North West CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2004

IRepublic of Cameroon Ministry of Public Health Si t Savers International I NORTH WEST CDTI PR Pro iect N OJECT me:COUNTRY/NOTF: CAMEROON 2003 Launch lng vear: 2003 Appro Year: From: January 2004 Toz Decent Month/Yearonth/Year Reporting Period ber 2004 )report: (1Year of thisProi SIGHT SAVERS INTERNA NGDO partner: TIONAL2005Februa Date submr tted: ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) l{orlh}l'est fl D'[I l'l"lr.i*ct Year I 0 5 fl'jft :r'irf DEAD FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNcHocERcIASIS CONTROL (APOC)@,v WHO/APOC, 24 November 2004I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSE,ME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Cameroon National Coordinator Name: .. Signature: Date Zonal Oncho Coordinator Name Signature: Date: .. NGDO RePresentative Name Signature: Date This report has been prepared by Name: " " " Designation: Signature: Date WHO/APOC, 24 November 2004 Table of contents ACRONYMS ........... """"""""""" v DEFINITIONS......... """"""""""'vI FOLLOW UP ON TCC RECOMMENDATIONS """"' 1 EXECUTIVE SUMMARY......... ,, SECTION 1: BACKGROUND INFORMATION"""' """"""""""" 3 1.1. GpNeRaIINFoRMATIoN'......'...'. 1.1.1 Desuiption of theproject (briefly) t .1 .2. PartnershiP 1.2. PopuLeuoN..... 10 J 3 6 8 SECTION 2: IMPLEMENTATION OF CDTI"""' 2.1. TtvtplrNnoFACTIVITIES......'..'.. """' 10 2.2. Aovocecv """"""""""' 12 2,3. MosILIzeTIoN, SENSITIZATION AND HEALTH EDUCATION OFAT RISK COMMUNITIPS 12 2.4. CoNaNaLrNrrrY INVoLVEMENT.....'... ""' 14 2.5. CaPectrY BUILDING'. """ 16 2.6. TRrarlmNrs...........'.. ""' 18 2.6.t. Treatmentfigures.......... """""'18 2.6.2 What are ihJ "out"t of absenteeism? """"" """"""""' 21 2.6.3 What are the reasons-for refusals? """""""" """""""' 21 2.6.4 Brie/ty describe all kiown and verified serious adverse events (SAEs) that -.. 2l 2.6.5. Trencl if-treatntertt achieventent from CDTI project inceptiott to the current year 23 2.7. OnoeRtNc, sToRAGE AND DELIVERY oF IVERMECTIN """""""' """""""24 2,8. COVVUNITY SELF-MONITORING ANO STETEHOLDERS METTINC ......"""26 2.g. SupeRvrsloN............... """""""""""27 2.g.t. Provide a/low chart of supervisiort hierarchy' """""" 27 2.g.2. Wtat were the ruain issues iclentified during superttision? .........................""' 27 2.g.3. Was a supervision checklist used? """"""' 28 2.g.4. Wat weie the outcomes at each level of CDTI implementation sttpervision? 28 2.g.5. Was feedback given to the person or groups supervised?................................ 28 2.9.6. How was the fiedback used to improve the overall perfonnance of tlte project? 28 SECTION 3: SUPPORT TO CDTI """""""29 3.1. 3.2. J.J. 3.4. EqurunNr FININCIaT- CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES.. Orupn FoRMS oF coMMUNITY suPPoRT .........'.'... ExpgNortuRE PER ACTIVITY ......29 ......30 ......30 SECTION 4: SUSTAINABILITY OF CDTI....... 4.I. INTTRNeI-; INDEPENDENT PARTICIPATORY MONITORINC; EvalUaTlON..'... 4.1.1 Wss Monitoring/evaluation carried out during the reporting period of the following which are applicable)........,...4.1.2. Wat were the reconunendations? 4.1.3. How have they been itnplemented? ............. 4.2. SUSIINRsILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT'. Yn 3) ? (tick any 31 32 32 32 32 32 32 )Z 111 WHO/APOC, 24 November 2004 4.3 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 4.3.1 4.3.2 4.3.3 4.3.4. Planning at all relevant levels... Fwtds....... Transport (replacentent and maintenance) . Other resources To what extent has the plan been implemented INrecRertoN ............... . Ivermectin deliverY mechanisms Training.... Joint supervision and monitoring with other programs Release offitnds for project activities 4.3.5. Is CDTI included in the PHC budget? """""" 4.3.6. Describe other health programrnes that are using the CDTI stntcture and this was achieved. Wat have been the achievernents? """"""' 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OppnarIoNAL RESEARCH. 4.4 . 1 . Sumntarize in not more than one half of a page the operational research undertaken in the project area within the reporting period' 4.4.2. How were the results applied in the project? """"""' SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... """""""""' 34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS """""' 36 lv WHO/APOC, 24 November 2004 ..32 32 32 32 ...32 ...32 ... 33 ...33 ...33 aa ... JJ 1a ... JJ how ... 33 ...34 ...34 ... 34 ... 34 Acronyms APOC ATO ATrO CBAF CBH CBO CDD CDTI CMO CSM DMO LGA MOH / MoH NGDO NGO NOTF NW NWPSFH OPC PHC REA REMO SAE SHM SSI TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Chef of Bureau of Administration and Finance Chief of Bureau Health Community-B ased Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Chief Medical Officer Community Self-Monitoring District Medical Offi cer Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Northwest Northwest Provincial Special Fund for Health Onchocerciasis Project Co-ordinator Primary health care Rapid epidemiological assessment Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sight Savers lntemational Technical consultative committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities withintheprojectarea(basedonREMOandcensustaking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area' (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in *"ro/hyp".-"nd.-ic aieas that a CDTI project intends to treat with ivermectin in a given Year. (ir) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to U. t.*t.A "-r*tty in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic covera8e (normally the project should be expected to reach the UTG at the end of the 3'' Year ofthe Project). er of people treated in a given year over the total(v) (vi) (vii) (viii) (ix) population (this should be expressed as a percentage Geosraphical coverage: number of communities treated in a given year over the total number of mesJ/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' Integration: delivering additional health interventions (i.e. vitamin A supplements, uturra*t. for LF, fcreening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and emptwer communities to solve more of their health problems' This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabilitlz: CDTI activities in an area are sustainable when they continue to fr..tir, "ff*tively for the foreseeable future, with high treatment covefage' integrated into the available healthcare service, with strong community ownership' usin! resources mobilised by the community and the government' Community self-monitoring (CSM): The process bf -l[t-h the community is empowered to o.,r..r.Ilidi*itor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme isbeing executed in the way"intended. It encourages the community to take full responsibility of ivermectin iistribution and make appropriate modifications when necessary. ) vl WHO/APOC, 24 November 2004 FoLLowUPoNTGGREGoMMENDATIoNS ()sing the table below, filt in the recontmettdations of the last TCC on the project ancl describe how they have been addressed. TCC session - (Please add more rows if necessary) 1 Number of Recommendatiort in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY V/HO/APOC, 24 November 2004 Executive Summary Prepore an Executive surrrmary of the report in not more tltan one page, 1. Background on treatment and population data - Total comnuutities, contmunities treated, total population, UTG, ATO and persons treated. The Northwest CDTI project has just completed its first round of activities' The project was approved in 2003 and started in June of the same year even before APOC funding. The project area has a total censured population of 682,829 inhabitants spread ou.. u. surface area of 18,100Km2' It is made up of 14 health districts that comprise of 163 health areas. The project area has a total of 993 communities. CDTI did not take place in the whole Province. Njikwa health district, Elak Oku health area of Kumbo West and part of Wum health district were left out due to poor accessibility and the pr....." of Loa loa. The meso lhyper endemic zones that did CDTI had a censured populatio n of 648,665 inhabitants. Our treatment objective (65% of meso/hypL. poprlation) for the year as well as ultimate treatment goal (84% of mesoi iryper population) was 4Og,906 and 555,357 persons respectively' A total of 430,436persons were treated giving a therapeutic coverage rate of 66.4o/o. 2. Background on population movements' There is constant miiration to the urban towns by the youths in-search for better jobs. During iire farming season people also leave their villages and t"-poi".ily migratE to their farm housei. The province also has cattle rearers that migrate with their cattle following seasonal changes, looking for green pastures. 