South West II annual project technical report to Technical Consultative Committee (TCC) : year 4 (December 2003 to August 2004)

[-l+.$*[ t{$.}{ {}[; { ,\,\,'{ fi'f,tiiq,ha, tr * I t; t',t{'t , r,tr $'it iriii' $ fi 1.:,; }l ir ''ii.1{;i \:;[1 r-i'r'titr*'t' [i;:f !r,r!,, \ COUNTRYAIOTF: Comeroon Proiect Name: South West II Arrproval year: 1999 Launching year: 2OOO Period Month/Year Year 4 (December 2003 to August 2OO4) Date submitted: 30th August 2OO4 NGDO nartnerh): Sight Sovers Internotionol \ \, ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) brLwgwa tsi i i i I I Jo hu u u, r.^.".{ ;f l+lA ,(rc{'l'o* -lo',. l'",,-h Garl}: i 'is$(I,r I aPBlrl I H *.rS'-.: i lc r't$lHLr.. 0 5 sEP,20C4 ePut/DlR AFRICAN PROGRAMME FOR, L*.* ONCHOCERCTASTS CONTROL (APOC) fi i' i R, I tQv i I 5 -t WHO/APOC. 29 August 2003 FFL-ll'l : irr_j-.,:,tttL-, L;_,rlrr. :i r=! -! t rr- . - -'-i _r -,,- -, \\ Nt ,\L Pt-to,fitc T Tti(.H\i(.At. REt,()tti- r(l l'i'( II\l(-',,\L ( ()\S['[- I \l l\,,1: (,()\4\ll I ll]1. (.1 L,L.) Ei\DORSEN{EhIT I'lu.r=u (L,rrfi.rir.1',rrr hare r"earj this repor.t bv signirrg irt rheAppropriatc spirce Qt[C,t-ltS rzr tign ihr r(p(]rt, c'ounr^, C]ifrnel'O0I1 \irtirrrrri i t t,,.trrlinator \ir'rc; }l. . ".f\/,.T, €..P . ...M*.klhr,_, D t):AZ,,,,zMq H-r'_:, lr_r =-,_ri-r-+ 1.1 : .iErl r F l- !t'*t irtr;irr I i]rL:gale \av ru*',,*,llhrtrr.Ij;.Lrt4.*:.r-,y,lly+.!.ttt[u1+ lhte s l{Ilnturc: Date: I r.., -?*l .-:,.,., 'Ihis reyr,il [,]rar l-rccn prcp:rr.ecJ h]:ft-t- \anre: .,..I,,!S ?s..0pc.s,,ilT., ?,C,.SSI rlusigfiatiur, .$f.Q L.\g tr r.q.:& signirrurei.. #hotr- fiats + \i l() \lr)( l.r '\._j,:-.:,t,, Dare: .3 q .: c--E> v larrrlr Table of contents ACRONYMS III DEFINITIONS IV FOLLOW UP ON TCC RECOMMENDATIONS v EXECUTTVE SUMMARY VII SECTION 1: BACKGROUND INFORIVIATIONERROR! BOOKMARK NOT DEFINED 1.1. I I 1.2 GpNgnan rNFoRMATIoN............. I.l. Introduction and new developments in the project (briefly) l. 2. Partnership ......... PopuLnTIoN nuo FGaIrrI SYSTEM SECTION 2: IMPLEMENTATION OF CDTI....... ........5 2.1. PsRtooopACTrvrrrES 2.2. ORnriRnqc, sroRAGE ANDDELTvERy oF IVERMECTTN 2.3. Aovocacy nNo SsxsrrzerroN 2.4. MoSILTzRTIoN AND HEALTTI EDUCATIoN oF AT zuSK CoMMUNITIES 2.5. ComvruNrrIES INVoLvEMENT IN DECISToN-MAKrNG... 2.6. Calacny BIIILDING 2.6.1. Training... 2.6.2. Equipment and human resources.. CoNolttoN oF THE EeurpMENT + PLERsp srATE........ 2.7. TnsarnmNTs..........,,. 2.7.1. T\eatmentfirytres............... 2.7.3. Trend of treatment achievementfrom CDTI project inception to the current year l8 2.8. SrprRvrsroN ....................19 SECTION 3: SUPPORT TO CDTI ...............20 5 ..7 ..7 .8 .9 l0 l0 12 l3 3.1. Fn.IANcTAL CoNTRIBUTIoNS oF. THE PARTNERS ANDCoMMUNITIES 3.2. Orrmn FoRMS oF coMMUNITy suppoRT............... 3.3. EIpsNDITUREPERACTIVITY............. SECTION 4: SUSTAINABILITY OF CDTI....... 4.1. IxrenNal-;INDErEM)ENTpARTICIpAToRyMoNIToRING;EvALUATIoN.................... 4.2. ColvrurrxnY SEI-F-MoNIToRINGauo SrexEHoLDERSMgnrruc 4.3. SustarNasILITY oF PROJECTS: pt,AN AND sET TARGETS (MANDAToRI'Ar yR 3)............4.4. IvrecRa.uoN.....,,...... 4. 5 OppnauoNAl RESEARCH. SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES 20 2t 21 )) 27 22 23 23 25 26 1l WHO/APOC, 29 August 2003 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 Annual Training Objective Community-Based Organization Com munity-Directed Di stributor Community-Directed Treatment with Ivermectin Community Sel f-Monitori ng Local Government Area Ministry ofHealth 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 Or ganization lll WHO/APOC. 29 August 2003 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking) (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area, (iii) Annual Treatment Objective: (ATO): the estimated number of persons livrng in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (i") Ultimate Treatment Goal (UTG): calculated as the ma,ximum number of people to be treated annually in meso/tryper endemic areas within the project are4 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 3d year ofthe project). (v) Therapeutic covera€le: number of people treated in a given yqlr over the total population (this should be expressed as a percentage). ("i) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the prqect area (this should be expressed as a percentage). IV WHO/APOC. 29 August 2003 FOLLOW UP ON TCC RECOMMENDATIONS The last TCC that dwelled on South West Two Project was TCC 15. Recommendations as such were not made. [nstead issues were raised and complementary information requested. The table below details the issues and information provided by the project. Tuhla,s lrtritrg Stahn o.f tlrc la,st rcc'otrrttrctrclatrott,s S/ I{ ISSUES RAISEDAT TCC 15 INFORMATIO|V PROVIDED BY THE PROJECT 1 Misopproprioted futtds The funds misappropriated by the then acting DMO of Mamfe Health District, Dr Andoseh Victor had been paid back and placed rn the Bank as of thg lgth Septernber 2002. As soon as this happened APOC was inforured. 2 Stolett Velticles The insurance comtr)any hacl already paid the WHO office in Yaounde for the two vehicles (Southwest I and Southwest 2 Project vehicles) that were stolen. WHO has supplied Southwest 2 project with another vehicle as a replacernent. ,) S,4Es tlteir diogrtosis cutd tttotrugentettt In the first year of distribution Dr Bisseck investigated upon the cases of deaths that occurred in the project area. Following a urission by Dr Bisseck to investigate about the cause of the deaths, all the cleaths were classified as not clue to Mectizan except one of the cases for whom no rnformation was obtainert and so no definite staternent could be made. In the second year the only case of death reportecl cluring the Mectizan@ cUstribution period was that of an 11 year old boy who had malaria with severe head ache before taking Mectizan@. He was not confirmed as having died from Mectizan@ so we did not see the need to report his case as an SAE- No where in our reports did we ever say the project was suspended due to SAE- SSI suspended treatment of remote communities and did treat these communities after testing individuals. This entailed trekking in the health areas concerned for about fifty days. Only persons without Loa loa were treated since there was no possible means of uranacing any SAE if it occurrecl. 