NW CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January to December 2009

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MINISTRY OF PUBLIC HEALTH ! slCxr SAVERS INTERIANONAL t{ATI OtIAL Ot{C HOCE RCIASIS COIITROL PROGRAIII IIORTH WEST REGIOITAL i oeleclrox FoR PUBLtc HEALTH MINISTERE DE LA SANTE PUBUOUE SIGHT SAVERS INTERflANOflAL P ROGRAiIIIIE HATIOiIAL OE LUTTE COIITRE L'ORCHOCERCOSE CON PROJECT - NV\IP t I I I iI ,. il r f5 r r r I I II T ri II Date submitted: A}INUAL PITOJECT TECHNICAL REPORT SUBI\{ITTED TO TEC}IN ICAL CONSULTATIVE COh{N{ITT TCC) D EADLTNE FOR SII'BMISSION: Management b;'31 .Ianuarv lirr Marclr TCC meeting To APOC lVlanagenrent by 3l Jttlv for $eptcmber TCC meeting qs/ COIINTRY/t.{OTF': CAi\IEROON Proicct Narne: NWCDTI PROJECT Anproval vear: 2003 !sunchins vear: 2004 REPORTING PEzuOD FROM: JINUARI'2009 To DECEMBER 2009 Month/Ycar I\{onfh/Yea APOC funding vcar: (circle onc) | 2 I 4 5 (6) 1 89r0lll7.t3 APOCProiectimnlerncntation venr report: (circlconc) t 2 3 4 5 (6) 7 8 9 10 ll 12 t3 Pa4ners; - l\'Iinistry of Ilealth - African Programme for Onchocerciasis Control (APOC) - l\{cctizan Donation Program (I1{DP) - Sigttsavers - 768 dcmic communities 0 / stP. 20,0 ^PoClCEV R Ecu AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) N 1I/IIOfAPOC, NWCDI'I PRQJECT. C'AMEROON !OO9 ix TPnee 0 3 sEP. 2010 RECU LE i oELEGATIOI{ RETGIOiIALE I OE LA SANTE PUBLIOUE OU }IORDOUEST ; i PROJETTIDC NORDOUEST i I ANNUAL PROJECT TBCM{ICAL REPORT Io TECHMCAL CONSULTATTVE COMMTTTEE (TCC) E,I\DORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sigu thc neport; Country: CAlt/IEROON National oncho coordinator Name: Dr Ntep Marceiline Sign a. j.Lbtoate FOEI) !.eJ Regional De rchu Afa te NGDO Representative Name: Dr. Oye Enyegue Signature_', -.i.i. ,q,fu(, Date . Regional Oncho Coordinator: Name: Dr. GHE Kingsley Signat Med Medecin) vt.b. (Honil. MPH (Hons) a Date: 291'l2l20}g I TLq(HANOC. },IWCDTI PROJECT. CAMEROON 2OO9 )::_,t,-- lt I I I I I il Table of contents DEFINITIONS 6 FOLLOW UP ON TCC RECOMMENDATIONS EXECUTTVE SUMMARY SECTION 1: BACKGROTJND INFORMATION 1.1. GeNeRer. TNFoRMATToN .. 1.1.1 Desciption of the project @nefly) 1.1.2. Partnership . 1.2. Popu1nr1oN............... ERREUR ! SIGNET NON DEFINI 7 9 9 9 I4 l5 17SECTION 2: IMPLEMENTATION OF CDTI 2.1. Trrrreltrue oFAc1vt1ES............ Couruerurs 2.2. Aovocncy 2.3. MoatttzAloN, sENStlzATtoN AND HEALTH EDUcATtoN oFAT RtsK coMMUNIIES 2.4. Conauururry rNVoLVEMENT.............. 2.5. Capncrry BUTLDTNG 2.6. TnEnrnneruTs.............. 2.6.1 . Treatment figures...... .......... 25 2.6.2 What are the causes of absenteeism? ..........29 2.6.3 What are the reasons for refusals?................ ........ 29 2.6.4 Biefly descibe all known and veified senbus adverse events (SAEs) that. 29 2.6.5. Trend of treatment achievement from CDTI project inception to the curentyear.......... ...........:...... .......... 3 I 2.8. OnorRrNG, sroRAGE AND DELTvERy oF IVERMECTIN 2.8. Corunaururw sELF-MoNtroRrNGnruo StRxeHoLDERS Meertuc.. 2.9. SupeRvrsror.t 2.9.1 . Provide a flow chart of superuision hierarchy....... .......... 36 2.9.2. What were the main issues identified duing superuision?............................... 37 Some of the problems identified duing Regional and Health Distict superuision included the following;.............. .......... 37 2.9.3. Was a superuision checklist used? ................. 37 2.9.4. What were the outcomes at each levelof CDTI implementation superuision? 37 2.9.5. Was feedback given to the person or groups superuised? .............................. 37 2.9.5. How was the feedback used to improve the overall pefformance of theproject? ......37 SECTION 3: SUPPORT TO CDTI...... 3.1. EourpueNT............... ....17 .... I 9 ....19 .... l9 ....21 ....22 ....25 32 34 I ...36 I .38 3 NWCDN PROJECT ANNUAL REPORI,28 DEC,2@9 38 3.2 3.3 3.4 FrrunructRt coNTRtBUTIoNS oF THE pARTNERS AND coMMUNtIES OrHen FoRMS oF coMMUNtry suppoRT.............. ExperuotruRE PER AcTtvtry... 39 39 39 SECTION 4: SUSTAINABILITY OF CDTI .................41 4.1. lrureRrunl; TNDEpENDENT pARTrcrpAToRy MoNrroRrNo; Evnlunrtoru .. 4l 4.1.1 Was Monitoring/evaluation canied of the following which are applicable)......... out during the reporting peiod? (Tick any 4.1.2. What were the recommendations?... 4.1.3. How have they been implemented?.......... 4.2.1. Planning at all relevant levels........ 4.2.2. Funds 4.2.3 Transport (replacement and maintenance)............ 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented...4.3. lr.rtEcRntroN............... 4.3.1. lvermectin delivery mechanisms................ 4.3.2. Training... 4.3.3. Joint superuision and monitoing with other programs 4.3.4. Re/ease of funds for project activities... 4.3.5. ls CDTI included in the PHC budget?............ 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Other programmes using CDTI structure include 4.3.7. Describe othersissues considered in the integration of CDT\.... 4.4. OpennroNAl RESEARcH 48 4.4.1. Summarize in not more than one half of a page the operational research undeftaken in the project area within the reporting period. ........ 4g SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES............49 SECTION 6: UNIQUE FEATUR-ES OF THE PROJECT/OTIIER MATTERS...... 50 4I 41 41 47 47 47 47 47 .........47 47 48 48 48 48 48 48 4B 4 NWCDN PROJECT ANNUAL REPORT, N DEC, 2OO9 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Comm u n ity-Di rected Distributor CDTI Comm u n ity-Directed Treatment wMyelrmectin CSM Community Self-Monitoring DO Divisional Officer EPI Expanded Programme on lmmunization LGA Local Government Area MDP Mectizan@ Donation Programme MOH Min of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force NW North West Province NWPSFH North West Provincial Special Fund for Health PDPH Provincial Delegation of PqQljq health PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SDO Senior Divisional Officer SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization 5 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO!) DEFINITIONS (i) Total ulation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eliqible pooulation: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. nnnua rreatment oo : (ATo): the estimated number of persons livingin meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of (ii) (ii i) (vii) lnteoration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI(using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (v) (vi) (viii) (ix) 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'o year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Qeoqraphical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). Sustainabilitv: CDTI activities in an area are sustainable when they continueto 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. Communifu self-monitorinq (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 6 NWCDTI PROJECT ANNUAL REPORT, 2E Drc, 2OO9 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the proiect and describe how they have been addressed. TCC session 28 TCC RECOMMENDAI'OA'S ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report-related . Find a solution to the recurrent problem of accessibility so as to cover the 18 communities of Furu- Awa - Funds have been secured to carry out treatment in FURU-AWA during the months of January and February, 2010 and a detailed work plan has been elaborated to this effect Proiect-related . lncrease the rate of therapeutic coverage to the high levels achieved in 2007 (72o/o). - IEC was intensified in districts and communities which had a low therapeutic coverage last year and the distribution extended to ensure treatment of absentees. Also more IEC materials were printed and distributed to all communities in the project area - Financial motivation for 2007 was paid to CDDs by the Ministry of Health These led to a significant increase of the TCR to 74o/o for the current distribution round 7 