Western Bahr El Ghazal CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2013 to December 2013

WESTERN BAHR EL GHAZAL (WBEG) CDTI PROJ CT whowbe ro e mail.com i aD ORIGINAL: Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Nlanagement by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNcHocERclASIS CONTROL (APOC) I t I I i COUNTRY/NOTF: Republic of South Sudan Proiect Name: Western Bahr El Ghazal Apprayalrcar: 2004 Launchtnq yeal:2005 Reportinq Period: From: January 2013 (MonthA/ear) To: December 2013 (Monthf/ear) APOCfundinqvear: 1 2 3 4 5 6 i (8) 910111213 APOC Prgiect implementation vear report: 1 2 3 4 s 67 (8) 9 10 11 12 13 Date submitted: o7F nugust 20 1 g Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Christoffel Blinden Mission - 674 communities I aWESTERN BAHR EL GHAZAL 2013 TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COIVIMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Republic of South Sudan National Coordinator. Dr. T ng Chor lMalek Project Coordinator: Dr. Edmon Ramadan Sebit PP signatur"' fidryv*. .S-6.+ Date:. . .\lhArg ustli:ol4 NGDO Representative: John Alal Ujwok *Nf,ij sisnature: ... .. Date: ./AugusV2O'l4 Sionature: o"ate: ? +?' PP Sig IAugus u2014 nature: F/.t*. ..S..u.+ Date:..!tT.n sU2014 This report was prepared by: Dr. Edmon Ramadan Sebit Designation. Project Coordinator Table of contents DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1.1. GrurRnl rNFoRMATIoN............... 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopumrroN......... SECTION 2: IMPLEMENTATION OF CDT!... 2.1. TrrvrrrruE oF ACTrvrrES........... 2.2. Aovocncv ........8 2.3. MoetLtzArtoN, sENStlzATtoN AND HEALTH EDUCATIoN oF AT RtsK coMMururrtEs.8 2.4. Corrrvururry INVoLVEMENT.......... ......10 2.5. CnpncrrvBUrLDrNG .. ..........10 2.6. TREerurNrs........... .........12 2.6.1. Treatment figures ............12 2.6.2 What are the causes of absenteeism?.. .....14 2.6.3 What are the reasons for refusals?....... ........ ...........14 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that 14 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear......... ....... .. .15 2.7. ORoEnrruc, sroRAGE AND DELtvERy oF tvERMECTtN ......17 2.8. Coutr,turutrv sELF-MoNtroRtNG Rruo STRTeHoLDERS MeertNc... . ....18 2.9. SupEnvrsroN.............. ..............19 2.9.1. Provide a flow chart of superuision hierarchy.......... ............19 2.9.2. What were the main issues identified during superuision? ...................19 2.9.3. Was a superuision checklist used? ...........19 2.9.4. What were the outcomes at each level of CDTI implementation supervision? ............ ...........19 2.9.5. Was feedback given to the person or groups superuised?...................19 2.9.6. How was the feedback used to improve the overall performance of the project? 19 SECTION 3: SUPPORT TO CDTI .........20 3.1. EourpueNr ..............20 3.2. FtttRNctRl coNTRTBUTtoNS oF THE pARTNERS AND coMMUNrrES......................20 3.3. OrneR FoRMS oF coMMUNrry suppoRT .............. .........24 3.4. ExpeNorruRE pER AcTrvrry.... .....................24 SECTION 4: SUSTAINABILITY OF CDTI.. ............24 4.1. lrurrRruRt; TNDEpENDENT pARTrcrpAToRy MoNrroRrNc; EvRlunloN ........... ......24 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable).......... 4.1.2. What were the recommendations?... ..................24 4.1.3. How have they been implemented? ............ .......24 4.2. SustnrNRstlrry oF eRoJECTS: eLAN AND sET TARGETS (MANDATonv nr............24 1 3 4 a 4 4 5 6 lll 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. lrurEcRnrtoN......... 4.3.1. lvermectin delivery mechanisms........ 4.3.2. Training 4.3.3. Joint superuision and monitoring with other programs 4.3.4. Re/ease of funds for proiect activities... 4.3.5. ls CDTI included in the PHC budget?..... 4.3.6. Describe other health programmes that are using the CDTI structure and how fhis was achieved. What have been the achievements? "-.' 4.3.7. Describe othersissues considered in the integration of CDTI. 4.4. OpEnnloNAL RESEARCH 4.4.1. Summarize in not more than one half of a page the operational research undeftaken in the proiect area within the reporting period. 4.4.2. How were the results applied in the proiect?... SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPPORTUNITIES .-..........-.