North West CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2008 to December 2008

I at i .l Proiect Name: NORTH WBST CDTI PROJECT COT]NTRYA[OTF: CAMEROON Launching vear: 2003 Anproval vear: 2003 From: fanuary 2008 Toz fune 2008Reportine Period: MONTTYYEAR Proiect vear of this renort: (circle one) I 2 3 4 ( 5) 106789 NGDO oartner: s(ners Internationol Date submitted: FIN Arrivd REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROON MINISTRY OF PUBLIC HEALTH MINISTERE DE LA SANTE PUBLIOUE STGHT SAVERS INTERNATIONAL SIGHT SAVERS INTERNATIONAL NATIONAL ONCHOCERCIASIS CONTROL PROGRAM PROGRAMME NATIONAL DE LUTTE CONTRE L'ONCHOCERCOSE NORTH WEST PROVINCIAL DELEGATION FOR PUBLIC HEALTH DELEGATION PROVINCIALE DE LA SANTE PUBLIQUE DU NORDOUEST CDTI PROJECT- NWP PROJET TIDC NORD OUEST NORTH WEST CDTI PROJECT YEAR 5 MID.TERM PROJECT TECHNICAL REPORT SUBMIfiED TO TECHNICAL CONSULTATIVE GOMMITTEE (TCC) DEADLINE FOR SUBM SSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 3{ Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCER * -&q €h&H b6 tssJ {-Jo k o;r I 0 sEP, 2008 A ..M ss p I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to the report: t I Country. CAMEROON National Coordinator Name: Dr Ntep Marcelline Signatu Date: p. 1).O g./Acting Provincial Delegate Name: Dr Odil Tcheku Signatu Date: Name. Mr. re NGDO Representative Signatu Date .. /A o+ uo bPs' sE' Provincial Oncho Coordinator Zonal Oncho Coordinators; Dr. CHE SOH Kings Mr Akiumbeni Mon ieu, Mr Tangwa Patrick, Mr Tekwe Thomas, Mr Geh Oscar This report has been prepared by Dr. CHE SOH KINGSLEy, Mr Akiumbeni Montesquieu, Mr Tangwa Patrick, Mr Tekwe Thomas, and Mr Geh oscar Designation: Oncho Coordinators Date ...11107108..... NWCDTI PROJECT MID TERM REPORT, 1I JULY, 2OO8 Table of contents DEFINTTrONS................. 5 FOLLOW TIP ON TCC RECOMMEI\DATIONS....... .................6 EXECImTyE St MMARY............... 7 SECTION 1: BACKGROUND INFORMATION........ .................8 Ll. GpNSRAL rNFoRMATroN................ 8 1.1.1 t. t.2. Description of the project (brietly) Partnership ..8 .14 l5t 1.2 PopularoN 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.5. project? 37 SECTION 3: SUPPORT TO CDTI......... SECTION 2: IMPLEMENTATION OF CDTI...... ........ t7 2.1. TtuelrrueoFACTrvrrES...............,. .17 ColalaeNrs ........... t9 2.2. AovocecY ............... l9 2.3. MoertrzRttoN, sENSlrzATroN AND HEALTH EDUcATIoN oF AT RtsK coMMUNTIES ............... l9 2.4. COtvfr,tUrutry |NVOLVEMENT................ ..........21 2,5. Capacrry BUTLDTNG ..................22 2.6. Tnenruerurs...... ..................25 2.6.1. Treatment figures....... .....252.6.2 What are the causes of absenteeism? ................29 2.6.3 What are the reasons for refusals?................ ......292.6.4 Briefly describe all known and verified serious adverse events (SAEs/ that..........29 2.6.5. Trend of treatment achievement from CDTI project inception to the cunent 2.7. ORDERTNG, sroRAGE AND DELTvERv oF IVERMECTIN......... .................32 2.8. CoutuuNrrv sELF-MoNrroRrNG Rlro STRxEHoLDERS Mgertruo .......34 Cotrruunrrv sELF MoNrroRrNG rs srLL To BE cARRTED our. ..........35 2.9. SuprRvrsror.r 35 Provide a flow chaft of supervision hierarchy ....,..................Jj What were the main issues identified during superuision?.......................................36 Was a superuision checklist used?........ ............36 What were the outcomes at each level of CDTI implementation superuision?.......36 Was feedback given to the person or groups superuised?.......................................37 How was the feedback used to improve the overall pertormance of the 37 .....37 2 3.1. Eourpurrur NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 3.2. 3.3. 3.4. FtrueructRl coNTRIBUTtoNS oF THE pARTNERS AND coMMUNtIES Ornen FoRMS oF coMMUNtry suppoRT ....................... ExpEruotruRE PER Aclvtry.... Planning at all relevant levels.... Funds Transport (replacement and maintenance) .......... Other resources To what extent has the plan been implemented.. 38 38 39 40 40 SECTION 4: SUSTAINABILITY OF CDTI.. 4.1. lrurenrunl; TNDEpENDENT pARTtctpAToRy MoNtroRtNG; Evnlunrtoru. 4.1.1 Was Monitoring/evaluation canied out during the reporting period? (Tick any of the following which are applicable) ........... 4.1.2. What were the recommendations? 4.1.3. How have they been implemented?.............. ....40 ....40 ....40 INTEGRATION .......... 43 STIPERYISION/NIONITORING .........,...44 TIt MAI\ RESOURCES............. 45 coyERAcE............... ............45 4.2. SusrntrunatLtrY oF eRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT Yn 3) ...................45 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3.1 4.3.2 lvermectin delivery mech anisms Training.... /t ..,....,.........45 .................46 .................46 .................46 ...............46 ................46 .......,...,..,.46 .,..,...........464.3.3. Joint superuision and monitoring with other programs,4.3.4. Re/ease of funds for project activities... ................46 4.3.5. ls CDTI included in the PHC budget?............. .....464.3.6. Descibe other health programmes thaf are using the CDTI structure and how this was achieved. What have been the achievements?......... 47 Other programmes using CDTI structure include 4.3.7. Describe othersissues considered in the integration of CDTI. ...47 ...47 4.4. OpennroNAL RESEARcH ,.,,,.47 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the repofting period. ..................47 4.4.2. How were the results applied in the project? ......47 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES...........47 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS..... 49 J NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 Acronvms APOC lRfri.an Programme for Onchocerciasis Control ATO lnnnuat Treatment Objective ATO hnnual Training Objective CBO lCommunity-Based OrganizationCDD lCommunity-Directed Distributor CDTI lCornrrnity-DirectedTreatmentwithlvermectin CSM lCommunity Self-Monitoring DO lDivisionat Officer EPI lgxpanOeO Proqramme on lmmunization LGA Jtocal Government Area MDP lMectizan@ Donation Programme MOH lnainirtry of Health NGDO lNon-Governmental DevelopmentOrganization NGO lNon-Governmental Organization NOTF lruiiion'rronchocerciasisTaskForce NW lNortn West Province NWPSFH lf.fortn West Provincial Special Fund for Health PDPH lProvincial Delegation of Public healthPHC lFrir..v n"alth care REMO lRapiO Epidemiological Mapping of Onchocerciasis sAg ls"*r" roverse eventSDO lsenior DivisionalOfficerSHM lStrf"notO"rs meeting TCC ilni.