NWCDN PROJECT ANNUAL REPORr,28 DEC,2OO9 EXECUTIVE SUMMARY The NWCDTI project is found in the North West Region of Cameroon and coyers a total censored population in 2009 of 1,328,788. lt is made up of 768 meso/ltyper - endemic communities having a population of 780,952 inhabitants and distibuted in 1g health disfnbfs. This year, Treatment with mectizan was canied out in only 750 of fhese meso/hyper communities giving a geographic coverage of 96.4%. Ihis is as a resu lt of the absence of treatment in thel8 communities of the Furu-Awa health area of the Wum health distict, which has been envisaged for the beginning of 2010. The Annual treatment objective for 2009 was planned at 75% of the totat population i.e. 619,984 persons. However out of the total population of 780,g52 inhabitants in the meso/hyper endemic area, 577,856 persons were treated, giving a therapeutic coverage of 74%", a 2% increase compared to tast year. The uttimate treatment goal was estimated at 656,000 persons. The populations in the vaious communities where treatment was canied out were more orless stable this year with no noticeable movements. Training of CDDs started in most health disfnbfs in May, 2009. Out of 4175 CDDs who were planned for training, 3845 of them were effectively trained, giving an achievement rate of 92.1%o. Also, Out of 804 health center sfarfs that were planned for training, only 499 of them were effectively trained, giving an achievement rate of 62.1%. There is therefore a need to train staff on CDTI activities in the entire project area in 201O. ln addition, the regional and distict teams were trained on resource mobitization, while 2O staff from three selected health disfricfs and the regional project coordinator, were trained on community self monitoring. The maior challenge that was faced by the project was the unwillingness of fhe District Medical Officer of Kumbo East to implement CDTI activities teading to the tate start of activities in this health distict. For this reason the District Medicat Officer was replaced by the Minister of Public Health. 8 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9 SECTION 1: BACKGROUND INFORMATION t1.1. General information 1.1.1 Description of the proiect (briefly) A. Geographical locations and administrative area(s) The NW CDTI Project covers the entire North West Region. ln 2009 the total censured population in meso/hyper endemic communities for onchocerciasis was 780,952 inhabitants. The region has a total surface area of 17,500 km2. The North West Region has 18 health districts and 200 health areas. Table A: showing administrative units, health districts and health areas within the project area of2008 Divisions Health Distrlcts Health Areas Mezam Tubah (10 H/A) Bambui, Bambili, Kedjom-Keku, Sabga, Kedjom-Ketinguh, Kwighe, Tikebeng, *Lih *Bafokum*N Bamenda (17 H/A) Azire, Nkwen Urban, Nkwen Rural, Mankon, Nloven Baptist, Mendankwe, Ntamulung, Alabukam, Mbachon$va, Ntambag, Atuakom, Mulang, Alakuma, *Alalrtadum, *Ntankah, *Ndzah, *Akumlam Santa (e H/A) Mbu, Menka, Akum, Ndapang, Buchi, Baligham, Pinyin, Santa Urban, Awing, Bafut (13 H/A) Manji, Nsern, Mbakong, Mambu, Mforya, Buwe-Burari, Mundum, Akofunguba, Mankanikong, *Tingo, *Nsoh, *Mankwi, *Akossia Bali (6 H/A) Bali urban, Bossa, Gungong, Bawock, Catholic mission, Wosing, Momo Batibo (13 H/A) Batibo, Guzang, Tiben, Larinji, Kulabei, Gwofon, Widikum, Bifang, Ewai, Ashong, Olorunti, Eka, Kugwe, Mbengwi (ls H/A) Andek, Abebung, Bome, Mbengwi, Nkon- Teze, Njah-Etu, Njindom, Ajei, Tinechung, Acha-Trrgi, Munam Nryen-Mbo, Etwii Njilova (6 H/A) Njikva, Bassa, Kuttin, Konda, Oshie, Akanunku NgoketunJia Ndop (r4 HlAl Babungo, Babessi, Bamali, Baba, Bamunkaurban, Bangolan, Bamunkarural, Balikumbat, BAlqgqltng, 9 NWCDN PROJECr ANNUAL REPORT,28 DEC,2OO9 Bafanji, Bambalang, Mbissa-Mbaw, Bamunkumbi t, Mighang-Mbaw Boyo Fundong (11 H/A) Konene, Aduk, Mbessa, Fundong, Anyajua, Belo, Mentang, Mejang, Mbengkas, Kilf,rini, Fuanantul Menchum Benakuma (8 H/A) Beba-Batomo, Befang, Benakuma, Bawuru Modele , tQkqromanjang Benade, Benabenge Wum (r2 HIA) Furu-Awa, Abar, Esu, Yemnge, St Martin, Weh, Wum Urban, Ise Bu Bafmen, Kumfutu, Bui Kumbo East (1e H/A) Mbah, Sop, Wasi Ber, Jakiri CMA, Vekovi, Dzeng , Nkar, Kwanso , Shisong, Mbokam , Jakiri IHC, Tatum, Mbonso, Mbiame, Mbam , Wvem, Wainama,Ngorin, Ngehndzrn, Kumbo West (17 HlAl Kumbo, Elak-Oku Jikijem , Kikaikom, Melim, BBH, Kevu, Nkor, Buh*, Kuvlu, Djottin, Nkum Kov, Ngeptang, Simon Kov, Ichim, Kitium , Donga & Mantung AKo (s H/A) Abongshie , Ako , Akwaja, Berabe, Kuta Nkambe (10 H/A) Nkambe urban , Misaje , Fonfuka ,Binka, Tabenken, Dumbu, Buabua, Kom, Lus, Mbot Ndu (9 HA) Luh , Ndu Urban , Mangu, Sop, Mbiye, Ntumbaw,Mbongong, Kakar,Mbowrong (Ndu CBC is satellite to Ndu urban) Nwa (5 HA) Gom, Ntem, Ngu, Nwa, Ntong B. Topography, climate, access The bioclimatic zone of the Northwest province is mainly Sudan savannah grassland, with plains, rolling / steep hills and valleys. lt makes up most of the Western highlands and is one of the minor watersheds contributing to both the Niger and Atlantic basins. These valleys form beds for swift running streams especially in the rainy season, which are dispersed through out the province. The rivers beds are frequently rocky and sometime interrupted by falls all contributing to highly aerated waters which make a good habitat for Simulium, the vector of Onchocerca volvulus. The rains begin in March and are very heavy in August through October, followed by a short dry season. The roads, mainly dirt roads become impracticable during this period. Farming is all year round, maize groundnuts, vegetables and beans are planted all through the year, in swampy areas during the dry season and in the main land in March l0 NWCDN PROJECT ANNUAL REPORT,28 DEC,2OO9 and August. These are harvested three to four month later. The intensity of farming is low or moderate only during the months of December and January. The men farm the cash crops while the women farm the foodstuff. C. Communication Systems Of the 3291 km of road network in the province only 187 km are tarred the rest is made of dirt road, which becomes impassable during heavy rains in the months of August through October. Some of the villages are only accessible by trekking. This is quite evident in Wum, Benakuma, Njikwa, Nwa, Nkambe and Ako. D. Pop ulatio n : activities, c ultures, lang uage The people of the NW are mainly dispersed living in family groups surrounded by their farmland, scattered through out the area. Among them are Fulani cattle rearers who are nomads The ethnic groups are the Widikum, Fulani, Tikari, Bali, Ngemba, Aku, Essimbi, Beba, Aghem, Njikwa. The rural communities are mostly homogenous while the semi-urban and urban communities are heterogeneous. There are some Fulanis, nomads dotted all over the project area. There is constant migration to the urban towns by the youths in search for better jobs leading to increase urban poverty. E. Adminktration structure The communities of the Northwest province have retained the hierarchical structures of old. The chiefdoms are still existent and highly respected. Each clan / family has a family / clan head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the community. ll NWCDnI PROJECT ANNUAL REPORT.28 DEC,2@9 F. Health system & health care delivery The North West Region has the following health facilities; . 1 Regional Hospital- . 18 health districts services . 14 district hospitals ' 5 private (confessional) Hospitals (some of which serye like district hospitals) . 