3. Training data t - CDDS, health workers, Total population (cornmunity) per CDD trainea' Trainings started in July 2OOg in most of the project area. These trainings were in cascade starting for the provincial level right through to the community leveI. 322 iealth workers were trained in all' A total of 2'676 cDDs were trained. The population: cDD ration was 242 persons: 1 CDD' 4. Challenges and hotu they were overcome' The following are some of the challenges encountered by the project this Year: F 1 -:r^r^r^^cr^-*I I-pl"rr,entation of the project with little funds available after massive budget cuts that APOC had made. To overcome this the following were done amongst others; a lot of sensitisation had to be made in order to convince the communities to finance the registration exercise themselves' the planned provincial launching of Mectizin@ distribution was cancelled and replaced by low-keyed distr[t launchings, Sight Savers International had to financei RBe and supplement for other activities' - To attain the treatment objective of at least 650/o of the population' This was also attaineJ through a lot of health education sensitisation and a lot ofmonitoringandsupervisionoffieldactivities. - To improve on the transport situation of the health sector of the province' A four-wheel-drive vehicle and.27 motorcycles were provided to the project bY APOC and SSI' 2 WHO/APOC, 24 Novembet 2004 SEGTION {: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Populatiort: activities, cultures, language Communication systems (roads ...) Ad m i ni s tr at i o n s t ru ctur e Health system & heatth care delivery (provide the nuntber of health posts/centers in the project area if the information is available)' Numbir of healti staff in project area and number of health staff involved in CDTI activities. A. Geographical and administrative area(s) The Northwest project area will cover the entire North West Province, which lies longitude 0" 45', and 11" 10' east and latitude 5" 35', and 7" lo' north. It is bordered in the south by the Akwaya and Mamfe health districts of the South West Province, in east by the West Province and in the north and west byTaraba State, Nigeria. It covers a surface area of 18,100 km2. It has a totai population of 682,829 inhabitants in meso and hyper endemic communities. The NW province is made up of seven administrative divisions, which are divided into 14 health districts with 163 health areas. Table i. Administrative units, Health districts and health areas 3 Divisions / Sub-divisions HealthDistricts District population Health Areas Mezam Bamenda Santa Tubah Bali Batut Bamenda 1 13683 Azire Nkwen Urban Nkwen Rural Mankon Nkwen BaPtist Mendankwe Bambui Ntamulung Alabukam Bambili Mbachongwa Ntambag Atuakom Mulang Alakuma om Keku om Santa 16714 Mbu Menka Akum Ndapang Buchi Pinyin Santa Urban A Bafut 35615 Manji Nsem Mbakong Mambu Mforya Buwe-Burari Mundum Akofunguba Mankar{gtg Bali 16729 Bali urban Gungong Bossa Bawock Catholic mission Wosing Momo Batibo Mbengwi Njikwa Ngie Widikum Batibo 44644 Batibo Guzang Tiben Laringi Kulabei Gwofon Widikum Bifang Ewai Ashong Olorunti Eka Mbengwi 30536 Andek Tezeh Abebung Njah-Etu Bome Njidom Mbengwi Ajei Nkon-Mengom Tinechung Acha-Tugi Munam Ngyen-Mbo Njikwa 12474 Njikwa Bassa Kuttin Konda Oshie Akanunku WHO/APOC, 24 November 2004 Ngoketundja Ndop Central Balikumbat Babessi Ndop 41619 Babungo Baba Bamunka urban Babessi Bangolan Bamunka rural Bamali Balikumbat Bamessing Bafanji Bambalang Mbissa-Mbaw Bamunkumbit Mighang-Mbaw Boyo Belo Njinikom Fundong Bum Fundong 94n0 Konene Mbessa Belo Mbengkas Aduk Fundong Mentang Kiktuini Anyajua Mejang Fuanantul Menchum Wum Fur-Awa Fongun Menchum ValleY Wum 103486 Furu-Awa Bawuru Benakuma Kumfutu Befang Ise Abar Esu St Martin Modele Bafmen Bu Yemge Weh Beba-Batomo WumUrban Bui Kumbo Jakrri Oklr Mbiame Noni Kumbo East 25541 Mbah Wasi Ber Vekovi Mbam Kwanso Mbokam Tatum Mbiame Shisong Jakiri Sop Mbonso Wvem Kumbo West 66641 Kumbo Elak-Oku Jikijem Kikaikom Melim BBH Djottin Ke"u Nkum Kov Nkor NgePtang Buh* Simon Kov Kuvlu Ichim Donga & Mantung Nkambe Central Ako Ndu Nwa Misaje Nkambe 53358 Nkambe urban Fonfuka Dumbu Kom Misaje Binka Kuta Lus Berabe Ako Tabenken Buabua Mbot Ndu 27619 Luh Ntumbaw Ngu Ndu Gom Nwa CBC Mangu Ntem Ntong CTE 682829 The 163 Health areas have been divided into 993 zones (communities) for better management. B. TopograPhY, climate, access The bio climatic zone of the Northwest province is mainly Sudan savannah grassland, with plains, rolling / steep hills and valleys' It makes up most of the W""i.." friihlands and G'orr. of the minor watersheds contributing to both the Niger and Atlantic basins' These valleys form beds for swift running sireams Jspecially in the rainy season, which are dispersed through out the prlui"... the riveis beds are fiequently rocky and sometime interrupted by fatts atl contributing to highly aerated waters which make a gooJ frauitat ior Simulium, the vector of onchocerca uouulus. The rains begin in March and are very heavy in August through october' followed by a short dry season. Th; road;, mainly dirt roads become impracticaUfe auii"g tfri" period. Farming is year round, rnaize groundnuts ,-.glt"Ut.s and beais are planted all through the year, in swampy areas during the dry season and in the main land in March and August' These are harvested three to four month later. The intensity of farming is low or 4 WHO/APOC, 24 November 2004 moderate only during the months of December and January' The men farm the cash crops while the *omen farm the foodstuff' Of the 32gt km of road network in the province only 187 km are tarred the rest is made of dirt road, which becomei impassable during heavy rains in the months of August through October. Some of the villages are only accessible bY trekking. The people of the Northwest Provinc e are mainly dispersed living in family groups surrounded by their farmland, scattered throughout the area' Among tfr"ttt are Fulani cattle rearers who are nomads' 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. The communities of the Northwest province have retained the hierarchical structures of old. The chiefdo-" ".e still existent and highty respected' Each clan I family has a family I clan head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the community. The main occupation in the rural communities is farming, animal rearing and petty trade. Most communities have a week of 8 days and the Sft day is observed as the traditional Sunday. In most communities this is the market day. Everybody is in the village on that day since no one goes to the farm. Also the dry "...on is reserved for funeral celebrations and other traditional feasts. Table : Number of health staff involved in CDTI 5 WHO/APOC, 24 November 2004 Number of health staff involved in CDTI activities. Percentage Bs,=Bzl Br *1OO Number of health staff lnvolved in CDTI BzB Total Number of health staff in the entire project area Health District 38o/o1539BAFUT 5lo/o1835BALI 24o/o34139BAMENDA 35o/o257tBATIBO 7%36524FUNDONG 32%t237KUMBO EAST l4o/o50358KUMBO WEST 39%287tMBENGWI 32o/o2063NDOP 48%l429NDU 0022NJIKWA 43%2l49NKAMBE 62%1829SANTA 45%2453WUM lO%o549Provincial dele J 2L.Lo/o3.20681TOTAL 1.1.2. PartnershiP * The provincia-l ielegation has hea-lth staff that do not fall under any health area. These health staff some of these heatth staff are