--27 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........27 25 25 27 27 27 IV Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM African Programme for Onchocerciasis Control An nua I Treatment Objective Annual Training Objective Commu n ity-Based Organ ization Christoff Blinden Mission Commu nity-Directed Distributor Co m m u n ity-D irected Treatment with Ive rmectin Commu n ity Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Onchocerca Volvulus Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization TCC TOT UNICEF UTG WHO v Definitions (i) Total population. the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). ii Eli^qible population: calculated as 84% of the total population in meso/hyper-endemic communities in the project area. (iii) Annual Treatment Obiective: (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 maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UfC at the end of the 3'd year of the project). (v) Therapeutic coveraqe. number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraqe: 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). lnteqration: 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. (vii) (viii) Sustainabilitv: CDTI activities in an area arc 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. (ix) Communitv self-monitorino (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl - 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 _ 37 The recommendations cited below are those that were given to the parent project Western Bahr e! Ghazal and are responded to as thus. The same responses are provided for the now three separate CDTI projects i.e. Western Bahr el Ghazal, Northern Bahr el Ghaza! and Warrap. Number of Recommendatio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Recommendations to improve repoft (i) Provide clear reason why the drug balance is high. The very high drug balance was due to a combination of challenges. The top two were failure to access flooded communities since the distribution was conducted in the rainy season, and transport problems since there was no car in the project area and the available motorcycles could not provide appropriate substitution. ( ii) Correct the number of CDDs trained which was 7 ,217 in table 4 and 5,477 in table 5. A clarification on the figures. Table 4 is on community involvement; and there were a total of 7,217 CDDs involved in CDTI. However not all available CDDs received training and that is the reason why the number of 5,477 CDDs trained is less than the total number of CDDs available in the project in 2012. (iii) Reflect the findings of the sustainabili$ evaluation in the report and actions carried out to address its recommendations. This is not applicable since there was no sustainability evaluation done in the project. Recommendations to improve report project I (i) Ensure that the purpose of separating the project from one huge to three projects is achieved which are for better project management and supervision. The project acknowledges with appreciation the separation of the project areas and willwork hard to the purpose of separation is achieved. lt is anticipated that upward trends in coverage rates will be realized in subsequent implementation. ( ti) Train more CDDs and retrain more health workers. This is work in progress and the project is striving to ensure that this is realized. (iii) lmprove community participation through CSM and SHM. This is a recurrent recommendation whose great importance is acknowledged. The project will continually work towards ensuring that this recommendation is realized. (iv) Ensure that the use of media which was started some years back is sustained. There is a challenge with the use of media. The available media stations are mainly privately owned and profit oriented and the project funding does not much up with the required costs to engage them. However there is a UN mission supported radio station based in Juba that can be explored for possible collaboration. (v) lncrease and maintain high geographic and therapeutic coverage. The project will continually work towards ensuring that this recommendation is realized. Recommendation to APOC (i) APOC to consider replacing the capital equipment for this project and ensure early release of funds - 2 Executive Summary This report covers the CDTI activities implemented by Western Bahr El Ghazal project in the period from January 2013 to December 2013, the eight year of APOC funding. The project area had a totat population of 386,538 and an ATO of 309,230 during this reporting period. Beginning with this funding year, the project only covered Western Bahr el Ghazal state only. During this reporting period, 551 out of the 674 communities received mass treatment with mectizan thereby covering a population of 160,157 and achieving geographic, therapeutic, and ATO coverage of 88.1o/o,41.4o/o, and 51.8% respectively. 