19 Sub-divisional medical centers (CMAs) ' 200 integrated health centers (152 are state owned and 48 are private) , 141 community pharmacies , 17 commercial pharmacies . Several illegal patent drugs stores t2 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9 IG. Number of heatth staff in project area and number of health staff involved in CDTI activities- 'l: Number health s involved in CDTI Number of health staff involved in CDTI activities. Number of health staff involved in CDTI Percentage Health District Total Number of health staff in the entire project area 30 62.sAKO 481 38.4130 502 BAFUT 50.042 273 BALI 47 22 .34 BAMENDA' 2ll 42 39.65 BATIBO 106 80.826 2t6 BENAKUMA .2114t2 467 FUNDONG 27.2158 438 KUMBO EAST 18139 259 KUMBO WEST 31 t6.610 MBENGWI 187 49 4r.911 *NDOP Lt7 27 44L2 *NDU 62 10020 2013 NWA 100t7 t7l4 NJIKWA 33 49.315 NKAMBE 67 2l 100t6 SANTA 2t 82.947 3917 TUBAH 55 79.718 WUM 69 37.OL725 639Total 13 NWCDN PROJECT ANNUAL REPORT,z8 DEC,2UN 1.1.2. Partnership The partners involved in CDTI implementation in the North West Region are as follows: -lnternational partners: APOCMHO, Sight savers lnternational and MDP -National level: Ministry of Public Health. -Regional level: RDPH-NW, NWRSFH, Regional Hosp Bamenda. -District level: District Health Services, District Hospitals, Confessional hospitals. -Health Area level: lntegrated Health Centers, confessional health centers -Community level. Dialogue structures members, CDDs, Social Mobilisers, Opinion leaders, Local Council members, chiefs/fons, quarter heads etc. There is good collaboration among all the partners involved in CDTI implementation. The Ministry of Public Health provides the health staff for the programme; they are responsible for managing the day to day running of the programme. APOC provides funding and logistic support. Sight savers !nternational provides technical support, logistic support and funding. The community is responsible for furnishing the programme with Mectizan@ distributors (CDDs) and health committee members (the dialogue structure members) who all contribute to the smooth functioning of the programme at community level. Local administrative authorities (The Governor, Divisional and Sub-Divisional Officers, District Heads, mayors as well as traditional leaders and quarter heads), religious authorities, have always been involved in the implementation of project activities. They have always assisted in social mobilization of the communities and in increasing adherence of community members to taking Mectizan@. As has been the case since the launching of this project, these dignitaries will continue to be utilized for the successful implementation of project activities. D t4 NWCDTI PROJECT REPORT,28 DEC,2OO9 otooN d ul o 6 1-'q oa UIc *J 5E =]-o ur oq a. tr ooi e ra) o oo o o-L :,o o) .gCc o o- L o G3 t)L =II rF o (UE o c)E :f o .E c o o =o- oo .9,E * o tr .9 s J CL o o. gE crtr EEeE - Lrn-,J-Vv + F{ F( oi OI \o G) @- o(o tr f.- \o^ \o Fl s Otq ro (f) f.-N c)- N ro 6 + \O- rO(o \o F{ \O^ N|.- Ot sf, \o" (Y) CI r- o\q rO \o rOocl o(f) oo o- rO CI f.- G) o r-{ +Nq ot OI N{-ol r- r.- \O. @ co N o\cl o + F{t-tt(o oo @- (o f.- ooq \o lo 1o o _rE E.B >rO EA€O=trFEo \o OI Co- rO ct o \\o CO \f, roq Ot r-{ Ott-\ r-{ \f, $oq ol\o @ Coq OIi' co +t- \o6 sf lO @ ol @\o ro- @ F- @ tr)q u) co o @ @^ Ot CI CT @\ OI ol o F{q \o ol \o C\I ro^ o OT r- coq \ov FT\oq f.-t t- COq F{t lO D.-q. F- @ N Ioq o6 !,. o(!5s or-(, .ELgi ts'- o r€ P.3i6 R E ol\t' c)^ t- r{ o\ roq \o OI t cr) CI \o F.-t rjr- \o G)N \O^ CI rO CY)$q Ot cr) \o\o ro- cA C.I r< @ @- N t< f.-q \t- CA r-{t @^ @ F{ OI\ott OI F.- ct OI CI @\o(o^ \o F{ C\l OIq. a Fl lO @ @- f... 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E; .9 rSq) o- U)CEo o- E q) O)r- .E =E +.ior l*o Eq) (U e P(U \ Q) \q) (I) =Ri(l, (U (, o 0 a. q, o o sab 'tr $ o (E =ao a-bq(! q(t) c h\ oo NI o)l al NI E o a-f IU -3c otr aN a F t Was a census for the project done during the repofting period? Yes, Census / registration update was carried out by CDDs atongside Mectizan@ distribution A/8. A community is made up of a group of people tiving together under a common leader within a pafticular agglomeration. This leader could be a Fon, chief or even a quarter head. Sometimes fhe number of people serued by a CDDis considered a community. ls there any other information of interest about the population in the project area? lf so, include it here. There were some other health programs like the Mother and Child Health week, in May and June 2009. This was used to intensify sensitization on CDTI activities. t6 NWCDTI PROJECT ANNUAL REPORT, 28 DEC, 2OO9 SECTION 2: IMPLE ENTATION OF GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities wereimplemented by the month they began and the month they ended. This year's activities started in March, 2009 with HSAM. Training and re-training of CDDs was done in May 2009, in most health districts due to delay in acquisition of funds for the exercise. Distribution of Mectizan also started late (in June 2009) because of its late arrival in the project area. In addition, the Kumbo East Health district had not yet started implementing CDTI activities by August, 2009, due to the negative attitude of the District Medical Officer. ln order to solve this problem, the North West Regional Delegate for Health made a report to the Minister of Health, 'hile the launching of CDTI activities in this health district was done by the Regional NWCDTI project coordinator. The District Medical Officer was consequently replaced by the Minister of Health in August 2009. The timeline of activities for all the 18 health districts is shown in table 3. t7 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2(N9 I lo)t6lo l6{ o' u!a €(\t l-r lst= = l-o ur oea , c "9 .9, z(, CL =U' .9- EEo,oEEo- o)oo c.,l o o o\oON o z o)oo ol oc = - b -ooo, 8H o)ooN (\, = o)oo c! o- oa o,oo c\l ooo b -ooo) 8R o o,ooN oz o)ooN ooo b -ooo, 8R 6foDo)oiR 6 =oD(])c)iR o,ooN o- o @ o)oo c\l oc fa o)ooN o- o) U) o, c)aN o) :, o,ooN(n = E"- E-E9 o- o,oo C\l oc f -) o,oo c\l o q,oo C{ C(l, - o)ooN o o,oo c\t Lo o)oo(\l L o- o,oo C\t o o)oo(\l o o)oo c\t f -) o)ooN c(! - o,oo6l (I, o)oo c! L o- o)ooN L o- o)oo c\l co '1 o)oo6! Lo o)ooN .>a - C')oo C\l L o- o)oo ol c(u - c o =lt .12!, E'T =o 9- EE cLoEEo-(J- oJd) 98 <N o =c,) = o)ooN ocJ -, b -ooo, 8R o,ooN (l' o)ooN o- o U) O)oo N :f - b -ooo, 8R o,ooN oz o)ooN o- o U) b -ooo) 8H o)oo N f - o,oo N f, -) o)oo6t oCl -) o\Oo cl >. cl o)ooN(,) :, o)oo c{ oc f -) o)oo c\t o) = E"- 'EC H9 o- o,ooN oc f -) O)ooN o)c f -) 5- ER o)ooN ocJ -, O)ooN o- o)ooN L o- O)ooN L o- b -o E9o,88(r)N O)oo N f -) o)ooN oc f -) O)ooN ocJ - O)ooN L o- o,ooN L o- o,oo C\l: L o- o)ooN: o o,ooN > f - O)oo c! o_ o,oo6t o = o G'E' CLf, o otr o,o .9- EE cLoEEo-o- o)ooN o- o U) of o) = O)oo C\l(, c = - b -oOO, 8H o,ooN (U o)oo c{ o- o U) O)ooN = - b -ooo) 8R b -o Eqo) iR o,ooN o-oa b -ooo) 8H O)ooN :, -) O)oo N f -) o,oo c\t o = o,ooN (o O)ooN o)f, o,ooN o O)ooN o)f x,55N ED- 'i= E;e o' o)oaN o)c f - O)ooN q) c = - Eoct E8zc! o,ooN oc5 -1 O)ooN L o- O)ooN .E o_ o,ooN o- b -o E9o,88g)N o,ooN(,) f O)oo6l L o- O)ooN q) ca -) o,ooN L o- O)oo C.l L o- o,ooN o- o)ooN L CL o,oON = - o,ooN L o- o,ooN (E = E) .=E '6 F .9- EE cLoEEo-o- o)ooN oC f - O)ooN oc :f - o)ooc! o o lJ- O)ooN oc - o,ooN o O)ooN oc f - o,oo c{ o 0) -o E .9 o,O-O(Dc)(r)N O)ooN .> l -) o,ooN q) c = -) O)ooN q) c :l - o,oo C\l oc -) o,ooN ocf, -) O)oo c\I L o_ O)oo N L o_ o,ooN -) o,oo N L o- o,oo N o- ED- 'Eehe O)ooN oc :l -) OJooN o o)oo c\t o c)L o)ooN o O)ooN L o_ o)ooN L o- O)ooN L o- afoD o)cl:Io <N O)ooN oc f - o)ooN: L o- o,ooN o 5- SR 5- SH O)ooN L o- o,ooN L o- o)oo N f, -) o)ooN o- O)oo o,t L o- oo .E =E E oo o E .9 G' .N .Et o = .9- EE GLOEEo- b -o E9o, &8(r)N O)oON o) = o,oo(N o)c f - b -o E9o,88U)N b -o E9o, &8 U) c\r b -o E .9 o, gH O)oo c{ oc :la b _o E9-r8(r)N O)ooN oz o,ooN oc f - b -o E9o38(r)N O)ooN L o- O)oo c{ L o- O)ooN oCf -) o,ooN o o)ooN = - o,oo C\l oc f -) o)oo C\l(,, f E E o E E" .Et c, o @oo c.,l ooo o,ooN o O)oo c\t c(I, - o)oo c\t c o - @ooN o c,o o,ooN c(I, - o)ooN EoLo = o)ooN co - o,ooN C o 'a o)ooN Eo - o,oo c! c C, a o)ooN -coL o O)oo c\l -c.oL o O)ooN c o - o,ooN c o -) O)ooN g o- O)oo c.,l C o - O)oo ol c o - (, Do !!o oY Ff]L m = tr) oz tU dt o(Il tr trI lY z LUdl (, z oozf,IL F U) lU o d) f,Y F U)t! B o(D fY = oz tl'J d] (L ooz :)o z. Bz B\z =z tudl !zz Fz U' I drfF l 3 ooso\ =(, o !o Go t4 G E G o \ € to o (, G h. l oi o otr i: a) o afl Comments As has been the tradition, registration update and Mectizan@ distribution are both being carried out by the CDDs. In addition to CDTI the CDDs also measured visual acuity of everybody they recorded in their registers. Persons with visual acuity less than 6/18 or any other eye problem were referred to the nearest eye clinic. 