External monetary incentive policies for community volunteers in the far North, province of Cameroun: short preliminary results

External Monetary Incentive Policies for Community Volunteers in the Far North Province of Cameroon ff"K Short preliminary results (Nov. 2006) By Z. Njoumemi J. Atedjieu For African Programme for Onchocerciasis Control (APoc) I TABLE OF'CONTENTS Abstract 1. Introduction 2. Purpose and scope 3. Methodology 4. Summary of preliminary results z 1. Introduction The African Programme for Onchocerciasis Control (APOC) provided funding to study the external monetary incentive policies for community volunteers in the Far North Province of Cameroon. This study is part of APOC's interest in identifying the external monetary incentive policies for community volunteers through a multi-country protocol in four African countries: Cameroon, Ethiopia, Nigeria and Uganda. The APOC's interest reflects the challenges for the durability of public health progralnmes in Africa which are increasingly relying on community involvement and the use of volunteers to help provide these services. The incentive policies are key to explaining and understanding volunteerism, effectiveness of community involvement, coverage and sustainability of most public health programmes. However, there is a dare lack of information on incentive policies and practices across and within African countries. These issues are particularly relevant to the Far North Province of Cameroon, where many externally-firnded public health progralnmes are not yet integrated, thereby implementing different monetary incentive policies for community volunteers. Since the introduction of community-directed treatment strategy in which communities are responsible for managing and implementing activities of health programmes through their own selected community-dtected distributors (CDDs), both monetary and in kind incentives for community volunteers become a cornerstone of community-based health programmes in the Far North. 2. Purpose and objectives The purpose of the first phase of this multi country study sets out to document the external monetary incentive policies for community volunteers by different health programmes, the determinants of these policies and to what extent they overlap at the district level. The findings of this study are to inform policies on incentives for community-based programmes. They also highlight a second phase study which will be carried out to determine the practices and perceptions at the community level with respect to external monetary incentives. Specifically, the study aims to: To document any general policy at the national level (states/provinces) on external monetary incentives for community volunteers in the health, HIV/AIDS, agriculture and water sectors. To document the external monetary incentive policies of the different health programmes for community volunteers, including the type, monetary value and frequency of the incentive provided, as well as the involvement of communities in setting these incentives. To determine the rationale for the above policies and the role of donors in influencing these policies. To determine the current and potentiaUfuture overlap of these health programmes in the different districts/LGAs. To determine whether programmes have policies on using volunteers selected for other health programmes and how they deal with incentives in such cases. J To document any coordinationlharmonisation of incentive policies and practices alnong different health programmes at national and state/provincial levels' To compare external monetary incentive policies in different countries (existence; range; and uniformity of donors' and programmes' policies)' 3. Methodology This study relied extensively on secondary sources of datq available from existing policy documents, pronouncements, MoU, minutes of meeting, technical or financial reports, budgets, etc- and checklists. The field research team composed of a health economist, a pubiic health specialist and two fieldwork assistants, conducted all checklist intervievn and document reviews. The data collection did cover the both national/central and provincial levels. The Far North Province was chosen for the French language zone. This province is chosen based on the results of overlap at the national level (it is the anglophone province with the most overlapping programmes). Two checklist instruments and document ievie* guide were pre-tested before their use for data collection. The checklist I was administired to appropriate technocrats at MoH, Mo Water, Mo Agriculture, Mo Environment and other relevant agency at national level as well as to the equivalent of director of public health at state/provincial level. The checklist 2 was administered to heads of health programmes at national level (MoH, NGOs, and agencies) as well as to heads of health programmes at state/provincial ievel. Data were entered using Epi Info and were transferred to Stata for data analysis. A document review guide was used for the content analysis of the relevant documents. 4. Summary of results Objective 1: to document any general policy at the national level (states/provinces) on external moietary incentives for community volunteers in the health, HIV/AIDS, agriculture and water sectors. Results .. the general policy exists in all sectors ofien as a practice rather than a fotmal written polrcy. Objective 2: to document the external monetary incentive policies of the different health pro!