South West 1 CDTI project semester report incomplete mid-term technical report submitted to Technical Consultative Committee (TCC): 1st January 2006 to July 2006

RESEB VED FOR PR OJEC T L O G O/TIEADINGG I E EI E t t Y/NOTF: CAMEROON Proiect Name: SOUTH WEST 1 CDTI PROJECT Approval year: 1998 Reporting Period From: January 2006 To: (Month,/Year) July 2006 ( Month./Year) Proiect year of this report: (circle one) 12 3 4 5 6 7 (S) e 10 Date submitted: 31ST ruLY 2006 NGDO partnerl SIGHTSAVERS INTERNATIONAL Semester Report Incomplete MID -TERM TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FORSUBMISSION: To APoc Management by 81 January for March rcc meeting To APoc Management by 81 July for september TCC meeting AFRICAN PROGRAIVIME FOR ONCHOCERCIASIS CONTROL (APOC) c,9 ? f, A0uI 2006 lDiR WHO,APOC. 24 November 200.1 Launchins ]rear: MARCH 1999 E i I I i I I I I I : I I : I I I I I I I I I frl$ -Ttrrq PBOJECT TECHMCAL REPORT TO TECHNICAL CONSULTATNTE COMMITTEE (TCC) ENDORSEMEI\I1T Please confirm you have read this report by sigring in the appropriate space. OFT'ICERS to sigu the report: Country National Coordinator Name: D- f.{TE\P.$h -L Date. 4T/ 0 B)ttd Provincial Delegate Name: -be- M 1 il1u Signature B tq s( ?46Date NGDO Representative NameN P^-. Signature: ,. Date:.t t* 2.,oo% Provincial Oncho Coordinator Nam ". 14.A (01 Signature Date. ...0).: Q-o De This report has been prepared by Name , Yt/.*.11-. . I 16n I i ! i I I i I Ko,wqu i Ii ! i I i I ! 1 q Designation: Signature: . .. .. q D1 q,,qit (Date . ..0) .:. ,20 l I I i ! I t r ;l- r l. Table of contents ACROI\TN\4S 2.9.1. 2q, 2.9.3. 3.1. 3.2. 3.3. 3.4. .........v DEFINITIONS......... FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY.......... SECTION T: BACKGROUND INFORMATION 1.1. GBNnnal rNFoRMATroN.......... 1.1.1 Descilption of the prcject (brielly) 1.1.2. Partnersltip . ........ 1.2. PopulerroN........... SECTION 2: IMPLEMENTATION oF CDTI 2.L. TII,TBI-TNB oF ACTI\.ITIES......... 2.2. Aovocacy 2.3. Moetl-rzarloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RrsK CON{IIIUNITIES ..... 2.4. CoIT,IUUNTTYINVOLVEMENT 2.5. Cepaclty BUILDING 2.6. TRoertrpurs ........... 2.6.1. Treatment figures.. 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals? ...........2:6.4 Brielly describe all known and verified serious adverse events6agd that......... 2.6-5. Trend of treatment achievement from CDTI project inception to the current year............ 2.7. ORoBnTNc, SToRAGE AND DELIVERY oF iVERMECTIN............2.8. corrlruNrry sELF-MoNIToRTNGAND STAKEHoLDERS MBBttNc2.9. SupeRusroN \rI I I 2 I I i- ,...2 ,... 2 ... 6 ... 8 ...9 ... I . 11 Provide a flow chart of supervision hierarchy.. What were the main issues identified durtng s Was a supervision checklist used?... "i"r"i"ir"z;. .12 .74 .L7 .21 .21 .23 .23 23 25 26 28 29 90 30 30 30 30 2'9'4. What we.re the outcomes at each level of CDTI implementation supervision ?.............. 2.9.5. Was feedback given to the person or groups supervised?2.9.6. How was the feedback used to i'mprove the overall performance ofthe project? ............ SECTION 3: SUPPORT TO CDTI EqurrueNT ............. FrNeNcraL coNTRTBUTIoNS oF THE pARTNERS AND coMrvIUNrrIESOtupn FoRIvIS oF coMIuuNITy suppoRT......... ExpeNorruRE pER ACTIVIT\- SECTION 4: SUSTAINABILITY oF CDTI.... 4.I. IXTERX.qI; INDEPENDENT PARTICIPATORY }IONITORING; EVALUATION 30 30 30 32 .32 .32 .33 .33 ln \\'HOiAPOC, 2J \ovember 200{ 1.1.1 ll'as llont'tonng/ertt]uation carrted out durtng the repot'tingpet.iodl) Gick an-t,of the follow,ing vhich are applicabld ......... 4.1.2. ll'hat s,ere the recontrnendations?.. 4.1.3. How have theS' been inplenented?......... 4.2. St'srllxeBILITI oF pRoJECTS: pIAN AND sET TARGETS (rtrxl.rroRy AT Yn 3) 1.2.1. Planning at all relevant levels 4.2.2. Funds..... 4.2.3 Transpot't (replacement and maintenance). 4.2.4. Other t'esource-q 4.2.5. To what extent has the plan been intplenented4.3. IxrpcnauoN.......... 4.3. 1. fverntectin delivety ntechanisns ............. 4.3.2. Training.. 4. 3. 3. Joint supervision and monitoring with other progt ams ...............4.3.4. Release of funds for project activities ............. 4.3.5. Is CDTI included in the PHC budget?............4.3.6. Describe other health programmes that are using the cDTr .34 .34 34 34 34 34 34 34 34 34 38 38 38 38 38 39 t_ l_ structure and how this was achieved. What have been the achievements?. Sg 4.3. 7- Describe others issues considered in the integration of CDTI. ........ Sg 4.4. OpERATToNAL RESEARCH ................ Bg4.4.1- Summarize in not tnore than one half of a page the operational tesearch undertaken in the project area within the reportingpert'od........... Sg4.4.2. I{ow were the results applied in the project?.. ................. Jg SECTION 5: STRENGTHS, WEAI(NESSES, CHALLENGES , ANDOPPORTUNITIES .40 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS... 42 [. lv WHO'APOC, 2.1 \orember 200{ - ;I E I E I I Acronrrrrs APOC ATO ATrO CBO CDD CDTI CSXl LGA N,TOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programnre for Onchocerciasis Control Annual Treatment Objective Anntral Training Objective Communit),-Based Organization Community' Directed Distributor Community-Directed Treatment rvith Ivermectin Communitl' Self-1\Ionitoring Local Government Area Nlinistry 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 scientifrc advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization WHO, APOC. 24 Norember 200J t E I (iil T E G I t I Definitions (i) Total population: the totai population living in meso/h5-per"endemic comruunities u'ithin the project area (based on REX{O/REA and census taking). Elieible population: calculated as 8J% of the total rneso/hyper-endemic communities in the project area. population ln (iii) Annual Treatment Obiective: GTO): the estimated numbel of persons living in meso/hyper'-endemic areas that a CDTI project intends to treat rvith ivermectin in a given year. (iv) (v) teT Goal calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within theproject area, ultimately to be reached rvhen the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMo in the project area (this should be expressed as a percentage). Inteeration: delivering additional hearth interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) throughCDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities orinterventions carried out by community distributors outside of CDTI. abilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future , with hightreatment coverage, integrated into the available healthcare service, with strong community ownership, uslng resources mobilised by the community and the government. (vii) (viii) (vi) (tx) communitv self'monitorine (csM): The process by which the communityis empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view toensuring that the programme is being "*u"..t"d in the rvay intended. Itencourages the community to take full responsibility Lf ivermectindistribution and make appropriate modifications when necessary. vt WHO APOC,2{ \or.enrber 2004 v6] ! ! z .f o{ c o { a S U \Ys I c< ok F- x c< s rrr 5 tA U) a a tI] ra z IIJ vl( fA o U\ cg d,3fHE }TOro o v!H-^ F a.l .iO-6 z(9Jr'9or:-tr /tPr- F E Ab €'\ o7z )d- tr uiF o .iA =cHP>.'uinclt -:. r r\ }r >cqFvS'5 'i,.- 9 I 9 v v'J .rEexHsE'EGr, oUEEii E 3EY f !YslaIVUAf6 a.8rE.E q- .PHI!i6.Eo' AH-Ll<? 