel, Nguti, Konye, Kumba) which are subdivided into 70 health areas. Population.Size The total area of SWI is approximately 14300 km2 and the population registered in 2001 was 4710050 people living in hypo, meso and hyper communities. The census update this year 2003 of the population living in meso and hyper endemic communities stands at 245,638 persons. Topography, Climate, Access SW I features has a diversified landscape, The predominant vegetation is the Equatorial Rain Forest. Besides this main type of vegetation, there is mangrove vegetation on the coastal areas. The rumhpi hills occupies the whole of Meme Division. The altitude ranges from 0 metres on the coastal areas to 2200 metres in Buea with a multiplicity of small hills. The Cameroon Development Corporation (CDC), an agro-industrial unit has put its stamp in this region with its numerous large plantations of rubber, tea, palms and banana SWI has a very rich network of drainage system most of which flows from high altitude and are interrupted by numerous cascades, rapids and waterfalls. These streams provide breeding sites to Simulium vectors which can be found on high altitude in the area. The rainy season starts from mid-March to mid-October with its peak around July and august. The dry season goes from mid-October to mid-March. Farming is practised all through the year, the highest activity being registered around March and April at the beginning of the rainy season. Tlre roads in SWI are mostly un-tarred. They are generally practicable during the greater part of the year, with only about 3 months (July, August, and September) when they are difficult to ply. During ttris period of the year movement of Community Directed Treatment with lvermectin personnel should be reduced and oriented towards areas where the roads are practicable. WHO/APOC, 29 August 2003 1.1.2. Partnership - Indicite the partners involved in project implementation at all levels MoH, NGDO s -national, international) - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved- - State plans ,f any to mobilize the state/regiott/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation.. African Program for Onchocerciasis Control (APOC) Support the Community Directed Treatment with lvermectin (CDTI) Projects by providing giving financial assistance for training, supervision, mobilisation of communities and purchising of heavy equipment e.g. Cars, Computers, Photocopy Machines, and Motor bikes Mectizan Donation Program. Ensures the production and donation of Mectizan free of charge to the port of entry of various CDTI Projects. Sight Savers International SSI is the main implementing Non Governmental Developmental Organisation in the Province. It is assisting South West I and SW II CDTI Projects with logistics and finances in project implementation and ensures good resources and financial management of the project. MinistrT of Public Health . Provides personnel in the field at all levels, i.e Province, Districts and Health Areas and support the community in implementing the program ' Organises training of health personnel and CDDs . Advocacy at all levels ' Planning, mobilising, sensitising and supervising activities at all levels . Monitoring, Supervision and Evaluation of the project Endemic Communities These are the affected communities. They are the principal partners of MOH as the implementation of treatment with Ivermectin and its sustainability depend on them The community - Selects Community Directed Distributors (CDD's) and send for training. - Takes decision on the mode of distribution - Planning for distribution - Participates in mobilising the community to take Mectizan - Participates in supervising Mectizan distribution within the community - Identifies and refers adverse reaction within 7 days of Mectizan treatment - Sanctions the CDDs. The Community Directed Distributors (CDDs): - Ensure storage and safety of Mectizan. - Collect Mectizan fiom the Health centre - Distributes Mectizan to their communities. - Carries out census of their communities aL WHO/APOC, 29 August 2003 rl ,NI ! o! 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[.J o\(,(/) €5 € o\\o (.+)(, 5\o(4) N) \o{O 5 N) -I o\ o\te o\ b,.)6\o\o5 6\o UI UI (, N)t)a -I\o5 (!- *E - EEg HE E'(Dr lt + (, tJ l.J N) N)\o \] l.J{ NJ\o m tJtJ (/) N) t.J NJ \o { N) s t-.J\o u)5 o\!@ A{t, (J) o geFria <t8?r; I9lzIts t=. IEl19 l^ '-(!HI' EE F BrE ir E I,I €g rio ohi+rEootrao ET hJ:3t r!OTaEl 't EE oo E =I E ls E:\i G\O rrlGA-SrJSiltpxt oa S- SR\\ €E 6'* 8sEB\l1.8t l's]SFS .\\ =^ =\G\' :ds.ts xo 3x'xr\3c;rGl' o] *sNiRE}Y Nx s8ss:t:\ ^JGt) S R.s3I.(\O$s d-N .od ds: vsGAS\- a€i86:\t TS3ssE! s' R .R. .q o s G G $a -t-|\s s G\\ G' x +sh u.) o o ! tD .3 { o Ia -\o 0! 0 hJ 8 l-) - If you are using the term community or village define what constitutes the community or village. This will help understand the profile of the Project area. - Any other information of interest to programme. The village is made of people of the same tribe living as a group in a given setting. The number of persons in a village can be as small as 52 person to more than 4500 persons. A community is a group of persons living in the same vicinity who could be part of a village, or a quarter in town or more than one small village. The community should have around250- 300 persons Communities have been determined by the different health areas. ln some health areas, the number of persons covered by one CDD are considered to make up one community while in others the culturally structured unit has been retained as the community. Because of this difference, the number of persons per community can vary between 300 to 1500 persons. SECTION 2: Implementation of CDTI 2.1. Perlod of activities Insert Plan of action indicating activities by month, which were implemented Structure of District Operational Plans It was generally accepted that operational plans of action could not be done in this meeting of 7th and 8th January 2003 as the actual actors for the various HD were not in the meeting. Consequently, only a structural plan was accepted to be drawn up at this level. After an exhaustive discussion, the following