Organisation of SUFI Phase 2 Home Visit in Cameroon

By Helen Ayamba, Email: camlink99@gmail.com 2,089,647 home visits will be covered by 4354 Community Health Workers (CHWs) throughout Cameroon during the second phase of SUFI. With SUFI Phase 2 strategy the target coverage is estimated to be about 80% of the households and all CSOs would have done at least two visits per year before December 2015. The number of Community Health Workers per district depends on the demographic weight. An evaluation of Phase 1 led to re-arrangement of the strategy for Phase 2. Pregnant women and children between 0 to 5 years constitute 52 % of the target population to be reached.

The community health workers will identify home with malaria cases to be handled with the support of the district health service. While Plan will send reports to the Global Fund, it will also assure the conception, definition and elaboration of the norms for execution of the programme.At the regional level, the CSO of the district sign and manage collaboration contracts at grassroots and funds for paying CSOs and CHWs will come from Plan International Cameroon. The role of the CSO is to carry out advocacy within the administrative locality and assure payment of the community health workers. The care delivery of identified persons during home visits is approved by the district CSO. A health community worker is expected to spend at least one hour for a home visit and has to accomplish at least two (2) homes a day. The community health workers selected were trained during the SUFI Phase 1 execution and these persons are well identified, of good morality, reside within the community and exercise subsistence activities. The community health worker will receive 350 CFA for every home visited.

M. Bahel Alain of the Malaria Unit at the regional delegation for public health in the Littoral made a presentation of what malaria is. Malaria is a major problem in Cameroon and many children die from its infection. This affects the economy of Cameroon and the use of MILDA and TPI is encouraged. He remarked that 66% of homes in Cameroon received LLIN, but only 39% make use the nets. This means that LLIN usage did not give positive results during 2012-2013 period. Participants were told that a mosquito can displace itself for a distance of two kilometers from where its eggs were laid and hatched. Within the context of behaviour change communication, at least 80% of pregnant mothers would be convinced to go to health facilities to receive their TPI, while CSOs supervise the activities of the community health workers. It is recommended that communication must be adapted to the context of the environment and in the local languages appropriate. One of the channels to be used is educative talks and the next technique is counseling, which helps a person to take a well informed decision on matters concerning health. A good community health worker considered as a person with an appreciable attitude, is welcoming, respectable, polite, attentive to the reactions of the population, available at all moments, well organized, dynamic and courteous. A health worker should have a good base of communication and master the health issue in question, use simple language, get people to participate in the community health actions. He or she should assure the family head to make sure that the pregnant woman and children sleep under a LLIN, because it is valid for at least three years. Once a pregnant woman is discovered, she should be advised to visit a health facility for consultation and protection of herself from malaria after rapid diagnostic test. When a child’s temperature goes high, the child should be taken to the community health worker or the nearest health facility. To carry out a home visit, the community health worker makes an action plan of homes to be visited and get the plan validated by the SUFI CSO. On introduction into a home, he or she should greet the persons met and thank them for being available as a means to establish confidence and create a friendly environment for counseling.

