Joint visit to Cameroon 22 October - 2 November 1996: preliminary summary report

WORLD HEALTH ORGANIZATION AFRICAN REGION October 25: ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE I i f AFRTCAN PROGRAMME FOR ONGHOCERGTASTS GONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERGOSE B.P. 549 OUAGADOUGOU, Burkina Faso T6169r.: ONCHO OUAGADOUGOU TOt.: (2261 30 23 01 - 30 23 12 - 30 23 13 T6lex: ONCHO 5241 BF Fax: 1226\ 30 21 47 JOINT VISIT TO CAMEROON 22 October - 2 November 1996 Preliminary Summary Report by Dr A. S6k6telil Dr D. Etya'a162 Dr U. Amazigo3 1. OBJECTIVES To sensitize the national authorities and the NGDOs on APOC objectives and strategy. To gather useful information on the health policy, administrative structure of the Ministry of Public Health, of the National Onchocerciasis Control Programme (NOCP) and activities of NGDOs in Cameroon To assist the National Onchocerciasis Task Force (NOTF) to further develop the National Plan, the proposal for sustainable community based lvermectin treatments (cBlrs). CHRONOLOGICAL OUTLINE OF THE VISIT October 20 - 23 Anival of members of the team in Cameroon. October 23 ln-house preparatory meeting with wR/cameroon; meeting with the National Coordinator; visit to the NGDO Coalition Office and meeting with the NGDO Coalition Group for lvermectin (MECTIZAN@) distribution in Cameroon. October 24: Meeting with the WR; meeting with the NGDO Coalition Group; meeting with Dr Monique Traor6, UNICEF Programme Manager for Health; meeting with the NOTF. The associate Director of the Mectizan Donation Program (MDp) joins in. Meeting with WR; meeting with the NOTF; courtesy visit to the Secretary General of the Ministry of Public Health: visit to the World Bank resident economist, Mr Joseph Ntangsi. coordinator. office of ocP Director, programrne Manager, Apoc. ouagador.rgou NGDO Coordinator, WHO/PBD, Geneva STP, APOC. Ouagadougou (i) (ii) (iii) 2. 2 3 October 26 October 27 October 28 October 29: October 30 October 31 November 1 November 2: November 3 2 Meeting with the NOTF. Selection of project sites for CBlTs. Meeting with Dr Rosa Befidi-Mengue, member of the TCC; report writing Visit to Dr Remo Melloni, GTZ Coordinator for Health; meeting with Dr OWONA, Director of Community Health and Chairman of the NOTF; field visit to Monatele Health District. Meeting with WR/Cameroon. Meeting with the NOTF. Discussions on the National Plan and Project Proposals; meeting with the World Bank NGDO liaison officer, Mr Minang George Vishio. Field visit to Bafoussam (Western Province). Discussions with the Provincial Health team. Visit to Balessing, a health centre distributing lvermectin with the support of Sight FirsUGlobal 2000 project. Meeting with the NOTF. Discussions on the National Plan and Project Proposals Meeting with the Honorable depu$ Minister of Health (Secr6taire d'Etat i la Sante Publique); meeting with the NOTF: Discussions on the National Plan and Project Proposals, on administrative and financial management of CBITs Meeting with WR/Cameroon: final debriefing session; departure by road to Douala and flight from Douala to Nairobi via Abidjan. Arrival in Nairobi; Report writing and night in Nairobi. November 4 Departure to Lilongwe 3. MAIN FINDINGS, CONCLUSIONS AND RECOMMENDATIONS 3.1. Primaru Health Care Policv and Structure in Cameroon There is in Cameroon an official poliry of PHC. This policy, known as the Reorientation of PHC was initiated in 1989 and was formally adopted in 1992. The goal of the reoriented PHC is to make PHC accessible to the entire population of Cameroon using decentralization of the greatest bulk of the management process to the health district level, fixing the health centre as the first contact of the patient with the health system, integrating all PHC activities (promotive, preventive and curative) of the health centre and empowering the community by including it in the financing and management - through cost-recovery - of the PHC system. This new approach to health care. which was developed on the basis of lessons learned from past failures and with the full support of the intemational community (USAID, GTZ, UNICEF, WHO, European Union, French Cooperation, World Bank) has the following essential sub-systems: 3.1.1. The Health Area This is the catchment area of a specific health centre and is based on the population effectively served by that