South West 1 CDTI project report 2007, Year 9

i AgSgaVED FOR PROJECT LOGO/TIEADING I I a COUNTRYA{OTF: CAIVIEROON Project Name: SOUTH WEST 1 CDTI PROJECT Approval year: 1998 Launchins year: iVIARCH 1999 Reportins Period From: January 2OO7 Tol December 2007 MONTH/YEAR) ( MONTH/YEAR) Proiect vear thisreport: (circleone) 1 2 3 4 5 6 7 8 (g) 10 Date submitted: January 2008 NGDO partnerl Sightsavers International South West 1 CDTI Project Report 2007, Year 9 A}INUAL PROJECT TECHMCAL REPORT SUBMITTED TO TECHMCAL CONSULTATT\TE COMMITTEE (TCC) DEAD ON: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 JuIy for September TCC meeting AFRI CAN PROGRA]VIME FOR ONCHOCERCIASIS CONTROL GPOC) a I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confrrm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: CAMEROON National Coordinator Name: Dr Ntep Marcelline Signatursl ..... Date: Provincial Delegate Name: Dr Mafany Njie Martin Signature: Date l NGDO Representative Name: Dr Rosa Befidi-Mengue Signature: Date: Provincial Oncho Coordinator Name: Ms Mah Cecilia Signatursl ... Date: This report has been prepared by Name: Ms Mah Cecilia Designation Signature: Date 1l DEFIMTIONS ......VI Table of contents FOLLOW UP ON TCC RECOMMENDATIONS...... EXECUTIVE SUMMARY SECTION 1 : BACKGROUND INFORIVIATION... 1.1. GpNpnar, INFoRMATIoN ............ 1.1.1 Description of the project (brieflil SECTTON 2: IMPLEMENTATION OF CDTI Tttupr.INp oF ACTIVITIES . Aovocacv....... MoerLrzArroN, I 1 1 3 3 3 I 01 2.L. 2.2. 2.3. SENSITIZATION AND HEALTH CoMMUNITIES ....,,.......... 2.4. CounauNrryrNVoLVEMENT..... Capeclrv BUTLDTNG TnparmBNTS............ 2.6.1. Treatment figures... 2.6.2 What are the causes of absenteeism?....... 2.6.3 What are the reasons for rcfusals?............ 2.6.4 Briefly describe all known and verified serious adverse events(SAE) that 2.6.5. Trend of treatment achievement from CDTI project inception to the current year ..278 2.5. 2.6. 2.7. 2.8. 3.3 3.4 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 256 OnopnlNc, sroRAGE AND DELIvERY oF IVERMECTIN............ .....289 COvTuuNITY SELF-MONITORING AND STAKEHOLDERS MPPIINC.... .............. 30 2.9. SuppnvrsroN........ ........31 Provide a flow chart of superuision hierarchy. .................31 What were the main issues identifred during supervision?.........-.-.32 Was a supervision checklist used ? ........32 What were the outcomes at each level of CDTI implementation supervision? ................ 32 Was feedback given to the person or gzoups supervised How was the feedback used to improve the overall performance of 32 ............32 SECTION 3: SUPPORT TO CDTI....... 33 3.1 EqurunNr....... 33 3.2. FwaNcnr, coNTRIBUTIoNS oF THE pARTNERs AND coMMUNITIES .............33 Omrpn FoRMS oF CoMMTINITY SUPPORT...... ExppNoItURE PER ACTMITY.. SECTION 4: SUSTAINABILINT OF CDTI. ..........37 34 Jb lll 11 25 256 2 4.L. INrpnNar,;INDEpENDENTpARTICIpAToRyMoNIToRINo;E 4.1.1 Was Monitoring/evaluation carried out dwing the(tick any of the following which are applicabld.......... 4.1.2. What were the recommendations 4.1.3. How have they been implemented?......... ..........37 4.2. SustelNaBILITy oF pRoJECTS: pT,ANAND sET TARGETS (uaNoaroRyATYR 3) 37 4.2.1. Planning at all relevant levels....... 4.2.2. Funds 4.2.3 Transport (replacement an d m aintenance).............. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented4.3. INrpcnerroN 4. 3. 1. fvermectin delivery mechanisms.............. 4.3.2. Tlaining VALUATION........37 reporting period? 37 37 37 ,7/ 37 AZ 37 38 38 38 38 38 38 t 4.3.3. 4.3.4. 4.3.5. 4.3.6. Joint supervision and monitoring with other prcgrams Release of funds for project actiuities.............. Is CDTI included in the PHC budget Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? .39 4.3.7. Describe others issues considered in the integration of CDTI. ........39 4.4. OPERATIoNAL RESEARCH 40 4.4.1. Siimmarize in not more than one half of a page the operational research.undertaken in the project area within the reporting period. ..........40 4.4.2. How were the results applied in the project?....... 40 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPORTUNITIES... .............40 SECTION 6: UMQUE FEATURES OF THE PROJECT/OTHER MATTERS....42 1V Acronyms ANC APOC ATO ATrO CBO CDD CDTI CSM FLHF HESAM IT IWC LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo Ante Natal Clinic African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distrib utor Community-Directed Treatment with Ivermectin Community Self-Monitoring Front line health facilities Health education sensitisation advocacy and mobilization Information technology Infant Welfare Clinic Local Government Area Ministry of Health 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 scientifrc advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v Definitions (il Total population: the total population living in meso/hyperendemic communities within the project area (based on REMO/REA and census taking). Gil Elisible population: calculated as 84%o of the total population in meso/hyper-endemic communities in the project area. (iiil Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyperendemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment GoaI (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 3.d year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total pgpulation (this should be expressed as a percentage). (vi) Geosraphiaal coveraee: number- oT com.munities treated in a given year over the total number of meso/hyperendemic communities as identified by REMO in the project area (this should be expressed as a percentage). (viil Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through COtl (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. (viiil Sustainabilitv: CDTI 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. (id Community 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 programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take fuII responsibility of Ivermectin distribution and make appropriate modifications when necessary. v1 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 session24 South'West I CDTI Project (gth year report) Number of Recommend ation in the Report TCC RECOMMENDATTON ACTIONS TAI{EN BY THE NOTF SECRETARIAT FOR TCC/APOC MGT USA ONLY 6 This is the Sth year technical report, which is closely similar to the previous year containing sometimes exactly the same figures. Many activities have been under taken in hypo endemic areas in spite of difficulties encounter in meso/hyper endemic areas. The following observations were madei o Contrarily to the previous year, ratio per number of people and the proportion of female CDD have slightly increased. a The report does not provide sufficient information on integration activities, especially with regards to eye care programme. This issue was addressed during re- training sessions at the beginning of the year. We hope there would be a change when we get the activity reports. It is however getting more and more difficult to get more CDDs as they complain of not being motivated. We will do our best to submit a more detailed and original report this year 2007 1 Pxecutive Summary 1. Background. on treatment and population data ' Total communities, communities treated, total population, UTG, ATO and persons treated in the current year 2007. CDTI Southwest 1 project covers 10 health districts i.e. Buea, Limbe, Tiko, Muyuka, Kumba, Konye, Nguti, Tombel, Bangem and Mbonge. These are further broken down into 75 health areas having a total of 478 meso / hyper endemic communities and 340 hypo endemic communities. CDTI activities started this year early in January 2007 with integrated training (CDTI and Eye care) for nurses, and CDDs. Census update, distribution of Mectizan, supervision monitoring of SAE, started in March and April in some districts and ended in JuIy 2007 with appraisal meetings in the health areas and Districts- We have completed our annual distribution cycle which ended with the Provincial evaluation meeting. The analysis of annual reports from. Communities, health areas, and health districts gives us the following results. - Total communities 478 ' Total Communities treated, 478 ' Total population from census update 360 353 - uTG, 302 697 - ATO, 288 282 ' Personstreated, 282604. 2. Background on population movements Population movements do not affect our CDTI population. If they occur at all they occur mostly in the hypo endemic communities of Buea, Tiko and Limbe health districts. Training data - CDDS, health workers, Total population (community) per CDD trained. From the analysis of our annual activity reports, a total number of 391 CDDs were trained in Hypo endemic communities and 804 were trained in MesolHyper endemic communities, making a total of 1,195 CDDs trained. The total number of Health staff 229. The total population Erreur ! Liaison incorrecte. This is due to the reluctant attitude of CDDs not willing to perform their task after training because of late motivation from the state. 