South West 1 CDTI mid-term project technical report submitted to Technical Consultative Committee (TCC)

RESENWD FOR PNO,TECT LOGO/TIEADING t COUNTBY/NOTF: CAMEROON Proiect Name: SOUTH WEST 1 CDTI PROJECT Approvalvear: 1998 Launchins vear: MARCH 1999 Reoortine Period: Mid From: January 2008 To: JuIy 2Q08 ( Month/Year) Project year of this report: one) 1 2 3 4 5 6 789 (ro) Date submitted: June 2008 NGDO partner: Sightsavers Internatio4a I I I ! MID-TERM PROJECT TECHNICALREPORT SIIBMITTED TO TECHNICAL CONST]LTATITre COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting ) (9v a a I AFRICANIPROGRAMME FOR ONCHO CERCIASIS COI{TROL GPOC) i"i : 2 6 SEP 2001 hY C { J -'tlt F To AA .sb tof AW AH BrO rc for lnformoilon To, StR B, I I F I F i if t 11- -El#,iE L, .5 b I ! F .L ANNUAL PBO.IECT TECHNICAL REPOBT TO TECHMCAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFT'ICERS to sigu the report: Country: CAMEROON National Coordinator Name: Dr Ntep Marcelline Date:..1.v lt qlu{ Provincial Delegate Name: Dr Mafany Njie Martin Signature: Date: D dIu+ 1dD NGDO Representative Name: Mr. C Signature: Date: c) Provincial Oncho Coordinator Name: Ms Signatursl ... Date:?.b..1.. b or. This report has been prepared by Nape: Ms Mah Cecilia C C .\)Designation: . gtd Signature Date .?S..:..b..}.:.?qP Table of contents ACROI\TNUS V DEFINITIONS....... FOLLOW UP ON TCC RECOMMENDATIONS... VI EXECUTIVE SI]MMARY SECTION 1: BACKGROUND INFORMATION 1.1. GpNBnar, INFoRMATroN........... 1.1.1 Description of the project (brielly) .. 1.1.2. Partnership.. .. 1.2. Popu1arroN............... SECTION 2: IMPLEMENTATION oF CDTI 2.1. Ttupt lNn oF ACTI\TTTES ........... ........................92.2. Aovocacy .....................1I2.3. MoeTLIzaTIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RIsKcoMMUNrrrES............ .... ... .......1I2.4. ColrtruNlrrr iNVoLVEMENT ..........142.5. Capacrry BUILDTNG .............. .......162.6. TnBarupNTS.............. .....................192.6.1. Treatment figures.. ...........1g2.6.2 What are the causes of absenteeism?...... .........222.6.3 What are the reasons for refusals? ........... .........222.6-4 Brielly describe all known and verilied serious adverse events 6AEs) that......... .............22 2.(;-5- ?tettd of treatment achievement from CDTI project inception to the r:ut't'ent .yt)ar..........2.7. OnrxRiNc, sroRAGE AND DELIVERy oF IVERMECTIN ..............2.8. CoIT,IIT,TUNITY SELF-MoNIToRING aNn StaxIHoLDERS MBpuNc2.9. SuppRvrsroN............. 2.9.1. Pt'ovide a flow chart of supervision hierarchy. 2.9.2. what were the main issues identified during supervision?.........2.9.3. Was a supervision checklist used?....... 2-9.4. What were the outcomes at each |evel of CDTI implementation supervision?............... 2-9.5. was feedback given to the person or groups supervised?............2.9.6. How was the feedback used to improve the overall performance the project?............. SECTION 3: SUPPORT To CDTI 3.1. Equ1runNT............... 3.2. FrNaNcml coNTRIBUTIoNS oF THE pARTNERS AND coMMUNrrrES3.3. OIUBR FoRMS oF CoMMUNITY SUPPoRT........... 3.4. ExpnNoITURE PER ACTIVITY 1 .......1 .......2 2 oz 5 8 I ....29 ....29 of ....29 ...29 .....29 ,....30 .....3 I ...3 I llt ....24 .....25 .....27 .....28 ....28 ....29 ....29 SECTION 4: SUSTAINABILITY oF CDTI. 4.2.1. 4.2.2. 4.2.3 defined. 4.2.4. 4.2.5. To what extent has the plan been implemented .....4.3. INrBcRauoN........... fvermectin delivery mechanisms .... _.............. Training.. Joint supervision and monitoring with other Eelease of funds for project activities Is CDTI included in the PIIC budget?........... Describe other health progtammes that are 4'1. INtpRNaL; INDEPENDENT pARTICTpAToRy MoNIToRING; EvALUATIoN.........324'1'1 Was Monitoring/evaluation carried out during the reportingperiod? ftick any of the following which are applicab\d......... .....J24.1.2. What were the recommendations?.. ...................J24.1.3. How have they been implemented?......... ..........524'2' susralNnsILITY oF PRoJECTS: pr.AN AND sET TARGETS fruarr,natoo" or......:zYn 3) 32 Planning at all relevant levels ..........55Funds...... . .... .. ....Error! Bookmark not defrned- Transp ort (replacement an d m ainten ance) ........ Error! Bookmark not Other resources. 4.3.1. 4.3.2. c.o.,J. 4.3.4. 4.3.5. 4.3.6. struct 4.3.7. progTams using the CDTI ure and how this was achieved. What have been the achievements ?.. 34Describe others issues considered in the integration of CDTI. 344.4. OPERATIoNAL RESEARCH ..354.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the repofiing period. 354.4.2. How were the results applied in the project?.... ..35 SIICTTO N 5: STRENGTHS, WEAKNESSES, CTIALLENG ES, ANDOPPORTUNITIES. 35 SITCTION 6: UNIQUE FEATURES oF THE PRoJECT/OTHER MATTERS... Bb IV Acronyms ANC APOC ATO ATrO CBO CDD CDTI CSM HESAM IT IWC LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC 'I-OT I I NICII]I I J'l'(; WHO Ante Natal Clinic African Programme for Onchocerciasis Controi Annual Treatment Objective Annual Training Objective Community-Based Organization Community'Directed Distributor Community'Directed Treatment with Ivermectin Community Self-Monitorin g Health education sensitisation advocacy and mobilization Information technology Infant Welfare Clinic Local Government Area Ministry of Health Non - Governmental Develop ment O r gan izatton Non-Governmental Organization Nationai 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 I]itimate Treatment Goal World Health Organization Definitions (r) Total population:. ths totar population living in meso/hyper-endemiccommunities within the project area (based oi npnao/REA and censustaking). Elieible popuration: carcurated as g4% of the totar population inmeso/hyper-endemic communities in the project ur"r. - (n) Gii) Gv) t GtO): the estimated number of perscnsliving in meso/hyp er-endemic areas that a CDTI project intends to treatwith ivermectin in a given yeAI U1 ate a (v) (vi) Therapeutic coverege: -n"T!:, of people treated in a given year over thetotal population (this should be expressed as a percentage). Geoqraphical coverage: number of communities treated in a given yearover the total number of meso/hyper-endemic communities as identifiedby REMo in the project rr", (tt i. .hourd b" "*;;.;a ,. , percentage). Intesration: delivering additional health interventions (i.e. vitamin Asupplements, arbend azore for LF, screening for cataract, etc.) throughCDTI (using the same systems, training, .r]p"rui.-, and personnel) inorder to maximise cost-effectiveness u.rd u,,rpower communities to sorverrrore of their hearth problems. This does not include activities orinLcrventions carried out by community distributors outside of CDTi. s!