involved in cDTi and other health Prograrnmes' - Inclicate tlte partners irnolvecl in project implementation at all levels [MoH, NGDOs (rtatiotrul/itttenrutional), communities, local organizations, etc.J - Describe overall *oriing relationship among partners, clearly indicating specific areas of p,ojecr activitiei (planning,iupertision, advocacy, planning, mobilization' etc) where all partners are involved' - State plans, 'rf ony, to ntobilize the state/region/c{istrict/LGA decision-makers' NGDOs,NGOs,CBOs,toassistinCDTIimplementatiott' Partners involved in the implementation of Northwest GDTI Project are the Government of cameroon liainistry of Public Health [MoH]), the African programme for onchocerciasis control (APOC), Sight savers International (SSI) and the Community. These partners all work together for the smooth running of Project activities' planning was done with the full participation of the MoH, SSI and the community.Thecommunity,sopi.,io',*assoughtonprogramm.ing activities. These dates wers however changed when the various health areas delayed in condu"ii.rg REA and registratiot . National Immunization Days (NIDs) against poiio-"y"1itis that *2.. not originally planned for also affected the dates originally agreed upon for CDTl'ttiuiti"i' These partners together carried out mobilisat[n. Helttn education was mostly done by the health staff. 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C) -o 0) o z$ an d H a) CAEO ,, G) Es Et= f,:$ EsT EEN qE$ EBH EHE Huo-e I:.8 € .Hq oE# bg3 HEs, X .sE qHF .g:fE S;* :H.HVPe(DJnr./)Os 3E iri 4\ b d tr-c o -iJT H3 818 ES 8rP 9(u 'cE dr tPq = .i be or6E b( iflr-' f 83 3 ^ EilE ;gg SN b3E B;e q=i iEE E.tE g 'X, .! cs o 9 0A ($ EEil EJe E: I:! b.5r E .{ !Zr-._ ,g'E $ € I:ts EEE +" * a$s Itas ;: B.Ee ;3E.3 ;E S IbA Egsg:E; 3ao ;-EaE E: S rst EE;E X*t < i I € o, rt -r cl: ;Ei EHgi E! i ao.9 E,.!* e'i .g;st ;uEE sE S #I* ;Zst eE3 b-,-3 E8hry E3i EE; =Hgg f,it gHf, s ;BH #EEE €? v q) \o'r. q) ? $) sq) > q F! qj bo B \ o o(J q) qj q o() > q) \ \J bo \ o U s a) a,) bo hi Ss -9!. \.)p'5A,y r\. \ 4 uq) o'\ A. U L .o o : Sr.SP h\ .:a \-o' o' \ll Iq.rg I *E-\l!\l si^ I '= -' I\ul 'E\l >El;t I$: IL\IBu o, .eN zE{TS -EB sP xt L\$!, 6\q, o 8t N.QrNh. H^: EL-V -'P:s bsx a.si bo FU S*b.Bs xvN3 $(Jr s- rr I . U \P-t \ :: bo -. qJ 'F *'& \:!! ^sYL\ ,\:r Pb- =vrS \XB\ sh .x-\.s y E!\ =AJ*:bod\ .EL\ P^\\si \iUA qr] \ -s.Y q ?\ qsh Ery QqlAJR Iis v){: .5 !\ B9t' E ild l\B\q) SEGTION 2: lmPlementation of CDTI 2./1. Timeline of activities Fitt in table 3, tinteline of activities for areas treated in current year, indicating when the key activities were implerr",it"d by the month they began and the month they ended' As shown on table 3 below, activities all started in February 2oo3 while still waiting for funding from APOC. Activities started with advocacy visits to administrative and traditionaiauthorities of the province. This was then followed by community mobilisation. During this peiiod NGDO (sight savers International) staff visited all the referral hospitals in Ihe province to access what equipment was available for the eventual management of side effects. Trainings then started in July and went on right to December 2003. These trainings consisted of the following; training of the stafiof the provincial delegation, training of district medical officers and chiefJ of bureau health of all health districts, training of the district and provincial finance officers, trainings of doctors and nurses of referral hospitals, training of laboratory technicians on the calibrated smear for diagnosis of Loa loa, training of health centre nurses and training of cDDs. As can be imagined these trainings took place at different levels (provincial delegation of health, health district servi&s, health centres and within the communities)' community mobilisation was an ongoing activity. It went on right through Mectizan@ distribution itself and even after. It-was done by the health staff, the community members themselves (CDDs) and the NGDO stalf. During and even after Mectizan@ distribution community mobilisation was geared more towards the early detection and *"ru.g.-ent of side efiects, especially aftei the first case of severe side effects occurred in Fundong health district' Mectizan@ distribution was postponed. thrice. It was originally scheduled for october 2OO3. Registration lcensus)^andREA was not completed so it.was pushed to November. Still registration was not complete. The new distribution date was January 2OO4. Thi"s time national immunisation days against poliomyelitis which were not planned for came up, further pushin gMectizan@ distribution to February 2OO4. This distribution went on till .r.ily April when the stock of Mectizan@ 1f ,SOO,OO0 tablets) got finished. A suppiementary stock of 300,000 tablets was sent by MDp and distribution resumed in iune. This distribution continued till Late July 2OO4 in some health districts' supervision was done for each rever of activities; from community mobilization right through Mectrzan@ distribution and appraisal meetings. Every level above supervised the level directlY below it. 10 WHO/APOC, 24 November 2004 <- N Ho -o Eo o z dN O o Fi -+ ts C') oo Sr oH .og op O () o p ! a (g >' c)!li o oo U)tro Ftr ti5 '=a o\9otr ACB =N y 0.) >\a -o oo+ic aa trIJdA (g0) >-c 9>. aPtrOo!O(! a* Qa L() a1 €or -trJi C) ()ca -i o)()(g PO-(HA o) ad !lotr!cs;a (n q) oU I B a)e \J \) * \\J B\) q B\) B \){ ?) a) '= :i \3 S. t\ ..i r a)l _ol cdlFI rn Lq) a o{E =9 (J $o a =q = $O o :,(,): $o o =o) = $O U' f o)f $ooN o $ooN = -) sfooN oca -) $o o f o)f $o o =of $o U' =of $o o =o)f so U) fo = $O o =O) = P.c 1itr d:J;tr cf)O = -) cf)o o (ao o (a o o (f)o = - (f)o .> a - Cf)O ->a - (9o o COO o cf)o (-) o (f) O o COo o (f) O o o U) ox L o o: =L =o(, $OON o)Cf -) soo N f -) $ooN = - $oON -> = - sfooN rfOON q) c =-) sOON c)C = -) slooN = -) .c.9soo >R $OoN o- $ooN -> = -) $oON > = -) sfOON .> f -) b!_tr+ .ti E 6= $OoN -oo TL $ooN -o o) Lr $ooN o o)Ll $oON -o c) LL $ooN -oq) IL sOoN -o o) LL sooN -o c)tt sooN -o o) Lr soON -o o) LL $ooN ! 0) LL sloON -oq) I,L sooN -oo TL $OoN o €) LL q,) c, p tt) (o q) U o =o(, sfooN o)c ='a sooN .- = -) sooN ) - $oO N f -) sfooN ! o) LL (Y)ooN o)c f -) sfooN o)c f -) $ooN :, - sooN o sooN Lo $OON o)C = -) $OoN .> = -) $oON = -) b!- Efi '!i tr d= a- C9ooN o oa (f)oON o oa cf)ooN o 0)a cf)ooN o- o @ (f)ooN o) = (o OON o. o)a (Y) OoN of (f)ooN o 0)a (Y)ooN o (eooN o) f (a oaN o- oa (o OON o- oa (o OON oq) a ar cl F =9,oI $ooN -o0) LL (9ooN oq) o (oooN oq) o COoON() oo $ooN ! 0) LL $OoN C o -) sooN o (f) OoN oq) o $ooN C o - (aoON o o)o cf)OON oq) o COooN oq) o cf)oON o 0) o 3^c (f)ooN o o COoo N f, -) (oooN ->f -) CEOo N f -) (oooN -> = -) (ooON -> = -) (o oON .> f -) (ooON -> = - (oooN = -) (f)aoN o o (a Oo N f -) COOON = -) d)OON -> = -) tQ) iJtr s= -atrooFr92 o *E =9o Q sooN = -) sooN -> = -) sooN ->l -) $ooN .> f .c.ot(E)< AN $ooN ->a -) sfOoN -> = -) $ooN = - $ooN = -) $OoN o $ooN ->a - $oo N f -) slOoN .> f -) oD-Er Ptr 6Y a- (o ooN oc a - (o oON o (o ooN o (o oON o cf)oON = - cf)oON o) f, (o oON o o) TL COooN o CAoON o ct)ooN 0,f (OooN o cf)ooN o (r)ooN o I tr cn 6gq) F A ca '] cq l-1Z E] ca o Fq F. pa (, zo R zD tu Fa rI] o Eq ZFr v F CN rI] B oa aD v ts rP1 z E] EA A Ao IJz a z ts M h z E] ca a M z 3 z a Ap Njikwa is a very enclaved health district. Most of the communities in the district can orrty u. ^"..""id by trekking. No GDTI activities were carried out there this year. The plair was that afteitreatment in the other 13 health areas of the health districts .."orr.." would all be centred on Njikwa; the whole provincial and NGDO teams were to be totally deptoyed to the health di"t.i.t and treatment as well as monitoring of side effects done jointly. This however did not work because of the unexpected sessions of poliomyelitis immu nization campaign that took place shifting the distribution period in the rest of the health district" "rrE, beyond the year of the project area. We hope that in the second year things would be smoother and treatment would take place in this health district. 