3. Challenges and how they were overcome. Our greatest challenge still remains the motivation of CDDs. State funds for their motivation are not made available on time and the process to acquire them is very long and strenuous. This results in CDD attrition yearly. Another challenge is securing adequate state funds for the implementation of project activities. I'here rs strli to ire a deti.ned. State buctget, ilne 'ffitnin EIIe Ministry of Public Health for CDTI activities. 1 Supervision at all level is slow because of means of transportation. Majority of motor bikes that were put in the freld 8 years ago are all broken down and most of them now need high cost of maintenance or replacement. Understaffing is a problem in most of the front line health facilities (FLHF), where practically most of our numerous health activities are implemented. Most often you fine one or two staff to run at least six health programmes plus consultations and deliveries. Just of recent the state employed 225 health staff that were sent at all levels in the Province. Hopefully this will remedy the current situation of understaffrng in all the districts and health areas of the project zotte. Currently there are temporal health staff employed by the communities and the state is looking forward to integrate them into the health system, which will further boost the strength of the staff situation in the Districts and Health areas. Community ownership of the project still remains a challenge, most communities still feel motivation of CDDs is basically the affairs the Government. The community leadership and supervision is not satisfactory. 2 SECTION 1: Background information 1.1. Generalinformation 1.1.1 Description of the project (briefly) Geographical location, CDTI South West 1 project zone is part of the South West Province of Cameroon. It lies between 5o20 and 4oN and 8"45 E. CDTI SW 1 includes 3 administrative divisions- (Fako, Kupe-Muanegouba and Meme), these divisions are made up of 10 subdivisions- Buea in the Fako Division hosts the administrative headquarters of the SW Province. SWl is bordered to the North by the SW administrative divisions of Lebialem and- Manyu, to the South by the Atlantic Ocean, to the East by Litoral and West Provinces a.nd to the West by the Republic of Nigeria. From the health point of view SW1 is divided. into 10 health districts (Buea, Limbe, Muyuka, Tiko, Bangem, Tombel, Nguti, f{onye, Kumba, Mbonge) which are subdivided into 75 health areas and 340 hypo and- 478 meso/hyper endemic communities. . Population i The total area of CDTI SW 1 project zone is approximately 14300 km2 and the total population of the entire project zone (hyper, meso, and hypo communities) is estimated at 984 433 inhabitants following extrapolations from the 1987 national population census. Activities, The most important economic activity of the inhabitants of this project area is farmingi fishing and hunting. They grow cash crops like Cocoa, Coffee and OiI Palms. Agro industrial institution in the project area eg, the CDC, Cameroon Tea Estate and Pamol Plantations Limited also grow rubber, tea, banana and oil palms most of which is for export. Subsistence farming is also donei mainly foodstuff and fruits, for their / Iivelihood and excesses are being sold to the local markets of neighbouring towns and Countries. Cash crop farming is done mostly by males while the females are more engaged in food crop farming. Most of our CDDs are engaged in farming activities, which explain the reasons for low participation of female CDDs, rapid drop out and replacement by communities is slow. Sometimes they abandon their activities during the peak of Mectizan@ distribution. A small population is engaged in administration (white collar jobs) and small scale trading. Cultures, The cultural setting is made up of the Paramount chief who is the head of the tribe. He controls the sub or second class chiefs who are the heads of the clans that make up the tribe. These chiefs an<i their councillors make traditional iaws, pr"otect traditionai believes, laws and the custom. Traditional ceremonies for example, marriages, deaths, festivals and births are celebrated according to the norms and standards of the tribe. They all have one belief in common, the pouring out of libation to appease the spirits 3 and the ancestors to intervened for their wellbeing. Some of these cultures are a hindrance to a lot of health intervention. Language The local dialects are widely spoken within the clans and tribes in the project area. Ttre language commonly used during communication is Pidgin English. The literacy rate is very high many can express themselves in perfect English and French. Topography, climate, Access SW I features has a diversifred landscape, the predominant vegetation is the Equatorial Rain Forest. Besides this main type of vegetation, there is mangrove wegetation on the coastal areas. The Rhumpi hills stretch through the Meme and Kupe Muanegouba divisions. The altitude ranges from 0 metres on the coastal areas to 4095 rnetres in Buea with a multiplicity of small hills. The Cameroon Development Corporation (COC), an agro-industrial unit has put its stamp in this region with its numerous large plantations of rubber, tea, palms and banana. CDTI SW 1 project area, has a very rich network of drainage system most of which flows from'high altitude and. are interrupted by numerous cascades, rapids and. waterfalls. These streams provide breeding sites to Simulium vectors which can be found on high altitude in the area. The rainy season starts from mid-March to mid-October with its peak around July and August. The dry season goes from mid-October to mid'March. Farming is practised all through the year, the highest activity being registered around March and April at the beginning of the rainy season. Communication systems (roads...) The roads in CDTI SW 1 project area are mostly un-tarred. They are generally practicable during the greater part of the year, with only about 3 months (July, August, and September) when they are difficult to ply. During this period of the year rnovement of Community Directed Treatment with Ivermectin personnel should be reduced and oriented towards areas where the roads are practicable. Despite every odds with the use of four wheel drive car a person can still make a successful journey within the project zone. Telephone, Fax, E' mail and Postal services, Communication services by telephone are well developed and cover 90% of the entire project zone except for Konye and Nguti health districts. Administration structure The Governor is the head of the Administration in the South West Province. 4 The Senior Divisional Officer is the head of Administration in the Division. The Divisional offi.cer is the head of Administration in the Sub Division Traditionally the Paramount chiefs are heads of the tribes made up of clans The chief and his traditional councillors administer in the communities. Table 1.1 Health system & health care delivery facilities. (Provide the number of health posts/centres in the project area if the information is available). Table 1.2 Showing Administrative [Inits, Hea]th District, Health Areas and Number of Communities (Hyryo, Meso and hyper Communitieil. Health System Administrative Facilitie s No of Facilities Health Care Delivery Facilities No of Facilities fntermediary level Provincial Delegation of Public health Buea 1 Provincial Hospital Limbe. Provincial Hospital Annex Buea 1 1 Peripheral level Health District Services 10 District Hospitals (Pubtic) I Private Hospitals L2 Centres M6dicaux d'Arrondisse ment (CMA) 6 Health Areas 75 Health Centres (PubLc) 72 Communitie s me sb/hyper 418. . ., lle.alth Centres'Private 37 DIVISION SUBDIVISION 'DISTRICT HEALTH DISTRICT HEALTH AREA N'OF COMM FAKO BUEA BUEA BOVA 7 BUEA TOWN 6 MUEA 21 MOLYKO 10 BUEA ROAD I BOI(A/AONGO o TOLE 7 TOTAL 69 BATOKE BATOKE 7 BOTA 15 LIMBE MOLIWE 15 LIMBE ZONE 2 I LIMBE SEA PORT 11 MABETA MABETA I IDINEAUO IDINEAUO 9 BOJONGO 7 TOTAL 80 TIKO TIKO MONDONI 11 MODEKA 16 MiSSELLELE 7 LIKOMBA 25 MUTENGENE 18 TIKO 10 HOLTFORTH 14 5 ](ANGE 14 TOTAL {15 MUYUKA MUYUKA BAFIA 34 MALENDE 20 MUYUKA 19 MEANJA I EKONA I TOTAL 90 MEME KUMBA KUMBA BANGA BAKUNDU 10 EKOMBE BONJI 9 KUMBA TOWN 7 KBE MBENG/BUl(WE 15 POLYTIN 4 FIANGO 7 NTAM I LADUMA 8 BIG NGBANDI 12 BIG BEKONDO 8 DIFINDA BALUE I MASSAKA 8 DIKUME BALUE 5 TOTAL fi0 MBONGE MBONGE KOMBONE 14 KOTTO BAROMBI 7 