South West 1 CDTI annual project technical report submitted to Technical Consultative Committee(TCC): January to December 2008 8

II I I I RESERVED FOR PROJECT LOGO/HEADING t .T I COUNTRY/NOTF: CAMEROON Proiect Name: SOUTH WEST 1 CDTI PROJECT Approval trear: 1998 Launchinq vear: MARCH 1999 Reportinq Period From: January 2008 To: December 2008(Month/Year) ( Month/Year) Proiectvearofthis report: (circleone) 1 2 3 4 5 6 7 I I (10) Date submitted: December 2008 NGDO partner: S ightsavers I nternational ANNUAL PROJECT TECHNICAL REPORT RESUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRTCAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) For To: Tcc tg A0 for Tot .\R rt- - --+ ! I I 1.. '10 L0 0't rfili i0.ig OCIDIRAP RECIJ ,-E SOUTH WEST 1 CDTI 2008 aI ANNUAL PROJECT TEGHNICAL REPORT TO TECHNTCAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sir the Country: CAMEROON .! National Coordinator Name: Dr Ntep Marcettine Signature: tAlL Regional Delegate Name: Dr. Chuwnga Signature: ... Oate:.Q a.CI. tRitu Dr ^HBo1 Z0Us ,i'' :'tt) /j trr;;/ Ji.,l,*.. j Llua John It /., Pt7 7Lq a 0 j-" Datei,.ZY.,t., NGDO Representative Name: Dr. Oye Jos Signature: ort",.Al-4 sa 6-I;, r'iAL C Regional Oncho Coordinator Name: Ms Mah Signature: Date: .7.f,1.r..O..h.r This report has been prepared by Name: Ms Mah Cecitia Designation: Signature: ...... Date ...2*..'. s+) r...() ? ,f: I rS L\\-) ll TABTE OF CONTENTS VI FOLLOW UP ON TCC RECOMMENDATIONS.'.....'.'.. """"""""""""" 1 South-West t CDTI Proiect (1dh year repoft) . ... .. " l 5 5 8 9 0 1.1. GEHERIIINFORMATION 1.1.1 Description of the proiect (brietly).. 1.1.2 PaftnershiP. MINISTRY OF PUBLIC HEALTH 11.2. Popuuttott SECTION 2: IMPLEMENTATION OF CDTI..... """""""" 11 TrruEltrue oF AcrlvlrlES.............'. ADVocAcY ......... MOB|L|ZAT|ON, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIES""" Cotvtwturutrv INVoLVEMENT .........'..'.... Capncrw BUtLDING 2.5.1.1 REFRESHER COURSE FOR CHIEFS OF POST 2.5.2 TRAINING OF CDDS AND OTHER HENITU STAFF FOR CDTI 2OO8 2.1. 2.2. 2.3. 2.4. 2.5. 11 13 13 15 16 17 17 20 20 20 23 23 23 2.6. Tnenruerurs 2.6. 1 . Treatment figures tF THE pRoJEcr ts Nor AcHtEVtNG 100% aeoaaapHrcAL covERAGE AND A MlNtMum or 65%o THERAPEUTIC COVERAGE OR THE COVERAGE RATE 'S FLUCTUATING, STATE THE REASONS AND THE PLAAJS BE"VG MADE TO REMEDYTHIS 2.6.2 . What are the causes of absenteeism? 2.6.3 . What are the reasons for refusals? -..... 2.6.4 Briefly describe all known and veified senbus adverse events (SAEs) that occurred duing the repofting period and Pro vide (in table 8) the required information when available. 2.6.5. Trend of treatment achie vement from CDTI Proiect inception to the current Year. 2.8 ORDERING, sroRAGE AND DELIvERY oF lvERMEcrlN........... CouruuNtw sELF-MoNlroRlNG AND StRrexouoens MEert 2.7. 2.9. Supenvtstott........ 2.9.1. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 4.3.1. 4.3.2. NG.................... Provide a flow chati of supervision hierarchy..... Was a supervision checklist used? -.......... What weie the outcomes at each tevel of CDTI implementation supervision? " ' Was feedback given to the person or groups supervised? How was the feedback used to improve the overall pertormance of the proiect? SECTION 3: SUPPORT TO CDTI. 3.1. Eoutpuerur.. 3.3. OIHER FORMS OF COMMUNIrY SUPPORT. 3.4. ExpeNottuRE PER Acrlvlw ....'.... 4.1. lNrenNal; INDEPENDENTPARTICIPATORYMONITORTNC; EVAUUnTtON....... 4.1.1 Was Monitoing/evatuation carried out during the reporTing period? l"n "'"t',"'t "-^n ti ..........32 which are applicable) 4.1.2. What were the recommendations?4.1.3. How have they been implemented? .-.. 4.2. SuStatNgstLl1y OF PROJESTS: PLAN AND SET TARGETS (runruoeronv nr Yn3) 32 4.2.1 . Planning at all relevant levels......4.2.2. Funds 4.2.4. Other resources.............4.2.5. To what extent has the plan been implemented 4.3 INTEGRATION 32 32 i2 32 33 33 I ve rm ecti n delive ry m ech an isms, Training...... lll 4.3.2. 4.3.3. 4.3.5. 4.3.6. Joint superuision and monitoring with other programs Re/ease of funds for project activities...... ls CDTI included in the PHC budget? Describe other health programmes that are using the CDT| structure and how this was 33 33 33 achieved. What have been the achievemenfs?......... 334.3.7. Describe others lssues considered in the integration of CDTI. .......... ...............34 4.4. OpencnoNAL RESEARcH............ ........344.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the repofting period......... . 34 How were the results applied in the project?.................. .... ... ... .. .. 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUN1T1ES..............................34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 34 iv Acronyms ANC APOC ATO ATrO CBO CDD CDTI CSM HESAM IT IWC LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO Ante Natal Clinic African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Comm unity-Directed Treatment with lvermectin Community Self-Monitoring Health education sensitisation advocacy and mobilization I nformation technology lnfant Welfare Clinic Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical consultative committee (APOC scientiflc advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v Definitions (iii) (i) Total population: the total population living in meso/hyper-endemic communities withtn the plolect area (based on REMO/REA and census taking). endemic communities in the project area. Annual Treatment Obiective: (ATO): the estimated number of persons living in aiaCDTtprojectintendstotreatwithivermectinina given year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be ndemicareaSwithintheprojectarea,ultimatelyto be reached when the projbct 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 coveraoe: number of people treated in a given year over the total population (this should be expressed as a percentage)' Geoqraphical coveraqe. number of communities treated in a given year over the total number of meTJhyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage)' lnteoration: delivering additional health interventions (i.e. vitamin A supplements, ahendazole for LF, -screening for cataract, etc.) through CDTI (using the same systems, training, supervisiJn and personnel) in order to maximise cost- eifectiveness 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. Sustainabilitv: CDTI activities in an area are sustainable when they continue to function efrectively 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. Communitv self-monitorinq (CSM): The process by which the community is r the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the wai intended. lt encourages the community to take full ,".poniibility of lvermectin distribution and make appropriate modifications when necessary. (ii) Eliqible oulation: calculated as 84o/o of the total population in meso/hyper- (iv) (v) (vi) (vii) (vii i) (ix) vl FOLLOW UP ON TCC REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 28 South-West I CDT! Project (1Oth year report) No TCC recommendation / suggestion for writing better report Action taken / Management response For TCC/APOC MGT use only 10 TCC draws the attention of the project to the fact that the weaknesses listed in the "form of the project" must be addressed in the next report. lt calls on the project to complete the report with the missing data from Kumba and Mbonge, i.e. 14 communities and to redo all calculations with new data; verify data in tables to ensure it conforms to the text and provide information on strengths, weaknesses, challenges and project specifics. Weaknesses, Strengths, Challenges and project specificities have been addressed. See page 33 Kumba and Mbonge Data. Mbonge: Bomana and Boko Maliba communities did not have treatment as CDDs absconded due to absence of motivation. All attempts to make them work failed. Kumba: Kumba Health district uP to this moment has not submitted anY 2008 data in 12 of its communities from one health area. The health district is yet to provide data for these communities. Check the calculation in table 2 lo harmonize the number of meso/hyper communities with that on page 3 (section 