North West CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2006

RESERVED FOR PROJECT LOGO/HEADING COT]NTRYAIOTF: CAMEROON Proiect Name: NORTH WEST CDTI PROJECT Approval vear: 2003 Launchins vear: 2003 Renortine Period: From: January 2006 To: (Month/Year) December 2006 ( Month/Yenr) Proiectvearofthisrenort: (circleone) I 2 (3) 4 5 6 7 8 9 l0 Date submitted: January 2007 NGDO nartner: Siqhtsavers International ;Q Acti;^-.Ai\NIUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) Io TC I (nD !v I AUE 'I ,/ 7'- !/ 6€0 NORTH WEST CDTI PROJECT YEAR 3 itor crmciion DEADLINE FOR SUBMTSSION: To, $'tA' To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for Sentember TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) /*) t I It rr 1 FFU ii!,l,l IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: CAMEROON National Coordinator Name: Dr Ntep Marcelline ag LT SA S Date: 3il./u.:il.t./*. Provincial Delegate Name: Dr Ndiforchu Victor Signature: NGDO Representative P I* A J:: -", : : :ilkffi r- r r a n gw a Patrick, Mr Tekwe Thomas, Mr Geh Oscar. Date This report has been prepared by:Mr Akuimbeni Montesqueu, Mr Tangwa Patrick, Mr Tekwe Thomas, Mr Geh Oscar Designation: Oncho Coordinators Signature Date I I I I {+{ 1l WHO/APOC, 24 November 2004 Date: .+. ... l''11.. ig0 Name: Dr Rosa Signature Table of contents ACROI{YMS v DEFINTIIONS YI T.OLLOW UP ON TCC RECOMMENDATIONS.. .........1 EXECUTIVE SECTION I.: BACKGROUND II\TFORMATION Ll. GpNsnan INFoRMATroN............. Ll.1 Description of the project (briefly). 1.1.2. Partnership 1.2. Popr_n-enoN SECTION 2: IMPLEMENTATION OF CDTI....... ........9 3 4 4 4 7 8 2.1. 2.2. 2.3. 2.4. 2.5. 2-6. Tnzmrnrm oF ACTrvmIES............... ........9 Aovocacy ......11 MOSILZATTON, SENSITZATION AND HEALTH EDUCATION OF AT RISK COVNT'INTTTMS 1 1 Cot nvrulrrryINVoLVEMENT ...............12 CapecrryBUrLDrNG .........14TRpenrmr.rrs.........._.... .....16 2.6.1. Treatmentfigures 2.6.2 What are the causes of absenteeism? 2.6.3 What me the reasonsfor refusa1s2................ ...............20 2.6.4 Briefly describe all lmown andverified serious adverse events (SAEO that....20 2.6.5. Trend of treatment achievement from CDTI project inception to the carrent year 222.7. ORoBnl.tc, sroRAGE ANDDELIVERy oF MERMECTIN ............232.8. Cotrrtatnvrry SELF-MOMTORINGAND SrareirOLpSRS N(EETtrrc .............242.9. SupsRvtsrotr ....................252.9.1. Provide afiow chort of supervision hierarchy. 2.9.2. Whqt were the mqin issues identified during wpervision? ....262.9.3- Wqs a supervision checklist used? ..............27 2.9.4. Watwere the outcomes at each level of CDTI implementation supervision?.272.9.5- Wasfeedback gtven to the person or groups supervised? ..............27 2.9.6. How wqs the feedback used to improve the overqll pedormance of the project? 27 SECTION 3: SI]PPORT TO CDTI ...............27 19 30 3.1 3.2 3.3 3.4 Equrevmvr FnvaNcrer coNTRIBUTIoNS oF TIIE pARTNERS ANDCoMMUNTTIEs Orrun ronrras oF coMMUNTTy suppoRT E>cpsNom,np pER AcTrvrry............. 4.1.2- l[/hqt were the recommendotions? 27 28 28 29 SITCTION 4: SUSTAINABILITY OF CDTI. .................30 4.1. rwrenNar; TNDEIENDENTpARTTcTpAToRyMoNTToRTNG; EvALUATIoN....................30 4.1.1 Was Monitoring/evqluation carried out during the reporting period? (tick any of the follo+ing w hich are applicab le) ..........304.1.3. How hqve they been implemented? ... .....30 4.2. SusrnNasILITY OF PROJECTS: PLANAND sET TARGETS (veUOerOnV er................30 Yn3) 30 3t 3I 3I 3I 3I 4.2.1- Planning at all relevont levels 4.2.2. Funds..... 4.3 hmcnartoN 4. 3. l. Ivermecfin delivery mechonisms ............... 4.3.2. Training... 4.3.3. Joint supervision and monitoring with other programs 4.2.3 Transport (replacement and maintenonce).... 4.2.4. Otherresources.- 4.2.5. To what extent has the plon been implemented..--.. ...........3 1 4.3.4. Release offundsfor project activities .........iI 3I 3I4.3.5. 4.3.6. Is CDTI included in the PHC budget Describe other health programmes that are using the CDTI stacture and how this was achieved. What have been the achievements? ..--..-..... 3t 4.3.7. Describe others issaes considered in the integration of CDTI. ......31 4.4 OppneUoNALRESEARCH. ......31 4.4.1. Summqrize in not more than one half of q page the operational research undertaken in the project oreawilhin the reporting period 32 4.4.2. How were the results applied in the project? ........... ......-...-..--......32 SECTION 5: STRENGTHS, WEAKI\TESSES, CHALLENGES, AI\DOPPORTUNTTmS .......32 SECTION 6: IIMQIIE FEATURES OF THF PROJECT/OTEER MATIERS...........33 Acronyrms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring Local Government Area Ministry ofHealth Non-Governmental Development Organization Non-Governmental Or ganization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Definitions (D Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census tat<ing) (iD Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the ma:rimum number of people to be treated annually in mesolhyper endemic areas within the project are4 ultimately to be reached u*ren the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year of the project). (") Therapeufic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (-) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vir) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (usirrg the same systems, training supervision and personnel) in order to marimise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or intervenfions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coveragq integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention prograrnme), *ith a view to ensuring that the prograrnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. FOLLOW UP ON TGG REGOMHENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session D Number of Recorunenddion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/A.ruC MGT USE ONLY 1.1.5 l) Activities in carried out in January, February and December. Activities carried out during this period constituted the following: collection of leftover Mectizan@ tablets from the field (from the CDDs, through the health centres, health dishicts to the central drug store oftheNIVPSFH in Bamenda; Training/retraining of health staff at all levels and CDDs (targeted trainings); reimbursement of supervision dues to districts and health areas (they pre-financed activities since APOC funds arrived late; carrying out of IIESAM within the communities. 1.1.5 2) Community response to sensitization and mobilization. - Communities responded favourably to sensitisation. More people took Mectizan@, there were fewer refusals, Side effects were reported more promptly and management staft,ed much earlier. This contributed in the slight increase of the good treatment coverage. 1.1.5 3) Suggestions on how to improve sensitization mobilization. -Provide Hand megaphones to CDDs. -Increase Funds for HESAM. -Training at all levels on accnlerated/ facilitative HESAM. -Provide means of transport to all health areas. 