2.2. Advocacy - Sfafe the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggesfions on how to improve advocacy. Most of the health districts did advocacy with administrative authorities. They held meetings with the senior divisional officers and the divisional officers as well as heads of other government administrative services, traditional chiefs and religious leaders. The administrative authorities' inturn ordered the chiefs and quarter heads to cooperate with health staff as well as organize their various communities to ensure maximum adherence to treatment. 2.3. Mobilization, sensitization and heatth education of at risk communities The use of media and/or other local sysfems to dr.sseminate information Health education, sensitisation and community mobilisation was integrated with that of other health programs like the EPl, Malaria and TB. Mobitization and heatth education of communities including women and minorities More than 8,000 calendars and more than 3000 fliers carrying pertinent information on CDTI were printed and distributed to all the communities in the project area. ln addition, , mobilisation and health education was carried out by the health centre staff, dialogue structure members and CDDs. Churches, schools and socio cultural meeting groups were also used for dissemination of CDTI information. The recruitment of more female CDDs was encouraged in many of our communities. Respons e of ta rg et co m m u n iti e s/vi I I ages Target communities generally responded very well to HESAM especially to the distribution of the IEC/CBC calendars. With the delay in the arrival of Mectizan, many communities were worried and a majority of them sent their leaders to come to the proiect office and enquire about the situation. However they were re-assured and the drug was finally received and channelled to them. 19 NWCDTI PROJECT ANNUAL REPORT, 28 DEC, 2(N9 Accomplishments HESAM was done but usually not 100% accomplished in atl communities. The most common complain given by the health staff was the inadequate means of transport. Allthe targeted CDDs were trained. Suggesf ways to improve mobilization and sensitization of the target communities- Produce more IEC materials next year 20 NWCDTI PROJECT ANNUAL REPORT,28 DEC, 2OO9 ooo(\' >- -t5 l--( o a- urq = q H o =l-o u! Be o- tro() = = c.l t,o 'L- Go ooa \o r>lo Itrto G *. co E Go o o i Go G G o s sq5tL o to o 5 o o € o ot5 o o 'tr .eE G o 5 = 14 o f E oo qi = t- ao q) .\ q o 5 oo \tl tr o E o o .E +, .E E E oo aN o u0 6l o ogr o Ii ,ii la s ol\o so F. s @ o\ s\to sot sa(o s o\ @ s b.-\o s\o 1/) s$ b.- s Or f.- s r.-I\o @ s c.lq @ sq\ r/) st\f, s \o s @ F-. s \r st.o o 60 a 0 E o o c! E z onU :'E 6 L OFoEL) c €';.d =56>EEa E,o @ ot a c) Orc) o\o \l(o o $rO olCI +N ot (o oo\ \o tol ocl @N o$ @ r{ u) la + tr lt tr oF $oN f.- \o\o ol \r ot rn a)$ n't ct b.-N rOo \o\o o@ o @ (- c.l oo \ool OI NN f.-@ o\o ct CoN @(l) t- C' Nla 2-6OE^' \i-\r f.-a \o olo lO c) f- ao\ oN (D o\\o @tr) tnC\ NcO N(o @ol o@ alo r{ r{ I o tr o o o c6 a o O o I .o E z A U 36 2 ca o \ro loo Oro o\@o rON o\ CI COv o\o \i- o n- t. r/) a) @ s@ o' € oo o\ro o c,l oto$N o0!(( I o Cr ll + la ra la so \oo\o so so so \o o so o -o o\o o\o \oo\o \o \o + oo sO \o o \oo\o so s r{ c, o _a o !E= ';c; - E'-Iabd --.= d ==AZEe oI o o o o o o oo o o O o O o F{ 6! o ..o o E o ! 0 u06 o E o o o ,D z o L a) o1 q,6 to E63 .l'- g =6a) = E'3 .5c! Ftro E!otr ro(' @+ o+ H(f) \o@ ,J)ol \o (Y)CO cf)t @ro tol ro f.-ol tro d)cr) \oCO F.-Ot o10 0,. oV F Jt\ c0 J o oz o co o m F m DV za a oz o oz Dlr. Fa rd oE p Fo frl ts o o DV E o z E1tr 0. o o z D oz z E -z rd m sz Fz a o)F DB al +, o t I I!I tIIII! t t!I aII IIIIII tt tI tIIIII I IIII aIIII!IIIIi I I I t III II! I t I t I II I I I I I I II I I I I I I I I I I I I I I II II I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I It I I I I I Comment on: - Attendance offemale members of the community at health education meetings With the exception of Moslem communities, female community members attended health education meetings more than their male counterparts, especially when these meetings did not take place late into the evening. In general, how do you rate the participation offemale members of the communigt in meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - During these health education meetings female participation was generally more than that of males. They asked more questions and generally looked more interested in the programme than males. - Incentives provided by communilies for the CDDs The financial motivation for 2007 was paid to the CDDs by the Ministry of Health. ln addition the CDDs were given food, kola nuts and drinks while carrying out CDTI activities in many communities. - Attrition of CDDs. Is attrition a problemfor the project? IJyes, how is it addressed? The attrition rate of CDDs was significantly reduced during this distribution round. About 95% of the CDDs who were trained participated were involved in CDTI activities carried out. Other ksues 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Generally there problem of shortage of health staff is still persisting. However some health staff have just been recruited by the Ministry of Health.. lYhere frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important tssue to describe is what meosures were taken to ensure adequate CDTI implementation where not enough knowledgeable r mdnpower was available or if staff are frequently transferred during the course of the campaign). Transfers have not been frequent this year. However there were a few retirements and deaths some of whom are still to be replaced. 22 o,c c J oo (I) af,oB o C,, eq)c (u e Jq o) (u =s- so (tr o b) bco o_(r, s)t o()co o e'l ob P a. qt a(tr (u G oc G 0)E a+- \q)g !q) =+ Eotr (B E q oo C) o rt) -o E z IEII (JO,:+t- L., : O S.lqv i-\),:t \.) to C{ +o ol o Ot olr) + o CI ro rJ) o ro ol c.,l @ co\o t c.I rO C\I (o OI C.I \f, + \o ol co (o t.-t \o H + t- tr) \o @ r.- lJ') Ol cl roo 0,..O @ (f) @ r.-\o rO H 0o o\ \o \o o CO (f) \o \o ct o\ b..- N 0..- ol co o{ O Ot rO ol d co(t (o @ CO a Ot c\l H tr) \t r.- @ @ OI Ol tr) r/)o$ \o f- c-,1 \o C.l u)t(,(? ooo(9 t.(a F s F{ ci ol +, tr(, E(, '>(, t(, \o u) h. \tio <-oCi olOc\ \o\o olOc\t totrO tt (o F.- + ro o{ o (r) @ \o Ot Cf)\o F..r.r (\I o oo+ o l/) b-@ rO l/) rO o q ko .AodFrbb ,L4 6rg<o otr bE E z 'dll+ NO-t <iot'r *:o<v S^ tsr, ? o o o o o O o o O o o o o o o o o o o o o o o o o o o o o o o o o o o o O O O O O o o o o o o o o o o \o o {J tr(, tr(, (, t(, rO o\(J o F o O o o o o o o o o o o o o o oo qj (d @ o o. o ofrod; ad =d3E I(.) z E &3- U U *q)' : $) e @(o F.- cf) @(- (r) t,,r o o o (o f- (\{ ro cr)N o o o a c\I tr) OI o \o(- \o(o o rO + CY) cf) C.I U) O LO N \o il (' \o rO\r \o cO @ O \o rO o o co t.- tr- + ca \o\r CO o\ (f){- @ co b- oot o6 : o rOo\ r{ N 1o .P (, tr(, C' o qO o\O o F @(a co+ (a cf)r.- 6ot rool H+ O r.o N o oN 'lo o o \od sf\o @ \o+ Otd- to d, !