2.2. AdvocacY State tlte nyntber of policy/decisiort makers mobilized at each relevant level during the current year; the reoron$) ior unclertaking the advocacy and the outcome. Describe "clfficulties/consti:raints beingfacecl and suggestions on how to improve advocacy' In April of 2003 an advocacy visit was made by the NGDO staff to the provincial l delegate of health for the prtvince. Discussion on the program and plans toward the starting of the proiect *.- made during a meeting that including the whole team of the provincial delegation. This being the first year of GDTI activities in the Northwest province, an advocacy visit to the Governor of t"he province was arso pranned. This visit also took place in-April 2oo3. It involved the sSI country representative and the provincial delegate of health meeting the governor and educatingii.., o, the whole programme. The governor had already been informed about the Cifl project and how it had succeeded of other provinces of the country. He was in aciordance of the fact that registration as well as ihe other activities of the programme be carried out in the province' In March 2oo4 the west Africa Regional Director of Sight savers International also made an advocacy visit to the prorTincial delegate of health for the province and the rocal administrative head of rubah (Bamenda rredtrr district). This visit took the Regional directoi rrght to one of the referral hospital treating the cases of severe adverse events the 6ccurred. He also visited treattfr staff and communities in Bamenda and Ndop health districts' prior to the commencement of cDTI activities within each health district, there was an advocacy visit of the district medicat hearth team to the local administrative head. This local administrative head was a Senior Divisionar officer, a Divisional officer or a District Head. Viff"g. chiefs a.rd luarter heads were also seen' These administrative heads and traditional rulers were "ll .dr."ted on programme' They were given brochures and fliers on Onchocerciasis control through CDTI' t2 WHO/APOC, 24 Novembet 2004 2.3. Mobilization, sensitization and health education of at risk communii Provide information on The use of media and/or other local systems to dissentirtate inforntatiort , Mobilizaiion and health education of comntunities including women and minorities Respons e of target communities/villages Accomplishments Suggeit ways to improve mobilization and sensitization of the target communities' Journalists of the Northwest provincial Radio Station of the Cameroon radio television in Bamenda as well as those of the private radio stations were trained on the type of messages that needed to go on the air. These journalists consisted of those producing and pr-esenting English, French, Pidgin English and vernacular languages. Within the health areas the health personnel targeted social, cultural and reiigious groups for health education. Some of these groups were women and youth groups' When ever people were called for health education within the communities, the response was not always satisfactory. Very few people usually turned up' This poor response was noted most in large heterogeneous communities. In future the village chiefs and not health personnel should be made to summon such meetings. Dialogue structures members and trained social mobilisers used for EPI should also be used more. In some health districts, the health district staff, particularly the DMO was not very implicated. Their full implication will give more weight to the programme as they have greater regard within the communities than the health centre staff. 13 WHO/APOC, 24 November 2004 a.l H() .otr 0.) z t a.l O \J H sf I I o sots@(f) s(o (f) so Isro@ sN(o s @$ sO(o st- o, s F-(a s O) ro o UD CI o o Iil so ro o @N I I oo) t- o Ico cf)N O)N(o@ Ncf) oco(oN |r)N bo -1=r) z = -H L O-9'r= {:,/ ==i a l.Q) oN co o F.oloN o @ CY) (Y) f.-cv)(o Nco roNr o)@ r o .f, N F* F*N $rN F*$ F-@ NNN CI F I o F{t$ o o$ INlo N 1r)NNco @(o I co$roN f-@ 2o Orl @$ t o t I ooo o @F-N o)@ r r r 1.-lr) r N f.- IO) O) N(o roco U o z o c) I o o z oo o oo o oo oo o oo o oo o oo cl o o il ca * oo o oo o oo oo oo o oo o -9 q =E:; E.EL:I Ft= a=d o o [.-o\o LON N(oN F-$ o@o(o sNoN t-cf)O)@ f.-@ roNLO N$ O6EO 2aQ frCo E€OEoO c! o o oo cl o Lo z FT F o F. o d boo C)Atol-rA H Fq g z F. z a D aZ BV f- z E(, z rrl cq Ao l-l z zo t-l z t! F.a H ca z Dg FaH B o ezD V azH cq o F. m 3 H cq J Fq cgo n! U \) .it c) F q a) ,a xl -ol(tt FI +. E o E oI o .5 E E =E E o o {N $OON C) -o o o z$N O L' ta) O t4 +J H bo J(li a H oatr O * ov C) +J (H ; o +J Cd bo o Cd O o t<o o *9H(*F O /'\ HO -Scao ouo €.sit-7tH3 9E 'r ojJ l- Vr1!/ aa)IJ. .r >H.!) at ;i'o -5 ^{ ^0)V( a a:d ds h 90 .6 FaE 9aO C)(H .ltrl.L' E', gS .F! \J ^Li)+) -l! =+JC[H(U!.t oCL J-r vV.HO O! .i(U(g tbo .O l.J a\ -d iic)t ,-E o o?b0 '.5 .x(U'-1U -fiF vH;r fi.H \VA -v9dL >H^A - l-ar a){-) o o o +J od a cd B o o n O lH a 0) Xoa O a4 +J dH o o +-Jd aP O tr +Ja :) d o t4 a4F B Cd dl-)t4 da lff o o o bo.9 AL -: (.) iF > -.: -1 L8.9 o)x a=o! ^oad0)tr .:h +JLq5(!ri ,trtrEh5oo li ar -rdUc.9Eo'oO E'E >(E+Jcoa .:EE L O-COJ +J>-c= O-1 0)t<OaiO O-Bs;(, t-1 tut PCI o';. * uoPHrHb.H IETE odoootr PH d.a XH(UHl*u a< ti iJtr (!';. ^+JC -c +-i x ?dv e.3€ ,^o)d 5€.3Eyr !IJ.E -OQts E aaO o'ij -q.o IOEi -c (g.= ." c o..r:o> iJ +, O;aiOqi:cd l-r !)o o_cur'to 9Ey,d Bar{ G) dcd 8E -oe a, .io a> '= c)tc 8B .1 Ltrc) ^lli c)cu> aE b0fa !U 9's H+J -C)Lrio'" 'rl o(E +J oA -roEtsOO ..! P4 -i!gE a)Y cogEs d *'.= -Y(JdHdLo.9o? $H e .i;a H.r(g .-- >a9.q'6 c cd.c qEPF "E .9 8.$rE C)g HEeE 8.a6u o-o 'E 9-q 'ao-^ 'dtrbo n -h€ -1 ;C) EUH# l-iI 8o€Pot) .alA O dnO R R9 EFb !EH qt U ! ! q) ! V')q) U1q U .*i s !J \,)t\ h a,) qq n\ E-i aU AD > la bo i $N.SN \'6 Uk"s sw\ R L A \ $vca E!-\. .Pb G Bh u;(Jtqj *N !e]Hus -\)\e(\- 'Ss!. Ust $ *S TB.S z, \ sB 3+Sx QIS': $t.s= "\F!hs\)\L$):! eEt S-{3 XhN.!'E 3VEV :nS s S sN*soso -v ^\ 'i ilh srsSS !Sa:>.vq, Q t -a'{.E lqrN .Nrrtx .ll r \'I Xb.€ i Ru.I *:'S >h I s s s R,s s aEES!NEbRTSS$iF S \ '\ 5.{ r i-> .o\Jrrrrt 2.5. GapacitY building - Describe tlte acleqttacy of available knowledgeable manpower at all levels. - Were frequent transfers of trained staff occur, state what the project is doing, or intencls to do, to remedy the situation. (The most important issue to describe is what measures were taken lo ensure adeqtiate CDTI implementation where nol enough knowledgeable manpower was available or if staff arefi'bquently transferyed during the course of the campaign)' As mentioned on table 3 above trainings started in July 2OO3 in most of the health districts and went on right through May 2OO4 in some health districts. prior to trainings at th" diff..ent health districts, all the district teams and the provincial team were all by the staff from the NGDO, NOTF secretariat and MDP/Centre Pasteur. This training took place at the provincial delegation of health in Bamenda' The different health districts then proceeded with trainings within their different areas with the level above training just the level below it. This being the first year of activities the NGDO staff co-facilitated the trainings at district levels. cDD trainings at health area level were co-facilitated by both the health area nurses and ihe health district staff. In some districts like Ndop however, the health district carried out cDD trainings in the presence of the health area staff. This was in order pass on the same information down to the cDDs. It was also considered as part of the training of the health area nurses, as the district thought the health area nurses were not capable enough to train the CDDs by themselves' As you will notice on table 5 below, only the column of "new" is filled' This is because this is a new project and all trainees are being trained for the first time. Due to the vastness of the health areas and remoteness of most of the rural communities of the Northwest Province, and we planned and budgeted for the training of 2 nurses per health centre (health area)' Most of the health centre nurses are just .rr.". aids and training more than one per health centre is good "" tfr.y will complement one another during CDD training and otherprojectactivitieswithintheirhealthareas. To the tables 4 and,S, we added a row to in pick up data of the staff of the provincial delegation, who do not fall under any health district' This consists of persons like provincial delegate himself, the provincial chief of service of commurrity rr.u1th, the provilcial chief of service of administration and finan.., trr" f.ouincial .tri"r of seruice of pharm acy, an ophthalmologist' the GTZr.pr"".rtative, the person in charge of health information management system, and four project co-ordinators' t6 WHO/APOC, 24 November 2003 (\I \o @ (-) €(t O carr o (') r- (\l ra(f) .I ra ra c.l ra (\I rn O t t r-r*t\ rrrr6I t N t (\I ta\o ra rat\ l,aN \o ra(\r \o rn6t tN !f, N 6lr- t\tt* r-a r- € -9 ;il 6l F- a\ q) () o I \v € N rn ra \o rn ra r-r- o\ o\vt ra\o \o\orn N r-r-N o o\6lF- t € ia N o cl q) (, o q) z 6 € a ao o o ltI QF U -:\ 3 = \o ?a (v) ?a () 0) q) (J v\oo q) o .