MBONGE 16 BOKOSSO 15 BOA BALONDO 15 TOTAL 66 KONYE KONYE KONYE 8 MATOH 8 IKILIWINDI 7 KURME 4 NYANDONG 11 MBAI(A/A SUPE 5 IBEME 8 WONE 8 TOTAL 59 KUPE NGUTI NGUTI MANYEMEN 11 MAUNEGUBA NGUTI I 9 NGUTI II I NTALE 11 EYANG 6 BAKOGOGO 13 AYONG 7 ELUMBA MBO 18 TOTAL 84 TOMBEL TOMBEL EDIBENJOCK 15 EBONJI 24 TOMBEL 11 NYASOSO tt NDOM 11 BASENG 7 NDIBENJOCK 10 TOTAL 89 6 BANGEM BANGEM MUAMBONG 11 EKANJO BAJOH 6 BANGEM 15 EBAMOT 9 NKACK 8 MUABI 7 TOTAL 56 GRAND TOTAL 818 Number of health staff in project area and number of health staff involved in CDTI activities. Table 2: Number of health staffinvolved in CDTI District Number of health staffinvolved in CDTI activities. Pertentage of h.er gta.ffinvoh/ed. on CDTI Bs=B2l Br *10O BANGEM 48 0 48 11 22.92Yo BUEA 70 7 77 2L 22.27Yo KOI\IYE 13 0 13 10 76.92o/o KUMBA 86 7 93 30 32.26Yo LIMBE 28 4 32 32 t00% MBONGE 32 2 34 26 76.47Yo MITYUKA 90 4 94 22 23.40Yo NGUTI 52 4 56 I t6.07Yo 57.tLYoTIKO 50 6 56 32 TOMBEL 28 31 59 23 38.98% PROVINCIAL DELEGATION 35 0 35 5 \4..290/o TOTAL 442 65 607 221 43.58% NB: The private health sectors are made up of staff from Catholic, Baptist, and Presbyterian confessional health units, as weII as those from Cameroon Development Co-operation (CDO. They are trained in Primary Health care and aII health intervention prcgrammes and are responsible for some health areas as leading health units. The above data do not include staff from the Prouincial and district hospitals. 7 L.L.2 Partnership Indicate the partners involved in project implementation at aII levels IMoH, NGDOI 6ational/international), communities, Iocal organiza tions, etc.l African Progxam for Onchocerciasis Control (APOC) Mectizan@ Donation Program (UOP), Sightsavers International (SSI) Ministry of Public Health MOH) Endemic Communities - Describe overall working relationship among partners, clearly indicating: specific areas of project actiuities (planning superuision, advocacy, mobilization, etc) where all partners are involved. There is good collaboration among all the partners involved in CDTI implementation. African Program for Onchocerciasis Control GPOC) As part of APOC activities to continue capacity building and improve the experiences and skills of field staff implicated in CDTI projects in Cameroon, APOC organised a three days workshop on standardization and harmonization of CDTI data collection, entry and analysis tools for Cameroon CDTI projects in Kribi May 2007. Mectizan@ Donation Program, They provided the required Mectizan@ tablets free of charge to the CDTI Project this year. Mectizan came in on time and in enough quantity as requested by the project. Sightsavers International Sightsavers is the supporting Non Governmental Developmental Organisation in the Province. They supported the CDTI SW 1 Project withi . Logistics (purchase of car insurance, car tyres) . Financing activities like training of nurses and CDDs, supervision and evaluation meetings at the provincial, districts and health area levels. . Ensuring good resources management and reporting by supporting training, supervision, monitoring and evaluation of district and provincial team. . They carried out an integration supervision of eye care and CDTI projects. Thanks to their financial support and the frnancial contribution in the districts, we were able to start CDTI activities. . They also supported OPC SW 1 targeted supervision in Mbonge, Kumba and Konye health districts. Their impact is being felt across all districts of South West Province. Ministry of Public Health The Nlinistry of Public Heaith provides the health staff for the programrne; they are responsibie for managing the day to day running of the programnie. The Ministry of Public Health is the main coordinating and implementing body of the project from top down levels. During this 9th year of Mectizan distribution cycle, we 8 organised an integrated eye care and CDTI planning meeting, where a1l the districts and province submitted their annual budgeted plans of actions to the National Onchocerciasis Coordinator. The OPC carried out targeted supervision in Mbonge,(umba, and Konye supported by Sightsavers International. MOH staff carried out srdvocacy at all levels and opportunities like national days celebrations were used for advocacy, mobilisation and sensitization of the masses. At the lower level, the nurses a.nd the CDDs mobilised and sensitized the chiefs, traditional council, Village health committee members, quarter heads and community members. Endemic Communities These are the affected communities. They are the principal partners of MOH as the implementation of treatment with Ivermectin and its sustainability depend entirely on them. Motivation of CDDs and the ownership of the project still stand as a challenge to themi they are willing to cooperate in all areas of project implementation. Mutualit5,. and voluntary work is not yet part of their system, these are the areas we have problems with them in the course of project implementation. The comnunity from the beginning of the project has always: . Selected Community Directed Distributors and send for training. . Planned for d,istribution. . Accepted registration update. . Mobilised and sensitized the communities to take Mectizan. o Supervised and monitored Mectizan distribution within the communities. . Contributed in the identifying and referring cases of adverse reaction within 7 days of Mectizan treatment to the health unit. The Community Directed Distributors (CDDs) as members of the community have always: . Ensured storage and safety of Mectizan@ within the communities. o Collected Mectizan@ from the Health centre. o Distributed Mectizan@ to their communities. . Carried out registration update of their communities. o Assisted the nurse to summarise treatment reports at the front Iine health facility. . Carried out visual acuity testing. State plans, ff *y, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. With the new approach coming up strongly on health sector strategy on programmes, the Ministry of Public Health is planning to support the project in ali areas of project implementation. The province and the districts have alread.y submitteti their budgete<i plans of action to the Ministry. The NGDO (Sightsavers) partner is supporting the project and is still willing to continue supporting the project. Districts and health areas are also making their own contribution to the success of the project this year. 9 Oa .E Rq q) .q \a asp & a) -es o\ qt a) S s$ H\l\J o s "co(! 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Was a census for the project done during the reporting period? Yes there was census update in the meso / hyper endemic communities. If No, what is the source of the data in the table above? * Sourcet National census Year : other source, specify: - If you are using the term community or uillage, define what constitutes the community or uillage. This will help understand the profile of the project area. The village or a community is either made of people of the same tribe or many tribes living as a group in a given geographical setting. In most community setting, the Chief and the traditional council are the leading head of the people. Their social and economic activities pull them together as a community. In some health areas, the number of persons covered by one CDD is considered to make up one community while in others the culturally structured unit has been retained as the community. Is thqre any other information of interest about the population in the project area? If so, include it here. . . ' Mutuality and Volunthry services is difficult to offer in many communities because in most community setting, the population is made up of people of different tribes, cultures and ideas. There is this issue of Grass Landers, Bamilekes and coastal population that has been prevailing for long nowi it is constantly dividing the community making it difficult for them to come together for a common interest in the community. In some communities they do not see why they should pay allegiance and respect to the chief and his traditional council. Considering the fact that, not everybody living in the hypo endemic communities were born and bred in these communities and coupled with high rate of community urban migration in search of better living standards, employment and commercial activities, Mectizan treatment is also currently being distributed in all the hypo endemic communities in the CDTI SWI project zone, using the clinic base strategy. SECTION 2: Implementation of CDTI 2.L. fimeline of activities Fill in table 3, timeline of actiuities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 11 c.t Ho aiq)p v) Ho +t o) E8ds F-aa6t $a ts-aa6l a c.-aoN(oa L.