(1) (6 (rl o L q o o kil)3 z .11 dil\JE,t+F"d \J U tq)' a< : n)3 N ot o (r) CO o o o o rO co C\I o o o N ol o + Ci ol o o o H o \l + o CO (f) o t t o o o o o o O cO o.t co (Y) o t d- o ol OI o ot to(o to \oo\ 0,.o +, E o E o o t(, s (JoF ol (a a a + (f) \f, t o v o sl CI ot t sJ- t (Y) oo o tsq o o M F D fJ. m -1 m oz rd m o ca F m z atr oz o a z Dt\ Fa H otr Dv Fa E] B oE DV E o z H m 0. o oz az B2 E bz frl a Vz Fz a A ro DF ts I t{ oF c .o (U c o E o o- E tro o o o o o #c oL oItr E o)t (, tJ) .cC '6 LF tbr ol -ol(Ul FI - Comment CDD training was carried out in all 18 health districts. During these trainings, government contribution in all the districts was remarkable accounting for about 65% of the funds needed for the exercise. ln addition some training of staff involved in CDTI activities at the health district and health area levels was also carried out. Table 6: Type of training undertaken (Tick the boxes where specific training was canied out duing the repofting period) Trainees Type of training CDDs Other Commu nity member s e.g Commu nity supervis ors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education X Management of SAEs x CSM X SHM X Data collection X Data analysis X Report writing X Others (specifu) - Any other comments Community supervisors, Religious authorities should be trained on CDTI activities. Training of these persons was not planned this year. Considering the position these persons hold in society, training them will contribute to the good implementation of the project. However this has been included in the provincial three years sustainability plan. 24 NWCDTI PROJECT ANNUAL REPORI,28 DEC, 2OO9 2.6. Treatments 2.6.1. Treatment fi gures lf the project is not achieving 100% geographical coverage and a minimum of 65%o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Treatment took place in all 18 health districts except in the FURU-AWAH health area in Wum health district. This is because of poor accessibility and co-endemicity of onchocerciasis with loasis in the area, and therefore a calibrated blood smear has to be done before treatment with Mectizan can be done. However, this activity has been planned for the end of 2009. Table 7 gives treatment results for all health districts 25 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9 o,ooc{ ()' UJ o 66t l-'co a-l!q s = = 1-o ut oea \oc\ (!^d AU-9vac,l--^eE'= EeHErfiEEf' E Ei H6ETg-z grr g" o o o o o o o o o o o o o o o o o o o q a U) k() -oc z (* o o o o o o o o o o o o o o o o o o o o ooo o -od L() -o E z o to\o F{ o r{ o\o (f) \o € co olN(f) tr) rot- l,O F{ c) F{ ol ro o OI ro F{ D- r-{ oi ol/)o F- l/) Or\o N\o lo_ t-{ t-(f) @ \o f.- @ '-{ \o f..-o ot (o(a sl. (f) t Ot sf\o N CI @ cf) o OI c{ tr) Iolo olo [;t-E(l)-otr=z o loa@ to(r)ol @f.- r/)$o\ F{ rf)\o N Fi t @\o lr) Cf) rO N H N @^ F{ o\ @ f..- ol F.-o \t- f-o CO (Y) \o OI @ o\\o r-{ t CI r.- o\ot- r-{ @ sf, o ti \o o @ @(r) r{ o @o(o -oo\\f !,,- S" ffe E=e? ll -OAdi a s\o F.- s r.-\o 6\v @ s r-l F.- -oo\t f.- \oo\ Ot b.- st- r.- \o \oo\ tr) L.- s F{ L.- so f.- \oo\\o tr- s cr) r.- s ca f.- sN @ \o G)t- so @ s t..\o F b E= EgE o f.-q o OI @ cr) \o^ t CT \o CO \O^ \o H tOoq OtN cA CY) ol \ot t.- rJ) c)^ o)(r) rJ) @q \o \o Nq Ot F{ \o otq @ ro CO a) ro ro ol \o F{ Oro ot r-{ CI .f- t- CI$ F{ o FI LO @ co^ t ?i f.- ot \o^ D.- co C\IO o^ l/) cO $t-\ CI co o @\6 ro 0lo @ F,.F rO I o.rE b.zZEEc (n.L < g4'FU \o r.- co^ OIN ol\o co^ CI o co co^ lrD F{ oo r/r^ LO co oo @^ ros @ F.-q \o cO \f, F{q \o\o \o t< H r-{ OI F-{ co\t-(o o cY)q F.. C{ o r-lt CIN co €q \o co cet @^ t-{ co F-{ si' oI f.- 'it.- \o^ @ co tr)o F{ oi co o G) oq. CI cr) o ro \o- a\o too ol t{ a tro (U o.o Or (!qI b$ *dS'i o )o --9U' a 3*E EE \o ol c')- \o ot o F{\\o Cr) $ rO @- Or F{ o\t-\ r-{$ \f, Otol N\o @(9q N$ @$q \o @ t ro ".{ @N @\o tr)- @ r.- @ lOq a a) o6 @^ Or OI ol @\NN Ot F{ o! \o CI \o OI rD- o OI f-- co o^ \ot r-\oq. F.-$ t- G)q F{t rot-q. 0... @ N to oI o @ F.. ll * aa n doo '= oo EL,A Gl O\ob:eguo- soo F{ soo F{ soo soo r-{ soo F{ soo F< soo F{ soo H soo F( soo F{ \o oo r< soo r-{ soo .-{ soo Fi soo r< soo F{ soo t-{ \oo\q a \o 1lo o l'= q9.- Op E ooEo=do EEiE LOt @t ot r-{cr) \o@ \oOI F{!O C')(f) CD+ @U) tOI U)F{ riF{ F-OI trO COcr) \oo otF.. otoF tsoE U.Z E€L<86 l/)$ @sl' o\f, ri(o \o@ \oN F{\o c)CY) CDsf 6l/) sf,CI roF{ riH f.-N vtr) cqco \o(f) f..Ot @ 1o D,- q o6I) d o oO -Bc j. tE$-$e e. - Hi H' ro + 6 + o\f ?<cf) \o@ \oCI F{ ''o c) cr) co + o LO t CI ro ri r-{ F{ F- ot tr/) coco \o(f) D.-o @0!- o uo o oV F Dt\ m .l m oz rI] m o m t- a DV z ri m o z o o z Dft o- EE 5fiV Eagts E o z fr]tr 0, o az D o z Bz F M =)z rdtr g z t-z a E m Dt- B i t{ of{ J o (u o G' o ru (l, c o .2E o lU a E'c(U +rc o Efl(E oLF t- o ll GF Comment The geographic coverage this year was the same like that for last year (97.6%), since treatment still did not take place in the 18 meso/hyper-endemic communities of Furu- Awa. However, the project registered a therapeutic coverage of 74% with a 2% increase cornpared to 2008. TREATMENT IN HYPO.COMMUNITIES No HEALTH DISTRICT NUMBER OF PERSONS TREATED 1 BAFUT 1,87L 2 BAMENDA 56,575 3 KUMBO WEST 44,661 4 MBENGWI 5,788 5 NDU 14,651 6 NWA 11,919 7 NKAMBE 3L,712 8 SANTA 9,526 TOTAL L76,7O3 a 27 NWCDTI PROJECT ANNUAL REPORT, 28 DEC, 2OO9 Formula for computinq therapeutic and qeoqraphicar coveraqes Therapeutic coverage rate = Number of people treated x 100("/r) Total population living in meso/hyper-endemic cornmunities within the project area Geographical coverage rate = Number of communities/villaqes treated x 100(%) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate ("/") Number of people treated x 100 Annual Treatment Objective % UTG achieved = Number of people treated x 100 Total number of people to be treated in meso/hyper- endemic areas within the project area (UTG) ATO = The estimated number of people living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. UTG = The maximum number of people to be treated in meso/hyper-endemic areas within the project area, ultimately to be reaChed when the project has reached full geographical coverage (normally the project should be expected to reach the llTG at the end of the {d year of the project). 28 NWCDN PROJECT ANNUAL REPORI,28 DEC,2OO9 r2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals? 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provid-q (in table 8) the required information when available. ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. x 29 co ) tr a) o a. os o\ oa E5 c G 'tr oq I =E*07 r9;o <.E E ;P8c'.= cEES(l,oi, -^= E frEg E a> ,9E2oE sH q OHeY bEgP-7i Eo-c tr *SEo.o.c 6 a - d= PHF'T(B@O9 n E,E,E o!r'; xv q-Eu' vri-I€ U 9IJ (6.CGi ;gs€E 0. V) tr'u *EF 6) =c) A >\O.H66 q(! ((, N ged iigJzazs o (l) ooc6.1 =bo>b xq) a o) o0 * z a E o 'tr o a. Ul tr oao o trt IE Eo\5oo o a a'lU g1 tn o o o eo E G ta5 o o tt,\ oq o ta Go 6t ol al fl! C')so(\I o't! a 6(\{ l-'q o o- UJq -l 5 = =ql-ol! oq o_ troo\ = c) b0 P $s /O O s o' r- sv @ ri @ sq tO sq sf, @ \o o\ Lri @ soo tr a 6J o. o ell -9 eiH *.H o ^o09 EaF Oo\d >v o s F{ oio r-{ s\oo r{ s Fl o F{ sI Ot @ \o o\tq C\o F{ s(oq\ o * I 14 oa =c)o olJO- (g,^ ai-o k \oL.rvo\o >v -coFo st\o\o sq @\o s a? o|.- s\ F{ f.- -oo\ 1r? Fi D- stF ri (H Q --E5.U!odEbs = o.rz \o coq o cO sf F.- CY)- OIN + @t o) D'- C{ lJ) F-{ o ct cot LN D- oI D- rJ) rJ) @o @ !'- D,-ln F t-l E c.r d ().= L=(.)f uF ti \J c) cr) \O- F{ CI$ @t "-{ n'$$ lo o\\ OI OI ro o\ c/)\o|n tr) ln co \O^ ot$U) \f6 o\o \o J.5 9<.r E E.€ 5 s H *t:E.tsEEH- o.tr ro \o \o^ @t\o F.- ro co^ @ @ @ o\t 00^ \o$ r.- @o @ F.- ro F.- f- oloI Ot Dr D- No o\o @ t'- (D C) bcG a, rD (-) oTr{{ o) ^609 Eat< Oo\d >v -o o \oq o cr) H q Ort r< s LO d o\ \oq @ o\ \oo\\q oo o\ sq 6 o\ $c $8,h B i sq co o\ (r)\ o\ o\ s tr) d Ot st\o Or \oo\ =r:\o Ot sto o\ f-l b Eg't E= EE Ez g.e 3 o$ ro (o \o D.- + t.- o ro f... oU)N o ro !.. B] Iq>E 6.22EAE H.9.;!D-o' F\J o Ot$ roo r/) CI ID F.- @\o[.* @\o Dr o 1o 0,. IE:EE.s = 3b E-o E boa 6)F ES EE3-'6 ol @\o \oN F. CIl/) r.- 6\o F- @\o D- @\oF 4 H coooN $oo ct roooN \oooN f..-oo OI @oo ol olooN ce =C, .s o H .= E o C oT' o ;(E E =E" .9 ; o = Ioood LN(o I G E(U o o '9-' CL o E2 e3F(E oo €t ;, (, EH, 9o 3,8 .EPo-f G.t ! .gIu o o r-bqs EEgro i ttt =Aog oA. v oo+ro .ETE88 'F' EEEOEgb cLo -c o: ojJ Eol.rO -lE€Iocl9d)|L-t6,(Ul .o,? -OlC'OGo)j-EE9EO+t()EE *r(U b9EE6,Ets6 'o "iFF?t -ol(El FI I 2.8. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answell MOH T WHO f] UNICEF tr - Other (please specify): NGDO N Mectizan@ delivered by - (please tick the appropiate answer) MOH tr WHO I UNICEFf] NGDO N Other (please specify): - Please describe how Mectizan@ is ordered and how it gets to the communities Mectizan@ needs for the project were obtained during the provincial appraisal meeting for last year. A workshop organised by the NOTF was then held in yaounde. This workshop was attended by the executive secretary of NOTF, the country representative of SSl, Project officers, and all OPCs. Mectizan@ needs for all the 15 projects of the country were estimated as follows: The total population of the project area was muttiplied by 3 to get the total number of . tablets needed. The quantity of Mectizan left over from the previous year was then subtracted from this total number of tablets in order to obtain the number of tablets required for the current year. Mectizan for the country is cleared from the seaport by WHO country office in yaounde. This is the handed to the NOTF secretariat who further hands the tablets to the Supporting NGDO. The NGDO then arranges for the drugs to be transported to the North West Provincial Special Fund for Health (NWPSFH) in Bamenda. The various districts then collect their needs from the fund. The heatth areas in turn collect their quantities from the district and hand them to the CDDs who now take the drugs to their communities. 32 10: Mectizan@ lnven Comment: All districts received 100% of the total number of tablets which they requested through the project office to the NWRSFH. - How are the remaining ivermectin tablets collected and where are they kept? At the level of the NWRSFH, 50,000 tablets are still in stock. Also, 207,540 tablets of Mectizan are remaining in the health dr'sfnbfs, and allfhese tablets will be sent to the NWRSFH for storage. Number of Mectizan@ tablets District B/F from 2008 Received Used Lost Wasted Expired Remaining AKO o 60,000 53,768 46 6 0 6,1 g0 BAFUT 4t9 00 85,000 74,557 o LO,624 BALI 6,000 42,OOO 47,OLL o 631 0 3sa BAMENDA 13,500 272,500 251,806 o o 0 34,194 BATIBO o 125,OOO L23,734 448 5 0 18,213 BENAKUMA 6,000 80,000 76,321 o 843 0 8,836 FUNDONG o 185,500 L77,227 945 170 0 7,L64 KUMBO EAST 0 250,000 t97,627 o 301 0 52,O72 KUMBO WEST 0 176,778 o 241 0200,000 10,433 MBENGWI 5,000 75,000 76,599 o 50 0 IT,267 NDOP 10,000 200,ooo 19,090 o 104 0 9,1 69 NDU o 146,000 39,355 46 0 0 1,145 NJIKWA 5,000 35,000 37,470 o 0 0 2,530 NKAMBE 20,000 150,OOO 162,357 o o 0 7,642 NWA o 72,798 71,587 L25 o 0 1,O94 SANTA 0 I l9,OOO 101,352 63 o 0 7,L59 TUBAH o 85,OOO 86,340 20o 0 0 5,960 WUM 180,000 166,500 o0 0 0 13,500 TOTAL 65,5OO 2,362,799 Lrg3g,473 L,873 2,77O o 2O7,54O 33 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9 - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Health personnel collect the drugs from the NWPSFH to the heatth districts and the health areas. They then supply the drugs to the CDDs following their needs. They are also responsible for inventory and storage of the drugs at th6'health districts and health areas. - 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. lf so, When? A training workshop of District teams and Chiefs of 14 health areas selected from 3 health districts (Santa, Bafut, and Mbengwi) , funded by the Ministry of Health and conducted by Sight Savers lnternational- Cameroon, our NGDO was conducted in August 2009. After this training, these health areas were provided with funds to carry out CSM which they did. ln addition other health areas in the project area which were not involved in the training also carried out CSM. We are therefore recommending that additional funds be rnade available from APOC and Sight savers so that training on CSM can be extended to other health areas in other to improve on the quality of this activity. 34 PROJECT ANNUAL REPORT,28 DEC,2OO9 ITable 11: Community self-monitoring and Stakeholders Meeting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. District Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (csrt[) No of Communities that conducted stakeholders meeting(SIilQ (health arrce/Health district appreisal meetings) Hyper/mes o Hypo Hyper /meso Hvp o AKO 45 o 45 o 5 BAFUT 48 6 29 0 13 BALI 40 0 42 0 6 BAMENDA 31 6t 36 61 t7 BATIBO 86 0 86 o 86 BENAKUMA 26 0 11 0 11 FUNDONG 6r 0 24 o r2 KUMBO EAST 33 65 0 o 8 KUMBO WEST 43 66 43 0 9 MBENGWI 58 20 58 20 T4 NDOP 24 72 24 o L4 NDU 15 50 15 0 5 NWA 11 2L 11 o 5 NJIKWA 27 0 27 o 6 NKAMBE 54 52 49 22 1l SANTA 33 t4 20 1 9 TUBAH 36 0 36 o 10 WUM 97 1 79 0 79 TOTAL 768 424 635 LO4 3t2 35 NWCDTI PROJECT ANNUAL REPORT. N Drc,,2dN 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy Commu Level -CDDs -Dialogue Structure members -Community members Centrol Level -APOC -NOTF -NGDOS (SS! -Provincial Delegate -Provincial Chief of Service of Community Health -Oncho Project Coordinator -Finance Officer Provinciol Level -DMO -CBH -CBAF -CMO District Hospital t LevelHeolth Di Heolth Area Level -Chiefs of Health Centres 36 NWCDN PROJECT ANNUAL REPORT, 28 DEC, 2UI9 2.9.2. What were the main issues identified during supervision? Some of the problems identified during Regional and Health District supervision included the following ; ) Late start of distribution of Mectizan in all health districts but_most especially in the Kumbo East Health District. F Lack of functional motorcycles in a majority of health areas ) lnsufficient training of health staff for CDTI implementation ) Delay in the fonnrarding of technical reports and financial justifications 2.9.3. Was a supervision checklist used? Yes this was used at all levels 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 2.9.5. Was feedback given to the person or groups supervised? After each sqpervision visit, a feedback meeting was carried out during which a problem-solving plan was established. 2.9.5. How was the feedback used to improve the overall performance of the project? The therapeutic coverage rate increased from 71.4% in 2008 to74% in 2009 37 NWCDTI PROJECT ANNUAL REPORT,2E Drc,20i/.9 Source Type of Equipment APOC MOH DISTRICT ILGA NGDO Others No. Condi tion No Condi tion No Condi tion No Condi tion No Condi tion 1. Vehicle 1 F aJ F 9 F I wo I wo 2.Motor cycle(s) T6 F 23 F l0 F 7 CNFR l5 CNFR 2 wo 3. Computer(s) 1 F 18 F 4 F I F 4. Printer(s) 1 F l8 F 4 F I F 5. Photocopier (s) 1 F aJ F 3 F 4 wo 6. Fax Machine(s) I F 7 . Over Head projector I F 8. Flip chart stand 3 F b) beds 3 F c) SECTION 3: SUPPORT TO CDTI 3.1. Equipment Table 12: Status of equipment (P/ease add more rows if necessary) "Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written off). - How does the project intend to maintain and replace existing equipment and other materials? Duing this year, maintenance of CDTI capital equipment was done with funds from the Ministry of Health which were inadequate. ln the APOC approved budget for 2009, it was mentioned that separate funds were going to be made available for vehicle maintenance, but up till now this has not been done. ln addition a new vehicle has been requested in the 2010 annual work plan, in order to replace the old project vehicle. This would certainly facilitate the implementation of project activities like HSAM, superuision and monitoing for side effects. 38 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9 3.2. Financia! contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years lf there are problems with release of counterpart funds, how were they addressed? No problems for now Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity lndicate in table 14, the amount expended during the repofting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndictate exchange rate used here Contributor Year 3 (2006) Year 4 (2007) Year 5 (2008) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (tJSS) TOTAL Cash Released (us$) TOTAL Cash Budgeted 1us$) TOT AL Cash Rele ased (us$ ) MOH (Central + ProvinciaUState) MOH (District/LcA) LocalNGDOG) ( if any) NGDO partner(s) Others a) b) Communities APOC Trust Fund TOTAL 39 NWCDTI PROJECT ANNUAL REPORT.2E DEC,200E Table 14: lndicate how much the project spent for each activity listed below duing the reporting period Any comments or explanations? Activify Expenditur e ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Offiqgtquipment (e.g. computers, printers etc) Others TOTAL Total number of persons treated , 40 NWCDN PROJECT ANNUAL REPORT,28 DEC, 2OO9 SECTION 4: SUSTAINABILITY OF CDTI 4.1. lnternal; independent participatory monitoring; Evaluation -A.1.1 Was Monitoring/evaluation carried out during the reporting period?