structuralplan was drawn up with just the activities and timing. The rest of the information on the plan was to be filled in the various Health Districts. The activities were to take place between January and April, 2003 4 AJO ACTIVITIES TIMING I (a) Supply of Resources (Finance, material Mectizan) 4th week of January I (b) Distribution of Resources 4" week of January I (c) Operational plans ls week of February I (d) Re-training of WCentre personnel 2no week of February 2 44yqgucy Meetings 2nd week of February 3 (a) January to April 3 (b) Selection of CDDs End of ls week February 4 Training ofDialogue structures 2no Week February 5 Community H/Education January to April 6 I.a!nching Feb 2003 7 Up-date Registers and distribute Mectizan 4tt' week Feb. to I't week March 8 Monitoring & management of side effects 4ft week Feb. to 2nd week of March 9 Daily mqnitoring ldaily evaluation at HA & HD 4' week Feb. to I $ week March l0 Report Writing ( Ii4ancial, technical & Mectizan) 3'd week March 1t Health Area Appraisal 4* week March t2 District Appraisal 1o to 2no week April t3 Provincial Appraisal 3'd week April _lqpervision of all activities January to April Feed back WHO/APOC, 29 August 2003 Community sensitisation Fl o H F ID 2, ofrl? -lo td rrl - z oe *l n(J z rd Xc 3 ED C -x -l X t. = TEIt EO E' .A rt .) F .; ,/, ,_. )- -./. ).x )- :- ); "a 1, ), )- (- ,,tz F ):.1 - F P .1. - '>N t/ J. c9 :DT E'* EE 2tr=oo ES = 5'. =ot!,(A^ Ei , ), 2 ,1. -J = v -l-- >t T' -i = -U - .U F Egb'troB _t'l :T',lrI 2 2 '7J ,n 'n :t -:, n :r1 r:l '). -T1 T1 ll N F rrl F a'_ -r1 :rl -r'1 r-' IU C, -?'l v n '.8 a9:r, E4 riE r-l n!, pa -a fi1 ,i, F ,:: i- ;o '-t 1 E N -r1 rn F .n -n v - v rn C. 'i1 m a- (-. P -r1 FN - 'P nfrlt, C). oo o o o E' 1'1 r--l ,iD 1: ? -afiE -' ;o '! rn n :!(", -rl i-n il aa F rn E :tr a)- ^r'l CD t- F -n rrl a!t -. -a =!,E* iiE oa oo O 0 lP ItD I I I \1 .-1'l a . 7: 'T 1:rl rri n , -rl rr';iI v 7) -t .r1 i E 'r-i rn w C 'J- -rt iN IDF a-: -N t-r: rD - P En F P ;o -Ti rn ID -, ooBEiE c! '7, - EE - P rn p F TI .I tLl N -. 'p -!'l Ii rT) ,N -:.).F 'n i11 -n rr1 w a:- _T1 an TD C, .T] i-ri F a?BPE43E' r! xe a U' rl r o 7 J- .) T !).va ;f .> ,) & F ,- I ? :f, 7 )- a - ;L J>F - .P a .T OA EBOE =t! "/, )? )4 ,,/ a: "L. )- ,: '/ j- 1, -'t- ,tr ;L a'_)- ,p -)- .1 F Z "tF ', '1. p 39 !l* ii5m a E CD{ .A o? ). '7 )- '7 Eeg)E 6'E l-l la)td t(a It.: ; (D (D o F{) 0oo o t/7 o' op Fl o Fe t) El o t9 (D o- o C) r_t -1o (D F) a E. CA(\ F. \(\ eq (\ G(\ ? 9 o o tD a/) (/l I a 3o ;\o ga co f.JIlJ) 2.2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - @lease tick the appropriate answer) MOH N WHO N UNICEF N NGDO NX Other (please specify). Province and Districts The project request was made to MDP by the NGDO following directives from the MOH while the district requests were made by the MoH district staft. Mectizan@ delivered by - @lease tick rhe appropriate answe) MOH f] WHO f] UNICEF - NGDO N Other (please specify): Province and Districts Mectizan was delivered to the province by the NGDO and some districts collected Mectizan from the province Please described x Supplied by NOTF, coming from South province. Table 3: Mectizan@ Inventory N B 26'312 tablets of MECTIZAN' rvere left over at the Pror;ince and 18000 in the Districts toward passivetreatment and treatment of abseniees from last s,ear,2002 MECTIZAN distnbution. 6 Number of ivermectin ta for the rtedblets 764 000 Cz Number of ivermectin tablets received by the project 764 000 +70000* Cs umberN comof nmu es/viti which collected fromillages teddrug designa collectionof District/LGA N mber of Mectizan tablets Requested Received Used Lost Waste Erpired transferred BUEA 82 000 96600 8879 I 219 0 Buea to Tiko 7000 LIMBE 63 000 94'735 92763 53 0 TIKO 76 000 91233 90933 r59 0 IvTI,YUKA 79 500 9489 I 93204 69 0 KLMBA 199 000 27 537 1 26097 1 t2t2 0 KONIYE 90 000 85488 78382 t23 0 Konye to Tiko 6000NGUTI 46 500 48913 3909 I 561 0 Nguti to Muluka 9000TOMBEL 80 000 8 1658 73946 t9 0 Tombel to Kurnba 7500BANGEM s2 500 60982 50487 l16 0 Bangem to Kurnba 10000 TOTAL 768 500 929871 868568 2531 0 35900 WHO/APOC, l0 April 2003 - State activities under ivermectin delivery that are being carried out by health care personnel in the project area. - Collect Mectizan from the province and district - Determination of'number of tablets required by the health area ldistrict - Health education of community members - Monitoring of side effects - Management of side effects - Training of CDDs - Eye examination - Collation of treatment figures The health care personnel pick up Mectizan from the provincial level and district levels, making it available at the health centre for collection by the communities. In the campaign strategy Mectizan v,ias taken to the community for those who did not collect it during training of the CDDs. The nurse at the health area level also works with the CDDs to determine the number of tablets distributed and to analyze the treatment records. - Any other comrnents 2.3. Advocacy and Sensitization State the rutmber of policy/decision makers mobilized at each relevant level during the current year; the reasonsfor the sensitization and outcome. Describe dfficulties,/constraints beingfaced and suggestions on how to improve advocacy. The administrativ,e authorities, the Governor of the province, Divisional officers, the Sub divisional officer, Chiefs, Church leaders, Principals and head teachers of schools and leaders of social groups in all the health districts were mobilized The distribution was launched in each of the health district by the Sub Divisional Officer This done to sensitize more of the population concerned and the result was that more persons were treated in the project area 2.4. Mobltization and health education of at risk communities Provide informal.ion on : - The use of media and/or other local systems to disseminate information The radio, s<lund systems, and face to face talks were the means used to disseminate information - Mabilization and health education of women and minorities - method and response Health education talks were given to women in their social groups, at church groups, and during clini,;s. The response was positive - Response of target communities/villages Most of the communities responded positively to the program. - Accomplishments More people treated - Weaknesses/Constraints Sound sysl.ems not available for all health areas Mectizan not,enough to cover for all those who wanted to take treatment especially those in the hypo endemic communities 7 WHO/APOC, 29 August 2003 - Suggest ways to improve mobilization of the target communities. - More advocacy on the community ownership of the program - More health education material such as posters and flyers 8 WHO/APOC, 29 August 2003 ts{ o o x (\k \(\ G .a - R- gr l-l rJE3#z:1iEts F61<te ,.EF) -l El 13qrud 9g= E 5*ES6-nz{ E (.t i-F>a haF=3b?5E.l EB' >BH3 -o^;z;>bFo E o:'Fi,r>i.z3 AA: El -. 