centre. lts size varies from 5000 - 10000 people. Each health area is characterized by the following elements: (i) An integrated health centg, delivering a core package of comprehensive services that respond to the identified needs of its popUlation. A communication channel between the community and the heafth seryrces, through the formation of dialogue structures between the two partners. This is effected through two main structures: the COSA (Comite de Sante) through which the community directly participates (through two representatives of each village in the health area) in the management of the health area; the COGE (Comite de Gestion) through which the community actively participates in the financing of health care. (i i) (iii) 3 Support sysfems that include the supply system and the local generation and use of information (iv) A team at the health centre that is identified culturally with the local population and which has the communication skills to function in the development of the above mentioned channels of communication between the health services and the community. 3.1.2. The Health District The Health District consists of a District Hospital, the component health areas and the District Health Office made up of Doctors, nurses and administrators from the district, responsible for the effective implementation of all the programmes in the health district. Like the health area, the management of the district is carried out by a management committee, the COSADI (Comite de Sant6 de District), which draws its membership from community representatives of each of the health areas and the district health office. 3.1.3. The Provincial Subsvstem Cameroon is divided into ten provinces. The province is the level at which technical support is provided for the health district. lt assures the coordination, training, supervision, supplies, monitoring and evaluation of the health district with the province. ln addition, the province plays a specific role in operational research and technical support such as the maintenance and repairs of equipment and vehicles in the district. This is made possible thanks to funds generated by the CAPP (Centre d'Approvisionnement provincial en Produits Pharmaceutiques) and the Provincial Solidari$ fund to which the various levels, from the health area upwards contribute. The implementation of the reoriented PHC policy in Cameroon has not yet been completed throughout the tenitory. As of today, the overall situation can be summarized as follows: Provinces with reoientation or nearly completed ( >80% ): Adamaoua, Far North, North, South Provinces still needinq reorientation' Centre, Littoral, West, South West, North West, East. It must be noted that many districts in which onchocerciasis is a public health problem are yet to be reoriented. This is particularly true in the Centre, West and Littoral Provinces, where many districts and health areas are still less than 20% reoriented. Sections 3.5.1 and 3.6 show how adequate the Cameroon reoriented PHC system is for the integration of CBIT and its sustainment through the cost recovery system. 3.2. Secretariat of the National Onchocerciasis Control Programme The structure of the National Onchocerciasis Control Programme is closely linked to the existing administrative and PHC operational structures. The office of the National Coordinator has been created since 1994. However, the National Coordinator is also in charge of all the endemo-epidemic diseases in Cameroon and her official position in the organogram of the Ministry of Public Health is such that both her operational power and administrative authority are rather limited, something the Task Force and the team considered needed to be urgently remedied if the Coordinator were to effectively carry out her duties. After discussions with the Director of Community Health and Chairman of the NOTF, it was agreed that one quick way to achieve this was through a ministerial act that would not only officially appoint the National Coordinator. with a rank within the MOH structure commensurate with the operational importance of the position, but would also clearly spell out her duties, especially as the overall manager of the National Onchocerciasis Control Programme. lt was also agreed that the MOH will reinforce the secretariat of the NOTF by making available to it some additional staff such as an