=c6t- LF G) 'ti (t) .oE L9{ o) 4.,! z F OrN(\l o\(\l(\I\o e ia [n 6l 6t o\ o\ N 6l a a ra c.l ta N r- r- s'q = ?rrE.T N N Ar o\ \ot\I \o N (v)\o in $ : () c) q) I \E?v o\ \ora ?a N \ot vo € \o rr 0) d cg 0 U) G q,) 6) z [aa raa (a ca r- r-. \o \o @ € F- F- s t r- o F- \o in ra $ s a € F- F- F- r- lt QF .L n< z \o w € \o \o \o\o \o \o \o \o\o \o \o \o c! 0 tt) I o l-l E, oL c) z U \o c! o ti q) () () o N o 3 z a !ra cn ooq) q) o Lr z D a z V l,? Z ri !ra vZ rh Z o Z tu 3a Ii !rZ D v t'{0 F] FE\rfap v I z ri Fa '.] FE n z rittla o 3 9 o 6l 0) F)tr FA cl k() -o () z$ c.l OUA o r- M o -a o o I p I o bO o p o \ o\ \i o FiI o \) AJ \)s B \ +- :. l z ; (.) C6F r- r- 6lN (\t(\l o\ o\ (, + Q I + I (, U Q Q + U U U Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (Journalists) Program management ,/ ./ How to conduct Health education Management of SAEs CSM ',/ ./ SHM ./ ./ Data collection ar/ ',/ Data analysis ./ J Report writing ./ J Others (Mectizan@ distribution) J Program management / ^t cotnments Trainings were targeted; persons were trained depending on what is expected of them as far as cbtl implementation was concerned' Health workers who are actually directing the programme received the most detailed training as can be seen from the table. Also there were no community supervisors' who supervised CDTI activities were health 2.6. Treatments In all the health districts those staff 2.6,1. Treatment figures - If the project is not achieving t 00% geographical coverage and a minimum of 650% therapeutic coverage or the ,oinrrg, rate is /luctuating' state the reasons ancl the plans being made to remedy this' This is the first year of treatment in this project. Therapeutic coverage rate was 66'4%' Geographic coverage was 93.8%. The Jt uti.ng. is noijust to maintain these coverages but to increase them. 18 wHo/APoC' 24 November2}}3 sOON ! 0) -o E(.) o z t a\ O o H o o\ Ss v B s E !{ a( le ts s +t R' a,s\{ u s :,tI: a\ \:,r a.E hu .E\ =s iEsi U1KE S!3 :r a; FS .sE E3 *= ';'s UI r:E qr={ s.= a)\EIrs$> E.: !: "Ell .:\ itr SS qrk a:o qef*ss*q vt, d !/> o o o+-EEHEBolI o>o o-OL a o o o o -o E z o o o o N o o o o r o o o o (o #?>a =qAO o o o o N o o o o O o o o (e EB 5"9z€ O) @c{ CO rO r o- N o) CY)\o r s r o- r (f) @ o-(o N \ cf) F- @ tr) lO Cf)(o- $ o)f- co- (Y) @ o) @- (f) o roNf-- ro o n $ rO Lo- o) lo^ @ (E o.. +cLc--oO a uE C3;.E O LEb}EF >q! r- ro(o N F- C) o$ cD- N r$\ cY) $ F-f-- lo o)(o nN $(o ry r (oo @ N @ O) (o @ o- co o coo r tr) (o Ns @s nN @ @t_ o, C{ oo o< ll r o5o =boO da FOo\i: >voo -toF sq(o F- s\N F- s u? t-(o s a? cf) ro s nN(o s(f, c.ilo s o? @s sq N f.* sq F-@ s (f) f- I sq co(o s\$ F- sq @(o s a @(o o a-EFUf,rE = o-!z @ O) (f)- t-N o(o ^ir @ o- 1.-(o F- roo @- (Y) N cf)o @- @() o(o (f)- Cf) r 1r) f-- N O) rr)- NN (o (Y)$- @ cf) Nf- oN o cf)s Or- (f) C9 N O) nN rf,) @ot r N @(Y)t- o CAt :oE 6.2 =Eo J 9.o' FU o ro r Cf)N sF- co- o $ O) @- co f.- O) o- O)N r N. r(0 No(o- @ @ o{ o)N @$ @- O)r Nto o- t-N Nlo Or- N r o C9@ @- $ C9 s@ @- o r (o(o N. N(o (f, (Y) (,o^ (\$ .= _t 6E q9 = o Pcg -+E E.vK:E E E - g€ .-o trEF lo r(o- rr) (f) O)N f.--(o CO @(o-(, r t$(o- $$ oIt r $ O) r$ to_ rr)N lf) o- $s @ (f) lo- o CY) O)r(o- t o) (o- F-N o @ rr) c)- co r.o $r F*-(o r @@ n ct)o ro @ @- €$@ r,/) o o0(t \ .h 0-) trt oU ll * ^.j = .9 o.r dS ^6^ =L\Oi: 9 c'.bo<- 6o o soo soo r soo r soo r s c! @ o) soo s no @ soo r soo soo r so soo soo r s\(o O) s oq (Y) o, E.9 .^ u.E U!3 5 Sf;tr tr= o =E>,ko (.) F-$ lo(r) o@ F-@ r1r) oN f.-(f) o(o $N NN o o€ @N o(o o$(0 =od O.= ac'oh:o r .o,D' l-t-,t \t (f) lr)N ot- ro@ r$ ror $cf) ros @ f- o o(o N lr)t oo)\t \OaAa-tdL o=: oo.! c EEIt e - >' ,, - - o-E.= E E!'EE O>-iD tr- .t (nca o\@ r-@ .tra) c.l \o.t O\o $c.l c.lN F-N @ @N ca (\@@ o o t-l o F fJ< ca J ca RzH ca o ca F FA o zo l-.17 tu L./ ca. Z'aD< 11 rr.1 FQ r- >a -i t!tJ i- ** B zr! EI a l-lz l-.1z B v z s.l ca a vz F z U) A D B cl F *aa q Bp B \3 d S aJ o G. alrl s v2\ B q) Ep Fr rrt o.)l _ol(nt FI NOTE CDTI activities have just finished but evaluation meetings are still ongoing' Data submitted in this report is not final. The final report which will be submitted as soon as the evaluation meetings is over will have more the complete data. F, for Therapeutic coverage rate (%) Number of peoole treated x 100 Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate (%) ATO coverage rate (%) 66.4% 640 X 100 682 Number of people treated x 100 Annual Treatment Objective 430.436 X 100 42t,633 430.436 X 100 648,665 Number of communities/villaees treated x 100 Total number of meso/hyper-endemic communities as identified by REMO in the project area 93.8% 102.1% %UTG achieved = 430.436 X 100 = 79% 544,879 ATo = The estinated trumber of persons tiving itt meso/ltyper-endemic areas that a cDTI proiect intends to treat witl' ivermectin in a given 7'ear, urG = Ttrc maximnm ttuntber of peopre to be treated in meso/hyper-endemic areas withitt the proiect area' ultimately to be reached n,hen the proiect has reachedfittt geogra)t,irot ,ou"iis, (normally the proiect should be expected to reach the llTG at the end ofthe 3'd year ofthe proiect)' Number of people treated x 100 T"t"l "r-b.r of people to be treated in meso'/hyper-endemic areas within the project area (UTG) 20 WHO/APOC, 24 November 2004 Table 7 bis: Number of persons treated per health district i n hYP o-en de m ic com m u nities Health District Number treated in hYPo endemic communities BAFUT 2 BALI 2 1 BAMENDA 2 BATIBO 5 )977 FUNDONG 3,698 KUMBO EAST 38,352 KTA4BO WEST 30,1 59 MBENGWI 5,909 NDOP 25,824 NDU 2,195 NJIKWA 0 NKAMBE 1.6,437 SANTA 5,790 WUM 12,661 Total 154,096 2.6.2 What are the causes of absenteeism? The main causes of absenteeism were as follows: - The two treatment interruptions pushed treatment into the farming period and people did not want Mectizan@ side effects to trouble them during farming. 2.6.3 What are the reasons for refusals? Some people refused treatment because of the following reasons: - General fear of side effects, especially as there had been two deaths from side effects in the province already - In Ndop health district some persons left their homes and travelled out of their villages during distribution period just to escape treatment. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. A total of three cases of severe adverse events were reported this first year' Unfortunately two of them died. They were all managed in referral hospitals that were well equipped and whose staff had been trained on the management of such cases. One of these patients who died was even transfirred from District Hospital Ndu to the intensive care unit of the Provincial Hospital in Bamenda. Both of the cases of sAEs that died developed bed sores. The four cases of side effects that occurred are described in table 8 below. 2l WHO/APOC, 24 November 2004 $ Nk(.) -o (.) o z$N r\ o H I.J q) ^o9 6yo '-nE2 o O()ze o ooo A6 o ooo Ad " an q,,lPE B ij cu .:Gloo EE<.rX o.=I!o() c) o €{) cq (Jk a 0) ca o o.2 !2 00 (, a. €o c d C) c) oooil o'(, (Dmex 12!a d.9 uo-( tr ava E o o! 5oJ= ^U<.H c\1 c-9o-o 5oJ= oqls1 o -oo-o Bo N(-i a)XoJ-67i.