5xlo r-l t .lo'z o =U)o Fi tr{t!aFi -EF oLi ts o F.] F tr, @-l-l tsgE 9. d6PoEi 4, es -C,' =o!e qj Eg (! o 6' :J iqr :JQa;;E. oa oHt z 0() 4- a z U o f.J Aq(Dho o dl a98 EEB< =o -. o' 8E' =o c.o in6 C) o o,lf a o F b9ir. o o 0e o, (t Fl OolsF. ai. 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FUE-l(.Df:r- r(DF0g-;gE lJ F! -.1(trCr- rGp,e-egE '1, tsrJ -l(DCr-IraF) ^ -=E!': t^gE FU E -.1t)cr-n(Dp)e-agE a A' o o a o o.(! EEE rn?, ? o 5E -o ? o z o ? o V) U)o <€gt1 11 ZE6d ln 41 cnaI (AU)z 7o 2FP.tJEi9oi+5'q o ?F Ei9 or ;l5-q o E 3 v, ot, Fot oT o+t VI E 3 VI o E' g'< Eiad9. rN FBo.o5'* <: E* o, e :i t! E€.cL-g? 5E >EET. 8E A' o. F(D!o =In DO 6 8. ?Fd€ E(DAA &= FO)o,L <3 Ed. F(DE o :1 o) Pg D'd o F(! o J D9 o9 A,q (D F .D o 0)C o F .D o A' o, o) o F .8 (D o)i:.o o { o IY() ;\o 0c q tJ 8t, Ho l9 z o rn? -l z frj - z i X z rr1 X ? ED ? X -l 4 L,, r 7 td ln LAJ rn g 0 3.(. h o\ @ s\o o\\o o\ tI o\ I I \o tt t.J E[[['-E v Er AO \JE r.l 6 iiD !og $.4 r:. !a9, =!8e: o 6A E' A o N) t\) A N) N) 5 ='za5. =Erir< E D t =8.aFEl, ;i FE o 6 E' D OQ(D =# ll \l Or N)5 5{ t) 5\o t,) o\ !g.trOJ €.a - 3 b'91EE8xi'-E - H'13: Ft0(D aZOE5Eil- =G =.oq] EO6EE' E' 6E ;E o( EF J.38{ aE: + + + + * * t E-si iTE ia;qEi Eo oIt , 0e(D =Elr @ o\ -JN) \o \o t) t..) 5 -,1 Oz FF zaEOE trEr!, ar E. 9.9. ar aU 1E6rrEt @\o 5 t) A { { ^Ej!t 6UtrVE,6. { {tJ a -lo\ \o5 5 { R Fl a EE il + @ 5 t) A { { 3.9 z 9tE? F t'e" ]z !,=0cE8r 3.:Fi e9EEl PE aE.;-l ct. u8 :d o a E a da o(lt N agt I o o 3 3 Er)rttI' o o ra -) o - o 3 oIt II -) c o o -toIt o3I3 -Itrla3o l-l IA'lo t(Dls C) o o ct, ! D) -l o ! o) o o o U -l e G aa) G s s (\ s GoG ?, \- ,+ {- ob' \./ 5o3 (D3 =<)3 ?toEts4oi FO (D o-o ;, A'o1+ ;-.i. -.ogts (D- (r) o (, rJ) 0o FD o- o cr lt) pD o o+) (D oo F9(, CD o ? U) >1 C') I o Io *\o 0a o IJ Comment on: - Attendance of female members of the community at health education meetings The talks at the child health clinics and most of the social groups were in particular to women In most of the communities decisions are taken in the council meetings and there are few women as members of such councils, as such there are few women participating in decision making in the communities In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). Other issues 2.6. GapaciQr building 2.6.1. Training t2 WHO/APOC, l0 April 2003 s 6 G oE o t Fl H F EE zo rrjz I E lr,t z o - .l Xoz rrl XC? Ed ? C CX -l X o t-? Ed ln EUe rd o a F o t.)\a 5 +. .t 6 z cro o D? (Da)oa F o ta a DB tJ\o to O O O O +. O O 5 +' 2G h :lr l^-r .1 0 ^ll \oo\ .) et(! .D o EI 5 l.J NJ 5 N.) NJ t\) J\ rl z, ao =tz <5E+6@ id *t *(!qE E.=5r oo t.) o\ O h.J t.J O l'.J NJ v J: N) +- -l O NJ NJ l: o, tJ t9 t.J +. Ft ^! ,:n a^; -F. tr ^rl I s aJ o o o E o Ut Fl 6 z -rots'i EB(D0 arE:r Y-rEFo=' ort ra o ul O c O O O O O at .{ !\ : ^rla;: I ^,1 ! = s .l ('D (! E(! \o qr{ },J b.)a -lO o, oo .F h..) s -I5 (,) H z, z g orl o oUUla D (D EL -t \) l'^J oo -I \o5 5O \t 5 :.F .{ ^b "q "*, iAII D I'l lo)ld lol* -l -.tp) OQ D' o o. o'r-t o (D o tn o o UFl rc o o o) o B R- lil(\ x F5 S o G\ o{ a4 G(\ V)laA g t s f o o o I 0a o G i. o G G f, E. Ee o 00 UJ =o ! E - I'J 8 u) Jr Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rows if necessary) the equipment (Functional, Currently non-functionalbut repairable, Written off). Trainees Type of training CDDs Ottrer Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others(speci&) Program management ./ How to conduct Health education ^/ ./ ./ ^/ Management ofSAEs ^/ ^/ CSM ^/ ^/SHM Data collection ./ ^/ ./ Data analysis ^/ Report writing ^/ Ottrers (speci&) Source Type of equipment APOC MOH DISTRIC T/LGA NGDO SW EDA ELE P GTZ Condition of the equipment * Please state l. Vehicle 1 2. Motor cycle 28 2 stolen 7 16 lNF L 4NF 2 3NF 1 1 NF 3. Computers 2 9 nL 4. Printers 3 functional 5. Fa,r Machines 2 written off I I 6. Others a) Over head projector 2 functional b) c) *Condition of t4 WHO/APOC, l0 April 2003 How does the project intend to maintain and replace existing equipment and other materials? The equipment and vehicles will be maintained from the running credits of the district / health area. Any vehicle provided by any other projects will replace the existing fleet - Describe the adequacy of awilable htowledgeable manpower at all levels. There are at least two staff in each of health areas however there are still some health areas without staff. In such health areas, staffs from the district hospitals carry out CDTI activities - Where frequent transfers of trained staffoccur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensare adequate CDTI implementationwhere not enough knowledgeable manpower was available or staff often transfeted during the course of the campaign). The project will try to train all the staff in the project zone such that if the staff is moved around within the project zone then there will be no problem. 2.7. Treatments 2,7.1. Treatmentfigures l5 WHO/APOC, 29 August 2003 l-.1 lAtId lo lm ; o A) o DO a. a [rJt) C' o. V) o r{ O p F' (D A,ta 0) V)7r es H(\ ss o(\ Q V) s\ G !\?(\ t- * zo (D F+) o a F1 () po(n (D tr) o- JI (D o(, te o- Fo (h 0a v) A ,+, l Fl H F,( EO z It7 -.1 ! t rlt. z - -j X z rd X 7 7 7 -l X t- E Ed lrt E! t4 rn x91 >d' -lo\ |.)