CDTI SW II mid-term project technical report submitted to Technical Consultative Committee (TCC): from January 2008 to June 2008

so RESERVED FOR PROJE CT LOGO/IIEADING MID-TERM PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) R UBMISSION To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) (aoPl B b h To -qh4^ I Proiect Name: CDTI SW IICOUNTRY/NOTF : CAMEROON Launchins year: 2000Approval yearz 1999 Period: From: JAI\UARY 2008 To: June 2008. ( Month/Year) Repo (Month/Year) Proiectvearofthisreport: (circleone) I 2 3 4 5 6 7(8) 9 10 NGDO paltuer: Sightsavers International Date submitted I 8 SrP 2003 I ! E I t I I 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 sign the report: Country: CAMEROON National Coordinator Name: Dr. Ntep Marcelline Signature: . Date Provincial Delegate Name: Dr. Mafany Njie Martin Signature Date NGDO Representative Name Signature Date Provincial Oncho Coordinator Name: Mr. Ebongo Peter Oponde Signature Date: This report has been prepared by Name : Mr. Ebongo Peter Oponde Designation: OPC SWII Signature Date ll Table of contents Acronyms v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS 7 Executive Summary 8 SECTION 1: Background information Erreur ! Signet non d6fini. 1.1. GnNBRer.rNFoRMATroN............. ...............ERREUR!StcxrrNoNDEFINI. 1.1.1 Description of the project (briefly) .........Erueur ! Signet non diJini. 1.1.2. Partnership .........8neur ! Signet non diftni 1.2. PopularroN .. l3 SECTION 2: Implementation of CDTI Erreur ! Signet non d6fini. 2.1. TnaelnreoFACTrvrrIES............. ...............ERREUR ! SIcNTTNoNDEFINI. 2.2. Apvoc.q.cv..... t6 2.3. Mostt.tzRuoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNITTS 16 2.4. CorraNat-rNury rNVoLVEMENT........ ......17 2.5. CepecrtvBUrLDrNG.. ......18 2.6. TRreIMBNTS.............. .....20 2.6.1. Treatmentfigures............. .........20 2.6.2 What are the causes of absenteeism? .......... .................23 2.6.3 Wat are the reasons for refusals?................ ............... 232.6.4 BrieJIy describe all known and verified serious adverse events (SAEI that.... 23 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current 2.8. Couutwrry sELF-MoNrroRrNc eNo STITEHoLDERS MeerrNc ............27 2.9. SupBRvrsroN.............. .....28 2.9.1. Provide aflow chart of supervision hierarchy............. ..................28 2.9.2. What were the main issues identified during supervision? ..............................28 2.9.3. Was a supervision checklist used? .............29 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 29 2.9.5. Was feedback given to the person or groups supervised?................................ 292.9.6. How was the feedback used to improve the overall performance of the project? 29 SECTION 3: Support to CDTI 29 3.1. EqurnunNr............... ......29 3.2. FrNeNcnl coNTRTBUTIoNS oF THE pARTNERS AND coMMUNITIES...........................30 3.3. OrHpR FoRMS oF coMMUNrry suppoRT............... ................31 3.4. ExpeNorruRE PER ACTTvITY ....... 3 1 SECTION 4: Sustainability of CDTI32 4.1. INreRNel; TNDEIENDENT pARTrcrpAToRy MoNrroRrNc; EvaluarroN ......... ...........32 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick year.......... 2.7. ORoeRtNG, sroRAGE AND DELIVERv oF IVERMECTIN any of the following which are applicable) .. .. .. .. . , .4.1.2. What were the recommendations? 4.1.3. How have they been implemented? ............. 4.2. SusrnrNegrt.rry oF IRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT.... Yn 3)..... 4.2.1. 4.2.2. 4.2.3 ......25 ......26 32 32 32 55 aaJJ 11JJ 33 33 Planning at all relevant levels........ Funds....... Transport (replacement and maintenance) ul Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Arurual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v FOLLOW UP ON TGC REGOMMENDATIONS 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 Number of Recommend ution in the Report TCC RECOMMENDAT- IONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY (i) Scale up advocacy towards government to take care of CDD incentives Discussions have been held with NOTF and even letters have been written to the Minister of Health on this issue. This is an ongoing activity and results are not to be measured immediately. (iD Scale up advocacy towards communities to make CSM effective The health district and health area teams were refreshed on community self- monitoring during preparation for CDTI