experienced and competent accountant, a secretagy and a driver. (i) (ii) 43.3. The National Task Force The National Task Force was formed in 1994 and has met twice ayeat since . Outside these two sessions, the roles/functions of the NOTF in lvermectin treatments are rather limited and its composition does not fully reflect the importance of the NOTF in the planning, implementation and smooth day to day running of lvermectin treatment systems. lt was noted for instance that nearly all the current members of the NOTF were drawn up only from the central level. The visiting team therefore recommended the incorporation of the Provincial Delegates, their PHC officers and some district medical officers from endemic areas in the Task Force, given the crucial role they all play in the operationalization of CBITs at provincial, district and community level, as well as other experts whose contributions can make a significant contribution in the success of CBlTs. These contributions would be particularly essential during the writing up of the National Plan and Project proposals. The team also recommended that this "extended" NOTF structure should be approved by an official Ministerial Act clearly defining the roles/functionslobligations of the various partners involved. 3.4. Drug Procurement And Delivery 3.4.1. Current svstem (See Annex 1) There are two systems cunently in operation in Cameroon with respect to lvermectin procurement. With the exception of the new Sight First project, all lvermectin destined for mass distribution is cleared from Yaounde airport and delivered to the NOCP office in the Ministry of Health, from where the drug is sent to the provincial drug procurement and delivery agency, the CAPP which is the official channel through which all essential drugs (of which lvermectin (MECTIZAN@) is one) are supplied to the most peripheral health centres in the reoriented PHC system. Alongside the above and in an attempt to curb the growing problem of pilfering of lvermectin in the country, it was also decided by the MOH that as a temporary measure and until a more secure system is set in place within the MOH central services, lvermectin for the new Sight first project will be procured through the office of the WHO representative in Cameroon, from where lvermectin is delivered to the communities through the CAPP as described above. 3.4.2. Proposed sysfem (See Annex 2) ln the proposed lvermectin procurement and delivery system which it is hoped, will replace all existing systems once the NOTF has been restructured as suggested above and the problem of lvermectin pilfering has been adequately addressed, all drug ordering, procurement and delivery throughout the country will be coordinated through the NOTF secretariat. ln order to ensure the speedy delivery of lvermectin to endemic communities, it was agreed that consignments of lvermectin from the Mectizan Donation Program (MDP) will be sent directly to the following international airports: (i) (ii ) (iii) 3.5. 3.5.1 Garoua Airpoft: from where lvermectin will be procured by the CAPP and then delivered to the Northern Provinces of Adamaoua, North, and Far North Yaounde Airpoft: from where lvermectin is procured by the CAPP and delivered to the Centre, South and East provinces Douala Airpoft: from where lvermectin is procured and delivered to the Littoral, West North-West and South-West provinces. Development Of The National Plan And Project Proposals The concept of in Cameroon The visiting team discussed at great lengths with the NOTF regarding the form that CBITs should tafe in Cameroon in the context of the reoriented PHC in general, and in view of-the great reluctance in Cameroon to allow non medically trained community members to directly handle any drug in general, and lvermectin in (i) 5 particular. lt was recognized that the two underlying principles guiding the discussions should be: (i) the need to ensure that the government policy of PHC is upheld and lvermectin distribution system fully integrated into it, and (ii) that APOC chief concern for community involvement, adherence to and ownership of the programme is also satisfied. lt was agreed this could be achieved by making optimal use of the existing dialogue structures (COSA, COGE, COSADI, COGEDI) within the PHC system as detailed below. The visiting team and the NOTF came to the impoftant conclusion that even though