4 Detoils of iternrcctitt receipt ortd usoge. This was not lequested in the previous grriclelines for reporting. However by the time this report was written, Mectizan@ hacl been requested for the Southwest 2 project jttst once and this was in 2001. We received 601,000 tablets of Mectizan@ in September 2000, after ctistribution 341,908 tablets were left which were to expire in JuIy 200f . Haute Sanaga ancl SWI used these tablets in exchange for SWl tablets, which were to expire in September of 2002. For the second vears ctistribtrtion we required 25,1,280 tablets. Given that this exchange could be made there was no neecl to request for rnole dlugs but a lequest forur was dully filled for WHO/APOC, 29 August 2003 tracking of the drugs Second year's distribution Tablets Available: 341,908 Since all the district were not distributing at the same time, drugs brought in by one district was eventually transferred to the next district. Thus the number of tablets moving around is greater than those really available. Total oftablets given to other projects: Haute Sanaga 35,000 HKI 46,500 Tablets left in the offi.ce of the co-ordinator at the provincial delegation at the end of 2"d round of distribution: 73 287 Health district Tablets supplied Tablets used Tablets returned Fontem 110,000 74,397 33,895 Mamfe 9r,474 48,307 40,145 Akwaya 70,000 17,862 40,489 Ekondo Titi 70,000 22,96L 45,95L Mundemba 60,000 26,046 33,342 Total 189,573 vl WHO/APOC. 29 August 2003 Executive Summary Prepare an Executive sammary of the report in not more than g!!g.page 1. Background on tredtment and population data - Tolal communities, communities' lreated, lotal population, UTG, A7O and persons treated. Southwest II CDTI project was approved in 1999 but launched in 2000. It covers the five health districts of Akwaya, Ekondo fiti, Fontem, Manfe and Mundemba. The project consists of 40 health areas and 452 communities that are either meso or hyper endemic for onchocerciasis. This year, just like Iast year all the 452 communities were treated with Mectizan@ giving 100% geographical coverage- T'his project area has a total population of 208,580 inhabitants in the meso and hyper endemic communities. The ultimate treatment goal and annual treatment objective of the project were 177,293 and 156,364 respectirrely. This year a total of 148,716 persons were treated given a therapeutic coverage rate of 7l-3o/, and a percentage UTG achievement of 83.9%. 2. Backgyound on population movements. In this project area, population movements are generally due to farming seasons. This has been a difficult problem to address adequately. Mectizan@ distribution periods have been changed several hmes in some health areas to suit periods requested by the community and to avoid farming periods. This does not seem to have solved the problem as each year complains still come of distribution haven taken place during the farming season. This time it was reported that some persons for not wanting to take Mectizan@ left their homes during the distribution period and pretend to have migrated to their farm houses. Such persons were recorded absent or travelled where as they actually refused taking treatment. Training data - CDDS, healthworkers, Total population (community) per CDD trained. Following the recommendations of the midterm sustainability evaluation and for more effective resource management, trainings this year were targeted to areas of weaknesses and not routine as it was the case in the past. Except for CDD trainings all training targets were met at lO0%. Training targets for CDDs were achieved at 83.5o/o. The target of training / retraining 849 could not be met because of their abandoning the work. Instead, just 709 were trained or retrained. From this number of CDDs trained the ratio of CDDs to population was 1CDD tn 294 population. Right from the beginning most CDDs had a misconception of their work. They say this as an employment for which they should be paid. It has not been possible to clear this from their minds all this time. As this dream could not be met many of them withdraw from the programme. Selecting new ones in some communities was not possible necessitating health personnel to carry out distribution. In some other places CDDs even went on a strike and had to be persuaded greatly by vll WHO/APOC. 29 August 2003 the district medical officer for them to carry out their work. A lot of sensitisation and HSAM still needs to be done on this. 3. Challenges ond how lhey were overcome. This project has just completed its 4th year and has jus one more year of APOC funding. After the mid term sustainability evaluation two years ago, sustain2fufity plans were drawn by each of the hea]th districts. On the whole these plans are being followed, proof of this is this improved treatment coverage rate. The main challenge this project has is to keep up if not increase this good treatment coverage. Another important challenge would be to step up government financial involvement into the project. So far there is no budget line for CDTI activities. However pooled govemment funds are sometimes used to finance CDTI activities. Also there is need for a plan to replace existing equipment during the post APOC period. vlll WHO/APOC. 29 August 2003 SECTION 1: Background infomation 1.1. Genera! information 1.1.1. Desciption of the project (Very bri"Ily) Location The South West Two (SW II) Project Area is made up of three administrative divisions (Ndian, Manyu and Lebialem) of the South West Province of the Republic of Cameroon. It covers five health districts (Mundemba, Ekondo Titi, Fontem, Mamfe and Akwaya) Most of this project a-rea 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. SW II has a very harsh topography with many rolling hills and valleys. This renders the terrain very rough making accessibility diflicult. 