activities this year. They were encouraged to do the same with the communities so that they implement this activity. As the distribution is ongoing, the results will be known only during the end of year evaluation. (iiD Take concrete actions to increase therapeutic coverage in areas where performance is low The province during planning meetings with the health districts pointed out those communities with low therapeutic coverage. This was to enable the districts intensiff sensitization of such communities. However, it was discovered during the OPC's supervision in June that this had not taken place yet. The OPC then visited the communities of Afap, Mkpot and Bakwelle in Afap health area (Eyumojock Health District). It was agreed that Mectizan@ be returned to the communities for re- distribution to continue for another week. The Provincial Delegate of Public Health has written to the District Medical Officers of Eyumojock and Ekondo Titi to to take actions to increase therapeutic coverage where it is low. (iv) Undertake project evaluation, after several postponements The re-evaluation was finally carried out from 14 - 28 April2008. Amongst others, the main finding was that the project was making good progress towards sustainability but much still needed to be done in the areas of funding for the project and provision of transport facilities. 7 SECTION {: Background information 1.1. General Informatlon 1.1.1 Description of the project Location SW II Project is situated between latitude 5" 12'and 6o 30'north and longitude 8o 30'and 9" 45'east . It is made up of three administrative divisions (Ndian, Manyu and Lebialem) of the South West Province of the Republic of Cameroon. It now covers eight health districts (Akwaya, Bakassi, Ekondo Titi, Eyumojock, Fontem, Mamfe, Mundemba and Wabane) and 40 functional health areas. Bakassi health district was created in December 2006; Staff to take care of the health district have been posted there already. The health districts do not strictly follow the administrative units such that a health district or health area can cover more than one division or subdivision. The administrative headquarters of the province is Buea Most of this project area is characterised by dense and luxuriant equatorial forest except for part of Akwaya Health District especially towards the border with Njikwa in the North West Province and the border with the Republic of Nigeria, which has Savannah vegetation. The Project shares boundaries in the west with Nigeria, in particular Cross River, Taraba and Benue States. In the north it shares boundaries with the North West Province; in the east with the West Province; in the southeast with SW I and is bordered in the south by the Atlantic Ocean SW II has a very harsh topography with many rolling hills and valleys. This renders the terrain very rough making accessibility difficult. In most of these valleys run fast flowing streams, providing good breeding grounds for the black fly, simulium. This area has two seasons; the hot dry and the wet rainy seasons. The rainy seasons are usually long (April to mid November) during which the streams get flooded. The road network is very poor with all roads being earth roads. These roads get very slippery and muddy during the rainy season making work in the field diffrcult even with a four-wheel drive vehicle. To get to Akwaya one has to go through the Republic of Nigeria and drive across large streams with no bridges and rough mountainous terrain. The new district of Bakassi can only be accessed via Mundemba by engine boat. Most of the area is maritime. The main economic activity in this project area is farming. Males are more concerned with cash crops, planting cocoa, coffee, and oil palms. The common food crops include plantains, cocoyams, cassava, yams, groundnuts, maize and a rich variety of fruits and vegetable grown mostly by women. Fishing is also carried out in the maritime area. 9 Division Subdivision/District Health District Health Area Lebialem Alou Fontem Wabane Fontem Wabane Fontem Azi Essoh Attah Fonjumetaw Fotabong Menji Takwai Bamumbu Bechati Fotang Kupe / Muanenguba Nguti Mbetta**** Njungo**** *Kombo Abedimo and Idabato are health areas that are really non-functional as the areas were found in disputed Bakassi area and occupied only by soldiers. Although the area has been declared by the International Court of Justice as Cameroon territory, effective civilian