1.1.5 4) CDDs attrition -Communities are sensitized to support CDDs in many ways like exonerate them from community work, give public compliments during communal occasions, integrate/use them for other health programmes like Malaria control, EPI &TB etc. Gov't should promptly pay them as promised after each distribution cycle. 1.1.5 5) Procedure for ivermectin delivery. -Ivermectin is received from MDP through WHO with the assistance of Sightsavers. It was then transported to the Bamdenda by the I oncho project vehicle and stored in the NVIPSFH drug store alongside other essential drugs of the Norlhwest province. Districts made their requests and were supplied from there. Ll.5 6)Results of CSM&SHM -7 7 6 MesofHyper communities did CDTI. 657 dtd CSM all held SHMs. Most who did CSM did it poorly. It was done more by health staffthan by community members themselves. l.1.5 7) Intergration - CDTI activities are sometimes done concurrently with other health programmes like EPI, Ivlalaria Control and PHC supervision. - During the year 2 provincial appraisal meeting discussions were made on fully integrating CDTI in other health progr:unmes - This year Vitamin A is currently being distributed along side Mectizan@ treatment 8) Recalculation of figures in table 4 - This was redone in last y@.r's report. The end of year three report will carry good calculations on all tables. 9) Train and use community supervisors This is yet to be implemented. It has been prograrnmed fortraining for year 4 l0) Resolve the problem of 2004 motivation All financial motivation for 2004 has been paid to CDDs. This money was to the tune of 14 million CFA frs. It was provided by the Ministry of Public Health. 1 1) Encourage community motivation of CDDs This is an ongoing activity but timidly implemented. During sensitization meetings it is always discussed with community members. l2) Intensif sensi ;zation to dispel rumour and fear of severe side effect Advocacy and sensitisation meetings were held this year with political, religious, culfural and administrative leaders on the issue. We also insisted onthe prompt and proper management of all side effects. Extensive radio programmes on CDTI were orgsnised this year to dispel all forms of fulse mmours and fear of side effects. This has rezulted in very high compliance and adherence rate to Mectizan@ treatnent. 2 Executive Summa4y Prepore an Executive summof,! of the report in not more than one page. l. Background on treatment andpopulation data - Total communities, communities treated, total population, UTG, ATO andpersons treqted. This is year three of this project. Activities in most areas started in January 2006 (though in some districts they started in November 2005) with community mobilisation. This was then followed by trainings at different levels and later census update alongside Mectizan@ and vitamin A distribution. This year apart from a few communities in Wum and Benakuma health districts all meso and hyper endemic communities were treated giving a geographical coverage was 98.57o. In Wum health district due to inaccessibility two health areas (Furu Awa and Esu) 8 communities were untreated, 8 ofwhich have neither had REA nor census. In Benakuma health district two endemic communities were not treated due to CDD attrition. The project had a total censured population of 746,849 persons in meso and hyper endemic communities spread over 7l health districts and 186 health areim. The annual treatment objective and ultimate treatment goal were 522,795 and 627,338 respectively. A total of 527,948 persons were treated grving a therapeutic coverage rate of 70.7Yo. 2. Background on poprlation moyements. Population movements have not been a serious problem this year. In areas where this occurred, it involved mostly the Fulanis who are herdsmen rearing cattle and leaving on hill tops. To get Mectizan@ to these goup ofpersons CDD were obliged to make an extra effort to meet and treat them in their new settlements an provide the eligible with treatment. 3. Training data - CDDS, healthworkers, Total population (community) per cDD trained. _ Trainings which took place in cascade and at all levels consisted in training the follow: lDDs 3,127 against 3,275 planned; Health centre nurses 433 against485 planned; healthdistrict staff62 against 70 planned. The CDD population ration was I CDb to 239 population meaning the CDD still has to treat more people and do a lot more work than it is recommended should the ratio of I CDD to 100 population were respected. The ratio is this high as a result of CDD attrition for poor and late financial motivation. Atthough 3,127 CDDs were trained as shown on table 5, not all participated in CDTI. 170 absconded leaving us with just 2,957 who effectively took part in CDTI activities as indicated by table 4. 4. Challenges and how they were overcome. - Getting treatment to the inaccessible communities of Wum and Benakuma health districts. - Prompt financial motivation of the CDDs by the government. - Treating inhabitants that migrate to new settlements for new grazingor farming land. To overcome this, CDDs have been forced to moved to these new settlements to treat the eligible population. - Reduction of CDD attrition. This can be reduced by advocating for the government to pay their incentives promptly. -J SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) A. Geographical locations and administrative area(s) The CDTI NW project area covers the entire North West province. It has a total censured population of 1,332,305 inhabitants. Spread over a surface area of l8,l00km2.A Population of 746,83L inhabitants are found in the meso and hyper endemic communities. It is bordered in the south by the health districts of Akwaya and Mamfe in the South West province, in the East by the west province and in the North and West by the Federal Republic ofNigeria. The North West Province is made of seven administrative units (divisions) Thirty one sub- divisions. This is further divided into seventeen health districts and one hundred and eighty six health areas. Tqbb A: sltotolng odndntsffi*te unlts, hcatth dtstTiclcs and luatth atled:, wtthtn tlu proJed atea D ivisions / Sub-divisions Eedth Districts District population Health Areas Mezanr Bamenda Santa Tubah BaIi Bafut Tuba (7 tVA) 32,035 Bambui Bambili Kedjom-Keku Sabga Kedjom-Ketinguh Kwidre Tikebene Bamenda (r3 wA) lo7,0l9 Azire Nkwen Uftan NkwenRural Mankon NkwenBaptist Mendankwe Ntamulung fil3$rrkam Mbachongwa Ntambag Atuakom Mulang AlakumaK Santa (e rvA) 63,997 Mbu Menka Akum Ndapang Buchi Balieham Pinyrn Santa Urban Awing Bafirt (e rvA) 38,795 Manji Nsem Mbakong Mambu Mforya Buwe-Burari Mundum Akofunguba lvfankanikong Bdi (6IVA) 20,988 Bati urban GungongBossa Bawock Catholic mission Wosing Momo Baribo Mbengwi Njikwa Nge Widihlm Batibo (13 rVA) 65,559 Batibo Guzang Tiben Larinji Kulabei Gwofon \4/idikurn Bifang Ewai Ashong Olorunti Eka Kugwe Mbengwi (14 rvA) 46,702 Andek Teze Tinechung Abebung Njah-Etu Acha-Tugi Bome Njidom Munam Mbengwi Ajei Ngyen-Mbo I.