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 difficult 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 main economic activity in this a-rea is farming. Males are more concerned with cash crops, planting cocoa, coffee, and oil palms. The common food crops include plantains, cocyams, cassava, yarns, groundnuts, maize and a rich variety of fruits and vegetable grown mostly by women. Tablel.7: Showing administratiue units, health distric* and health areos. Division Subdivision/District Health District Health Area Ndian Mundemba Isangelle Kombo Itindi Kombo Abedimo Idabato Toko Mundemba Mundemba Lipenja Madie Ngolo Isangelle Kombo Itindi Pamol Kombo Abedimo* Idabato* I WHO/APOC. 29 August 2003 Ekondo Titi Bamusso Dikome Balue** Ekondo Titi Ekondo Titi Kumbe Balue Bamusso Bafaka Rissoro Bekumu [.obe Bekora Illor Manyu Mamfe Eyumojock Upper Banyang Mamfe Flkok Ogurang*** Kembong Bachuo-Akagbe Eyumojock Tali Mamfe Afap Kendem Kaiifu Akwaya Akwaya Akwa Akwaya Amassi Baqundu Lebialem Aluo Fontem Wabane Fontem Menji Azi Essoh-Attah Bechati Fotang F.onjumetaw Fotabong Bamumbu Takwai Kupe / Muanenguba Nguti Mbetta Njungo xKombo Abedimo and [dabato are health areas that are really non-functional as the areas are found in disputed Bakassi area and occupied only by soldiers. No civilian activity goes on there. **Dikume 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 Mamfe health district. It has no roads. The whole area is acces-qed only by trekking inside dense equatorial forest across large streams. Health interventions in thi-s area are done only through outreach from the district health service at irregular intervals. SW II is situated between latitude 5" 12'and 6" 30'north and longitude 8" 30' and 9" 45' east. As mentioned above this project area spans in three administrative divisions, consists of 5 health districts and 40 health areas. The health districts do not strictly follow tt1s 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, situated in South West One (SW I) Project Area 2 WHO/APOC. 29 August 2003 SW II 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 vrith SW I and is bordered in the south by the Atlantic Ocean. 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), Sight Savers 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. They together also carry out supervision and 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 speci$ring which of these partners does what and at what time. 1.2. Population and hcalth system The surface area covered by SW 2 is approximately 10,610 sq. Km. Registration update this year revealed a total population of 208,580 an increase of 24,824 inhabitants. This year data processing was much better and census updates 'were done to together with treatment in most of the communities. The table below shows the population change since the onset of the project. Table showing prtgression in yearly population ftom onset of prcject in 2000 Year of activity Total Population l=t Year, 2000 185,874 2"d Year, 2001 172,956 3"d Year, 2002 183,756 4th Year, 2003 208,580 1J WHO/APOC. 29 August 2003 i ol.l F ? 1(D T A a' E rD rn o o- Fl o FTY 3g b,.) 6 Ur € 1..) 5{ {IJ IJJ.IJJ: oo @s @ (}J UJ i -u -R HS o' _9+ =Q tr-D'- d'ti o b,J6 o IJJ o. o O =-,= 2G i =-= N ! +t G=' z .D - tD(Ai. re ID(, (lJ ti \o {{ \oOl (}J .o l.)s .o +. IJ @ .o { .o rl t!E N. ='1 I (rl o(,) -I(r) o\o{ UJ l.) IJ -I ,oO .o @IJIJ o\ 7 iXo f!rDl a -.i! !,-= =Ni99- -.rPltt tt =,a3='3! ,4r.-rg;," \o UI\o5 l.J l.J 5 -]O rJJ .o oo IJ o\ iJJ A A l-)5l.)s o l.)IJ oo oo +.@ b,J -to\ 5 o\ A ?9 s N= E' Ei -t\t b,J\o(r) 'o O {IJO -l o\ l,) o. ^3 iY= =. *=?. l:+ a I IN a ! oE E I Dt -lof Dfc I * o D -t - J o ot o 3 l-l lDot6l- lrDl- \.) vL) 6 ;-.1.oi(D(^ (hko, \c o- o) o F0 r.t (n 7r (D (D rt (D -o (D a) !, tD AT o (D >t (D o) -t(D Et (Dg) (D o- oFt o o- it 0a (D Ft (D o 0a oEt o + A (\ s a 6$ z - Io B - c ,Q rf I I tl Fl Ii 6 I a 4 a\ !il ==r^i ^-\ ,i ^:-:\ x=- '.i :{ ,:= ::r .:* : 1\E\ <li.: .:' 7\SX ii \a <= ^': <A .:{ -a)i .: 3=/in i= tJJ : rt 'ia{ ^{\> =dx\\i '-: s!* - .i < = .i r: .i, - t -*'-j <=.d of5tr ** o> Aqcd '(D-E'P ; 6',5 -r (IO A) iJi(D =(D Jfo50(D563(r) c EoOFt F0=looioa5(DrD o-(D @{ FJ oo tt) (D(, (D o o oEi !D 0q !D gJ <r){ (D o-(DFt(a to (D -t H @ ot o r?r ts ,o t\) oa a NJO A A community or village is either made up of persons of the same tribe or of heterogeneous origin living together in one geographic area and sharing common social facilities like market, church, health unit, school etc. and having a common leader. In some health areas the population covered by one CDD is considered to be a community. SECTION 2: Implementation of CDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented On the whole CDTI activities for this year started in September 2003. This was even before the December I't when the project year officially starts. These initial activities were just sensitisation and community mobiliz.ation, and this went through the whole project life for the year. Apart from Ekondo Titi and Mamfe that started distribution in 2003, the other districts all started distribution in March and April of 2O04 after the Natiopa] immuniz.2f,iea campaign against poliomyelitis which took place between December 2003 and March 2004. The table below details the t'meline of activities