activities will take place there only after the 14th of August 2008 when the area will be completely handed over to Cameroon. **Dil<ume Balue is under Kumba Health District in South West 1 Project Area. ***Ogurang health area is the only health area without a functional health unit in Eyumojock health district. It has no roads. Only trekking inside dense equatorial forest across large streams accesses the whole area. Health interventions in this area are done only through outreach from the district health service at irregular intervals. ****For the purpose of proximity and accessibility, Mbetta and Njungo health areas in Kupe/lVluanenguba division are administered by Fontem Health District in Lebialem diyision. 1.1.2. Partnership Partners involved in the implementation of South West II CDTI Project are the Government of Cameroon (Ministry of Public Health MOH]), African Programme for Onchocerciasis Control (APOC), Mectizan Donation Programme, Sightsavers International (SSI) and the Community. These partners all work in harmony for the smooth running of project activities. Planning is done with the full participation of the MOH, SSI and the community. Together , they also carry out supervision, mobilisation and monitoring of side effects during Mectizan@ distribution. Advocacy is usually reserved for personnel of MOH and SSI. Plans of action are usually drawn at the beginning of each distribution round, specifuing which of these partners does what and at what time. The working relationship of partners in the implementation of CDTI activities has remained quite cordial all through the 8 years of this project. Each partner has assumed its responsibilities. The communities selected and replaced CDDs that abandoned mectizan distribution. They are also through the CDDs mobilizing communities on the importance of mectizan and when to take it. A few of them motivate their CDDs in diverse ways. 11 ca o z I .^to o Loa o0 ! g(I)k o bI) L E o o o 0) ?a o Lr ,.9 U))(n o) c) d (n(g <,(D C)oo o (d () (l oL o L(6(l) >. 0 L € )a(1)L cC o cl o tr 0) B C) bI) d o >.(! oo() F lj cl(') >. od o(.) L o0 o (6 q og o E o ,Ii E() (.) C) Y o.q o)q) o) (0 () -o(B o o .od C) *E :bn =(iSo; 9F t: o Eo cl o er o;r! ;-r =Ed vEE€ 5DE V to\ + co o\ co co \a|.a 00 \o oq C.lN o\ @ ca o\ $ cn .+ o\ c.) 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It is hoped that this will be the case this year. Suggest ways to improve mobilization and sensitization of the target communities. 2.4. GommuniQr lnvolvement Table 4: Communities participation in the CDTI Comment: Figures in this table shall be completed in the annual report. Mectizan distribution is still going on. Cornment on: - Attendance of female members of the cornrnunity at health education meetings It has been mentioned in previous reports that calling on the population for health education sessions in community halls etc used to pose a lot of problems of attendance. Most people, be they women or men were not attending as expected. The women especially were not well represented because when they returned from their farms, they were tired or not just interested. That is why the methodolory was changed to meeting different groups in their respective social gatherings. Consequently, the attendance of female members of the community at health education sessions has not been a problem. DistricULGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B{ Number with community members as supervisors B. Percentage Bc= 85/ B. *100 Male CDDs B7 Female CDDs Br Total Bq= BrfBr Number of communities with female CDDs Bto Percentage Brr= Bro/84*100 AKWAYA l0l t4 13.9o/o 202 BAKASSI 9 0 0 t3 EKONDO TITI 40 0 0 96 EYUMOJOCK 32 0 0 65 FONTEM 97 0 0 236 MAMFE t02 0 0 t2l 23 144 MUNDEMBA 8l 0 0 84 WABANE 44 0 0 84 23 t07 Total 506 t4 2.8% 947 17 o\ o= -C c€f4 d9iHH'iHd V.r -cg vs wA 10xHH .':i(JU)YaEe5!2 5aIE€ E'.4 E :E#& L<.He c'- a€8Yf o.;H H ,l .r9voU)Ed./ .tt€ > -aO9HLENA .='t-.,! 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Comment: The above to be addressed at end of the distribution. 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 23 WHO/APOC, 24 November 2004 n (l) bI)ri (d ^F US' O ol tt. .+ tf) o\ \o co o\cl F-r- ra)\ o\t-- .o ^\n o\ € .o o\\o o\ o (t ao O. o ^oo o(, !s-ll -o? I5'5"rEo -oo\t--ta) \oo\ o\t o\ o\ o \oo\ ,a; o\ \oo\\ o\ \0o\q co o\ 1Qo\\o o\ ll r ri li E] o 'E() ,hoO cd-3US ooFc)F \o o\ .l r- ao \o o\ 09 co s9 rn\o \oo\ n t- .o o\q c-l cr -oo\ ,a; t'- \oo\cl \o t'- o --o=o +!a(d 5 [Ez o cl o\\o (.) ooq ta) oo(.) 