<1(J r: tr+ d@ooOE,!qg o C6o \<{ -A*Bsd ': a.l o l-.1 - N € :E=.H E E:€>€ orr. Ed iFsxto l-.1 - N o ;64 uAi- r-.1 6 E (i: p 0)trr <. coO -N .o() frr <,(r)O - C.l .o 0)Er <. O\Oa (-.l t d €-gE.E = A o.2 <)iiEHrgH€x6>- *qtPa () H 0) tu () o o. 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Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) - ^- - ro" I *rr -- *rio I uNICEF ! NGDo n / Mectizan@ delivered by - Qtlease tick the appropriate answer)' ^-- ;;; a/- -" * wno tr uNICEF n NGDo tr Please clescribe how Mectizan@ is ordered and how it gets to the commwtities Mectizantables were ordered by the NGDO. This order was done with the aim of treating 500,000 persons, following the recommendations of Mectrzan@ donation programme. A total of 1,800,000 tabtets were received for the project; t,soo,oo-o at the onset of the distribution and 300,000 in May when the iriti^t stock got finished. For easy clearance Mectizan@ from the"port, WHO Cameroo., *L= the consignee. When these drugs were cleaied by wHo, they were handed to the Ministry of Public Health in yaounde (NOTF secrltariat). The NOTF secretariat then handed the drugs to the NGDCi, Sight Savers International who transported them the Northwest provinciat speciat Fund for Health (Drug Programme), at the provincial delegation oi public health Bamenda. The drugs were transported to the Norihwest province during one of the routine trips to the project site' Table 10: Mectizan@ InventorY Number of Mectizan tablets Used RemainingExpiredWastedLost hvpoMeso/hyper ReceivedRequestedHealth District 168310412536546971746950000Bafut 954201790635333926500000Bali 557801327057311864442020000Bamenda 20473010901641858400960000Batibo 28003017720977687141936I 865000Fundong r2232n505085321359421 340000Kumbo East 14492066073897566111450000Kumbo West 97900t34l012879577 56830000Mbengwi 21020216038336913461 320000Ndop 53928037507036591611205000Ndu 00000000Njikwa 225200480044128r170961900000Nkambe t65070570t970433732700000Santa 4141809960259821699232500000Wum 2534220744026333495411 12001917540000TOTAL 24 WHO/APOC, 24 November 2004 This being the first year, health district staff did not know how to request for the stock of Mectizan@ tablets needed by districts. The onchocerciasis project coordinators at the provincial level had to then use registration iigrr". to allocate drugs to every health district, taking into consideration thlat only 1,500,000 tablets were available' This resulted in drug shortages in almost every health district. The various district medical officers then collected their stock of Mectrzan@ from the drug programme during a routine coordination meeting they had at the provincial delegation. Mectizan stock management data collected from some health districts was not complete for ,., .ir,*ple of this is the case of Ntumbaw health area of Ndu health district wheradata on tablet management could not be got because the nurse who implemented activities retired mid way in the programme year and left the place without adequately handing over' In Fundong health area (Fundong health district) a cDD',s home got burnt and all tablets in his keeping 1Z,ZOO tablets) were all lost in the fire incident. This accounts for the high number of tablets lost' - How are the remaining ivermectin tablets collected and where are they kept? After Mectizan@ distribution, all left over tablets with CDDs were forwarded to the health centre nurses who made and inventory of what they had left at the health are level and in turn returned this stock to the health district' A few tablets were signed out and kept at the district level for passive treatment and the rest returned to the essential drug programme (NWPSFH) at the Provincial Delegation of Public Health in Bamenda. - List and briefly describe the activities under ivermectin delivery that are being caffied out by health care personnel in the project area. As soon as ivermectin got to the drug programme at the provincial delegation of health in Bamenda,lt was stored and managed with the provincial stock of essential drugs. From there it was collected by the health districts. From the health distrtts the various health centres collected their stock. There is need for these drugs to be transported to he health districts by the drug programme as they do for other drugs within their essential drug p.o[r"*-.. This will not only help develop the spirit of ownership of the prog.r--e but also reduce cost if programme implementation as irarisporting Mectizan@ to the needy areas will not entail any additional cost. - Any other comments Now that active distribution is over, remaining drugs within the health districts is being returned to the drug programme. This is such that the actual stock of Mectizan@ left should be known. This information is needed for requests of year 2 to be made. 25 WHO/APOC, 24 November 2004 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for commttnity self-monitoring been done in the project area? If so, when? Training of trainers that took place at the onset of the program in May - June ZOO+ included training th.- in community self monitoring as well. APOC organized. a training session on this activity mid way in the years CDTI implemeitation cycle during which a representative from this project was trained. It is planned that during retraining for year 2 activities, more emphasis would be laid on CSM. Provincial supervisors and health district teams will also be properly trained so that they can in turn train the health centre nurses who^would be the key actors in supervising the activity on the field. It would not be wrong to say that no community self monitoring was not carried out this y.^. Lr this project. In some health areas the health staff single handedly aia tfr. ,,,o.ritoiirrg and filted the CSM form. In others the actlvity *^. *.11 started but ended half way complete' Some health area staff referred to community and health area evaluation meetings as community self monitorin[. Others regarded CSM as a separate activity and not an integral part oICOft imptementation and were expecting extra f additional funds for the activity, especially as it came up have way during the implementation cYcle. Evaluation meetings that held at the various levels brought together all the stake holders of the project at that level' T l: Commun and Stakeholders-rrrort No of Communities that conducted stakeholders meetrng_(IEVI)- No of Communities that carried out self monitoring (CSNf) Total # of communitr in the entire Project area es/vi11agesHealth District 54 42 r20 &7 55 80 86 80 98 62 0 t65 0 55 54 42 t20 o) 6l 80 95 80 98 67 47 165 25 62 BAFUT BALI BAMENDA BATIBO FLINDONG KUMBO EAST KUMBO WEST MBENGWI NDOP NDU NJIKWA NraMgE SANTA WUM 9841088TOTAL 26 WHO/APOC, 24 November 2004 Describe how the results of the community self- ntonitoring and stakeholders meetings have affected project implbmentation or how they would be utilized during the next treatment cYcle. 2.9. Supervision 2.g.1. Provide a flow chart of supervision hierarchy' Provincial teamlOPC Health areateam 2.g.2. What were the main issues identified during supervision? In many places CDDs made mistakes in fitling of registers and household cards. Some health staff had told CDDs that they were to be paid for their job. As payment did not come forth, some CDDs in certain areas decided to witfrfrtta keep treatment data pending payment for the work they had done. Time line of activities was not respected in most of the health districts' Funds for activities were found to be mismanaged in Kumbo East Health District where the DMO was found to have disbursed less funds to the health areas that was supposed to for supervision of Mectizan@ distribution. He was called to order by both the staff of the provincial delegation and SSI and the situation corrected with appropriate funds as bud[ed disbursed to the health areas and appropriate justifications made. Many health staff at health area and a few at district level still did not see the ieason why treatment stratery was based on the endemicity on onchocerciasis. This was particularly felt in Kumbo East, Kumbo West and Ndu health districts where the health personnel did not see why persons in hypo endemic communities should be treated differently from those in meso I hyper endemic communities. District team/OPC CDDs 27 WHO/APOC, 24 November 2004 2.9.3. Was a supervision checklist used? In most of the health districts supervision checklists were used systematically during supervision. The provincial Onchocerciasis Project Co- oidinators also usedlupervision check lists for supervision' 2.g.4. What were the outcomes at each level of CDTI implementation suPervision? Generally, good performance was commended while errors were corrected on the spot. 