in Cameroon CBDs were not actually distributing the tablets, there was basically no conflict between the existing reoiented PHC system and APOC strategy of CBIT since both were aiming at sustainability through government and community ownership of the Programme. However, it was also recognized that at the present time, the PHC has not yet been reoriented throughout the ten provinces of the country and this should be reflected in the implementation of CBlTs. The visiting team and NOTF thus agreed on the following: ln all health areas where reorientation has been completed: CBIT should be canied out fully integrated in the PHC structure. ln all these reoriented health areas, every effort should be made to improve the overall functioning of the system and to promote a greater involvement of the community in planning, sensitization and mobilization activities, in fostering community ownership of the program, and in the recognition and refenal of all cases with severe adverse reactions to the health centre. (ii) ln all accessible health areas where reorientation has not vet taken olace: Distribution activities should be initiated using the nearest reoriented Health Centre. That way, CBITS will serve as a trigger to reorient the health area concemed. Once the health area has been reoriented, the strategy should become that described above. (iii) ln the veru remote. inaccessible and non reoriented areas, where it has been clearly demonstrated that using a nearby reoriented health centre is neither feasible nor practical, trained members of the community will be used to initiate distribution activities, until the area concerned is reoriented. Annex 2 summarizes the proposed lvermectin procurement, delivery and distribution system as agreed upon and recommended during this mission in Cameroon. ln all cases, the visiting team strongly recommended that particular attention should be paid to the problem of adequate coverage of target populations, taking fully into account in the designing of new CBlTs, (i) lessons leamed from previous lvermectin treatments (especially with respect to poor coverage) in the country in general, and (ii) recommendations from final evaluations of these programmes in particular. 3.5.2. National Plan A plan of Action aimed at controlling onchocerciasis in about 5Oo/o of endemic areas in Cameroon was developed in 1994, within the framework of the ongoing Sight first S-year Project ( now in its first year of implementation ). This Plan was written before APOC came into existence, and at a time when the current REMO data were not available. lt was agreed that the National Plan should be reviewed and revised, based on existing REMO results, and in conformity with the agreed strategy for implementing CBIT in Cameroon. lt was also agreed that within the National Plan, provision should be made for clinic-based treatment of communities living in hypoendemic zones which normally are not eligible for APOC funding. 3.5.3. The CBIT Proiect Proposals ln order to objectively select sites for CBITs and phase them in a rational manner over time, the NOTF with the assistance of the visiting team defined and agreed on the following selection criteria: .?(i) level of endemicity based on REMO/REA and severity of clinical disease (ii) potential for integration into Reoriented PHC (iii) presence of and commitment (including financial) of NGDO or other partners 6(iv) preparedness/readiness of partners to provide the required 25o/o for CBIT (v) geo-political considerations On the basis of the above criteria, 16 CBIT projects covering an estimated population at risk of 4.719.000 were identified. lt was agreed that these will be submitted in 4 phases, between August 1997 and August 2000 (see Annex 3). Among the five projects of the first phase, one specific project would be aimed at strengthening the NOTF office and secretariat which role and efficient running will be crucial to the overall success of the Onchocerciasis Control Programme in Cameroon. 