\o tJ\\o o\\o UI o o o U) I a 18 r$Ba$ E$a 9,2 cS.EE'Q =E 3 r$ g'q o!aq' o eB s6E -#3o5' P. ll (,) -lo\ !.J (,,I \o 5 5 tJ\ o (.) -Io\ b.J\o Ur\o \o (.) tJ\ O N) o\ ?J4 b.) *5 € o\ (, \o t) \o{O .l\|.J -I o\ -l o\ [,J Q\o\o5 Q\oli Ul b.JtJ Ul -t\o J9- o' o-x b lI 9? o-E.3"8 Bf -t F p$a z $E+*t o F]8# s#Et, x o\ ?Jl N o\ t_r\ IA -t -Jo\ 5((,r \o -Jt) { -t,i -t \o o\ 5 o\A(, b.) b,J \t € ?rtN h.) -I -Io\ o\ o\ ulta hJ{ --t 00 U t) -l FJ -l[.J Ul\o Q\o 00 hJt) -l5O a €(,J {h,J\o \o b,J5\o o\ -I o\\o N6 € I.r\o c\a €gJ o\\o .A6 UIu\ \ot -l 905 o\ a l -t tJl UJ o\ alrt o\\o 5{ o\ -J l.J{ {t,.)O |.) o\|., -lt\, t\J6 ? o\(rl { UI o\ -t t) a6 (rl{(.] $$-8f, t\) -J 6 (r) ca ca F.)tJ o\{ h.)(.) \o NJ b..) a{ UI Ut (.) b,J a { ar{\ € coZdc HIq\ 5 tJ o4 aEt>arq hJ 9*$6FHi .l or-t F) CD \e; O\ F'val o o o E 0a() tD o il z (t oFt o H (.D olo o E (D a. X l-r -J s.r l! IO\ lX' A,Ele aY'l- (D €l^ l-a e all v w\ It.i -9Uv fl\o !)o\+ A o>r a U) a (D ts o (D 3o oEl t- FD eo a'o o o\ j o ! E *\o oa 6 N Geographical coverage rate = (%) ATO coverage rate =(n Number of communities/villages treated x 100 Total # of communities/villages in meso/hyper-endemic area 375*100 =100qio 375 Number of people treated x 100 Annual Treatnent Obj ective ATO:65% of population registered in2002 POP :169529 77666* 100: 104.97% t69529 Provide UTG of the project. Eligible population.= number of persons treated+ number of refusals+ number of absentees UTG= 177666+ 40767 + 20718 : 239.151 %UTG achieved Number of peop letreatedx 100 Total number of people to be treated tn meso/hvper-endemtc areas within the project area (UTG) r77 .666 X 100 74 29% 239.15t ATO - I'he qtinsted nunber of penorc living in madhlper-endemic ueos thol a CDI'I projed intendr to trcot with iventudin h agiwnyeu. UTG - The nshntm nwnbq of people to be treateil in madhyperenbnic oreat within the prujea arca, uhinolely to be rerched whot the projed has rcachedfull geographicol covoge (nomolly the pruject shouW be upeded to reach the IITG d thc end ofthe t' ycu ofthc projed). IJ the project is not achieving 100% geographicql coverage and minimum of 65% therapeutical coverage rate or coverage rate isJluctuating, state reasons and plans being made to remedy this. 2.7.2 What are the causes of absenteeism? Main causes of absenteeism How to treat absentees Farming 1. Treat all no matter where they are coming from. This willtake care of farmers within the farming community. Their treatment information should be transferred to their community of origin Student in boarding school 2. Treat in boarding schools, and record in village as student not absentee Travel for family/social reasons 3. Same as I t7 WHO/APOC, 10 April2003 2.7.3 2.7.4. In case the project has no case period, please tick in the box. of serious adverse event (SAE) during this reporting No case to report Briefly describe all known and verified serious adverse events (SAEO and provide in table 9 the required information when available. i8 WHO/APOC, 29 August 2003 x (,f) z o> 0a U)ox o4 E.F5oo o o r;EF N "g;g g)d !6 H i-ovt a E o o $F$Hg B, E'P USrtBqrBE.q 70 sr?*v ==ts, a., i 6'o -UIET o) 2;F3 5@ s sg - 60xoI] a u, oc oo o ot!o Cta oq 0 r)oln xEXH€ g BgB HEE0H E 5'> =<Fo 9-Un1= agg lFl lA)l6 tta l.o ; F)t)(D(n oFi.) V)o o t, A' o. (D q) o (D o V) O rn(/) F) ooo Ho o- o.c J. 0a (D Ft (DE o3 0a (D o o- a R-s V)G R\ (\ o €la oGbf- I * G. B(! \lG (\ \o { o FU oo - fd f.J 8(-) N) 8(, N) N) f.)o f.J \o\o\o t1J ! o\ tJJ ! o\ UJ{ o\ oos- E O.X ^ iJ ElgB3gS E.}E EE HE TgI v1 Eo da t { o\ {o\ u)-l €ilr THE.O:a l+) ! o, (,) !N UJ ! o\ -824iE Ea =ts ts6'f; E E*g ts: oiD E) o\ v \o o\ ,- o Ll .O(! --^< - O .'-'SQ Ui9+ ' </ qJ -!d =dat =(D= o .o o\ o\ .oo\ o ^< I\o(! :-j .o) i! ,: -dt \Jo .)o (D art D oooo N) o\ N) @5 N) A @ oo -J t'.J o\ @ AAA \o -.I * (,.)\] -lA -l ,( *a E '=E$rEA Hr q \o NJ v o\ NJ\o o\ N)\o N) oo N) oo oo{N oo NJA(,(}J L'I o\ E$s -J! o\ o\ o\ oo ooo *.1 oo L'I ! @(, o\ l.)(Jl {!6 Eg7 'z'{ Ii o\!\oo\ UJ ! o\ N) o\\o o\ A\, o\ @ o\ o\a ! \o o\ Fl8# 8$* 1r E. A !\o (^ N) .o ^\ 9 \o\oo\ o\ o\(^ .o o\ OP o\ o\ rl o ^? >SE -l:/ si ar (t { !o -,1 o\ :J{ o\ 90 6\ 'oa o\ { +. o\ 8- ssH IH ls l(al- F,lo irL) -.t' FigE IA oo5- V); O'E o.E8g5BFtE#a'(D.it-Bt<elo3lFo rrIE' E lo- tslg, ..,lau(Drip) *tg' x.;a o3E€ dE Er(!8eFriPE(D?PN otr = -G ,0\ s s R- .o G o G $ oa N G * S o o b N t FU 8 tt\o E oa fh N 2.8. Supsrvision 2.8.1. Provide a flow chart of supervision hierarchy. Supervision was effectively carried out by all levels given that distribution was done in a campaign form. The district team supervising identified problems in the communities, to which solutions were proposed. Some of the nurses during their supervision did not control the registers to see what was going on. 2.8.2. What were the main issues identified during supervision. - The registers were not effectively updated Some registers contained persons who had moved out of the community. - District staff supervising communities without health centres did not do along with side effect medications but asked the persons with side effect to report to the health centre for treatment. - There were cases of persons not swallowing the Mectizan in front of the CDDs This was not picked up by the health centre stafl - CDDs rushed and treated in schools without transferring the data to the villages - Some persons collected drugs for fbmily members at the clinic / centre point distributions 2.8.3. Was supervision checklist used? Yes 2.8.4. What were the outcomes at each level of CDTI implementation supervised - The number of absentees remained high because persons who no longer lived in the communities were counter in the denominator, and children were treated out side of their communities. - Increased rate of refusal because of poor management of the side effects locally 2.8.5. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project -Emphasis was laid during the health area evaluation meetings on the importance of proper updating of the register. -All staffwere reminded that it was for the good of the project if side eflect drugs of mild conditions could be made available in the villages during supervision. - CDDs and nurses were made to transfer children treated in schools into the village registers - CDDs were reminded that everybody was to swallow the tablet in front of the CDD SECTION 3: Support to CDTI 3.