36 health staffs were involved in CDTI activities this reporting period, representing 11.7% of the 308 health staff that were available in the project area during the reporting period. A total of 654 CDDs were trained in 2013, of these 190 were newly trained while 404 attended refresher training. The project faced a number of weaknesses and challenges that included: . Low literacy levels at community levels leading to poor data recording at the community level; . The difficulty and inability to supervise the conducting of a community census; . lmplementation of the bulk of the CDTI activities during the rainy season contributing to low coverage rates due to poor access to the communities. . There was no counterpart funding for direct implementation of CDTI activities in the communities from either the government or the supporting NGDO. . The available funds from APOC were received in September and this led the project into a rushed implementation in the remaining last months of the year. J SECTION 1: Background information 1.1. General information 1.1.1 Description of the project Geographical location, topography, climate The West Bahr El Ghazal CDTI project is located between latitudes 6.5'N and 10.5"N and longitudes of 24"E and 28.5'E. |n2013, the project covered one state, West Bahr El Ghazal and three counties of Raga, Jur River and Wau. The topography of the project area varies from mountainous and rocky in the western side that covers Raga County to flat expanses of muddy soiled plains in Jur River and Wau counties. The climate of the project is cold during the rainy season that runs between May and September; and it is hot during the dry season that runs from October to April with temperatures going above 40"C. Population: activities, cultures, language ln this reporting period, the Western Bahr el Ghazal CDTI project area had a population of was 386,538 inhabitants. The main activity of the people in this project area is predominantly subsistence farming and with some engaged in nomadic cattle rearing and hunting of wild game. Arabic is widely spoken in addition to about 30 other local languages. Communication systems (roads...) The road network within the project area is generally good; though there are a few roads others that may be difficult to traverse during the wet season. The project area can also be accessed through air by planes and helicopters from Juba, and Rumbek The Wau airstrip is one of the busiest airstrips in South Sudan and a connecting hub to all other points in the project area. The project area is covered by the available mobile telephone networks; making communication with the national coordinating office relatively easy. Adm i nistration structure The Administrative structure follows that set by the government of the Republic of South Sudan; that is tiered through the state, county, payam, boma and village that are administered by a Governor, County Commissioners; Payam Administrators; Boma Local Councils and localVillage Chiefs respectively. Health system & health care delivery The state ministry of health is responsible for directing the implementation of all the health policies. There is a teaching hospital in Western Bahr El Ghazal and in addition to this are 14 primary health care centers and 29 Primary Health Care Units totaling to 44 front line health facilities. Number of health staff in project area and number of health staff involved in CDTI activities 308 health workers existed in the project area in 2013; of these 36 (11 .7o/o)were involved in CDTI activities. Details are as shown in the table 1. 