$aueb&tv: CDTI activities in an area are sustainable when theyc,.t.i,ue r,o fu,ction effectively for the foreseeable future, with hight.cirL,rent coverage, integrated into the availabie hearthcare service,with st.ong comrnunity ownership, using resources mobilised by thecommunity and the government. calculated as the maximum number ofpeople to be treated annually in meso/hyper endemic areas within thepro;ect area, ultimately to be reached when the project has reached fullgeographic coverage (normally the project should be expected to reachthe UTG at the end of the 3"d year ofthe project) The process by which the comm unityrs empowered to oversee and monitor the performance of CDTI (or anycommunity-based health rntervention programme), with a vtew toensuring that the program me is being executed in the way intended. Itencourages the community to take fuil responsibility of lvermectindistribution and make appropriate modifications when (vii) (vrii) (ix) VI necessary 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 26 South-West I CDTI Project (gth year report) No 7B TCC recommendation / suggestion for writi better Action taken / i\{anagement res onse For TCC/APOC MGT use I The executive summary should include total population, number of persons treated and the therapeutic coverage in the meso-hyper-endemic and hypo- endemic The 2008 annual report will show all this data in the appropriate sections inciuding the executive summary Reason why the column "community supervisors" is ticked in table 6 Last year community supervisors were really not trained. Hence it was by error that this column was ticked on table 6 of iast year's Reasons for the drastic increase in the number of CDDs in the hypo-endemic areas while it decreases in the meso/hyper-endemic areas; licirsons fbl the cllop ilr the number of hcirllh pcrsounel, as compared to ligures in the previous report; The hypo-endemic areas are generally more densely populated, making up more than half of the population of the entire project area. Also, because CDDs trained carry out not only CDTI, but also eye care and other community health intervention, they are trained equally in all areas irrespective of onchocerciasis endemici In the 2007 report unlike that of 2006, only staff of frontline health facilities were considered. Health personnel of the provincial anddistrict hospitals were not included. The 2008 annual report will take into consideration all health staff at aII ievels.After nine implementation years of project provide reasons for (a) IEC materials being not distributed at the right time, (b) health education messages in local languages were not developed (c) dialogue structures are not full involved; Integrated eye care activities. What do CDDs actually do? How many people are screened through this? How many of them are oriented to referral facilities? What is the impact of these activities 0n eye care carried out by CDDs are required to measure visual acuities of all members of every household they register within the community. All persons who cannot count at three metres are t u t1 t ! tative data would beCDDs? Quanti rnteresting proper evaluation and possible referral to the eye unit. Generally information on those referred to the health facilities is not collected. However it has more persons turn up in the eye units with visual problems. CDDs' eye care activities have also contributed to increase the awareness of the communities been noticed that referred to the health centre for health in neral.on more and (vaccination, malaria,programmes leprosy, etc. of sln programmes is as follow - EPl'Vaccination. They serve as: Vaccinators Recorders Social Mobilisation agents - Malaria Control programme. They serve as: Community relay agents. Impregnate mosquitoes net Social Mobilisation agents Home base malaria treatment agents - HIV/AIDS Control programme: They do the following: Sensitize the community on the need for voluntary screening and counselling on HIV/AIDS. - Tuberculosis Control programme They participate in: Identifying and refering persons with TB to the treatment centres. Following up of treatment in the communities and defaulters. - Leprosy / Buruli Ulcer Control Programme. CDDs participate in:Identifying and referring Leprosy and Buruli Ulcer patients to tnl treatment centres. Foliorving up of treatment in the communities The role of CDDs in other health ves wt other ofpartners CAPO wl th torespect oldrepl acmg vehicles wl newth ones nistry of Public Healthis currently providing vehicles to the various health districts. Given the scarce resources, thisis being done slowly, starting with the health districts rhai are least accessible or most in need. The Mi 2 The impact of the recruitment of a high number of health personnel on work load in the Health Districts and Health Areas The staff recruited (both administrative and technical) were for specific posts, mostly at the provincial and district levels. Their recruitment was very timely as thy have greatiy helped to lightern the workload of not justCDTI but of ali health programmes that health staff implement. This CDTI project has not benefitted from any of these newly recruited staff at provincial level. However, most of the health districts have at least one new and high level staff who have greatly lessened the work load of the districts. cost per person treated in meso- hyper-endemic areas The The cost per person treated in the meso-h54per endemic communities will be provided in the 2008 annual technical The amount allocated adverse events to treating in 2007 -----dollars were provided by SSI to cover for the cost of treating mild and moderated adverse events. Up to this moment, CDDs have only had partial payment of activities of 2005 Mectizan@ distribution. Nothing for 2006 and for 2007. Time lapse between the end of the distribution campaign and award of incentives to CDDs. 3 EXECUTIVE SI-IMMARY 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. CDTI Southwest 1 project was approved in 1998 but launched in 1ggg. It covers 10health districts ( Bangem, Buea, Konye, Kumba Limbe, Mbonge, Muyuyka, Nguti, Tiko and Tombel ). These 10 districts are further broken downlnto 75 health ur"u.having a total of 478 meso and hyper endemic communities. Information on communities treated, total population, urc, ATo, and persons treated will completed by the end of this year. We wish to plead with the authorities concerned that this report is quite devoid ofdata- This is becnuse this 5,-ear's nctivities started lzrte and most districts are still cloing distributi<ln. So ferr is only the training of nurses and CDDs has been cornplctcd as part of CDTI activities 2008. Even these are not fi1lly reported uponin this report as we are yet to hold evaluation meetings. 2. Background on population movements. Population movement is only experienced in December around the fishing ports. The population movement don't affect our CDTI population because the arefound in the hypo endemic communities of Tiko and Limbe health Districts butif any, in Mbonge health district, they are always back from their Christmas fcast before the start of Mectizan distribution. :1. 'l'r;rining data - CDI)S, health workers, Total population (community) per CDD trained. Information on this section will be fi]Iin the final report. 