{. Flnancial contributions of the partnelts and communities Table 1 l. Financial contributions by all partners for the last three years Contributor Year I (APOC Sept200LAusust 2001. SSI 2001) Year2 (APOC Sept200l- Ausust 2002, SSI 2002) Year3 (APOC Sept2002- Ausust 2003, SSI 2003) 2t WHO/APOC, l0 April2003 TOTAL Budgeted (us$) TOTAL Released (CFA) TOTAL Budgeted (us$) TOTAL Released (CFA) TOTAL Budgeted (us$) TOTAL Released (CFA) The Ministry of Health (MOH) The local NGDO(s) ( if any) The NGDO partner(s) Addition 15,28'7,496 33,000,000 1r,253,997 18,799,s22 r 9,590,955 6,530,3 i 8 14,904,943 4,500,822 I 5,53 I ,06 9 4,886,347 | 1,293,110 4,389,800 District/LGA Communities *7,81 3.360 *8,164,345 APOC Trust Fund $ 104,330 35,668,9t I $ I 06,100 64,86t,925 $86,282 44,7"t 5 ^885 TOTAL For SSI funds under the column of released are actual expenditure since all funds 6udgeted for were available Fund for payment of staff, administration and central level support are not included in the NGDO expenses. Only funds for direct project cost are presented above. In 2001 DTS were not identified on time as such funds budgeted to support their activities were not used. * These are funds contributed by the population through cost recovery. If there are problems with release of counterpart/unds, how were they addressed? Expenses made by the districts using government funding have not always been reported as expenses for the project since funding does not come in as such. Districti have been advice to indicate all funds release for project activity as such in the future - Comments 3.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Health committee members helped in supervising the CDDs The communiiies did not provide any other in-kind contribution. 3.3. Expenditure per actiyity - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 12.Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ US) /Source of funding s of fundin Drug delivery from NOTF HQ area to central 9_f cgryry_ug_i_1y Mobilization communities and health education of of CDDs APOC SSI 75.00 3 715 18 r 666.67 3 675.002190.00 MoPH 22 WHO/APOC, 29 August 2003 rraique qf !E"qltb_s1a[4 all lqyp!, Supervising CDDs and distribution Q"pq,rylriql by qlllevgJq 9f qll g{9r activitie_s Internal monitoring of CDTI activities App.f pSgl-ey_a\r{_i_o_t/plqryj!,eq,_egtings Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment - Register - Household cards Treatment forms Vehicles/ Motorcycles/ bicycles maintenance Vehicle/motorbike Insurance Office Equipment (e.g. computers, printers etc) malntenance Others 4 955.79 | 072.92 12 910.62 6 51 1.13 5 571.50 968.00 t2 028.t0 3 568.76 3_.!91,61 90.83 2 77s.08 299.38 1 rsr.6i| 392.025 36r.244 828.90 I 501.50 3 455.t6 21 066.67 3 809.19 76 411.35 31850.47TOTAL Total number of persons treated 177 666 Hyper/meso communities 324234* persons treated in project area *Total number of persons treated including those from hypo endemic communities NB. SSI expenses do not include indirect project cost. MoPH expenses are not available SECTION 4: Sustainability of CDTI 4.1. lnternal; independent particlpatory monitoring; Evaluation 4.1 .I Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) No Year 1 Partici patory Independent monitoring No Mid Term Sustainability Evaluation Yes 5 year Sustainability Evaluation Ne Internal Monitoring bY NOTF ---------b --- Other Evaluation by other partners 4.1.2 What were the recommendations? 4.1.3 How have they been implemented? Below are the recommendations from the Sustainability Evaluation and action taken so far 23 WHO/APOC, 29 August 2003 RE,COMMENDATIONS ACTION TAKEN 'Planning' 1 The roles of each partner in planning and other CDTI activities should be clearly defined and adhered to based on their project proposal. 2. Nl parties should be involved in the financial planning. 3. Specific 3 year plans for sustainability should be made lan.a5or10and followed immediatel 1 A reminder to all partners on their roles and responsibility has been circulated by the province. 2. A detailed 3 years Sustainability Health plan containing all CDTI activities should be available has been developed by the provincial level, district and health area levels. 1. Supervisory visits should be planned, targeted and integrated with other PHC programmes. 2. Supervisory check lists should be a.shared type, or integrated checklist, so that it could be used foimost pHC activities carried out at this level. 3. All Health programmes should be involved in CDTI activities. 4. Funds from dependable sources available for these own. 'Monito ring/S u pervisi on, procurement and Distribution, 1. Mectizan ordering, procurement and storage should entirely be the responsibility of the province through the Essential Drug Programme. 2. SSI should empower the province to enable them take up this task. 3. NOCP should ensures that the right quantity of mectizan gets to the projects well ahead of time for distribution to the communities Mectizan province has been empowered to carry out Mectizan ordenng. This was done in a training session on the 9'h July 2003 attenaei'Uy the staff of the Drug program. The ' Training/IISAM, 1. Training should be more focused to needs.2. Training should be integrated with other pHC activities. 3. HSAM activities should be properly planned and eflectively implemented. Appropriate HSAM materials should be available for use. NOTF is developing appropnate HSAM material. HASM activities are usually planed are effected just before distribution to raise awareness of the programme, ( fntegration of support activities.' l. Integration of CDTI into other pHC activities like EPI, HIV-AIDs, etc at this level. Eye care activities are being integrated into CDTI where the two programmes exist 24 WHO/APOC, 29 August 2003 SSI contribution is clearly spelt out Project accountant has taken up duty in Buea. Delegation has opened an APOC account in Buea, while the Limbe account will receive SSI funds only 1. Appropriate financial planning and budgeting of CDTI activities should be carried out at this level and should be reflected in the yearly Estimates of Recurrent expenditure for the delegation. 