'A-lso, subsequent supervision trips focussed more on problems identified during earlier supervisions' 2.9.5. Was feedback given to the person or groups supervised? Just as during supervision of other health activities, feedback was always given to the supervised. This was used as bases for improvement of fierformance. At the end the supervisee also wrote a supervision report that was forwarded to hierarchy. Sometimes, for these reports to be written and submitted, the supervisee had to be pushed. 2.g.6. How was the feedback used to improve the overall performance of the project? Just as mentioned in "2.g.4" above issues identified in previous supervision trips served as starting point for the subsequent supervision visit' The supe*isee always *"J" it a point of duty that the points raised were fully addressed bY the suPervised. This ideal situation did not however occur in all places. In Kumbo East Health district for instance the DMO did very little supervision' Neither did he facilitate the process of any other district staff carrying out supervision' This not withsta'nding, most or trr" health areas in this district supervised their CDDs. 28 WHO/APOC, 24 November 2004 SEGTION 3: SuPPort to GDTI 3.{. EquiPment Table 12: Status of equiPment *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existirtg equipnent and otlter materials? During this early phase of the project, the equipment will be maintainedjointly"by the Ministry of Publi; Health, APOC and Sight Savers International "" "pltt.a out in the Lpproved budget. As APOC funding starts reducing the Ministry of Health will gradualty take over maintenance till the Sft year which is ApOC's last funding year. After this time, the Ministry is expected to take over this maintenance. Replacement of the equipment will be made by the Ministry of Public Healthjust as it does for its other equipment within the province' This however does not yet future in their budgets. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Conditron No. Condrtron No. Conditton No. Condttton No Conditton 1. Vehicle 1 F 7 1 F CNFR 10 F 2. Motor cycle(s) 12 F 15 F t4 F 3. Computer(s) 1 F 20 F 4. Printer(s) 1 F 20 F 5. Photocopier (s) I F t7 F 6. Fax Machine(s) 1 F 1 F 7. Others a) Overhead Proiector I F 1 F b) Flip chart stand 1 F c) Power point point projector 29 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Year I ('provrde tlrc Penod) Year 2 ('provide the period') Year 3 ('provide the period') TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgete d (us$) TOTAL Released (us$) TOTAL Budgete d (us$) TOTAL Released (US$) Ministry of Health (MOH) 187 0s0 163 139.00 Local NGDO(s) (if anY) NGDO partner(s) 84 843 t49 456.16 District/LGA 0thers a) Communities APOC Trust Fund 238 718 t44 398 TOTAL 510 611 427 852.83 If tltere are problerns with release of counterpartfunds, how were they addressed? Additional comments APOC funds for capital Equipment were not transferred' However the equipments were btught by WHO Cameroon and handed to the project through the NGDO. The Ministry of Public Health's did not transfer any funds to tl-re project ofr its contribution to the project. The contribution is mainly through already existing infrastru.tri., import duties and staff salary' 3.3. Other forms of Gommunity support - Describe (irtclicate forms of in-kincl contributiotxs of communities if any) The community members carried out registration without any financial support from t-he Ministry of Public Heaith, APOC or the NGDO' They provided the exercise books in which registration data was recorded' During Mectrzan@ distribution, most of the cDDs were not given any support from their communities. However a few were given food, drinks and kola nuts as they went on their activities' In one community on Bangolan health area of Niof-rr."rth district a cDD was provided with a bicycle to facilitate his movement from house to house as he went about his 30 WHO/APOC' 24 November 2004 distribution. In Djotin and Ngeptang health areas of Kumbo West health district, the comniunities orga.rised themselves such that each family contributed 50 CFA frs (in DJotin) and 100 CFA frs (in Ngeptang) to a fund and this was given to the cDDs as compensation for their work' 3.4. Expenditure Per activity - Indicate in table 14, the antount expencled during the reporting periodfor each activity listed. Write the antount expenclei in US dollars using the current United Natiotts exchartge rate to local currency. Inclictate exchange rate used here 1$ US = 600 CFA Tabte 14: Indicate how much the proiect spentfor each activity tisted below during the Expenditure ($ US) Source(s) of funding MoPHSSIAPOCSource 13 600.00 8820,13 3038,27 8202.33 7366.06 8457.9 548.6 t742.51 t7o9.g 1092.3 12 735.67 20 069.71 30 488.51 2 579.76 5238.1 9l't.43 Drug delivery from NOTF HQ area to Mobilization and health education of communities Training of health staff at a[levet Intemal monitoring of CDTI acliyltiqs 4{rq.qsyirsUq to h9q!1! all{pg IEC materials Summary (reporting) forms for treatment - Registers - Household cards - Treatment summary form Y.._h!.lq/ Motorcyc les/ bi.cyclgs maintenance- - Office Equipment (e.g computers, printels etc) - Others co litical authorities llection oint of community central Training of CDDs 2327.8| 247.54 -S 74139.00666.t|12 152.38Personnel r35.661 871.53 - General Assemb 76r.68 5202.37 - Communication 28 088.86sal and 7 400.00t0 214.37 2 590.39 - Other o 25r4.28of Mectizan Distribution 6 404.t9 - Side Effect 3450.29REA 68 0009t59r.27tal co 163 139.00132 763.75 149 456.16TOTAL treatedTotal number of Any comments or explanations? 31 WHO/APOC, 24 November 2004 SEGTION 4: Sustainability of GDTI 4.1. lnternat; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year SustainabilitY Evaluation lnternal Monitoring bY NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. sustainability of proiects: ptan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportittgperiod? Was a sustainability plan written? - lilhen was the sustainabilttY Plan submitted? Wat arrangentents ltave been made to sustain CDTI after APOCfunding ceases in terms of: 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, lntegration outline the extertt of integration of GDTI into the PHC structure and the plans for complete integration 32 WHO/APOC, 24 November 2004 This has just been the first year of project implementation' Much advocacy has been done with regards integtrlitrg CDTI into the other existing health projects. This has already started in some areas: 4.3.1. Ivermectin delivery mechanisms This first year ivermectin was transferred from the NoTF in Yaounde to the NWpSF in Bamenda were it was stored and managed together with the other drugs of the provincial essential drug programme' Health districts al1 made theiirequests, which were studied and approved by the opcs. only after "pprouu.i by the opcs could the districts then collect their drugs from thi NWPSFH. The districts had to collect their stock of Mectizan@ from the NWpSFH themselves instead of it being brought to them because Mectrzan@ arrived the province after the normal drug distribution period. However, drugs for side effect management as well as materials for management of Sevei Adverse Events (SAEs) that were in the province much earlier were all transported to the districts and health areas. 