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A Nlinisterial text signed in 2004 created Mbonge as a heath district carving it out frorn Kumba health district. This makes a total of 10 health districts in CDTI SW I project. The project still consists of 75 health areas and 478 meso and hyper endemic communities. Mectizan@ distribution was carried out in 478 communities but treatment data received in the Province so far is from 43I communities. This year so far the geographical coverage is 90.20%. Total population obtained from census update this year is 349 584 persons, Ultimate Treatment GoaI 293 650 persons @+r/r) Annual Treatment Objective for the project 227 229 persons GSN). Finally persons treated was 258 592 persons giving a therapeutic coverag e of 73.97% 2. Background on population movements. Population movement is only experienced in December around the fishing ports. The population movement don't affect our CDTI population because they are found in the hypo endemic communities of Tiko and Limbe health Districts but if any, in Mbonge health district, they are always back from their Christmas feast before the start of Mectizan distribution. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. Total number of CDDs trained 735 in meso and hyper endemic communities, number health workers implicated in CDTI activities both public and prlate 22g and total population (community) per CDD trained is 425 which is very high. We also trained 246 CDDs in hypo endemic zones who assist the health staff to mobilized the population for clinic base distribution. 4. Challenges and how they were overcome. Our greatest challenge is the motivation of CDDs from the state budget. Thesefunds are not readily made available and the process to acquire them is very Iong and boring- The CDDs are very impatient to wait for their motivation. This has leJto the high drop out rate in some communities and CDDs abandoning the activities to the health staff. State budget for CDTI activities, there is no stable and rvell define budget line on supervision of activities at the level of Province, District and health a-r-.eas. \\'HO,APOC'. 2{ \or.enrber 200{ I E D I I t, t- l. 1.1 lntegllltron of ilctlvltlr)s rs r)ot iI solutrort be.cirttse eitch ltrnchng bodl' hirs rts o\\'n roles atrd regulations. To maintain a good therapeutic coverage next ]'ear'. \\-e are s'aiting on the Stare to take decisions on the above ntentioned isstres. SECTION 1: Background information General information 1.1.1 Description of the project (briefly) - Geographicallocation, South West 1 (SWI) is part of the South West (SW) Province of Cameroon. It lies between 5'20 and 4oN and 8"45 E. SWI 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 Province .SWl 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 Litoral and West Provinces and to the West by the Republic of Nigeria. From the health point of vierv SWl is divided into 10 health districts (Buea, Limbe, N{uyuka, Tiko, Bangem, Tombel, Nguti, Konye, Kumba, N{bonge) which are subdivided into 7b health areas. A N'Iinisterial text was issued last year creating Nlbonge as a heath district from Kumba health district. Population The total area of SW I is approximately 14300 km2 and the population is estimated at 710,050 people living in hypo, meso and hyper communities. Following the definition of, (Total population; the total population living in meso/hyper-endemic communities within the project area (based on REMOiREA and census taking and communities which were grouped with REA result were separated when we were requested to code all the CDTI communities in Kribi 2005), the number of communities in CDTI SWI proje ct zone have increased from 375 to 478 meso/hyper endemic communities. We do not see any rational living out hypo endemic communities spotted in between meso/hyper endemic communities when they are all expose to the same ecological, geographical, entomological and sociological factors. REA was repeated in Muyuka, Kumba, Mbonge and konyehealth districts in communities which were spotted between meso and hyplr endemic communities and results reveal that they are meso or hyper endemic. These communities could not understand why they were isolated u. hypo endemic communities while their neighbors were either meso or hyper endemic. These errors'might also result from the sample population of the health worker who carried out REA in those communities. Total population obtained from census update this year is 849 584 persons,Ultimate Treatment Goal Zg3 6b0 persons (g+N), Annual rreatment objective for the project zz7 22g persons (6bo/o), Persons treated was 2b8 bg2 person s Qg.WW) Mectizan@ distribution was carried out in all communities but (g0.2% geographical coverage) 47 communities have not sent in their reports.Total number of CDDs trained 735 in meso urd h1p"r endemic communities, number health workers implicated in CDTI activities both public and private 22g s 2 \\'[IO APO(', 24 \ovember 200{ E r1 I Ii tarld total populiltlon (coruurunit)') pel' CDD tl'ailred is {25 s-hich ls vel'\- hrgh. \\-e also trained 246 CDDs in h-r'po endemic zones rvho assist the healtlt staff to nrobilized the population for clinic base distlibution. Activities, According to prioritS', majority QSN) of the population living in the project area are engaged in cash crop farming rnainly Cocoa, Coffee, Palms, Rubber, Tea, Banana etc. Sustainable farming is mainl5' foodstuff and fruits, for their livelihood and excesses are being sold to the neighboling torvns and Countries. \\'e rvill rvish to mention here that, most of our CDD's are engaged in farming activities, rvhich explain the reasons for low participation of female CDDs, rapid drop out and replacement b1' communities is slorv. Sometimes they' abandon their activities during the peak of i\tlectizan@ distribution. Rest QSN) are engaged in administration and small scale trade. Cultures, The cultural setting is made of the Para mount chief who is the head of the tribe. He controls the sub or second class chiefs who are the heads of the clans that make up that tribe. These chiefs and their councilors make traditional laws, protect traditional believes, Iaws and taboos. Traditional ceremonies for example, marriages, deaths, festivals and births are celebrated according to the norms and standards of that 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. Some of these cultures are a hindrance to a lot o f health intervention. Language The local dialects are widely spoken within the clans and tribes in the project area. The language commonly used during communication is Pidgin English. The literacy rate is very high many can express themselves in perfect English and French. Topography, climate, Access SW I features has a diversifred landscape, the predominant vegetation is the Equatorial Rain Forest. Besides this main type of vegetation, there is mangrove vegetation on the coastal areas. The Rhumpi hilIs occupy the whole of Meme Division. The altitude ranges from 0 metres on the coastal areas to 22OO metres 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, tea, palms and banana. SWI 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 which can be found on high altitude in the area. The rainy season starts from mid'March to mid-October with its peak around Jul5. and august. The drl' season goes from mid'October to mid-March. Farming ispractised aII through the year, the highest activity being registered around March and April at the beginning of the rainy season. _) 3 \\'HO APOC,24 \orernber 2004 i Communication svstems (roads... ) The roads in S\\:I are mostl5' un-tarred. Thel' ale genelalll' practicable during the greatel part of the 1'ear, rvith only about 3 rnonths (Jul1-, August, and September) rvhetr thel' are difficult to pl),. During this period of the ]'eal' movement of Communit5' Directed Treatment with Ivennectin persorlnel should be reduced and oriented towards areas rvhere the roads are practicable. Despite e\rer\- oaths with the use of four wheel dlive cal a person can still rnake a successful journel' rvithin the project zone. Telephone, Fax, E- mail and Postal serrrices. Communication selvices by telephone are well developed and cover 90% of the entire project zone except for Konye and Nguti health districts, for the other onll' Tiko, Kumba, Limbe, Buea, Nluyuka are saved. Administration structure The Governor is the head of the Administration in the South Wes Province The Senior Divisional Officer is the head of Administration in the Division The Divisional officer is the head of Administration in the Sub Division Traditionally the Para mount chief head of clan's chief. The chief and his traditional councilors administer in the communities. Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). 4 Health System - Administrative Health Care Delivery Central level Number Number Minis of Public Health Referral Hos tal 2 Central hospital L) fntermediary level Provincial Delegation of Public health Buea 1 Provincial Hospital Limbe Provincial Hos ital Annex Buea 1 1 Peri level Health District Services 10 District Hospitals Public 9 Private H itals t2 Centres M6dicaux D' arrondissement. CMA 6 Health Areas 75 Health Centers Public 72 Communities me er 478 Health Centers Private JI \\'HO APOC. 2-l \ovember 200-l I iNumber of health staffin project area and number of health staff involved in CDTI activities. Table l:Nuntber of health staff involved in CDTI (PJea-qe adcl mot.e rory-; tf netcssin't-) District/LGA Number of health staff rnvolved in CDTI activrtres. Total Number of health staffrn the entire project area Public i I j Total Number ofhealth staff irr the entire project area Private BI Number of health staff involved in CDTI Percentage B, i B*Bzl Br *100Bz BANGEl\,{ 48 0 1 4 29% BUEA r29 61 40 3t% KOI\TTE 19 0 8 42% KUMBA 88 58 30 34% LIMBE 93 91 32 34o/o MBONGE 25 L4 10 40% MITYUKA 91 18 15 t6% NGUTI 18 t27 13 72% TIKO 84 68 30 36% TOMBEL 23 35 L7 74% PROVINCIAL HOSPITAL 105 0 0 0 PROVINCIAL DELEGATION 35 0 5 t4% TOTAL 758 466 2t4 28o/o t a t t_ NB: The private health sector is made up of staff from Catholic, Baptist, presbyterian, missions and cameroon Development Co operation (cDC). Some are train in primaryHealth care programmes and are even responsible for some health areas as leadinghealth units and authorized, private for profit health institutions. 5 \\'HO APOC, 24 November 200J I E G r, ti t" i LL.2 Partnership Inclicitte the partners involved in project irnplementation at all levels htoU. NGDOs (national/international), communities, local organizations, etc.] Describe overall rvorking lelationship among partners. cleerrlf indicating specific areas of project activities (planning, supervision, advocac5', mobilization. etc) rvhele all partners Are involved. African Program for Onchocerciasis Control 6POC) APOC designed the project and supported the project rnaximally for the first five years. It provided most of the equiprnent (vehicles, IT materials etc) that are still currentll- being used for project implementation. This year it provided funds for HESAN'I and trainings. Mecti zan@ Don a tion Program, Provision of Mectizan@ free of charge to the CDTI Project Sight Sa vers fnturna tional SSI is the supporting Non Governmental Developmental Organisation in the Province. They have assisted the CDTI SWI Project withi - Logistics (purchase of car insurance, tyres for car and motorbikes of the health districts/ health areas); - Finance activities like training of nurses and CDDs, supervision, evaiuation meetings and HESAM at the provincial, districts and health area levels. - They have ensured good resources management and reporting. - Integration of eye care program into the CDTI programme Ministry of Public l{ea|th The Ministry of Public Health is the main coordinating and implementing body of the project from top down. - Provides personnel in the freid at aII levels, i.e. province, districts and health areas and support the community in implementing the program. - Organises training of health personnel and CDDs - Motivation of CDDs - Financing of activities at the provincial, districts and health area levels - Contributed to the repairs and maintenance of equipment at all levels. - Organise advocacy at all levels. - Planning, mobilising, sensitising and supervising activities at all levels - Monitoring, Supervision and Evaluation of the project - Produce IEC materials - Management of Mectizan@ stock through the essential drug program. Endemic Communities These are the affected communities. They are the principal partners of MOH as the implementation of treatment with Ivermectin and its sustainability depend entirely on them. They are on the driving seat of CDTI project. - Select Community Directed Distributors (CDD's) and send for training. - Take decision on the mode of distribution (Central point distribution method) - Plan for distribution. - Accept census update. - I\'Iobilise and sensitize rhe community to take L{ectizan. t_ ) 6 \\'tlo APOC. 2{ November 200{ Sttpet'r'ise and monitor Jlectizan distribution s'ithin the communit5-. Identi8- and refer advet'se reaction rvithin 7 davs of ilIectizan tr.eatnlent The Community Directed Distributors (CDDs): - Ensure storage and safety of Mectizan@ s'ithin the commtrnities. - Collect Itlectizan@ frorn the Health centle. - Distribute l\fecti zan to their communities. - Can'1' out census update of their communities. - Assist the nurse to summarise treatment report at the first line health facilitr - State plans, if any, to mobilize the state/region/districttLcAdecision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. There are no plans to mobilize more NGDOs, NGOs, CBOs to assist in CDTI implementation in SW Iproject zone at the moment. I 1 WHQ;6pgg. 2.1 \or.ember 200{ n N ! tr ! z <t N .9 li -. cii O!i .o q>x 'EtrCoRA 3g 9 o.r o)ooo t<9(dd 9.,!a?-or odoaiq-o 15E ni tla*A0)xd;(gt: $E <5 ';Q ,o c) _q .EHe q-9b aa.{'aodBtr -CE CEHT o(U{r }r!cd a. 6'9(,irco0)C EA)Jjti cddg< - rrlo)^2 NH 'd bD c6trH'T trl "tJ(,3 Qa. '<, o0)t{ >bD 8s,e.xo.; x6>o) :dq ;€:t 3,H P'l ,iH;9E E.;bE!qo6 D f ) H riE92(,oYo() tr€= +JC)F q-o .. I q Z?. I \ (a p p ts ! t Nl aJ orl 3 =lsFl c bI, L c. ,< o bt li +) t{ +J oti +) o d +) ti 0) ! o) cd 0)ti cd +) C) a) 'a trq oti {J 0) c) +J a tr .P o +) C! a p. n a 0.) rJ E () o +) c6 ao O{ ".i T t t t I t E t t= L', l" t, t, tr tj E tl @ @ ri r< N 30 \N rO N N a) N ss r{ @ N r-fN 00(o LON Y @v r-.1 crf ll: @ ca O)N N cfJ N oO :o rc v tr- tr- D- ri rC al tr- .+ N rC c-rv rO .$ rc cc raN N r+ r-{ @ .n{ D- CD .+ @Io .+ .3 EhE:G.^ $H EEU NH L c)ah €o cn E c) oN O E 0) .(, c) ss @ F D (H o o +)(! (6 F t ils 3c o G)-trE!E E(5EC) ,5 Ees r;n gEs \ + il ti C)a-.}H<oONa-. EE -0) (dA) +) oF N ri w rO O t-l (o TO$ $@ roFl (o .9 HgS .ET HE.EtLoo)bi tr'RgR E. *{ @ D- r+ H .i ct) 0) bo cn a 0) +) tr E E oO +{ o li 0)p E a z Hgso)E H E =€ sEE "Es.9 H? o- "i3 U_ts 8: P'F a..= a N li N @ IOv O) tr- c- t-- Fl rO O) co r- O) .+ N r() r-.t D--$Ir)\tr ro @ co rO6l N O)$ li ri @$ D- r+ @ IO o) .