for the year 5 WHO/APOC, 29 August 2003 IH lo)ld l.D ls> ; o (D oF+) EDo @ ct) Ao' -1 (D s)Ft (D te U) r.1 o o o- o C) r-t -t(D (D s)r-t e(\ ,)(\ G s \(\\ -q (\ a 7 ai g rl Fl F ? o- .D o 7 !) rlj' E o (D lnIo o -l o D! op O TJ I (n rD lJ zo IJ (A rD IJ Frl '.D IJ I _ (r) E-l tc ?a-oo JNtrD (r^IJ L IJ .t- ? r', IJ I lJ I J I o =J Frl o IJ ! zo tix IJ I a .D tJ t, rD IJ I -O =i=,Q aFt D' Ie ? tso IJ E rl o IJ I lJ I oo IJ ; 11(D IJ I =J 7 o IJ I zo a IJ IJ ! -o IJ TI rD lJ I -(n =-li= ,c o(! an (, lr (D - IJ I 7 .) IJ I ? ,/, IJ I z lJ 7 o l9 +- - -Z == ? a) l9 l- H (D a) IJ IJ ! Uo l9 7 o lJ I _a =-l rc rt oa t, Et 5 oIJ I IJ I 7 lJ I E l9 I IJ I -3 =+ IJ I V)(DE lJ I l9 I a(D lJ +1 rD IJ .t- _a rc a (D O o.D IJ I 7 l9 I a IJ I 7 IJ .t- ? l9 .l- E= o\ - ts L,,, P NJ\o oa @ I..JOO 2.2. Ordering, storage and delivery of iverrnectin N'Iectizan@ ordered/applied for by - Qtlcasc tick the uppropriute unsaerl 1VIOH tr WIIO tr LINICEF f] NGDO trX Other (please specifu) l\Iectizan@ delivered by - Qtleuse tick the appropriote unsuerl N,IOH EX WHO f] TTNICEF E NGDO f] Other (please specifr) Please describe how Mectizan@ is ordered and how it gets to the communities This year Mectizan for Southwest II Project was ordered by the NGDO following the requests from the different health districts. Mectizan@ was ordered through WHO offi.ce in Yaounde. The drugs were collected from WIIO by the NOTF and handed to the Southwest Provincial Special Fund for Health who then distributed it to the health districts through the regular drug delivery system. This year drugs were delivered on time and in sufficient quantity. Table 3: Mectizan@ Inventory (Pleose add more rows if necessaryt) Stote qctivities 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: 1. Mectizan requests 2. Tlansportation of Mectizan@ from the province to the health districts and to the health areas. 3. Distribution of Mectizan@ to CDDs. 4. Storage and stock management of Mectizan@ 2.1. Advocacy and Sensitization .\lula lhe rnrmltcr of polic.t'daci,stott ntukcrs nrohrli:cd at etrc'h ralcyattt lcrel chrritry thc L'tu'ranl )'ear: llrc rcu,srlt,s.fot' tlrc ,scttsiti:ctliott atrcltntlc'ottrc. De,sc'rilta dfficultiestconstraints beingfaced and suggestions on how lo improve advocacy. 7 Health Districts Number of Mectizan' tablets Requested Received Used I,ost Waste Expired Akwaya 73000 73000 6W68 0 449 0 Ekondo Titi 50000 43350 34770 0 l0 0 Fontem 133000 r33000 I 18343 0 0 0 Mamfe 0 125000 117709 0 1 7 1 0 Mundemba 62095 43000 41202 0 37 0 TOTAL 3r8095 417350 381992 0 667 0 WHO/APOC, 29 August 2003 At health district and health area levels local administrative authorities (Senior Divisional OfEcers, Divisional Officers and District heads), traditional rulers and quarter heads were involved in advocacy and sensitisation within their al'eas of jurisdiction. After being briefed by the health personnel, they used occasions like National Youth Days. World Health Da5rs, Labour Day ancl "meet the peoples tours" as well as other' cornmunitv gatherings to pass across sensitisations and rnessages. 2.4. Mobilization and health education of at risk communities Provide information on : - The use of media and/or other lrcal systems to dis.seminate information - Mobilizalion and health education ofwomen and minorities method and response - Response of target communities/villages - Accomplishments - WeaknessesiConstraints - Suggest ways to improve mobilization of the target communities. The province made a wonderful effort passing slots over the radio, which some listeners of this project got and became more convinced to take Mectizan@. The most effective medium of communication used in the project area was the CDDs' lectures and letters to Churches and social groups; inter personal contact with meeting groups and announcements on health messages- The public address system was also used to some extent. Most social groups were mobilized during crowd puling events such as Youth Day and Women's Day celebration and'meet the people's tour" of the administrative authority members during which they together with the health personnel explained to the population the need to actively participate in the CDTI project. The response of the target communities was good this yea.r as shown in the treatment results. Mobfizing people to come out for sensitization remains a big problem. Hence the use of megaphones during occasions as already mentioned above has proven very successful. 8 WHO/APOC. 29 August 2003 N Itt a o o =Jf) E -J -atIt o o -a - - o - o - -) o - -t -t - e o o I' o I' orJt 3!tr -a3(a la t-_l9t- l(D l+- - (D(, ,o J o o o H t s G G l\ = 6 a7 .- Fl ? o ? .D' E o .D |.nF Fl F DJ rD ls rt r! N)6 € @o +:5 -l.o +. f, 7=-'=z; *iE I - '+)- ,+6-:a *ear- E = +i z (}I ljte 9.o ?=' o tDo \o(,J UJ t'J UJ .\ IJ IJ l.J5 l.J ='z.a -7=E; i+; -- 'trt- ='aJ+ 0q rDl.) l.J; (}J A IJl.) l') o' d 5 ?Jr N) o\qJ oo .o UJ a \,1 s,;r)-;='-tr- =.d f =.E aZ li =(r 65 .DE BE 6,8 o< o' l.-) o -=nZ 1.i)9 a - =.'1n a-'1 ? qJ \o ^\ o\ +r o\ o .o { .o o" G ,e e: -IhJa @ IQ @ azt 7tr zatr 5-56 EO 3.AgU AE ={4= (D \o UJ IJ UJ o\ UEcd' 6 utl s ooUJ J.I I'J@ :l \o l.J o i.2 z -+= E F9ET ;l+ ;;z rcBsr1. *a .n' Y, D:ldc rr I.i-i s. Jd, b..) s IJ 9o j lJJ{ o. :g o (D E de rrro o SEFSH(D{.G\H\C:\:R= -.*'d R! ^adI=:a { < A :.R X.s'N% Y:^:6S(\ =bs$x< ^Y =+o x\B -i\G aNsEr'+Q *.Q -:%\x.O ^,!\ -!R .\- s.. N IUA \il ! =ia\' = =s^ !{i..