-o N(o o E-O N t-a t- ON(o o tr-oa c\(o o t-ooN(o o !-oo c\ @o ts-oo N IOO bo +, {J H8fiE t-aa6l .$ a t--aa6l a t-- c\ c{a t-- ON co E-aaN .s a t-aoN cr)O t-oo c\ coa ts-OaN 6Ia tr-oo c! $o ts-Oo6l Ho +) ,o F{ +)o .d hI kc .9 *iE TE ESC)C ts-o N(o t--OoN so F-o N rO F.- a6l(o t--O 6l F.a L.- ON @o L--Oo c\(o t-oa6l IoO F-ooN o r-{ t-ao c{ rOa h0 .E -o HE t-aa c\ o t--aa6l co t.-o c\ o t'-OoN$ tr-aON .$ o f--oON co a t--oO6I{a t- O c\ cfj I t--OaN coa t--oON co o o) +)dEa e @ aq) EI o)O Ho +)o tss F8dE F- o6l o F-Oa c\ $o ts- 6l rOo F-aa c\(o F.oO6l tr-O ts-Oo c\(o o tr-aON(o t-OON lriO E-ao c\ $o t-oON rO bD .E -a+, +JHFfiE ts- 9O6l mO t--oO6l a D- o6l coa tr-aON $a ts-OaN .$ O ts-O 6l a ts-Oa C.l <tO t=oON t--O N CY)o E-oaN coO UI c d df{ E< H o € o H{ {l F85E tr- oN O F.OON O F-O c\ Na F-o N $O F-OON coO c- a c\ a tr-OO c\ $o t--oO6t c\o b-o 6l tr-aa OI c\O bo .H -d+, {JHFfiE F- O6l CDo t-o N co F- Ia c\ 6lo tr- o6l cOa t--aa6l cYl O D-o c\ N ts-aa6l co a F.oO cl c\ E- O c\ a tr-aaN c\o aAxo 'E .t SE EEIE >8 o Ho +, o) atlEE 6H tr-Oo c\ $ t-- o c{ .+ o E-OON Ioo ts-o N(o ts-O N tr- E-OoN(o tr- N(o O tr- 6I rOa tr- N $ F- c! rO a bD .Ee #E F-oo CN t-Oa6I FtO t- o6l C\ ts-oa CN cYro E- oN .+ O tr- aN 6la tr- N m E-o c\l NO tr-oO c{ No ts-oo 6l r-l O d4:{(J FI {J C) k €o o rI]o z Fq H tq E] D, M Fq = M tr1 c0 H F-I H z o m a il E H E{ o A o t4 Fi Fl trl m F a{Jt o E E oO a G1d6 ai\) aq\ 'Fi !aF p S) B c\t N q) t/) csq) E ti cd o >. +) E otit{ C) 0) {J 6 o +)(! otr +J U) cd a)trd 0) +) li € a o lJ {Ja(d c+i o 0) tr 0)6l.l . '-{E-l mr ,l -ol cdl FI 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the cttrrent yeari the reasonG) for undertaking the advocacy and the outcome. Describe dilfrculties/constraints being faced and suggestions on how to improve advocacy. At the Provincial level we had no advocacy to the policy makers. In all the health districts and health areas of the project zone, they organise advocacy to the senior divisional offi.cers (SDOs), divisional offrcers (DOs), Mayors of municipal councils, educational authorities, health area health committee members, traditional leaders, chiefs of post for agriculture and religious authorities. Another opportunity for advocacy was during the national celebrationsi National Youth Day (11tt February), International Women's Day (8tt, March). Reasons are numerous because we depend much on HESAM to maintain good therapeutic coverage, to reduce the number of refusal, absentees and CDDs attrition: To cause awareness in CDTI activities, in order to improve on therapeutic coverage rate, especially communities whose total treatment rates were less than 65% in 2006. To increase active participation of the communities in support of the CDDs during distribution of Mectizan. To cause the involvement of communities to carry out community self monitoring after Mectizan distribution. Outcome of advocacy have given us a good respond. Out of 115 communities whose therapeutic coverage rates were less 65% last year, only 55 communities have less than 65% this year. HESAM was focus on these communities and we feel the performance is good. The following difficulties/constraints were faced during the advocacy and sensitization exercise: . Difficulty to get in touch with policy makers due to their very tight schedule of activities. o IEC materials for distribution were late and insufficient in quantity. o Transport means for DMOs and COPs are inadequate since most of the bikes put at their disposal are old and have broken down already. Most of them have no cars either. fmprovement on advocacy.. We intend to improve on advocacy by applying the following: o Ensure that, besides sending letters inviting these policy makers to meeting. more time will be allocated to ensure a high level of personal conta,ct . Do all in our power to get more IEC materials. . Ensure that the policy makers accept ownership of the project. o Request for more support funds from our partners. 13 a o a 2.3. Mobilization, sensitization and health education of at risk communities Prouide inform a tion on : The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities At the health area level and communities social mobilisation were carried out by the nurses and CDDs. Through trained social mobilisation agents, announcements in cht{rches, schools and. markets, Health Districts that had access to radio stations e.g. Tiko Buea, Limbe, Muyuka and Kumba had radio slots about the program which was disseminated over the air as activities were ongoing. HESAM was ensured in all communities and especially in meeting houses. Town criers using whistles, Ioca1 tongue translators and other means of traditional communication such as the use of talking drums were used to educate and mobilize women and minorities. The content of the messages on this subject matter was as follows: o The disease . The drug . The rationale for mass treatment . Those to take the drug . Those not to take the drug o Treatment is free of charge . Importance for being treated. . The number of tablets to be taken according to height . How to swallow the tablets. . Possible side effect with management taken care of by the project with 7 days after mectizan is swallowed. . The reason and usefulness of census update. . Eye care VA testing. Response of target communities/uillages The Hyper and Meso communities/villages were the major target for mobilizationi a good respond was recorded this year. Out of 115 communities whose therapeutic coverage rates were less 65% last year, only 55 communities have less than 65% therapeutic coverage rates this year. HESAM was focus on these communities and we feel the performance is good. The geographical coverage of Mectizan distribution is LDO% Accomplishments Awareness about the CDTI project, the social, economic impact and health status of the population affected by' the disease is sc high among the inhabitants of South West Province. This is confirmed by the steady increase in therapeutic coverage rates through out the project zone. t4 The followin g we a kn e sses/constraints were ob serve d : . InsufEcient means of communication e.g. Mega phones . Insuffrcient means of transportation because most motor bikes are old and need heavy maintenance or replacement. o Most communities do not support their CDDs . Motivation of CDDs by the state is slow. o IEC materials supplied this year were not enough. Suggest ways to improve mobilization and sensitization of the target communities. Below are ways to improve mobilization of the target communities Early supply of adequate IEC materials for mobilization and health education using slmple meaningful drawings and messages on posters. Developed health ed.ucation messages in the local dialect of the endemic communities. Reinforcement and following up of mobilization and health education sessions in the communities. Ensure full involvement of dialogue structures, local NGOs, and CBOs at all levels. Hierarchy needs to address the issue of health staff commitment to the CDTI program. We need to repair and replace most motor bikes in the district and health areas. Build up more strong community members, CDDs and nurses friendly relationship in all the communitiesi because late motivation of CDDs have created a big gap and break in communication between most nurses and CDDs. a a a a o a a 15 E € B @o bo(d 't tD .9{ q a E Eo c) o oE HC)o-. EdtrE z,P oo F{ *Ie tqFq o hD(d9 trookop{ \o CO F{ \o o\ tr-t- o m \oo\ N6l c.i OI \oo\ tr- .{, ro \oo\ D-qo (o(o \o o\ ro @ + cYl s @tr' t- ti \oo\ O) F{ .i \o o\ O) s (J CJ co solo oi6I o te oti E EE ".88 E ETz 8e r-..| <t Nri Io .+ coc\ @ FI $t-{ 6 .(f rto o E @ @ ! d E Eoo oA H6 o oaO +{o ,rop Edz trl +ts Fq Io Fq dIoH s co (o c\ coO c\o t-{ FI 6I r.t?6l o tr- t-.i o) F{ @o F{ o@ Fq o Ea50h() t-{ $ c\tr-{ rO $ 6I @ F{ sF-l @F{ r{ Fi ts trl o a oo o d m LO c\ F{O) (o CO ti ts- ti 6lO t-.1 (o t-.{o ts-F.{ oo) lo(o(o EI E $a $[ 'ee Eg ES E EH E .d gE oo F{ + ,' t trtq o UDdI Eo()t{o& o o O o o o O o 6 tq €8'E6 E iE€B o o o o o o d gEE oCoo6EgEq,5o =H B E Ee E 6l crl <1 o (0 @qo Ios1 '+cD Io og) aoF <,| 3 E E lD 6 r<{a rq(5 z ca trl m H 2 M FqEia) M rq mk{a Fl r4 o z o Fq a $ ts a Er rh z o F{ rl tr] Fq a E{ d{JoH \o a\A $ U) ta a)$ a)q \(n Np q) A ! t c! q)(a c! AJ s F a() o +) )-{ tr o +J ae cdHgo':-l EEo ;.{>(sEs>r,H.9 {JH 'E= ,EHg El r1o-Oir ,l ntl c.t Fl Comnents on: Attendance of female members of the community at health education meetings The general attendance of female members of some communities at health education meetings is good, the few whose attendance is poor is because many women pay more attention to their farm work probably because this is the sole source of income and survival. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discussed (attendance, participation in the discussion etc). The participation of female members of the community meetings when CDTI issues are being discussed is also good in some districts. For example in Kumba Health district, their numbers out number the number of men present in the meetings. In decision making, their fuII participation was observed on the acceptance on the time and mode of distribution. Incentives prouided by cominunities for the CDDs Community mutuality and voluntary services offered to CDDs is not a common practice and this makes it very difEcult for community members to assist CDDs in kind or cash to carryout their task. Attrition of CDDs, fs aftrition a problem for the project? ff yes, how is it addressed? Attrition is common in all health districts where some CDDs refused to distribute or even abandoned distribution midway because of the late payment of state motivation. Other issues. Majority of communities are so alert during period of distribution. The individual rush for the intake of Mectizan@ is so high. AII destructive rumours and myths that surrounded Mectizan@ and treatment of fiIariasis have died completely in most communities. There is drastic reduction of side effects following treatment with Mectizan@ among community members. 2.5. Capacitybuild.ing Describe the adequacy of available knowledgeable manpower at all levels. Given the recent government recruitment of (ZZil health staff and their deployment throughout the province, the current situation of understaffi.ng in a1l the districts and health areas of the project zone will improve. Currently there are temporal health staff employed by the communities and the state is looking forward to integrating them into the public service t7 health system, which will further boost the strength of the staff situation in the Districts and Health areas. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (fhe most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferued during the course of the campaign). Most health staff in CDTI SW I project area have been trained on CDTI and eye care programme. Transferring them within South West Province is not a big issue that can cause problems in the course of the year during project implementation. With the recent recruitment within the project zotte, the project is planning to increase staff trained on CDTI at all levels. 2.5.1 Training Training was very intensive, because it carried the component of CDTI and eye care program. It was organized by the d.istricts for both health personnel and CDDs and sponsored by Sightsavers International. The district sutrlervised the COPs during the training of CDDs. 2.5.t.1 Refresher course for Chiefs of Post A total of 75 chiefs of post were retrained in the entire project zone at the level of each district on CDTI and eye care programmes, while 154 other front line health facility staff were also trained. 2.5.2 Training of CDDs and other Health stafffor CDTI and Eye carc 2007 A total number of 801 CDDs were from the Meso/Hyper endemic communities and 391 in Hypo communities. In the district and health areas, the outline of training comprised the following topics: On Eye Care programme o Basic anatomy of the eye. o Visual Acuity ffeJ measurement and refresher, Distant VA measurement with Snellen's Chart. . Ocular pathologies and management (red eye, cataract, and criteria for referral ofeye cases). . Integration of eye care into CDTI ( integration matrix) . Training of CDDs on eye health in combination with CDTI, i.e. sensitization and health education by CDDs, VA checking at the level of the community using the protocol. . Criteria of referral of eye cases to the health centre and filling of the referral forms. o Reporting and follow up of referred cases. . Health area reporting and referral l8 o Criteria of prescription of reading glasses by COPs . Health education on eye related issue and content of messages. On Onchocerciasis and CDTI programme A The Disease o Aetiology(Definition) o Geographical distribution of the disease . Mode of transmission and vectors o Clinical presentation and Complication if not treated o Health and Socio'economic impact of the Disease. B The Treatment . The drug mectizan ( treight range / number of tablets) o Non-eligibles . Possible side effects o Management of side effects, . Possible side effect with management taken care of by the project with 7 days after mectizan is swallowed. C Reporting . The registers . Recording . Census up dating . Numbering of Houses . Registration of treatment o House Hold cards . Community treatment forms, community self monitoring forms, Health Area treatment forms, census and mectizan Distribution summary forms, Adverse reaction forms, fi.nancial justification, etc. D Activities o Monitoring and supervision of distribution o Management of side effects o Management of Mectizan tablets, . Health ed.ucation and social mobilisation, o Integration of CDTI and eye in the minimum health package, . 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C) s o + o to aa d E'lE<O I *E o a O o a O a a o a a :. o O o O o O a a O O o (> o a € A o Eo o !(, s s o l+a o @tr o)d dt{{J iia(Do .q E-rE9 c+{ FOv H!Do6) .ct'o E.E5dzl okt< a o o O O O o o6 o E< s tsq [+()Q t$ r-.,| F{ o F{ F{ rOl rO$ O N F{ o ci r-{ (o c\ (o c\ O m (o O N N o 6l m6t o Ori a r-{ F. : F- : O 6l (o c\ g) NN O)NN o {J .J rd ts9 rr{ 'B li +) G -(+1 '.i-{ d9+) o +) <nobe -.o o) EEr; O)AC) ok E< t-{ rl rOs 6lr-{ (!)6t (oco cog\ cr)c.l F{ t--ri (oN o)NN +) Ho Eo o -(C) \oo\ oot-{ \oo\ U Gqj €,tt ::? *$ ca a co co rO rO a co cYt a co a a co a co a cO a c\ co N CA o ti cd +) @ cD o F1 d) +) c) }r +)(o a(+{ o Fro6Eo)Fltr3'e)zk aP ok Ei cO cD cO lll co co co co 6I cr, 6I co * FI (, ts!o o r<{a FxIo z ca E tq frl 2 M m E LT fr] ta a Fl rd z o ca A #5 h) HAtr-t,(, z o M E< FI tr] ta z o Fi Fl Ho Ei {rd o E 0) d) -d(, s \oo\ oo 1\ qu t)bq)$ a) H \ !a p p ts q \ N a) a Nq)g d o +) cE +) 0) H 0) p< H E-'t aO e,{-.4 o a() c) +) trotr e+{ ''{ € 0.) +) € cd b! )-r -i crdt{F rof .l -ol cdl Eil Trainees ftpe Of training CDD'S Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(spec ifv) Program rnanagement x x x flow to conduct flealth education x x x x Management of SAEs x x x x CSM x x SHM x x Data collection x x x x Data analysis x x Report writing x x x x Primary Eye services care x x x x l/isua1 acuity testing x x x x Others (specifv) x x x x Table 6: Tfue of training undertaken. (fic* the boxes where specifrc training was caruied out during the reporting period) Any other comments 2.6. Treatments. 2t o.lC\ +jk oaoH d d c6 o)E +) H d oa n, o €t{ og ot{ Q)p B o !d +) o op Cd o +) FI o d +) c!E +) H o E +)d oH +) rd c Cd hD H o hD co +) CD o) o {J 'r'l() d F{ oO t - sd.E t E EEAEE.g_; EE 6e*-gEA t{ex O O O O O O O O O o EE,tE9 22a O O O o O o O o O o sfr EE Ez€ ro @ o c\ r{ @ r-f @$ ro co @ ro co OOO co t'- t--(o N (g t-- Io tr-N "i N .$ ca ri (> @ o)6l6I gg*E - i O)$ c\I (o$ c\l N O) co .+ @O(o .S O) tr- O\tt(Os lo6t @ O) @ Co t-{ OL- ro ro @ co co @ E- E- o .lJ cd ag o tu oo ll rdd A \o I ,o)ohD a(UE9Bo>fi8 O)q @ (o @ oj @ c\t(o oj tr-(o d tr- TO trj @ O)q rO tr- Oq co oO co r.- tr- Oq D. s rri @ s6l n @t- o Eer $O$ O) O)O O) @ @ @t- c\t co 6l @ @$ 00 $ co6l ro 6I r-lN @ co O @ O)(o c'o tr-$ roNN O) $N t-l O)N6I ctx !$o(o 6l coN €Ag=Egr E*.itr€ x{ EF (0 @ O) co O) tr- tr- tr-(o tr- $ co(o @ @ O)$ O O) coO$ rO .$(0 IO IO 00 CO cr]N O) O)$ co r-l @ co CO O)N co @ c{ @ @ c\ a t rft roY i O Fc! -E!8{3F' ;tia o:P EE d) co @$ .$ r-{ O) O) (o O)OL-$ c\i O) @ tr-O L.$ (o tr- @$O\o (o IO l()$$ 6I QJN .S tr- @ \J-l r-{ CO t--(o(o colr) CDo(o co aq) hDd 'Hk q o +) n E E o() oo ll rdd a qo '= bDtdk'b<:f, ie 0)OG sOO F{ soo Fl so F{ \o o\oO r-.t 6\ o F{ s r-{ 6\OO \o O F{ OO F{ soO F{ sOO a (fl 0) o5 0 x'E SEXCcd€ E E!Eze, 6I c6 co $Io coO (o (o@ lJ)$ \tt@ TO (o @E-$ a tro?9 .t aE liEE-6{E I 6lco CD $rO coO @ (0(0 ro<1 $@ rO @ @t-$ ..6:E 5 E,+ES,5HB* " Ei€<* gAE Ei B E cdE:La OO ..E> E 6I CD co <t ro CDO (o(o l1?.+ $@ rO Co @t-!S t E< .EQAEi H(5 z ta B tq trI 2 o H E 5 M ts] m =Fl tr1(5 zo Fq il ,) h lE{a ljbo z o MHH Fl tr1 eao Fr FI flo E-{ o +)dti o ho(d $i o O c) +) t{ o 0) bo cdt{ 0) o C) .9t D alt\6Hqo: cd aJS{ q)ooAHrri \+r \- \O '{o\ (nroS Ui(nt oe)E.gA(,!J r.i L' .EE{tr-\!t6dEE i;dEREss E ss&* #cd ='nLVH6 Fu-)!uo bo-^av)HI . .l LvE3 s 'a(," +ia- H- =cdcdLV-t s.E 8-3<bo€(5 e 'd r-Io\ .'l \n+)(J .r ri@HdD bo 5.9tr (2'il .il ^{ cl t{ -OEo@ E Hf 9h+, ojX .$EE; +rrrtrtrEl.d ^ cg9 r- hD! # E€ IEPEElr^Fr+l\' - -lj a{ v =j,q:J-i .DQJH *s.gL, ol ,=l dl E-{l -l lE!r toolEEIE SE tF -H' la o lFtol.) 