2. NOCP should ensure that Government commitment for all projects in Cameroon; towards CDTI sustainability is maintained. 3. Contributions of the various partners/stake holders at this level should be clearly spelt out. 4. The project accountant should move down to Beau from Yaounde, or the Provincial Chief of Service for Admin and Finance should take up the task of accounting for all aspects of CDTI at this level. 5. Delegate and SSI should put in place a process that is sustainable, more realistic and less complicated for fund management. t Financet t Transport/other Resou rcest 1. Maintenance and fueling of project vehicle/motorbikes should be properly planned with Provincial funding. 2. Realistic plans for the replacement of vehicles should be made. 3, As the project is in its 5th year, and the fact that the vehicle has been efliciently managed even after the motor accident last year. Replacement by APOC is recommended. The Provincial Oncho team was actively involved with the elaboration of the sustainability plan and the ordering of Mectrzan. ( Human Resourcest 1. The Provincial Oncho Task force team should become more involved with CDTI activities as well as the of the SWI ect.erational Treatrnent in hypo endemic communities is clinic based and everybody requesting for treatment is entitled to it. Not making treatment available for persons from the hypo will encourage a parallel market for Mectizan. t Coveraget l. Therapeutic coverage should be improved upon. 2. The issue of treatment in Hypo- endemic areas should be addresqed by NOCP /]vIoPH 25 WHO/APOC, 29 August 2003 RECOMMENDATIONS DISTRICT LEVEL Recommendations Action taken Planning The campaign approach used to mobilize communities for treatment in year 2003 should be discontinued. Community requirements should be taken into consideration in planning for CDTI activities Development of integrated plans with government budget a a o Due to the possibility of having severe adverse reactions in any part of Cameroon, Mectizan distribution is carried out as a campaign in most projects of the country. The official campaign period is launched by the Minister of health. In the southwest project area taking into consideration the period the population as asked for Mectizan, fall out of the oflicial campaign period as such distribution will take place in the first months of the year. The health staff at this level should initiate CDTI activities a Leadership 26 WHO/APOC, 29 August 2003 Monitoring and Supewision O Supervision of CDTI activities should be carried out more in areas/communities that have specific problems to be tackled such as refusals, non- compensation of CDDs etc. o Checklist should be used during supervision to enhance the tracking down of activities carried out and those pending a Use of SSI supported DTS to retrieve should be reviewed. o Plans/itineraries for supervision should be drawn before supervision is carried out a The cost of supervision should be borne by government. o Treatment data should be submitted to the COPs by CDDs who in turn submits to the district Mectizan Procurement and Distribution a Quantity of Mectizan required should be based on updated @nsus population and growth rate.( usually a factor 3 tablets per person, on average) o All tablets required for treatment for each district should be sent in bulk to the district before the commencement of treatment through established government system of supply of drugs Request to MDP has always been based on 3 tablets per person on average To prevent shortage in the future, the number of persons to be treated in the hypo endemic communities will be estimated as 7jYo of that population Training & HSAM o District to empower COPs to train CDDs a Training should be targeted to address the needs of the personnel involved a Training should be conducted in an integrated manner to include other health programs 27 WHO/APOC, 29 August 2003 High powered advocacy visits should be paid to government policy makers to encourage them to budget and release funds for CDTI activities ldentify other sources of funding outside APOC and SSI Finance a o Transport and Material Resources . The available motorcycle log-books should be put to use. Where they are not available, efforts should be made to provide them . Produce additional Health Education materials There should be increased commitment by the staff lntegrated training of additional nurses Human Resources o a Efforts should be made to obtain better estimate of the population in CDTI communities There should be conscious efforts to increase therapeutic coverage in subsequent years Policy on treatment of hypo endemic communities should be reviewed Goverage o a a RECOMMENDATION FLHF 28 WHO/APOC, 29 August 2003 Recommendations Action taken Planning a A three year sustainability plan should be prepared and integrated into the health activities of FLHF o The campaign approach used this year and already planned for year 2OO4 should be modified to conform with CDTI approach a The work plans for FHLF should incorporate the inputs from CDDs, Chiefs and quarter heads Monltorlng and Supewlsion . Chief of post and other health personnel at FLHF should be trained on CDTI. o More motorcycles should be made available for supervision at the FLHF level o Supervision should be targeted at solving specific CDTI problems such as lack of support for CDDs and perception of CDTI as government project. a An integrated supervisory checklist should be developed Mectlzan a Training of FLHF and CDDs on how to determine quantity of Mectizan to be ordered using the census figures as recommended by APOC 29 WHO/APOC, 29 August 2003 Training of COPs should be done by the District Team and should be based on needs. Training of CDDs should be done by the COps at centers close to the community Other qualified heatth staff at the FLHF( health areas) should be trained on CDTI HSAM activities should be targeted at solving identified CDTI probtems. lnnovative and effective HSAM approach should be used to sensitise the communities to own theprogram and support their CDDs. Training manuals should be updated and provided to CDDs. Training & HSAM o a a a a o o uffiS ecr nt EC rimate a S should