$pn-Mengom Azem Njikwa(6WA\ 18,438 NjikwaBassa Kuttin Konda Oshie Akanunku Ngoketundja Ndop Cental Balikumbat Babessi Ndop (14 rVA) 187,334 Babungo Baba Bamunkaurban Babessi Bangolan Bamunka rural Bemali Balikumbat Bamessing Bafanji Bambalang Mbissa-Mbaw Bamunkumbit Mighang-Mbaw Doyo Belo Njinikom Fundong Bum Fundong (11rvA) 93,297 Konene Mbessa Belo Mbengkas Aduk Fundong Mentang Kilftini Anyajua Mejang Fu:manful Menchum Benakuma 39,475 Beba-Batomo Befang Benakuma 4 Wum Fur-Awa Fongum Menchum Valley (8 rrlA) Bawuru Benade Modele Benabenge Okorornnjang Wum(ll rvA) 74,096 Furu-Awa Abar Bu BaftnenEsu Yernnge StMartin Kunfutu Weh WumUftan Ise Bui Kumbo Jakiri Oku Mbiame Noni Kumbo East (leIvA) 103,486 tvlbah Kwanso Shisong Sop Wasi Ber Mbokam Jaktui IHC Jakiri CMA Tatum Mbonso Ndbiame Vekovi Mbam Wvem Wainama Dzeng Ngorin Ngehndzen Nhr Kumbo West (16 rvA) 145,054 Kumbo ElakOku Jikijem Kikaikom Melim BBH Djottin Kevu NkumKov Nkor Ngeptang Buh* SimonKov Kuvlu Ichim Kitiun Donga& Mantung Nkambe Central Ako Ndu Nwa Misaje AKO (s WA) 25,478 Abongshie Berabe Kuta Ako Akwaja Nkambe (l0 rvA) 94,809 Nkambe urban Misaje Fonfuka Binka Tabenken Dumbu Buabua Kom Lus Mbot Ndu (r5 rvA) 175,753 Luh Ndu Mangu Ntumbaw Gom Ngu Nwa lvlbongong CBC Sop lvlbif Ntem Nsam Ntong CTE B. Topography, climate, access The bio climatic zone of the Northwest province is mainly Sudan savannah grassland, with plains, rolling / steep hills and valleys. It makes up most of the Western highlands and is one of the minor watersheds contributing to both the Niger and Atlantic basins. These valleys form beds for swift running streams especially in the rainy season, which are dispersed through out the province. The rivers beds are frequently rocky and sometime interrupted by falls all contributing to highly aerated waters which make a good habitat for Simuliurn the vector of Onchocerca vovulus. The rains begin in March and are very heavy in August through October, fotlowed by a short dry season. The roads, mainly dirt roads become impracticable during this period. Farming is all year round, maize groundnuts, vegetables and beans are planted all through the year, in swampy areas during the dry season and in the main land in March and August. These are harvested three to four month later. The intensity of farming is low or moderate only during the months of December and January. The men farm the cash crops while the women farm the foodstuff - Communication systems (roads...) Of the 3291 km of road network in the province only 187 km are tarred the rest is made of dirt road, which becomes impassable during heavy rains in the months of August through October. Some of the villages are only accessible by trekking. This is quite evident in Wum,Njikwa, Nambe. - Population: activities, cultures, language The people of the NW are mainly dispersed living in family groups surrounded by their farmland, scattered through out the area. Among them are Fulani cattle rea.rers who are nomads The ethnic groups are the widikurn, Fulani, Tikari, Bali, Ngemb4 Aku, Essimbi, Beba, Aghem, Njkwa. 5 The rural communities are mostly homogenous while the semi-urban and urban communities are heterogeneous. There are some Fulanis, nomads dotted all over the project area. There is constant migration to the urban towns by the youths in search for better jobs leading to increase urban poverty. - Administrotion structure The communities ofthe Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and highly respected. Each clan I family has a family I clan head and each tribe has a chief and, acouncil of elders. The chief and his councillors take decisions for the community. Health system & health care delivery (provide the number of health postVcenters in the project area if the information is available). Number of health staffin project area and number of health staffinvolved in CDTI activities. Table l: Number of heolth staffinvolved in CDTT DistrictllGA Number of health steffinvolved in CDTI activities Total Number of health staffin thc entire project area Br Number of health steffinvolyed in CDTI Bt Percentage Br=B:/Br'lfi) AKO t7 t7 700Yo BAFUT 87 45 5l.7Yo BALI 40 18 45Yo BAMENDA t7t 77 4s%o BATIBO 85 36 42.4Yo BENAKUMA 29 l8 62yo FUNDONG 345 43 12.5Yo KTJMBO EAST 60 25 4l.6Yo KUMBO WEST 243 36 14.\Yo MBENGWI 46 25 54.3Yo ,ft6op 38 27 5sYo I.J. NDU 18 18 lOlYo NJIKWA 30 30 l00Yo NKAMBE 45 26 57.$Yo SANTA 48 35 72.9% TUBAH 45 t8 40%o WUM 67 46 68.6yo Total 1414 s34 37.8Yo 6 L.1.4. Partnership Indicate the partners involved in project implementotion at all levels IMoH, NGDOs(national/international), communities, local organizations, etc. J The partners involved in CDTI implementation in the North West province are as follows: -International level : Sightsavers International, APOCAMHO, MDP -National level: Ministry of Public Health, NOTF. -Provincial level: PDPH-NW, NWPSFH, Provincial Hosp Bamenda. -District level: District Health Service, District Hospital, - -Health Area level: Health Centres {ommunity level: Dialogue structures memberg CDDs, Social Mobilisers, Opinion leaders, Local Councils. Describe overall working relationship among pmtners, clearly indicating specific areqs of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. There is good collaboration among all the partners involved in CDTI implementation. The Ministry of Public Health provides the health staffforthe programme, APOC provides funding and logistic support. Sightsavers International provides technical supporf logistic support and funding. The community is responsible for furnishing the prograrnme with Mectizan@ distributors and health committee members who all contributeto the smooth functioning of the programme at community level. State plans, rf any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementafion. Local administrative authorities and traditional leaders have always been involved in project activities. They assist in social mobilization of the communities. 7 Fl oH F E |> He EU U) DH 2. x ? E frl Zx{ e e z, U oFU ? EU rnz o s Xe? E o 4 rrjOFl Xe?|- TD o rd aH 41 , Uoz O EU rnz x ?|- Ed H Ed o EU E E 2. 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H I a o (t q R (\\ .o\(t o\(\ o s G Y(\ tr Gj Dss s = (\ a4 Y t(\\ a\(! s(\\\t.(! o GS b G = U s.$\ s G (! \\ (\ e) s v, d ao (\\\' 0q(sI ts o o o (b\S 06(! s o\: a $\\ a. ao o, o Ba o{ Go (s\ \(\ sGs s(\ a\ Hl Ci s S$(\ \ ,o s a { ds\ s N \ e(! o Q- c)(\ a.) w o'\ (\ \ .o(! o $ G s\\ G (\ .(\\ o\ G\(\\ o s. '\) (D(t) + (t) p) U) o.o sD Fl (DFt(D{ a, v) F) o(D v)t V) E o- F' o o.o (D o) o oq U'p- (D 7 (D o+ N F)!j @ a. (n+Ft dtr o F @ If y*, me using the term community or village, define what constitutes the community or villoge. This will help underrtand the profile of the project area. A community is made up of a group of people leaving together under a common leader within a particular agglomeration. It is usually made up of between 100 and 3,000 inhabitants. This leader could be a chief, Fon or even a quarter head. Sometimes the number of people served by a CDD is considered a community. SEGTION 2: lmplementation of GDTI 2.1. Timeline of tctivities Fill in table 3, timeline of activitiesfor weas treated in carrent year, indicatingwhen the l<ey activitieswere implemented by the month they began ond the month they ended. l) Activities started in November 2005 with the mobilization of the communities. It was done by health stafi and community distributors. 