3.5.4 Plan of Action and timetable for the develooment of the National Plan and the five proiect oroposals for Phase I A detailed Plan of Action and timetable for the development of the National Plan and Project Proposals for Phase I was produced and agreed upon by the NOTF (see Annex 4). The visiting team is of the opinion that these documents cannot be adequately developed without full involvement of resource persons from Provincial and Districts levels. This involvement could be achieved through special meetings and workshops to be organized by the NOTF. ln view of the particular financial problem the MOH is currently facing, it was agreed that all the partners (MOH, NGDO, WRl/office, APOC) will be kindly requested to share the cost of these preparatory meetings and workshops. lt is recommended that the NOTF should prepare the budget of the activities aiming at the development of the above mentioned documents and submit it to the different partners for cpnsideration. 3.6 Field visits Two field visits were organized for the visiting team, one to Nkolassa, a health area in Monatele district, Centre Province, supported by HKl, where lvermectin distribution had helped reorient the PHC in the district; the other to the Western Province, in the health area of Balessing, supported by Global 2000/Sight first Project, in which lvermectin treatment was taking place in an already reoriented health area. The main purpose of these visits was to meet with affected communities, discuss with their representatives in the dialogue structures (COSA, COGE), and gain first hand knowledge regarding their exact roles and expectations in CBIT. The visit also provided the opportunity to meet those officials at provincial and district levels charged with the implementation of lvermectin treatment. The following main conclusions could be drawn from these field visits: The existence of a real and very strong perceived benefit of lvermectin treatment by the communities and their willingness to fully be involved at all stages of lvermectin distribution pro@ss. The adequacy of the reoriented PHC system to integrate lvermectin treatment and wanant its sustainment. The necessity of conducting operational research on the problem of incentives to the communities' representatives in the COSA who are involved in the process of CBIT. The importance and usefulness of urgently identifying all endemic districts where Loa loa infection coexists, so that a more focussed approach for increased medical surveillance can be planned and implemented within the framework of the National Plan. Cost recovery funds, if properly managed, could serve as a genuine means to strengthening the PHC system as a whole, and be a very positive element in the sustainment of CBIT in Cameroon. (i) (ii) (iii) (iv) (v) 3.7 3.7.1 Other important matters dj$essed Administrative and Financial Manaqement of CB|T The visiting team provided NOTF members with detailed explanations regarding the various aspects of financial and administrative prodedures for the management of APOC funds, in'keeping with the guidelines provided to all participating countries. The need to open a separate and special bank account for CBIT projects with two r;- 7mandated signatories as stated in the guidelines was particularly emphasized. The visiting team also informed the NOTF members that once the first project proposals have been approved for funding by APOC, a Letter of Agreement will be signed between WHO/APOC and the NOTF. This Letter of Agreement will define the work to be performed in line with the Project Proposals, the obligations of WHO/APOC and the NOTF, the financial and the legal arrangements. After discussions, the NOTF agreed to open at the Central level in Yaounde a separate "NOTFMHO-APOC" account. Funds from this account will be made available to the partners involved in the implementation of the projects through different secondary accounts opened (or to be opened) by these partners. 3.7.2 Minister of Heafth attendance to the Second Session of the Joint Action Forum (JAFI The team stressed on two occasions, during discussions with Ministry of Health officials, the importance of the Ministry of Health of Cameroon to be represented at the highest level possible at the forthcoming 2nd session of the Joint Action Forum on 5-6 December 1996 in Cotonou, Benin. Before the end of its mission in Cameroon, the team was pleased to learn that attendance to the JAF had been officially confirmed to APOC Management, indicating that the Cameroon delegation to Cotonou, consisting of 3 persons, will be led by the Secretary of State for Public Health. 