be roducedp by ment dand butedistri theto ticommuni ES FLHF should have a budget line for CDTI. Operational Research should be conducted to compare the effects of cost recovery, payment of CDDs by govemment and support for CDDs by the communities on the effectiveness and sustainability of CDTI Finance a a Treatment data for hyper/meso endemic communities should be separated from that of hypo endemic communities Therapeutic coverage should also an indicator of Sustainability at this leve. Goverage o a Geographic coverage based on treatment in endemic communities only has always been hyper/meso COMMI.INITY LEVEL 30 WHO/APOC, 29 August 2003 Recommendations Action taken o Planning CDDs should interact more frequently with their community leadership, and there should be more involvment of communities in planning for CDTI and empowering them to solve any emerging problems. HSAM meetings on CDTI need to be conducted by the leadership and the community at large at least once every year before distribution. o Leadership The community leadership should take proactive role in initiating CDTI activities in the community, and support CDDs activities. Community empowerment for decision on all issues of CDTI including, selection of CDDs, time and mode of distribution of mectizan.. CDDs are selected by the community Community always determine the period of distribution Health staffwill endeavour to respect community decision on time of distribution Monltorlng and Supervislon o A reliable transportation for the CDD to submit reports at the FLIIF to be arranged whenever necessary. o Community self monitoring system to be introduced. Community self monitoring was implemented in two health districts illectlzan The community should design a system of collecting Mectizan from FLIIF in each distribution season, and arrange a reliable transportation mechanism for the CDD. Reserve drugs should be kept within the community level for absentees and temporary non eligibles. Treatment records to be accurate and kept in the community. Training of all CDD to be conducted on how to determine quantity of Mectizan to be ordered using the census figures as recommended by APOC o o o o The eventuality of severe adverse event makes it unrealistic to keep Mectizan in the communities for long periods. Community members asked that record and registers be kept by nurse for better preservation. a { 31 WHO/APOC, 29 August 2003 I ITraining & HSAM o Community leadership should take effective and proactive role in doing sensitization and in mobilizing community at large on CDTI issues. o District and FLHL authority to intensify sensitization and mobilization of community leaders and members on CDTI o There use of the dialogue structures should be intensified for CDTI activities, Health committee members, town criers actively participate in the sensitization and mobilising the communities. Finance o The community to be sensitized on the need for them to support CDTI activities and motivate their CDDs. o Central government to provide resources to substitute what accrued for CDTI activities from cost recovery funds. Central government will support CDDs with 25fr per person treated. Human resources o Arrangement for replacement of CDDs who dropout and training of new CDDs. o Adequate number of CDDs to be selected and trained. Goverage o Community leadership should interact more with the district leaders to improve the advocacy and community mobilization 4-2- Gommunitlr self-monitoring and stakehotdens Meefing Table 13: Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) BUEA l0 LIMBE It TIKO 5 t2 49 8 MTIYUKA KUMBA tt2 18 I DistricV LGA Total # of communities/ villages in the entire project ar@ No of Communitie s that carried out self monitoring (CSM) No of Communitie s that conducted stakeholders meeting (sHrvr) No of Health Areas that conducted stakeholders meeting (SHM KONYE 45 112 32 WHO/APOC, 29 August 2003 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle, At the end of each distribution an appraisal (evaluation) meeting is held a1 tle health area level which involves all the CDDs,iire health committee members and chiefs form every uitlug.. The village performances are evaluated at this forum' Decisions on type of distribution and the period of next distribution is announced by the representatives' health staff. 4.3.2 Funds The government now has a budget line for onchocerciasis control. cDDs are being paid by government. Government is awire of APOC withdrawal and is determined to continue with the control of onchocerciasis 4.3.3 transport (replacement and maintenance) Motor cycles on the?istricts and health areas) are currently being repaired and maintained with funds from the Ministry of public Health. The government is aware of the fact that they it will be their place to replace the transport means piovided by APOC and SSI.. The vehicles are in a pool and used foiall order activities as such means of transportation will always be made available for onchocerciasis activities when the need is expressed' 4.3.4 other resources SSI will continue supporting onchocerciasis control as part of the comprehensive Eye care NGUTI TOMBEL BANGEM 65 53 24 46 {r TOTAL 375 Services. Please provide a written plan with set targets and achievements for so far To what extent has the plan been implemented lntegration outline the extent of integration of cDTI into the PHC structure and the plans for complete integration ^ ,, -.r- --- L^^r+LThJstaff carrying out CDTI activities are same responsible for all other health activities' The logistics put-in place for CDTI are used for other activities t t..ti,ri, of health siaffare integrated e.g. CDTI and Leprosy of EPI CDTI i.tiuiti"r are integrated in the coordination meetings t 4.3. Sustalnabllity of proiects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of 4.3.1 Planning at all relevant levels' eiUott the proiincial and district levels integrated plans are now being drawn up by the 4.3.5 4.3.6 4.4. l JJ WHO/APOC, 29 August 2003 !4.4.1. Ivermectindeliverymechanisms Ivermectin is collected from WHO office by the NGDO via NOTF. This is transferred to the provincial delegation from where it is disbursed to the districts for distribution. 