2) Next was training of health personnel which was done in March and April 2006. Participants included: District Medical offrcers, Chiefs ofBureau health, health center staff and chief medical officers of district hospitals that managed side effects. Training at the district was organized at the district health service for chiefs of posts of health centers and at the health areas for the CDDs. 3) Census Updates: This was done from the beginning of distribution April2006 to the end of distribution August 2006. This was an activity that went on concurrently with distribution. 4) DRUG DISTRIBUTION: It went on simultaneously in all the communities in entire project area from April 2006 to August 2006 except in Furu Awa health area and some communities of Esu Health area because of inaccessibility. Distribution did not take place there thus keeping the Geographical coverage of the province at 91.5yo 5) SUPERVISION: It was carried out at the district Level by the DMOs / CBHs/ CBAFV and some competent members ofthe District team. At the health area level, CDDs within their respective communities carried out supervision of the exercise and were at the same time supervised by the chiefs offthe health centres and community leaders as in Esu. In general, despite the level of supervision everybody was particularly very involved in monitoring and managing side effects. Supervision took place between February and August 2006 9 lslE lR- 1,., \) xi (\s G .S FG Gb S'\ SG S dSv, + G!S GF. S!t\ G I Gl \< GS\ { c r- FlC Ed lr V) 2Fl zx ? E EI Z x{ 2, U e zU oFU 5lnz o = Xq E o { lrJ(n Fl Xe? Eo td (r) H Ej e z, U o 2, o Ed lr, 2, XCd EU =tdo Ed ? EzU td r. EU frJ FJ X o g (n =. fl F o oo t\)o tj ot5 tJa Or FD N)oo o\ zo Noor, q) N)I o\ zo tJaO r.rr E i.Jo o\ p0 tJoo o\ rd t.)oo o\ \ tDd l..JO o\ 7 D)Hf)t t'.JaO o\ nt b.) O o\ D9 !.Joo o\ 41(D(t h.Joo0\ F) t.)oo o\ +t(D(t N)oo o\ zo N)oo(rr c9 5.+ +E'oe ?t)=ooId ES i. 3. t!,ooN)oo o\ (! t.Joo o\ E'I. 1..)oo o\ ta N)o o\ t oc l.Joo o\ a (D t..)oo o\ N)o o\ 0a b,J o o\ c b..Joo o\ cqa t'.JOo o\ d 0c tJoO o\ d 0ct)oo o\ @ tJoo o\ t t*)oo o\ t (D l.JooOl c tQo Ot F!,(! \i oOl -o BEOE =iDo rJt. t) o o\ 41 @cr !.JooO! t,I. N) o o\ ? o,lfo h.Jo o\ z !, c) t.)ooo\ s)li c) t\)oO o\ !I. N)oo o\ ? !) c) tJOoOt r3t. N) o o\ E'ir. N.)oo o\ A'Hcl t.)oo o\ ? o,lr c) l.Joo o\ ? D)H C) tJoo o\ ,Tt t'Dd tJoo o\ o,H c) Noo o\ z h,H c) l..Jooo\ o, o N)oo o\ d9 =4ii It'oa FJ r.t DT 0e E t\)oo o\ 7 A'lr c) f.Jooo\ EI. N.) o o\ E' T. hJoo o\ tr. NJoo o\ EI. tJoo o\ 7 A' l'Joo o\ EI N)oo0\ E NJoo o\ ? 09 t.)oo O1 z A) NJoo o\ rd t'.)oo o\ EII. f.)oo o\ ? A)Hc, N)ooo\ E J. Noo o\ ? A'H a) l.Jooo\ 13 t.Joo o\ -oEO 5E OE =(! o rd T. N)oO o\ s, l.Joo o\ E'I. tJoO o\ E' il. h.Joo o\ E T. f.)ooO! E' t\)oo o\ z A) tJ o Or rJ 5. tJ o o\ E T. t'.JOO o\ ? D' N)o o\ EI. tJoo o\ u i. N)oo o\ E J. N)o o\ ra,5. b,.Joo o\ iEI. l..Joo o\ z A)H c, tJoo o\ Ei. Noo o\ AE E* Eil oe o(D t, u2 r5a DT (D l.Joo o\ c f.Joo o\ z o) t.Joo O1 F b,Joo o\ oq t'JoO N)Oo o\ N)oo o\ 0q t'.^)oO o\ i.Jo o\ oc N)o o\ oc N)oo o\ d oq N)oo o\ oq t.)oo o\ !1(D l'.J o o\ t (D t)oO o\ t.JoO o\ N)Oo o\ -oH =(! o ro il. t\Joo o\ !5. t.)oo o\ N)oOOl 'o t.)oo o\ E t'.)Oo o\ E T. N) o o\ z A) !.Joo o\ EI. NJ o o\ r5t. t'.)oo o\ 7 B) N.Jo o\ Er. t.Joo o\ '6 1..)oo o\ ftrl i.J o o\ EE N)oo o\ E' t'.)oo o\ 16 t-)oo o\ fC,I. N)oo o\ E3 5* liE oa U!t oer .A rl er o E i.Jo o\ t-JOO o\ 7 f'J O o\ d N) o o\ a oa t.)oo o\ Y T,Joo o\ t t') o o\ 0c tJoo o\ F N)oo o\ dqa N)oo o\ tqc t'Jo <> o\ c @ 1..)oool c oc N.Joo o\ t (! iJoo o\ o tJoo o\ E N)oo o\ N)oO o\ -oH 3o o rd i\)oO o\ ,7, (D d l..JoO Or E T, 1..)oo o\ 'dE. N)Oo o\ E' $.) o\ E t.JoO o\ '1, N)oO o\ E NJoo o\ fcl T. l'.)oo o\ FrJ (D d t..)Oo o\ r3 5. t\)oo Or z o) o tJ o\ E3. tJoO o\ 4r .D6 l..J o o\ 7 H c) l.JOo o\ '(,I. N)Oo o\ rdI. t) o\ a9 54 *E' oa a CD{ ln o= N)oO o\ |.Joo o\ d t) o o\ tr oc t.)oo o\ @ 1..)ooo\ d@ N) o o\ d t)oo o\ @ hJooOt h-)oo o\ oct) O o\ t 0q t.)oo o\ c oq Noo o\ d oc 1..)oO o\ c l'.) o o\ o N)O Or t t.)Oo o\ oq t') o o\ -o =f! o Comments 2.2. Advocacy State the mtmber of policy/decision malcers mobilized at each relevqnt level during the cunent year; the reason(s) for undertaking the advocacy qnd the outcome- Describe difficalties/constraints beingfaced and suggestions on how to improve advocacy. During this third year of the NW CDTI project, fewer advocacy meetings were held by the health authorities than in the two previous years. This was partly because of the fact that most of he traditional and administrative were the same and had not moved. Just 7 out of the 17 health districts effectively had advocacy meeting sessions with there senior divisional officers at the health district level. In all the 186 health areas traditional village chiefs, quarter heads and local administrative authorities were seen. These advocacy visits were meant to increase adherence to the treatment with Meaizan@ and hence increase treatment coverage rates. The trips were very successful. All those met were happy with the exercises and they all provided moral support to the eye unit. 2.3. illobilization, sensitization and health education of at risk communities Provide information on. - The use of media and/or other local systems to dissemirnte informafion Vernacular language broadcasters gave important messages through their media on CDTI this involved mostly communities around Bamenda and Oku where radio signals of the Cameroon radio television (CRTV) and other private radio station respectively are received. Mobilization and health education of communities including women and minorities CDDs and social mobilisers of other programs targeted social, cultural and religious groups for health education. These included women groups, youth groups and church organizations like Christian Men Fellowship, Christian Women Fellowship Catholic Women Association and Catholic Men Association among others. Re sponse of tar ge t communi ti e s/v i I lage s During these sessions, those that were organized at health centre levels were highly attended by women who came for other PHC activities. Within the community, the female attendance was higher than those of the male. Accomplishments The communities' awareness on CDTI increased. False rumours were dispelled. This led to increased acceptance ofthe Mectizan@ with a consequent increase in tieatment coverage rate. Dialogue structures, special populations like the Fulanis were also actively involved this year. Suggest ways to improve mobilization and sensitization of the target communities. 