=t conrrltrtive committee (APoc scientific advisory lsroup) TOT lTrainer of trainers ururcEFltlnit"o rurtions Children's Fund UTG lUnimate Treatment Goal WHO lWortO Health Organization 4 NWCDTI PROJECT MID TERM REPORr, ll JULY,2OO8 i Definitions (i) fqtal population: the total population living in meso/hyper-endemic and census taking).communities within the project area (based on REMO (ii) Eliqible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) I Treatment Ob (ATO): the estimated number of persons living in meso/hyper-endemic areas that a cDTl project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3m year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraoe: 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). (vii) lnteqration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDT! activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitorinq (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. a 1 5 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 a 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 TCC RECOMMENDATIONS ,ACT'ONS TAKEN BY THE PROJECT FOR TCC/AP OC MGT USE ONLY APOG Related ThatAPOC should assist CDTINW project to determine the exact number of communities in the project area. No action has been taken yet Pioiect-reldtiid - lncrease the involvement of communities by engaging some members as community supervisors; - Accelerate the attainment of full geographical coverage by using altemative strategies to reach the remaining 1 8 difficult-to-reach communities; - Address the issue of high number of absentees; - Release allocated funds by the government directly to the programme (apart frorn government salaries). - The plan tor thE training of community supervisors has been proposed to APOC as an urgent activity for technical and financial assistance - Strategies are being sought to treat remote communities in Wum health district. Advocacy is ongoing to mobilize resources to be able to treat in this area. A plan has been drawn on how to proceed and this has also been included in the provincialthree- year sustainability plan - IEC has been intensified and the distribution extended to ensure treatment of absentees - Advocacy is continuing. Funds are already being disbursed by lower levels ( Health district and First Line health facilities), but this is still timid at higher levels 6 NWCDTI PROJECT MID TERM REPORT, 1I JULY,2OO8 I t a Executive Summary The North West CDTI project which was lunched in 2003, is in its fifth year of implementation. Presently, the project covers 768 meso/hyper - endemic communities in the North West province which has a total population of 1206943 inhabitants. Treatment with mectizan is being carried out only in 750 of these communities with the exception of 18 communities in the Furu-Awa health area of the Wum health district. The Annual treatment objective for 2008 was planned at 70% of the total population, i.e 844861, while the ultimate treatment goal was estimated at642720.The populations in the various communities where treatment is carried out were more or less stable this year with no noticeable movements. The training and retraining of CDDs started in most health districts in April, 2008. Partial training figures show that 4565 CDDs were trained, while training reports are still pending foi some districts. However, no training for health staff was carried out during the first semester of the current round. The major challenge that was faced by the project is the inability to begin treatment in the 18 meso/hyper-endemic communities of the Furu-Awah health area in the Wum health district. Consequently, this has been included in the project's three-year sustainability plan, which will be submitted with this report. a 7 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 SECTION 1: Background information '1.1. General information 1.1.1 Description of the project (briefly) A. Geographical locations and administrative area(s) The NW CDTI Project covers the entire North West Province. ln 2007 the total censured population in meso/hyper endemic communities for onchocerciasis was 765,044 inhabitants. The province has a total surface area of 17,500 km2. The North West Province is made up of 7 divisions and 31 sub-divisions. The province has 18 health districts and 189 health areas. Table A: showing administrative units, heatth districts and health areas within the project area Divisions Health Districts Health Areas Mezam Tubah (7 H/A) Bambui, Bambili, Kedjom-Keku, Sabga , Kedjom-Ketinguh, Kwishe, Tikebenq Bamenda (13 H/A) Azire, Nkwen Urban, Nkwen Rural, Mankon , Nkwen Baptist, Mendankwe, Ntamulung , Alabukam, Mbachongwa, Ntambag, Atuakom, Mulang, Alakuma K, Santa (e H/A) Mbu, Menka, Akum, Ndapang, Buchi, Baligham, Pinyin, Santa Urban, Awing, Bafut (e H/A) Manji, Nsem, Mbakong, Mambu, Mforya, Buwe-Burari, Mundum, Akofunguba, Mankanikong, Bali (6 H/A) Bali urban, Gungong,Bossa, Bawock, Catholic mission,Wosing, Momo Batibo (13 H/A) Batibo, Guzang, Tiben, Larinji , Kulabei, Gwofon, Widikum, Bifang , Ewai, Ashong, Olorunti,Eka, Kugwe, Mbengwi (15 H/A) Andek, Teze, Tinechung, Abebung, Njah-Etu, Acha-Tugi,Bome, Njindom, Munam Mbengwi, Ajei, Ngyen-Mbo, N[94{vlengom, Azem, Etwii Njikwa (6 H/A) Njikwa, Bassa, Kuttin, Konda, Oshie, Akanunku 8 NWCDTI PROJECT MID TERM REPORT,1l JULY,2OO8 Ngoketunjia Ndop (14 H/A) Babungo, Baba, Bamunka urban, Babessi, Bangolan, Bamunka rural, Bamali , Balikumbat, Bamessing,Bafanji, Bambalang, Mbissa-Mbaw, Bamunkumbit, Mighang-Mbaw Boyo Fundong (11 H/A) Konene, Aduk, Mbessa, Fundong, Anyajua, Belo, Mentang, Mejang, Mbengkas, Kikfuini, Fuanantul Menchum Benakuma (8 H/A) Beba-Batomo, Befang, Benakuma, Bawuru Modele, Okoromanianq Benade, Benabenge Wum (12HtA) Furu-Awa, Abar, Bu Bafmen, Esu, Yemnge, St Martin, Kumfutu, Weh, Wum Urban, lse Bui Kumbo East (1e H/A) Mbah, Kwanso, Shisong, Sop, WasiBer, Mbokam , JakirilHC, JakiriCMA, Tatum, Mbonso, Mbiarne, Vekovi, Mbam , Wvem, Wainama, Dzeng , Ngorin, Ngehndzen, Nkar, Kumbo West (17 HtA) Kumbo, Elak-Oku , Jikijem , Kikaikom, Melim, BBH, Kevu, Nkor, Buh*, Kuvlu, Djottin, Nkum Kov, Ngeptang, Simon Kov, tchim, Kitium Donga & Mantung AKO (5 H/A) Abongshie , Ako , Akwaja, Berabe, Kuta Nkambe (10 H/A) Nkambe urban , Misaje , Fonfuka Tabenken, Dumbu, Buabua, Kom, Lus, Binka, Mbot Ndu (15 H/A) Luh, Ndu, Mangu, Sop, Ntumbaw ,Gom, Ntem, Ntong,Mbongong, CBC, Mbiye, Nsam,Ngu, Nwa, CTE (Kakar) Divisions / Sub- divisions Health Districts Health Areas Mezam Bamenda Santa Tubah Bali Bafut Tuba (7 H/A) Bambui Bambili Kediom-Ketinguh Kedjom-Keku Sabga Kwighe Tikebeng Bamenda (13 H/A) Azire Nkwen Urban Nkwen Rural Mankon Nkwen Baptist Mendankwe Ntamulung Alabukam Mbachongwa Ntambag Atuakom Mulang Alakuma K Santa (e H/A) Pinyin Santa Urban Awing Mbu Menka Akum Ndapang Buchi Balisham Bafut (e H/A) Manji Nsem Mbakong Mambu Mforya Buwe-Burari Mundum Akofunguba Mankanikong Bali (6 H/A) Catholic mission Wosing Bali urban Gungong Bossa Bawock Momo Batibo Mbengwi Niikwa Batibo (13 H/A) Ewai Ashong Olorunti Eka Kugwe Batibo Guzang Tiben Larinji Kulabei Gwofon Widikum Bifang 9 NWCDTI PROJECT MID TERM REPORT, 11 JULY, 2OO8 Ngie Wrdikum Mbengwi (15 H/A) Andek Teze Tinechung Abebung Njah-Etu Acha-Tugi Bome Njindom Munam Mbengwi Ajei Ngyen-Mbo Nkon-Mengom Azem Etwii Njikwa (6 H/A) Njikwa Bassa Oshie Akanunku Kuttin Konda Ngoketundja Ndop Central Balikumbat Babessi Ndop (14 HtA) Babungo Baba Bamunka urban Babessi Bangolan Bamunka rural Bamali Balikumbat Bamessing Bafanji Bambalang Mbissa-Mbaw Bamunkumbit Miqhano-Mbaw Boyo Belo Njinikom Fundong Bum Fundong (11 H/A) Konene Mbessa Belo Mbengkas Aduk Fundong Mentang Kikfuini Anyajua Mejang Fuanantul Menchum Wum Fur-Awa Fongum Menchum Valley Benakuma (8 H/A) Beba-Batomo BefangBawuru Modele Benade Benabenge Benakuma Okoromanjang Wum (12HtA) Furu-Awa Abar Bu Bafmen Esu Yemnge St Martin Kumfutu Weh Wum Urban lse Bui Kumbo Jakiri Oku Mbiame Noni Kumbo East (1e H/A) Mbah Kwanso Shisong Sop WasiBer Mbokam JakirilHC JakiriCMA Tatum Mbonso Mbiame Vekovi Mbam Wvem WainamaDzeng Ngorin Ngehndzen Nkar Kumbo West (17 HtA) Kumbo Elak-Oku Jikijem Kikaikom Melim BBH Kevu Nkor Buh* Kuvlu Djottin Nkum Kov Ngeptang Simon Kov lchim Kitium Donga & Mantung Nkambe Central Ako Ndu tlwa Misaje AKO (5 H/A) AkwajaAbongshie Berabe Ako Kuta Nkambe (10 H/A) Nkambe urban Fonfuka Binka Dumbu Kom Misaje Tabenken Buabua Lus Mbot Ndu (15 H/A) CTE Luh Ndu Mangu Sop Mbiye Ntumbaw Gom Ntem Nsam Ngu Nwa Ntong Mbongong GBC B. Topography, climate, access The bioclimatic zone of the Northwest province is mainly Sudan savannah grassland, with plains, rolling / steep hills and valleys. lt 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 l0 NWCDTI PROJECT MID TERM REPORT, l' JULY,2@8 sometime interrupted by falls all contributing to highly aerated waters which make a good habitat for Simulium, the vector of Onchocerca volvulus. The rains begin in March and are very heavy in August through October, followed by a short dry season. The roads, mainly dirt roads become impracticable during this period. Farming is 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. C, Communication Sy stems Of the 3291 km of road network in the province only 187 km are tarred the rest is rnade 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, Benakuma, Njikwa, Nwa, Nkambe and Ako. D, Population: activities, cultures, lang uage 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 rearers who are nomads The ethnic groups are the Widikum, Fulani, Tikari, Bali, Ngemba, Aku, Essimbi, Beba, Aghem, Njikwa. 