1). Done Review page numbering; pages 1, 2 and 3 are repeated in the document. We have retyped the table of content to be able to change the page numbering Provide information on the differences in duration of supervision (2 to I months). See comments under table 3, page 11 below. Provide information on the outcomes of advocacy The Outcomes of this advocacy were that, the administrative and local authorities use every available opportunity to educate the population (during national/international celebrations) on the importance of Mectizan@ consumption, the CDTI project and all health programmes in general within their areas of jurisdiction. See page 12 and13, below. lnformation should be provided on the sensitisation and mobilisation activities carried out, in particular on reactions of the population, their outcomes, problems and planned solutions. See section 2.3 on pages 12 and 13 of the report. Provide information on CSM and SHM None of the communities of the I No TCC recommendation / suggestion for writinq better report Action taken / Management response For TCC/APOC MGT use only activities which were conducted project zone carried out CSM. This has been a problem in this project for long. Given that this activity is not paid for specifically and no funds are set aside for it, carrying it out is difficult as community monitors are unwilling to work voluntarily. Despite the training of health staff which took place two years ago, this activity has never been implemented. The Government has however made available the sum of CFA 2,069,500 to pilot CSM in three Health Districts. This money will be used for the training of health staff and initiation of CSM in the communities. It is planned that once the training will be done, health staff will visit communities, educate and sensitise them and hopefully, we should report on CSM having been implemented in the 2009 annual report. lnformation should be provided on the quantity and quality of human resources Scale up IEC materials for effective dissemination of information See comments under table 1 of page 7 of the report; they consist of medical doctors, nurses, nurse aids and health technicians. For effective mobilisation and dissemination of information on the CDTI project, The project plans to produce more fliers and posters on the CDTI project. This is however subiect to availability of resources. Scale up sensitization and mobilization to bring therapeutic coverage to the levels expected for a project in its tenth year Sensitisation and mobilisation have been increased this year. We hoPe despite the drastic drop in funding and the disgruntlement of CDDs, therapeutic coverage will improve, as these pose big challenges for the improvement in implementation of project activities. Raise the awareness of health workers and CDDs for better collaboration Health staff and CDDs are well aware of the CDTI project. The problem here is CDD de-motivation and attrition because of lack of financial incentive as was done by government in the past. Some CDDs believe that funds provided by government for their incentives are being misappropriated by health staff. During coordination and meetings of health staff at regional and health district levels, this issue has been 2 No TCC recommendation / suggestion for writing better report Action taken / Management response For TCC/APOC MGT use only dealt with repeatedly Encourage communities to take charge of their CDDs through sensitization This is done yearly. lt is an ongoing activity. During sensitisation meetings, emphasis is alwaYs laid on the fact that communities should provide support to their CDDs in kind and / or in cash. Although a few community members Provide incentives to CDD, it is insignificant compared to the fact that the bulk of CDDs receive nothing as incentives from community members. Find a strategy to reduce the number of refusals and follow-up absentees. We intend to achieve this bY increasing sensitization, especially through the media, and local I traditional communication means like town criers and dialogue structure (health committee) members. Plans are also undenruaY to increase the number of CDDs as well as encourage the different communities to carry out communitY self monitoring 3 Executive Summary 1. Background on treatment and population data ' Total communities, communities treated, total population, UTG, ATO and persons treated. CDTI Southwest 1 project was approved in 1998 but launched in 1999. lt covers 10 health districts ( Bangem, Buea, Konye, Kumba Limbe, Mbonge, Muyuyka, Nguti, Tiko and Tombel ). These 10 districts are further broken down into 75 health areas having a total of 478 meso and hyper endemic communities. lnformation on Communities treated, Total census population was 394,790. UTG was: 331624. ATO was 315,752 Total number of persons treated was 301,136, giving a therapeutic coverage of 76.28%. 464 out of 478 communities were treated giving a geographical coverage of 97%. 2. Background on population movements Population movement is only experienced in December around the fishing potts in Tiko and Limbe health districts. These population movements do not affect CDTI population as they occur but in hypo endemic communities of these health districts. ln Mbonge health district, there is some population movement as well. Some of the fishermen travel our of the district to spend the Christmas feast in their areas of origin. However these people are usually always back before the onset of Mectizan distribution. 3. Training data CDDS, health workers, Total population (community) per CDD trained. The districts and health areas planned to train 1,148 CDDs but the total they finally trained was 1,115, giving an achievement rate of 97.1%. This gave a population to CDD ration of 354 to 1 CDD. Most of these trained CDDs actively took part in distributing Mectizan in the communities. Number new health workers trained/re-trained at the health district level was. Within the health centres, 144 nurses were trained/re-trained. 4. Challenges and how they were overcome Our greatest challenge was and still is the motivation of CDDs. State funds for the motivation of CDDs are not always readily made available and the process to acquire them is very long and strenuous. This has always led to some CDDs dropping out. Another challenge is securing adequate state funds for the implementation of project activities. Although there is no budget line for CDTI, the government provides some funding for the activities in an integrated manner with other health programmes. 4 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) - Geographical location, South West 1 is part of the South West Region of Cameroon. lt lies between 5'20 and 4"N and 8"45 E. CDTI SW 1 includes 3 administrative divisions. (Fako, Kupe Muanegouba, Meme). These divisions are made up of about 10 subdivisions. Buea in the Fako Division hosts the administrative headquarters of the SW Region .SW1 is bordered to the North by the SW administrative divisions of Lebialem and Manyu, to the South by the Atlantic Ocean, to the East by Littoral and West Regions and to the West by the Republic of Nigeria. From the health point of view SW1 is divided into 10 health districts (Bangem, Buea, Konye, Kumba Limbe, Mbonge, Muyuyka, Nguti, Tiko and Tombel).which are subdivided into 75 health areas. Population The surface area of CDTI SW 1 project zone is approximately 14300 km2 and the total population of the entire project zone (hyer, meso, hypo communities) for Oncho is estimated at 1 012 975 inhabitants following extrapolations from the 1987 national population census. There are 478 meso/hyper endemic communities in the project area. Activities, The most important economic activity of the inhabitants of this project area is farming. They grow cash crops like cocoa, coffee and oil palms. Agro-industrial institutions in the project area are the Cameroon Development Cooperation (CDC), the Cameroon Tea Estate and Pamol Plantations Limited. They grow rubber, tea, banana and oil palms most of which is for export. Subsistence farming is also done with mainly foodstuff and fruits, grown for