**-". for community volunteers, including the t1pe, monetary value and frequency of the incJntive provided, as well as the involvement of communities in setting these incentives. 4 Health programmes Results Onchocerciasis control programme Transport:2000frs per day during the training once per year. Perdiem:25frs per person treated in average each CDD treated more than 100 persons per year (>2500 frs CDD er Malaria control programme Perdiem:280 frs per household visited per CDD for amaximum of 579 householdPerYear Bicycle (in kind): a bicycle of about 68000 frs per CDD once per project life. Tuberculosis and LeProsY control programme Traruport:500fis per CDD per month about 6000 frs per year monitoring of TB patients. Perdicm:2000 frs per CDD per month about 24000fis er lmmunisation programme Transport:500frs per day during the immunisation days trvice per year. Perdiem:2000 frs per day per CDD during the immunisation days twice peryear. Guinea Worm control programme Transport:500frs per day per CDD during the training sessions once per year. Perdiem:1000 frs per day per CDD during the sessron once STI and HIV/AIDS control programme Transport: 12000fis per month per CDD for motorcycle maintenance, repairs and fuels about 180000frs per year Perdicm:50.000 frs per month per CDD about 600000frs per year Motocycle (in kirul): a motocycle of about 280000 frs per CDD once per project life. 5 Reproductive Health (Child and Maternal Health, Family Planning, Population activities) programme Tran^sport:2000frs per CDD during the trainmg once per year. Perdiem:5000frs per CDD per day during the training sessions per year Sales revenae.' 1500frs per CDD in average per year Bicycle:65000 frs Per CDD once per life. 6 SUMMARY TABLE OF RESULTS 1 SITE NAME Cameroon Francophone (Site 8) Indicators related to Specific study objectives S/N VARIABLES Yes No Number o//o I Availability of general policy on external incentives 375 625 8 100 1.a. Availabitity of general policy on external incentives at MOH 66.7 33.3 3 37 1.b. Availability of general policy on external incentives at MO Aqriculture 333 67.7 3 38 1.c. Availability of general policy on external incentives at MO Water 0 0 0 0 1.d. Availabitity of general policy on external incentives at MO Environment 0 100 2 25 2 No. of health programmes using community volunteers 100 0 7 100 3 No. of health programmes that have policies to give external monetary incentives 100 0 7 100 4 No. of health programmes that give cash incentives 86 14 7 100 3 No. of health programmes that give in kind incentives (with monetara value) 57 43 7 100 6 No. of health programmes that give both cash and in kind incentives (with monetary value) 43 57 7 100 7 No. of health programmes that have a policy to involve communities in setting external incentives 57 43 7 100 8 No of health programme where donors influenced incentive policy 100 0 7 100 I Number of districts/LGAs with overlapping health pro grammes 25 0 100 100 7 10 Average number of overlaPPing health programmes per districULGA 7 0 100 100 tl Number of districts/LGAs with potential overlapping health programmes 28 0 100 100 12 Average number of potential overlapping health pro grammes per districULc[ 10 0 1()0 100 13 No. of health programmes with policy of using existing co volunteers 7t 29 7 100 14 No. of health programmes with ioint external incentive policies 43 57 7 100 15 No of heallh programmes with policy on coordin ationl harmonisation of external incentive policies 43 57 7 100 8 CROD( rouge nationale ASBFLS/LC CCDICOMIT E DIOCSAIN ACDEV GAPFEN INADES Formation GIC rapideS. CAPROPRAF COPRE-SA AUPRAES ACEEN- Action 21 ASEN AJED.MIR AGIR AFSU-EN. 6r J Reproductive health programm. OFSAP CAMNAFAW UNFPA UNFPA 1,2,6 ?J GuineaWorm Program wHo wHo t1 SUMMARY TABLE 4 SITE NAME 8 List of Agriculture programmes using community volunteers SECTOR: AGRICULTURE s/F{ Name of PROGRAMME national de ,le1 2 national de securit6 alimentaire l2 SUMMARY TABLE 5 SITE NAME List of Water programmes using community volunteers SECTOR: WATER 8 S/N Name of PROGRAMME 1 de 1' 2 t3 SUMMARY TABLE 2 SITE NAME 8 Type of External Monetary Incentives SA{ Incentive No of programmes o/" I Cash 7 100 la. Per diem 7 100 1b. Travel allowance 6 86 1c Stipend 3 43 1d. Sales revenue 3 43 1e Other cash I t4 2 In-kind 4 57 2a. Bicycles 4 57 2b. Motorcycles 3 43 2c. Radio 0 0 2d ITN 1 14 2e. Others In-kind 1 t4 9 SUMMARY TABLE 3 SITE NAME List of health programmes (including HMAIDS) using community volunteers, their implementing partnersr financial donors and types of external monetary incentives provided Type of External Monetary Incentives Legend: tlier Diem, z:Travel Allowance, 3:Stipend, 4:Sales Revenue, 5:Other Type of Extemal Cash Incentive, 6= Bicycle, 7: Motorcycle, 8:Radio, 9:ITN, lO=Other Extemal kr-kind lncentives SECTOR: HEALTH, including HMAIDS I s/ N Name of PROGRAMM E Implementing partner X'inancial DONOR TYPE of External Incentive @nter from 1-10 which is applicable ) National NGO Int. NGO UN agency l. J Onchocercosis programm. HKI wHo HKI,LCIF, APOC, MOH, PIPON FOI.JNDATIO N 1,3 2J Malaria progr:rmm. ACDEV CARE, APRICOM wHo GB, OMS, MOH, HIPPIC 3,6 ,J Tuperculosis and Laprosis programm. wHo GF, OMS, MOH HIPPIC ol Expanded programm of immunisation. ACDEV OCALPAS AGADJAS SALAMA Programm e d'appui aux huit districts ( cooperatio n Belge) wHo UNICE F MOH HIPPIC GAVI UNICEF OMS I 5 'J HTV AIDSprogramm SALAMCEFAAD RESAEC OCALPAS AGADJAS CARE-EN owHo GW, [DA, GF HIPPIC MOH 1,2,3,7 l0 I