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. E. Administratio n str ucture The communities of the Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and highly respected. Each clan / family has a family / clan head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the community. n NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 F, Health system & health care delivery The North West Province has the following health facilities; . 1 provincial Hospital . 18 health districts services , 14 district hospital . 5 private (confessional) Hospitals (some of which serve like district hospitals) . 19 Sub-divisional medical centers (CMAs) . 200 integrated health centers (152 are state owned and 48 are private) , l4l community pharmacies , 12 commercial pharmacies . Several illegal patent drugs stores t2 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 G, Number of health staff in project area and number of health staff involved in CDTI activities. Number health st, involved in CDTI Number of health staff involved in CDTI activities. Health District Total Number of health staff in the entire project area Number of health staff involved in CDTI Percentage 1 AKO 30 17 56.7 2 BAFUT 113 42 37.2 3 BALI 47 18 38.3 4 BAMENDA' 155 74 47.7 5 BATIBO 122 42 34.4 6 BENAKUMA 25 17 68.0 7 FUNDONG 399 46 11.5 8 KUMBO EAST 83 70 84.3 o KUMBO WEST 168 67 40 10 MBENGWI 88 41 46.6 11 NDOP 74 43 58.1 12 NDU and NWA 103 38 36.9 13 NJIKWA 33 33 100 14 NKAMBE 67 36 53.7 15 SANTA 58 28 48.3 16 TUBAH 88 27 30.6 17 WUM 84 41 48.8 Total 1725 639 37.0 13 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 1.1.2. Partnership The partners involved in CDTI implementation in the North West Province are as follows: -lntemational partners: APOCMHO, Sight savers lnternational and MDP -National level: Ministry of Public Health. -Provincial level: PDPH-NW, NWPSFH, Provincial Hosp Bamenda. -District level: District Health Services, District Hospitals, Confessional hospitals. -Health Area level: lntegrated Health Centers, confessional health centers -Community level: Dialogue structures members, CDDs, Social Mobilisers, Opinion leaders, Local Council members, chiefs/fons, quarter heads etc. There is good collaboration among allthe partners involved in CDTI implementation. The Ministry of Public Health provides the health staff for the programme; they are responsible for managing the day to day running of the programme. APOC provides funding and logistic support. Sight savers lnternational provides technical support, logistic support and funding. The community is responsible for fumishing the programme with Mectizan@ distributors (CDDs) and health committee members (the dialogue structure members) who all contribute to the smooth functioning of the programme at community level. Localadministrative authorities (The Governor, Divisional and Sub-Divisional Officers, District Heads, mayors as well as traditional leaders and quarter heads), religious authorities, have always been involved in the implementation of project activities. They have always assisted in social mobilization of the communities and in increasing adherence of community members to taking Mectizan@. As has been the case since the launching of this project, these dignitaries will continue to be utilized for the successful implementation of project activities. t4 PROJECT MID TERIfr REPORT, 11 JULY,2OO8 ,L 6ooN s Eq H ta-oo = = |r) gE IUtr A EEEP - Lrn-,JaJ\rrv rN@ N s o,(f) o !t o,tt 1() @ ro @(o o N(f) ro (a N@(a (f) roNl-lol- l-lo(oloN (o o)No(o N(o (f)o(o o o) o)(f)s lo ro$l-(f, @(o N(o (o(o N o) cf, o ro(o rr)(f) o @(f) rif (f) oo(o (f) N oNi\ N{(o trl o EL>o s fi* e -o:troFtrON F-(f)o(o N $f-(o F-(f) t-@N N ro(f) o) los lr)$(f) (f)(o (o(o N os o,$ o O) srt ro o(f) (o (f, o,oI- rlo r(o (f) (f) rf) f.- rto N O)lo .trt F-(o(a O)r o)oI-(o$ s$- N!t @N o, os + o, (o l-@ @(\t o, o)N tro'-r.F E $f e$ ss rss-(o r (f) rO o)(a N cf) @ O) lo lr) sf(o @ t- .f rO o,N @(f) o,@(f) .f N lo .t- cf) t-l-or$ NNN @r N$los (o (f)(o os lo rO 1() @NN(o N o,r o) @ c\l o$ ro .f r N!t(o- rf) (o N!t tf tt o o 8EO-O 'I.! r-. 3f s s (o o,[o o, N$ (f) rto @_ o o) ryt- CO @NN o, r-(o N o(o F- ro(o (f) o,o F*N @ ro @ o,N o,N o, r* r Nt*s o) ro o)(", N rr) @(o F @!t- oN c\l c{ ro ro (o @(a @N t- F- o) ro(I) No tO_ NN(e o gR >(, E a€ FE0, 9E =oNo- .eE4Eo &€s s5'l- a Lr o.= aE 8E o-G 'I .! .r. !; n g tr tr oo f E E oo o L olt E z los @$ o$ (o (o@ (oN r(o (f)(a (o$ @lf, $N (oN t-N $lo (f)(f, (oa? F-o) GO(ot\ (f, NN rO N Ni.- o, lo - (a roN (a(a r (f)N N F(f) o) N $rr) dl,o!+ \f r (o c\l roN $N rt l- (os o(e roN (f)N cf) (o (oN $r rtc! (o\t tO(o F' otr.co+, .q ,.8 == EO- ti & - E'g'uF CL.= o CL(E N cf)o(o N r(o os @ cf)(f) @ r N@ ro Nr lo$(f, co(o (o(o N o sf o)rf o O) |,-(f) @ F* o, N (f)(a r Nr @ lr)!t lolo ro o)(o ss@o @ r t-(o (f) o, (o rO @ o) N(o rO (f)(o @N O) os N(o @- F* @ 0(, st C')(oo(\1 oox.= .=E q E,Ho ox -ts oi-i O o.= o. oY F-f LL c0 = co oz LrJ tr] o co tr c0 :)Y z UJ m oz oozf TL Fa UJ o m fY F U) tu =o m f)< = (, z tu m L ooz Bz Ec(I, loz = Y =z [! tr] Yz Fz a I d)fF ) = F oF o obo o o e G o d E G E o o .\ o B $ ca o L \oo tr oEf IE -3c oE IN IF oo Uto o-LJ o- o)c cc(U o- Lo o =IfL :flt o lvt(El<y a oE :lE .tr c o (! f o- o o- .9, .r-I * N W* a census for the project done during the reporting period? Yes, Census / registration update is still ongoing and being carried out by CDDs alongside Mectizan@ distribution. Given that these activities are still taking place, updated population figures for 2008 can only be available after the health district appraisal meetings in August 2008. NB. A oommunity is made up of a group of people living together under a common leader within a particular agglomeration. This leader could be a Fon, chief or even a quarter head. Sometimes the number of people serued by a CDD is considered a community. ls trere any other information of interest about the population in the project area? lf so, include it here. There were some other health programs like the Mother and Child Health week, in February 2008, and the distribution of long lasting insecticide treated mosquito bed neB to children (0-59 months), in April, 2008. These caused a delay in the start of implernentation of CDTI activities for the current year. I 16 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 I SECTION 2: IMPLE iIENTATION OF GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. This year's activities started in January, 2008 with HSAM but were interrupted during the months of February and March, 2008. Training and re-training of CDDs was done in April and May, 2008. Distribution of Mectizan started soon after training in the same month of April, 2008, and is still ongoing. (See table 3) I t7 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 6oo(\ >. -l5 l-'coq. UJt Etr!!t\ o =l-ot! -totrq- oo cg o E ooJo 9- EEo.o EEo-o- ol .E o o, c o CD .E oq) c o C,,c '6 o) c o o)c '6 o, c o olE '6 o) c o o)c '6 o, c o o)E 'o o, c o C,,C o o) c o o)c o(,, E o o)c o(,, E o t,)c o ol c o o)c 'o o) c o o,c o o) c o o)E o(,, c o o)E o o) c o o) .Eo o, c o o)c o o)C o o- EE EP @ooN i o .