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': o' rj]iLrr:Eqcl'Fs s .ile:f,oF6!E x9.2 -*r\ P -vLreE€g orr=L(dvtIo s>'GltIul t)g€l HE 8I Ea-l qJG)(EI .+E3t eH5le +.o9E &',ttr909-q .88c,5€trEEPEE.Etr(.)rjgtr0) lri..!93E!q .92.=ia-r,G '.. E .i orl ';(.)l ar)El !{ ')l YtutFl tr List and briefly describe the actiuities under iuermectin deltvery that are being carried out by health care personnel in the project area. When ivermectin is received at the provincial level, two things happen: . The districts collect it from the Drug programme when they happen to be around. . The Drug Programme takes along the ivermectin to the districts during routine distribution of essential drugs. At the district level, the health areas are informed of the availability of ivermectin. A health area staff goes to the district to collect the mectizan or a district staff takes it to the health area if this coincides with district supervision From the above level, the communities are informed and the CDDs are sent by their community leaders to collect the mectizan. Alternatively, the CDDs collect their mectizan just after their training in the health centre. 2.8. GommunlQl self-monitorlng and Stakeholders Meetlng Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? We trained all trainers on CSM in2004. After this training, staffs were retrained annually and this year was not an exception. We are now waiting for reports from the field if the community actually carried out the activity. Table I l: Community self-monitoring and Stakeholders Meeting DishicU LGA Total # of communities/villages in the entire proiect area No of Communities that canied out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) AKWAYA 101 BAKASSI 9 Er!_oNDo_Tru_ EYUMOJOCK 40 32 FONTEM 97 MAMFE t02 MUNDEMBA 81 WABANE 44 TOTAL s06 27 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Since my supervision was carried out only recently,(June 2008) it is not possible to appreciate the outcomes of the supervision. This section can be commented on in the annual report. 2.9.5. Was feedback given to the person or groups supervised? On the spot feedback was given. 2.9.6. How was the feedback used to improve the overall performance of the project? Same asfor 2.9.4 SEGTION 3: Support to GDTI 3.'1. Equlpment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Cunently non-functional but repairable, WO=Written off). NB. How does the project intend to maintain and replace existing equipment and other materials? There is no clear cut policy put in place on replacement of equipment. The provincial level applies for equipment needs of the province on annual basis and waits for supply from the central level. Occasionally, some of the needs may be et while at other times nothing is supplied. This year for instance, a 4x4 Toyota OthersAPOC MOH DISTzuCT NGDOSource Type of equipment No. Condition No. Condition No. Condition No. Condition No. Condition l. Vehicle 1 F I F 2 F 1 F 7 F 2. Motor cycles 20 wo 0 0 7 CNFR l5 wo ll wo 3. Computers 1 CNFR 6 F 7 F I F 0 0 4. Printers 1 F 5 F 7 F 0 0 0 0 5. Photocopiers 2 1 F wo 2 wo 5 CNFR 0 0 0 0 6. Fax Machine 0 0 1 F 0 0 0 0 0 0 7. Others a) Laptop 1 wo 0 0 0 0 0 0 0 0 b) c) IIIITIIIIIIIIIII 29 - If there are problems with release of counterpart funds, how were they addressed? When noticed at the beginning of activities that APOC funds were not going to be available on time, the project applied to APOC to approve pre-financing of CDD training by Sightsavers. The application received timely approval from APOC. However, the activities still started later than expected because it was forwarded late to APOC coupled with the late arrival of mectizan. 3.3. Other forms of communlty support - Describe (indicate forms of in-hind contributions of communities if any) This will be reported on at the end of the year after evaluation of CDTI activities 3.4. Expenditure per actlvity - Indicate 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 Nations exchange rate to local currency. Indictate exchange rate used here: us$421.124ll000FCFA. This exchange rate is at June 2008. The exchange rate has been fluctuating so often. Table l4: Indicate how much the project spent for each activity listed below during the d Activity Expenditure ($ US) Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of community 1,425 MOH Mobilization and