4- Challenges and how they were overcome Our greatest challenge is the motivation of CDDs. State funds for the motivation of cDDs are not always timely. This has led to cDDs being disgruntled and dropping out. Another challenge is securing adequate state funds for the implementation ofproject activities. Although there is no budget line for CDTI, ih. go,o..nmentprovides some funding for its activities in an integrated manner with otherhealth programmes. Also, most of the health staff involved in CDTIimplementation are government personnel Despite these however, direct statefunding of the project is inadequate and needs to be increased. 1 SECTION 1: BACKGROUND INFORMATION 1.1. Generalinformation 1.1.1 Description of the project (briefly) - Geographicallocation, South west 1 is part of the South west Province of cameroon. It lies between5"20 and 4'N and 8'45 E' CDTI SW 1 includes 3 administrative divisions.(Fako, Kupe Muanegouba, Meme). These divisions are made up of about 10subdivisions' Buea in the Fako Division hosts the administrative headquarters of the SW Province .SW1 is bordered to the North by the SW administrativedivisions of Lebialem and Manyu, to the South by the Atlantic ocean, to theEast by Litoral and West Provinces and to the West by the Republic of Nigeria.From the health point of view SW1 is divided into l0 health dlstricts (Bangem,Buea, Konye, Kumba Limbe, Mbonge, Muyuyka, Nguti, Tiko and rombel).which are subdivided into 75 health areas. Population - The surface area of CDTI Southwest 1 project.zone is approximately 14800km2. The totar population of the projecf urlu (hyu;, ;.;;;;; hypo endemiccommunities for oncho) is estimated at l,ol2,gTb inhabitants followingextrapolations from the 1987 national population census. There are 47ghyper/meso endemic communities in the proj-ect area. - Activities, 'l'ltt' tllos{' important economic activity of the inhabitants of this project area is{irlrilirtgi they grow cash crops like cocoa, coffee and oil palms- ig.o industrialirrsl'il'ution in the project area the Cameroon Development Corporation, theo:ttneroon Tea Estate and Pamol Plantations Limited. They grow rubber, tea,banana and oil palms most of which is for export. Subsistence farming is also donewith mainly foodstuff and fruits grown for livelihood and excesses are being sold tothe local markets and neighbouring towns and Countries. Cash crop farming isdone mostly by males while the females are more engaged in food crop farming.Most of the cDDs are engaged in farming activities, which explain the reasons forlow participation of femare cDDs, ,up1d d.op o.,t and slow repracement bycommunities' Sometimes they abandon their activities during the peak ofMectizan@ distribution. A smali population is engaged in administration (white collar jobs) and small scale trading. - Cultures, The cultural setting is made of the Paramount chief who is the heads of the tribe.He controis the sub or second ciass chiefs who are the heads of the clans that make t b 2 r up that tribe. These chiefs and their councillors make traditional laws, protect and uphold traditional believes laws and taboos. Traditional ceremonies like, marriages, deaths, festivals and births are celebrated according to the norms and standards of each tribe. They all have one belief in common, ih" pouring out oflibation to appease the spirits and the ancestors to intervened for their *"1tb"i.rg.Traditional authority is not highly respected as is in the grassland and northern regions ofthe country. - Language The local dialects are widely spoken within the clans and tribes in the project area.The language commonly used during communication (lingua frarrca) i. prag,;English. The literacy rate is very high with many people being capable of expressing themselves in English and a few in French. - Topography, climate, Access SWl project area has a diversified landscape with the predominant vegetationbeing the Equatorial Rain Forest. Besides this main type of vegetation, ihere is mangrove vegetation along the coastal areas. The Rhumpi hills occupy the whole of Meme Division. The altitude ranges from 0 metres on the coastal ,..u. to 4095 metres on Mount Cameroon in Buea with a multiplicity of small hills. TheCameroon Development Corporation (CDC), an agro-industrial unit has put its stamp in this region with its numerous large plantations of rubber, tea, oil palm and banana. CDTI SWI project area has a very rich network of drainage system most of whichlltrws frorn high altitude and are interrupted by numerous cascades, rapids and w:rt..rlirll,s.'l'hese streams provide breeding sites to simulium vectors. 'l'htt t'ainy season starts from mid-March to mid'October with its peak aroundJuly and August. The dry season goes from mid-October to mid-March. Farmingis practised all through the year, the highest activity being registered aroundMarch and April at the beginning of the rainy season. - Communicationsystems (roads...) The roads in CDTI SW1 project area are mostly un-tarred. They are generallypracticable during the greater part of the year, with only about B monihs (,l.rty, August, and September) when they are most diffrcuit to ply. During this period Lithe year movement of Community Directed Treatment with Ivermectin plrsonnel should be reduced and oriented towards areas where the roads are practicable. Despite every oaths with the use of four wheel drive car a person can still make a successful journey within the project zone. 3 TTelephone, Fax, E- mail and postal services. Communication services by telephone are well developed. In cover g0% of theentire project zone except for Konye and Nguti health districts, there is mobiletelephone network coverage. - Administrationstructure Health System - tive level The Governor is the Administrative head of the south west province.The Senior Divisional Offrcer heads the Division.The Divisional offrcer heads of the Sub DivisionTraditionally the Paramount chief are head.s of the tribe that is made up of crans.The chief and his traditional councillors admini.t.. thu villages and quarters. - Health system & health "r.g ^ delivery (provide the number of healthposts/centres in the project area if the i"ro"-rion is availabre). number of health posts/centres in the project area if the information is available. )rovincial Delegation of Public health Buea -Iealth District Services Ic;rlt,h Ar.c;rs ommuniti cs mes er P heral level ' Number of health staff in project area and number of health staff involved in . CDTI activities. +blc-l: Number of health staff involved in CDTI Health Care Delivery 1 Provincial Hosp ital Limbe Provincial Bueatal Annex 1 1 10 District Ho itals (Pub 9Private Ho tais 72 Centres M6dicaux CMAJd'Arrondissement 6 75 btic)Health Cen tres 72478 aPriv Hete alth Cen tres 37 I b 4 3 i of health staffinvolved in CDTI activities. Disstrict th staff in project area Nrrmber Total Number of health staff in the entire project area Private B1 Number involve irl CDTI Bz Bs=BzlBr *100 tage BANGEM BUEA KONYE KUMBA LIMBE MBONGE MITYUKA NGUTI TIKO TOMBEL TOTAL NB: The private health sector is made up of staff from Catholic, Baptist, andPresbyterian confessional health unites as well as those Cameroon Development Co operation (CDC). They are trained in Primary Health care programmes and are even responsible for some health areas as leading health units t.L.z Partnership - Indicate the partners involved in project implementation at aII levels [lrtoU, NG D O s (n a ti o n a l/i n te rn a ti on aI), com m uni ti e s, Ioca I orga ni za ti on s, e tc - J - Desr:t'ibe overall working relationship among partners, clearly indicating strx'r:ific at'eas of project activities (planning superuisioi, advocac], ntoliJization, etc) where all partners are involved. Alrir::rn Program for Onchocerciasis Control (:{pOC) APOC provided funds for training of health staff and CDDs, for advocacy, community mobilisation, for supervising trainings, distribution and monitoring of side effects. I1 also funds procurement of drugs for treatment of adverse reactioris. ApOC has alsoprovided a vehicle, motorcycles and office equipment and stationery to the project. Mectizan@ Donation Pro gram, Provision and shipping of Mectizan@ free of charge to the project. Sightsavers International Sightsavers is the supporting Non Governmental Developmental Organisation for theproject. It supports the project by providing the followingi - Logistics (vehicle maintenance, insurance and consumables) 5 Financing activitiesi training, supervision, evaluation meetings and HESAM at the provincial, districts and health area levels, the treatment of side effects and production of some IEC material Ensuring good resources management and reporting by supporting training, supervrsion, monitoring and evaluation Ministry of Public Health The Ministry of Public Health is the main coordinating and implementing body of the project from top down. - 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 - Motivates of CDDs - Contributes to the repairs and maintenance of equipment at ali levels. - Organises integrated advocacy at all levels. - Planns, mobilises, sensitises and supervises project activities at all levels - Monitores, Supervises and Evaluates project activities - Participates in the production of IEC materials - Manages Mectizan@ stock through the provincial essential drug programme. Endemic Communities These are the affected communities. They are the principai partners of MOH of theproject is concerned. They also have a big part to play with regards to sustainability of the project. Arnongst others the community's activities are as follows: - select community Directed Distributors and send for training. - l)l;rn ftn.distribution. - Ar:r:r.;lt, r.egistration update. - Mrtbilise and sensitize the communities (themselves) to take Mectizan@. - Sttlrtrt'vise iind monitor Mectizan@ distribution within the communities. - Idtrnt,ify aud referring cases of adverse reaction to the health unit. The Community Directed Distributors (CDDs): Collect Mectizan@ from the Health centre. Ensure storage and safety of Mectizan@ within the communities. Carry out registration update of their communities. Distribute Mectizan@ to community members. Measure visuai acuity of community members. Refer those who cannot count frngers at three metres to the health centre forfurther evaluation. Monitor for side effects. Assist the nurse to summarise treatment reports at the front line health facility. State plans, if any, to mobilize the state/region/district decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. 6 oo \o o\$ @ o F{) fJOH €o)GtdEE-ES3 kJ t ilb .g 0)t8EN >, -9 -< HS H€ -oxdtsrll(D 8fl LEgT $t s [*(l1 o H o +) .g -3E-.4 o(l) E sI AsBt<lc,L <Nq 6I co co r-.1 -+ tr) O r{ (o (o(o rO$ v@ rorl O(o @L.-v @ @ N(o rl (or{ r-lN r-lro Io cori r{cr: c\l \ + il sl .Ft H E E oo <+{ o li o ,o E 7 z o E o) .d H Pt{ o)AhH lJi (J E o) .d 0) oo a) a o) H N 0) +J q 0)do N d o)& cd {Jo o) o}r9. d 0)tr cd €O 0) l<p. H CD q () p t 0)R >a €o-.3HdOtrN i(J :Edo{r'd -oiF{ o) r-{ rl r-f N TO @ ri rlv -$ Oro vN Nco Or{ N$ tr-.+6t q) !dcEti €8Hds _ ji o c) '; 5.q o) _€ s: gF< p..= a (o tr- @(o @ t-- .$ -ico tr- @ tr- o tr- Or$ @(o N cnN co rO co r-l O O .i O) rY.\ c- oi(o @ N O)(o .{, a. t--(o r-{ t-N .i O)N o @ mt- O) N o^ I 9Rtc) o}.E E. c)Fr'i a 0) t-'t jl < .H cd sTEE fi a trl rh z cq frl pq Frl ZI Ml cal Ei rI] ml >tHI 'rl Ho z o1 cal >l t D B >l H H) o z o M €. tl rl pq AoF Fl H o Fi ht .H lJtr P.q) t{ C' {J ho d .d Fr d lJo fr o a){J(d a) Fi]J 0)trd 0) -F) F{q) -q+) 0) -q (d a)tr cd +Jo 0) 'a t{a 0) .H .p H 0) 0) p .!(n , €(g H o €d P. o a. H d tl) q) {J tr tr oO i.rr ,I _I -oldl FI Ho +)d q o tr{ ^i 'd UTG = calculated as .!he maximum num.ber of people to beendemic areas within the ptole:cfa|?r,',ii,-rr"r" to be reached .::::"!, annuaily in meso/hyper ";;:f;{;,;;;i;;;.;;;,:"ishouli;;;;;;;;;;;",:,;,,i;:,i;;,:,;;ii:*"x Nfi f; '"T H,ti: ffi f yf: j"liot T n g t he rep or tin g p e rio d ?)mrc communities, by CDDs. If No, what is the " so,;;;;il;;#i:H:i.o"o" data in the tabre above? If you are using the term community or viilage, define rvhat constitutes thecommunitv or v,Iage. thiswiji'rr.ro rria*rrr"T?ne profrre of the project area. Th" rrurse or a community is made of peopie of tl ;:.:,f#"""iillffi;Jlifi1T::yn.i,,i'1,",'i:,&T'"Ho;.";:ffi ,?fl ";; In some health .Tt*T1fu1ffifr,,{,_',il:iffi;xHTJ,.,H,H:,Xi:3:J.,:'#i::T:# ?,J!:';:::"",!X;:f:;ation or interest about the poputation in the project i,;r|i::ffi.r:#lill,ly:,'Jervbodv riving in the hvpo areas was born andnrigratio, i.r-.Ju..r, of better ,rrt3"'"0 with hish r;.-;i;;;Jr.rity urban ilIt; i1:,y e cti z a n tre a tm e n r,. ; i:: -Jii;i :lli. .#,rJ;lT#: *fl ;fmlli SECTION 2: Implementation of CDTI 2.7. Timeline of activities Table 3' below deta,s the timerine of actiuities for a lXHi::H"X,f t*.I;#;1#1x:wereimpr._.,;f, i;'i;y,:,"::,;ff:il;:: Yes a census was specifir: 9 t- ON t-{ op Eo() 0) a H .H o() OJq .! o o +) 0) H N +) 0) .F trq 0)k +) tr o o .lJ .H a 0) U)lr) H H € bo H .- tr C! ,r +) .d o +J Cdt{ bo 0) -{J tr H <t: 'rh -p H 0)dH E O A o +) C) EAEHiio c)E aOON tr- @OoN(o O coOON roa @OON va @oO c\ o @aON toO coOoN tr'-a @oo c\l rool @Oo c\(o a @oo c\ (o a bo .E -c €! HEOYba @oON vo @oON va @oo c\I o @OO c.l CDO @o O N cfJo @oO c\ crtO @OON(o ol @o c\\ crlol @OON coO] @OO c\ crJO H o .F4 € p .H l.{IJ a) .H rdl fr a o oti E88eQH @aO c\I o @ooN c-o @Oo 6l @o @oO ot Ioo @OO ol va @Oo c\ Cr:o cooa ol rO O @ooN o F-{ I oO o:l lI:o coOo c\(o OI bD .5,< €a H86E @ao6l coO cOooN vO @OoN '+O @oO cil O @OoN O @oO c! cOo @Oo N coO @oO C\t \so @OoN CDo @oON coO o +, o EFo9()E ho ..E *hE AE q) € cd r3 O @O N (O a @oo c\l tr-a @OO c!