<l{ c.o €oc)Ec) ''r'a -\Akcgl3'd a 9 o,)L.r.'il( X aEEq€()o- c) a z E] z coz, ri z -] r z o D F z o F frl t. Fl FoF tiII : t E I I 'I l'r t. UTG =calcttJ:tted a-: the ntt.r'trrtuttt rtuntberofpeople to be treatetl annu;tll_t-i2 nteso,,h-'pet.endenrc areas vttht, the pt.o1'ect a).ee. urtimaLry'to b" r",""hoi ,rti" iil'irillrlr'i* reached rblrgeographtc co,eraoe (:tornalJ-t'the prolect shoulcl be e-rpected to t-each the t'TG at the encl of the .y',t .t'ear of the proyct). \\'as a cens,s for the p.oject clo,e cltrri,g the reporti,g period? yes If you are using the term community or village, define what constitutes thecommunity or village. This rvill help understand the profile of the project a.ea. The village is rnade of people of the same tribe living as a group in a given setting. Thenumber of persons in a village can be as small as 52 f,ersons to more than 4500 persons. A community is a group of persons lil'ing in the same vicinityrvho could be part of a village,or a quarter in towns or more than one small village. The community should Save aroun d 250-300 persons. Communities have been determined by the different health areas. In some health areas, thenumber of persons covered by one cio ls considered to make up one community while inothers the culfurally structured unit has been retained as the community. Because of thisdifference, the number of persons per cornmunity can vary between 300 to 1500 persons. Is there any other information of interest about the population in the projectarea? If so, include it here considering the fact that,.noteverybody living in the hypo areas was born and breed in thesecommunities and coupled with high rate of cJmmunity;rban migration in search of betterliving standards, employment and-commercial activitils. Mectizan treatment was also carriedout in all the hypo areas of GDTI SwI projec t zone. A total number of 9g 509 persons wastreated in the hypo areas. If No, rvhat is the s * Source: National Year SECTION 2: fmplementation of CDTI 2.1. Timeline of activities iource of the data in the table above? census CDD: Yes Other source, specifl' Fill in table 3, timeline of activities for areas treated in curuent year,indicatingwhen the key activities were implemented by the month they began and themonth they ended. 9 @kr'12l-- WFlQr4pgg. 2{ November 200.1 N L. cN r: N ra N !a N ra CcN ro N ra NN t: il ra : :c,qo EE Oa F a I t E E I E I I N L .J () z rc(\ (r' O a ! c) C) Gt .A(r) a)(.) AJ N\ '*i o o AJ a \ N q) a cB -q) 'Id\_: LU 0) +J o S{! 0) ]J 0) +) a)fr +) ct) o! c6 o JJ ! -o aq) +) {J() (! o c) F *r -clclFI I t, t, I] tj t' ti ti tl u 5a .,81itr #E OON N CN N N N CN N (, OON N (o CON 6l (t OON N O N N (c N N ON N qE oioEEo- (O OON v O N s (, CON 'i cON !i OON rO @OO6l v OON \i OON v (c OON s OON ! +) p tr -{J a .d bo k a Hs JE oaN (o ON N OON oON CD (O o N v (o O N OO6l @Oo6I N OON (O o 6I N o -eEqd EE o oO6I '+ (O OON v (O OON .3, OON $ @OO6l rt) (o OON .$ @OoN '$ OON $ OoN $ (O OON ou(d q (D a tr 0)() b-o .Ef tsE #E OaN (o o ON N OON ci) (o aO6I (t) ooN $ OoN (o OON (o OON N ON @OO6l N o '5 -qgEgo EE o() (oOO6l N OO6l (, OON OON (o OON N (o OON N (o OON 6l (o o Odl N @OON c.l (o OON N ho dt{F bD .E€1itr dY9Ha- O N N (o OON N (t OO6l 6t (o OON N O N N OoN N @OON N OON (o O N 6l (O OON N o oqatEEo(J (o aaN .$ (o ON (! oO6t (o OoN O6l lo (o oa6l cr) (o oN s ao6t rO (!) OON OI (o aa6I 6I Oo d0) O{r TEis .oHoo >(, bDtrt e9 diH (O aO6l 6l (O OO6l N OO6l (! aON (o oo6l N (o ON N (, o ON N O N N (l) aoN 6t (t) aON N (5 -I +,o ,. +)o a z z I z z -] z z C z, z o F -] c- t E ll I I 2.2. Advocacy State tlte tttrtnber of poltc_t'hlecistott rttttkers ntobilizad ot euch relevont lev'el dttring tht, crrt't't,rtt .r'eor; tlte reason(s)-for undertaking the udvocttc.t'and lhe otttcotrte. Describe difficultics'constrdtnts being.fiicetl and suggeslions on hott' to irnprore odvocttc.y,. Funds for HESANI given by APOC Nlanagement this year boosted the health education. Sensitization, Advocac)'and Social mobilization of endemic communities in the entile ploject zone. T-shirts rvere printed by SSI and MOH and given to the all the CDDs rvho actively participated in the Mectizan@ distribution this year 2006. This gesture helped maintain some of those disgruntled CDDs who were to abandon distribution. Advocacy was ensured by the DMO to some policy makers of the Districts such as the four Senior Divisional Officers, the 10 Sub'Divisional officers, the two Government Delegates of Urban Council, the Mayors of rural council and Parliamentarians of the Districts etc. At Health Area level the Heads of leading Health Units carried out advocacy in the various Health Areas by meeting quarter heads, block heads and village chiefs. During ANC and IWC clinics as rvell as during individual consultations sensitization was carried out. These policy makers were mobilized during the launching of Local immunization days, the international day of the woman and national day (11th February), and before the start of the distribution of Mectizan@ and during the lunching of Mectizan@ distribution in each District. They rvill be re'visited after the Provincial appraisal for a feedback of the 2006 CDTI programme. It was imperative to get these policy makers and community members as a whole involved and fully sensitized. This rvas to make them have a clear insight into the CDTI programme and to involve them as front-Iine advocates for the CDTI project, mindful of the fact that the project is in its Sth year, this being the 3'd year of sustainability by the communities in the absence of APOC. The outcome for this advocacy and sensitization was quite positive since we observed less refusal of Mectizan@ which has also accounted for an increase in therape utic coverage.. The following difficulties/constraints sensitization exercise : were faced during the advocacy and Diffrculty to get in touch with policy makers due to their very tight schedule of activities. Some of the policy makers invited during advocacy meetings were expecting money for fuel at the end of the meeting. Lack of IEC material for distribution. We intend to improve on advocacy by applying the following: Ensure that, besides sending letters inviting these policy makers to meeting, more time rvill be allocated to ensure a higher level of personal contact. Do all in our power to get more IEC materials. t" t t, t, ti t_ t, U v rl il - ll WHO,APOC, 2.1 Nor ember 200.1 tEnsure that the policl' makers accept orvnership of the project Request for strpport funds from our partners. 2.3. Mobilization, sensitization and health education of at risk communities Provide information orl The use of rnedia and/or other local systems to disseminate inforrnation N,Iobilization and health education of communities including women and minorities Response of target cornmunities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Mobilization and Health education was ensured on the mass-media by the Provincial Delegation of Public Health Buea, (OPC SW I). The Lake side Local Radio station in Kumba was rvhere we decided to carry out our programs because that was where most of our target populations were located. The radio programs were just timely because Konye, Mbonge and Kumba have just started Mectizan distribution whose communities were our main target on problems of refusal, absenteeism and CDD attrition. Our radio messages were focus on - . Importance of Mectizan tablets . Need of taking Mectizan continuously for 15 year- . Role of endemic communities as main partners. . Management of side effects . Mectizan distribution in relation with eye care. . A word to the CDD's and the entire public. These messages were recorded in both English and Pidgin English and were rebroadcast three times a week continuously for one month, during distribution. we also developed a spot (Promo) on mectizan. This also went on air continuously for one month. Chiefs of Post, CDDs and Communitl' leaders in aII communities of the Health Districts executed this activit5' that were supervised by the district teams. Torvn t. t t" t2 \\'HO .-\POC'. 