-, @ooN c o -) @ooN c o -) @ooN i o -) @oo c\l c o -1 @ooN i o --) @ooN i o ') @ooN c(E - @ooN i o -) @ooN i o -) @ooN i o --) @ooN c(! -, @ooN i N - @ooN c o -) @ooN i o - @ooN c(It - @ooN c o -., tr o JIl ottd =ol 9- EEoo EEo-o- o)C '6 CD c o o) .c o o) c o o) .c o o, c o o)c '6 O) c o (,, C o o! c o o) .c o ED c o o) .E o o, c o o) .g o o, c o o) .C o o, E o o)c '6 o) c o o)C '6 o) E o o) .c o o) c o o)c 'o o) c o o, .s o o, c o o) .c o o) c o (,, E '6 t,, c o o) .C ot,l E o o- i=eiso\ @oo c{ 'tr o- @ooN .E o- @ooN L o- @ooN '=o @ooN .E CL @ooN 'tro @ooN L o- @ooN .E o @ooN: o- @ooN 'tr CL @oo c! .E o @ooN J CL @ooN .E o- @ooN J L o- @ooN .E o- @ooN L o- @ooN J o- o (Ut, Ctf o =1r, cl ol ol 9- EEeoEEo-(r- o)c '6 o, c o o, .s o o) c o o) .E o o) c o o, .co o) c o o,c '6 ol C o o)C '6 ol c o o) .E o o, c o o, .c o o) co o)c '6 o) c o olc '6 o, c o o,c o o) c o o)c 'o o, c o o) .c o o, c o o)c '6 o, c o o)c o o) co o) .c o o) c o CD .c o o) c o D5)\ o-EE EP @oo ol .C o- @oo C\l 'C o- @oo ol 'tr o- @oo ol .E o- @ooN 'tr o- @ooN 'tro @ooN J L o- @oo c\t 'tr o- @ooN 'tr o- oooN 'E o- @oo c\t 'g- o- @ooN .C o- @oo6t 'tr o- @oo c\I 'tr o- @ooN .E o- @oo c{ 'L- CL @oo c{ L o. Ec E .EL]Fi 9- EEeoEEo- @oo c\t 'tr o. @oo c\t 'tr o- @ooN .E o- @oo C\l 'tr o- @ooN c, @oo N 'tr o- oooN .E o- @ooN .E o. @ooN 'tr o- @ooN .E o- @ooN 'tr o- @ooN 'tr o- @ooN .E o- @ooN 'tr o- @oo ot 'L- o- @oo c{ 'E o- @oo(\T 'tr o- P-c EEE9o- @ooN 'tr o. @oo c! .E o- cooo c{ .C o @oo c{ o. @oo c\I .E o- @ooN J o- @oo N .C o- @oo ol 'tr o. @oo c{ .E o- @oo ot .E o- @ooN .E o- @ooN o- @ooN J L o- @oo ol 'C o- coooN J L o- @oo ol J Lo @oo c! 'tr o- oo -oo= 6fNE =EttEoo =(, 9- EEoo EEOao- o) .c o o) c o o)c '6 o) c o o)c '6 o, c o o)c o o) c o o, .c o o) c o o, .E o o, c o o)c o o) c o o)c o o) c o o) .E o o) c o olC '6 o) c o o) .E o o) c o o) .co c,, c o cn .E o(,, C o o) .E o o) E o o)c '6 ul c o o) .s o o, c o o) .tr o o, c o ED- Ets E8o' @oo6t c o -) @oo ol c o -) @ooN c o -, @ooN c o -) @ooN c(! -) @ooN c o 'a @ooN c o -) @ooN c o -) @ooN c o -) @ooN i o -) @ooN i o -) @ooN c o --) @oo ol c(! _, @oo6t c o -) @oo c! i o - @ooN:L o - @oo(\t i o -a (9 o p o oY Ff 1r co = d) oz tu (D o(D tr (D fY z ]U(D oz ooz :) LL F U) ]U o(D =lY Fo uJ E o co lY = C2z LUo (I ooZ =zoz loz EY -z tu co Yz F-z a I cofF f = o o\ o o Eo G E ta Go G o \ € oo >l otGI o o o i: a L Comments As has been the tradition, registration update and Mectizan@ distribution are both being canied out by the CDDs. ln addition to CDTI the CDDs also measured visual acuity of every body they recorded in their registers. Persons with visual acuity less than 6/18 or any other eye problem were referred to the nearest eye clinic. ln allthe health districts, Mectizan@ distribution is currently being rounded up. Alongside Mectizan@ distribution, supervision and management of side effects as well as community mobilization are also carried out. 2.2. Advocacy Sfafe the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertahing the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. Most of the health districts did advocacy with administrative authorities. They held rneetings with the senior divisional officers and the divisional officers as well as heads of other government administrative services, traditional chiefs and religious leaders. The administrative authorities' inturn ordered the chiefs and quarter heads to cooperate with health staff as well as organize their various communities to ensure maximum adherence to treatment. Difficulties faced in carrying out advocacy meetings included the following: Some administrative authorities would not willingly attend such meetings without being given a tip; some money for fuel. Time was not usually respected and the health staff had to make several trips to the offices of the Senior Divisional Officer (SDO) and Divisional Officer (DO) while organizing such meetings. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local sysfems fo drbseminate information Many health districts made use of their local FM radio stations for health education, sensitisation and community mobilisation. The messages broadcasted were either in English, Pidgin English or vernacular languages. The health districts of Nkambe, Ako and Ndu used the Donga Mantung Community Radio. HESAM messages broadcast by the North West Provincial Station of the Cameroon Radio Television were received t9 NWCDTI PROJECT MID TERM REPORI, 1I JULY,2OO8 throughout the whole Province. CDTI health education messages were given along side messages on other health programmes (malaria, and EPI) Mobilization and heatth education of communilies including women and minorities Within tre health areas, mobilisation and health education is being carried out by the health centre staff, dialogue structure members and CDDs. Churches, schools and socio cultural meeting groups were also used for dissemination of CDTI information we encourage the recruitment of more female CDDs in many of our communities. Response of target comm unities/villages Target communities generally responded very well to HESAM. However this response has never been 100% as some individuals have remained very resistant to health education messages on CDTI. However the acceptance of Mectizan has greatly improved in many of our communities. Accomplishments HESAM was done but usually not 100% accomplished in all communities. The most common complain given by the health staff was the inadequate means of transport. All the targeted CDDs were trained. Suggest ways to improve mobilization and sensitization of the target communities. 1) Ensure that in every Moslem community male and female CDDs should be selected for CDT! activities, 2) Each round of Mectizan distribution should be officially lunched at various levels, 3) Produce new IEC materials carrying messages of sustainability. 20 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 aoa 6a >. 5 ljq o0. urt Etr H o E o Ur oe a. tro(, = = I o r>lo tr ta G o S ruo o o =G e G 6t ls Go st = St5\ o lt, o I ool6 lFo oEI(, (, 'tr ttt Go E5 = oo 'S -; =oE'E si =$ a) bt)q! o C) o cr o rr i .iq la I o\F- rr O t! c..l l6 a) bD 6t =\o SQ EU E* 5C9r!5 r.! a)E E zl E.E * tEEe*z d'i tf c.l € \o € € la +r aa lt ce 6 oF tf c.l oo co 00o c.^l o N t a.l \o ca \o o ca tt o\ N c.t O rat F-o 00oo c.) O \oo o rr)\oiA!f rq 9- EIdu € ra \o$ r.-o r\c.) 6!cFI l8 E t: E o() oE{ to EAqlOEa.. L) o 19 E E z A a(.) a) clEa FE @o F-00 c')00 Ol\o t-tla o bD cl tro cl ofr oo ll * cetri ne o o o Erre EEi [, 2Eea o o o o o o o o o o o o o o a o o1L]ot EIol trJrlol ol(ol zl arlEI EI e E o(,) E ' ot) b0ql 0t) E oI o oE E z .EE EE L* -E.)Og E'E H -EE oo()JE r .f @t $ co 00 \oN \o co { €ia !t(\ \o(..1 F-c.l $h c.) \ot) a-o\ oo\oF- q A o v Ffg c0 5 o o z H z o o F o Dv zr! co zo o z)l& Fa r! o ca zf v Faq.l > oo z V E zr!o o z z ! z D o z > Y z q.l t0 z SI z F z a o F 2 D 6t oF tr oo o b tn o \ oo g o Eo .: o .