9lED) ItJsls EIE5'F ,Fllr l!old l(D cD l\3 lCo lco lgto lte lt) HIP lslx ls l=HillB te,l!tlH.la) -J hD6 l,rbEsldIE lD)hlo oo oqq ts o) cE o te oo oFl tD oq o B tD eto lt oo s Fl o c) a?O\OVB D)qg o Bp cl'o sl* lolo t\9 lbo@l@O lt\gbg 16)6lOt9 la lx l=lo il il 10o\ \< Fl O tD() F.o og c, lt.]ol@ t\3 lt\9 6> lO)(olo -r lalx L-loIO il (g se c.D o,s gHc p> lTf E H[*p E f E FE T}EE io 9-* t E r[ fg[ E e,' $q E&E E.F€gLJ Fr L.. !s EET E.Es E96' F Q-. 15<l<(D ttEs esE aa$ g93 5'Bo pFs HFg ruX'e'. A) BH E[* E9.tr. o6F S o6H. aEf l, *I; g F.9. aL8 6' c+ el. el'Bx qBP ;trE +'$Ei r,.5E' t9\ .-1 io oHgHF* gFl' X )..VHFr E tJ u) (o Pog) s ll Table: 2.6.2 HlTo treatment results CDTI SW 1 Project Zone. Over the past years, since the beginning of the project we have been treating in the Hypo endemic communities. CDDs are equally trained in these communities and are implicated in other Health interventions at the level of the communities e.g. Eye Care, Malaria, EPI and HIV/ AIDS control Programmes. We cannot completely over look CDTI activities in the hypo endemic communities because:' . We have a lot of people who take Mectizan living in these communities, if we neglect this population, in future these communities might become meso endemic which constitute a risk for the disease becoming a public health problem. o CDDs trained are motivated as well as CDDs in Meso/Hyper endemic zones. These CDDs carry out both CDTI and are involved in primary eye care activities. . Our partners SSI and MDP needs information on the total number of persons treated with Mectizan tablets using clinic base strategy, which in this case majority of persons are mostly found in the Hypo endemic zones District Number of hypo endemic communities Number of persons treated in hypo endemic communities Number of Male CDDg Number of Female CDDs Total Number of CDDs BANGEM BUEA KONYE 24 9988 25 1 26 56 23105 39 47 86 5 2409 2 0 2 27 106 0 KT]MBA LIMBE MBONGE 7 74 0 15015 33609 0 27 65 0 0 4l 0 MIIYUKA 45 9991 27 1 28 NGUTI 0 0 0 0 0 TIKO 100 29 25828 56 47 5 103 13TOMBEL 5130 8 TOTAL 340 L25075 249 142 391 24 2.6.2 What are the cauges of absenteeism? . Travelling. o Farming. . Feast days o Business 2.6.3 What are the reasons for refusals? A few cases of refusals were either blatant refusals or refusals due to religious reasons. In fact some cases of Pentecostals faith remains a problem. Majority who have experienced mild side effects fear re' experiencing the same side effects. Some fear that Mectizan@ wiII reveal other underline health status e.g. HIV/AIDS, Tuberculosis, Hernia. 2.6.4 Briefly describe all known and verified serious adverse evente (SAEs) tUat occurred during the reporting period and provide (in table 8) the required information when available. There are no cases of severe side effects reported so far within this year 2007. 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 25 \o c\ *) F a) -! quq q) ^t:.r*i \ t\ qJ "aF Fr H .s ,E * 1\A cl(n Uiqj U a)q \ ha v p 6 N\ \q a)qq Q) s € o tr oA ao +)t{ o 0)tr o +) bD ./l rJ c)t{tr oO {J ,.q +) a) E] U) (t) {Ji o o 0)a 9r 0) d Cd a o tr 0)a +{ a oa O 'ol -ol cdl FI !qo =o)HXlr. oo-()5€ aEI U)bD uo !lE EEr 3uE EE0) 85+)trc)Jl r.5.!E{Ooo o.9E8Q( :bDko .5 <+r rrIJOQ. (Huo6 Ea -93 3H A otI s] tsEd 8= oH a- adt. .a-€3 E ETE(!Qo;ic) a€&-i.E o -tod E-Heq'= 'tHS '5o H.E.g oboad 6J{tSc ,86t-.N iiraj(U-O c)3Ee iJi- -o A ct) E o +)a E ais H3H eA#EF- a(!d .NB- -sts 6d.o) 5aE cS +{o obDd(cI 'riido i5 rr -o X a o bD * 4 U) E lFlg'lt pE; EFS'()OtlPreiJet et ,ioEij Fg Pb3g HLg as EFr>b e+d trEfrr +Otoo EH B €trg slS g Hltg ,EH $iie EHEoSr(+X E' H' iIE Eh E'. i+ HfiE E€ *+o XE +-oneF EEFts'o E sg E.hi EPsogB B ERE EE.* e$Fjo oH OIO ?8.Eilpa" sg C)R FE-t p ei o tro t9o (o b0oo @ NOoO -l t9oo O) b9oo Crl t9ooA b9oog) t9oo!9 !9ooH D9 oo H(o(o(o (o @ @ Ed !d F -l@ F -I@ A -l@ Cr){ C,I q){ C'I ql -I(I co -IClt =aA$ gE ts.lr t! E ='E.PaY6+id'-r tgl 6< 6 Hg oo E EI t tJ. a+ oa *rL 9) oq o(t) A -t@ F -l@ A{ @ Cr, -1C'I -lcn -lCrl C^) -fqll eFr(DD'E o+E 3 [* IEN A -J@ A -l@ A -l@ q) -1C'I -IqI *I cI C/) -lqI r$g 7SEE Bo-p tr (!0qtrE E B: s E!o HoOs P \o oos Hoo s oo\oo\ Fo s HoO s oo oqq E!,EF ., c) oo oEt, 0q o tdtr,trlG HOAO\+\ ll - oo Hoos Hoo s H o s oos Hoo s Hoo o\ Foo\oo\ rfi E 0q(D Hl t€ E5p@q +\ ll oo O)O c.,r Cr, q) C,I c.IIo g,qt CI A C/J t.9 CJJ(D A -lcrl t9 -IA o o t9 -l -lg) CD -l t9qn H Crt H Clr AAA H(O -l -l -IA -t t tD+ o FH LE F,E f a B $ E-L5'< Ei.rdo oI ts 'o *) OFI>t'I tr opZ odF +E P-6g + Bry6a EE936g 6 r.t o tt)+9o Go tslo\c) E' -o io<HOD'H* fiP R> :F;go c,$ o\ tdtdtrl o6@ *\ ll oo tdtdEd{oP J-oiloo ESjs eto @os t{ @ t9@@t9@ t\C i.0 gJ o @ T9q) H H t9 t\3 O) C.IT(o H -I@ o H @O t9 O)(O H rS @A t3 @ @ -lt9 @ t9Fq,l w cJl o) t\9@\e O)oF t9 Or@ F(o(o t€ O) @ @ o t9AO -1H t\9 ts A O)q) @ -f -f @P @(0 C'I H @(o (rr O) cI t9qIl H -l -l@ -lPAt9 s -l boqrl s -i cn b) s -f (o -I o\ -lHbA s q) .[9 o s cp s,CI O) s At9 b) @ \Qo\ O) P -l s CO 90o CJI s H H C^)b s P 9J \eo\ Ho !oo@\oo\ p b9 @\oo\ C'' H i.,q) s cIIo(o \6 o\ O)g O)ql\o o\ Ho|, OJ s (9 i,, o)s @ 90q) @ s (oobq) s @FA s @F(rt H s gl CT O) s C,^) 90{o s CJI P @o s -l(o ;trH s GO-c3 Bfl ID oq o t.J{ 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the te answer) MOH tr '/ wHOn UMCEFfI NGDOtrOther (please specifir) : Mectizan@ delivered by - (please tick the appropriate answer) MOH tr ./ wHon UMCEFII NGDon Other (please specify) : Please describe how Mectizan@ is ordered and how it gets to the communities. Mectizan@ for the project is jointly ordered by the Province and Southwest Provincial Special Fund for Health following the input from the ten health districts of the project zone. This request is taken to the NOTF secretariat where staff from all the CDTI projects nation wide meet to collate data and make a joint Mectizan@ order for the whole country. These drugs on arrival in the country are cleared by the WHO office in Yaounde and handed to the NOTF secretariat where Sightsavers staff collect for the project and send to the essential drug programme in Buea. From there the drugs are distributed to the various health districts through the DMOs when they come for meetings or other routine activities at the Provincial Delegation of Health in Buea. The Nurses in charge of each health areas in their turn collect their stock of Mectizan@ from the districts according to the needs of the health area. Then the CDDs collect for their communities from the health centre chief of post. In 2007 these drugs were delivered on time and in sufficient quantity. We were very strict with the stock management. The management of Mectizan at all levels is closely supervised to minimise loss, destruction and stealing. Table 10: Mectizan@ Inventory Health District Number of Mectizano tablets Requested Received Used Meso/hyper Used Hypo Lost / Wasted Expired Remaining BANGEM 53,464 53,464 25,971 26,586 36 0 87L BUEA L29,233 L29,233 27,L30 73,708 65 0 28,330 KO}ITE 97,239 97,239 85,536 5,297 65 0 6,35 1 KTIMBA 280,000 280,000 2L4,486 43,163 693 0 21,658 LIMBE 120,000 120,000 8,957 93,343 3 0 17,697 MBONGE 133,529 133,529 98,686 0 221 0 34,622 MI.Iy[JKA 141,000 141,000 L20,409 19,433 155 0 1,003 NGUTI 103,206 103,206 62,t44 0 78 0 40,994 TIKO lOO,4,J,, roo,4,J,J 38,26i totozv 35 U 4A,1ii TOMBEL 120,000 120,000 85,989 L4,087 27 0 19,997 TOTAL 1,333,104 1,333,104 767,669 362,22 7 1,378 0 211,930 28 Table 10 above summarises Mectizan@ stock inventory for the year. No stock outs were recorded. After distribution the project still had a left over of 2L1,930 tablets. How are the remaining Ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected through the same channel, but this time in a reverse manneri from CDDs to health centre chiefs of post, through the district to the central drug store of the essential drug programme at the provincial level for storage. All levels have a safe place to keep Mectizan. In the Province Mectizan is kept in the EDP store, in the district by the district medical officer and in the health centre by the chief of post. Dispensing of Mectizan at all level is according to request and need of the persons concerned. At each level there is good documentation of movement of Mectizan@ tablets. State and briefly describe activities under Ivermectin delivery that are being carried out by health care personnel in the project area. The health care personnel carried out the following activities under Ivermectin delivery. o Requ€sting for Mectizan@ o Transporting of Mectizan@ o Monitoring and supervising the distribution of Mectizan@ from top down . Storing and stock management of Mectizan@ tablets i.e. recording of movement and reporting on Mectizan@ stock at all leve1s. o Taking of inventory of Mectizan@ stock afber distribution cycle is over. National The NOTF collates request from aII CDTI projects in Cameroon, and request from MDP a joint stock through WHO regional office in Yaounde. When it arrives in WHO regional office in Yaounde, NOTF collects and distributes them through the supporting NGDOs; in our case is Sightsavers International. They facilitate the transporting of the drugs to the Essential Drug Programme for storage in Buea South West Province. Province The Provincial Delegate of Public Health then informs the District Medical OfEcers that, Mectizan@ is now in stock at the EDP. EDP Manager and OPC then ensure that districts requests tie with the quantities that were projected for each district before supplying. This is to guard against wastage and unnecessary stock in the districts. District DMO makes the request to the EDP according to health areas needs. From here either the DMO picks up the Mectizan@, or the Drug is transported to the district through the normal drug delivery system. 