2J Norember 200{ .: s D Tll I I E li ct'iers using rvhistles, local tongue translators and other nlearls of traclitional commutrication such as the use of talking drums rvere used to educate ancl r,obilize \\'olnen aud minorities. The content of the messages on this subject rnatter was as follorvs: .!. The disease .:. The drug * The rationale for mass treatment .:. Those to take the drug .:. Those not to take the drug .:. Treatment is free of charge * hnportance for being treated. * The number of tabrets to be taken according to height * Horv to srvallorv the tablets. '! Possible side effect with management taken care of by the project with 7days after mectizan is swallowed. The reason and usefulness ofcensus update. The Hyper and Meso communities/villages were the major target for mobili zation and health education. The lesponse from these communities was satisfactory. This explains the reduction in the number of persons afraid to take Mecxtizan and anincrease in therapeutic coverage. The following weaknesses/constraints were observed: Lack of adequate IEC materials for mobili zation and health education, very fewdialogue structures members were involved in the mobilisation of their communities.There weas inadequate health staff commitment to project activities. Below are ways to improve mobilization of the target communities: - Supply of adequate IEC materials for mobilizationand health education. - Reinforcement and following up of mobili zation and health education sessions. - Ensure full implication and involvement of dialogue structures at all evels. - Hierarchy needs to address the issue of health staff commitment to theCDTI program. ) J I) L ttlrP l3 WHO APOC'.2-{ \orember 200.1 IP rL;H o FA 0) bD q) ork 0) lA l ,q 'Co tH E^ b q8 H di{ =rc!2aq E ,.s oo E € A B o 0) bD(! -t, oQ0)A d E Eoo o k p E z s F- si sNN {@ s s s N sF- scO sc- .+ .$ N l1i ON @ N O rO o)tr- a) o E q) 0) a E EoI 0) ! A c! o a o() o ! C)p ts z +r 14 il ca (! oF $ N @ @ il c- N(o O) N @ CO tr- ca .9o(!-1 HO(D r\ fr. - O N(O F- o)N .+ N $ OCO ca ooo(-) 0)(! z vN Oi@ @6.1 NO @rO O)@ ON L.o@ @ i9) EB oCtFs6. -1 a'So B389,doa9gE EHTA :E3aEEaozo ll * mco ca 0.) h.0(! trootr 0)0. a O O a O o o O O ca fr.EeB'E e B € Ef t 28Ae o O O O O a o O co tr gEEH E Eit N vl!) O (, (.0 rOs !$@ rO C @tr-.(. o -] () t a z E z cI t z. z z ftl z F z I C! +) oF I E I I I t l t. O c.1 0.) -o o z $6l C, o o. -{- .\ 0u(n o, AJU qJq\ (n S p o N \\ q) a ar s F aO 0) +) o +) +r citr4.o'i.i 9.HLa! o)li >cd o* tr.9 aE 8()t:l .al .+ =lc.i al t t. t-, I ti lj ii 1r U TE tj I r; t" t t, IL. t_l.Li tJ --r Ij : i -J -- riliJ,% Comments on: Attendance of female nenber-c of the meetings contntunity at health educittion Very poor, female menrbers s'ere nrost often found in their social groups and churches. Ferv of thern attended big groupings nrobilized in trre villages. Nlajority of rvomen are involve in farnr rvork and therefore paid Iittle or no attention to nreetings. ht general, how do )'ou rate the participation of female mentbers of tlrc contnruttityt meetings wlten CDTI issaes are being discussed (attendance, participation in the discussion etc). Generally, their participation is poor. We can only reach out to them during their social group meetings. fncentives provided by comntttnities for the CDDs Comrnunity mutuality and voluntary services offered free to the community is very difficult. Attrition of cDDs, rs attrition a problem for the prol'ect? addressed? ff yes, how is it l : :i Attrition was common in Kumba, Konye, and Mbonge health districts where some CDDs refused to distribute or abandoned distribution midway because of the non payment of state motivation for last year. Others who did not abandon withheld their treatment reportsfor the same reason. Other issues ,t l6 WHO/APOC, 2-l \ovenrber 2001 D I I 2.5. Capacity building ' Describe the adequacl-of available knolvledgeable manporver at all levels. - Where frequent transfers of trained staff occur, state rvhat the project is doing, or intends to do, to remedl' the situation. ( The ntost inpot'tant issue to de-ccribe is w'hat nleasures tvere taken to ensut'e adequate CDTI inplententatiott +vhere not enough knowledgeable ntitttpon'er was available or if staff are fi'equentll, transfet't'ed during the cout.se of the campaign). Training rvas mainly targeted. It rvas organized by the districts for both health personnel and CDD's 2.5.1 Training 2.5.1.1 Eefresher course for Chiefs ofPost 2.5.2 Training of CDDs and other Health staff for CDTI Z00b Six zones to serve as CDTI center were planned at health area level and all were achieved. The DNIO, CBH and DTS ensured proper and standard training in all the six training zones with particular emphasis on the following: A The Disease . Aetiology (Defrnition) . Mode of transmission and vector . Complication if not treated . Socio-economic impact of the Disease B The Treatment . The drug mectizan ( height range / number of tablets) . Non-eligbles . 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. C Reporting . The registers . Recording . Census up dating . Numbering of Houses o Registration of treatment a f t I t a I l l _-t I 2 t 2 ) -1 t7 WHOiAPOC, 24 \ovember 2003 LI . House Hold cards . Cotrttnunit5' treatment fomrs, cornrnunitl' self monitoring fornrs. Health At'ea treatment foltns. cellsus and mectizan Distribution surnmill'\' forms, Adverse reaction folrns, financial justification, etc. D Itupot'tance of intergrated surveillance of Disease and notification of Disease trnder surveillance. It is u'olth noting that in all the training centers, the District training was accolnpanied by a team from the Limbe Provincial Hospital E1'e'care Unit rvho in all cases, gave a lecture on visual Acuity. Hence encouraging people to always go for a self-test of their vision. Visual Acuity charts were finally pasted at strategic and convenient points for the population to go for self eye testing. rJ aiid E t t iJ J l8 WHO/APOC, 24 November 2004 n L ...l E o -o c) z $ c.l (-, o. o A br p e -a € a q p a, .s .t p aJ t* \ .E Bp c t s i t * j Ett Q o-:+L9 I ' (-) ._.1 I Ilo]E: c;i< I E c) (E! +) a eeQ +r o ! 0)p z .O € € cC O N N OO lr- t-. F. O aa N ac r O It an Oo c- cnl r,.- l E 0) 0) () slC) N@ @N @ @ @ c- rO @ O N @ @ @ (H ak 0)da dE< r<ts0)v +) Yi o!Y +iH r{(dolr tr z =6 ll \J o-t+trv: C) Fi -; L) t "9 O o O a o o O o O o o O o O O O O O O O O O a O O O {J 0) E q) -d() \oo\()EE O O O O O O O O O O q) =cddH:\€ H }.H -(dHAO 'cD lr+)oa!oCQH}28, 0)O E33 >\U ! a t \!) rr) O O O O \o N rr) N N ; \r) rr) O rO co N il O i N N (.c o) O (o co N CN € o E 0) o (.) 6\O o! E< rO i O rr)N Ncr) I(: rO o c\ oCO Q () E,l €o ts i o F !H c! +)a a Fl *9o()0) ,<k D 'Fl'(, CE 'H! (t o ! 0) .o a z O (D (9 o o O v O \tr cO O c\ o co 6l ! tr o) E 0) (D o s cr) s .+ c\ oJ o ko @ o z Lan z Azo fr] a J D ) I rn z C a F oz o F '-]rn z, oF -1 E-,t oF ; t E t t; t. (r) CD AJU !J \ (n s o\ AJ e c\\ cir q) 0a CN es {J € 0) 0) F aO +r o a q) +) -a)!H a) ! +J b! iF ior .l -cl -lFI t t I tr ti t; u nla U t] N 9 C I O O Table 6: Type of training undertaken (Tt'ck the boxes s'here -:pectfic training wa.q carried out during tlte reporting penod) Any other comments Trainings were targeted; CDDs rvere trained on just what was required of them (health education, census update, filling of registers, Mectizan@ distribution, detection of side effects and community self monitoring). Only health workers were trained on programme management and data analysis. High level skill is impacted to the CDDs drop out is high. Nobody wants to offer voluntary services to the program, many have dissatisfied, de- motivating and disgruntled. Trainees Type Of training CDD'S Other Cornmunity rnembers oov,b Cornrnunity supervisors Health Workers (frontline health facilities) N{OH staff or Other Political Leaders Others(spec rtr'.) Program management X 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 rvriting x x x x Primary Eye services care x x x x Visual acuity X x X X Others (specifv) X x x x 20 WHO APOC.24 Novenrber 200.1 t^ :: == a'-'= Y I z - = =->:\\-- L-- u = N :) z v N C c..l q aq) U a)q\ '*i CA sp o\ o H tr\\ a)(/) es a tr {J C! a CB o)ir Cd _l =1tul -l .rl -.1\t LJIJI\l +)l()I Frl +Jl u)t .rl6t a rn CD Ct iJ c) +) o ,F :T =- z-c O O c .o -aZ-D tr-(o ro @ D- ro r-l ro tr- @ @ TON tr- .