1l Ho t, E7l> Fl eE (r) 2Fl 2. x z ED tn ZX{ 2, U e 2, U o >d 6 rrlz oI Xe? E o { frJaFl Xe? E o rd (r) H Frlq z U o z a EU E'z x e? EU Fl EU o Ed z E 3 ED F. EU E e -l Xo U a F o -IUI\J @ 00 (.) Ot (.) N (,rs N{ No\ N5 (,,t{ 5(.) u)(,) o\ NO @o\ UJo 5O 5\o so\ 6aEoi+ El rfEH -lo- = 1.8 r,I(DEr 19 aD E' zc Co o o cE a (D !9 0eo o E E1tE] <i l!J t(D 6rt !! r5(D 1 5 O o O o o o o o 9r N O o o o o (.)s o ?187 FE IET a, =.ta EqE! lrtUI s os os O\oo\ o\oo\ o\oo\ o\o0\ os OrOo\ t.)\o6\ o\ s o\o o\ O\o 6\ o s o\oo\ Os Or\o s O\o 9\ Eo a(!t oa(D E'q. T' E' rll oo hJ (,) o\ \o(JJ o\\o @o\ (/) Ur Or @ o\ A(, N(.) @(.) \)s No\o \os \o \oN (],lt4) A N z lc o o UU E!{ zF o o ovU l! d (! o E E (} o (D €N (.,lN tJo\ (/) 5 o\ (rr {A UJ o\5 AN (rtN 56 Ur 5{ @o NO (rr\o \o OF(,IUE0d'E! N\o UT -l t\)AUt \o(rt N)O 5 N { o\ t') o\O Ur @ @\) tJ(j No\ (/) L,I{ O\o N)(r)@ \)N {(.) \)t,) (+) hiot9 E! il E! a E! 5UI( (,) L,T N)O N{ (j)qrr \o { o s(JJ (J) N)01 A5 O (.)o N(,.r NJO u)\o N oi!t 3=r4 !or= =!r t, ^!L;Lio r o;. l, za E(t(! =>r9:6 Ett !cadr A=-Li st u8 l! 0qt! o\ qi\ sO s (,r o\\oo\ oo5 s o\ L'T\o o\ UJ(j) rO o\ Ot(rt\o o\ 5 t\J\o o\ \) L'I\o o\ {N s {\o\o 5\ { t..)\oq\ (,lO\o o\ (/)(,l \o o\ @lr)\o o\ UrO\o 6\ @o\oq\ N o\ rO o\ E(! (Dt, lc GI(D -Fhu F:x NtI o ol -:l E3 -a,l I'3 o I o 3 o3t l$Itr IGlr o o- (\ vi! I (.) E. a St G ot\t o o !1 (D o N) *gg1IS**a$tEE[$ E rrFF '[BR [$s '$BEan. ri$ fi$E Et $f,tE$ rFs ee* $$Eis;i [{* }E$ $$ Eggr$ erE $ - =- r$E$$FE$t$EE F€tE$Er$$$$ ififesg1g$g$g*;Ei) HH 6 Sflirni gi B EE'B'su Ag E S'nX.Be E+ u =qB.B, ar $Ee'e:. Hg :SdEs f3- SBUI9 EE N Ergg 1t E = 6'e. a;as gg slas; 3F $tg'E:3. oi h fii$$ ?$ $Sggs sE ;Et';r ?a si*H; Be $frEa ge Ng s' (\ ?1 (\ lr) (r) 2.5. GapaciQl building - Describe the adequacy of available hrowledgeable manpower at all levels. On the whole health personnel is lacking at all levels in quantity and quality. - Where frequent transfers of trained staffoccur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adeqnte CD77 implementationwhere not enough lmowledgeable manpower was qvailable or if staff arefrequently transferredduring the course of the campaign). Generally frequent transfer oftrained staffwas not a big problem; however in the health districts of Ako, Nkambe and Ndu a few staffwere transferred. Also some confessional health units in Kumbo East, Kumbo west, and Ndop health districts also experienced transfers. Retirement of old staffwho had been trained also a set back to CDTI implementation. When ever new staffwere transferred into the project area, they were rapidly trained on CDTI procedures. In some other places the health district deployed staffofthe district health service to help carry out activities in areas devoid of staff. 1,4 l$lSr IR- l,r. s S Oa S SrG \Si(!' G (\ r.(\F .S oU\;t\i €(! (\ s s 10o\ o tD (! (! E O 9og\ s H oH F t, o s U(D (D 0a O) o €c? Fl e Ed a 2,Fl 2. x ? E fd z X 2. U (i 2. U oFU E rnzo Xe? E o € rd(t) Fl X e? E o rrl OH Fd e z, U oz C) EU tr, 2, x e?rt Ed Fl ID o td ? E 2. U Ed tr EU E eFl Fo U O i f) F o \t t.) + s tJ) (.) (r) A u) { (+) (]) A (JJ 5 o\ o\ (Jt (,) Fl o z E'(t tDrt o U (A a la la s te .Da o (, \J o\ N) a t.) tJ b.J lJ) (, A o l+) t, o (, (JJ tJ UJ O 5 5 o N tJ Ot { o t, tJ o (,) (.) l' 5 A o t, tJ) I t, 5 N) s Ot o N N N (JJ o (+) u) 3 b .G >., o !t+ rO o\ (' o (! o -€\e \c(,) 5a(, o 5o 5N t') so N{ 5 N t+)A t)o Ur5 \o N (.)FT o\(,) u) (.)O t]) r.io zc du,tl E;iO 9EE9 tD (Dg t.)(D ort {\o qJ(n5 5(,(.J o o o o\ (,) A so N(.) UJ5 o @ @ t) (,) @ so (.) N5 N{ u) s 5 o 5 (.) tJ (r)5 { NN N)\o (.) N Ns H @ \o o HN N o @ ---i N) oo t) 5t.) o\ u) O o\ t.) @ Ot H{ t h Q. /^ :J 1E (\ + N N s a (D (! E(! I o o O O O o o o o o o O o O O o O o o H 6 z r:(D !9- E:r(Do .DEl'r Fld b=' tD q o o o O O o o o o o O O o o O o o o O o o O o O O o o O O O O o o O o o o o o o O o o o o o O O o o O o o o o o I u{ l^hi' s, E'^4+;_o nrE = t l' s a (! .D (DIt \o!,(,l s (.) b..){t. N)o\{ \oQ,T 5u) s(,ro @o t)o\o o\o \oo\ 5\t N)@ UJ(,{ 5@ N)Ur 00(,r {-J @ L'IO a'raB z v(D o oUU ao D9 (Do 5(,l(.) t-) o\ -I5 (.) t.){ o o (n \o No N) o\O t.J {s \o(,l @ HN{ (J)(,r 5@ t) o\5 5 N Ot, {5 {{ o\ (, o\ : UJ o\ o\ 5 A5 (n 00 (Jt {(,t \oo I 1,,, I : N) : tJ Nqrr o t\) o\ @ t..J{ 1 u)(rt -I I s u) o\\o N H\o N)(,J : tJ Llr u) L'T Lrro @(rr 6 (.,r o\ \)A N)5 s : {leJ N)\o Ot.) UJ = h H o t ! ii\c + d c cj o (/r + Although 3,127 CDDs were trained as shown on table 5, not all participated in CDTI. 170 abandoned their job. This left us with just 2,957 CDDs as those who effectively took part in CDTI activities. Details of the CDDs who effectively took part in CDTI district by district are shown on table 4. Table 6: Type of training undcrtaken 2.6. Treatments 2.6.1. Treatment figures If the proiect is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or lhe coverage rate isfluctuating, state the reasons and the plans being made to remedy this. Treatment coverage rate is increasing and well above 65Yo. However geographical coverage is not lolYo yet. In Wum health district due to inaccessibility two health areas (Furu Awa and Esu) have 18 untreated communities, 8 of which have neither had REA nor census. In Benakuma health district two endemic communities were not treated due to CDD attrition. The health districts of Wum and Benakuma are currently making arrangements for REA and census to be conducted in the I communities mentioned above. Plans are also underway to carry out treatment in the untreated communities. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political kaders Others(specifu) Program management x x Howto conduct Health education x x x x Management ofSAEs x x x x CSM x x x x SHM x x x Data collection x x x Data analysis x x Report writing x x x Others (specifu) l6 t:,l$ IG l.- G a h t: ,$ = E. os ts oA a G a4 q' ts -j -l - .-,(- a z zx @ F] z CX{ z C z o 7 L.J z ^ xe7 E o{ trJa -l xC o (r/ a -j C 2, oz o ttrtz xC7 -J o z -, X o -U .\3 -IUIt.) oooo L! o\ L'N) (,l5 l..J! N)o\ N)5 L,t\) 5(]) (}Jt, o\ N-)a ooo\ L,)o 5 A\o so\ o o)5 o l, -<o c c =5 -e d-eq:3 iQG jVc=E J'< =. I.+ ='UJ-^ -,i =o -trb G\ .r -lga f,og<3sE ,'G Pd=- oo> c s.= tr e =5 j;'# s 3' *a !.n3; R3 ^:crcro ci ilo\-g .vD U rio =-c6'g lt oa -IUI h.J oo @ (/) o\ (,J tJ A NJ --J. N) ."O| N)5 (,l,{ 5UJ t,) o\ I.JO @o\ t, 5 5\o." 5o\ -IA -J\o UJo\ t!tQ (,ls N){ tJo\ N)5 Uh{ Au) (J)(}J o\ @ ooo\ UJO 5O 5\o 5o\ \o 90 rrt s oo !c oo O Oo OO\o O\O6\ O\oo\ OOyO o\ O \o OO\oq\ O \o 9\ OO \o 10o\ \ao\ O O o\ $t {5\oo\ N)@\\o\o $l 5F(,l@(Jt coAU)oo 55"roo\t\) L,)(rr"5o\ (J)F\oN)5 !-.t\)"(*,s(r) UJ-.NJ"Nt\)A \o(JJN)\o\) (j)\os{LA o\Uh(Jl(,|\o (j)oot-J5 NJP{N)\) ,U)(,.l"(z.Oo\ LpL,l"A{oo r, o @5.-5oX 659 x !! =-lo <=.*l hv 5 Bg:; ^JV a'> ='6 5;4tc :'o Pd=-. z =E 5e-q GoYo *q O ,l o5Oir 6€DOocc(!=. o o\rll o (,r b,J b,J{\o Ur LA 'oo o\{ N)P (,l\o (}JPO N){ (JJ N) O tJ -ro O{ (]) 5{(J) tJF!\o N)5 "5 5\) (,l O o\5 N) N) "(/, (,l\] o\(n irJo oo 1...)S o\ UJ(JJ A(..l co\o l..JI o\ oo\) F(rr O\o N)F oo LN 5 \) oo(,)(n UI bJ -I\o5 ao (.,l N)\oO\o N)(/r\o t]) (].) O\o s UJ \] o\A (r) N) N)@ UJO\) ! N.) o\ o\tJ tJ(O^!@ s\o{\) o\ N) 5O oo tr @ oo o\\o L]) Ut 5\o A())O oo oo N) oo\o @ o\ N) ooo N)A(..l O N) -J oo *J(]) -IP -t s { 5 s {I o\ s ! l.J s { i.)yO o\ ! --J s o\ 90(/) s !(,) \oqO o\ ! bo\oo\ o\? @ ;: o\ o\ 5\o o\ o\F NJ\o o\ !SAqO 9\ o\(n \ -o o\ !Ifr)\o o\ ! 