29 Health Area DMO informs the Health area COPs of the availability of Mectizan@ in stock Each COP makes a request and collects Mectizan@ as need arises. Community Communities are then mobilised to come and collect Mectizan@ from the health centre. Each community assigns their CDDs to collect Mectizan@ per community needs. - Any other comments 2.8. Community self'monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes. If so When? During training on CDTI in SW I project zone in January 2007. Though TOT has taken place on CSM, as of now, communities are yet to carry out this activity, probably because there is no specific funding for this important activity as CSM agent demands compensation as CDDs. We will continue to sensitize the communities on the need and importance of CSM in CDTI and other health care interventions. Table 11: Community self'monitoring and Stakeholders Meeting District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meeting(sII\d) BANGEM 32 0 0 BUEA KOI{YE _ -1? 54 0 0 0 0 0 KUMBA 103 0 0LIMBE 6 0 MBONGE 66 0 0 MIIYIJKA 45 0 0 NGTJTI 84 0 0 TIKO 15 0 0 TOMBEL 60 0 0 TOTAL 478 0 0 30 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. Just like last year, 2006 community self monitoring was not carried out in 2007. With no funding for this activity community members do not seem to be interested in doing CSM. They have been trained and re'trained in the activity. 2.9. Supervision 2.9.L. Provide a flow chart of supervision hierarchy. Central Level - NOTF - NGDO Community - CDD - Dialogue structure members - Community members Intermediary level - Provincial delegate Provincial Chief of Unit Surveillance, Monitorin$ - and Supervision Oncho Project Coordinator - Finance Officer Peripheral Level - District Medical Officer - Chief of Bureau Health - Chief of Bureau of Administration and Finance - Chief Medical Officer of Disftict Hospital Health Area Level - Health Centre nurse 31 2.9.2. What were the main issues identified during supervision? o Reports of activities carried out were not always available at aII levels. . CDDs attrition was found to be less that was the case last year. . Full integration of eye care into CDTI is ongoing but some CDDs do not care much to check visual acuity measurement because their activities are either very early in the morning or late in the evening. At this time of the day, Iighting is poor and good visual acuity measurements cannot be taken. Since the motivation package of CDDs depends but on the number of persons they can successfully treat with Mectizan@, they prefer to rush more for persons to be treated in order to have a huge motivation package. . The condition of motor bikes in the freld is deplorable and this has contributed to none or ineffective supervision in some districts and health areas. The state of roads that link health areas and communities is very bad. . Too much work for one or two health staff in the health centre. There are many health programmes now being implemented and the few health staff are overloaded with a lot of activities. This however is being gradually addressed with the recruitment of new health staff by government. . CDD were disgruntled for late and low financial motivation from the state. 2.9.3. Was a supervision checklist used? Most health districts have developed their integrated supervision checklists and always use them when they are on supervision. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? o In Kumba health district, the CDDs motivation had a lot of discrepancies and a written feedback was send to the DMO to correct the situation. We requested for detail information on the state of the motor bikes in the field and estimated cost to repair each bike. o 2.9.5. Was feedback given to the person or groups supervised? Yes, The OPC SW I gave written feedback to the DMO of Mbonge, Kumba and Konye after her targeted supervision. 2.9.6. How was the feedback used to improve the overall performance of the project? Feedback is not readily welcome by the actors, because of the pressure we mount on them, but at the end they always implement the corrections for the good perfonnance of the project. 32 SECTION 3: Support to CDTI 3.1. Equipment Source T5,rPe of eqtripment APOC MOH DISTRICT /LGA NGDO Otbters No. Conditio n No. Condition No. Condi tion No. Conditio n No. Conditi on 1. Vehicle 1 F 2 F 1 CNFR 2. Motor cycle(s) 9 F 6 wo 28 wo 10 wo 20 wo 3. Computer(s) 2 wo 11 F L2 F 1 F 4. Printer(s) 1 F 11 F t2 F 1 F 1 wo 5. Photocopier (s) 1 F 1 CNFR 10 F 1 F 6. Fax Machine(s) 1 wo 1 F 7. Others d FIip chart stand 1 3 F b) Overhead projector 1 F c) *Condition of the equipment (F=Functional, CNFB=currently non'functional but repairable, WO=Written off) How does the project intend to maintain and replace existing equipment and other materials? Decisions on purchase and replacement of equipments are made at the Ministerial level. The province and the districts need to write and channel their request to the Minister of Public Health, and wait for the response. We wish to mention here that Konye Health District received a double cabin 4 x 4 wheel Nissan from the MOH this year. The cost of maintenance comes from the state budget of the province and health districts. In most cases the funds are not enough and the cost of maintenance is very high due the bad state of cars and motor bikes. At the level the health area, the bike is use for multi purpose activities in health programmes. There is the principle of risk bearing and cost sharing applied. The health centre chief of post uses health funds and contribution from other programmes to repair the bike. All these depend much on the willingness and conscience of the staff concern to take good care of the equipments and logistics put at their disposal. 3.2. Financial contributions of the partners and communities JJ Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? We submitted the budget for 2007 to APOC for the year's activities. This budget was approved late and we only had funds in Late July 2007. At this time we had gone far in implementation of the project. Counterpart funds from Sightsavers international are released hitch free. In fact this is our main sourse of funding now for project activities as the government does not directly fund CDTI activities. We used these APOC to train health staff in December 2007. Additional comments. 3.3. Other forms of community support Community support is so slow within the project area. However a few communities motivate their CDDs by offering them food and assisting them in their farm work. Contributor Year 7 ('2005') Year 8 (2006) Year9 ('20O7'1 TOTAL Cash Budgeted 6us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Re leased (fJS$) MOH (Central + Provincial/State) 12,552 50,885 50,885 71,130 66,424 MOH @istricUlGA) 9,600 Local NGDO(s) ( if any) NGDO partner(s) 44,363 27,665 34,280 14,378 49,754 49,-754 Others a) b) Communities APOC Trust Fund 33,863 14,909 15,000 17,353 14,850 18,094 TOTAL 90,778 42,574 100,165 92,216 135,734 134,262 3.4. Expenditure per activity 34 Indicate in table 14, the amount expended during the reporting period for each actiuity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate, The exchange rate used is 500Fcfa per 1$ USA 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) ssl Drug delivery from NOTF HQ area to central collection point of community 135 Mobilization and health education of communities 16,453 Training of CDDs 8,310 4,836 Training of health staff at all levels 8,693 3,686 Supervising CDDs and distribution 2,410 4,172 lntemal monitoring of CDTI activities 2 )360 1,327 Advocacy visis to health and politicpl authorities IEC materials 2,000 6,822 Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles Cost 4 ,522 4,043 Office Equipment (e.g computers, printers etc) 3,564 2,032 Others *SIDE effect druqs *Personnel 20,770 6,763 *Evaluation 10,557 ll ,489 *Offrce Stationeries and supplies 3,204 {.Registers *Communication *Bank charges 290 124 TOTAL 13,505 66,424 48,634 Any comments or explanaiions? 