I I I I I JJRESERVED FOR THE PROJECT USE I I I COUNTRY/l.,lOTF: Project: Comeroon South West II Approval year: 1999 Launching year: 20@ Year being reported: Period being reported: Yeor 3 (2002) Apri! 2@2 - Morch 2OO3 Prepared on: NGDO partner: zfh August 2OO3 Sight Sovers Internotionol \v--- t & v) ***"*I"r*:. LL- + / CnDeA C.'A G'f 6P Sttt 6l-o o.JbslL} - I ,l 1,, BECU ',-,, .\l*L 4e 0 I sEP, 2003 APOC/Dffi I PROJECT ANNUALREPORT 2 I Table of contents LIST OF ACROIYYMS FOLLOW UP ON TCC RECOMMENDATIONS SUMMARY SECTION I : BACKGROUND INFORIVIATION l. l. GTNSRAL TNFoRMATToN l.l.L Description of the project (Very briefly) 1.1.2. Partnership 1.2. Popur-artoNANDHEALTHsysrEM SECTION 2: IMPLEMENTATION OF CDTI 2.I. PSRIoooTACTIVITIES 2.2. ORoERlrrc, SToRAGEANDDELIVERyoFvERMECTIN 2.3. AovocecyexoSsNslrzATIoN 2.4. Mos[zAnoN AND HEALTH EDUCATIoN oF AT RISK coMMLrNrrIES 2.5. COTTNT,TUIUTES INVOLVEMENTINDECISION-MAKING 2.6. CepecllyBUILDING 2.6.1. Training 2.6.2. Equipment and human resources 2.7. TnserrvffiNTs 2.7.1. Treatmentfigures 2.7.2. Trend of treatment achievementfrom CDTI project inception to the current year 2.8. SupsRvrsroN 2.8.1. Supervision o/ health personnel was achieved 2.8.2. Supervision of CDDs and distributionswas achieved 2.8.3. Quality of records was ensured 2.8.4. The results of supervision were ufilized SECTION 3: SUPPORT TO CDTI 3.I. FngaNcTaT CoNTRIBUTIoNs oF TTIE PARTNERS ANDCoMMUMTIEs 3.2. OrrmRponvsoFCoMMUMTy suppoRT 3.3. Cosr pen AcTrvrry SECTION 4: SUSTAINABILITY OF CDTI 4.1. hrrenNer-; TNDErENDENT pARTICIpAToRy MoMToRING; Evaruerroll 4.2. ColrytururysELF-MoMToRTNG 4.3. SusrenIABILITy oF pRoJECTS: pLAN AND sET TARGETS 4.4. IvrrcnanroN sECTroN 5: DrSCUSsroN, coNCLUsroNs & RECOMMEI\IDATrONS APPENDIX J I Llst of actonyms APOC African Program for Onchocerciasis Control ATO Annual Treatment Objective CBAF Chief of Bureau for Administration and Finance CBH Chief of Bureau Health CDD Community Directed Distributors CDTI Community Directed Treatment with Ivermectin CMO Chief Medical Officer DMO District Medical Officer DTS District Temporary Staff FLHF First Line Health Facility (health centre) HIPC Highly Indebted Poor Country initiative HSAM Health Education, Sensitisation, Advocacy and Mobilisation IEC Information Education Communication MoH Ministry of Public Health NGDO Non Governmental Development Organisation NGO Non Governmental Organisation NOTF National Onchocerciasis Task Force OPC Onchocerciasis Project Co-ordinator REA Rapid Epidemiological Assessment REMO Rapid Epidemiological mapping of Onchocerciasis SSI Sight Savers International sw2/swrr South West Two CDTI Project TCC Technical Consultative Committee UTG Ultimate Treatment Goal wHo World Health Organisation 4 FOLLOW UP O]I TGC RECOHTE]IDATIO]IS The last TCC that dwelled on South West Two Project was TCC 15. Recommendations as such were not made. Instead issues were raised and complementary information requested. The table below details the issues and information provided by the project. Tahle i: Status of the last recommcndations s/N .rsSUES RAISDD INNONUITTON PROVIDDD BY T\{E PRo.'tcT AT TCC 75 1 Misappropiated The funds misappropriated by the then acting DMO funds of Mamfe Health District, Dr Andoseh Victor had been paid back and placed in the Bank as of tlre 26n September 2OO2. As soon as this happened APOC was informed. 2 Stolen Vehicles The insurance compa.ny had already paid the WHO office in Yaounde for the two vehicles (Southwest 1 and Southwest 2 Project vehicles) that were stolen. WHO has supplied Southwest 2 project with another vehicle as a replacement. 3 SAEs their In the first year of distribution Dr Bisseck diagrnsis ard. investigated upon the cases of deaths that occurred management in the project a.rea. Following a mission by Dr Bisseck to investigate about the cause of the deaths, all the deaths were classified as not due to Mectizan except one of the cases for whom no information was obtained and so no definite statement could be made. In the second year the only case of death reported during the Mectizan@ distribution period was that of an 11 year old boy who had malaria with severe head ache before taking Mectizan@. He was not confirmed as having died from Mectizan@ so we did not see the need to report his case as an SAE. No where in our reports did we ever say the project was suspended due to SAE. SSI suspended treatment of remote communities and did treat these communities after testing individuals. This entailed trekking in the health areas concerned for about fifty days. Only persons without Loa loa were treated since there was no possible means of managrng any SAE if it occurred. 