ff"K of for

External Monetary Incentive Policies for Community Volunteers in the Far North

Province of Cameroon

ff"K

Short preliminary results (Nov. 2006)

By

Z. Njoumemi

J. Atedjieu

For

African Programme for Onchocerciasis Control

(APoc)

TABLE OF'CONTENTS

Abstract 1. Introduction

2. Purpose and scope 3. Methodology

4. Summary of preliminary results

1. Introduction

The African Programme

for

Onchocerciasis Control (APOC) provided funding

to

study the external monetary incentive policies for community volunteers in the Far North Province

of

Cameroon. This study is part of APOC's interest in identifying the external monetary incentive policies

for

community volunteers through a multi-country protocol

in

four African ^countries:

Cameroon, Ethiopia, Nigeria and Uganda. The APOC's interest reflects the challenges for the durability of public health progralnmes in Africa which are increasingly relying on community involvement and the use of volunteers to help provide these services. The incentive policies are

key

to

explaining and understanding volunteerism, effectiveness

of

community involvement, coverage and sustainability of most public health programmes. However, there is a dare lack

of

information on incentive policies and practices across and within African countries. These issues are particularly relevant to the Far North Province of Cameroon, where many externally-firnded public health progralnmes are

not yet

integrated, thereby implementing different ^monetary incentive policies

for

community volunteers. Since the introduction

of

community-directed treatment strategy

in which

communities are responsible

for

managing and implementing activities

of

health programmes through their own selected community-dtected distributors (CDDs), both monetary and in kind incentives for community volunteers become a cornerstone

of

community-based health programmes in the Far North.

2. Purpose and objectives

The ^purpose

of

the first phase

of

this multi country study ^sets out to document the external monetary incentive policies

for

community volunteers

by

different health programmes, the determinants of these policies and to what extent they overlap at the district level. The findings

of

this study are

to

inform policies on incentives

for

community-based programmes. They also

highlight

a

second phase study which

will be

carried

out to

determine

the

^{practices and}

perceptions at the community level with respect to external monetary incentives.

Specifically, the study aims to:

To document any general policy at the national level (states/provinces) on external ^monetary incentives for community volunteers in the health, HIV/AIDS, agriculture and water sectors.

To document the external monetary incentive policies

of

the different health programmes for community volunteers, including the type, monetary value and frequency

of the

incentive provided, as well as the involvement of communities in setting these incentives.

To determine the rationale for the above policies and the role

of

donors

in

influencing these policies.

To determine the current and potentiaUfuture overlap of these health programmes in the different districts/LGAs.

To determine whether programmes have policies on using volunteers selected for other health programmes and how they ^deal with incentives in such cases.

To document any coordinationlharmonisation of incentive policies and practices alnong different health programmes at national and state/provincial levels'

To compare external monetary incentive policies

in

different countries (existence; range; ^and uniformity of donors' ^and programmes' policies)'

3. Methodology

This study relied extensively on secondary ^sources of datq available from existing policy documents, pronouncements,

MoU,

^minutes

of

meeting, technical

or

^{financial reports,}

budgets,

etc-

and checklists. The

field

research team composed

of

^a health economist, ^a pubiic health specialist and

two fieldwork

assistants, conducted

all

checklist intervievn

and

document reviews.

The

data

collection did

cover

the both

national/central ^and

provincial

levels. The Far North Province was chosen

for

the French ^language zone. This province

is

chosen based on the ^results

of

overlap at the national level

(it is

the ^anglophone province

with

the most overlapping programmes). Two checklist instruments and document

ievie*

guide were pre-tested before

their

use

for

data collection.

The

checklist

I

^was

administired to appropriate technocrats at MoH, Mo Water, Mo Agriculture, Mo Environment and other relevant agency at national level as well as to the equivalent of director of public health at state/provincial level. The checklist

2

was administered to heads

of

health programmes at

national level (MoH, NGOs, and agencies) as

well

as

to

heads

of

health programmes ^at state/provincial ievel. Data were entered using Epi Info and were transferred

to

Stata for data analysis. A document review guide ^{was used} for the content analysis of the relevant documents.

4. Summary of results

Objective 1: to document any general policy at the national level (states/provinces) on external moietary incentives for community volunteers in the health, HIV/AIDS, agriculture ^{and water}

sectors.

Results ^.. the general policy exists in all sectors ofien as a practice rather than ^a fotmal ^written polrcy.

Objective

2: to

document the external monetary incentive policies

of the

different ^health

pro!**-".

for community volunteers, including the t1pe, monetary value ^and frequency of the incJntive provided, as well ^as the involvement of communities in setting these incentives.

Health

programmes ^Results Onchocerciasis

control

programme

Transport:2000frs per day during the training once per year.

Perdiem:25frs per person treated in average each CDD treated more than ¹⁰⁰ persons per year (>2500

frs CDD er

Malaria

control

^programme

Perdiem:280 frs per household visited per CDD

for

amaximum

of

579 householdPerYear

Bicycle (in

kind):

a bicycle of about 68000 frs per CDD once per project life.

Tuberculosis and

LeProsY

control

^programme

Traruport:500fis

per CDD per month about 6000 frs per year monitoring of TB patients.

Perdicm:2000 frs per CDD per month about 24000fis ^er

lmmunisation

^programme Transport:500frs per day during the immunisation days trvice ^per year.

Perdiem:2000 frs per day per CDD during the immunisation ^days twice peryear.

Guinea Worm

control

programme

Transport:500frs per day per CDD during the training sessions once per ^year.