} tx- Q'A$\ A\ 6-3\\s \RsS(\T AAt* 6 \\o v)N .oF\\),- $ ^(\A! \\ \- E' su qc i (\ \J 7 (\ 4 A ci Ar oa $q a ?1 Gq :\\.1 ts G * a .Q lTt FU op O f6 t N)O (,) \o Attendance of female community members was very low- This can be explained by the fact that women are more involved in domestic activities within their communities. They do not get very involved in community work. 2.6. GapaciQr building 2.6.1. Treining In general training objective were met; the number of health district and health area staffthat were planned for training were trained. Just 83.5% of CDD planned for training were trainsfl. This is because some CDDs were disgruntled, not well and promptly motivated. In Akwaya for instance the CDDs all went on strike because they complained the motivation they had for last year's distribution was too small and not paid on ' me. Many CDDs in this health distria have a wrong conception of CDTI. They view what they do as an employment for CDTI as an employment for which they expect pay. The DMO did a lot trying to sensitize the CDDs and still plans to reinforce this next year. 10 WHOiAPOC, l0 April 2ff)3 la la)l6t- l(Dl* ;Et e0 0a c) o :t a'r.t o o (D (D t o UFl (D (D p + o e(\ N(\ G$ \(\ i U1 \ (\ o(\ a, 6 \- a (D o (! \e rl o Ft F ? o T ? D +.(D' Ej o (D ln i a o Fl ?, G q a o\ tJ (]) (rt o\ B z d o o U 0 a (o 0 D' E' (Do o\ o\ tJ N) O UJ u) tJ) NJ (,l o O (,l o\ x El .) (D (D (! .\ -Ib,J \o tJs ! NJ a o =*z -<5 5q0tl t| :L 'i A, og 5 () € -It) (/) o\ \o t) N) N) NJA o\ \) O UJ oo t.) :l € \e .) t! o tD \e N,.) N) 7. z i'o ;+r .DO (D Fl- ..i rj0=' o (r) € b..) O O O o o UJ @ N) ? ! ,G:i\ a s tD o G €Pt,l s €5\o O oo(,l A5s A( tJ(^ Elts z o o o U E'(r, DO (D l.J{5 5(r) L'I { \o l.J A(,l qrr{ @ {( oo(r.) t) UJ(,) NJ UJ (J) o\ 5 5 { \o N) \o\o z Fl 4 hl Frr FU LJ P tn NJ O Table 6: Type of training undertaken (Tick the boxes where specific training was canied out during the reporting period) A t n' r tilrc r c( )tlt tttc t tl,t flainings were targeted; CDDs were llained on just what was required of them (health education, census update, filling of registers, Mechzan@ distribution, detection of side effects and community self monitorirg). OnIy health workers were trained on programme management and data analysis. 2.6.2. Equipment and human nesounces On the whole this project is fairly well equipped but for the fact that that there are not vehicles for the health district. Except for Fontem, no other health district has a vehicle. The absence of vehicles coupled with the rough terrain of Southwest II project area, supervision is very difEcult for the health district team. The table below details the available material resources. Tramees T: pe of tranmg CDDs Other Communitr tnernbers e g Conununrtr supenrsofs Health Workcrs (frontline hcalth faciLtrcs) MOH staffor Other Political Leaders Others(specrfl ) Pro,qram rnanagerncnt X X Hou to conduct Health educatton x x x x Managerneut ofSAEs X x CSN,{ x X x x SHM X X X Data collcctron X x x X Data analr-srs x Report ulturq X X X X Others Detectron of srde effccts X X x x t2 WHO/APOC. 10 April 2003 Source Type of equipment APOC MOH DISTRICT NGDO Others (sowEDA GTZ,ILEP) Condition of the equipment * Please state 1. Vehicle I I I 2. Motor cycle 20 7 l5 ll 3. Computers I 6 I 4. Printers I 5 5. Fax Machines I 6. Others a) Photocopier I 5 b) Flip chart stand I c) Overhead proiector I d) Mobile phone I e) TV set I Table 7: Status of equipment (Please add more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written off) All equipment listed in the table above is functional. - How does the project intend to maintain and replace existing equipment and other materials? So far equipment is being mainlziasd jointly with funds from the NGDO, APOC and the Ministry of Public Hedth. There is however no clear-cut plan of how new equipment shall be replaced. - Describe the adequacy of available lmowledgeable manpower at all levels. Some staff at health area level as well as CDDs have doubtfirl and confusing knowledge on CDTI and therefore need routine re-training especially in areas where they are weak (targeted fraining)- - Where frequent transfers of trained staffrccar, state what project is doing or intends to do to remedy the situation Qhe most important issue is what measures were laken to ensure adequate CDTI implementation where not enough htowledgeable manpower was available or .sluff rflctt trutt,s.fcrrccl duritry the cotrr':;c o/'tha cunrytoigrt) This is non applicable as health staff in the project are fairly stable l3 WHOiAPOC. 29 August 2003 14 WHOiAPOC. 29 August 2003 PI {rt o!lt 3 o Jt o lFl !')lo: -r t(D It6 ":l F- rr!6E HID (D+5=r tr)tr *.d V) |.n(, d o- U) -t o F te t0i-1 (D cD v) A)+ r-.t(, 7r e(\ ! :r. s \ \ =(r) (\ a ? d \- Fl oll F 7 o q ? +(D' o rn o a- rl D) DJ U b i .) 5tj h..) oo (}J { .o 9=s8L^-1-C ZH E SF <6 r lD ?,iq=/eP+ ='J ) + ^it 3 e.6:i 'i,d,< -o (D o) UA rD\n ..t. h.J oo .o rJJ -lto - -'PJlh GdpsS 4 @- a- tJn h,J @o (}J (}J { -82.: S.E E 1.fi E q -o1^ O+r Oo .o o OO ..o OO .o o' O a8 ^vdErord R vCo !4rcPo6 b,J €(,I € IJ 5{ 6{(}J l.J o\l-) +\IJA oo ooA @ UJo il ',! q o- tst-e lri o L ;i 5 oE o UI o\(r) o\5 IJ o. oJ. \,1 -l l') +- IJJ IJl.) IJ 1..) 'o+- --J .dd I6'rp do5=?dIo* 5 € -I o\ +: o. @ @ .t:{ o. oo J: o. o. l.J IJ{ @ J: 2.ats ci8f;1d95 *- o -I UJ s { @ qj \.1A UJ a { o F-.1o:lOo road $ o\HEvlD OoaE(D tr'.o [.Jo o\(r){ .o\oo { o. @ l.)OA 12 d+)=NEr9! P tro s 4 !.!a-- IJ l.J{ J-o s +:IJ IJ{IJ t =Zfr^= n'7 O O a2 't- i != Lll C O O O O O -^z'o rdlg-a-f9.1 :JiD- o q'r- = E 56 >7:g *wlz,ruv4 Itslol-I=t,l-l- lDt*ld' Ilar le ,IE l=l=' (rcl* l(D laito lrD l---l+ t-rt.)l-t;t)lo_ 1," l(Dlo lrj lajto la lo)l- lsl< lrD IBUi l.Dlt, .l oI 8t) (D \v+ <..J o o ort o)0a(D n s, (D o(D o 0qt s) :-o le o o (DFt s)0a(D Et s) (D .l L,, o o a^, _. ( I v ri 0ea t E) a \o Fl o g) o @ o N.r l-ols oo loo(^ l-I oo l- c lo\ lx l=lo l5l(r lN) &l* sr I-IOIO l- l.r- - licU' l-J ^t rJ) l-\ ?1,l= l= -l- -'r ls -l looN.r l-r\o t- ur lo\ al" ;l= I ll { '(r) ^\6\ c ,.lr C oo UJ '\o o\ L..I + op N) oe 0 l.J (}J If the project is not achieving 100% geographical coverage and minimum of 65% lherapeutical coverage rate or coverage rale is Jluctuating, state reasons and plans being made to remedy this. The project has had a geographical coverage rate of IOO% now for at least two years and the therapeutic coverage is increasing steadily. 