health education of communities Training of CDDs 1,-q90 5,206 MOH APOC Training of health staff at all levels 0 0 Sr.rpervi sing..CDD s and di stributi on Internal mqnitoring of CDTI activities APOC SSI MOH Advocacy visits to health and political authorities 500 3,561 598.5 1,200 MOH IEC materials SSI Summary (reporting) forms for treatment 337 MOH ycles/ bicycles maintenanceVehicles/ Motorc 500 MOH Office Equipment (e.g computers, printers etc) Others Insurance for vehicle Appraisal meetings 598.5 SSI TOTAL 8,767 1,197 5,462 APOC SSI MOH Total number of persons treated 31 4.2. Sustalnablllty of profects: plan and set targets (mandatory at Yr 3) Was the project eualuated during the reportingperiod?-Yes- Was a sustainability plan written?-l{es- When was the sustainability plan submitted?_ To be submitted this July 2008 What arcangernents haue been made to sustain CDTI after APOC funding ceases in terms of: 4.2.L. Planning at all relevant levels Plans have been drawn to cover health areas, health districts and the Province for 5 years with the government expected to fund most of the activities and the communities to get more involved in the implementation of CDTI. 4.2.2. Funds Health District Development Plans have been drawn up and submitted to government for study and eventual allocation of resources (financial included) using the Sector Wide Approach. This approach encourages the putting of all frnancial resources together and used from a common basket to finance all district activities without discrimination. It is hoped that this will become effective from the beginning of 2009. 4.2.3 Transport (replacement and maintenance) The government has begun to supply/replace vehicles more regularly now than ever before. It is hoped that the situation will improve as time goes on. The project has requested for the replacement of project vehicles (Toyota hilux and motorbikes) from APOC for the province and health districts. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The implementation of the present plan will take effect from 2009. 4.3. lntegratlon- Outline the extent of integration of CDTI into the PHC structure and the plans for complete tntegration: 4.3.1. Ivermectin delivery mechanisms This year, an Eye care team on a trip to Yaounde transported Mectizanto the drug program in the province. The drug program in turn dispatched JJ 4.3.7. Describe others issues considered in the integration of CDTI. In the provincial planning meeting at the beginning of this year, all the provincial supervisors where requested to submit their supervision checklists to the unit in charge of supervision. This unit intends to strengthen integrated supervision by ensuring that all supervisors use these checklists when on supervision trips. A briefing of all supervisors on the various programs, of course, will precede this. 4.4. Operatlonal researeh 4.4.L. Sumrnarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research was carried out. 4.4.2. How were the results applied in the project? No operational research was carried out. SEGTION 5: Strengths, weaknesses, challenges, and opportunitles List the strengths and weahnesses of CDTI implementation process. List the challenges and indicate how they were addressed. Comment: To be commented on at the end of the activities SEGTION 6: Unique features of the proiecUother matters The new district of Bakassi created at the end of 2006 became operational this semester with the appointment of a medical officer in charge. As already reported before, the health district is predominantly maritime. It has four health areas. Two of the health areas (Isangele and Kombo Itindi) were carrying out CDTI under Mundemba health district while the other two (Idabato and Kombo Abedimo) were not implicated in CDTI because of the Bakassi border crisis between Cameroon and Nigeria. Just when the province was planning to train the district team on CDTI, assassination of the divisional officer of Kombo Abedimo and 5 military men by unidentified persons took place. This incident has disrupted planned activities in the area as this is the second time such assassinations are taking place there. Health staffs are now very hesitant to visit the area for fear of being attacked and even killed. 35 OE 3B F$ _o o g l!oIL z oot otUEEc< =o C"tr +,o C"!, tt L o Eo o C'tr oLL =o tr o t,(U EL o ;o o oL o- E89(,o-z N = o Foo g 2(u Gov- o, orooooNN 1'o co EogO.(EEo.