(o O @oON Ioa @Oa c! c6lol @oO c\ IoO] @oO c\ vol @ ON(o @ O6l crtrO @OON vO @OoN vo @ o c{ CDo @ooN coO @OON CDO] @oo c\t cr)o/ @oO c\ cool @oON o H o JJ 0) F]PEddoOE b! .E -q #E @oON crlo @oON c6o @Oodt $O @oON coO @aON cAo N co o coOo6l c!O @oo c\\ cDlol @ooN co ol @oON CDO @oON CDo tr-OON cr)o @ ON O @OoN cr)ol c-OO c.l coo @ooN N N CDa @Oo N o @OON c'trO q< o dAXoE.I SE .d Fl -o=OH >8 Ho +) o EEo9()E o c{(o O @o N c-O @oON(o o @ooN loo @O <)N vO @oON '+t lol @oON trJO @OO c\ wO @oON rO o @oON(o o b! .Ee HFSYAE @OON CDOI @oON Flol @OON coO coOON cool @OoN CDo U Fl +) C) fr +)o a Ho zo m fr] pq Fl Fq E M trl)" z o M f'l frl o zJ FA Fl frl m aoF o XH t-{ tip o z s P() a >t N(^ vj a)\)q) \ sa Rp q)\o q \\ eu q)q Nes Fr cdq) {-) H a) ,A CJ aJ -q -rJ (L) +) cd a)9r{-) (t) 6d c)t-{ c6 c) +) Fr .O+{ CJ) o) +J ;> +) C) ad <rr o 0) q) HH t-..r cor ,lHI -ol(dl E"l @OON o @Oo N vo @OO @OO c\l OO 2.2. Advocacy State the n current r,#!;:X::::W"r:*,* makers mobilized at eaclt rejd i rn c' i,i,,r" o, " t r a i n t s b; ;; ;; ":; ii J* ;;, l1u u a *, u "i " ;;' ;' :,* " t t e v e t d u ri n g t h e ions on t,; ;;' ;*;; :: :7#:, Describe Advocar ^ distril ffil;:1.j:"XXT"?ouou F ,h. DMos to some poricy ffi il.tlfili::;:r';',#'*#Fa*:#i,nt'L?rTtrftLd:[l*,l'' Parliamentarians within tir" il.^ttr, districrs. --^ls, the M;;;;J Jr .r.ur councils and At Health Area leve] therhevariou.u.,r,r,L",;;ffi "*Xi.r",rj#,ilLfi ii1fl i,.Tr:TT*,:,_::;::i.:,,These noi:l;;;1i,";#fffi :;.iT#3,1;P'I;ffi";,3"1,,,.ffi # na"*i,..b;rli.*,Fj"f:*lfi.1i1;,#{#",1;T**.T,tflg.$l* and communit ,r,"* lli";':;I::*!'1' 3' u " ,auo"uil.;;;"" tnsight into tlr,"coii,,#:;,ff ":?J:iffi ffi H,1ii j"J:,,.ffi ::::":_T,[,f,?,0:?-shirts wprp ny^r._^- r r vru.lect was tn its Sth year. itrfr irjY#::",iffi 'i,-lrffi :'#xry"Uff.[t;t:,.r,:t",i##H,HcDDs *ho *..u-i""#""rll"n9"ttrre helped marntain .o-. of ]governme.r, -tu to abandon distribution-?, i"r" nr"r.iui-#rffffirTffi"Hj .f.lrr, Iirllow.. s.rr.sir.rr,,,,r',, .r"i:l_"l,rn.ultics/constraints were faced during the advocacy andflxifiil.T lT,i:ilr schedure, n.lll staff sometimes has to make- some "J ,!; ;;,#;:i:ififfi::,;,j::: to get,, iil"*lmonev fo. fuel at the ""a Jtiru'ilil;:'ng advocacv meetings expecred' I*_p*veaent on advocacy.. we intend 10 img"out ".1.*:.:u.{ !v anllrins the folrowing:' ""J,i:;,,11" l; T :'.H- j: *';ff ir... *i",',-,ia " u ao, ini s tra ti vepersonal contact. me will be alocated to ;;;;2.3. Mobiliz: "rryiri"t|li*"rsensitizationandhearrheduc?he use rr::::o-1tr,^ .. - _-- uvarun eoucation of at risk communities Mo titiiu;: " ou a n d/or o'u':_ ! : "1.1 sv s te m s b di s s e m i n a t e in form a il on?ioontier-n and healtlt educatioi ,i'i"*l**iti"" inriane women and - I:::tr;:#::;t comm unities/viilages I] i:nxY"r;::: to improve mobitization and sensitization or the target sensitisation' community mobilisation and health education was carried out in- Kumba using the rocal FM radio station (t at<e side Locar Radio).The radio programs focused on: Importance of taking Mectizan@ tablets. ' Need of taking Mectizan@ yearry for at reast 15 year- . Role of endemic communlti.. u. *ui, pu.t.r....Management of side effects r-l - . Mectizan@ distribution and eye care. - These radio programmes did not only focus on the health districts of Kumba butalso Konye' and Mbonge that are always prone to refusals and cDD attrition. - These messages that were in both English and pidgin Engtish and were;:l;fi:il'i Jffi".:t*es a week continuoffi ror one -o'.,il,-a,rring Mectizan@ fJiiil.:l?:x6'.,1iX:.i",riTil;riit this went on the air for a month (during - Town criers using whisties and sound systems. Local language translators and other ' means of traditional communication ..r.h u. the use of "talking drums,, were used toeducate and mobilize wome., u.rd other-mino.ir, ,"i""rity groups. The content of the-messages on this subject matter was as follows: . * The disease _ Onchocerciasis * The drug _ Mectizan@ - * T'hc rationale for mass treatment * T'hose to take the drug _ the eligible. * Those not to take the ir,rg _ non.eligible. * Tr.eatment is free of charge * Importance for being treated. 'l The number of tabrets to be taken according to height* How to swallow the tablets. * Adverse events. The following weaknesses/constraints were observed: ilX::J: .11i:l;t IEc materials for mobilization and heatth education, inactive Below are ways to improve mobilization of the target communities: IJ:H:;."' t"rrlv of adequate IEc materiars for mobitization and heatth }Ht""tt:ment and following up of mobilization and health education flm:iilJ[Tijication and involvement of dialogue structures at al revels B??;tlHTls to address the issue of heatth staff commitment to rhe l2 ca OC\ C) () oz sc! () o o- r-\ <- A B o o 60 dl E .D o € 'a g E oo o "Ekc)9o Eld;Eze oo il * ilQ taM 0) bo agIq oo ts{o Ar m o a a() E B @o € titrot dti 5ElbO d Q) o 9l .tt o 9 d g Eoo @E .d Hq, q o o O o ko -o fi + fil rrl ml d oF al Fq o EA6AEqO o ooO (l) c! 3 Se =o.d@>.d .gE. '1a EgEe8I E -c) oE rdo, TEctr>oAO .4 B oo * ca1il -ilqlq| ob!(! !q 0)()t{ 0.)A ca €3'E* e)AH *'E I3 -8 E.8 E EEE$AOAO o(i o)li 6 c; tr od €o 'El +lal AI =rir\ z <1 cql trl I'J.] trl >"z o\,/ J m e vl m 4 J E] o z o u-l L 4.\,) !) Fo z \-/ F. rl trl cq A oF d{J oF F o() (D +J H H o -+J -+r dHqo'I1d.xF{+)Or{ o E.9 -pH 'arJ AHgE ;io EOO .rir .l iEl or E-l Comments on: Other issues. X'::irXX" of female members of the community at heal*t education ';:f,i;j::J,:;,ffi;ffi;!: partrcipltien o! remate members or the httendanle," lu,tir*,tio, in In)' ;;:::rrx:: :#' discussed Incentives provided by communities for the CDDs community mutuarity and voluntary services offered to cDDs is not acommon practice and this makes it very aifn."ft iassist cDDs in kind or cash to lrrrro,rt their task. or community members to :l!;r",:;r"{ CDDs, rs aftrition a probrem for the project? rf yes, how is it Attrition is still common in entire project zone especially _Kumba, Konye,,Mbonge, Nguti and Bang.;;;j;f ;;:;;#;#" .o-e cDDs rerused todistribute or even abandoned dist.ibrtir, ;;;uy because of the latepayment of state motivation for last year. l5 E2.5. Capacity building - Describe the adequacy of avaiiable knowledgeable manpower at all levels. There was adequacy of available knowledgeable manpower at all levels. This was the 10th year of Mectizan distribution in this project and all health staff are already used to the program already. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (fhe most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpowei was available or if staffs are frequently transferred during the course of the campaign). Transfer of health staff was not an issue. Very few transfers in and out of the project zone have taken place this year. The few transfers that took place, the health staff were quickly accepted during the targeted training on the program. 2.5.1 Training Training was organized by the districts for both health centre nurses and CDDs and supervised by the provincial co-ordinator. 2.5.1.1 Refresher course for Chiefs of Post A total of L44 chiefs of post were trained obtaining 100% achievement on what was planned. Of this number 32 were new and 112 were refreshed. Just like for the CDDs, new chiefs of post were schooled through the whole CD'fl programme while for those who were being refreshed emphasis v/ere I;ritl on ilreas of defrciency and weakness as discovered the previous year. 'l'r;titling of health centre nurse which consisted of CDTI and eye care ;tlwitys took place at the level of the health districts. This training was{acilitated by the district health team and an ophthalmic nurse from the nearest eye unit or satellite eye clinic. 