90(,l \oo\ !oa \oo\ {I N) s (, 6(,(, A{O UJ(JJ (JJ 5\] t\)L,I5 \o @ (/) N){\o t].)\o{ 5\] tJ) @(, ())L,I {\o(,r\o O(/)oo (]) b.J u) t\) UJ\o L.r oo oo(rr N) o\(/r (,! A oo 5GZ .i::) !cPA€Y33 &=8 SQ-"5X :a= 0 ac+ 6 b.J -Ira @ @ oo (/) Lrr{ t,J{5 oo 5 o\ t-J o\ tJ L,r 55\c(, O55 5O{+ qrr 5 @ N) (,) oo N) oo {\o I UJtJ \c o\ tJ) 5 @ @ N) t, A 55\c oo oo(,l -J czg= =cf.^ C O a a o C c O ",7'J) =2= ..- c O =?,;7^ - z <a;r'ig.=7.=7{)>iF.=.ii.=*!;.7_a* q: o \) .l oFt F'io (D \o :+ .g 5' o o oFt D' 0a(D >t D) (D o(D o 0cFt o,GEo6' 9) oo oE A' 0ao Ft A' (D Ho oo sd -ij @ @ r_t D) d(D s eFl o g, o @ o o- O\ l(,r Alryt.r lsr o'17 J-I L{ F 15u) l\o : ld(J) l-tr P l(D@t@ E l;\.,. d lE)r\ (DlclFr loH alOo Blc,o u-16-It 8lq r BI$i.J 6' lii\o olx(Tl- t+ lo6lo o, -(D 0- (D oo fc, (DEl Io 0-(D5 o s) F,(D 0llu + ri (D rc, >t €.(D o A'lr(D c, e -l c)\, se! \ sii tsEil ll .ss slla G6s DE! $.ns s3: Iss s ss $' €s *sst&N : -R$o s-rrE tSrc oa$s s'$R XGE F xs gJ8 eBG I-s.s s sE $EA E. E$ Fa:- Di bG itrs S EE i .o{ HB$ EQ: I\* S *"{ E !r t:- =R$stJls s$FStr. s(t* s<q.SGsTFEr{ :i.t&s' +ESoosR's.: -{s(\ c. FF G S6 - R E' 0! GI € s R. H E Oa 8 PF 3 6lS E alsl- - l(\ 3: ?l*ga sr9 F' oa E' !tAts 2,tii. ql =ta .+ 89O+ tsB o)AJE'tJ -(D (D6' 5c,)> E'EE#trt(D ooO t'+)5pr-#u(D o\ g, P. ur itro (Dg\ $) ':f F-l - if, p. AU' @-.E'30Q E/)B)- r, !:<d9p,k6 'c, oA)<>r (D Ed =(DHp <(D Eoq E1 EIji+ o-Qo: 0aE =riJ&ed\Ofo\ o-a{ =.(Da)ts:-. 6{(D (D Ft F) (D DD @ illtlt >I lL^ alZ.5lN) O lc'O\ l\f El lrJ -oo Lo rl&5. lr! ! l(D rotao S Ix ilf - ='loo slitJ o Pl= HI\Jll Z'lq'! E.IE:- oq 18{ -'lO-S 3lx5l-(Dlo Al^o'- E(DtIg 0'g o o o c ='(D(t){ I + (D €i €.(D C) p I(D p) dtx tENrt- SIIx ;lsc l'-r5 tlg"o HIeil :lE\o BIEa eltrh EIB.x glfi S ls-- vli(Dl-?[6(DIo 3 lthO-l+ s16c lsl5 lg. 8lx Hl=Ht^9IV i:(D(n o, an L*(D H(D o- d F tT,? o (D '6 e.(D C) o)rr (D a) $ ls >tzN)l{ H lH "dfx E l* Lrr lm ,l-r x tl$ . Erlo5 HlSo eh- - sla = slro\ 6lx t5lo As mentioned earlier in the report, vitamin A was distributed to children and post partum womenalong side Mectizan@' This iist.ibution was carried out in the non frontier health districts that didnot take part in NIDs' The table below details the data on vitamin A tablets distributed. Tabte 7.ii: showing ire.iTan@ distribution in hypo endentic cont ntunit ies district by d istrict. Health district No. treated 1 Ako 2 Bafut 2,990 .\ Bali 193 4 Bamenda 54,695 5 Batibo 6 Benakuma 7 8 Kumbo East 42,02I 9 Kumbo west 38,994 l0 6,170ll Ndop 5 96t t2 Ndu 12,0gg t3 ikwa l4 Nkambe 27,393 15 Santa 57 t6 Tubah 4,612 t7 Wurn TOTAL 252,465 Tuble 7.iii: Doses Vitamin A distributed in the non. health districts o.N of Vitam AIN sdo des uistrib dteHealth districts 6 -11 months t2-59 months Post-partum women 1 Ako 2 Bafut 767 3,933 4t2 J Bali 344 1,817 103 4 Bamenda 2,439 l0 684 50 5 Batibo 3lI 4 64 54 6 Benakuma 7 2,843 7 6 555 8 Kumbo East 2,379 7 109 564 9 Kumbo west 3,379 t2 l-79 i 362l0 I 097 2,841 428II N 3,342 13,073 698 t2 Ndu l3 N ikwa t4 Nkarnbe ls Santa 435 1,694 76l6 Tubah 236 I t3 232l7 \\/tun TOTAL I 9 I 65,922 1,534 Page I 9 2.6.2 What are the causes of absenteeism? -Farming -Transhumance -Job-seeking -Death celebration out ofthe community 2.6.3 What are the reasons for refusals? -Fear of side effects -Illness -Preference to alcohol since both are incompatible -Rumors of death from side effects -Period of class examinations -Skepticism about free drugs -Some religious beliefs (some Pentecostal churches) 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table E) the required information 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. No SAE case to report X No case of SAE was reported 20 U) z * 0ao V)(D x o1 da=H.st, dq(D oH) { zuigB E.N6P NOOH *gv 'ts i9R €(iH 0-=a.3 a 5E o h zsgsi( $Hregs F,T B. P ==E.oi)rl!ao - ;'i' Hro B'+gUbOirD) == 5 (D .7 :r 6'o -(D!a>n SP @ H 3 =AH *B - 6q E.'.qs6q o E11 €F da 6'(Dq 9. a rrlhvxgE g oc)htFo); HHEq9 t E'> e agx5e;4!- lJ IAF la- Ioo (a S. a4(\ U) .S ?2l! S aa) S G aG G(\ ra slaA ttr .car' s.S s()(: TG !t\ Oq S:.(s - €s\ Oe\(\\ s EG l-(\ S !!. s G s E u2 (! 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Ea H o I N)N 2.7. Otdering, storage and deliveqy of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MoH trxx wEo ! I]MCEF D NGDO Dxx Other (please specifu) Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH tr WHO trX UI\IICEF ! NGDO tr Other (please speci$): Please describe how Mectizan@ is ordered and how it gets to the communities Table l0: Mectizan@ Inventory @lease add more rows if necessary) - Comments From the tablel0 above it is noticed that the health districts ofBenakuma, Kumbo East, Kumbo West and Nkambe were given less tablets that they requested. This is as a result of the fact that on cross checking the coordinators realised that this did not match with their population figures and was far beyond the quantity of tablets they distributed last year. In addition to the 411,800 Mectizan@ tablets left over in the health districts after this year's Health District Number of Mectizant tablets Requested Received Used I-ost Wasted Expired Remaining AKO 55,000 55,000 49,340 0 373 0 5,287 BAzuT 90,000 90,000 74,579 l5 189 0 15,218 BALI 50,000 50,000 46,719 0 11 0 3 270 BAMENDA 405,000 405,000 249,394 0 994 0 754,612 BATIBO 121,500 121,500 l0l,95l 0 627 0 18,922 BENAKUMA 79,000 75,000 74,792 0 208 0 0 FUNDONG 155,000 155,000 151,933 0 282 0 2,885 KUMBO EAST 280,000 187,000 147,746 0 337 0 38,917 KUMBO WEST 300,000 271,000 220,262 0 565 0 50,173 MBENGWI 90,000 90,000 80,737 0 834 0 8,429 NDOP 235,000 235,000 209,179 0 588 0 25,233 NDU I12,000 112,000 101,633 617 342 0 9,409 NJIKWA 3J ,000 33,000 3 1,103 0 t9 0 1,878 NKAMBE 200,000 185,000 136,ggl 0 578 0 47,431 SANTA 1o4,275 104,275 95,824 4,904 394 0 3,153 TUBAH 90,000 90,000 75,973 32 163 0 13,832 WUM 149,000 149,000 135,231 0 6t7 0 13,152 TOTAL 21549,775 2,407,775 lrgg3,2E6 5,568 7rl2l 0 411,800 23 distribution 39,313 tablets were also remaining at the provincial level undistributed to the health districts. This makes a total of 451,113 tablets in stock for the next year's distribution. - How are the remaining ivermectin tablets collected andwhere are they kept? Cheifs of health centres collect left over Mectizan@ tablets from CDDs, reconstitute them into tins of 500 tablets, forward to the district that further reconstitutes and send to the North West Provincial Special Fund for Health (NWPSFH) for storage. - List and brieJly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Districts collect Mectizan from the NWPSFII and Health area chiefs collect from the health districts and share out to CDDs to distribute. - Any other comments 2.8. GommuniQr self-monitoring and Stakeholderc tleeting Has any training (of trainers) for community self-monitoring been done in the project qrea? If so, When? Training / re-training oftrainers for Community self monitoring was carried out in all health districts. Timing for this training is as shown in table 3 above. This training \ilas part of the routine training that took place at the beginning of the year's