=>(D E-oEeoE o0)()> @60 ut a .q =CUtaP= .9E .9. 6E'() oo LLoo) -o -oEEJ5zz iH5sEEE E' *E E EU EEEE8 E;F=O E: EEEf =22€eB € E a# # B e -ab b b b b b ALLLLLLXo()(r)ooo --o -o -o -o -o -oEEEEEEE oJ=JffJ1-zzzzzz o! s o L PROVINCIAL DELEGATION OF PUBLIC HEALTH FOR THE SOUTH WEST ! g JtJtL 200i ONCHOCERCIASIS CONTROL PROGRAMME COMMUNITY DIRECTED TREATMENT WITH TVERMECTIN (CDTI) SOUTH WEST 2 PROJECT BUDJECT JUSTTFTCATTON OF CDTr ACTTWnES FOR 2008 (YEAR 8) 1. TRAINING AND RETRAII\IING OF NURSES AND CDDS The training of Nurses to introduce new indicators for management of data atthe health area and district levels will go a long way to ensure the inclusion of the required data for completion of reports. The training will also include areas of weakness identified during the year 7 activities. This training will help familiarise the newly transferred nurses in to the pdect area with the CDTI programme. We still need to train more CDDs as many keep dropping out as a result of late and inadequate financial motivation. Efforts to increase the numbers this year yielded some fruits in almost all the districts. We hope this trend continues as this would reduce the work load on individual CDDs. APOC approved $14,275 for this activity this year. Part of this money was released but not used by the project because it came late. The money was received about 2 months after CDDs had been trained. We are appealing to APOC to reallocate the balance that was not released and approve the use ofthe funds in the project's account for 2008 CDTI activities. 2. HEALTH EDUCATTON, SENSTTTZATTON, ADVOCACY ANn MOBTLTZATTON (HSAM). At the end of the 2006 Mectizan@ distribution, I 12 communities were identified as not achieving a therapeutic coverage of up to 65%. These were particularly earmarked for HSAM in2OO7. The health districts and Province were to give support to the health areas in the area ofHSAM. The exercise was not effective due to lack of funds. Financial support from APOC as per budget would go a long way to improve on the therapeutic coverage of these communities. ir- {q:; . ".) ir t3. SUPERVISION Supervision by all levels is indispensable to ensure continuous capacity building. The province will carry out targeted supervision in those districts with difliculties to i I I i I 4 1{ i ; 0r,vr UP 4tls BFO #o S-o -i* ,|rf ,tb 6r'tr,rrid. t(. rarD Cs,t Cr U j:or i",l :.,;;:,-rlcrr implement CDTI such as Wabane, Akwaya and Eyumojock. These districts have experienced transfer of staffof various levels. The districts will be supervised training of Nurses, Mectizandistribution and evaluation of activities. Although Health districts use integrated resources to carry out supervision, these resources have always been insufficient to enable them effectively supervise CDTI activities. This is why APOC's support is solicited in the budget for supplementation. To, l-iAAn ea ,/,u /,.-. ./.Ct. I1,- trt4, lv4trf L I 1 4. REPLACEMENT OF MOTORBIKES 20 APOC motorbikes were supplied to the project in 2001. 80% of these bikes are either completely bad or break down very often because of the very bad terrain of the project area. Their breakdown has also been facilitated by the fact that they are used to supervise other health activities such as EPI, Malaria Control, Tuberculosis, Leprosy etc. Their maintenance has become very expensive and even when maintained they breakdown soon after. The health districts and health areas do not have enough government credits to regularly replace or maintain the motorbikes. Even the motorbikes supplied by the government suffer the same fate. The lack of means oftransport affects supervision of activities adversely. 20 Motorbikes have therefore been requested for in the budget for replacement by APOC. ) ! O> 8.9(l)ElrLao (n tro aclPO5tio.'E7) (ne .=_ U)tro +l(, Glri() O(+r Qeo) u)e.7 (n o P6(\jP() O(+{o.'Eaut4.7 (H o hol 5;8cB'- tr clo<>oP<;a o €o -9* '^ d)5-q .6 oEt;S '- u) '-l (D E- E#d= 8E o< q>4. ,n (gotro. LEg (n o (,(B .PO O r+r o..Eaa4.2 rn o (,(gfo5qo.'Eaae.z €)IL oa o(t) c)tr o a) €,)& Fl Fr o Fr o ra)\o c.l oON cl c.I$oo o o c-t c-lo\o ct oo ca F- r l-laa r-la) rn c-t o IA t*-ci o o r-@ @\o oo c-t O tro!ra o\o o\r- oO o.t c.l r- ta)$ o O @a ca sf, o r-tr) (J o Fi cac.t o o tr) o\o$ o o o\ rat r--rf o o li €)I o q) E 1r, oa u)(l)il a O{ ,aA ui(J 0.r EO-Ot)it" t s 0; r _11 E YTE+ ,;a .