= .E =E E oo .q 6t I aComment on: - Attendance offemale members of the community at health education meettngs With the exception of Moslem communities, female community members attended health education meetings more than their male counterparts, especially when these meetings did not take place late into the evening. In general, how do you rale the participation offemale members of the community in meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). During these health education meetings female participation was generally more than that of males. They asked more questions and generally looked more interested in the programme than males. - Incentives provided by communitiesfor the CDDs On the whole cash incentives were not given to the CDDs. However in many communities the CDDs were given food, kola nuts and drinks while carrying out CDTI activities. - Attrition of CDDs. Is attrition a problemfor the project? If yes, how is it addressed? Attrition of CDDs is a problem. However, CDD motivation from the Ministry of Health for 2006, was recently paid. - Other issues 2.5. Gapacity building Describe the adequacy of available knowledgeable manpower at all levels. Generally there is a severe shortage of health staff. Most health centres have just a single health personnel who is responsible for all health programmes, CDTI inclusive. These few staff are however adequately knowledgeable on CDTI, but have not been trained for 2008. ll/herefrequent transfers of trained staff occur, 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 adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). Transfers have not been frequent this year. However there were a few retirements and deaths some of whom are still to be replaced. 22 p, .\ soo o a5oE o (/) t ca6l lo o o g an o r<(U 5co I(U o o, .\Eco a-qp\oo o loIE e a. ot a(BE s$ o o ob 'L .*L o E =o =* ?rrd o.i+tu: Q +h qw ir *d $oN r- c.) r..\o oo ca ca 00oN a.)\o o N \tNia \o c.) r) \o o c.t a.t r-\o c.,t \o co C'l o\ N(O F- c.l N o ro c.t$ @ F..o ----l 6 € c') co $ aa c.l o \o o rat la\o ro$ n ra GI \o ctN () 6l no Q o a)E II z Pet:O oc.l +ooc..t \o\o N \fN!a) \oc.t rr@\o iac.l o$ coo\ o \o o oov r-C.te.l cao.l $O\o taiA EoE c o a) s U +. c( 3s *6 6ll+9dc; Fdc;Q t---- .---i O o o I o f---- 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 '---t o o o lo li €)E 6lL L a)E o o ,roE E z io o o o o o O o o o o o ru o .J E9 s E &,," u Usq a' I s = o o O o o o I o o o o O o o -_-.1 o o o o o o I I o o o o o o o o o o o o o -l o O o o o o o ,---i o o o o o o oe a) A a) TJ E 6 a) o tlE E z tsC a {o F- o(\l r) NF. @cl c.)c-,1 ooc.l \t o\o s ooN cac.l oco Fr\o (\I or \oaa -t\o tr a, E a) o E a) s ql I Ii,E/!+F-d dsq $:* o o l= o o ---i o o o o o o I t---- o o o o o o o o I o o o o o I o O t---- o o F---. o o o I 6l a o Q?F t $ $ .+ :f s ca s + 00 c.t t cO s 3 t-\o c) q A o v F tJ. c0 J o a ztll o oo F a ) v zr! c0 zo o zD lJ- F(/) lrl oo fV F(/) rlJ o z V zql c0 z a. o z B zE d o z BV z tI]o v z F z U) ca DF > J t- oF lt() E 4) o I s Co Foo o o o o E Eo € os o .E(! LF -l6Q a- Comment Only the training of CDDs has been carried out. For the current year no health staff nor trainer has been trained so far in all of our districts, due to inadequate funds for training. Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting peiod) - Any other comments Community supervisors, Religious authorities should be trained on CDTI activities. Training of these persons was not planned this year. Considering the position these persons hold in society, training them will contribute to the good implementation of the project. However this has been included in the provincial three years sustainability plan. Trainees Type of training CDDs Other Commu nity member s e.g Commu nity supervis ors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program manaqement How to conduct Health education X Management of SAEs X CSM X SHM X Data collection X Data analysis X Report writing X Others (specifu) 24 NWCDTI PROJECT MID TERTII REPORT, 11 JULY,2OO8 2.6. Treatments 2.6.1. Treatment figures - lf_the proiect rb not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating,ltate the reasons and theplans being made to remedy this. Treatment is still ongoing in all 18 health districts except in the FURU-AWAH heatth area inWum health district. This is because of poor accessibility and co-endemicity of onchocerciasis with loasis in the area, and therefore a calibrated blood smear has to be done before treatment with Mectizan can be done. However, this activity has been planned for next year. Table 7 gives the partial treatment results for some districts. t a 25 PRoJEcr MtD TERM REpoRT, tt JAN, zoogNWCDTI 6oQNt' J5 ., tjq oq- IUq = q FU o E E ;* r atEg o o o O O O o O o o€?2Oi*/.o o o o o o o O O o O oEb9 .otrEgas z(n \o$ c.t o\ l... al!ot g ar+- g I c.lF- r)$N \o\o o\ aeo oo * a 6\ s" Pii= 9fdg oo\o rrrr.) a rE."4EC EE.EZ*Po t o \o co \o c-$ c.l F-N \o :o iEg \oo\$ \f!e.l \o6 o\ Nln ao G, o. o o. =E-6f ce o\Orr =t\o \o F- o\ F.t-o oo il* o'd a doo =9g, a) \cEhie)86o- qQ o soo \oo\oo ao o so \oo\o 6\o \oo\oo .o o\oo 6\oo -oo\oo soo soo soo soo s o \oo\ oo s n\o o\ A t= su tr bO!o5 Gl o EEEE t oo+ osl c.) \o6 \oc.t \o a7) co* 00 $N \oN +r)cr(..t coc.t \oc.l o.F- ou1t- o Par d O-a286 E 8.9 <gP'FIJ rf 00s ot co \o@ \oe.l \o s @ $a.t \o(\ t--a{ t c.) \o F-o\ co\oF. @_LOLLo:E'; 8_.e+tEgo:bE3 -EE-E'*:3qao c= 6 tr'"F E: E. .t @$ $ co \ooo \oc.t \o co c.t$ € stN \oN F-al .+ c.)c.) \o c-o\ €\or- o o o v F Dq. o J c0 azt! 2 o @ F o V z trl a o z ! zf rJ. Fa rl] o ) V FO rl] > o ta D v E o zr! o A o z p A z x z rl.]o v z F z O o F 2) '] F o F. \o N lololoIE l-wlolol€ o (l) c co E (U o oLoc =o =s =3 TL o oc o o)EJE .E c o o f o-o o- a -o .E o .E E .E TE q, o E o UJ U' E'E(E E(l, |Eq, F I\ c, -ol(EIFI .a .cF l-o ur Bq o. F-ao = = $t 3) E E1 No POPULATION COMMUNITIES No OF PERSONS TREATED 1 AKO 2 BAFUT 3 BALI 4 BAMENDA 5 BATIBO 6 BENAKUMA 7 FUNDONG 8 KUMBO EAST 9 KUMBO WEST{0 MBENGWI 11 NDOP 12 NDU{3 NJlIOVA 14 NKAMBE 15 NWA ,6 17 TUBAH 18 WUM TOTAL 27 11 DTSTRICT tFormula for computino therapeutic and qeoqraphical Coveraoes Therapeutic coverage rate = Number of people trealed; 100 f/") Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate = Number of communities/villaqes treated x 100 (Yo) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate (Yo) Number of oeople treated x 100 Annual Treatment Objective % UTG achieved = Number of peoole treated x 100 fotrt nrrOer of people to be treated in meso/hyper- endemic areas within the project area (UTG) ATO =The estimated number of people living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. UTG = The maximum number of people to be treated in meso/hyper-endemic areas within the project area, ultimately to be reached when the project has reached full geographical coverage (normally the project should be expected to reach the UTG at the end of the {d year of the project). 28 NWCDTI PROJECT MID IERM REPORT, 11 JULY,2OO8 2.6.2 What are the causes of absenteeism? This can only be addressed after treatment 2.6.3 What are the reasons for refusals? Treatment is still going on 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in tabte 8) the required information when available. Mr' Jam lgnatius,46yrs of age, measuring 1.7m and a housekeeper residentin Bambui in the Tubah health district, was reported on the 19/06/08 for moderate side effect following treatment with Mectizan. ln his medical history, he had an unknown health status before taking 4 tablets of Mectizan on the 6/06/08. One day later, he consulted the Bambui District Hospital for headache, body weakness, fever and dizziness, but no red eye nor unconsciousness. On laboratory investigation he was blood smear positive for Loa loa. He was thus placed on oral Falcimon, Amodiaquine/Artesunate, and ciprofl oxacin. On re-examination of the patient (i.e. after notification of the provinciat onchocerciasis control unit 2 weeks later), he was conscious, but still presenting with mild dizziness and body weakness. A calibrated blood smear done at the Bamenda Provincial Hospital was positive for Loa loa with a parasitic load of 88mf/100m1. He was then placed on multivitamins, paracetamol, and ORS, and regular clinical follow- up visits by the nurse in charge of the CDTI program in Tubah health district, and the provincial OPC recommended. ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. T 29 D =FP8E b <.E E o z L;e8C.T tr .EEiE €oia I *5iEctrl 6'6 o o z o o.3EAg$ oa o oo() Er 9o ?-E oS -! .,'u ap Iq)-c tr troO >'d oo .Yoo.o *EE To.9'q 6o c c= E€EE !() s€Ad .E tro!'; >v qE u' o'=e= E€EE IC o tr ! cl oz EfiEgE Bo- tr:.{d ,)Eo Eo o. Exa 2_ = EU; E.B E F$ Q)tiq -coqooodctr E i't:N e:E5,Oe () tra@ FN G, F cEE AiE o()b0cG.l =b05'Eao x c) a () tr =oo \o c..t o ,o d ca (! (J o0 >l\ot+ * a O ca 0) (E a. q) rf. o Q)a (u 't oq I ! o 'tr o a.p E o a-o-\ o p) 'tr 5! !o LI(, o o G a. ui q2, tn o o o Eo ! G an5o .\ o u, o tn(I, .4 Go 6l ol al fll Jl-{ lo)lo lolse Xii'&+io)ga6g oad(,o=bo o3BtsF loo to3laElo)=laEg c^8 -tJo!tg .d.E!: (Degp5'Aog.o8Bre' (Doo \ioH'gUr=od == rE o da il a. a o! {L R!>a OBqio(o-.o3 o90ro 6-Etro E=6'orc?1vO o o E' E.oo A, o o, I'o) 5N{o ,o o o o GI o A,o o CL o o A' o =!, C -{o UJ tTo(- m C)I =o S :< Nooa N N)oO\o tJoo@ N)oo -l N)oo o\ NoO(,| N)Oo5 Noo u.) rr, F \t o\6 -to\ oo { L,I N -t\t o\ o\ €N g - -8FAE'9, rcE.3E E g aAP-.) o*'$.*h d +s gA:.'(D\ Egs?'s eL(DB g a'8 a *!?r 7g=Ee"e &#i. E E**rE s$ rf; E E'p .8ff t4 lr, N :$ oo { o\6 -lo\@ \t(, t\) L'I 5\oo {(a o {5 {Or UJ o\5o \o o\ 5 s \o @(, s \op -Jl+) \o u.) a s \o 6 b\ .o o\ \o 90(,l s +\o o t,o b. s -l(,t{ ooo6 {5 o\ oo5\o Ot@a 6(Jl{ o\56 o\ o\(, .H : .H ggF5E o\ UJ\o (JI tJ N){\o(, s55 5@ 5i.J o\(,.) t, er-l;x >E.E EgHE i' 1r P)(DH tl'{ (Jl 5 UJNo (.,l N)j-J\o56 5{tJ()) -I 5 UJPsu) o\ $EIFIO -l\\oo\ {I(rl s o\@ b\\o o\ o\ o\ 5\o o\ o-l oif .6^-. IOil t'€tsg{q tit6 rt oo\oh 1g o\ o .o o\ o o\ -o6\ !., s oo- ^<,P\oo LJeAd o T! '* Bl ,F o\ Il 00I \o 6 5 N.J .o o\ a(rl bo5 s {\o\o6\ oo- -< (- \Y (li FleE ci 0a 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (p/ease tick the appropriate answer) MOH I WHO tr UNICEF ! NGDO f] Other (please specify): Mectizan@ delivered by - (p/ease tick the appropriate answer) MOH f] WHO I UNICEil NGDO f] Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan@ needs for the project were obtained during the provincial appraisal meeting for last year. A workshop organised by the NOTF was then held in Yaounde. This workshop was attended by the executive secretary of NOTF, the country representative of SSl, Project officers, and all OPCs. Mectizan@ needs for all the 15 projects of the country were estimated as follows: The total population of the project area was multiplied by 3 to get the total number of tablets needed. The quantity of Mectizan left over from the previous year was then subtracted from this total number of tablets in order to obtain the number of tablets required for the current year. Mectizan for the country is cleared from the seaport by WHO country office in Yaounde. This is the handed to the NOTF secretariat who further hands the tablets to the Supporting NGDO. The NGDO then arranges for the drugs to be transported to the North West Provincial Special Fund for Health (NWPSFH) in Bamenda. The various districts then collect their needs from the fund. The health areas in turn collect their quantities from the district and hand them to the CDDs who now take the drugs to their communities. 32 District Number of Mectizan@ tablets Requested Received Used Lost Wasted Expired Remaining AKO 55000 55000 BAFUT 82500 82500 BALI 40000 40000 BAMENDA 278000 278000 BATIBO l 37000 I 37000 BENAKUMA 109,000 109,000 FI]NDONG 196000 r96000 KI.JMBO EAST I 83000 l 83000 KI.JMBO WEST 279332 279332 MBENGWI 90000 90000 NDOP 213000 2 r 3000 NDU 148000 148000 NJIKWA 45000 45000 NKAMBE 180000 I 80000 NWA 5000 5000 SANTA l 14000 ll 4000 TUBAH 90000 90000 WLIM 200,000 200,000 TOTAL 2,444,832 2,444,932 Table 10: Mectizan@ lnventory Comment: All districts received 100% of the total num ber of tablets which they requested through the project office to the NWPSFH. However srnce treatmentis sfr/ ongoing, data on how these tablets were managed in the field will only be availabte by the end of the year. How are fhe remaining ivermectin tablets collected and where are they kept? Tablets are still in the communities as treatment is still ongoing. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Health personnel collect the drugs from the NWPSFH to the health districts and the health areas. They then supply the drugs to the CDDs following their needs. They are JJ NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 also responsible for inventory and storage of the drugs at the health districts and health areas. - Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting - Has any training (ot trainers) for community self-monitoring been done in the project area? No. lf so, When? Table 11: Community self-monitoring and Stakeholders Meeting 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. District 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) (health area/[Iealth district appraisal meetings) __'Ir:11*'_ 45 48 40 3l 86 26 Hypo 0 6 2 6l 0 __I!yp_cr/m-eso Hypo AKO BAFUT BALI BAMENDA BATIBO BENAKUMA FI.JNDONG 6l 33 !: 58 0 65 66 20 KIJMBO EAST KUMBO WEST MBENGWI NDOP 24 26 27 54 72 44 0 52 NDU NJIKWA NKAMBE NWA 33 36 97 768 0 l4 0 I 403 SANTA TUBAH WUM TOTAL 34 NWCDTI PROJECT MID TERM REPORT,11 JULY,2OO8 Community self monitoring is still to be carried out. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy Community Level -CDDs -Dialogue Structure members -Community members Central Level -APOC .NOTF -NGDOS (SSf Provinciol Level -Provincial Delegate -Provincial Chief of Service of Community Health -Oncho Project Coordinator -Finance Officer Heolth District Level -DMO .CBH -CBAF -CMO District Hospital Health Area |.evel -Chiefs of Health Centres 35 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 2.9.2. What were the main issues identified during supervision? Supervision is still ongoing. However below are some of the issues identified PROVINCIAL SU PERVIS!ON DISTRICT SUPERVISION 2.9.3. Was a supervision checklist used? Yes this was used at all levels 2.9.4. What were the outcomes at each level of CDTI implementation supervision? There was on the spot correction of mistakes and errors found on the field. Work / action plans were recommended for production and utilised. STRENGTHS WEAKNESSES High levelof acceptance of Mectizan by the community Limited number of health staff trained on CDTI because many of the staff are new No rumour lnterruption of CDTI activities by other health programs Payment of MOH motivation to CDDs Poor and late fi nancial justifications STRENGTHS WEAKNESSES All districts were distributing at time of supervision Refusals of some CDDs to work No stock-outs of Mectizan on the field Mistakes on filling of registers Use of Mectizan inventory forms Poor and late fi nancial justifications Reduced number of minor side effects Absence of work plan in some health areas Absence of drugs for management of side effects in some health areas 36 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 2.9.5. Was feedback given to the person or groups supervised? Yes on the spot feedbacks were always given to the supervisees. 2.9.5. How was the feedback used to improve the overall performance of the project? SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (P/ease add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written offl. How does the project intend to maintain and replace existing equipment and other materials? Source Tlpe of equipment APOC MOH DISTRICT /LGA NGDO Others No Condi tion No Condi tion No Condi tion No Condi tion No Condi tion 1. Vehicle 1 F 3 F 9 F 1 wo I wo 2. Motor cycle(s) 10 F 23 F 10 F 7 CNFR 2 wo 3. Computer(s) I F 18 F 4 F I F 4. Printer(s) I F 18 F 4 F I F 5. Photocopier (s) I F 3 F 3 F 4 wo 6. Fa:r Machine(s) 1 F 7. Over head proiector 1 F 8. Flip chart stand 3 F b) beds 3 F c) 37 MIYCDfl PROJECT MID TERM REPORT, 11 JULY,2OO8 a oHealth districts and health areas used government funds for maintenance of CDTI project vehicles. However, the project in general has not got any laid down plan for the maintenance and replacement of these equipments. 