2-5.2 Training of cDDs and other Health stafffor CDTI 2008 In the whole project area, a total of 1,115 cDDs (144 new and gz1 refreshed) were trained from a training objective of 1,148, achieving a training objective of 97.1%. This training whose contents centred mostly on actual field activities was targeted to areas of weakness noted during previous year's supervision of activities. However new CDD5 were quickly given a rundown of the whole programme and provided more close supervision by the health centre nurses. l t t t r t ! 16 E Q srLto::E<()O sdo tb= F-{ CD Y N(o O : o) O) @ tr- (o : O @ : (o a O)N C\] F-.{ O H oo il L-N tr-N H OJ @ @ (o (o @ o tr- D- O rl o c\ : O ri : t- : N ri O) o) rdr$ ri Io F{ r-{ : F{t- o) d o df{ +) a) a aO(H o F{q) E z okEi: N(O O)cO o6l F-t CO F.{ c\ a .s H tr-N il o) @ @ oN r-{ O)o) @t+ F{ r-{ +, H o E 0) o) E() sl s FI t- o) laItr d) H dfr +) lio +)o(H o f{ o) .o E z o E< aq) o tr dfi +)qi ol .*! o0( * ok €i \ () :(J € ut Er()(J o: +) H o) Eo o .Fl c) <i s N r--{ o : N O O : o il 6I(D o : ot H co (o : cr: : ro '$ J r- cO O Fi o) LO \s (o : N i ----t rO6l ot6l cr) '+$ ti c\ +-{ : N crj l 'dq) tr dk +) trd €a otr trq)(J +) d a) *{(H o t{ o .o E a ,/, ,!\-q() (J +() dtraEi() o!F o) O) O O) c\ oH c\lcYr (0H rO Oil O) (oH rr)N .+ \tt H o\ o Fl {J H 0) E o (D E c) o\ oo r< lt +O() Od o t-i $\ € $ FI CD O crl F{ N r(] cY) N v $ O cr) H N Io v co Fl N I() o co o oFl tr- : E-N o o Fl U) .L) o tr +Ja a(H o tr C) -oi z c) H d F< {lql (d {J ct) 1-'k Fr cn c/) V) $ rO LO CD t-co (5- Fl ! o k +J at) a a rI] z cal ca 14).z o\,/ frl nq : rl trl ol ZI cal >i F z o\,, F ,ll rI]t Fql >t olEl FI Ei o Er s o r-{ {J H 0) H 0) 0) C) s o Fl c- r-lt- c\ ct) o H o N $3. Eh, :H8q {.H _a FdStr ocu) 'iq Frqor r.i HH<0, TEd0)$h s& $tSr SH a.w s3s0) 3E *.r t.H!aPV;9{}< -o Cd .g f{s+) P.a1ataS()G,*io :t{d o.l rp $E\tri'- ,s(dqi +)aco :. E<: SFqi-z \!u(n ojq) AJq!-\(n Bp p o E\\$ o o)(t a) G Ho .P Cg .{J tr o) tr o) rl l--lFaU(+{ o cn <l) a) +J 0)k -a)(+{ .<J (l)(1 {J -{J 6J b_0 cl .i 6Jk Fi ,o1 o)l H, .aldlFI tr- O) o o) lI) M Q E] >l (rick the boxes where specific training was carried out during thereporting period) - Arry other comments ('l)l)s wcrc ltaittccl on jLrst what was required- of them (health education, census update,lillirrg .l'tcgistcrs, Mcciizan@ distribution, and detection and referral of side effects and :lJ:;l::i:ifi:llrlJJl"' acuitv) ontv hearth workers were trained on p.og.;;;'**asement Table 6: Typ" of training undertaken. Trainees Type Of training CDD'S I othet I Community members e.s l Community I supervisors I Health Workers (frontline health facilities) MOH staff or Other Poiitical Leaders Others(spec Program ment x x How to conduct Health education Mana n t of SAEs CSM SHM x x x x x x x x x D a ta collection Data analysis x x x x x x x x xPrimary services Eye care Visual x x x x x t8 0) € cdt{ 0) bodk 0) o C) a) € F{ o o ho Cdt{q) o() () .d € o)pr 0d Fi Q) .p \oo\|r)(o (H o U) -{J 'd a) E 0)fr o +J 0) CS b! 0) .o a CS A. o) +J t ct) o\-Ya tr -.pd ad 0)l{ Cd cd .1 o rl -{J +)a .(J .o a rn U) .CJ d +J o) H] +J Cd 0)f{F la " tf* E#*HS{;E 3cH< a@ AO o!c)OO E64AEr*Pa{Od l* f E96 d 9!r{olrdo@: :€fE+E 0)q d o) F{ o)b!(! ko>,185 oo "!aa l9<o ,r o) .od A .d q) d ofi s) Aooli o)q a = g; 5€od6o E g3<FO a :sb@ Ho +) cd tu l(Hloq (d " bqo o-'u sAv(g -c=a7 b5t ao Xi.IJd3.fHE a o ,, ! QA .9o aM A9dF6ilioX o Eo oc) "'A 3I 5 5!d .9c(doEiH-€: tr:; (dzStt a a oY(dE 55! oEg s <F€O U) H H oO o .9.: L "ig H, sEfsE*tr a +) lrd{ ar\ .1 J d o U) oJ 0)t{ q) '+) c) -+.)d +) al) bo 'H{Jd {JO H+.t a H .d .d (d .d H(d 0) bodfr 0) oO cd c_) p, cdA bo o bo \oo\OO r-{ ho q) (-) d .{-) o a {J 0) a F{p, q) {J +r th oti bDtr +) H 0) E +)(U o)kF r-l cc; ^i 1- o o r< d o .u o -o a/.) (u -o (d (g .IJ 0.) tr (d(.) L{F ; o ho o h0 x oF o v, a) o tr!(t 0)kF U) +) o) E € CU of{ti (o c.i O C\ q) E oN lJOq) 'a f{ r-l (/) Fr FiO a) -{J a q.) fr +) d U .< tr -u(d 0)t{ .P o Prxl-{lJ{ c\I (o oi '6 .o CdF \{q L tq q qq oqFtFr -q)\ ru* 9a)6t +J9cd5 . r a.3t o\.! € qH elo d-\EEe =.S:'stN ; HS3 $*aH .i B8 -' .u f R, .e H }xcE'{lB : $uat { $tf € HiE T 'FS,5 s*a> :F d3H .$ {Ic il. 'SF .;LEe F-] hq)E R $T .H \J \\A * tsal H d .s!5 :l ; { HsXl: H E{ 3l ; E hxfiIE E SEPl o -q Aotl€ F $E6l :-, $ q8 €l€ $ Ifge $ $i Els $ s$s SR'F. Pqil.Bdt -\ o!LI bsil 'aq .d EEs isEt -vri x Hq:H T E$g E HX+r U EEE 9 q,tU S flNt lr' rr$J (\ ut1I (6'x i 5& olOI *l o.>xl.i Els 9loH; EH o)l +) ai(!ql I ;IF 3lE ,I€ od ofr c6 -p o o Frq lJ o A trl H< -o .<J 0)iE +i a) .<J .H ad a) o +) IE ld H o(.) O H o 0) Fi 0) ;\ o U) a) qr 9r 0) H k CduoF (U a)tr(s +J 0) alr a o +) tr .p oq) {J H H (.) tr 0) "i1 0) o P. o a 0) tr b0 o JJ ad J P.og +) oF o]J c! r< 0)b!d!^Q) ro B€) <J oF4 lt 0) tJ tr 0)b!(g c) oO cd() !,^ .Li \o (t :r bo o 0) rh lt C)I(U 0)b! Cd Sr a) c-) o t,-> o) .o',a.-(d fr 0) F c6 L b t F ! II -l o F) 5 z?jlrl t4 ,q '> =,cF.iC -l o )> Ed t5t- *l h:{r\ o bd tdqr> rJ :zPc) td A EX?qEr<Ed iEd Xo z v4 trr' A td o z Ot! U aCtHH.o c+ rAo HOO t9(o ACI {A crtOJ 19AO O -l Cn z B (D H o ,1 c: H o-(D4 o rJ oo ts B o p. o E do5 c+ o oa o \3 o o5 o B B ry o trb o H(D A) p- (D E c) (D et o a p. FgF 8. E'FU'3 Fz iDE /-\ (,i-i oL, HUo cn *1 z nBl sH *L,/D (D , 6,'r o+) zoE,- aH')g&3 l-,, o 0Jr,sl:E oH) N a 2.6.2 What are the causes of absenteeism? This information will only be available at the end of the treatment 2.6.3 What are the reasons for refusals? This will only be available at the end of treatment 2'6'4 Briefly describe all known and verifi.ed serious adverse events (SAEs) thatoccurred during the reporting period and provide (in trb; gi-;;e requiredinformation when available. In case the project did not have any cases of serious adverse events (sAE)during this reporting period, please tick in the box. T No SAE case to report ./ 22 cf) N .r-) r .aJ!'rN N a. q) .e\-\o\oa E E\ftr .\ -avf * io =6EX >r, oovt iH U) hn bo 9i .E Eijjp(qs 36E 4E o gi5 +6irAaHi a) o o bo o(fi lioa. -t(.)la -e3 E cn @\! +9croq.)-a €! o) E oo +J o <* o o) {J cn c)fr o- (! 8 axt€A E E;=cdo?o;ioo -E.n -E.g o cEo(U B-B:'f;E EA E EE @ho E.E(5J6Sc dfsE(U-0 og'6 * ,\ -D /2, E o A. E (/) 0)tr(d 0) o. o,(d-d o) (d Hc, € orQ bF0,a aE ad(!NgB(do) AA o 0)hotr(U-d -boi: r<t2O xq)a (l) bo * z a .\ (Nd(a q)$q) E\\(n r+ p p\ v \\ 'IJ c! a)t) c! o E .d o , 0)a bo .A{J S{ o 9. G)t{ o {J h.0 tr tsr a .d .d a)AA OU o p Gj p af'l U) (t) -{-) Ho o 0)aA 0-) t cd a o F<q) a(+< o a a)a(d O c-rl -l -ol cdl F,.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the app MOH tr ./ WHO n UNICEFtr,ropriate answer)NGDONOther (please speci&) Mectizan@ delivered by - (please tick the appropriate answer)MOHT { WHO[] UNICEFtr Other (please specifu) NGDO! Please describe how Mectizan@ is ordered and how it gets to the communities. This year's Mectizan@ for the project was jointly ordered by the NOTF anclNGDO partners following the requests from the ten heaith districts of the project.Mectizan@ was ordered through wHo office in yaound.e. The drugs werecollected from WHO by the NOTF and handed to the NGDo who latter ontransferred the drugs to the Southwest Provincial Special Fund for Health. Fromthere the drugs were distributed it to the various health districts through theregular drug delivery system. The Nurses in charge of each health area collectedMectizan@ from the districts according to the r-equest by the CDD,s of eachcommunity' This year drugs were delivered on time and in sufficient quantity.Stock management of the drugs has been good at all levels. However, details ofstock management is not yet available. itris will only be available after thetreatment. 