35 This year CDDs motivation has been held in the state treasury because of taxes. The State procedure to withdraw fiscal cash from the state treasury is very long and boring. However we struggled to pull it out though very late. SECTION {: $ugfainability of CDTI 4.1. Internali independent participatory monitoringi Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) o Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation -Not applicable 5 year Sustainability Evaluation Internal Monitoring by NOTF one Other Evaluation by other partners 4.L.2. What were the recommendations? Not applicable 4.1.3. How have they been implemented? Not applicable 4.2. Sustainability of projsgls: plan and set targets (mandatory at Yr B) Was the project evaluated during the reporting period? -NO-The project was evaluated for sustainability in 2003 and sustainability plans for 2004,2005 and 2006 were submitted. Was a sustainability plan written? Not applicable -When was the sustainability plan submitted? -Not applicable What arrangements have been made to sustain CDTI after APOC funding ceases in terms? o 36 4.2.5. To what extent has the plan been implemented 4.3 Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms, Mectizan@ distribution follows the normal channel as other drugs in the essential drug program. Monitoring and supervision of distribution is at all level. This activity is integrated into the drug supply system of the MOH through the essential drug program. The South west Special fund for health is in charge of storage and delivery of Mectizan@ to the districts. 4.3.2. Training To minimize cost, efforts are continuously being made in the health districts to integrate trainings. This year eye care training was carried alongside CDTI training. Information on other health prograrls qgch as routine lpmunization, Roll Back Malaria,. Leprosy and Tuberculosis even HMAIDS are usually passed on during trainings. Coordination meetings at District hnd Provincial' levels ensure that issues concerning all programs are discussed. 4.3.2. Joint supervision and monitoring with other programs At the district and health area levels, most often supervisions are done in an integrated manner to minimize time and cost. Funds put in place for other programmes are pool together in one basket in order to carryout a cost effective and cost effrcient supervision. District and Health area staffs are so polyvalent that they implement all activities at their level. The transport means available are used for the implementation of all health programs. 4.3.3. Release of funds for project activities Sightsavers international had release some funds for provincial supervision, districts and health areas training of nurses and CDDs. As at now, no health district or health area has indicated the amount of funds released for CDTI activities from state budget. MOH contribution in cash is coming on very slowlyi the MOH is still to allocate budget line for CDTI activities. Sightsavers supports activities at all level with funds. 4.3.5. Is CDTI included in the PHC budget? in the state budget, there is no line as PHC budget, but in district and health areas, state budget carries a specifi.c line on supervision of health activities. CDTI is part of the health programs they run. Hence this budget line is used for CDTI as well as other health programs. There is no particular budget line 37 for just CDTI. Not all the health areas have state budgetsi some are run by private / confessional bodies and hence have no funding from state budget. Hopefully, health sectorial stratery may have a better solution for us because we have been requested to submit budgeted plans of action. 4.3.6. Describe other health progxammes that are using the CDTI structure and how this was achieved. What have been the achievements? CDTI structure is just like a pace setter for other programs in the province. The door to door strategy has been adopted by other programs in project implementation. Majority of CDDs are used for multipurpose services in other proBrams in the communities. A CDD maybe used in the community as a social mobilising agent or a registrar in Expanded Program on Immunization (EPI), to register children newly born in the community so as to recruit them for vaccinationi as a community relay agent in Roll Back Malariai as a community health worker in Leprosy, and Tuberculosis and as a community agent in HIV/AIDS programs. These programs have also benefited from the use of motorbikes at health area level as well as Onchocerciasis project vehicles at provincial level for supervision of their activities. CDDs trained through CDTI initiative have become the link between the communities and health structures. They have mastered their communities very well and are therefore preferred to be used by all health programs to reach the community. Now they have been trained to do visual acuity testing and most of them carried out the activity. Some health districts have decided to pool the motivation for community workers in one basket. Most often is the CDD that is being used, is only their narres that changes within programs. In fear of loosing re-numerations from other projects, most CDDs have preferred to stay within the project. We feel this is a good strategy that will be implemented in all districts to reduce CDDs attrition. 4.3.7. Describe others issues considered in the integration of CDTI. Management of side effects following Mectizan Treatment, The drugs for treatment of minor side effects are dispense free of charged to the patient following treatment with Mectizan from health centre community pharmacies, which are controlled by the Provincial Essential Drug Progtamme. The total bills are paid by Sightsavers International at the end of each distribution cycle. Medical doctors and nurses are also trained to carter for any severe adverse event following Mectizan treatment in the district hospitals free of charge. SSI takes care of all expenses at the end of each distribution cycle. Currently the eye care program is being integrated into CDTI program at all levels. RoIl back malaria, TB, HIV/AIDS, l,eprosy and BruIIi ulcer control programs are using CDDs at the levei of the community to implernent their programs. 38 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 research carried out, but there is an operational research that we will be carrying out sometime next on reason for CDDs attrition within the project zone How were the results applied in the project? Not applicable. Strengths: o Most districts attained their therapeutic coverage . Some CDDs were supported by their communities. o Most districts pre financed their appraisal meetings. . There was a drop in the number of refusals in some districts. o Spontaneous requests of mectizan by some communities. Not applicable. 39 azo Hz trI tr trlA2 =ntr Btro f-{ B CD 6*o E E€ir a Els oi a €*;A d I !teE E tt = 6 tr.: tr frEtsEd I i8 o o>otr> .i '5 Xcg oijla ts.8(!H E.d =cgo.dEi(,)d cd? 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H P.E !!6 tEg eEEd cds =aa.5-r'= s3E EE.E -ocE -{J H G) F{ ct) 0)tr .P(J ti{J U) o bo bnO.1 -l .=cE ;i .dq !+)baotr a{ bo a.=tr6 \lF{ alu 3.^ E 'I1 '+' 0.1 .x od +) 0) .r E gi h., tr 'tri tdc:D+)3,* tr;ooE p.E EEEx H E E8 ;E F€ g H.Et 8tr(/)'\ hl-l v l-{ J..l a a aO o €O c! o hD +)tiog ol{ o +J cd -I CN E{(J F]p{ a rJa a rI] B AAOHE Ezl #Hs!qod(, r! >o O$ li hr 'P o) r-O '.1 o o +) d lioaao E EI cd ao h0 tro cds() (n o CDaotr ,!d cd o B IDE bD Holr +)a zo Ei() tr]a a U rd trl rd hd td c)Fla F aD \.,16g E c, F r{ FU(DH 5? c) te E. H FUP. EA 5 q) ld q.E H [EE E EAQq-Hooroo $$re gggs o-F !rE.o (,iJc?(,)Oi F PS8<B f e *E g - h H trE OX = -'<+Fu) : +: H-'E H EA5' tFEtoo(/)ogoSB E ilFHa E B*p('+oo[a fE.E 8oE.RG D)FEBOel{(D Fo,)D5Eoo.oH. oo EE (D et(D lD Bo ol*l oU U a) E5 F.0c s'PPP OUrHC+pt+ a(D+tr r+r dtroFI9- u)cnld FB Fr t6 -a. eti 6E A) t,$'E(+ c+o!t o eFHo Fe cn <ft8 D(DrroP6 grtrK f,r. j-1, E r-r s 7=EP fr.E.8VHHHU9Pdate H.@ $-'86FtrE ioFlor,CDHAo E.o s"e 3 -ott}+Jp EE5 =' t. oqFlHro8;iFEq rE H'E c)EHO ut6acnaI sts sg 3H 'u, A' -E U9 < P...<9o AP PE' etH rtlJiD !,, V)(+ tel(+lo zE <gop a'6''rltr:i()F3 ii I &EtrHO-- H a'85 S= + H: i-.:. 5 [&et H. at5'9 EHP+ Eh8 ld -r €etrEip) E' boEtr e3 -p(D- x:55-* ox' FEoor+ +r .tt) c* Ero !d(D a oo P a el.t-l dtet o e|H. Eo A) trP rd otl o P F?O H3 tota a)t rdE ol{rp 4 oq o o!)(+ U? o el.o at 13 p H oc ct) c'fo tsts.t<tplel le I C)tdAOP O d t+{O rEiBF ESRE$ p <.6 E E.5i H E E-Boo Eilg g.Hll D)g;,,=BUoox lF)Itrlp H"uf,EBS. OB3rHo.triD V(D ,-ts $ro{ H,.3 6pg'? EEg5' cn el o ct)o ? Pa 4oatoa e|. aE Bo+ p et o + Eo s SECTION 6: Unique features of the project/other matters D 42