3.2. Financial contributions of the partners and communities Table 13: Financial contibutions by all partners for the last three years lf there are problems with release of counterpart funds, how were they addressed? No problems for now Additional comments 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Some CDDs were given kola nuts food and drinks to their CDDs during distribution. Contributor Year 3 (2006) Year 4 (2007) Year 5 (2008) TOTAL Cash Budgeted 1us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released 1us$) TOTAL Cash Budgeted 1us$) TOT AL Cash Rele ased (us$ ) MOH (Central + Provincial/State) MOH (DistricYLGA) Local NGDO(s) ( if any) NGDO partner(s) Others a) I b) Communities APOC Trust Fund TOTAL 38 NWCDTI PROJECT MID TERM REPORT, 1 I JULY, 2OO8 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United lVations exchange rate to local currency. lndictate exchange rate used here Table 14: lndicate how much the project spenf for each activity listed below during the repofting period Any comments or explanations? t Activity Expenditur e ($ us) Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities of CDDs of health staff at all levels Sgpgrvlgq g CD_D s qld _d i stribut i on_ Internal monitoring of CDTI activities {lvqcacy visits to health and political authorities IEC materials @) foqr_rq fot -treafinent- Vehicle s/ Motorcys le_s/ b icyc I es- maintenance Office Equipment (e.g. computers, printers etc) Others TOTAL Total number of persons treated 39 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) Year 1 Participatory I ndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. 4.1.3. a) Provincial level What were the recommendations? How have they been implemented? Recommendations by Group of lndicators Level of lmplementation Planning 1.The Provincial level should elaborate an overall plan with costs that contains CDTI activities This plan willbe ready by December, 2008 2.The CDTI plan for the provincial level should contain only activities to be executed by the provincial team The provincial plan containing activities only for the provincialteam has been elaborated and will be submitted with this midterm report 3.There should be a follow up of the execution of the approved CDTI plan Supervision of CDTI activities for the province has been carried out by the provincial OPC and all 4 zonal OPCs 40 NWCDN PROJECT MID TERM REPORT, 11 JULY,2OO8 Supervision/Mon itori ng 4.Activities should be appropriately documented and copies kept at this level for action and future reference Supervision reports are ready for all districts 5. There should be a documented routine system to reward well performing staffs. This has been planned for December, 2008 Financial Resources 6. Government funds should be allocated and etfectively disbursed at this level for CDTI activities. This is still being done timidly T.Staffs should document Govemment contributi on with regards to CDTI This will be done immediately funds have been disbursed Human Resources S.There is an immediate need to appoint a provincial coordinator to closely follow-up on CDTI activities A provincial OPC in the person of Dr. CHE SOH KINGSLEY, (M.D., MPH) has been appointed Transport /Other Resources 9. Staff should ensure that adequate training and HSAM materials are available for the entire Province. The provincial supervisors carried along adequate IEC materials to all 18 districts during the last supervision exercise 1O.Staffs should document the use of transport and other material resources at their disposal A log book for the project vehicle is available 11.Staffs should continue to advocate for transport materials for the District and levels below Yet to be done Training/ HSAM 12.The provincial level should ensure that all stakeholders are involved in appraisal and advocacy meetings Yet to be done 4t NWCDTI PROJECr MID TERM REPORT,1I JULY,2OO8 13. HSAM activities should effectively be planned, implemented, and followed-up in an integrated and targeted manner. Yet to be done l4.Written report on HSAM activities have to be made to document successes Yet to be done lntegration of Support Activities 15. Staffs should have integrated written plans and reports showing that integration of activities is effective. Yet to be done Mectizan lO.lnvolve the NWPSFH in the ordering, supply and follow-up of Mectizan Yet to be done Coverage 17.Ensure that all communities/villages have at least 65% TCR annually Treatment is still ongoing b) District level Recommendations by Group of lndicators Planning 1. Staffs should make their own situation analysis and elaborate their plan based on it. 2. Staff should include costs on their yearly activity plans 3. There should be a follow up of the execution of the approved plan Superuision/Monitoring 4. Staffs should have integrated plans for supervision written out 5. Staffs should ensure that activities are documented and copies are kept at their own level for action and future reference Financial Resources 6. Once the approved budget from external sources is made available, staffs should look for ways to bridge the gaps between money expected and money approved 7. Staffs should document Government contribution with regards to CDTI 42 NWCDTI PROJECT MID TERM REPORT, 11 JULY, 2OO8 Human Resources 8: D-MT should put in place a routine documented system to reward well performing staffs Transport /Other material resources 9. Staffs should document the use of transport and other material resources at their disposal. 10. Staffs should continue to advocate for transport materials for the District and levels below HSAM/Training 11. Staff should organise targeted training that is train only those in need and/or only on relevant subjects. '12. Staffs should effectively plan, implement, follow-up and make written report on HSAM activities. 13. Written report on HSAM activities have to be made to document successes. 14. Staff should ensure that appropriate and adequate training and HSAM materials are available for the entire health district. INTEGRATION OF SUPPORT ACTIVITIES 15. Staffs should have integrated written plans and reports showing that integration of activities is effective. Mectizan 16. Staffs should set up a stock forms for stock control. Coverage 17. Staff and all stakeholders should ensure that all communities/villages have at least 650/o TCR annually c) Health Area level Recommendations by Group of lndicators Planning 1.All health center staffs should elaborate integrated work plan including CDTI, plans should include costs lntegration 2. Health center staffs should have integrated written plans and reports showing that integration of activities is effective. Leadership 43 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 3. The management team at health center should fully engage in CDTI irnplimentation 4. Staff should empower community leaders so as to enable them take ownership of the programme. Su pervision/Monitori ng 5. Health staffs should ensure that activity reports are written and copies are kept at own levelfor action and future reference. 6. Health staffs should have integrated plans for supervision written out. 7. Health staffs should ensure that feedback is given appropriately to the communities. Mectizan supply 8. Health staffs should set up a stock form for Mectizan management. Training /HSAM 9. The chief of centre once trained should involve all other staffs so as to insure that activities are not discontined in case of his/her absence. 