2.7.2 Wat qre the causes of absenteeism? The reasons for absenteeism do not look convincing;just as in the past years they still complain of distribution taking place in the farming season as the main cause of absenteeism despite the fact that this fact that treatment period has been changed to their demand. Another reason given for absenteeism is fear of side effects. It appears as if some persons intentionally leave their homes during distribution period and as such recorded as absent. Also seasonal population movements in certain communities following socio economic activities also accounts for some absenteeism. 2.7.3. Brie/ly describe all lmown cmd verified serious adverse events (SAEI and provide in lable 9 the required informationwhen available- No Severe Adverse Events were recorded. 2.7.1. In case the project has no case of serious adverse evenl (SAE) during this reporting period, please lick in the box. No case to repoft t6 WHO/APOC. l0 April2003 *aD z (D> oa CAox 9< 0Q-F.D =da(D o f5:/F- F= BY N A) a- €(D o- V) o 0 J016fo(D o g z6s'9!d $,T*rg B, E.P Uo: f P) =tD E.(D*S@^t4 Sr^ v --=.6 =o C0 ori) BAci;' J.S/) @ 'a o) 2;F \;c)tr -rr. ^ = - dq 5'9-o:.o.6 o 0 13 0 a'tB Hr:78HBgAJ6'o ooEi'9 i'PE 6, oOb)irN; HEq@9 I E'> =1Fo lao11?' :laio la lDeIql- l(D lro o !Dq) (D o o+) u)oFt o (r) o) o-4(D -t cl) CD (D @ J 0 (/) rn(r) eD ooo Ft rt (Dp- o- tst oc (D Ft (D o -t oa (DFt o o- e(\ ! s GS\ o =V1 (\ o(\ ? *( G^.\ A B(\\ 6 (\ { Ao FU op EHH TJaO NJ @ t-)O -T t-JOO o\ N) l.J O5 tJO t) tJ I,J O 1..) O rrl F lt- CI @ CJ' @ c5 7*^a4 tr -t- 7. - J ; =2 =- -:'/dc+ ria" --/*. D rr: }t.(,rt b3 l]. CI[\] r+:qIr ti r{- C)rt9 4- CJI @ qIr @ =dx -Lia-r.= --o) 4P+ {-()r[o CJIT9 rl- CI CI rl- @ '/- a Z1 =-a= 1,==eL .:3\ ^\ to 3\. 3 .a ^\ ac -/ -a . 4 t: tli :- z =ittl '- H s (9 Lo s 3 .\ ^i>aGJ tta -G -o .Dq tta rD H ^\- lJ @ .w -I CJT ..t N9 ia CJT H @qIr 'Co -l +- tt 90(JI @ H CI H H L r{-g, H H I\3Lt.] H tJ -Co @ :i..jot .,FZ)dt' a3 r]- @ -I t9 c,t cJr CI @ crl I..9 qIr ,- G a= =cCE,- a' -_ --lH .- C\ C)l \. Cr, lr bo .= C,^J -T r.9 :i Fl a.= =iE r,= -ro g H ^\ *- qn -l a\. -z>io iJ -! q'- -G o D) o H -l -.I "t9 C,g) CII L c,l] H *- .-t H[.: -o- ^"o i 0q rD IH lD)ld loINJ15! (.) a >lIR; =5 oo :J-(ne o)tl o-E IDo=o; (D?, r=d6e(D.i +/ r!l- 5lC) +lA:+ lod15 E5lo-lpo Olrt, (D>i o) 'f)-oElD (D5(D8 (DJ .D(,) ': (D:i tD G @ t o _o tJ@ oa @ N)OO 2.8. Supewision 2.8. 1. Provide a flow chart o/ supentision hierarchy. Central level - NOTF - NGDO Provincial level - Provincial delegate - Provincial Chief of Senice of Conrmunity Health - Oncho Project Coordinator - Finance Offrcer Health District Level - District Medical OfTicer - Cheif of Bureali Health - Chief olBurea of Administration and Finance - Chief Meical Ofl-rcer of District Hospital Health Area Level - Health Centre nurse 2.8.2. Whqt were the main issues identified during rupervision. Some people collected treatment but did not swallow the tablets on the spot. t \ Community - CDD - Community members l9 WHO/APOC, l0 April2003 Some CDDs not committed as they argue that motivation of 25 frs/person treated given by the government is small. Some registers were not properly updated Registers were not available in some areas and exercise books were used. Nurses had to distribute Mectizan@ in some areas where CDDs where reluctant to work effectively or had resigned.. People from hypo-endemic communities felt cheated for being left out of mass treatment. The number of people accusing Mectizan@ for their illnesses dropped since side effects had greatly reduced. Mix-up in financial jusffications between APOC and SSI funds. 2.8.3. Was supervision checklisl used? In most of the health districts supervision checklist were used routinely for supervision. 2.8.1. What were the outcomes at each level of CDTI implementation rupervised Errors discovered were corrected on the spot. This senred as continuous learning process for the level being supenrised. 2.8.5. Wasfeed-back given to the wpervised, and how was thefeedback used in improvirtg the overall performance oJ the proiect Feedbacks were always given during supervision. These were always by correcting errors discovered on the spot as well as congratulating the stafffor good performance. AIso supervision reports were sometimes written and circulated to the persons concerned. SECTION 3: Support to CDTI 3.{. Financial contributions of the pailnens and communities Table 1 1: Financial contributions by all partners for the last three years Contributor Year 4 ('Dec 2003 No 2004) Year2 ('pra,ide the penod') Year3 ('prande the period') TOTAL Budgeted (US$) TOTAL Relcased (us$) TOTAL Budgeted 1US$) TOTAL Released 1US$) TOTAL Budgeted (US$) TOTAL Rclcased 1US$) Ministry of Health (MOH) 50885 Local NGDO(s) ( if any) NGDO par-tner(s) 46486 46953 Comrnunities APOC Trust Fund 62022 37007 TOTAL 20 WHO/APOC. 29 August 2003 If there are problems with release of counterpart funds, how were they addressed? - Comments 3.2. Other forms of community support - Describe (indicateforms of in-kind contributions of communities if any) Few communities motivated their community distributors in cash and kind. This happened in four health areas of Akwaya where some communities gave CDDs money and others gave food and drinks as compensation. In Bachuo Akagbe health area of Mamfe health district some communities exempted their CDDs from community work as compensation of their CDTI work. 3.3. Expenditure per activityr - Indicate the expenditure on activities bebw in US dollars using the carrent United Nations exchange rate to local currency Table 12.Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure (s trs) Source(s) of funding Dn-rg delivery from NOTF HQ area to central collection point of couununity Mobilization and health education of comrnunities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to liealth and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Off-rce Equipment (e g computers, printers etc) Others (Insurance) Motivation of CDDs 5643 378 l0l I 1823 1733 ll86 5652 371 708 4588 3333 4331 7082 APOC SSI APOC SSI APOC SSI APOC SSI APOC SSI APOC SSI SSI MoH APOC SSI APOC SSI APOC MoH 2t WHO/APOC, 29 August 2003 TOTAL 26291 3758 7790 APOC SSI MoII Total number of persons treated 148.716 - Comments The financial input by the Ministry of Health stated above is certainly much higher than indicated. This is because most of the expenditure made at the different levels is usually not documented. An example is the expenditure borne by all the health districts during the training of Health District and Health Area Teams on Community self-monitoring. All the health districts financed this training. During most of the training and or other CDTI activities, forms are photocopied and other financial inputs are made but not recorded. It is hoped that the practice of recording these expenditures will soon become part and parcel of them as they are reminded again and again to document those expenditures. SECTION 4: Sustainability of CDTI tLl. lnterna!; independcnt prrtic-petory monitoring; Eyaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick where applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 1. 1.2 What were the recommerulations? These were reported in last year's annual project report and 1.1.3 How have they been implemented? - Monitoring and supenrision: The activities were better monitored and supervised this than in the preceding years. - Mectizan Procurement and Distribution: Mectizan was order in time, received early enough and delivered to the various levels following the existing health systems. - Financing/Funding: The movement of funds from the funding bodies to the various levels has greatly improved. Separate accounLs for SSI and APOC funds were opened in Limbe and Buea respectively. With regards to government funding, the health districts and Province have already started contributing in various ways to the X 22 WHO/APOC. 29 August 2003 project. Provincial Supervisors for instance carry out integrated supervision with funding from government coffers. The districts also do the same. The only problem is that this contribution is usually not evaluated in terms of financial input. - Coverage: The coverage is on a steady increase even though two health districts are still below the 650/o annual coverage objective. It is hoped that this situation will improve for the better as the communities are becoming more and more aware of the importance of the progremme. - Tlansport and other material resources: It is still not very clear as to how goveflrment is going to ensure replacement of transport and other materials. However, government has started contributing immensely in the area of maintenance of the project vehicle and motorbikes. 4.2. Gommunityl self-monitoring and Stekcholderc Heeting Table 13. Community self-monitoring and Stakeholders Meeting (Please add more rows if necessary) Describe how the resalts of the communitlt self- monitoring ond stakeholders meetings have affected project implementation or how they would be utilized during the nexl treatment cycle. 4.3, Sustainability of proiects: plan and sct targets (mendatory at Yr 3) What arrangements hove been made lo sustain CDTI after APOCfundirrg ceqses in terms of 4.3.1 Planning at all relevant levels. At all levels plans are made in an integrated manner for all health programmes. 1.3.2 Funds Financing stjll fliff"rs depending on the health programme. This is because different health programmes are funded differently. The government is still to provide a budget line for CDTI activities. Government health facilities however mobfize funds for different budget lines to support CDTI activities. 4.3.3 trqnsport (replacemenl and maintenance) Drstrict Total # of comrnunities/r'illages rut the entrrc pro.iect area No of Cornmumtres that carned out self monrtorin.q (CSMI No of Cormnunitres that conducted stakeholders rneeturg (SHM) Akrvaya Ekondo Titi Fontem Mamfe Mundemba 79 40 143 t.t0 93 29 l6 0 9 TOTAL .195 23 WHO/APOC, 29 August 2003 Specific zurangements are yet to be made for the replacement of existing transport facilities. However the government also occasionally provides transport materials to its health senrices- Maintenance of these equipment is however jointly done with funds from the government, the NGDO and APOC. 1.3.4 other rescntrces 1.3.5 Please provide a written plan with set targets and achievements for so far. ACTIVITY TARGET RESPONSIBLE ACHIEVEMENTS Carry out Health Education to increase awareness H/Education was to start in October 2003 and continue to end of the treatment period in all communities HA, HD, and Provincial Ievels HlEducation intensified in most of the communities Carry out re- training of relevant personnel at all levels Targeted training of all relevant personnel before commencement of mectizan distribution in all HDs. Between October 2003 and February 2004 IIAS, HDs, Province HAs and HDs carried out targeted training for personnel idenffied in advance. The Province did not carry out two trainings planned for Laboratory technicians and DMOs. Make request for mectizan on time and in sufficient quantities. Mectizan to be made available before the distribution period (October 2003 to May 2004) IIAS, HDs, Province, NOTF, NGDO Mectizan made available in September 2003. Distribute mectizan Mectizan was to be distributed to all s6ppqnities in the project area within October 2003 and May 2004 All levels Mectizanwas available in alt communities for fistribution. Ooly Ogurang HA in Mamfe HD