(Tick any of the following which are applicable) _Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. 4.1.3. What were the recommendations? How have they been implemented? Mid Term sustainability evaluation of the project was done in 2008. The level of irnplementation of the recommendations is as follows a) Regional level Recommendations by Group of lndicators Level of lmplementation Planning 1.The Regional level should elaborate an overall plan with costs that contains CDTI activities A health development plan for the Region including CDTI activities have been drafted for both the distict and regional levels 2.The CDTI plan for the Regional level should contain only activities to be executed by the Regional team Ihe Regional plan containing activities only for the Regional team was elaborated and submitted with the mid-term APOC technical report for 2009 4l NWCDTI PROJECT ANNUAL REPORT,2E D&,2(N9 3 There should be a follow up The level of execution of the approved Annual Work of the execution of the approved CDTI plan Plan for 2009 was assessed during the annual regional appraisal meeting for 200g Su nitori 4.Activities should be appropriately documented and copies kept at this level for action and future reference Reports are well kept at all levets 5. There should be a documented routine system to reward well performing staffs. This has been planned for December, 2010 Financial Resources 6. Government funds should be allocated and effectively disbursed at this level for CDTI activities. The financial contrib ution of government has been increasing over the years. This year many stationeries were supplied to the regional project office by the regional Delegate for Public Health T.Staffs should document Government contribution with regards to CDTI This has been done Human Resources 8.There is an immediate need to appoint a Regional coordinator to closely follow-up on CDTI activities This was done in 2008 Trans /Other Resources 9. Staff should ensure that adequate training and HSAM materials are available for the entire Region. The Regiona IEC materials I supervisors carried along adequate to all 18 districts during the last supervision exercise 1O.Staffs should document the use of transport and other material resources at their disposal A log book for the project vehicle is available and being used 11.Staffs should continue to advocate for transport materials for the District and levels below This has been included in this 2010 plan of Action Traini HSAM a 42 PROJECT ANNUAL REPORT, S DEC, ZOO| 12.The Regional level should ensure that all stakeholders are involved in appraisal and advocacy meetinqs This was done during the 2009 annual appraisal meeting 13. HSAM activities should effectively be planned, implemented, and followed-up in an integrated and targeted manner. This was done in 2009 l4.Written report on HSAM activities have to be made to document successes Ihis has been done (see secfion on HESAM) lntegration of Support Activities 15. Staffs should have integrated written plans and reports showing that integration of activities is effective. Yet to be done Mectizan l6.lnvolve the NWRSFH in the ordering, supply and follow-up of Mectizan This was done in 2009 Coverage 17.Ensure that all communities/villages have at least 65% TCR annually HSAM was intensified this year in health districts with TCR less than 65% like Nwa and Bafut health districts b) District level Recommendations by Group of lndicators Planning 1. Staffs should make their own situation analysis and elaborate their plan based on it. District sustainability plans were done 2. Staff should include costs on their yearly activity plans Annual costed pla.ns were elaborated 3. There should be a follow up of the execution of the approved plan. Follow up of plans done in most districts Su pervision/Mon itori ng 4. Staffs should have integrated plans for supervision written out Some districts have integrated plans of supervision 5. Staffs should ensure that activities are documented and copies are kept at their own level for action and future reference Activities and Supervision reports of the district are available 43 NWCDN PROJECT ANNUAL REPORT,z8 DEC,2009 t Financial Resources 6. Once the approved budget from external sources is made available, staffs should look for ways to bridge the gaps between money expected and money approved Some kind of contribution was done at the HA level but amounts not clear. Nothing came from the Councils and the NWRSFH -7. Staffs should document Government contribution with regards to CDTI Government motivated CDDs in 2009 and documents signed by beneficiaries available Human Resources 8. DHT should put in place a routine documented system to reward well performing staffs Pending Transport /Other material resources 9. Staffs should document the use of transport and other material resources at their disposal. lnventory of transport and justification of funds for fuel done but used of log book not effective at the District and HA level 10. Staffs should continue to advocate for transport materials for the District and levels below Has been considered in the 2010 CDTI annual work plan HSAMffraining 11. Staff should organise targeted training that is train only those in need and/or only on relevant subjects. Was done in sorne districts but other carried out routine training. 12. Staffs should effectively plan, implement, follow-up and make written report on HSAM activities. Done but not properly documented and reported. 13. Written report on HSAM activities have to be made to document successes Not documented 14. Staff should ensure that appropriate and adequate training and HSAM materials are available for the entire health district. Activity done but with inadequate HSAM material INTEGRATION OF SUPPORT ACTIVITIES 15. Staffs should have integrated written plans and reports showing that integration of activities are effective. Not effective in most districts. No integrated checklists Mectizan 16. Staffs should set up a stock forms for stock control. Stock managernent cards and registers available and used in all districts Coverage 17. Staff and all stakeholders should ensure that all communities/villages have at least 65% TCR annually Done in all Meso and hyper endemic communities of all health districts. a t 44 NWCDN PROJECT ANNUAL REPORT, A DEC,2OO9 c) Health Area level Recommendations by Group of lndicators Planning 1.All health center staffs should elaborate integrated work plan including CDTI, plans should include costs This was done for all health areas' lntegration 2. Health center staffs should have integrated written plans and reports showing that integration of activities is effective. CDTI activities are included in integrated plans and activity reports Leadership 3. The management team at health center should fully engage in CDTI irnplementation Health centre management teams are fully engaged in CDTI implementation 4. Staff should empower community leaders so as to enable them take ownership of the programme. Community leaders are involved but not yet taking full ownership of CDTI Supervision/Monitoring 5. Health staffs should ensure that activity reports are written and copies are kept at own level for action and future reference. Done in all health districts and health areas 6. Health staffs should have integrated plans for supervision written out. Plans available but integrated check lists for supervision not available 7. Health staffs should ensure that feedback is given