Jerôme ATEUDJIEU1,*, Martin YAKUM1, Pascal GOURA1, Corine KANGMO1, Valerie TSAKAM1, Victorin GNODJOM1, Frank Kiadjeu1, Ismael KENGMO1, Landry BEYALA1, Moise NGWA2, David A. SACK2
1M.A. SANTE (MeilleurAccès aux soins de Santé), Yaoundé-Cameroon;2Johns Hopkins Bloomberg School of Public Health, Baltimore-USA;
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OAUU0115
Background: Immunization with Oral Cholera Vaccine (OCV) through a vaccine campaign intends to provide population based protection against cholera. The efficiency, acceptability, success and impact of the campaign can be maximized by ensuring adequate monitoring and evaluation (M&E) of campaign-related activities. Between May and June 2017, the Cameroon Ministry of Public Health and its partners conducted an OCV campaign in the Mogode Health District in the Far North of Cameroon. The OCV campaign used a door-to-door vaccine delivery strategy in two rounds, and targeting 127,978 people 1 year and above (excluding pregnant women) living in eight health areas. M.A. SANTE, a Cameroon based NGO was in charge of M&E for the campaign. Objectives of M&E activities were to: i) document the preparatory and campaign procedures, ii) provide day-to-day monitoring to improve coverage; and iii) disseminate timely results to guide decision makers for a better planning of future campaigns.
Methods: M&E were divided into preparatory, roll-out-, and post-campaign phase activities. During the preparatory phase, staff attended and documented the meetings of micro-planning, coordination, trainings as well as visited the health facilities to evaluate their resources for the campaign. During the roll-out-phase, the M&E staff evaluated i) availability of resources of the health facilities with regard to vaccine management, planning and supervision of activities; ii) vaccination teams on the compliance on campaign procedure and methods; and iii) quality and coverage of communication with households. Health facility-based surveillance of Adverse Events Following Immunization (AEFI) started on the first day of the campaign and continued for 14 days after the end of each round. Health facility-based surveillance of cholera started two weeks before the campaign and is on-going. The M&E staff participated in daily meetings of campaign staff where they provided feedback to encourage the staff for their successful work and also to identify opportunities for improvement.
A four days post-campaign survey was conducted following each vaccination round. Data from households were collected from households selected using, as a sampling frame, a household list obtained from a mosquito bed net distribution program. Households were selected by a stratified systematic random sampling. Data were collected on ODK forms in smartphones and send electronically to a central server. Results of each monitoring activities were promptly analyzed and shared with key actors and used to maximize OCV campaign coverage.
Results: Monitoring and Evaluation identified weaknesses in the campaign preparatory and roll-out phases. In preparatory phase, weaknesses were on training, planning, resource allocation, cold chain, and power supply which was required for the cold chain. These results were shared with the campaign leaders for correction. Corrective measures were also taken regarding weaknesses in scheduling, supervision, reporting, immunization, and communication coverages per target and per village.
Coverage and KAP data from the first round was shared with the campaign staff prior to starting the second round with the goal of improving immunization coverage and correcting deficiencies. Reported OCV coverage increased from 87.1% (1255/1440) in the first round to 92.9% (1338/1440) in the second round and documented coverage increased from 81.8% (3616/4418) in the first round to 83.2% (4041/4856) in the second round. AEFI reporting rate increased from 2.5 per 10000 doses administered (27/108333) in the first round to 22.2 per 10000 doses administered (249/111893) in the second round.
Conclusion: M&E should include more than simply conducting a coverage survey after the campaign is finished. Including independent M&E during all phases of the OCV campaign provides an opportunity to document the campaign activities and provides an opportunity to share results in a timely manner to improve the decision making process, the quality of the ongoing campaign, and the planning for future campaigns.
Key Words: Monitoring and Evaluation, OCV , Cholera , Cameroon