Before leaving, the community health worker should ask questions to verify if the SUFI message was well understood and take an appointment for a next contact. CHW are reminded that In the case of counseling, such a meeting is with one or two persons, while a counseling session is at least 30 minutes. The CHW is paid based on the number of visits done by the end of a month. The CSO will have to verify the content of the message left in the home visited and that the message is positive. CSO has to identify the infringements and find ways of correcting situations found on the field. He has to guarantee that the message is given to the right persons or target. Make appointments and precise fix time for the appointment which permits good exchange. CSO are also charged to undertake advocacy campaigns with the support of the local authorities and community leaders. The two axes for advocacy include lobbying and negotiations. Lobbying will involve the SDOs, DOs, Mayors, religious leaders and the traditional leaders. During contacts, the CSO precise the type of support needed from the authority. He will always write a message of thanks to the persons who assisted y during the field work. The CSO should be able to identify the community health workers of the district, their names, place of residence, and date of birth. The CSO will accompany the community health worker to the area of territorial coverage zone to avoid double tasks in the same zone. CSO support CHW in the making up of their action plans. Every community health leader has to limit his work within the attributed zone. The community health leader has a report and action plan to submit each month. Organisation of SUFI Home Visit Tchana Eric after giving room for comments and exchanges, presented a paper on the house count., focusing on the objective for the home visits and head count, target homes, the usage of the house count cartography. The CSO have to master the strategy of house count. The home visits have to target the pregnant women and children below 5 years. The house count aims at determining the geographic area of the targets of the homes having pregnant women and children below 5 years. The specific objective is to collect information about the persons in the homes counted. The exact number of persons living in the home has to be recorded. The community health worker will be paid on the number of homes visited. A home is any place where people live under the same roof with a family head. In a polygamous home, each mother and her children constitute a target group. A home can be headed by a man or a woman depending on the marital status. The home visits permit better supervision of the territory and facilitates control of the work of community health agents, especially as it would be opportunity to sensitize the target groups within the homes. Traget house count is expected to last 10 days. The exercise will cost CFA 30,000 per community health worker. 50% of the amount is paid at the beginning and the rest at the end of the exercise on reception and verification of the reports. An identification number has to be attributed to homes visited in a way readable and visible manner like this example: SUFI/MN001/Initiales ASC/VAD 01/ 2014. Follow up and evaluation At the end of the SUFI CSO training, the participants were able to explain what monitoring, follow up and evaluation and data is. The have a mastery of the tools for collecting data and the frequency of reporting the data collected from the field. It was explained that a follow up is a routine collect system of data of a programme or project which permit verification of the progress of activities. Community health workers have the role to collect data from the field during home visits. Data is measurable like numbers, distances, age, while qualitative data concerns sex and colour. The SUFI report should be able to show how activities were carried out. Indicators are variable quantitative and qualitative data used for measuring the manner of the objectives and results. The performance framework determines the indicators to be realized. An indicator could be the percentage of visits undertaken in a home with the number of children below 5 years and pregnant women IEC and BCC were carried out. The percentage of community health workers supervised for a example is also an indicator. The percentage of reports produced by the CSO is also an indicator of performance. Reports should be promptly transferred to the field supervisor before the 5th of each month.The CHW activities realized must be conform to the action plan validated by CSO regularly and these community health workers must respect their zone attributed to avoid duplication of the same activities in the same health areas and zones. The two key documents for follow up and evaluation are the identification forms of the homes and the data collection sheets on BCC. The community health worker may cover more than one bloc and the precise information of health areas covered should be mention in the data collection sheet to make the output visible.

The target home code does not changes throughout the project and collected data at during home visits is registered on the data collection sheets as follows: SUFI/MN001/TE/VAD1/2014 and SUFI/MN001/TE/ASC/VAD1/2014. Community Health Workers are not authorized to treat pregnant women during home visits. His or her role is to counsel pregnant women and refer them to the nearest health facility to receive the TPI after checkup. During the home visit, the community health worker register information on the subjects discussed, which include MILDA (1), TPI (2) and PECADOM (3). He should say when the discussion started and when the discussion ended to permit evaluation of the duration which must be up to 30 minutes at each home. The report from the CSO is a compilation of the reports from the community health workers in a health district including a financial report and a supervision report. Community health worker must transmit his or her report to the CSO by the 30th of each month and the report must be transmitted to the regional field supervisor by the 5th of each month. The regional field supervisor sends his report to the central desk at Plan by the 10th of each month. CSO has to validate the report of the community health worker before payment. The number of homes must correspond to the number mentioned in the action plan submitted by the CHW from the beginning. How the community health worker is supervised Supervision is a technical assistance from a top level authority to a person working in an organization. There are three types of supervision: •Facilitating approach (coaching and joint resolution of problems and communication in both ways). •Training supervision (Follow up of community health worker on the field and correcting errors noted in delivery during execution on the field. •Integrated supervision: supervision with participation of other stakeholders of different programmes. •The techniques of supervision consist of direct observation and exchanges during contacts. There is also the analysis of documents presented by the community health worker. •Organisation of auto-evaluation and to make constructive criticism on the work realized by the community health worker. This is done in a team and constitutes an internal evaluation. •Role of supervisor is to oversee the work of the community health worker. The supervisor helps the community health worker to improve on his performance on the field. •The supervisor has to promote team work, should be available, flexible and has humility, be ready to help others to develop, should be honest, credible and impartial, have the aptitude of good communicator, be attentive and give efficient feedback, should be a good manager of identified problems and have an aptitude of planning activities and carrying out a supervision. •In order to prepare a supervision, the term of reference document should be elaborated, which defines the objective, establish a calendar of supervision with dates, hours and venues to be visited. Elaborate a budget for the supervision. •The community health worker has to establish a cartography of the health area covered. •Prepare a mission order and get it signed by the supervisor.