3.7.3 The Sioht First Proiect in Cameroon The Sight First project is an lvermectin distribution programme that was established in August 1995 following a Memorandum of Understanding (MOU) signed between the Coalition of NGDOs in Cameroon in the one hand, and the Ministry of Public Health on behalf of the govemment of Cameroon on the other hand. The coalition of NGDOS, itself formed in November 1994, consists of the following intemational NGDOs: the Lions Club lnternational through its Sight First Program (the main sponsor of the coalition), Helen Keller lntemationa, (HKl), lntemational Eye Foundafion (lEF), the Carter Centre/Global 2000 and Sight Sayers lntemationa, (SSl). The Sight First project, with a total budget of US about $ 2 millions dollars (Lions Club Sight First 48/o, NGDOs 33/o, Ministry of Heafth 19/o), aims to distribute lvermectin to 50% of endemic communities in Cameroon (as known at the time of signing the MOU), in the Adamaoua, the Westem and parts of the Central provinces. Under the terms of the Agreement, the project which was officially launched on 29 March 1996, should be entirely devolved to the Ministry of Health by July 2000. lt was agreed that though a separate project independent of APOC funding, the Sight First project should be closely monitored and provided all needed technical assistance, especially with respect to helping the project fall in line with APOC overall objective and principal strategy of CBIT. It was also agreed that an evaluation will be carried out at the end of the project, the findings of which will determine what further assistance will be required from APOC. 3.7.4 REMO/REA update in Cameroon and the need for additionat mapoinq in the Far Nodh Province While it is fair to say that in Cameroon the REMO exercise has reached a fairly advanced stage, it became also clear during the discussions with the NOTF that in some parts of the country, all available data had not yet been incorporated in the GlS. Such was especially the case of areas where extensive skin snipping had been done, like in the Adamaoua, Northern and Southern provinces. ln other parts like the Eastem province, what is mostly needed now is further REA, so that priority areas for mass treatment can be more clearly demarcated. To date, the only province where REMO/REA has not been conducted is the Far North, despite the fact that there is much to suggest that onchocerciasis is also endemic in at least two of its most western districts. The team therefore recommended that a proposal for REMO/REA in the Far North province should be submitted for funding by APOC in 1997. 3.7.5 WR office APOC The team is pleased to report that the WR of Cameroon, Dr lmboua-Bogui, showed great interest in ApOC and is prepared to follow any instruction from the Regional Office (WHO-AFRO) related to the support of his office to the NOTF and APOC activities. ln that respect, he made'avirilable to.the'visiting team his newly appointed officer for Disease Prevention and Control, Dr Nchar6e, who efficiently contributed to the discussions with the NOTF. The WR also expressed his willingness to assist the National Coordinator in her delicate duty of coordinating the activities of all the partners involved in the implementation of CBIT Projects in Cameroon. B3.7.6 Dr Befidi's special support to the NOTF in her capacitv as TCC member Dr Befidi's active participation and attendance to the NOTF meeting and discussions was highly appreciated by the NOTF which requested her to be their special adviser in the months ahead, during the elaboration of their National Plan and the first Project proposals for CBIT. The visiting team agreed to the appropriateness of that assistance, given Dr Befidi's experience as a member of the TCC, and assured the NOTF that APOC will see to it that Dr Befidi makes herself available to the NOTF as regularly as possible. 