activities. Table l1: Community self-monitoring and Stakeholders Meeting District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) AKO 46 49 40 30 86 20 6l 33 43 57 24 26 26 39 30 24 0 BAFUT BALI BAMENDA BATIBO BENAKUMA FUNDONG KUMBO EAST KUMBO WEST MBENGWI NDOP NDU NJIKWA NKAMBE 0 6 24 86 16 86 6 54 4l 15 15 43 51 43 55 0 0 20 0 27 54 27 27 50 0 SANTA 32 3J 24 TUBAH 36 36 30 WUM 88 44 9 TOTAL 752 594 366 24 As your can see from table 1l above, ofiof 752 endemic communities 594 and366 conducted community self monitoring and stakeholders meetings respectively. It was not easy carrying out this activity as there no special funds allocated for it. Also some community leaders who chaired the meetings and monitors who did the actual work in the field requested for motivation just like the CDDs. Describe how the results of the community self- monitoring and stakeholders meetings have affectedproject implementation or how they would be utilized during the next treatment cycle. In some health districts CSM and SHM were done after distribution and did not affect this year's results. In these districts they claimed this has increased awareness of the community to onchocerciasis and to the CDTI progrilmme in general. They have also become more aware ofthe health needs and the role they as community members can play in the improvement of the health of their communities. The admitted CSM could be used to evaluate the effectiveness of not only CDTI but of other community health programmes like the expanded programme on immunization and the measles immunization campaign. During the debriefing meetings at the end of CSM exercise words of appreciation and encouragement that some community members gave to the CDDs and health stafffor their good work also served as a big motivation. We plan to build on the lessons learned about CSM and SHM this year in order to not only increase the number of communities carrying out the activities but in using their out come to improve on proj ect implementation subsequently. 2.9. Supervision 25 Central Level -NOTF -NGDOs (SSI, APOC) Provinciol Level -Provincial Delegate -Provincial Chief of Service of CommunityHealth -Oncho Project Coordinator -Finance Officer 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? - Some CDD were very motivated and did their work well while others as usual complained of late financial motivation from government and tedious nature of doorto door distribution. - Some CDDs do not understand who a member of a household is. - Some health staffcomplained of too many forms to be filled - Some chiefs of centres considered CDTI activities as part of their minimum package of health activities, other see it as either an isolated project or added load. - Inadequate funds for supervision of activities at district and health area levels. - Data collection tools, particularly registers were insuflicient in some areas. In other places these registers were poorly filled. - Some CDDs were found to administer wrong dosage of Mectizan@ 26 Heolth Districf Level -DMO -CBH -CBAF -CMO District Hospital Heolth Area Level -Chiefs of Health Centres Communitr Level -CDDs -Dialogue Structure members -Community mernbers - Late justification of funds and reporting on activities carried out. 2.9.3. 'Was a supervision checklist used? Supervision checklists were used more at the district level. Very few chiefs of centres used a supervision checklist while supervising CDDs within the communities. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Errors identified on the field were given on the spot solutions though corrective teaching depending on the identified problem. CDDs were encouragedto continue distribution despite the minimal incentives they received. 2.9.5. Was feedback given to the person or groups supervised? - As earlier mentioned feedback in the form of corrective teaching was given to the supervisees to ensure that the right thing was being done. - Such feedback were also given to health staffduring coordination meetings. 2.9.6. How was the feedback used to improve the overall performance of the project? - Mectizan@ stock management improved - Correct Mectizan@ dosages were given - Data collection tools were properly filled - CDDs were more motivated and felt better to continue doing their work SEGTION 3: Support to GDTI 3.{- Equipment Table 12: Status of equipment @lease add more rows if necessqry) Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle I F J F 9 F I wo 1 wo 2. Motor cycle(s) l0 F 23 F 10 F 7 CNFR) wo 3. Computer(s) I F l8 F 4 F I F 4. Printer(s) I F 18 F 4 F 1 F 5. Photocopier (s) 1 F 3 F J F 4 wo 6. Fax Machine(s) I F 7. Over head projeclor I F 8. Flip chart stand J F !) c) 27 *Condition of the equipment (F:Functional, CNFR{urrently non-functional but repairable, WO=Written off). How does the project intend to mqintain andreplace existing equipment and other materials? Submission of composite budgets to the state, NWPSFH and German technical corporation fund (CTZ) with provision for maintenance and replacement of equipment and materials. Pleas for assistance from local councils 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners forthe last three years Contributor Yanl (2004) Yar2 (2005) Yar3 (2006) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released lus$) TOTAL Cash Budgeted russ) TOTAL Cash Released rus$) MOH (Central + ProvinciaUstate) 187,050 190,006 237,522 237,522 208,123 208,123 MOH (DistrictllcA) Local NGDO(s) NGDO partner (SSf) 84,843 '149,456 62,829.8 58,498.7 67938.4 67,938.4 0thens a) b) Communities APOC Trust Fund 238,718 144,398 129,O99 100,867 84,882 52,694.87 TOTAL 5l0,6ll 4E3,E60 429,451 396,E78 360,943 328,756 - If there are problems with release of counterpartfunds, how were they addressedT There was a big problem in arrival of Government funds for motivation of CDDs. CDDs have only been motivated for years 20Q4 and 2005. Funds for 2QO6 are yet to be released. Even on release of funds for 2004 and2OO5, this is done very late; into the following year. By the time the funds get to the CDDs they already start agitating and threaten they may no longer carry out CDTI activities. When treasury cheque for payment of 2005 activities arrived the provincial treasury, release of actual cash was another problem. It took several months for this money to be paid and even when it was finally paid, this was done in bits, making distribution of the funds to the CDDs difficult. - Additional commenls The community did not give any direct financial contribution for support of CDTI activities for the year. 3.3. Other forms of communaty support - Describe (indicate forms of in-kind contributions of communities if any) 28 -In some areas food and drinks were offered to CDDs -In some places CDDs were exempted from community labour -In Mendankwe @amenda health districQ a CDD was given an umbrella by her community -A CDD admitted being given preferential treatment in hospital by health staff. 