4 County Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Br=Bzl Br *100 Raia 78 09 11 .5o/o Jur River 72 11 15.2o/o Wau 158 16 10.1% Total 308 36 11 .7o/o Table 1: Number of health staff involved in CDTI 1.1.2. Partnership lndicate the partners anvolved in project implementation at all levels All levels of the health care system (state ministries of heatth, county health departments & primary health care centers/units), beneficiary communities, cbm and APOCA//HO were the partners involved in project implementation in 2013. Describe overall working relationship among partners The overallworking relationship was good; challenges faced were understandable to all partners involved in the CDTI work during this reporting period. State plans, if any, to mobilize the state/region/districULGA decision- makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation During this reporting period the key officials met were the state Minister of Health, Director-General for Health, Director of Preventive Health and the 3 County Health Directors in Western Bahr el Ghazal project area. The main issues discussed included provision of direct funding for the implementation of CDTI activities, the absorption of CDTI staff into the various ministries of health and integration of CDTI work into the routine primary health care services. 5 Eo oa\ O(! L ac oi,O:(o:CC o .l- 'EAE;P coqz ol- AI qJ L.:'o)oEo-c ,e .6 =E oc oo oDo ao G- =! =.-L)O >F C I otrx ;H 3LJ c"j 'E<s = = r+ c.(J - 1TI;, Eii (! .le c6_ Ig 60 E -c ero :'i = i= .qg +'o g6, c,-c.- : : tso oUJ^E =- E(! eE = o= tr =e>g^?E 8; .E 9J=e(5 tE'= (E e- o.E 3-E AgE P!= e8t EEE oG; tE0 59; or.9= 5EE E'i-E 3EE FbE ; sH6 1q,: E *EE E'EE EEE: ='tr,A tooF' EoolfrE 5,E eEXE t'r=! 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G+i o trg CL E N z o tro lU U' I 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy The policy/decision makers mat during this reporting period were the state minister of health, the Director-General for Health Services, the Director for Preventive Health and the 3 County Health Directors. Reason(s) for undertaking the advocacy The reasons for undertaking the advocacy meetings with them was to continue seeking for the involvement and support of the decision makers for direct government funding to CDTI activity implementation so as to bridge the funding gaps that exist and also to cater for the periods when funds from APOC Trust Fund are not yet disbursed to the project; especially at the beginning of the calendar year. The outcomes The officials met were reminded of the need to have CDTI fully integrated into PHC and thus better support and performance in future. Describe difficulties/constraints being faced The difficulty faced during the advocacy was that the officials were only able to give verbal support and there was no guarantee of financial support due to the processes that the government funding has to go through and also the competing demands of the health system. There was also a logistical challenge in meeting the county health department officials because the project vehicle is not functional. Suggestions on how to improve advocacy Suggestions to improve advocacy include: to continue conducting the advocacy meetings with the health officials and if possible increase it to twice a year; there is need for provision of means of transport so that there is movement from one point to another, continued decentralization of advocacy work and empowerment of the County Supervisors to take lead at county level, continued identification of community members that are passionate about CDTI to be part of the advocacy teams, and trying to target conducting the bulk of the CDTI activities in the dry season. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information FM radio stations exist in the project area, however since these are owned by private business persons, they were not able to air health education messages for free; and so were not used. Dissemination of information was mainly done at community gatherings/meetings, and through the communication channels of the community leaders. Types of IEC materials used There was no use of IEC materials because of no production due to lack of funds , 8 Mobilization and health education of communities including women and minorities Community mobilization and health education with emphasis placed on women and minorities. The messages were on the importance of taking mectizan and selection of more CDDs by the communities. However, not all communities could