livelihood and excesses being sold to the local markets and neighbouring towns and Countries. Cash crop farming is done mostly by males while the females are more engaged in food crop farming. Most of the CDDs are engaged in farming activities, which explain the reasons for low participation of female CDDs, rapid drop out and slow replacement by communities. Sometimes they abandon their activities during the peak of Mectizan@ distribution. A small population is engaged in administration (white collar jobs) and small scale trading. Cultures, The village traditional administration is headed by a paramount chief who heads the tribe. He controls the sub or second class chiefs who are the heads of the clans or big villages that make up that tribe. These chiefs and their councillors make traditional laws, protect and uphold traditional beliefs, laws and taboos. Traditional ceremonies like, marriages, deaths, festivals and births are celebrated according to the norms and standards of each tribe. They all have one belief in common, the pouring out of libation to appease the spirits and the ancestors to intervened for their wellbeing. Traditional 5 authority is not highly respected as in the grass land of the North West and Western regions of Cameroon some of these cultures arc a hindrance to a lot of health intervention. Language The local dialects are widely spoken within the clans and tribes in the project area. The language commonly used during communication (lingua franca) is Pidgin English. The literacy rate is very high with many people being capable of expressing themselves in English and a few in French. Topography, climate, Access SW 1 project area has a diversified landscape with the predominant vegetation being the Equatorial Rain Forest. Besides this main type of vegetation, there is mangrove vegetation along the coastal areas. The Rhumpi hills occupy the whole of Meme Division. The altitude ranges from 0 metre on the coast to 4095 metres on Mount Cameroon in Buea with a multiplicity of small hills. The Cameroon Development Corporation (CDC), an agro-industrial unit has put its stamp in this region with its numerous large plantations of rubber, oil palms and banana. CDTI SW '1 project area has a very rich network of drainage system most of which flows from high altitude and are interrupted by numerous cascades, rapids and waterfalls. These streams provide breeding sites to Simulium vectors. The rainy season starts from mid-March to mid-October with its peak around July and August. The dry season goes from mid-October to mid-March. Farming is practised all through the year, the highest activity being registered around March and April at the beginning of the rainy season. Communication systems (roads...) The roads in CDTI SW 1 project area are mostly un-tarred. They are generally practicable during the greater part of the year, with only about 3 months (July, August, and September) when they are most difficult to ply. During this period of the year movement of CDTI personnel is reduced and oriented towards areas where the roads are practicable. Tetephone, Fax, E- mail and Postal services. With the advent of mobile telephones, communication services by phone are well developed. They cover about 90% of the entire project zone. Just parts of Konye and Nguti health districts are left out. Admi nistration structu re The governor is the administrative head of the region The senior divisional officers head the divisions. The divisional officer heads the sub divisions 6 Health System Administrative NO Health Care Delivery Technical services NO lntermediary level Regional delegation of public health for the Southwest 1 Regional Hospital Limbe. Regional Hospital Annex Buqe 1 1 Peripheral level Health district services 10 District hospitals (Public) I Private hospitals 12 Centres m6dicaux d'Arrond issement (CMA) 6 Health areas 75 lntegrated Health centres (Public) 72 Comm unities meso/hyper 478 Health centres Private 37 Health system & health care delivery (provide the number of health posts/centres in the project area if the information is available). Table showing number of health posts/centres in the project area Number of health staff in project area and number of health staff involved in CDTI activities Table 1: Number of health staff involved in CDTI Health staff involved in CDTI include medicaldoctors, nurses, assistant nurses, nurse aids, laboratory technicians, assistant laboratory technicians, health education workers and administrative personnelworking in the different health facilities carrying out CDTI and 7 District Number of health staff involved in CDTI activities. Number of health staff in Public Health facilities of the entire project area Br Number of health staff in Private Health facilities of the entire project area 82 Total Number of health staff in the entire project area (Private + Public) (Bl + 82) Number of health staff involved in CDTI Bs Percentage of health staff involved on CDTI Bg=Bzl Br "1 00 BANGEM 50 0 50 14 28.00% BUEA 75 I 84 24 28.57% KONYE 18 0 18 14 77.78% KUMBA 85 11 96 32 33.33% LIMBE 30 6 36 34 94.44% MBONGE 38 3 41 28 68.29% MUYUKA 92 7 99 24 24.24% NGUTI 54 5 59 '13 22.03% TIKO 56 I 65 35 53.85% TOMBEL 35 31 66 25 37.88% PROV!NCIAL DELEGATION 35 0 35 5 14.29% TOTAL 568 81 649 248 38.21% at all levels. At health area level, most of those involved are nurses. However at the district and regional levels doctors nurses and laboratory personnel are all concerned Team work is very capital for the success of the CDTI programme. NB: The private health sector is made up of staff from Catholic, Baptist, and Presbyterian confessional health units as well as the Cameroon Development Corporation (CDC). They are trained in Primary Health care programmes and are even leading health units in some health areas. The health staff mentioned above; (public and private sector) consist of the following; medical doctors, nurses, nurse aids and health technicians. 1.1.2 Partnership lndicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.l Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, superuision, advocacy, mobilization, etc) where all partners are involved. African Program for Onchocerciasis Control (APOC) Over the years, APOC has provided funds for training of health staff and CDDs, for advocacy, community mobilization, for supervision trainings, distribution and monitoring of side effects. lt also funded procurement of drugs for treatment of adverse events due to Mectizan@ consumption as well as provided vehicles and motorcycles for the project. The project also received office equipment (computers, printer, photocopiers, fax machines) and stationery from APOC. ln 2008 however, despite its disengagement and withdrawal of support from old projects, APOC provided funds for training of CDDs, vehicle maintenance and conduction of evaluation meetings. Mectizan@ Donation Program, Provision and shipping of Mectizan@ free of charge to the CDTI Project, through the Cameroon representation of WHO. Sig htsavers lnternational Sightsavers lnternational, the supporting Non Governmental Developmental Organisation provided the following to the project in 2008; - Funding for - Training / retraining of health staff and CDDs - Monitoring and supervision of project activities - Vehicle maintenance - Maintenance of office equipment - Top-up to health staff - Evaluation meetings - IEC materials - Technical support from it's staff. 