10. Heatth statf should organise targed training that is train only those CDDs in need and/or only on relevant subjects. 11. Health staffs should effectively plan, implement, follow-up, and make written reports on HSAM activities. Financial Resources 12. Health staffs should document health centres'contribution to CDTI implementation. Coverage 13. Chiefs of centres and community leaders should ensure that all communities/villages have at least 65% TCR annually. d) Community level Recommendations by Group of lndicators Planning 1.CDDs should plan and carry out distribution in close collaboration with village/quarter leaders 2. Community as a whole should look for localways to facilitate CDDs work and CDDs motivation S u pervision/Mon itorin g 3. Community should engage in CSM as it will help them better understand CDTI problems and encorage ownership Training /HSAM 4. Community leaders and CDDs should plan to effectively educate the population 44 NWCDN PROJECT MID TERM REPORT, 1I JULY,2OO8 Financial Resources 5. Community leaders should organise their communities to devise means to provide funds to CDTI activities such as transport to collect Mectizan, material purshase, incentives for CDDs. TransporUother material 6. Community should provide transport for the collection of Mectizan when necessary. Human resources 7. Community should sellect CDDs suited for the job after the express concern of the individual. Goverage 8. CDDs and community leaders should ensure that communties/villages have at least 657o TCR annually. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportingperiod?YeS- Was a sustainability plan written? Yes Vfhen was the sustainability plan submitted? Still to be submitted What arrangements have been made to susfarn CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Three year sustainability plans for all levels are currently being elaborated and will be submitted with this report. 4.2.2. Funds Government funds are already being disbursed directly into the project at district and health area levels. Also an integrated plan of action including CDTI activities amongst those of other health programs will be drawn up by the end of this year. This has already been done at the district level through the elaboration of the health district development plans. This will consequently lead to integration of funding for the various health programs into a common basket. 45 NWCDTI PROJECT MID TERM REPORT, 11 JULY,2OO8 I4.2.3 Transport(replacementandmaintenance) Financial contribution in the maintenance and replacement of project motorcycles has been included in a memorandum signed between SSI and the NW-CDTI project. However there is still an urgent need for APOC to replace the project vehicle before terminating any flnancial assistance. Maintenance of this vehicle could then become the responsibility of the MOH, to ensure sustainability. 4.2.4. Other resources Training of more health staff and community members on the implementation of CDTI activities has been planned for next year. Also, a training of CDTI project staff on resource mobilization has been planned for early next year. 4.2.5. To what extent has the plan been implemented The implementation of our three year sustainability plan will take effect as from the year 2009. 4.3. lntegration See funds in 4.2.2 Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms Mectizan@ tablets are stored and managed by the NWPSFH along side other essential drugs in the province. 4.3.2. Training Training for CDTI is done along side that of primary eye care and some times other programrnes like Malaria and EPl. However training for most programmes cannot be integrated into that of CDTI as activity calendars are different for each programme. 4.3.3. Joint supervision and monitoring with other programs This is done especially when the activities take place at the same time. At the moment there is an integrated provincial supervision of all health programmes, including CDTI going on. 4.3.4. Release of funds for project activities Funds for project activities are released separately. Each project releases and manages its funds differently. 4.3.5. ls CDTI included in the PHC budget? It is not yet included in the MoH budget. 46 NWCDTI PROJECT MID TERM REPORT, l1 JULY,2OO8 4.3.6. Describe other health programmes that are using the cDTl structure and how this was achieved. what have been the achievements? Other programmes using CDT! structure include . EPI . Malaria program . TB program . HIV/AIDS program cDDs also serve as social Mobilisers in Epl, community relay agents in the Malaria, TB and HIV/AIDS programs. This has led to the integration of the activities of these programs and hence a reduction in the cost of their implementation. 4.3.7. Describe others issues considered in the integration of cDTl. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research has been carried out in the project area since the lunching of the project. The is an urgent need to train the provincial onchocerciasis project coordinator on operational research methodology (linear programming, etc.), to improve on the sustainability of the project. 4.4.2. How were the results applied in the project? sEcrloN 5: strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of cDTl implementation process. Strengths/Ac h i evem e nts High acceptance of the program Adequate availability of Mectizan Integration of the program into other health programs Active comrn unity parti cipation. High level commitment of stake holders within the Province to ensure sustainability 47 NflcDTI PRoJEOT MID TERM REPoRT, TT ,Iutv,Zooa fWeaknesses Eighteen Communities of Furu-Awa yet to be covered by the program Late and inadequate motivation of the CDDs Late reporting and justification of funds received from APOC and sight savers lnadequate supervision of project activities Non respect of distribution calendar Limited means of transport like vehicles and motor-bikes Opportunities Low rate of side effects Possibility of using CDDs in other programs as a source of valorization and motivation. Communities well structured to allow for effective community participation Good community acceptance Good treatment coverage Recommendations Allshould be done to have Mectizan distributed in Furu-Awa Communities. The chronogram established for the Provincial action plan should be respected Reporting and justification of activities should be effected latest two weeks after the end of each activity List the challenges and indicate how they were addressed. CHALLENGES HOW THEY WERE ADDRESSED 1. Furu-Awa health area not yet covered because of poor accessibility and co- endemicity of Onchocerca volvulus with Loa loa - Has been included in the sustainability plan (2009-2011) 48 NWCDTI PROJECT MID TERM REPORT, ll JULY,2OO8 SECTION 6: Unique features of the projecUother matters The province is predominantly English speaking Traditional authority is highly respected: any mobilization that emanates from their end is highly acclaimed; The drug delivery mechanism is highly developed; hence the delivery of Mectizan through the NWPSFH is an asset and favorable point towards sustainability. The dialogue structures are a major partner of this fund. The main ethnic groups in the North West province include; The wiikum occupies Momo, part of Mezam and part of Menchum Divisions The Tikaris occupy part of Mezam, Ngoketunjia and Bui divisions. The wimbumsl/'embas occupy part of Bui and Donga/Mantung 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 different divisional headquarters you must go through Bamenda the provincial headquarter which is centrally located. , a 49 NwC e