$ O c6 F{N ri NN ri co $ ri c/)Io N sN NN q!lcdtrEEe3,E i X J= €'d Z,q I Y (o \o ro IO co @ .+ ro O)t'- @ f- r-{ r-.1 .+ ro @ O)\r) tr-N r-l LO co O) ro(o ro IoN CD NN \o o ll r o'o ob! o.(dda!r-9o>F3 - cY)s(o @ coq O tr- O)q @(o CO tr- (o CO tr- 6i tr- @ r-{ @ roq co @ @ n tr- D- $ r-{ + @ tr- O) c.j tr- ? *o =!,c7tr:'i9 ,J Q.Pz a O N TO r-i (o$ r-{ N c/] tr-NN Fl tr- co O) .+ $ <t co Fi @ CA @(o 00 CO ri @ t-{N O)Io ti t-{ @ Cf) ro r< N o) ro @l{i N -(9(gC), ,E: -i 0,-a Fv =S ^6 @lo @ @ @ O)$ O) c\ ro tr- t-O @ .+ @(o .+ (o ro IO o) c\l O ro (o Io c\ L- O) ca(o $N O)NN c-NN {J ao Fr q@ -o *dSE q ?oo cg+< a -5 6\A. o, -: a a N c6 co N @ CO lr) .+ O) tr-t- tr-O ri ro O) co tr- $ NIo Fi tr-$ Io$ ro € ca Ir)N N(o o) .$ ri rl @$ tr- co $ @ ro O)\$ ll r -: ^-L-.,I H H AO '= ho F o)<; 6 ee o \J C! s so sao \o rOq co o) s s o) @ 5\ H so so \o 6\o \o o\ o qO) o5 @h; t-E :J(!!E E= 3 ,E-i5z3' c'o <r ro riO t-{ (o o) IO Io$ $@ Io o(o tr-CO '+ a Co ;!-o <a 5 O CD r-{ -SIO r-{a r-l (o O) ro Io .s $@ rori O(0 tr-cr:s alol bd c!l -l RI <t @1 0) .H +) tr () qi.r O9,^OUI: *:55 8^:E=-?.2e-F 6 j a tad= O co ri .+ ro coO r-{ @ (0(o ro$ $@ l(: O(o @$$ )< 't\ z ;J Z 2 = ='t z = a Z & 2, I FoF J i , !-c o O cd ! r< o c) hT ! o c) ]J 0)p. a, {J \o ro g< =a)-sCElip '.1'dtr o.> 4 d H o)U rrO c! rr 0)0) bn'15 R t"< !0) )-{ (Jd 0)drv! CJ .HA -<tr xtud<- dho ^,v9dc)i: -'d;<trOCgO,A Fd hoo dA .A !U oL -O)(J '\.:! Pt-Q J v dc!c:Y ,- .- -gE;$ E 5 5.=o :!'R: --YL.-r-< hF C.: -;. .! 949t-tc l-I=.2 d' aN T I: I I I t ) t. Il I tI t- I 9N z s N C c.lN \ s tto & -q o 5 .. x$r\"4tr-I :-{ uEBr .Ed\iqtrU H$N3s st\ s. .Q) E T'R; E9i ttI $it ixE HBHPSEii5. Si S sia 'si: vs s $Hrs -ovtD :ar(! E"AH ti H tu € Rs f, EIs :$B d*H *\E EE$ rI{ \.xr ttttth bif EEi is E :$s iH3 !i s strrrrSP P$\ f i f- G) a O c) oti a. q) ! +) a C! q) O q) -d q) c)p. ooq) 0)! € 0) -o o ]J 0) p. 0) +i o li € oF C Fl X .d 0)! c. + 0. c c o c) c.) () oFD =\ tc ? !(, c-) a a. c) ! o a trl F4 .o a) H {J 0) a U) 0) +J oO O 0) 0) ,r 0) tr oa 0) CH L 0) +J oF X E o lt c)! 0)b! liq) o a. C! bo 0) 9' C! r< €Oq) o t<p. q) +) +) a 0) {J O c.) q) ti 0)p. >) o a) o bo o +) C! p. (! {J oF C C X c)]J(! 0)! € o ! 0s 2 a) :r {J o L -c z ! C) .oo ! q) ! 0)!iF C! c) f,n b- C C t a+ d + o ,( 0 , c 0 -l I z 0) , ti c) hD cJ '-0) () O !^ ar O\ =v t- c) L. a o,li hx cBl ol ot CJI -lol .91 -cl ol cdlf{l bn ol olil cl cgl ,rl +)l ,l 0)l al c6l!l 0) +) b.( +) a O i< E !!. o al o! cC a) {i ! JJ CE il G r-Ir I t_ I I l. t_ L L- ll IJ I) D g i lt I2.6.2 What are the causes of absenteeism? Sonre membels of the communitl' migrated to farrns zrnd fishing ports irr other areas of the project zone, 2.6.3 What are the reasons for refusals? The main reason for refusal rvas fear of the side effects of Nlectizan 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. There were no cases of severe side effects In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report j i J 23 WHO'APOC. 2{ Novenrbcr 200{ I tr: >>, J>= a :I :II -'-- --_J : ;i, OEJ!trox.=, "' a FACa !?c :h!<o rJoo. .lcd '!()C) *3..1 0: =a9o€9atACd 3E i c( <H(, oad^ q H c==#HLH.i(E(/)0:x(JQ-5ei* E3E.a" oJ: oJ-=E-!-c'6A H Ed 9oo .n(Sts -c -. i5 0J '!1 0.) ,\.aA a o o. a 1q g ^r P Hg.^xd h,E 3." N .aAd ^r D d H;():"0) o 0) 5.YoE cS I I I boq6ijbo l- ,.?o I I I I c.)a I hf, Iz ,C 9 N z !'N .{- c.t *.) .a) $ a. CJts{s\ q) :\ a * :-1 T Ja CJiJ c) \ b + p o \ v a AJ \i o Uq ho +)li op. c) 0) ]J hD li .d 0)!li OOo ! +J a frl a U) +) 0) 0) a)aLq) a C oa a oa(, 'cl =l -l_etFI T E I r: r; t I j 'I ) I -/ I I I a :I v:-^ f >v -c C) 'T r-- .\ >- .E ^i s c- cc x ^\ aa ^\ 9 aa Y cc co ll- i /s !a bl < tv O ^\ N 5\ :< C.q c\ a\] @(! C\ ^\ ooq 6 5\ q @ \o { C ll r H f:1 r fb! o(! c! go\ oo Fo \- t-- \c 3\ co9 t\.tv c\ v_1 N co sO c.l ;<s j F- \c t--6 O F- q? lIl tr- .\ F- ; tr- ra o o6!9 -.o -aA ao OJq co Ir-r- 6l co o\ ca oo t-- r- co \o $ o' (\ r- s c.l (o o oq @(o N N lo @ roN -o\f:I to(o -Egc o., , E'i.,iEEq < gf Fv \o $ c! @ o.lr- @ @ 6l ri. @ \o o\\o(\ O @ oo co l-- o\ ONN q N O N t-NN !:9! -3 3.:, €€.e€5Eae-7- 3 ; Cqoc) r- <f t--r- r-- o\ $$ .f (\ t-- ce a-r- a.t O v tr- 6l a-s o\ ce N <. ,.ilo v @ rr) $ U) o) bo(g o O) I Q ll r tr5 tri r'I hD L!\o O \o O \o o\O \o \o OO o\ON A aiooIt EG rrl39 99eErO^><5-rd c\o o\ o\O o\O 6\OO o\ON o rd t:E 3_k c b.0YQ=og ; EtE t-t an r\ c.l r-cn r- @tr-s s _tr9(!cJU =2D)40 < gA E<v r- co c- r- tr- @D-v @ D-$ =.-qt6: b E *.:,P-x9-- ec^<.-r'lz=33: -aEoa-=L L- ts - = -5 U F- c- r- rr @tr- .+ cD c-s @ OcCN OC}I NO al a al cal rj)o ^l a al t\ it q O al cil c1l =t N !E ! z IGl t/) c'.t ^jaA .9 +) d a) .-.. j ft !v *)ots \cgPb JAG,U Pc> ots sD ".sEEE ! E 8Eoc!cd Ed E o.9 +r oJ!v;c!o) Xo+' .Y.o o : b'cdb"X o)CJHts{(JorI .;lrhD *5tE oii./) F<:+)gt o) .a Ee€,O E.ol H Y* o:lcofi El ..1r: €l c!c il Ioo;1tr B 3l t EHS € P"Ec!c(o) +) !-r-Etr 9'+)96xE c.rdsktrk P HE +) c- Q-oEg :Y!+J .^csC<O() .r.d ro tr-'o ,.1 l. tr v ^r.iN "l Iil- ^l Lu?l c.: alE ; R ti I i; I It I : i) I) I I 2-7. Ordering, storage and delivery of ivermectin trIectizan@ ordered/applied for b-r' - (please tick the appropriate answ'et) MOH D { WHO f] UNICEFtr NGDOtr Other' (please speciS') n'Iectizan@ delivered by - Qlease tick the appropilate an-qwet) MOH f] ./ WHO f] UNICEFE NGDOf] Other (please specif,') Please describe horv Nlectizan@ is ordered and horv it gets to the communities This year's Mectizan@ for the project was jointly ordered by the the NGDO and Southwest Provincial Special Fund for Health 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 handed to the NGDO who latter on transferred the drugs to the Southwest Provincial Special Fund for Health. From there the drugs were distributed it to the various health districts through the regular drug delivery system. The Nurses in charge of each health area collected Mectizan@ from the districts according to the request b5'the CDD's of each communit),. This year drugs were delivered on time and in sufficient quantity. Stock management of the drugs was good at all levels. Table 10: Mectizan@ Inventory (Please add more rows if necessary) AII data for the completion of this table is not yet available. The table rvill be complete in the annual r.eport. { , , State/District ILGA Number of Mectizano tablets Requested Boxes Received tablets Used Lost Wasted Expired Remaining BANGEM 50 000 50 000 BUEA 112 000 112 000 KONYE 95 500 95 500 KUMBA r50 000 150 000 LIMBE 117 000 117 000 MBONGE 136 000 136 000 MLIrtJKA 148 000 148 000 NGUTI 68 000 68 000 TIKO llr 000 111 000 TOMBEL 53 500 53 500 TOTAL I 04r 000 I 041 000 26 \!' HO'A POC. 24 r.'ovember 200.1 a-) !j ;I ti How are the remaining Ivermectin tablets collected and where are they kept? The lemairting Ivernrectin tablets are collected through the sanle chapnel in a re\Iel'se urannel'i from CDDs to health centre chief of post, through the clistrict to the ceutral drug store of the essential drug programme at the province for storage. State activities under Ivermectin delivery that are being carried out by'health care personnel in the project area. The health care personuel carried out the follorving activities under Ivermectin delivery. 1. Mectizan requests 2. Transportation of Mectizan@ from the province to the health districts and to the health areas. 