25 wN -a) E o +)d O d O 0) h0(d f{ 0) o() o t-{ (d l,i .d ! o+) c! E Eo H(D .d oE +-) a) Cd o) F.{ ho(H (t) E +) o)(n I\o6\v @ ..t CU o) OJ +J() (D 'a f{q 0) .P ti -o o t-.rD c) -l-) q) +J(d() H o(D qd o A Rt\ $ brI\ o -t: a)- s \.;kj a)q c! d ci c)k C6 {-)(.) o 'a t{c q) F{ .H +) Ho o) -< +J ,1 -o.* A OJ P :tdt cdl -(Jl dl o)l Hl cdlOI >l -al d)ho CIJ t-{ a) o(.) .rJ c6 ct){-) (D {J C6 a)t{ F-.r Orf ol Hl -ol 6JI F"f f{ cdq) +) tr 0)kt{ 7 C) q.) +J o +) H o +)g oo H -{-) o o 'a ,rg F aO Eofi € H(t) E(I) o ()(! -{-)AHo E +) crd a)t{ .P +ro .d trori Ft Iriq c\ c)b! CUkr\ 0) F Be \o rJv oi tr- \o O @ lI) o\(ot-d cO s(o o) ,.ci cr) 6\ r-{ Ioj @ \o dv v @ \o CDO o) \o @ cod @ \o(o c.j o H ilrQ9>Htrl 0) AD(d ^k\J 0)i Es 6\ (o c.io r-{ 6\ rO q? rO(o o\ o) o rO \o co c! F-{ rO 6\ @ c! oio rl \o coq OJO H O(o F-.1 d o\q F{ o\ q @ o) 6SE}r(go !> -3 lloFi oO G]il- frl H \o O c-(o(!) o\ @(! ci$ \o(o rO c,i' CD \o o6l a \o .+q Fl t-- \o tr- OJ O ts- s coIIo F- \o tr) oq cr! tr- o\6l d tr- Itsr dq) k Ee dOdq1A .5a)Ao. H @ tr- tr- H rON Tr) @ ro co *l rO O) @ F{ @ c-(o c- crt @ Co (0 $ ,-t c\H F. ov6l @o @ @(o 6l o) O) .rt{ a(O c\ .s o(o N @ c! P 5e oH.55eod6o a gE <FO sFr()H(o (o rO cO lI)vN @Ntr- @ @6l v @v cr) CO FJ OJ(o N o @ F{ ooH @t'- Fi rO @ O c\N F-t a H cr) C.l coo co(o N Nd o .d +)d) tu lqr o. trb3 R.q s'EG3 !i59 E gS H E fi a H t= c-r- tr- O) FI v .+v rO F{ rO ,-{ To N F. m co F-t-N Ooo v c-N ro b..-v O) co CD c\t cov ro\o cr) OIo rr) co(o co m r{) cYfO(O cr) o\Oo Fl o\oa ri \o oo H \o oo ri \o oO F-l \o oo H o\oo F-l o bD(d oejE- lG< 3€) *.',8 s,5e.; O &llt.- H r,I o\oO F{ \o oO il \o oO il \o oOt o\Oo H o\Oo o\Oo H fr] opq ,'E S9, (!'d ': H= A H H.i eE EE *Z83E rl1c- rOt- rOc.- co Iot- cr) co F- @L-v @t-v rd lp 3E(E trjfc€o;<6oE gE <E<o I(1F.-CD Io t'- co \o tr- co rOt- co @ t--$ cO L-v @ tr-v a) 0) bo d U) q) + E E oQ -oE6 0@oo :. oEcEH 5 -5! E gfl€o d tr ofe o (s o E ro F. cr) ll) L- co lIi tr- co lI) E- @t- .+ @ r--v @ tr- .dr tr F] @ O) O) OJ O) o) Fi OaON FlaO6I Na N maoN vOON ll)oON OaN t--OO c.q cOOo c\ O)OO c\ o F{oN \o o.l OD H d d E o pd .d o Hg X t=l l.d o) € a)(d a o o rl l.d o) €6 C)tr Fr A o tt)froA .d o <l) 'rJ o) a#CJ= e3 E 7 z o -l-) o) €d +) o EId N 'H+)o ol=ia +i o t{ o .o 13(l) r) u)3rdxoo €m +)o .H ti +)o 'Ha(oal. +) -:{((J a(/2< \r.{A trl L., z cq f'l c0 m a D M g E a o z o H E "lH ca Ao E rl H o Er ;<o -.p o q @ cg N -p(.) a)\ra OIerl o)lHl --oldI F-.,1 ,Iffi:1,'#;:ffi :T:,ffi iffi :i.Tlj"j;;:Jf ,T:ffi dwherearethevkept? :i:"t"oil:::ffi,fifl#*",.1:: u.,r'erv that are being carried out by hearth lnl:;"h care personnel carried out the following activities under Ivermectin 1. Mectizan requests : ffii:'r"fiX':""illffctizan@ from the province to the health districts3' Monitor and .r,p..ui." ih. ai.rribution of Mectizan@ to cDDs.4' storage and stock ,"u;;;;-ent of Mectira.ro ie Reporting on Mectizan@ - Any other comments Non 2'8' communitv s,eri.molitoring and stakehorders Meeting f;;;":;:,:':;'"r r;;"t.;*"'ii' communitv setr'monitoring been done in the Ifso llhen? During general training on CDTI in March 2OOB There is not information yet on community serf monitoring.available in the annual t..t ri.ri report. Table 11: Community serf-monitoring and stakbholders Meetin This will only be crb l)rst r.i<:(,/ l,CA cornmunities/villages in the entlrc project area Total tl of No of Communities that carried out self monl (CSM) No of that p Communities tedarticipa 1n stakeholder 's meeting BANGEM IMLryUKA Nqu.II.____ TIKO KOI\TYE KTT\,{BA LIMI]]I MBONGE 15 60 84 103 45 32 13 54 6 oe TOTAJ.. 478 27 Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Central Level - NOTF - NGDO Health Area Level - Health Centre nurse Intermediary level - Provincial delegate - Provincial Chief of Service of Community Health - Oncho Project Coordinator - Finance Officer - District Medical Officer - Chief of Bureau Health - Chief of Bureau of Administration and Finance - Chief Medical Officer of District Hospital Peripheral Level - CDD - Dialogue structure members - Community members Communi 28 2.9.2. What were the main issues identified during supervision? . Disgluntlement of CDDs over the failure of the government to pay them their motivation on time . Activities don't always go on as piannedi respect of timing needs to be improved upon. . Prompt reporting also needs to be routinely made for project activities. 2.9.2. Was a supervision checklist used? The systematic utilisation of a checklist still needs to be instituted at all levels 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Since activities are still going on, this point will only be addressed in the annual report.. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? SECTION 3: Support to CDTI 3.1. Equipment TOblq_l_Z: Status of equipment (Please add more rows if necessary) Sotr r<:t. 'l'.ypt.ol' l,)tltrip rrrcnL APOC MOH DISTRICT /LGA NGDO Others No Conditio n No Condition No. Condi tion No Conditio n No. Conditi on 1. Vehicle 1 F 1 CNFR 2 F nI F I CNFR 2. Motor cycle(s) I F 6 WO 28 WO 10 WO 20 wo 3. Computer(s) 2 WO 11 F t2 F 1 F 1 F 4. Printer(s) 1 F 11 F L2 F 1 F 1 wo 5. Photocopier (s) 1 F 1 CNFR 10 F 1 F 6. Fax Machine(s) 1 wo 1 F 7. Others d FIip chart stand 1 3 F b) Overhead agojector I F c) 29 *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Written ofO How does the prcject intend to maintain and replace existing equipment and other materials? Decisions on purchase and replacement of equipments are made at the Ministerial level. The province and the districts only write and channel their requests to the lVlinister of Public Health, and wait for the response' Most of the cost of maintenance of equipment and other materials now comes from the state budget of the provincial delegation, health districts and health areas. The cost of maintenance of the project vehicle and motorcycles is very high now that these equipment are already old. This is made worse by the very poor nature ofthe roads. 3-2. Financial contributions of the partners and communities Information on fi.nances will be made available in the annual report' Table 13: Financial contributions by aII partners for the last three years ( )on l,ritrul,or Year 6 APOC (Dec.2004'Nov.2005) S SI (Ja n. 20 0 6'D ec. 2 0 0 6) Year 7 APOC 0an..2006'Dec.2006) SSI (Jan.2006' Dec.2007) Year 8 APOC (Jan.2007'Dec..2007) Sil 0an.2007' Dec.2008) TOTAL Cash Budgeted (US$) TOTAL Cash Released (Us$) TOTAL Cash Budgete d (us$) TOTAL Cash Release d (US$) TOTAL Cash Budgete d (us$) TOTAL Cash Release d (US$) Moll (Ccntrerl Pnrvincial/State) + MoH (District/LcA) Local NGDO(s) ( lf any) NGDO partner(s) Others a) b) Communities APOC Trust Fund TOTAL 30 If there are problems with release of counterpart funds, how were they addressed? There were no problems in releasing counterpart funds Additional comments. 