3.7.7 Outcomes of the discussions with the Wotld BAAL UNICEF and GTZ (i) The World Bank: The team was informed by Mr NTANGSI, the resident economist that the World Bank, like many other major partners in Cameroon, was actively supporting community involvement and participation in health care planning and delivery in t he country. A US $ 43 millions programme funded by the Bank has just been launched, and aims to assist the Ministry of Health in reorienting 18 Health districts, 9 in rural areas, and 9 in urban areas, with a total of 150 Health centres. All district hospitals involved in this programme will be renovated and their equipment updated and in all health areas, dialogue structures (COSA, COGE, COSADI, COGEDI, etc..) will be established. Planned activities for 1997 include renovation and upgrading of 4 district hospitals and 10 Health Centres, sensitization and mobilization of the communities involved. The team also met with Mr Minang George Vishio, the NGDO Coordinator, who defined his main role as facilitating and improving collaboration between NGDOs and Government, soliciting participation of both international and national NGDOs in projects funded/supported by the Bank, and getting the Govemment to revise existing laws on NGDOS, especially the local ones, which classify them as Associations and therefore, make them ineligible to receive extemal funding. Mr Minang believes that if properly identified and strengthened and their role clearly defined, local NGDOs could play a more sustainable role in support of community-based programmes in general, and in CBIT in particular and could see them as the extension arm of the COSA for instance, at the community level. (ii ) UNICEF: Dr Monique Traor6, UNICEF Programme Manager for Health, informed the team that UNICEF has been one the major partners of the Government in the Reorientation of PHC in Cameroon, and has been particularly involved in the Southern, Western and Centre Provinces. The team learned that the community through their representatives in the COSA, took their involvement and participation in the planning and implementation of Health care delivery very seriously. Dr M. Traore was confident that if properly presented and explained, APOC objective and strategy will be widely accepted in the community. It was also learned that a joint evaluation was cunently going on in those areas where UNICEF has been involved, which will determine which form UNICEF involvement and support will take in the future. (iii) GTZ: GTZ has been one of the earlier partners of the Ministry of Health in the Reorientation of PHC in Cameroon and is today involved in the three provinces of Littoral, South West and North West. Dr Remo Melloni, the GTZ Coordinator for Health in Cameroon, informed the team that the main aims of GTZ in assisting and supporting the Ministry of Health were to attain community participation and ownership, and integration of all initiated Health activities and interventions in the reoriented PHC system. These objectives were quite similar to APOC objective and strategy of CBIT, and Dr Melloni confirmed GTZ willingness to support APOC funded CBIT projects in the three provinces mentioned above, and assist the government in meeting up the required 25% minimum contribution that will not be available from the APOC trust fund. 4. ACKNOWLEDGMENTS We wish to thank the Government of Cameroon who kindly invited us to undertake this mission. We are particularly indebted to the Honourable Secretary of State for Health, the Secretary General to the Ministry of Health, the Director of Community Health, the Director of Cooperation, Ministry of Health, the World Bank staff, the UNICEF Programme Manager for Health, the GTZ Coordinator for Health, for meeting with us and proviQing us with extensive and useful information for the Programme. 9The field visits were made possible thanks to the logistic support and coordinated efforts of the WR office, the NGDO Coalition, the Provincial Delegate of Health for the Western Province and his team, the District Medical Officer of Monat6l6 and his team, the Head of the Health Centre and the COSA chairman of Balessing and the communities of Nkolassa in Monat6l6, who waited long hours for our visit. Finally, our special thanks to the National Coordinator. Dr Marcelline Ntep and all the members of the NOTF for their availability, and especially for working extremely long hours during the entire duration of our visit in Cameroon, to Dr Rosa Befidi, TCC member, for all her assistance, to the WR, Dr lmboua-Bogui, who met personally with us nearly every day and provided us with all the technical, administrative and logistic support that was required during our visit. ANNEX 1 L0 DRUG PROCUREMENT, DELIVERY AND DISTRIBUTION IN CAMEROON: CURRENT SITUATION Sight First Proj MDP Prov. Del. MoH Yaounde Airport WHO/Sight First MoH/NOCP CAPP/Prov. Del Health District Distribution by Health Staff Community + Health Centre -Traintng -Monitortng -Supervtsion -Evaluation -Adv. Reactions