8 Ministry of Public Health The Ministry of Public Health is the main coordinating and implementing body of the project from top down. - Provided personnel in the field at all levels, i.e. Region, districts and health areas and support the community in implementing the program. - Organised training of heatth personnel and CDDs - Contri[uted to the repairs and maintenance of equipment at all levels. - Organized integrated advocacy at all levels. - Planed, mobilized, sensitized and supervised project activities at all levels - Monitored , supervised and evaluated project activities - Managed Mectizan@ stock through the regional essential drug programme. Endemic Communities These are the affected communities. They are the principal partners of MOH. They are the main beneficiaries of the programme. They also have a big part to play with regards to the sustainability of the project. Among others the community's activities were as follows: - They selected cDDs and sent them for training / re-training. - They took a decision on the mode of distribution - Accepted registration uPdate. - Mobiiised and sensitized the communities (themselves) to take Mectizan@' The Community Directed Distributors (GDDs): - Collected Mectizan@ from the health centre' - Ensured storage and safety of Mectizan@ within the communities. - Carried out registration update of their communities. - Distributed Mectizan to community members. - Measured visual acuity of community members alongside treatment. - Referred those who could not count fingers at three metres to the health centre for further evaluation and management. - Monitored for side effect. - Assisted the nurse to summarise treatment reports at the front line health facility' These partners all work together, complementing one another for the smooth implementation of this CDTI project. All achievements this project has had this year and over the years of its existence is thanks to the joint efforts of all the partners mentioned above. - State plans, if any, to mobilize the state/region/district decision'makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Plans are always made yearly to mobilise the above on the CDTI project activities. However, this year mobilisation was not done beyond the health district level, for lack of adequate funds. 9 !o .E o o_ o)E Eoo oL o -c o)E .E f,! oc L o r3 o)([ oL oL(U o .C Lo -C o -c =do G o o 'a CL o o o -g .E tl U' L (U c .o o :l o_ o o_ Ec(! @ .g e= 6tr cLooolt ..NI ol .i €l -Fl o c .9 (E cLl ol o.l .sE([E fi.gc.g5s @rN o, o o)_ (oNt- ros @ (f) ry o) o, f.-(r) @ .t cf) c",$ c\Ilo @ (f) rr) lf) f.- wN rr) @o N or-$- f.-N t6tq (Y)(I' .EJ- o >\O + -C'= v sEE ef P E E Rd sN o_ o r o)f.- s r (o (f) s_ s ro $ @ r oN ro rn (o rr)- rlo o s(o o@ 1.--_ @N N @ CA s No\ N (f) o o)l'-\f o,(9 9. =OL .9cq' t-'-PLE ()!DooclgE C.F --c o tr 9IONo-<I. cf)(o or- tr) (o o o) o) (r) @^ Nlf) ro O)$_ s(o v N r r rr)_ t-N oN o- cf) r cf) o_ f.*(\ (o@o) No CO $N $q(o C{ o5o 0)L .g.c N lEo!?ooo EE 5 g'zoNo- olo (f) f.-N .f coN @- (o\f(o- (elo (oo(f) (o o ro o_ $N o O)o -(o o,s\ ro n cf) oo a. @ CD$ od .E oo E')g oo .E =E E o(, o q, ll E z IELN >.o +<E A E H€ P,'8 E 6 Rd Ncf) (f) sro (oo (o (o(o lf).t $@ ro o(o @i-t 9oiE o-([ .-L J- E'- 6!Dooo SEFBa @ (o(o c!@ r (o N Nro |r, o(9(\t 9o!g()-$ .-L -'-*lE()!?ooro:[i P E'0' *>bxa< N lr) @ s tr) orr) sN N(a o Ns €t(\ .s9Eo EbH(stj E *r 5Fo-!o (ot- @-(o co @N s- r @ r\@r- o F- (o O)$- @(o N (f) N @_ lo(o o o) o- o) (f) NN @@ N O)(o w cf) f.* @ t-N (o O)N o @ rol'- o, c.i o q6 b i.o.t .Ee .bco .9,'-o -U)OF <.L (EOOE E()J O (E tU oz o UJl(Il r.rJ z oY co lY [! c0 = LU(, z o(D = Yl l = trl oz oY tr J [rJo =oF J o LJTG = calcutated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the proiect has reached fult geographic coverage (normally the project should be expected to reach the UTG at the end of the * year of the project). - Was a census for the proiect done during the reporiing period? Yes a census was carried out in the hyper / meso endemic communities, by CDDs. - lf No, what is the source of the data in the table above? * Source: National census CDD: Other source, specify: tf you are using the term community or village, define what constitutes the community or village. This will help understand the profile of the proiect area. The village or a community is made of people of the same tribe living as a group in a given setting. The number of persons in a village can be as small as 52 persons to more than 450 persons. ln some health areas, the number of persons covered by one CDD is considered to make up one community while in others the culturally structured unit has been retained as the community. ls there any other information of interest about the population in the proiect area? lf so, include it here. SEGTION 2: Implementation of CDTI 2.1. Timeline of activities Table 3, below details the timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. n NE9E 7EE <GfO O-cU)LF(1)r tr h E 3E 59E o P(E=-E .r,<E : .'= a =gE E1R s B E =:o 6=: z B5r& p = -d ctr(tr-. oR=Y 'a .$E E --E 5v(/l C U)o-c o Jq6b o b trE !s-= O) o.x € 'E E 2i I -.=ro o =ar llog 8 tr ..> ! ,igl 6 e .q .=6g'vL iEs H gfie, E .gii,l :E O0) V'LF^0) E: E E 8f Eo oO E .ri- o)A;= o-Frq .E(Ee EgLo u)v- EEs E ='l a <sEae ! E: E ;E >i L F O) \\E3E :E EC =Eur.L h _2. cI-€ ooEE6 EH| - o =2b E * s-E E E!EE Ea a= N - o rC-c c >= 5 ..5F;=SE €$:=:tu E;gHsE.EEtrbEdF6?. . L oo C oLLfo o -c .E U o (5 oL a(! oLo o ! L oI a .9 = o(I, o o .E6 E tr c"it ol -ol(trl FI .9 o 'E o CL @ tr o o 6eot @ooN o)o @ooN o,o @ooN o)o oooN O)o @oo c! o,o @ooN O)o @ooN o,o @ooN o)o @ooN t-o @ooN r.r)o E'CEEEGO OE @ooN ro @ooN o @ooN o @ooN o @oo c{ ro @ooN o @ooN o @ooN ro @ooN No @ooN o tr o ll o l, C" o o o FC59(JE coooN t-o @oON r.-o @OoN f.-o @ooN F--o @ooN F-o @ooN t-o @ooN r.-o @ooN ]..-o @ooN o r @ooN lr)o ct,tr-tr EE(!o @e @ooN COo @ooN cf)o @ooN (f)o @ooN coo @ooN (f)o @ooN (r)o @ooN Cf)o @ooN (f)o @ooN so @ooN(o o o (E E' CLf, o otr oo o o= FE(Je @ooN (Y)o @ooN $o @ooN rf,o @oo c\I(oo @ooN r-o @ooN(oo @ooN(0o @ooN lr)o @ooN so @oo CN lr)o E"tr-trEE .ggOE @ooN COo @ooN (f)o @ooN (f)o @ooN $o @ooN $o @oo c{ coo @oo c{ (f)o @ooN (f)o @ooN (f,o @ooN (f)o E') .= c GI o =o6EOc @ooN (f,o @ooN (f)o @ooN (f)o @oo(\ $o @ooN (f,o @ooN (r)o @ooN(oo @ooN (f)o @ooN No @ooN c{o E')CEEEg9 @E @ooN (f,o @ooN (f,o @ooN cf)o @ooN (f)o @ooN (r)o @ooN coo @ooN (f)o @ooN (f)o @ooN No @ooN No o 5g 'ji'= s= lttrg8 tr o o tre69ot @ooN so @ooN so @ooN lf)o @ooN(oo @ooN t-o ooN(oo @ooN(oo @ooN loo @ooN so @ooN rr)o E''tr-trEEcoAE @ooN (f)o @ooN coo @ooN (f)o @ooN (f)o @ooN so @ooN (f,o @ooN(r,o @ooN (f)o @ooN(r,o @ooN o o o o LU oz co IUf co tu z oY (n fY lJJo = = lJJ oz o c0 Yl f trl(, z oY tr UJ(n oF 2.2. Advocacy State 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 suggestions on how to improve advocacy. Advocacy visits were made by the DMOs to some policy makers within their districts. These included the three Senior Divisional Officers of Fako, Meme and Kupe-Muaneguaba, the ten Sub- Divisional officers of each district, the two Government Delegates of Limbe and Kumba Urban Council, the Mayors of rural council and Parliamentarians within the health Districts. At Health Area level the Heads of leading Health Units carried out advocacy in the various Heatth Areas by meeting quarter heads, block heads and village chiefs. These policy makers were mobilized during the launching of Local immunization days against poliomyelitis, the international day of the woman and National Youth day (11tn February), as well as before the start of the distribution of Mectizan@ and during the lunching of Mectizan@ distribution in each District. lt was imperative to get these policy makers and community members as a whole involved and fully sensitized. This was to make them have a clear insight into the CDTI programme and to involve them as front-line advocates for the CDTI project, mindful of the fact hat the project was in its 1Oth year. T-shirts with sensitization messages were produced by Sightsavers lnternational and Ministry of Health and given to the all the CDDs and health staff who actively participated in the Mectizan@ distribution activities this year 2008. This gesture helped maintain some of those disgruntled CDDs who were to abandon distribution for late financial motivation from the government. The Outcomes of this advocacy was that administrative and local authorities use every available opportunity to educate the population (during national/international celebrations) on the importance of Mectizan@ consumption the CDTI project and all health programmes in general within their areas of jurisdiction. The following difficulties/constraints were faced during the advocacy and sensitization exercise: - As a result of their tight scheduled, health staff sometime has to make several trips to administrative authorities to get to them - Some of the policy makers invited during advocacy meetings expected money for fuel at the end of the meeting. I m provement on advocacy. We intend to improve on advocacy by applying the following: - Ensure that, besides inviting these policy and administrative authorities to meetings, more time will be allocated to ensure personal contacts. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other localsysfems to disseminate information Sensitization, community mobilization and Health education was carried out in Kumba using the Local FM Radio station, Lake Side Local Radio. Radio messages were focus on - . lmportance of Mectizan@ tablets. . Need of taking Mectizan@ yearly for at least 15 year- . Role of endemic communities as main partners. ' Management of side effects . Mectizan@ distribution and eye care. 13 These messages recorded in both English and Pidgin English were re-broadcast three times a week continuously for one month, through out the Mectizan@ distribution period. A radio spot was also developed, and this went on the air for a month (during peak Mectizan@ distribution period) as well. Town criers used whistles and sound systems to reach the population within the communities. The content of the messages on this subject matter were as follows: * The disease Onchocerciasis * The drug Mectizan@ * The rationale for mass treatment * Those to take the drug (the eligible ) * Those not to take the drug (non eligible) * Treatment is free of charge * lmportance for being treated. n The number of tablets to be taken according to height * How to swallow the tablets. * Possible side effect with management taken care of by the project within 7 days after Mectizan is swallowed. - Mobilization and heatth education of communities including women and minorities There is no issue of women and minority groups in this project zone. Women and men were all mobilised together within the different communities. - Response of target communities/villages Target groups mobilised responded positively to taking Mectizan@. The main issue the project nas is the reluctance / abandonment of CDDs in doing their work as required. ln mahy communities CDDs are de-motivated as a result of non payment of their incentive by government. CDDs most often leave communities with persons eager to take Mectizan@ but with no one are there to carry out distribution. - Accomplishments Although there is general disgruntlement of CDDs, Mectizan@ took place in all the health districti, tough with a drop in over all therapeutic coverage rate as compared to 2007. We will continue to educate the communities on the benefit of actively taking part in distribution of Mectizan@. We also plan to meet the with community leaders and urge them to select more CDDs for training. - Suggest ways to improve mobitization and sensitization of the target communities. We will carry out door to door mobilisation / sensitization in an integrated manner with other community health programmes given that most CDDs also take part in immunisation activities, malarial control programme; HIV/A|Ds control programme, Leprosy and Buruli unlcer control programme etc. Continue training and utilisation of staff of local FM radio stations within the project area. Get more health personnel involved in radio health programmes on CDTI. The fol lowi n g weaknesses/constrai nts were observed : lnadequate mobilisation of target communities. Below are ways to improve mobilization of the target communities l4 Production and supply adequate IEC materials for mobilization and health education. Reinforce and follow up mobilization and health education sessions. Ensure full implication and involvement of dialogue structures at all levels by the district team. Hierarchy needs to address the issue of health staff commitment to the CDTI program 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Health District Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Ba Number community members supervisors Bs with AS Percentag e Bs= B5l 84 *1 00 Male CDDs B7 Female CDDs Bs Total Bg= Bz+Bs Number of communities with female CDDs Bro Percentage Brr= Bro/Bc*100 _. ..{GEM 32 0 0 32 0 32 0 0.0o/o BUEA 13 0 0 24 10 34 0 0.0o/o KONYE 54 0 0 88 17 105 15 27.8o/o KUMBA 103 0 0 145 32 177 30 29.1o/o LIMBE 6 0 0 9 3 12 3 50.0olo MBONGE 66 0 0 97 24 1 2 1 20 30.3o/o MUYUKA 45 0 0 99 6 105 6 13.3% NGUTI 84 0 0 85 1 86 1 1.2o/o TIKO 15 0 0 19 9 28 o 60.0% r vMBEL 60 0 0 77 16 93 16 26.7% Total 478 0 0 675 118 793 100 20.9% l5 Comments on - Attendance of female members of the community at health education meetings Generally more men attended health education meetings. Since these meeting were usually held in the evenings when women are busy preparing dinner for their families, their attendance was always mediocre. - ln general, how do you rate the participation of female members of the community meetings when CDTIissues are being discussed (Attendance, pafticipation in the discussion etc). When female members of the community attended these meetings their participation was always good. They participated just like the men. - lncentives provided by communities for the CDDs Community mutuality and voluntary services offered to CDDs is not a common practice and this makes it very difficult for community members to assist CDDs in kind or cash as they carry out their tasks. Attrition of CDDs, ls attrition a problem for the proiect? lf yes, how is it addressed? Attrition is still common in entire project zone especially Kumba, Konye, and Mbonge, health districts where some CDDs refused to distribute or even abandoned distribution midway because of the late payment of state motivation for last year. To address this problem, were are targeting the communities concerned for sensitisation of both the community members and the village chiefs / quarter heads. - Otherissues. 2.5. Capacity building - Describe the adequacy of avaitable knowledgeable manpower at all levels. Generally the health sector is in severe shortage of staff. This is felt more at the level of the health centres. However to address this problem, individual health facilities have recruited temporary or voluntary workers to support the few regular staff. Thanks to these voluntary stafi, theheafih facilities are able to carry out CDTI and other community health programmes more or less effectively. - Where frequent transfers of trained staff occur, state what the proiect is doi79' or intends to do, to remedy the situation. (The most important issue to descrihe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). Transfer of health staff was not an issue. Very few transfers in and out of the project zone took place this year. The few transfers that took place, the health staff were quickly accepted during the targeted training on the program. 2.5.1 Training Training was organized by the districts for both health centre personnel and CDDs and it was supervised by the regional project coordinator 16 2.5.1.1 Refresher course for chiefs of post A total of 144 chiefs of posts were trained obtaining 100o/o achievement on what was planned. Of this number 32 were new and 112 were refreshed. Just like was the case with CDDs, new health centre chiefs of post were schooled through the whole CDTI programme while for those who were being refreshed, emphasis were laid on areas of deficiency and weakness as discovered in 2007. Training of health centre nurses which consisted of CDTI and eye care always took place at the level of the health districts. These trainings were facilitated by the district health team and an ophthalmic nurse from the nearest eye unit or satellites eye clinics. 