3. Monitor and supervise the distribution of Mectizan@ to cDDs.4. Storage and stock management of Mectizan@ ie Reporting on Mectizan@ - Any other comments Stock balance at the start of distribution in Jan 2006 EDP unit was 1 027 500 tablets andthe balance in stock as of July B1 2006 is 36 500 tablets. a : a I j i J l I - t.::'-- .rr 27 WHO.A,POC. 24 November 200J 2.8. Community self-monitoring and Stakeholders IVIeeting Has an;'training (of trainet'-.) fot'cotnmunity -self-nonitoring been done in the proJ'ect area? Yes. If so fi'hen? During training on CDTI in S!\- I project zone. Table 11: Comrnunity self-monitoring and Stakeholders Nleeting Gdd row,s if needed) 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. Communities have no interest on CSM and SHM. By the time of writing this report, no community self monitoring sessions had been carried out. District/ 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 rneeting (SHM) I gaNcBu I BUEA KONryE KUMBA LIMBE MBONGE MTryUKA NGUTI TIKO TOMBEL 32 l3 54 lros 6 ao is s+ 15 60 TOTAL 478 28 WHO APO(',2{ \orember 200J D aT Ii tI i, E 2.9. Supervision 2.9-7. Provide a flow chart of supervision hierarchy Central Level - NOTF - NGDO Health Area Level - Health Centre nurse I J -2 j t 1 ! :l Intermediary level - Provincial delegate - Provincial Chief of Service of Communitv Health - Oncho Project Coordinator - Finance Officer - District Medical Officer - Chief of Bureau Health - Chief of Bureau of Administration and Finance - Chief Medical Officer of District Hospital Peripheral Level Community - CDD - Community members 29 WHO APOC.2.l Norember 200{ a2-9-2. what were the main issues identified during supervision? Full integrarion oleve c:lre into CDTI is still on going. Sonre nervlt'recruited CDDs still have problenrs in filling the registers. 2.9.3. Was a supervision checklist used? There rvas effective supervision in most of the health districts, and well developed supen'ision checklists in the districts tvere used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Poor record keeping. Health centre staffs are overloaded with a lot of activities 2.9.5- was feedback given to the person or groups supervised? Yes 2.9-6. How was the feedback used to improve the overall performance of theproject? High level commitment from health staffs, and CDDs. The project did not suffer CDDs attrition this year. SECTION 3: Support to CDTI 3.1. Equipment Table 12: status of equipment (please add more rows ifnecessary) *Condition of the equipment (F repairable, WO=Written ofO '=Functional, CNFR=Currently non-functional but I I I I t. t ! J Source Type of equipment APOC MOH DISTRICT ILGA NGDO Others No Condrtro n No. Conditio n No. Condrtio n No Conditro n No Conditron 1. Vehicle 2 Good 2 Good 2 Good 2. Motor (s) 30 L7 20 6 3. Com uter(s) 2 10 12 1 4. Prin ter(s) 1 10 12 1 5.P ier (s) 1 1 10 1 6. Fax Machine 1 7. Others a) Fli chart stand 1 3 b) Overhead ector 1 c 30 \\'HO APOC, 2{ \ovembcr 200.1 Hov does the pro1'ect intend to naintain ancl replace existing equipnte1t itncl otJter maten'al-.:? The equiptnents are ttsecl also fol other prograrns and the cost of mainte,ance isshared rvith other projects. The project ivilirequest from its partpers to r.eplaceexisting equiprnent and othel materials. r-t:t,t za 3l \\'HOTAPOC, 2{ November 2004 D 3.2. Financial contributions of the partners and comnrunities Table 13: Financizrl contributions bv all partnels for the last thr.ee \.eal.s NGDO partner(s) Others If 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) 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period foreach activity listed. write the amount expended in US dollars-using thecurrent United Nations exchange rate to local currency. Indictate exchangerate used here Contributor Year 7 (pronde the pertod ) Year 2 (pro+tde the pertod) Year 3 (prodde rhe TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash l Budgete d (us$) i TOTAL Cash Release d (US$) TOTAL Cash Budgete d (us$) TOTAL Cash Release d (US NIOH (Central + ProvinciaUStat e) MOH (D istrict/LGA) l Local NGDO(s) ( if any) T I i a) b) Communities APOC Trust Fund TOTAL 32 WHO/APOC, 2-l \or.ember 200{ - Table 1-1: Indicate horv much the project spent for each activitl'listed belos' during the reporting period Any comments or explanations? The total number of persons treated is both in hypo and meso/hyper endemic communities. Total in hypo communities is 88 257 and meso/ hyper endemic communities 258 592 SECTION 4: Sustainability of CDTI 4.1. Internali independent participatory monitoringi Evaluation i J I Activity Expenditur e ($ us) Source(s) of funding Drug deliverl, from NOTF HQ area to central collection point of community SSI Side effects mana gement Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CD_Ds 4nd distribution Internal mo_qrlor_lng of CDTI activities A{voc4gy yr_qftq_lo trqqlth an{ pqli tical authorities IEC materials Summary (fgpqfliqg) forms for treat!qe+_! Vehicles/ Motorcycles/ bicycles rnaintenance Office Equipment (e.g computers, printers etc) Others District Temporal Staff SSI SSI SSI MOH MOH SSI SSI SSI MOH NOTF MOH SSI wHo SSI Provincial Activities SSI Communication SSI Planning Evaluation meetin gs SSI Staff cost SSI Launchin ob SSI Insurance of Bikes and Vehicle SSI External TOTAL JJ WHO'APOC. 2.1 \ovember 200{ |l 4.1.1 Was Monitoring/evaluation carried out during the reporting period?(tick any of the follon'ing which are applicable) Year I Participatol'\, Independent N[id Term Sustainabilitv Evaluation monrtoung _Not applicable 5 1-ear Sustainability Evaluation No Internal l\{onitoring by NOTF Other Evaluation by other par.tner.sone 4.1.2. What were the recommendations? Mid tenn sustainability evaluation project report is still awaited. 4.1.3. How have they been implemented? Not applicable. 4.2- sustainabirity of projects: plan and set targets (mandatory at Yr B) was the project evaluated during the reporting period?_yEs_ Was a sustainability plan written? YES When was the sustainability plan submitted?_2008_ What arrangements have been made to sustain CDTI after APOC funding ceasesin terms of: 4.2.L. 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 U t_ 34 WHO'APOC, 2-1 November 200i n RECO]\INIENDATIONS I T I I t. I t NDATIONS FOR THE PROVINCIAL LEVELRECOJ}T]\TE LEVEL OF IIIIPLE]\,IENTATION AND INTEGRA.TION 'Planning' l. The roles of each partner in planning and other CDTI activities should be clearly defined and adhered to based on their project proposal. 2. All parties should be involved in the financial planning. 3. Specific 3 year plans for sustainability should be made and followed up a 5 or l0 lanimmediatel b A schedule/document issued as a reminder to all partners olt their roles and responsibility rvas distributed by the PDPH. A detailed integrated Sustainability Health plan containing all CDTI activities is available at all levels. Specific 3 year plans for sustainability rvas drawn in 2003 at all levels. ti ri I 35 WHO APOC. 2{ \ovenrber 2004 tE I t ' r\ Ion i tori n g/Su pen,is ion' l. Supen isorl' visits should be planned, tar_qeted and integrated * ith other pHC programmes. 2. Supen'isory clteck lists should be a 'shared type' or integrated checklist. so that it could be used for most pHC activities carried out at this level. 3. All Health progranlmes should be involved in CDTI activities. 