Perdiem:1000 frs per day per CDD during the sessron once

STI and HIV/AIDS

control

programme

Transport: 12000fis per month per CDD

for

motorcycle maintenance, repairs ^and fuels about 180000frs per year

Perdicm:50.000 frs per month per CDD about 600000frs per year

Motocycle (in

kirul):

a motocycle of about 280000 frs per CDD once per project life.

Reproductive

Health (Child and Maternal Health, Family

Planning, Population

activities)

programme

Tran^sport:2000frs per CDD during ^the trainmg once per year.

Perdiem:5000frs per CDD per day during the training ^sessions per year

Sales revenae.' 1500frs per CDD in average per year Bicycle:65000 frs _Per CDD once per life.

SUMMARY TABLE OF RESULTS

¹

SITE NAME

Cameroon Francophone (Site 8)

Indicators related to Specific study objectives

S/N

VARIABLES

^{Yes No}

^Number

^o//o

I Availability

of general policy on external incentives

375 625

^{8 100}

1.a.

Availabitity

of general policy on external incentives at

MOH

66.7 33.3 3 37

1.b.

Availability

of general policy on external incentives at

MO Aqriculture

333

67.7 3 38

1.c.

Availability

of general policy on external incentives at

MO Water

0 0 0 0

1.d.

Availabitity

of general policy on external incentives at

MO Environment

0 100 2 25

2 No. of health programmes using community volunteers

100 0 ^{7 100}

3 No. of health programmes

that

have policies to give

external

monetary incentives

100 0 7 100

4 No. of health programmes

that

give cash incentives

86 14 7 100

3 No. of health programmes

that

give in

kind

incentives

(with

monetara value)

57 43 7 100

6 No. of health programmes

that

give both cash and

in kind

incentives

(with

monetary value)

43 57 7 100

7 No. of health programmes

that

have a policy to involve

communities

in

setting external incentives

57 43 7 100

8 No of health programme where donors influenced incentive policy

100 0 7 100

I Number

of

districts/LGAs with

overlapping health ^pro grammes

25 0 100 100

10 Average

number

of overlaPPing health programmes

per

districULGA

7 0 100 100

tl ^Number

^of

districts/LGAs with

potential overlapping health programmes

28 0 100 100

12 Average

number

of

potential

overlapping health pro grammes per

districULc[

10 0

1()0

100

13 No. of health programmes

with

policy of using existing

co volunteers

7t

29 7 100

14 No. of health programmes

with ioint

external incentive ^policies

43 57 7 100

15 No of heallh programmes

with

policy on coordin

ationl

harmonisation of

external

incentive policies

43 57 7 100

CROD( rouge nationale ASBFLS/LC CCDICOMIT E DIOCSAIN ACDEV GAPFEN INADES Formation GIC ^rapideS.

CAPROPRAF COPRE-SA AUPRAES ACEEN- Action 21

ASEN AJED.MIR AGIR AFSU-EN.

6r J

Reproductive health programm.

OFSAP CAMNAFAW

UNFPA UNFPA 1,2,6

?J

^GuineaWorm

Program

wHo wHo

SUMMARY TABLE

⁴

SITE NAME

⁸

List of Agriculture programmes using community volunteers

SECTOR:

AGRICULTURE

s/F{ Name of PROGRAMME

national de ,le

1

2 national de securit6 alimentaire

SUMMARY TABLE

⁵

SITE NAME

List of Water programmes ^using community volunteers

SECTOR:

WATER

8

S/N Name of PROGRAMME

1 de 1'

2

SUMMARY TABLE

²

SITE NAME

⁸

Type of External Monetary ^Incentives

SA{ Incentive No

of

programmes

o/"

I

^{Cash 7 100}

la.

^{Per diem 7 100}

1b.

Travel

allowance 6 86

1c Stipend ^{3 43}

1d. Sales revenue ³ 43

1e Other cash

I ^t4

2

In-kind

^{4 57}

2a. Bicycles ⁴ 57

2b.

Motorcycles ^{3 43}

2c. Radio ^{0 0}

2d

ITN

^{1 14}

2e. Others

In-kind

¹

t4

SUMMARY TABLE

3

SITE NAME

List of health programmes (including HMAIDS) using ^community volunteers, their implementing partnersr financial donors and types of

external monetary incentives provided

Type of

External Monetary

Incentives Legend:

tlier Diem, z:Travel Allowance, 3:Stipend, 4:Sales

Revenue,

5:Other Type of Extemal Cash Incentive, 6= Bicycle, 7: Motorcycle, 8:Radio, 9:ITN,

lO=Other Extemal kr-kind lncentives

SECTOR:

HEALTH, including HMAIDS

I

s/

N

Name

of

PROGRAMM E

Implementing partner X'inancial DONOR

TYPE

of

External Incentive

@nter from 1-10 which is

applicable )

National NGO

Int.

NGO

UN agency

l.

J

Onchocercosis programm.

HKI

wHo

HKI,LCIF,

APOC, MOH, PIPON FOI.JNDATIO N

1,3

2J

Malaria progr:rmm.

ACDEV CARE,

APRICOM

wHo

^GB, OMS, MOH, HIPPIC

3,6

,J

Tuperculosis and Laprosis programm.

wHo

GF, OMS,

MOH HIPPIC

ol

^Expanded

programm

of

immunisation.

ACDEV OCALPAS AGADJAS SALAMA

Programm e d'appui aux huit districts ( cooperatio n Belge)

wHo

UNICE F

MOH HIPPIC GAVI UNICEF OMS

I

⁵

'J

^{HTV programmAIDS SALAMCEFAAD}

RESAEC OCALPAS AGADJAS

CARE-EN

owHo

GW, [DA, GF HIPPIC MOH

1,2,3,7 I