4.3.2. Training Trainings were not integrated. Trainings this first year were long and tiring. Integrating them would have made grasping or the material aifnirtt, especialf, to the health area nurses who are mostly nurse aids and assistant nurses. However during CDTI training announcements and distribution of materials for other health programmes were usually made. 4.3.3. Joint supervision and monitoring with other programs In most places (especially provincial and district level) supervisions and monitoring of cDTl was made jointly with that of other health programmi". Such supervisions were more resource management eflicient. 4.3,4. Release of funds for project activities CDTI funding from APOC and SSI is different from funding for other health projecls. However government funds meant for the running of the health i^"iliti.= were pooled and equally used for CDTI activities. This however may be difficult to evaluate. 4.3.5. Is CDTI included in the PHC budgetz There is no budget line yet for CDTI activities at provincial, district or health area level. This is what we still need to advocate for greatly' However, the government plans to motivate CDDs by paying them 25 CFA Frs per person treated. The Ministry of Pubtic Health also provided some stationary to the project. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. what have been the achievements? A11 community health programmes at all levels of the health structure are making use of the transport facilities provided by CDTI. These p.og.rm-es include; National Poliomyelitis control Programme, bxplnded Programme on Immunization, Tuberculosis control JJ WHO/APOC, 24 November 2004 programme, Leprosy control programme as well aS supervision of routing fr."itf, activities at district and health area levels' 4.3.7. Describe others issues considered in the integration of GDTI. 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 was carried out this year. RAPLOA was however carried out before the onset of the project' 4.4.2. How were the results applied in the project? The results of RAPLOA were applied in determining which villages were to have mass treatment. Health district staff were provided with these RAPOLOA results and advised to strictly adhere to the MEC I TCC recommendations when treating in communities at high risk for SAEs' SEGTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. a) Strengths CDTI programme has created awareness on filariasis within the communities The programme has made the community members involved in the project Implementation to become closer to the population and the health services. The community now has a better idea of what the exact population of their communities are Through the programme the provincial delegation has been provided a vehicle and.27 -tto."y.les motorcycles. These transport facilities are not only used for the Cptl project tut also for the implementation of all the other health Programmes' Due to the provision of free Mectizan@ by the project, the utilzation of some health centres in Ndu health district has increased' This is as a result of the fact that the population now has developed more confidence in their health centres' In most communities people are happy with the programme- as they admit that it has helpid tieat not only onchocerciasis but also intestinal worms, body lice, jiggers and bed bugs' 34 WHO/APOC, 24 November 2004 with the coming of GDTI in the Northwest province, there has been improved integration of primary health care activities within the health districts. b) Weaknesses - Sensitisation and community mobilization was poorly done such that most cDDs saw their jobs as employment for which they expect pay' Some even say if they are not compensated financially they would not work next year. Also persons in hypo endemic communities did not feel happy with the fact that they did not have mass treatment in their communities. - In some health areas with no health units some persons who had side effects bought treatment with their personal funds and felt cheated when they learnt that treatment for side effects was comptetely free in other places. - Funds for training of CDDs were inadequate in most of the health areas. As a result few CDDs had to be trained thus making the work load heavy on the CDDs. Those who worked in nomadic communities like in Mentang health area of Fundong health district had to walk long distances to treat cattle rearers up in the hills. - Some health districts have non-functional health areas i'e. health areas without heatth centres. Such health areas lacked health staff for programme implementation. Also making drugs for management of iide effects available to communities in such areas was difficult. The district had to arrange for drugs from the district hospital pharmacy to be dispatched to such health areas. This did not always work out well. - In Mbessa health area (Fundong health district), a Baptist health centre (CBC Akeh health centre) distributed expired Mectizan@ (545 tablets) from their old stock along side with Mectizan@ received from the CDTI programme. - Transport facilities are inadequate in most of the province. Most of the health areas have not got any means of transport' - Some heatth area staff complain of not being adequately trained in CDTI. List the challenges and indicate how they were addressed. Below are a list of challenges that this project has: - Successful implementation of the project after massive budget cuts by APOC. To overcome this, a lot of sensitisation had to be done to convince the communities about the need of their support. They bought registration books for their communities and finance the registration exercise themselves; the planned grand provincial launching of Mectizan@ distribution was cancelled and replaced by low-keyed 35 V/HO/APOC, 24 November 2004 district launchings; Sight Savers International had to single-handedly finance certain ""tiuiti"" like REA as well as supplement financing of other activities like appraisal meetings' - To make treatment available the very remote areas of the province like Njikwa health district, parts of wum health district. We did not succeed to carry out treatment in these remote areas due to their poor access; the prevalence of Loa loa and charged programme of the health sector. - To effectively manage persons having SAEs that may occur in future' Three persons devetopid SAEs. They were promptly taken_ to referral hospitals with trained staff in the management of these side effects. Unfortunately two of them did not survive' - To be able to provide sufficient means of transport to needy health areas. A four-wheel-drive vehicle and,27 motorcycles were provided to the project by APOC and SSI. To attain the treatment objective of at least 65oh of the population' This was also attained thr;ugh a lot of health education sensitisation and a lot of monitoring and ".rp"*i"ion of field activities. we now need to ensure that every1o..r*r.rity that is meso or hyper endemic for onchocerciasis ,.itu.irr" this coverage and maintain, if not increase it to the ultimate treatment goal (84%)' SEGTION 6: matters The main ethnic groups in the Northwest are; Widikum, Fulani, Tikari, Bali, Ngemba, Aku, Essimbi, Beba, Aghem, Njkwa and Nso' The communities of the Northwest province have retained the hierarchical structures of old. The chiefdo-= u.i" still existent and very highly respected honoured. Each clan lfamily has a clan I family head and each tribe has a chief and a council of elders. The chief and his councillors take decisions for the community. This traditional administrative set up has been.very helpful in the successful implementation of GDTI. As soon as the traditional rulers or chiefs (called fonsl and their councillors are well sensitised and buy an idea, it is very easily abided by by the whole community or clan' within the communities information emanates from the chief and is sent down to the population through town criers. Information is also passed down through church authorities, through existing health dialogue structures and in the case of agricultural informat-ion, through agricultural extension workers. Information can be passed on in the church, and announced in the market place through local radios and newspapers' 36 WHO/APOC' 24 Novembet 2004 Unique features of the proiect/other