be reached as desired. Response of target communities/villages Of the communities met, members generally appeared to understand the need to select more CDDs that are willing to volunteer as opposed to demand for payment. Accomplishments Having a better-informed community on CDTI that will be able to sustainably select more CDDs and thereby contribute to having an increased number of individuals that will receive treatment in future. Suggest ways to improve mobilization and sensitization of the target communities. The challenges faced are mainly due to funding, logistics, the right number of human resources and access difficulties. lf these are addressed then it is anticipated that there will be significant improvement in reaching out to target communities with mobilization and sensitization. 9 County Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Ba Number with community members as supervisors Bs Percentag e Be= Bs/ Bq *100 Male CDDs Bt Female CDDs Br Total Be= B7+Bt Number of communities with female CDDs Bro Percentage Brr= Bro/Bn*100 Raga 247 27 10j% 113 45 158 43 17 .4o/o Jur River 106 16 15.1o/o 154 122 276 71 67.0% Wau 321 39 12.1% 201 92 293 85 26.5% TOTAL 674 84 12.2% 468 259 727 199 295% 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Attendance of female members of the community at health education meetings No significant changes in female attendance; it is still quite low. Social and cultural factors are still quite strong hindrance. ln general, how do you rate the participation of female members of the community meetings when CDT! issues are being discusses It is still quite low. lncentives provided by communities for the GDDs No incentives were provided to the CDDs Attrition of CDDs. !s attrition a problem for the project? lf yes, how is it addressed? Attrition is still a persistent problem and it is being addressed by asking the communities to select CDDs that are willing to volunteer. Other issues - None 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. Generally, manpower availability is inadequate. All the staffs at the state, county and payam level have other responsibilities in addition to the oncho work; and thus they commit time partially and not wholly if they were fully engaged with oncho alone. This tends to affect the performance of the project. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. This was not an issue of concern during this reporting period. a l0 FoF o -c. B c oa(! o 0) -c. .a (g -c :o c(! F oF a oq) .c(! L o a q) '6 c) -c U'(E E o -o) oE oo (E E oC '(! L o L o B (5 e oE(E o := 'o .E u; -cP(EcD oiEco 9b =N ..o =6 EC s.Y =()(JH o, -c oo o a ob oc e5t4 q)\G iq o o o U)c! o a_q g)too q) € q) b o a. o \og > IU = t, otr (ll ooo o o o -o E:z :EttO EJ*=o t&d !.Pd (o N ;' F- t-$ (e N N N(o (o lr)o CO ;NN N @ sf lO(,o t(o$ o(t s e? oll tr o E o .9 o ;ee:ko N rON N O) rO No f.-- (o sf r4t_ o o .- Ul$FEO 6, '- :ti -o o.= -!!O.=!lsEo) z :ttttl Ed*=o ;: *d o o o o o O o o O o o o so o E o .g o so o F o O o o !,6' y(E l!t0)s +(E oo o9 :H-E= zE oo Erd F <-l- +-F(J o o +q)q i oa (f) (f) o s \f o lr) lo o (\ N o soa c o E o .9 o so o F o r o o o c'i, (E o tr =t,ooo.= rF (!o! olt E =z Erci F o'+-r() d o tq)t i !l) e (e N N r N r t (9 sq I tr o E o .g -co s o o F (e CO () ct) tr =oo (5 OJ(I,tr o) t = - =G' B J F oF c o (! c o Eg o. .E tro o o .9, o g tr o o E o (E U' :E(! idr ol ltl(sll-l t Trainees MOH staff or Other Politic al Leader S Others (specify ) Other Community members e.g Community supervisors Health Workers (frontline health facilities) Type of training CDDs Program management XXHealth education X XManagement of SAEs CSN/l SHTVI XData collection X XData analysis XXReport writing Others (specify) Tab T of traini undertaken Any other comments - None 2.6. Treatments 2.6.1 . Treatment fig ures lf the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The reasons for not reaching 100% geographical coverage and 65% therapeutic coverage are mainly due to: . Failure to reach out to some communities in the project area due to the logistical challenges that the project faced in the not having a functional vehicle. . The difficulty to access the communities due to implementing in the rainy season. . Mismatched timing of the release of funds, rainy season and activity implementation. Funds tend to be released to the project around June/August; when rainfall is at its highest and thus minimal activities can be implemented. a t2 co ! o q o o 'd'\ a. o \t E o o Or o o o a G .gc a. !! 