2.5.2 Training of CDDs and other Health staff for CDTI 2008 ln the whole project area, a total of 1,115 CDDs (144 new and 971 refreshed were trainedfromatrainingobjective of 1,148, achievingatrainingobjective of 97%.CDD training whose contents centred mostly on actual field activities was targeted to areas on weakness noted during 2007 supervision of project activities. However new CDDs were quickly given a rundown of the whole programme and provided more close supervision by the health centre nurses. The outline of training comprised the following topics: On Eye Gare programme . Basic anatomy of the eye. . Visual Acuity (VA) measurement and refresher, Distant VA measurement with Snellen's Chart. . Ocular pathologies and management (red eye, cataract, and criteria for referral of eye cases). . lntegration of eye care into CDTI ( integration matrix) . Training of CDDs on eye health in combination with CDTI, i.e. sensitization and health education by CDDs, VA checking at the level of the community using the protocol. . Criteria of referral of eye cases to the health centre and filling of the referral forms. . Reporting and follow up of referred cases. . Health area reporting and referral . Criteria of prescription of reading glasses by COPs . Health education on eye related issue and content of messages. On Onchocerciasis and CDTI programme The Disease r Aetiology(Definition) . Mode of transmission and vector . Complication if not treated . Socio-economic impact of the Disease The Treatment . The drug Mectizan@ ( height range / number of tablets) . Non-eligible . Possible side effects o Management of side effects, . Possible side effect with management taken care of by the project with 7 days after Mectizan@ is swallowed. Reporting The registers A B c a t7 . Recording . Census up dating . Numbering of Houses . Registration of treatment . House Hold cards . Community treatment forms, community self monitoring forms, Health Area treatment forms, census and mectizan Distribution summary forms, Adverse reaction forms, financial justification, etc. D lmportance of integrated surveillance of Disease and notification of Disease under surveillance. 18 E' o '6 oo o o o olt tr z Err+ =@tloL'Fooo h o o .\ q)( =oz (f)(o N(o o) @ o @ o) N 3 o O) N (o N oo (o (f) o,N r Oo O)N t-N :_ oo t-N o) @ CO @ @ @@ o) f-- t* oN o o O) o) N@ N lo lt- ? $t s t'-(,) o E o .9 o so o F N(0 o)@ oN @N o$ f.-N o)@ (o@ oNr O)o, G'$ o otr (E L,O e6 o_ EE r-Ootr =(! zo Err +E:3=Fooo o o o = .t o( oz s : o E o .9 (, soo<o =(U oEEotr .E =Ev(u o th oLCL ET z6 Noil+6@oo No ao E o .t to T = q) z o) O) o N o N o o :_ o N CO oN N (o (r) Cf) ro \t o N cf) o) _i $ (o N r $ lr)N N] (f) $ : N : N(9 s oo c o Eo .9 o s oooo o O) N o N(r) (o r lo o O) (o rr)N \f st @ (, o o .9,o oE tr b'E -cl +. =iEz6 f - "t8o oo No .t o( =o = cr) N (f) (a o (a N ro (o N $ v o (o r N ro $ r (f) r N rr) ro o (f, CO o o s tr o E o .g o s oo oo o o (o (f) (r) lo $ (r) lr) (o rtr) (f) 6.) o o .t!,o UJ(9 z d) uJl cl lJJ z oY (D f,Y UJ dt J uJ oz o(D = sf l trf oz oY tr J IUdl =oF FoF o\ lcnlc lc oo o a oE ocq eo o q) v) ol<(U i o $ o O) E o o_q p)t oo o s q) b Q a- ot a(U $ $ o \G ob tog =o =* FG(r) U) oo o u)ip eo E EE o o u) o(l) g. c o (! cq) E o o_ .E tro O o o o o C oL oE E oE (tr o) .E .g oLF rbt ol -ol(5l FI : T Trainees Type Of training CDD'S Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specify) Program management X X How to conduct Health education X X X X Management of SAEs X X X X CSM X X SHM X X Data collection X X X X Data analysis X X Report writing X X X X Primary Eye services care X X X X Visualacuity X X X X Others (specify) X X X X Table 6: Type of training undertaken. (Tick the boxes where specific training was carried out during the reporling period) - Any other comments CDDs were trained on just what was required of them (health education, census update, filling of registers, Mectizan@ distribution and detection and referral of side effects and mea-suring of visual acuity). Only health workers were trained on programme management and data analysis. 2.6. Treatments. 2.6.1. Treatment figures tf the project is not achieving lOO% geographical coverage and a minimum of 65% therapeuiic coverage or the coverage rate is fluctuating, sfafe the reasons and the plans being made to remedY this 'southwest t COft project currently has good treatment coverage rates although 7 of the 10 health districts are yei to attain the required 84o/o therapeutic coverage required by APOC. However though, thby all scored above the former minimum requirement of 65% therapeutic coverage. Geographic coverage dropped from 100% to 97% this year as a result of the fact that Kumba and -Mbonge health districts failed providing treatment data for 14 communities, complaining of the non payment of their financial incentives for the previous year and current year, 2008. To address tnis in 2009, the community heads will be approached and made to understand the consequences of withholding treatment data. 20 (\ Fa---o ;= o- E e 3 , aE E Ets 5 bElji i'=L-'E > o d.9) a' @ 2Y,R BOEE BE o o o o o o o o o o o ob -OoELU Z -U) o o o o o o o o o o o bp -ocCO =utls-o (/,z.o<na N @ o)N tr) r.- rr)$ \ifo 1r)o r r.-sN O)(oo (f) o)@(o rr) (a rn O) (f) lf) o) N$N (,(9 (,$l 8 * E P 5=[€teE= -o, lo(oN t-r--(r) o)@F- olr)r cf)s(o @N os@ ov@ (oo)ro (9 (Y)lo clol Pl(gt rl o.j olol oo n -I-6ts4ooo Hpb E^ E g 8E s o) @ +@ sN +@ sNq f.-(o s ro a? O)(o s @ oq @t- s co C9 o@ s@ c'i @ sN c! o@ s (r) '.ri@ s(oq (f) @ so a? @ No b E Eo €oo _Le6Jog) z. nE (o CA o) @N o) r ro 1r)t- @(f) o)N o) @ s ro (f,s Ns rlr r.- @(o N ro c{o (r) N @@ r N (o rov r.-N (o (Y) o e) @o\OB -eE I(E xJi!o ts P-o-<Fo O)f.- r.- @ (f)$(f) r o)slr,(r,s co lf)$ O) (o ss o,$N rs @@N tr) sNo(f, N o(o!t N(0 r @N $tloi- ro c) oo Et * o(E=FEE 3 E36 o* 9l E PF oo E o o (s $t* o)o o,f.- lf r (o(os .t ro v @ oNlolr) r(o lr) lo o s@ o@t-@N f.-@ co .f Not-N(f) o ct) !+ CD c) a o cr) -(I, = qt .9 =E) E E oo oo r -F$oFooo =r$ Pb Es B8 soo soo soo r s@ @ soo sF- o) soo r soo r soo soo r s ct) oo bE E Qf6',o! F: (l) 55;Ez.ooJE N(9 (f) rfrtr) o) (o $(o ro$ s@ lf)r o(o $(o-f No (trE 7,Jir o:o '7ttFE6 o Ncr) (f) $ro cf)or (o (o(o rf)s $@ ro o(o €t q o= .L o- {ti @ E '=rE H,E Em6 5b= I I r- E Il-- o o >- tr o o o N(f, (Y)r $lo (f,or (o @(o lotif s@ lo o(o et!+ 6;66{ =[!oz dt UJf cl tu z oY @ =f,Y TIJdl =) I,IJ(9 z o cl Yl f = trf oz o}z tr IU co =oF J FoF -Yo L o u,o oL(U (tr .E oJ (J 'tr .U'E -o U) LU U) !c o c o E (I, oLF -tF*l ol -ol(El FI NN oll EJOzo -o .E crO rr-FO f.-N Nv oo) t- F-N (oNf.-O)o @{(Y' Eg o Looo €EEF =6Z lJ- oNo Qr o(osocr,o I I rO$ I(, o oo 35tro =Gz= NNr.-N o@ .tNNr.- (oNiroilr) e,:'N og ll G @c GNEE'90,Oa =f, F-@@ o c{ N f.- o ro i(o .r,s .Jor (r)o@ o,o r o (f)s ss o) N cf) F.-o lo o@@ $f--o rf d C"(\t oo otroobPcL 6o o r.' ^.E .AL O!, >rl €gs EE(E Fit.sE (r) r o^ N r o (f) N(o ro ,o) a. o,co o)|r) N- r(f) @@ (f, @ @- oot- s f-@$- lr)No ro(9 C" .fo .n oEEL otr8 .EE EB€EiFE 8 $N (oro tO l- sr- o rr)s o)No,O,r o$(9 o o o J Lrl tD =oF oY tr trf oz I I :<f l = Lu oz o co tu(n =J [rJ< >mz>oifY:Y LUfdl LIJ(9 z tr) t- oF ocoN o o '6' Lo E U) troo .c o o =cf E Eoo .o E o a,c o Io o- -c .E U' =f U) oL c o) E ooLF C\] i- b =cF bo EOE !\O! t?"(EOos s! ox -o $s EG EE n;)g)o GT 5to'o Q.6 oi's!HO co .rj gi5 HshE .sB bo}Eb.s{9' EE.\o 8rEEtrtr .s5 E: sg o>ao BE tr€Ir -o =o .sE Ee ar*rGx()oi $$ rn QQ 5ss L$ o C o (,) o .g c .F o o EL o .E -_3 (g o L o aEcq) .c o o 'd Lo tro C) G o -c U'ooL(E .9 E o;eE oc) J_i0)6g -c oa rrPc ol col rl O) xl .E(ol $ >(OI N:rl (O Ct Fl-: ol crl !l c'llco E o_ Io Lilo o Ef,C Eo (5 C -L06i)o '=O ot-(Ul- P3 :)F _dx lt olol ;l col or(ol ro rl N -l toOl r(ol (f) o([ L o o)o Oro BOo oF lt C) oL o o)(! L o oo 6 .9^ -C \9 8-eL o)o c)(, o G,L o o)(U L o oo o ,E-f>so<i o- oLoEF s (() r.c, o) slt- o) olol -l coxl t- sl$(ol sl s co c\t trt lt olol -lxlo El$ blE col lt il 2.6.2 . What are the causes of absenteeism? Most cases of absenteeism were false absences. CDDs are reluctant to pass round to distribute Mectizan@ more than once; hence they recorded those they did not meet at home as being absent. To avoid this next time CDDs need to be sensitised more on their role as CDDs. Disgruntled CDDs will also have to be replaced by their communities with those more willing to work. The community leaders have to retrieve CDTI material from CDDs who no longer want to take part in Mectizan@ distribution activities. Also more CDDs need to be trained in order to decrease the work load and allow CDDs to work in their immediate neighbourhood. 2.6.3 . What are the reasons for refusals? Fear of side effects 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. ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 23 _Eboo -c>o6o >E6(.! o.l c o, P'8c.=l- 'E =Oq 36 c o-L ,9 EdX g O.!LIJO()()(, e3E3iO LJOO.bi- _co9(l) E9o 7, eE eE3 o5 @(,-> 19 E tr;=8€€gE o cio6 'Ao U'E>o'F =Ef; =.8octfE(U-Ytl.9 c(U -coN = L'E nrO()irrbpr_oz .tt E o o E U) ie ho!l E6 iP Bo[J(/,tr(t(l) ,$ $,gg.E +o oo)E(s'6i =5xo U) o o) *z U) $ C..l F o $ a. o o oa L $ .E oq + s Gq V) Q)oo (/)!p e o Eb a a) U) oo E !o L o o- o)C E oo oL 0)E C,)c LfE EoLLfoo o G -C U' uJ @ a C o o ooL o ! 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(oooN F-ooN @ooN 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (p/ease tick the appropriate answer) MOH N ./ WHO tr UNICEF tr Other (please specify) Mectizan@ delivered by - (p/ease tick the appropriate answer) MOH tr ./ wHo tr UNtcEF D NGDO f] NGDO N Other (please specify) - Please describe how Mectizan@ is ordered and how if gets to the communities. This year's Mectizan@ for the project was jointly ordered by the NOTF and NGDO partners following the requests from the ten health districts of the project. Mectizan@ was ordered through WHO office in Yaounde. The drugs were collected from WHO by the NOTF and tranded to the NGDO who latter on transferred the drugs to the Southwest Regional Special Fund for Health. From there the drugs were distributed to the various health districts through the regular drug deliVery system. The Nurses in charge of each health area collected Mectizin@ from the districts according to the request by the CDD's of each community. This year drugs were delivered on time and in sufficient quantity. Stock management is not yet avaitable. This will only be available after the treatment Table 10 Mectizan lnventory - How are the remaining tvermectin tablets collected and where are they kept? After the years distribution exercises, most of the remaining tablets are returned to the central stoie of the South West Regional Essential Drug Programme in Buea. Here there are kept alongside other essential drugs of the region. A few tablets, particularly the opened tins are kept in district referral hospitals for passive distribution. - State activities under lvermectin delivery that are being carried out by health care personnel in the project area. The health care personnel carried out the following activities under lvermectin delivery. 1. Mectizan@ requests 2. Transportation of Mectizan@ from the Region to the health districts and to the health areas. 3. Monitoring and supervision the distribution of Mectizan@ to CDDs. 4. Storage and stock management of Mectizan@ tablets. Health District Number of Mectizan@ tablets Requested Received / Carried over from 2007 Used Meso I hyper Used Hypo Lost / Waste d Expired Remaining BANGEM 5E*0Eo ?d$*ffi 26,876 29,887 20 0 14,467 BUEA liH$ioos ${ffi}*E0 38,771 50,712 81 0 28,556 KONYE r@i0-0b {$WSp 97,531 0 45 0 15,624 KUMBA ffi&80 ffi_8ffi36 232,086 11,416 577 0 43,457 LIMBE ffim.YpD0 ,Sgm*30 11,325 109,805 12 0 10,858 MBONGE ilS-gr,0P0 r.sss00 105,765 430 238 0 27,067 MUYUKA ffiffis*q "{lf,f#F"o 153,230 2,944 141 0 1,385 NGUTI ffioa s_?ffifl 59,1 79 0 111 0 23,222 TIKO ffifl$$o tSffiSss 35,926 74,880 174 0 19,670 TOMBEL $ffithop i$ffiae 74,626 15,073 30 0 1 1,903 TOTAL ilX",8--7,;'619 $:ffi*P$gg 835,315 295,047 1,429 0 196,209 Any other comments 26 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Training of trainers for community setf monitoring had be done several time in the past. However in 2008, no training was done for community self monitoring. Given that community self monitoring is always a problem in this project and that the government has provide funds for this training for 2009, the training will be carried out this year. lf so When? None of the communities of the project zone carried out CSM This has been a problem in this project for long. Given that this activity is not paid for specifically, community monitors are unwilling to work as volunteers. The general believe is that this project is funded from outside and despite repeated education on the functioning of the CDTI project voluntary work for the project has always been a problem. Stakeholders meetings have been taking place for planning and evaluation of project activities at all levels. Table 1 1: 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. DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) BANGEM BUEA KONYE KUMBA LIMBE 32 13 54 103 6 0 0 0 0 0 0 0 0 0 0 0MBONGE 66 0 MUYUKA 45 0 0 0 0 0 0 0 0 NGUTI TIKO 84 15 TOMBEL 60 TOTAL 478 0 0 27 If community self monitoring is carried out in 2009, after the planned training it is hoped that through this exercise communities will start being more concerned with sustaining the project. lt is also hoped that by seeing that CSM can be used not only for the CDTI project but for other community activities, it will be appropriated more and hopefully it will contribute towards better CDTI project implementation. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Health Area Level - Health Centre nurse Community - CDD - Dialogue structure members - Community members I 2.9.2. a a a What were the main issues identified during supervision? Disgruntlement of CDDs over the failure of the government to pay them their motivation on time Activities did not go on as planned; respect of timing needs to be improved upon. Prompt reporting also needs to be routinely made for project activities. Central Level - NOTF - NGDO Intermediary level - Provincial delegate - Provincial Chief of Service of Community Health - Oncho Project Coordinator - Finance Officer Peripheral Level - District Medical Officer - Chief of Bureau Health - Chief of Bureau of Administration and Finance - Chief Medical Officer of District Hospital 28 2.9.3. Was a supervision checklist used? The systematic utilization on a checklist still needs to be instituted at all levels 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Supervision involved activities carried out at each of the levels of CDTI implementation. This depended on the level at which the year's activities had proceeded. 2.9.5. Was feedback given to the person or groups supervised? The supervisee was always given a feedback of the supervision findings. Suggestions were equally made as need be. 2.9.6. How was the feedback used to improve the overall performance of the project? lmplementing the recommendations of the supervisor meant making use of the supervision feedback. Using these recommendations improved overall project performance. SECTION 3: Support to CDTI 3.1. Equipment Table 12 Status of equipment (Please add more rows if necessary) 4. Printe(s) Ph *Condition of the equipment (F=Functional, CNFR=currently non-functional but repaira ble, WO=Written ofO How does the project intend to maintain and replace existing equipment and other materials? Decisions on purchase and replacement of equipments are made at the Ministerial level. The region and the districts need to write and channel their request to the Minister of Public Health, and wait for the response. The cost of maintenance of project equipment comes from the state budget of the province and health districts. ln most cases the funds are not enough and the cost of maintenance is very high due to the bad state of cars and motor cycles. At the level of the health areas, the motorcycles are used for all activities in an integrated manner. The principle of risk bearing Type of Equipment APOC MOH DISTRICT/L GA NGDO Others No Conditio n No Condition No. Cond ition No Conditio n No Conditi on 1. Vehicle 1 F 1 CNFR 2 F 7 F 1 CNFR 2. Motor cycle(s) 3 13 F 6 WO 28 WO 10 WO 20 WO 3. Computer(s) 2 WO 11 F 12 F 1 F 1 F 1 F 11 F 12 F 1 F 1 WO 1 F 1 CNFR 10 F 1 F 6. Fax Machine(s) 1 WO 1 F 7. Others a) Flip chart stand 1 3 F b) Overhead projector 1 F c) 29 and cost sharing applied. The health centre chiefs of post use ther health centres'funds and contribution from other programmes to repair the motorcycles. 3.2. Financial 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? There were no problems in releasing counterpart funds. Additional comments. 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) There is very little or no community support to the CDDs, as mentioned earlier in this report. 