€OtEOr)6 <') FF \,O EE-O bOh.OQ a O F.lO- I iGIQ) U,*E -L)5!rt'Eg HEE ttt aA I lrE Oi<aa aaZa o -E#aa? E3HAZ< t U)NFO-QUo.E F *{ a F(J-EA (n Q-OE()O I Fr r. (JAE tth ;rr- I olE 5OO() ltt !o Lq) Fr -o(l) tJr l6 aO ER (B a I t'- aO SR o(l) o lF aOEol- C.l F-oo c.I a(l) a t--oo ol s o)rr okd a I r-po(DO Irr c.I o l<(d a I I-r90oolt C.t ct A I = l'- o.x<X aDq) q) qr o93 .=? d17 iDdE(cooDti tru) 5o'E O d (dLlt-.:() €* a(BOo .N5 5o.ov>t SN >t2q): H-A .q (B-9a E8 'i>5E .s< v>,A d8.E> EE#(B =trl.q)EHIETqU cB N c)(D z(H o ootr LroE tio qi o k(l) =(Do! otrES(Di-j -() =6)d> (H o EppN.= oo(l).ts <5(l)E ag ->EHrzr =tr-6e5trd'tr c)8.E€() o'5 (DE .t) (.|-{ o tr o) E(l) O0 ca :: t)EA = q-.izo (+< C) o) .F sp E9Etroo(-)E a ot ca $ lat \o t-- 6 6 li eBq) I 6oo6l L otH H o +.I tH o tr sg e{ o+)q) a0 ce f CJ c) oL ei HF aU 6l +) U)q) +) oa I Hl-l-i#l-l -i :\f I O\ I 5l'-) il.r; :@ t.) (DO (D s) + Ho s) rd Ft E) V)p v) <EtD !Pog-6i+ oaH v) Et C) fo !Ftp rn A)(t) >U r-t o c)p ,6 EFt c)(, F) c) o. ru oFt v) o 9 (D oo t o F) o;, lor' I'c, ig \J - F N) N)oo oo N)oO@ t)oO@ t)oOqo tJoO @ t)oo @ t NOo{ N)7 =F:5< I tr (D 8Pox{= I? FD E(D oa s9 >- Fl FUI' EEFU ot o9IEUH HUHOt =. 1 o ..1 U E8 9 O,o lJ +itso r+ F(Dq)!o O E (D o f!(Drt \o UI 5\oo {oooO o O o o o N(,l(/t o (JJ \o(Jr UJ Fg o o o\ Ut(/) € O tJt+)(rr o OrOo o\@{ N)O(.)tJ o\ 5o \otJ 5o\5 @ z -ohttl 56 o\{ t,J O s\os \ooo oN(,r L'T fr) O tJOo UJ(/)( o^\ a0 - Nott -I {Oooo \) N)\o t,)(,rOo { N u.)(rr 5 o\{ 5o (/.) o\\) \o(,{ Fl oFl F F(D ta, o rt tt(D eD ao El(.)(D i(n C) O) op(n t rr)+ lfio F) o (r) c C')+ o s) o u, trq) o s) o q) d(n+ c) F) o crt t(t) + h c) F) o U) ?.Fi- <Dg|. fo =?9c)JS) o v) z,'Fi, <D$.8F+r OO.+p (/, o (l) 7,'Fi, (ls.!!n9a)Jg) (,) o q) o>rt t- =(D;'P rlo I SOUTH WEST 2 CDTI PROJECT DRAFT SUSTAINANBILITY BT]DGET FOR YEAR 8 (2008) For submission to APOC Management July 2007 l9 JUIL 2007 SW|I Sustainabil Year 8 2008 2008 APOC MoPH SSI TOTAL 5,800 5,800 1,O78 1,O78 2,155 2,155 1.238 1,238 860 860 0 0 0 442 442 329 329 197 197 2,760 2,760 2,000 2,000 0 1,400 1,400 0 400 200 200 3,360 3,360 2,208 2,208 0 0 11,040 11,O40 SIGHT SAVERS INTERNATIONAL Salaries Projecl Officer Administrator $5388x20o/o of time Secretary $5388x40o/o of time Driver $3096x40o/o Cleaner 50o/o Technical Assistance Project officer 20 days x $45 Field officer 15 days x $40 Driver 35 days x $17 B. MoPH PROVINCE Salaries P DP H $368/mthx 12mx1 Oo/oof time PCSCH $329lmx12mx1Oo/o of time DEDP $329lmx12mx5o/o of time OPC $230lmx12mx1OOo/o Technical assistance OPC $1001mx12m PDPH $50/mx12m PCSCH $50/m x 12m DEDP $50/mx12m PCSAFA $50/mx12m DRIVER $50/mx12m Salary Finance otficer $300"12 D!STRICT Salaries DM O $2 80 I mx1 2mx5x2Oo/o CBH $184lmx12x1x2Oo/o Technical assistance DMO 5 x $170 CBH 5 x $80 HEALTH CENTRE Salaries COP $115lmx12mx49>QOo/o of time Technical assistance COP COP 40 x $55 PERSONNEL A. CENTRAL 0 TOTAL PERSONNEL 0 20,336 15,131 35,067 APOC CENTRAUSIGHT SAVERS 'aper reams $10x30 p chart sheets $60x3 catridge $50x9 for photocopying machine $120x3 ote pad $20x3 boxes $2Ox12 books $1.5x30 marker $12*4 rker $12x4 200E MoPH sst TOTAL 200 200 180 180 300 300 240 240 60 60 0 0 45 45 0 0 0 0 Sub Total 0 0 1,025 1.025 PLIES MoPH per reams $10x40 ns boxes $10x0 ncils $0.1x75 $0.3x10 $0.4x10 $0.2x1000 ples (Big and small) $2x20 'oner for photocopying machine $120x4 boxes $20x4 catridge $50x12 clip $1x10 smallsize $4x12 nvelopes big size $4x6 pad blocs $20x3 books $1.5x30 rs/counier $7x3 Register/accounting $20 marker $12*4 $12x4 $6x1 Reaction medication 200E MoPH sst TOTAL 150 150 30 30 4 4 4 4 3 3 100 100 20 20 120 120 0 250 250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 300 300 Sub Total 0 6E7 300 987 SUPPLIES DISTRICT Mundemba H/D Procurement & supply of Mectizan Mamfe H/D Procurement & supply of Mectizan Fontem H/D Procurement & supply of Mectizan TOTAL SUPPLIES 200E APOC MoPH ss! TOTAL 459 459 393 393 110 110 0 6E7 1,325 2,012 2008 APOC MoPH AL TRAINING OF HEALTH PERSONNEL Itamte l'lE) Selection of CDDs 0 286 0 286 Trainino of CDDs 1,905 1.562 500 3,967 HSAM 1.524 857 750 3,131 Traininq of Nurses 190 619 167 976 Appraisal meeting 1,333 833 2.167 CSM 0 381 0 381 Elaborate trainino content 0 0 0 0 Reportino 0 286 0 286 subtotal 3,619 5,324 2,zfi 11,193 Akwaya HID Training of CDDs 1,333 667 500 2,500 Trainino of nurses 190 381 167 738 HSAM 762 381 167 1,310 Appraisal meetino 1,905 762 833 3,500 Preparation CSM 0 190 0 190 Reporting 0 95 0 95 subtotal 4,190 2,19O 1,667 8,048 Mundemba H/t) Training of Nurses 286 476 250 1,012 Trainino of CDDs 848 571 250 1,669 