3.3. Other forms of community support - Describe (indicate forms of in'kind contributions of communities if any) 3.4- Expenditure Per activitY - Indicate in table L4, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate, 1US dollar was 422 Table 14: Indicate how much the project spent for each activity listed below during the rePorting Period Activity Expenditur e ($ US) Source(s) of fundins Drug delivery from NOTF HQ area to central collection oint of communi Siclc cffec!.s m3+qgq ment M olr i I iz,a{;ion and health educati.on 9f-c.om-l4unities - 'l'r'aining of CDDs 'l'r'aining of heaith staff at all lgyu-l-q- S_gp_g f yi.r"g_9D p s a 1d -d istrib ulio n CDDs Motivation District ggpg f y-is i9 tr 4!-d" pq-qr-ilo rln g o f q p T I a ctivit ie s to health and olitical authorities IEC materials s ugrqerv-qepprlrqd-f-qr-lq9- tqI. tr-e-q!!-o9-4! - Vehicles/ Moto maintenance Office-EgL.tp-rp.-.r!(9g-qomP,Bt9-ts.,pfinlefeC!q)- Others* _ _ District Tem ral Staff Provincial n -- -*i Communication Planning Evaluation meetings 3l Staff cost Launchin VehicleandBikesofInsurance External Moni TOTAL Mesol[IYPer communities Hypo communities treatedTotal number of persons Total SECTION 4: SustainabilitY of CDTI 4-L- Internali ind'ependent participatory monitoringi Evaluation 4.L.1 was Monitoring/evaluation carried' out d'uring the reporting period? (ti.k ;;;-"i the iollowin g which are app licable) Any comments or exPlanations? No Year 1 Participatory Independent monitoring No Mid Term Sustainability Evaluation -Not applicable 5 year Sustainability Evaluation Internal Monitoring bY NOTF Other Evaluation by other partners -No one 4-1.2. What were the recommendations? 4-1.3. How have they been implemented'? Not aPPlicable' 4.2.Sustainabilityofprojects:planandsettargets(mandatoryat Yr 3) Was the project evaluated' during the reporting period? -NO--.._.- The project was evaluated. for sustainability in 2003 and sustainability plans have been implemented since then. At the moment the project receives just *irri*ut financial support from APOC' was a sustainability ptan written? _- Not applicable 32 When was the sustainability plan submitted? -Not applicabie What anangements have been made to sustain CDTI after APOC funding ceases in terms: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4. 3 Integration Outline the extent of integration of CDTI into the PHC structure and the plans for comple te integration : 4.3.L. Ivermectin delivery mechanisms, The delivery mechanism of Mectizan@ is almost completely managed by the staff of the Ministry of Health. From when the tablets get the Southwest Province, they are stored and managed by the provincial essential drug programme just as is the case with the other essential drugs. At the end of the distribution campaign, left over tablets of Mectizan@ are Ibrwardecl back to tlie drug proglamme vial the various health districts. 4.3.2. Training This year trainings ail took place in March but for Tombel Health District that trained in February. As usual training was in cascade with the level above training the level below it. There was no training at the provincial level. Health centre nurses and CDDs were trained / retrained in CDTI and eye care in an integrated rnanner. During these trainings, as was necessary, information on other health programmes like EPI, HIV/AIDS, Malaria etc was passed to the health staff. 4.3.2. Joint supervision and monitoring with other programs Integrated supervision was more at the health district and health area levels where few staff are called upon to carry out all health programmes. At the provincial Ievei this was not the case as each programme has its provincial coordinator and its plan of action. 33 4-3.3. Release of funds for project activities Funds for project activities were released by APOC and Sightsavers International without any problem. Instead prompt release of funds was is being hampered by the delay in submission of financial justifrcations for funds earlier released. The Ministry of Health partner does not directly release funds for CDTI project activities since there is no budget line for such expenses. However, some expenditure is made by the government on the programme. Expenses are made on transport and office equipment as well as stationary that are used for CDTI implementation. 4.3.5. Is CDTI included in the PHC budget? In the state budget, there is no line for CDTI. However, the districts and health areas carry out expenses on CDTI either directly or indirectly from other budget lincs. One of such budget lines is "Supervision of health activities". In health zlroas, especially those not allocated any running credits from the government, haalth centre funds (collected from services the render to the public) are used to finance CDTI activities. The government is now advocating for a "common basket", whereby funds for all community health programmes are pooled together and used together from a common basket in an integrated manner. The difficulty in instituting this is the fact that different programmes have different calendar of activities, they have different donors each of whom wants fi.nancial justifications in a different way. 4.3-6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? CDTI structures are currently being used by almost ail other health programmes. ODDs arc used in the community as community mobilisers for all programmes. 'l'lxry irro used as vaccinators and recorders by the poliomyelitis control l)r'ognlnlnro (NIns). They are used like relay agents in the malaria control l)r'ogr;ul1r)ro. For tho leprosy and tuberculosis control programmes they are r:onrnlunil,y l-rclalth workers, for the eye care programme they are communityeye workcrs. Transport, fncilities (vehicle and motorcycles) provided by both APOC and Sightsavers zrrc used by all health programmes. Management skiils aquired during CDTI trainings are used by the health staff for the implementation of all the health programmes they run. In aII CDTI has iaid down a good foundation on which all other health programmes are built. 4.3-7 - Describe others issues considered in the integration of CDTI Management of side effects following Mectizan Treatment, Side effects for long have not been a big issue in this project. However, they are managed by the health staff with drugs from the essential drug programme, free of charge to the patient. When distribution will be over payment will be made by the APOC and Sightsavers to the drug programme. 34 4.4 - Operational research Summarize in not more than one half of a page the operational research und.ertaken in the project area within the reporting period' No research carried out. How were the results applied in the project? Not applicable SECTION 6: Unique features of the project/other matters 4.4.L. SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process - List the challenges and indicate how they were addressed. 35