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndicate exchange rate, 1US dollar was 450 30 Contributor Year 8 (2006) Year 9 (2007) Year 10 (2008) TOTAL Cash Budgete d (us$) TOTAL Cash Releas ed (us$) TOTAL Cash Budgete d (us$) TOTAL Cash Releas ed (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central Provincial/State) + 50,885 50,885 71,130 66,424 69,035 46,308 MOH (DistricULGA) 9,600 Local NGDO(s) ( if any) NGDO partner(s) 34,280 14,378 49,754 49,754 39,617 39,617 Others a) b) Communities APOC Trust Fund 15,000 17,353 14,850 18,084 25,390 25,113 TOTAL 100,{ 65 92,216 135,734 134,26 2 134,042 111,038 Activity Expenditure ($ APoG) Expenditure ($ MoHl Expenditure($ ssl) Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Traininq of CDDs 5,069 8,879 5,670 Training of health staff at all levels 3,407 Supervisins CDDs and distribution 2,458 3,200 lnternal monitoring of CDTI activities 3,326 2,170 Advocacy visits to health and political authorities IEC materials 4,692 Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance 2,502 9,035 Office Equipment (e.g computers, printers etc) 630 .SIDE effect drugs "Personnel 3,616 *Evaluation 4,926 20,770 7,075 "Office Stationeries and supplies 10,875 2,131 *Registers "Communication 450 *Bank charges 352 380 Others 211 TOTAL 13,059 46,308 42,456 Table 14: lndicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? 3l I SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) o_ Year 1 Participatory lndependent monitoring No Mid Term Sustainability Evaluation _Not applicable_ 5 year Sustainability Evaluation No lnternal Monitoring by NOTF -None Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? Not applicable. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) a Was the project evaluated during the reporting period? - NO The project was evaluated for sustainability in 2003 and sustainability plans have been implemented since then. At the moment the project receives just minimal financial support from AOPC Was a sustainability plan written? -Not applicable When was the sustainability plan submitted? -Not applicable What arrangements have been made to sustain CDTI after APOC funding ceases in terms? 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3. Trans port ( Replacement and mai ntenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3 lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 32 !4.3.1. lvermectin deliverymechanisms, The delivery mechanism of Mectizan@ is almost completely managed by the staff of the Ministry of Health. From when the tablets got the country, they were delivered to the NOTF secretariat. Wish Sightsavers' support the tablets were transferred to the South West regional delegation of Public health. ln the South West, they were stored and managed by the Regional essential drug programme just as is the case with the other essential drugs. At the end of the distribution campaign, left over tablets of Mectizan@ are forwarded back to the drug programme vial the various health districts as mentioned earlier in the report. 4.3.2. Training This year trainings all took place in March but for Tombel health district that trained in February. As usual trainings were in cascade with the level above training the level just below it. There was no training at the Regional Level. Health centre nurses and CDDs were trained / retrained in CDTI and eye care in an integrated manner. During these training sessions, as was necessary, information on other health programmes like EPl, HIV/AIDS, Malaria etc was passed to the health staff. 4.3.2. Joint supervision and monitoring with other programs lntegrated supervision was more at the health district and health area levels where few staff are called upon to carry out all health programmes. At the Regional level this was not the case as each programme has its Regional coordinator and its plan of action 4.3.3. Release of funds for project activities Funds for project activities were released by APOC and Sightsavers lnternational without any problem. lnstead prompt release of funds was hampered by the delay in submission of financial justifications for funds earlier released. The Ministry of health partner does not directly release funds for CDTI project activities since there is no budget line for such expenses. However, some expenditure is made by the government on the programme. Expenses are made on transport and office equipment as well as stationary that are used for CDTI implementation. 4.3.5. ls CDTI included in the PHC budget? ln the state budget, there is no line for CDTI However, the districts and health areas carry out expenses on CDTI either directly or indirectly from other budget lines. One of such budget line is "supervision of health activities". ln health areas, especially those not allocated any running credit from the government, health centres funds (collected from services the rendered to the public) are used to finance CDTI activities. The government is now advocating for a "common basket", whereby funds for all community health programmes will be pooled together and used together from a common basket in an integrated manner. The difficulty in instituting this however is the fact that different programmes have a different calendar for activities, they all have different donors each of whom wants financial justifications in a particular way and at a particular period. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? CDTI structures are currently being used by almost all other heath programmes. CDDs are used in the community as community moblisers for all programmes. They are used as vaccinators and recorders by the poliomyelitis control programme (NlDs). They are used like relay agents in the malaria control programme. For the leprosy and tuberculosis control ! 33 programmes they are community health workers, for the eye care programme they are community eye workers. Transport facilities (vehicle and motorcycles) provided by both APOC and Sightsavers are used by all health programmes. Management skills required during CDTI trainings are used by the heatth staff for the implementation of all the health programmes they run. CDTI has laid down a good foundation on which all other health programme is built. 4.3.7. Describe others issues considered in the integration of CDTI. Management of side effects following Mectizan Treatment, Side effects for long have not been a big issue in this project. However, they are managed by the health staff with drugs from the essential drug programme free of charge to the patient. When distribution is over payment is made by Sightsavers to the drug programme 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No research carried out. How were the results applied in the proiect? Not applicable. SECTION 5: Strengths, weaknesses, challenges, and opportunities 1 List the strengths and weaknesses of CDTI implementation process. Strengths Use of CDDs for other health interventions. Drop in the number of communities with low coverage from 144 to 71. lmproved awareness of CDTI e.g. High community demand for Mectizan@ Refusals and absentees have reduced. 2 Weaknesses Late reporting by the district and health area levels Existence of pockets of communities with therapeutic coverage less than 65% Delayed in motivation of CDDs by the state has affected the malaria program because some CDDs who at the same time act as community relay agents have embezzled funds from the sales of home base malaria treatment drugs. Communities not carrying out all their roles of ownership. Reduced lnsufficient financing of CDTI activities by the state and partners 3 List the challenges and indicate how they were addressed. o Maintaining therapeutic coverage and geographical coverage at good rates despite the drop in funding for project activities and the demotivation of CDDs. o CDD attrition o The unwillingness of communities to conduct CSM without any compensation. SECTION 6: Unique features of the projecUother matters Four pilot districts have been selected for the implementation of Sector Wide approached (common basket in financial management for all heatth interventions). a ) 34