4 Details of This was not requested in the previous guidelines for iuermectin reeipt reporting. However by the time this report was and. usage. written, Mectizan@ had been requested for the Southwest 2 project just once and this was in 2OOl. We received 601,000 tablets of Mectizan@ in September 2000, after distribution 341,908 tablets were left which were to expire in July 2OOl. Haute Sanaga and SWI used these tablets in exchange for SWl tablets, which were to expire in September of 2OO2. For the second distribution we uired 5 254,280 tablets. Given that this exchange could be made there was no need to request for more drugs but a request form was dully filled for tracking of the drugs. Second year's distribution Tablets Available: 341,908 Health Tablets Tablets Tablets district supplied used returned Fontem 110,000 74,397 33,895 Mamfe 91,474 48,3O7 40,145 Akwaya 70,ooo 17,862 40,489 Ekondo Titi 70,000 22,96r 45,951 Mundemba 60,000 26,046 33,342 TotaI 189,573 Since all the district were not distributing at the same time, drugs brought in by one district was eventually transferred to the next district. Thus the number of tablets moving around is greater than those really available. Total of tablets glven to other projects: Haute Sanaga 35,000 HKI 46,500 Tablets left in the office of the co-ordinator at the provincial delegation at the end of 2.a round of distribution: 73,297 6 Summary South West Two CDTI activities started in July and September 2OO2 with Ekondo Titi and Fontem Health district respectively taking the lead. As usual activities started with re-trainings at health area and community levels. Provincial and SSI stalfjointly supervised these trainings that all took place at the various district health services. After re-training of the health centre nurses, they on their part re-trained the CDDs. In some areas CDD training took place at the health centre. In other places the training took place in a public place within the village (primary school or chiefs palace). In Akwaya CDDs were all trained at the district health service and not within their communities. Though done at the district this training was carried out by the health area nurses and health area supervisors. It was done this way in Akwaya because of the peculiarities of the health district. Of the four health areas that the district has just two are functional with health centres, one of which has a new chief of post. In the other two, CDTI activities are supervised by teachers and other educated and enthusiastic community people. Effective supervision of these non health personnel during re-training CDDs would have been very difficult for just the staff of three, of the district health service in such a terrain where getting to every village is on foot through forest paths. Also training all CDDs together at a common place helped harmonise the training. After this re-training the CDDs were all given their stock of Mectizan@ tablets. In all, 39 health district stalf, 97 health a-rea nurses and 569 CDDs were trained or re-trained on CDTI. In most health areas as soon as the nurses were trained health education within the communities started. This health education went on all through to treatment. Closely following training was the registration update and treatment. This year health education was more intense and involved many more health sta-ff than in the past two years. Treatment was supervised by the district as well as provincial and SSI staff. During these supervisions megaphones were used on vehicles to give heatth education within the communities. Treatment in hyper and meso endemic villages was mostly door-to-door. In hypo endemic villages it was clinic based. This third yeff, out of 183,756 persons registered in all ttre 452 hyper and meso endemic villages a total of 120,500 were treated giving a treatment coverage rate of 65.60/o and a geographical coverage rate of lOOo/o. In hypo endemic villages a total of 7,262 persons were treated. No case of severe side effect was recorded this third year. The few cases of mild and moderate side effects that occurred were treated free of charges. Community participation was good, though most CDDs were males. Community support for CDDs is still a serious issue as the community members still do no not give any support to their cDDs. Though not up to what is in the letter of agreement, government support to this project has started trickling in. This year the Ministry of Public Health provided some equipment to the project area. Plans are underway for CDDs to be motivated financially. Funding is also expected from the Highly Indebted Poor Country Initiative funds. A budget has already been submitted to the Ministry of Public Health in that respect. In April 2003 APOC carried out a mid term sustainability evaluation of the project. The evaluation revealed that the project is not moving towards 7 sustainability.