appropriately to the communities. Feedback given only to health committee members and in some communities that carry ou[ csvt Mectizan supply 8. Health staffs should set up a stock form for Mectizan management. Done at all levels in the health district Training /HSAM 9. The chief of centre once trained should involve all other staffs so as to insure that activities are not discontinued in case of his/her absence. Done in most lHCs 10. Health staff should organise targeted training that is train only those CDDs in need and/or only on relevant subiects. Done in some HAs but most still carry out routine refresher training of all s(aff 1 1. Health staffs should effectively plan, irnplement, follow-up, and make written reports on HSAM activities. Not properly done Financial Resources 12. Health staffs should document health centres' contribution to CDTI implementation. Documentation was limited to government motivation of CDDs and finances from NGDO 45 NWCDN PROJECT ANNUAL REPORT,2E DEC,2TN9 Coverage 13. Chiefs of centres and community leaders should ensure that all communities/villages have at least 65% TCR ann Done in all HAs and communities d) Community level ! Recommendations by Group of lndicators Planning 1.CDDs should plan and carry out distribution in close collaboration with village/quarter leaders Yes it is done 2. Community as a whole should look for local ways to facilitate CDDs work and CDDs motivation Not done in most communities Supervision/Monitoring 3. Community should engage in CSM as it will help them better understand CDTI problems and encourage ownership Done in most cornmunities but local contributions for CDDs not effective Training /HSAM 4. Community leaders and CDDs should plan to effectively educate the population Done mostly by CDDs and health committee members. Financial Resources 5. Community leaders should organise their communlties to devise means to provide funds to CDT! activities such as transport to collect Mectizan, material purshase, incentives for CDDs. Not done TransporUother material 6. Community should provide transport for the collection of Mectizan when necessary. Not done Human resources 7. Community should select CDDs suited for the job after the express concern of the individual. Done in most communities Goverage 8. CDDs and community leaders should ensure that communties/villages have at least 65% TCR annually. Done in all Meso and hyper endemic communities. t 46 NWCDTI PROJ ECT ANNUAL REPORT, 28 DEC, MOg 4.2) Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written?_l No When was the sustainability plan submitted? No What arrangements have been made to susfarn CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Three year sustainability plans for all levels are currently being implemented 4.2.2. Funds Government funds were disbursed directly into the project at district and health area levels. Also an integrated plan of action including CDTI activities amongst those of other . health programs was elaborated. This was done at the district level through the elaboration of the health district development plans and will consequently lead to integration of funding for the various health programs into a common basket. 4.2.3 Transport(replacementand maintenance) There is an urgent need for APOC to replace the project vehicle 4.2.4. Other resources Training of CDTI project staff on resource mobilization was carried out in March, 2009. 4.2.5. To what extent has the plan been implemented All activities planned for 2009 were realised. 4.3. lntegration See funds in 4.2.2 Outline the extent of integration of CDtl into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms Mectizan@ tablets are stored and managed by the NWPSFH along side other essential drugs in the region. 47 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2@9 4.3.2. Training Training for CDTI is done along side that of primary eye care and some times other programmes like Malaria and EPl. However training for most programmes cannot be integrated into that of CDTI as activity calendars are different for each programme. 4.3.3. Joint supervision and monitoring with other programs This is done especially when the activities take place at the same time. At the moment there is an integrated provincial supervision of all health programmes, including CDTI going on. 4.3.4. Release of funds for project activities Funds for project activities are released separately. Each project releases and manages its funds differently. 4.3.5. ls CDTI included in the PHC budget? It is not yet included in the MoH budget. 4.3.6. Describe other health programmes that are using the CDT! structure and how this was achieved. What have been the achievements? Other programmes using CDTI structure include . EPt . Malaria program . TB program . HIV/AIDS program CDDs also serve as social Mobilisers in EPl, community relay agents in the Malaria, TB and HIV/AIDS programs. This has led to the integration of the activities of these programs and hence a reduction in the cost of their implementation. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research has been carried out in the project area since the lunching of the project. The is an urgent need to train the Regional onchocerciasis project coordinator on operational research methodology (linear programming, etc.), to improve on the sustainability of the project. 4.4.2. How were the results applied in the project? 48 PROJECT ANNUAL 28 DEC,2009 t aSECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES - List the strengths and weaknesses of CDTI implementation process. Stren gths/Achievements 1) High acceptance of the Program 2) Adequate availability of Mectizan - - 3) lntegration of the program into other health programs 4) Active communi$ participation. 5) High level commitment of stake holders within the Region to ensure sustainability. 6) Payment of CDD motivation for 2007 Weaknesses 1) Eighteen Communities of Furu-Awa yet to be covered by the program 2) Late start of distribution of Mectizan in 2009 especially in the Kumbo East Health District 3) Limited means of transport like vehicles and motor-bikes 4) Late reporting of CDTI activities by the health districts Opportunities 1) Communities well structured to allow for effective cornmunity participation 2) Good community accePtance Recommendation APOC funds should be disbursed at the beginning of each round of distribution and mectizan tablets should be sent early enough in order to permit an early start of CDTI activities planned for 2010. - Lisf the chatlenges and indicate how they were addressed. a CHALLENGES HOW THEY WERE ADDRESSED 1. Furu-Awa health area not yet covered because of poor accessibility and co- endemicity of Onchocerca volvulus with Loa loa - Funds have been secured to carry out distribution of mectizan in Furu-Awa during the months of January and February, 2010 49 NWCDTI PROJECT ANNUAL REPORT,28 DEC.2OO9 SECTTON 6: UNTQUE FEATURES OF THE PROJECT/OTHER MATTERS TheRegion is predominantly English speaking Traditional authority is highly respected: any mobilization that emanates from their end is highly acclaimed; The drug delivery mechanism is highly developed; hence the delivery of Mectizan through the NWPSFH is an asset and favorable point towards sustainability. The dialogue structures arc a major partner of this fund. The main ethnic groups in the North West province include; The Wiikurn occupies Momo, part of Mezam and part of Menchum Divisions The Tikaris occupy part of Mezam, Ngoketunjia and Bui divisions. The Wimbumsl/embas occupy part of Bui and Donga/Mantung divisions. The Aghems occupies most of Menchum division. The Koms occupy all of Boyo division The Lamnsos occupy Bui division The Fulanis are dofted all over the entire project area. It should be noted that to get to different dlvisional headquarters you must go through Bamenda the provincial headquarter which is centrally located. i a 50 NWCDTI PROJECT ANNUAL REPORT,28 DEC,2OO9