4. Funds from dependable sources available for these activities, especially goverrrments orvn. Supen'isory, r,isits are planned, targeted and integrated rvith other pHC prograntntes at all levels. We had some stock of HESAM materials from NOCP. ting planned & targeted Monitoring/Supen,ision. Perfornrance this treatment cycle has been greatly improved. Integrated checklists is available at all levels. Government funds for activities was provided at all levels. Reports indica Mectizan order/ inventory forms at the Provincial Essential drug pharmacy, Reports reflecting timely arrival and distribution of Mectizan are available 'Ntlectizan procurement a nd Distribution, l. Mectizan ordering, procurement and storage should entirely be the responsibility of the Province through the Essential Drug programme. 2. SSI should empower the province to enable them take up this task. 3. NOCP should ensures that the right quantity of mectizan gets to the projects well ahead of time for distribution to the communities respected theseThe concern recommendations. out integrated and ted trainin Districts carried lrd ownership of program is greatlyimproved especially the endemic communities. The results reflect their performance. Commitment of the various stake holders We intensified HESAM at all levels. ' Training/I{ESAM'l. Training should be more focused to needs. 2. Training should be integrated with other PHC activities. HESAM activities properly planned and implemented. J- Appropriate HESAM materials shoulcl be available for use. 2 should be effectively 36 WHO..{POC. 2{ Novembcr 200-l I'lntegration of support activities.' l. Integration of CDTI inro orhc-r PHC activities like EPI, HI\r-AIDs. erc ar rhis level. Provincial Schedules of inregrated support activities s'ith CDTTI in PHC progranrs are drarvn each year during planning meetings arrd strictly respected ,uvithin each APOC has replaced the project car as strongly recommended by the extemal evaluators in 2003. We have just received a 4x4 HILUX from WHO CR in Cameroon. We respected these recommendationsl. Appropriate financial planning and budgeting of CDTI activities should be carried out at this level and should be reflected in the yearly Estimates of Recurrent expenditure for the delegation. 2. NOCP should ensure that Government commitment for all projects in Cameroun; torvards CDTI sustainability is maintained. 3. Contributions of the various partners/stake holders at this level should be clearly spelt out. 4. The project accountant should move dorvn to Beau from Yaounde, or the Provincial Chief of Service for Admin and Finance should take up the task of accounting for all aspects of CDTI at this level. 5. Delegate and SSI should put in place a process that is sustainable, more realistic and less complicated for fund management. 'Finance' The Provincial Delegate of Health has taken full responsibilities in Maintenance ect vehicles/motorbikesand fuelin of ' Transport/other Resources, l. Maintenance and fueling vehicle/motorbikes should be planned with Provincial funding. 2. Realistic plans for the replacement of vehicles should be made. 3. As the project is in its 5th year, ancl the fact that the vehicle has been efficiently managed even after the motor accident last year. Replacemenr by ApOC is strongly recommended. of project properly 31 WHO APOC,2-l \orenrber 200J D IT I r I ' Human Resources' l. The Provincial Oncho Task force ream should become ntore involved uith CDTI actlvltles as li of tlre SWI 4.3.2 u'ell as the operational nrnning roject. t. 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plansfor complete integration: 4.3.1. Ivermectin delivery mechanisms, This activity is integrated into the drug supply system of the MOH through the essential drug program. The South west Special fund for health is in charge of storage and delivery of Mectizan in the districts. 4.3.2. Training To minimize cost, all the district training trainings are integrated. This year EyeCare was carried out during CDTI training. Informatfon on other healthprogram such as Routine Immunization, Roll Back Malaria, Leprosy,Tuberculosis etc are usually carried out simultaneously. Coordination meetinis at District and Provincial level ensure that issues concerning all programs aiediscussed. L, Joint supervision and monitoring with other programs During CDTI activities for instance, some time is allocated to supervise otherprograms as already enumerated above. It must however be stated thatsometimes time and financial constraints make it difficult for effective supervision of other activities. Provincial and especially District and Health staff are so polyvalent that they implement all activities at all their level. Thetransport means avairabre are used for the imprementation of alr hearthprograms. 4.3.3. Release of funds for project activities MoH contribution in cash is coming on very slorvly, SSI supports actiyities arall level s.ith funds. ri I L tj I At the beginning of each vear ar.r operational plan is drau'n Scheduling and assigning each person on their actir.iries. Micro inte ed lan of action Therapeutic coverage has improved after post APOC period rapidly 'Coverage' l. Therapeutic co\/erage should be improved upon. 2. The issue of treatnlent in Hypo- endemic areas should be addressed by NOCP /MoPH NOCP/ MoPH has no objection distributing in the hypo zones. 38 \\'tlo APOC, 2{ \or.enrber 200J l" t, l LJ L 4.3.5. Is CDTI included in the PHC budget? 4.3.6 The district artd health areas state budget carries a specific line on supenision o all health activities and CDTI is part of the nrininrum health package at rhese level. But not all the health areas have budget some are even run private bodies. The budget does not specifically carry a line on CDTI. The introductiop of a line for CDTI can only be done at Central level by the NorF office. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The Expanded Program of Immunization (EpI), Roll Back Maria, Leprosy, Tuberculosis have benefited from the use of motorbikes at health area levels for supervision of those activities and the vehicle at provincial level. CDDs trained through CDTI initiative have become the link betrveen the communities and health structures and are therefore used by all health programs to reach the community. Recently they were trained to do visual acuity and most of them carried out the activity. They are also used by EpI to register children nervly bom in the community so as to recruit them for vaccination. 4.3.7. Describe others issues considered in the integration of CDTI. currently the eye care program is being integrated into GDTI program at all level. 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. 4.4.2. Horv rvere the results applied in the project? Not applicable. 39 \\'tlo APOC. 24 \orember 200{ D s.J a =U z s c.l c c) L o ! o L o O c) o o (AL c,) O$ fo Jad) l) -rL\Ooc)>oo_ --SYrt.> \LCJO €g',F'(!-A tr c, =€o-c6: E '3i >.rh d.= vgH F €0)eHc.)LLJ6 >.'E E = €LF:a '=9tr!? =HOq2-)?|o.utr E 0>_q-3\*aY,*VH?o (!U = O c)L c.) F IJ(, r< ,o a .9 t o c) r= 'a =c) .= a/) ,, e) 0)= c)= ;- <) - t) OCoc! o N TA a) ln o ci c_) o () () bo cdF o (! c) oo 6d oo tr o C) H(! o =3,J 'tF :J: !-.}V T= 'J o.i) L EO af g.O =i oX :-o U- cl.I d ra .FOLthoa c)-.= i'j c-> .- <aF2E;; s,{ >9P< o.?u)o* Hfl c-)Inj- * i:2 ! 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"'d e2 a O El> .\PF(J b95orE(, t+-. ooc) .- (u u H 6t l-'cdEsH9 '--.:t!>o-6U^d- 'iq=5Ecduj .E U e.e f..E 3) .r' c,.l ts '-' ot 'X ^\xnr!i^HEe E'&r E'i -.= 0) Ss 0) () =Y;\ > ii o.> b =i 8E il S B (n a o(-) o6 o3 arz ELLC)0) ,eo(E Sb o-3O-XAe - c.=a9r';;tr'c h 6 osEisg3rr 6€.E:: (.) q. 2, =,EQ ^Ct-aOiil +F q5E H A:EU _i = aza .: =?E C)A ^HCO (!\JLLooC)E c.))C)-0)bO f,D ro iO \vLNL = 9o,9O oO b - of- o .J2 .J != a 'r. .) I t G I L t E t SECTION 6: Unique features of the project/other matters t i , 42 WHO, APOC, 24 \ovember 200J