Africanprogramme for Onchocerctasts Control (Apoc)
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RESERVED FOR PROTECT LOGO/HEADING COUNTRYAIOTF: CAMEROON Proiect Name: CDTI SW 2 Approval vearz 1999 Launchins vegr: 2000 Renortins Period: From: JANUARY 2008 To: DECEMBER 2008 (Month/Year) ( Mont!{eq) Proiectvearofthisrenort: (circleone) I 2 3 4 5 6 7(8) 9 l0 Date submitted: NGDO qartner: "l"""uivFzoog Sightsavers International South West 2 CDTI Project Report 2008 - Year 8. ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3l January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I I RECU LE I S F[,;, ?ur], APOC iDIR ANNUAL I'II().I Ii(]'I"IIICHNICAL REPORT 't'o TECHNICAL CONSU l.',l'A]'tvE CoMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriat space. OFFICERS to sign the rePort: Country: CAMEROON National Coordinator Name: Dr. Ntep Marcelline S l) u b Date: . ..?:.+/ c Ail 9ou R Regional Delegate Name: Dr. Chu + C( z z a tu Signature: n rJ ( Date 6t @ RY oF I DE LA NGDO Representative Name: Dr. Oye Joseph E Signature: .... Date:' g 2 JAN. u0g Regional Oncho Coordinator Name: Mr. Ebongo Signature: Date: 51-.12-Z This report has been prepared by Name : Mr. Ebongo Peter Designation:.OPC SWII Signature: *1.- ,l 1l Table of contents Acronyms .v Definitions vi FOLLOW UP ON TCC RECOMMENDATIONS. 7 Executive Summary.. 8 SECTION I : Background information......... 9 1.1. GrrueRruINFoRMATroN.................... 9 1.1.1 Description of the project...... 9 Location..... 9 1. 1. 2. Pa rtnership ............. It 2. PopuurroN.............. l3 SECTION 2: Implementation of CDTI 15 2.1. Tnmrnm oF ACTIVITIES............... l5 2.2. Aovocacv l6 2.3. MoaruzetroN, SENSITIZATToN AND HEALTH EDUCATIoN oF AT RISK COMMUNITIES ........... 16 2.4. ColryruurY TNVoLVEMENT.... l8 2.5. CepaCrrv BUILDING l9 2.6. TRraflqrNTS............. 22 2.6.1. Treatment figures 22 2.6.2.1 What are the causes of absenteeism?. 25 2.6.2.2 What are the reasons for refusals?......... 25 2.6.4.1 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table B) the required 25 2.6.5. Trend of treatment achievement from CDTI project inception to the current ..........27 2.7. Onoeruruc, sroRAGE AND DEuvERy oF rvERMECTIN................. ..........28 2.8. Cot4t"tur{rry sELF-MoNrroRrNG ano SrerEHoLDERS Mernruc. ..........30 2.9. SupeRvrsroN.........,,, .... ....30 2.9.1. Provide a flow chart of supervision 30 2.9.2. What were the main issues identified during supervision? 3l . Poor filling of registers and treatment reports .........31 2.9.3. Was a supervision checklist used? 3t Supervision check list was used in some health districts, though no routinely 3I 2.9.4. What were the outcomes at each level of CDTI i m plementation su peruision ?.............. 31 2.9.5. Was feedback given to the peuon or groups supervised?....st 2.9.6. How was the feedback used to improve the overall performance of the project? 32 SECTION 3. Support to CDTI.... .........32 3.1. Equnurrur............... .........32 3.2. Fruerucml coNTRTBUTToNS oF THE pARTNERS AND coMMUNITTES .........JJ 3.3. OrnrR FoRMS oF coMMUNrry suppoRT............. .........34 3.4. ExpelrorruRE PER AcrrvrrY.. .........34 I SECTION 4: Sustainability of CDTI 35 4.1. Irurrnruel; INDEPENDENT PARTICIPATORY MONITORINC ; EvalunrloN ...... 35 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) -----....... 4.1.2. What were the recommendations 4.1.3. How have they been implemented?...... 4.2. SusrarrunBlllTy oF eRoJECTS: PLAN AND SETTARGETS (uaruoeroRY AT Yn 3) 4.2.1. Planning at all relevant levels?........ 4.2.2. Funds... 4.2.3 Transport (replacement and maintenance) 4,2.4. Other resources...................... 4.2.5. To what extent has the plan been implemented 4.3. IrurrcRRrtoN-. .,. .. 4.3.1. Ivermectin delivery mechanisms.. 4.3.2. Training. 37 4.3.3. loint supervision and monitoring with other pro9rams..........38 4.3.5. Is CDTI included in the PHC budget?........... ...............-r8 4.3,6, Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ................... -38 4.3.7. Describe other issues considered in the integration of CDTI. 39 4.4. OprnATroNAL RESEARCH ....................39 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.... 39 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities........... SECTION 6: Unique features of the projecVother matters.. Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organ ization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization Defin itions (,) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking) (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treafinent Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the ma<imum number of people to be treated annually in meso/hyper endemic areas within the project are4 ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d 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). ("r) Geographical coverase: 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). (vrD Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viiD Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ir.) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any commturity- based health intervention programme), with a view to ensuring that the prografirme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 26 Numher of TCC ACITONS TANEN BY THE PROJECT FOR rcC/APOC Recontnend RECOMMENDATT MGT USE dioninthe oNs ONLY Report Scale up Discussions have been held with NOTF and (i) advocacy even letters have been written to the towards Minister of Health on this issue. This is an government to ongoing activity and results cannot be take care of measured immediately. CDD incentives (!t ) Scale up The health districts and health areas advocacy educated on the impoftance of CSM. They towards were also refreshed on carrying out the communities to activity. Despite these however CSM was make CSM still not done. lust like CDDs monitors are effective requesting for financial motivation. Even health staff do not seem interested in this activity. (iii) Take concrete The region during planning meetings with actions to the health districts pointed out those increase communities with low therapeutic coverage. therapeutic This was to enable the districts intensify coverage in sensitization in these communities. areas where However, it was discovered during the performance is supervision that this had not taken place low yet. The coordinator then visited communities with low coverage in Afap, Mkpot and Bakwelle in Afap health areas (Eyumojock Health District). It was agreed at the end of the treatment rycle that Mectizan@ tablets be returned to the concerned communities for treatment to continue for another week. The Regional Delegate of Public Health officially requested the district medical officers of Eyumojock and Ekondo Titi to do everything to increase therapeutic coverage in