4.4.2. Training Training at the different levels is run by the immediate superior level. This is done within the district of health are as the case may be. 4.4.3. Joint supervision and monitoring with other programs District supervision of health area activities are comprehensive if done out side of a specific activity session However most CDTI supervisions are activity oriented. 4.4.4. Release of funds APOC and SSI project funds are released on demand per activity The release of counterpart funding from government is rather slow. 4.4.5. Is CDTI included in the pHC budget? Yes 4.4.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The eye care program uses CDDs in the identification of cases with eye problems in the communities and refers them to the nurse in charge Re-Training of nursls and training of CDDs in visual acuity testing is done during CDTI training of CbDs. CDDs are used [uring vaccination In the foLrr health districts were eye care is being implemented, CDDs carried out visual acuity testing and identified eye problems during diitribution of Mectizan. Many persons with eye problems were referred to the eye clinic resulting in28 cataract cases being operatecl. 4.4.7 . Describe others issues considered in the integration of GDTL 4.5 Operational research 4.5.1 Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. How were the results applied in the project?4.5.2. SECTION 5: Strengths, weaknesses and challenges - List the strengths and weaknesses of GDTI implementation process Activities for the 5'h year of Mectizan distribution in the SWl project began in January with a consultation meeting to determine ways of achieving a better iouirug. 6r the provinie, At this meeting in was agreed that CDTI activities strouta be grouped together and carried out with a short period with all health staff in the project area icrively puii.iputing. This was termed as carrying out distribution as a campaign As indicatea ln itre plan abo"ve, training wasimmediately followed by health education and sensitization of the community and distributionfollowed without any gaps in between activities. The launching of the program at each health district was also a plus in creating awareness. This way the awareness which had been created 34 WHO/APOC, 29 August 2003 in the communities was still at its peak when distribution was carried out and the participation ofthe population can be seen in the coverage. Supervision and monitoring for side effects was effective, the nurses visited the communities taking along drugs for side effects thus there was better management of side effects. Cases necessitating hospital care were quickly referred to the hospitals. Because of the lifting of cost recovery, more persons took Mectizan, a total of 304,O98persons of whom 126,432 were from hypo endemic communities. The community was please with the distribution taking place during the period they had requested. Strengths and weaknesses of CDTI implementation process Strengths ./ Training of the CDDs by both the Health centre staff and the district staff at a central point made room for all CDDs to receive the same information and for the District staff to make corrections on the sport when any information given by the health centre staff was not correct. This also permitted cross fertilization among the CDDs ./ Launching at the same time in all the districts and carrying out activities at the same time made the radio messages relevant for all communities. '/ The lifting of cost recovery permitted more persons to take Mectizan ,/ Distributing before the farming season and respecting the period of distribution requested by the community increased coverage ,/ Carrying out mass distribution campaign r,vithin a limited period, helped in better use of the time of the CDDs and the health staff. ,/ Carrying of mass distribution campaign permitted for prompt retirements of financial justifications and treatment reports and better management of Mectizan tablets. ./ Carrying out mass distribution campaign permitted for effective supervision of CDDs, prompt correction of mistakes observed in the field and prompt management of side effects. Weaknesses x The work load was much for some CDDs covering big communities a The clinics were over whelmed with persons requesting for Mectizan x Some persons wanting Mectizan for the first time did not receive because they could not go for the calibrated thick smear. ,( Mectizan stock was short because of the large number of persons from the hypo endemic communities turning up for treatment. r Updating of registers and household cards were poor in communities where the CDDs registered treatment in exercise books before transferring to registers. x Counter part funding from the Government are not made available x Government compensation to the CDDs has not yet been paid. Conclusion CDTI activities should be carried out within a well defined period with no gap between activities. The lifting of cost recovery and the intense health education had a positive impact on Mectizan coverage The communities still need to take ownership of the program. Treating in area where there is an underlying fear of possible side effects can never be same with treating in areas where no such fears exist. APOC support for replacement of capital ) t 35 WHO/APOC, 29 August 2003 Iequipment which was not requested for in the 5tl'year of the project will be highly appreciated. List the challenges and indicate how they were addressed 1. During this cycle of distribution the challenges encountered was the lack of vehicle for district supervision of activities in the health areas and villages. The staffeither rented suitable vehicle or resorted in using their personal vehicles 2 The second challenge was the number of persons who turned up at the health centre for treatment for the hypo endemic communities, they out number our expectations. As such for the next round of treatment drugs have been requested for 75o/o of the total population in the project area not just the hyper and meso endemic population. tt 36 WHO/APOC, 29 August 2003