3.4 Expenditure per activityr Indicate in table 14, the amount expended during the reporting periodfor each activity listed. Write the amount expended in US dollors using the cttrrent (Jnited Nations exchange rate to local currency. Indicate exchange rate used here Table 14: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ us APoc) Expenditure ($ US) MoH Expenditure ($ us) ssr Drug delivery from NOTF HQ area to central collection point of community 84.46 Mobilization and health education of communities of CDDs 6,650.49 3,446.00 8,25r.23 Training of hgalth staffat all levels 10,894.56 9,271.00 5,912.32 CDDs and distribution 20,833.00 12,436.54 Internal of CDTI activities 3,922.33 visits to health and authorities IEC materials 28,74r.00 Summary (reporting) forms for treatment 750.00 Vehicles/ es/ bi es maintenance 6,410.67 15,287.85 Office e uters, etc Others *SIDE effect 3,565.00 *Personnel 6,213.59 136,962.00 2,524.27 *Evaluation 6,926.41 6,224.00 16,500.00 *Office Stationeries and supplies 2,438.83 2,746.00 1,992.81 *Communication 524.27 900.00 720.00 *Bank charges 266.36 282.65 TOTAL 43,790.18 208,123.00 68,654.46 Total number of percons treated Meso/hyper end emic conlnunities Hypo endemic communities Total 527,948 244.888 772,836 29 drugs Note: No funds disbursement was done from the Ministry but material were supplied and personnel made available Any comments or explanations? SECTION 4: Sustainability of GDTI 41. lnterna!; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) No Year 1 Participatory Independent monitoring No Mid Term Sustainability Evaluation _Not applicable _ 5 year Sustainability Evaluation No Internal Monitoring by NOTF Yes Other Evaluation by other partners At the end of Mectizan distributiorq evaluation meetings took place at the health are health district and provincial level. These evaluations meetings involved the main actors at each of these levels. One main issue raised during the evaluation was the late arrival of Mectizan@ to the project and inadequacy of transport means. 4.1.2. What were the recommendations? That Mectizan@ be made available to the project by January 2007. So that distribution should be over by April before farming starts. 4.L.3. How have they been implemented? Joint Mectizan ordering was made for all the Cameroon projects early enough to taking into consideration the distribution period requested by the community. +2. sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan wriuen? N/A When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 30 4.2.1. 4.2.2. 4.2.3 4.2.4. Planning at all relevant levels Funds Transport (replacement and maintenance) Other resources 4.2,5. To what extent has the plan been implemented 43. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery is already integrated into the provincial essential drug delivery system 4.3.2. Training Training is done in an integrated manner at district and health area levels. 4.3.3. Joint supervision and monitoring with other programs Supervision is done following a pre-prepared guide in an integrated manner at all levels. 4.3.4. Release of funds for project activities Funds are released differently since funding agencies and activity calendar differ per health programme. 4.3.5. Is CDTI included in the PHC budget? CDTI activities are budgeted for at district level but not in the budgets that come from the central level. At the moment advocacy is being made for CDTI activities to be included in the budget that come from the central level. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Expanded Program on Immunizatiory Malaria Control Programme, Tuberculosis control programme, Leprosy control programme and the Hry / ArDS control programme. The above programmes use CDTI structures to sensitize the population on their activities and look for drop outs. This is because they work in the same communities with the same population. 4.3.7. Describe others issues considered in the integration of CDTI. This year Vitamin A supplementation was carried out alongside Mectizan@ distribution in the non frontier health districts. It went on well and was highly appreciated by the communies. 4.4. Operational research 31 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out this year. 4.4.2. How were the results applied in the project? SEGTIOII 5: Strengths, weaknesses, challenges, and opportunities - List the strengths andwealcnesses of CDTI implementation process. STRENGTHS: -The joint distribution if Mectizan@ and vitamin A has contributed to the integration of health activities. -The yearly population updates during Mectizan@ distribution gives a near actual population ofthe communities which is not only used by the CDTI project but other community health projects in the province. -There is reinforcement of inter-sectoral collaboration amongst related services within the health districts. -The project has equally reinforced the spirit of community participation. -There is high acceptance rate of mectizan@ as a result of the following beneficial effects:- - expulsion of intestinal worrns. - improvement of sight and skin texturc - improvement ofthe general wellbeing - reduction / absence of side effects in people who had taken Mectizan@ before. -Adequate quantities of Mectizan@ in all health areas -Drop in the number of minor and moderate side effects, as the communities have become acquainted with them -A good coverage rates. -Provision of T-shirts and other Social mobilisation materials to cDDs WEAKNESSES - Lateness in reporting on project activities. - Improper financial justification of funds received for project activities. -Late motivation ofthe CDDs by government. - CDD attrition. - Cumbersome paper work - Getting treatment to the inaccessible communities of Wum and Benakuma health districts. - Prompt financial motivation ofthe CDDs by the government. - Inhabitants migrated to new settlements for new grazingor farming land. To overcome this, cDDs moved to these new settlements and treated the eligible population. - Reduction of CDD attrition. This can be reduced by advocating for the state to pay them their incentives promptly. 32 SEGTION 6: Unique fieaturcs of the proiecUother matters 1) The Province is predominantly English speaking 2) Traditional authority is highly respected. any mobilizationthat emanates from their end is highly acclaimed; 3) The drug delivery mechanism is highly developed; hence the delivery of Mectizan@ throughthe NWPSFH is an asset and favourable point towards sustainability. The dialogue structures are a major partner ofthis fund. 4) The main ethnic groups in the North West Province include; -The Widikum occupies Momo, part of Mezam and part ofMenchum divisions. -The Tikaris Occupy part of Mezam, Ngoketunjia and Bui divisions. -The Wimbums/Yembas occupy Part of Bui and Donga/Ivlantung divisions. -The Aghems occupies most of Menchum division. -The Koms occupy all of Boyo division -The Lamnsos occupy Bui division -The Fulanis are dotted all over the entire project area. It should be noted that to get to the different divisional head quarters you must go through Bamenda the provincial headquarter which is centrally located. JJ