HSAM 476 1,429 0 1,905 Appraisal meeting 476 952 417 1,845 Reporting 0 117 0 117 subtohl 2,086 3,546 917 6,548 Ekondotiti HII) Training of CDDs 857 476 250 1,583 Trainino of Nurses 571 0 167 738 HSAM 429 286 83 798 Appraisal meeting 886 29 689 1.604 CSM 0 0 0 0 Reportinq 0 560 0 560 subtobl 2,743 1,350 1,189 5,283 Wabane HlD Traininq of CDDs 952 286 283 1.521 Training of Nurses 143 190 83 417 HSAM 333 667 125 1125 Appraisal meeting 114 381 83 579 CSM 0 0 0 0 Reporting 0 57 0 57 subtotal 1,il3 1,581 575 3,699 Evumoiock HlD Training of CDDs 762 381 167 1,310 Training of Nurses 286 381 167 833 HSAM 95 190 83 369 Appraisal meeting 190 810 167 1.167 CSM 0 0 0 0 Reportinq 0 95 0 95 subtobl 1,333 1,857 583 3,774 Fonten HII) Training of CDDs 1.524 1,303 417 3.243 Training of Nurses 286 381 190 857 HSAM 476 762 167 1,405 Appraisal meetinq 381 571 333 1.286 Reporting 0 190 0 190 Production of IEC materials 0 0 0 0 subtolp,l 2,667 3,208 1,1o7 6,981 APOC FO, I 338 113 450 424 251 675 169 101 270 1,013 244 1,256 100 200 300 101 270169 150 150 38 13 51 250 250 2,550 921 200 3,672 20,731 19,977 8,4E8 DB'ELOPTEI{T OF OPERATK)I{AL PIIil'CilBI]{E APPRAISAL WORKSHOP Perdiem 5CBH,5CBAF,OPC,APOC FO, TRA!N!NG LEVEL 5 fiom drstnctsfiom provnce(Orc, CAPP, PDPH, CBHX5,BAF)6)secretary Duration=2days $30x15 costs x2 $67ldx3d!2 support & staff maintenance & fuel $17ld3d Flat rate) tobl DMO $67x3dapx5 CAPP,PDPH,PCSPH 19,197 TRAVEL 2008 APOC MoPH sst TOTAL NGDO Rythm=1/2 months Duration=Gdays Personnel=2 ( Country Rep. + Driver) Boarding CR / PO 6dx6/year 1,206 1,206 Perdiem d river $25ld;6dx6/year 450 450 Transportation $250/monthx6 750 750 suMotal 0 0 2,N6 2,406 PROVINCIAL SUPERVISION Supervision & monitoring PDPH 0 600 0 600 Supervision & monitoring OPC 1,000 s00 1,000 2,500 Supervision & monitoring Driver 600 300 325 1,225 Verifuing & Collecting of Justification APOC FO 480 417 897 subtotal 2,080 1,400 1,742 5,222 DISTRICTS Manrte H/D Census update & Dist 0 2,708 0 2,708 Supervision & monitorino 500 4,093 500 5,093 subtotal 500 6,801 500 7,801 Al<waya ll/D Supervision & monitoring 350 802 833 1,985 subtotal 350 602 0 952 Mundemba H/D Supervision & monitoring 400 2,882 500 3,782 Census update & Dist 0 778 0 778 Supply of mec{izan to HC 0 52 0 52 subtotal 400 3,713 500 4,613 Ekondotiti ll/D Supervision & monitoring 333 0 500 833 Census update & Dist 0 824 0 824 subtotal 333 824 500 1,657 Foilem lllD Supervision & monitoring 571 371 750 1,693 Control of registers 0 114 38 152 suhtotal 571 486 788 1,845 Wabane HlD Supervision & monitoring 333 238 250 821 Control of registers 0 86 38 124 subtotal 333 324 288 9/05 Eyumojock HlD Supervision & monitoring 190 181 125 496 Control of registers 0 57 38 95 subtotal 190 238 163 592 TOTAL TRAVEL 4,759 14,388 6,887 26,033 COMMUNICATIONS Telephone, Fax, E-Mail, Postage, Shipment, Gourses NGDO Telephone/fax Postage courrier PROVINCIAL Telephone/fax Postage counier TOTAL COMMUNICATION 2008 APOC MoPH SSI TOTAL 0 0 0 1,500 1,500 0 0 1,600 200 1,800 0 200 200 0 1,600 1,900 3,500 2008 OPERATING EXPENSES APOC MoPH SSI TOTAL NGDO Office space $10,1 70/yx40% 4,068 4,068 Administrative costs $4500x40o/o 1,800 1,800 Otfice insurance $1 500/yx40% 600 600 Equipment maintenace 0 Running fuel and lubricants 0 Bank fees 0 Veh.Maintand major repairs 800 800 Vehicule insurance $3000/vehicule 3,000 3,000 Office maintenance $1 000 500 500 PROVINCIAL Office space $2400x50% 1,200 1,200 Administrative costs $1 500x50% 750 750 Equipment maintenace 333 333 Running fuel and Iubricants 700 700 Vehicule maintenance and maior repairs ($133/month x 12) 400 1,000 1,400 Vehicule insurance 2,140 2,140 35 Moto bike tvres + tubes 0 0 lnsurance for motobikes(35 motobikes) 0 0 TOTAL OPERATING EXPENSES 0 2,350 14,941 17,291 2008 CAPITAL EQUIPMENT APOC MoPH SS! TOTAL A. CENTRAL MoPH PROVINCE Photocoping machine 0 0 0 0 Replacement of 20 Motobikes 70,000 0 0 0 TOTAL 70,000 0 0 70,000 2008 APOC MoPH SSI TOTAL 600 600 0 1,500 1,500 100 100 NCHOCERCIASIS DAY $60/piecexSpiecexS campaigns OTHER EXPENSES OTHER EXPENSES ia (Radio-TV) 0 2,2OO 0 2,2OO It00E APOC TOTAL i =RSONNELEQUIPMENT ES NG UNICATIONS PERATING EXPENSES RNAL AUDIT EXPENSES TAGE T PER PERSON to SSI20,336 15.131 35,467 70,000 0 0 70.000 0 687 1.325 2.972 20,731 19,977 8,488 49,197 4,759 14,388 6,E87 26,033 0 1,600 1,900 3,500 0 2,350 14,941 17,291 0 0 0 0 0 2,200 0 2,200 95,490 61,538 4E,672 205,700 46.4 29.9 23.7 100.0 0.3 0.2 0.2 o.7 MIIT,T