Mobilization (by COSA) ll ANNEX 2: PROPOSED TVERMECTIN PROCUREMENT, DELIVERY AND DISTRIBUTION Feedback from MDP on Quantities Batch Number Darc of dispatching & Consignee NOTT' PROVTNC[AL DELEGATIONS MOH MDP A AIRPORT YAOUNDE AIRPORT DOUALA AIRPORT PROV./CAPP ADAMAOUA NORTH FAR NORTH PROV./CAPP CENTRE SOUTH EAST PROV./CAPP LTTTORAL WEST NORTH WEST SOUTH WEST REO COMPLETtsD REO NOT YET IN PII\CE Accessible Areas Yery remote andNon Accessible Areas H. Areafrom reoriented H. Area Health Districts Health Districts Health Districts NCMAN Health Centres NCMA" Health Centres .CMAN Heatth Centres Communities Communities Communities Planning Sensitization Selection of Treatment site by COSA Disribution by H. Staff Referral of Sev. Adv. Reactions by H. Stalf and community p[nnning Sensitization Choice of treatment site by contnunity. Distribution & Referral of Sev. Adv. Reactions by trained Community members I ANNEX 3 1.2 IVERMECTIN DISTRIBUTION PROJECTS BY PHASE IN CAMEROON TotalPopulationat Risk = 4,719 000 * Endemic Provinces needing NGDO partner(s) ** Possible Areas for CBIT to be determined after evaluation of Sight First/lEF Programs ? Willingness to contribute to the 25 % (to be confirmed) PHASI PROJBT N' PROJECTPOP ATRISK NT'MBER/POP INFECTED DATEOF PROJECT SUBMISSION IMPTEMEN- TATIONDATE (YEAR) I South West I (370,000) August, 1997 (SSD 1998 2 Littoral I (251,000) August 1997 (rEF) 1998 5 Center III (l 75,000) August 1997 (HKr) r 998 4 North (215,000) August 1997 (Global2000) r 998 5 NOTF Office Reinforcement August 1997 1998 II 6 South West 2 (230,000) Augusg 1998 (ssr) 1999 7 Littoral2 (149,000) Augusg 1998 (rEF) 1999 8 North West 2 (290,000) August 1998 (GTZ?) 1999 III * 9 Dja et Lobo (83,000) August, 1999 2000 l0 South (Ntem) (159,000) August, 1999 2000 ll East (N + S) (368,000) August, 1999 2000 IV l2 North West I (514,000) August,2000 (GTZz) 2001 SIGHT FIRST GROTIP l3 ** Center I (46r,076) August 2000 (HKr) 2001 14 ** Center II (88,878) August 2000 (ssr) 200 I l5 ,t* West (667,873) August,2000 (Global2000) 2001 l6 ** Adamaoua (219,050) August, 2000 OEF) 200 I I I ANNEX 4 t3 ACTION PLAN FOR THE DEVELOPMENT OF THE NATIONAL PLAN AND THE FIVE PROJECT PROPOSALS FOR PHASE I OF APOC/GAMEROON NO DATEruENUE/TIME PERSONS IN CHARGE ACTIVITIES 1 . 12 November 1996 . Yaounde, Coalition Office . 09:00 a.m NOTF Chairman Dr R. Owona + Nat. Coordinator . Advanced notice to the Provincial Teams . Mail: Forms to fill on detailed information required to write up proposals (outcome of the first NOTF meeting) . Participants; NOTF (central level) 2 30 November 1996 Yaound6 NOTF Chairman, Dr R. Owona + Nat. Coordinator + Dr P. Ngoumou . Distribution of 1st Draft of Nat. Plan to NOTF members for proof reading/corrections. . Distribution of the 1st Draft on the reinforcement of the NOTF secretariat Project. 3 12 December, 1996 Yaounde NOTF Chairman + Nat. Coordinator Reminder letter to the ProvincialTeams 4 17-20 December, 1996 Yaound6, Coalition Office 09:00 a.m Dr Ntep, Nat. Coord + Dr P. Ngoumou . Review & Finalization of the National Plan . Finalization of the Project Proposal on the reinforcement of the NOTF secretariat 5 06 January, 1997 Yaound6, Coalition Office 09:00 a.m NOTF Chairman, Dr Ntep, Nat. Coord . Planning of the writing up of the 4 other projects of Phase I . ldentification and assignment of various tasks, including budget sections . Participants; NOTF (Centraland Provincial) 6 03-04 February, 1997 Yaound6, Coalition Office 09:00 a.m NOTF Chairman, Dr R. Owona Dr Ntep, Nat. Coord . Group Review of the 4 other Project Proposals and distribution of early draft copies. . Participants: NOTF (Centraland Provincial) 7 03{8 March, 1996 Limb6 09:00 a.m NOTF Chairman, Dr R. Owona Dr Ntep, Nat. Coord . Finalization of the 4 Project Proposal documents Parlicipants: NOTF (Central and Provincial) 8 10 March, 1997 Yaounde 09:00 a.m NOTF Chairman, Dr R. Owona Dr Ntep, Nat. Coord . lnternalReview . Submission of all documents to the MOH for clearance 9 April 1997 NOTF Chairman, Dr R. Owona + Dr Ntep, Nat. Coord . Advanced submission of all documents to APOC Management, Ouagadougou for amendments as needed.' 'These amendments by APOC Management will be communicated to the NOTF for their very final review, taking into account , the instructions contained in the first pages of the APOC Guidelines previously made available to them. I I aa' Y I