Cameroon Link Engaged in SUFI Phase 2 Project

By Helen Ayamba, camlink99@gmail.com

Cameroon Link has been engaged by Plan International Cameroon to participate in the coordination of the second phase of the Scaling Up of Malaria prevention for impact (SUFI) in the health district of Dibombari in the Littoral region of Cameroon. The collaboration agreement was signed on the 18th December 2013 in Douala during a regional training of Civil Society Organisations (CSO) selected. The representative of the regional coordinator of the Littoral Malaria Unit, M. Bahel Alain, who launched the training, called on the 20 participants of SUFI to follow up the training in a way to relay the key note messages and information collected smoothly while on the field during the execution phase. He announced that the second phase of SUFI will last for two years in December 2015. Key facilitators during the training were Mrs. Valerie Ahouama Etamba, IRESCO SUFI Project Coordinator, and Mr. Tchana Eric, the Zonal Field Supervisor of IRESCO, who will control and coach CSO throughout the execution phase. He gave the practical modalities and guided the participants to build up the norms and expectations after designating the minutes secretary and time keeper. Mrs. Valerie Ahouama Etamba, IRESCO SUFI Project Coordinator, spoke about the objectives and awaited results of the training to capacity CSOs on executing phase two of SUFI. The workshop which was basically interactive with the exchange of experiences during the first phase of SUFI Project, led to consensus on how to handle infringements while on the field, after discussing the differences between the two phases. The target groups of current SUFI Project coordinated by IRESCO in the Littoral and South West region are pregnant women and infants below 5 years.

For this reason, a pre-test was conducted to judge the level of knowledge of the participants on malaria generalities, before a lecture on behavior change communication and advocacy. The Zonal Field Supervisor emphasized on the home visits and the technique of identification of the target groups within the homes. A key role of the SUFI CSO will be to manage the Community Health Workers already selected in all the districts concerned and this will involve monitoring and evaluation at least twice every months.The third day of the training was dedicated to project financial management. The Project Accountant presented all the tools conceived to facilitate management and these tools were tested by the participants to evaluate the level of understanding their content.During the presentations, it was noted that access in some health areas is often difficult, especially during the rainy season when road network become very difficult though the short distances to cover. The funds put at the disposal of CSO are during this period not equivalent to the popular demands of the transporters.Valerie Ahouama Etamba, Project Coordinator, SUFI IRESCO presenting the objectives and outcomes of the workshop covered issues related to the context, general objectives, project structure; program approach; role of actors; rationale of the number of CHWs; criteria for selection of CHWs. She made it known that the general objective was to train the CSO on management of staff and finances of the project.

Mrs. Etamba observed that the Global Fund Round 9 Malaria component coming to the end of Phase I, raised a couple of key challenges in the area of monitoring and evaluation (M&E), financial management and program management/implementation. These gave rise for the need to check and make strategic modifications for the second phase, particularly in the program implementation structure, the target population and the reduction of the number of actors. SUFI phase 2 program will remain of national coverage and it will be implemented in the 10 regions of Cameroon targeting particularly the vulnerable groups made up of pregnant women and children less than five years. It will be recalled that the title of the Global Fund Round 9-Malaria Project being implemented in Cameroon is “Scaling Up Malaria Control for Impact in Cameroon 2011- 2015” and the goal is to contribute in the reduction of morbidity and mortality attributable to malaria by 50% by the end of 2015.

It is believed that if the actors play their roles well, an increase to at least 80% of the use of LLINs in the entire population and particularly among children under five and pregnant women will be achieved. The activities will raise to at least 80% IPT2 coverage among pregnant women; treatment according to the national malaria guidelines will increase to at least 80% of malaria cases at all levels; while all actors will have reinforced management capacity within the National Malaria Control Program. The strategies includes acquisition and distribution of LLIN to the general population; making available SP to pregnant women at ANC; purchase and supply of ACTs to health facilities; appropriate BCC (mass media and IPC) to promote adhesion to the various interventions; while monitoring and evaluation will be regular at grassroots.Pregnant women and children less than five years are vulnerable groups found in 52% of households of Cameroon. This means that there are 2,089,647 households representing a population of about 10,866,170 persons by the end of the project to be covered.