was partially treated because ofhigh Ievels ofco- infection with loa loa. Supervise all activities planned AII the activities were to be supervised at all levels as they were IIAs, HDs, Province, Central levels EIAs supervised CDDs, Districts supervised HAs, the Province 24 WHO/APOC, 29 August 2003 being carried out. supervised HDs and the Central level supervised the Province. Hold HA, HD, and Provincial Appraisal Meetings Each level to conduct an appraisal mee';ng at the end of the distribution in May 2004. All levels Appraisals meetings were held at each level except in Ekondo fiti Hea]th District were the District Appraisal meeting did not hold. Transfer of APOC Finance Officer from the Central Ievel to project area in Buea. In order to ease financial transactions in the project area and faeilil2ls financial jushfication. NOTF, PDPH Finance Offi.cer was transferred from Yaounde immediately and he's now working in Buea. Open separate accounts for SSI and APOC funds The accounts were to be opened before the begitrning of the activities of the fourth year. PDPH, NGDO, NOTF. APOC account opened in Buea in August 2003 while the SSI account still operates in Limbe. Increase coverage of 65.6% last year Obtain the UTG of L77.293 persons to be treated in year four- All levels A coverage rate of 7L-3o/o was obtained at the end of distribution in vear 4. 4.3.6 To whqt extent has the plan been implemented Generally, the plan has been implemented effectively- However, the areas of health education, retraining, and supervision have to be intensified at all levels in order to improve and maintain the upward trend of community awareness and the coverage rates. tL4- lntegration Outline the extenl of integralion of CDII inlo lhe PHC structure and the plansfor complete integyalion 4.1.1. Ivermectin delivery mechanisms CDTI is currently being integrated into the minimum package of health care activities at all levels. This integration is however not complete yet as some health staff still find it difficult integrating GDTI activities with other community health activities they carry out. At the provinciat and district levels 25 WHO/APOC. 29 August 2003 supervisions are fully integrated. Although trainings zrre not fully integrated yet, during CDTI trainings information on other health programmes was occasionally passed on to the trainees. Eye care is currently being integrated into CDTI at all levels. Frlly integrating trainings may still confuse the traingss, considering the level of health staffwe have in our health facilities. AIso this may pose a problem as different health programmes have different focal persons with different plans of action. 1.4.2. Training Other health programmgs like measles and polio immuniz.ation campaigns make use of both human (CDDs) and material resources (vehicles) put in place bv CDTI but the programmes are not community directed. Instead they are hedth intervention programmes. So far the achievements of these other programmes have been good. With the integration of primary eye care into primary health care CDTI and eye czrre training of CDDs will have to be carried out simultaneously. 4.4.3. Joint supervision ard monitoring with other progyams Supervision and monitoring is fully integrated with that of other health activities at all levels. 4.4.4. Releqse offuruls Release of funds is not integrated yet as fundings as well as means ofjustification differ with programmes. Government funds as also used in supporting some CDTI activities and government involvement is increasing with time. 1.1.5. Is C.DTI included in the PHC budget? CDTI is still to have a separate budget line in the running credits of the health services. However funds are usually mobilizsd from other budget lines to finance certain CDTI activities. 1.4.6. Describe other health programmes lhot are using the CDTI structure qnd how this was achieved. What hove been the achievements? CDTI facilities that the other health programmes utilize most are the transport facilities (vehicle and motorcycles). The APOC purchased vehicle at the level of the provincial delegation is used in an integrated manner for all health programmes. Similarly the motorcycles in the health areas and health districts purchased by both the NGDO and APOC are used for the implementation of all health programmes. 1.4.7. Describe others rsszes considered in the integration of CDTI. 4.5 Operationa! research 26 WHO/APOC. 29 August 2003 1.5.1 Summarize in not more than one half of a Wge the operationql research undertqken in the project orea within the reporting period. No operations research was carried out during the past year. 4.5.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses and challenges List the strengths and weaknesses of CDTI implementation process 1. Due to increased awareness of the programme people now come to find out when Mectizan@ distribution starts. 2. Many other activities in the district are done with the motorcycles provided by the project. 3. CDDs have a status in their communities that make them participate wilingly in other health programmes. 4. The health staffhave a better approximation of their populations. 5. The community people zrre exposed to some realities of their own community through community self-monitoring eg. Afap and Kembong health areas that reported this said the people were amazed. with their population figure, number of blind people, cataract cases etc. 6. The health staffs have been able to integrate CDTI activities with other health issues along side. List the challenges and indicole hou they were adrlressed 1. Community ownership of program is still low. HSAM and sensitisation still needs to be intensified. 2. Some CDDs reluctant to work because of delayed payments of their motivation by the government. 27 WHO/APOC. 29 August 2003