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E:*s I f-$N @o N co sf (o !=** o)o Cf)CON lf) (f) cf) @ €"E€E*E=;'e;r-e o o o o c o s5o o o- oo llr oo o s EoiBlE90EBto sq 6s s oq O) CO sq os s a \f o E r_ E 5Eso6 5 E.Ez N(o_ O cf) t-(o O)- @ l.c) O)(o ro- or- |(,ta o(o o 7or6 o.Z? E6 E 3a= -Fo @ o) cr)_ o rf) 6 O) s- @ N(o(.r- o$r o({' ol oo e) o o9 frE ,E-EE rr) o, o)- N(o NN @$ r N!f- lr) F* - o c:'lo-(o @ co oo cng 5 oo .E =E E oo oo ll+ o'd o (!oo = E) =(Eg 9s H',g - o- s : O) sq st- s o, @N s oq @ o I E$e E"Et* r()NN O)t- F-$N rOlo o coE9 .2 =E tiEE-6&E s-' F-!t N (oo -N(e tf (,o r E e-ie u' t-sN (oo r rN(e rt (o =oo (U o)o E. L o t L) - =(! E F oF 2.6.2 What are the causes of absenteeism? The main was due to having the distribution coinciding with the time to cultivate and thus the persons could not be readily reached. A few other absentees were reported to have travelled out of the village. 2.6.3 What are the reasons for refusals? Not applicable 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. There were no cases of serious adverse events reported. Parasitologist trained? None has been trained Existence of microscope? None is available Has the project reported all SAEs to Mectizan Donation Program (MDP)? Please tick one. Not applicable since SAEs have not been reported. XNo ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. None was reported No SAE case to report x 14 o9- ooy 8g bt.s = z \U) E,e E EEg c6tr ,9Edri8; z P?,EPAo):1 OOE E- z U' o o+DE8 9EcE-v og/)(JO)oE trt =-a z (o +AOtdt->r ^,= _=::- EEEEE z E=b Bt -o'= O.= E€:S z E5ePp.E gEEEg z o E o o- E @ z iaE E*= += z C oNqE,,6 as gt z o oo)co'6) >o z x o U) z o)(cr z z U) o E o L o o) c L. o o. o o -c o)tr fE E o o o o GE -c 0)eE l/,Y.!{d <Luto -LLIo(Eaoo>co c.r3bb, >g) EE o -G) .0P b'aoa rrEoi6 o .92o=o*(E=o:: ..o6lz ol .ol olFI o CDO E=F o:< I >vo o c.j @d c.l NN (os a?\ts q(o f* c.jst o o o o o. 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UJ (oooN f-oo c\ coooN o)ooN o oN oN N roN (r) oN \o O cf) C\t o,LO(!coEHE} o = E5otuNg6.E =o(5o'6'9 =h..o.0EBfrE gtroq ! iPI xE '6'Eo LLI_ cL(E\oJFho8 H?E 5I Ei El n5 a.sE t,X.a He(rOlttroaE 9 o9EFtrJ g,EET :fEtriEo'c IiIE 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by tr NGDO Other (please specify) Mectizan@ delivered by WHO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The Project Coordinating Officer submits mectizan requirement to the SSOTF; who then compiles this data with that from the rest of the CDTI projects and makes submission to MDP. After the reviews and approvals from MDP and production by MERCK; the mectizan is shipped to South Sudan and is received by the WHO Country Office. Mectizan is then supplied to the projects based requirement and balances that remained form the previous distribution. At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for collection; and cycle cascades to Payam Supervisors, then to Boma Supervisors and then to the different Bomas and villages. Table 10: Mectizan@ lnventory Comment: ln 2012 Raja County had a balance of 401,31 1 tablets; 200,000 of these tablets were redistributed to Jur River County for the 2013 distribution. How are the remaining ivermectin tablets collected and where are they kept? The CDDs collect all balances of mectizan tablets, quantify them and then submit them to the health facility staff for storage until the next treatment cycle. The health facility staff also rety this message of stock amounts to the Project Coordinating Officer through the respective Payam and County Supervisors. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health facility staffs train CDDs; issue mectizan tablets for mass distribution and collect balance after distribution; keep a mectizan inventory of available mectizan at the health facility; and manage any severe adverse effects to treatment. Any other comments None tr County Number of Mectizan' tablets ln stock from previous year Requested Received Used Lost Wasted Expired Remaining Raja 20 1,311 0 0 99,518 0 312 0 101,481 Jur river 200,000 155,000 155,000 191,643 0 589 0 162,768 Wau 170,592 250000 250000 229349 0 803 0 190,440 TOTAL 571,903 405,000 405,000 520,510 0 1,704 0 454,689 t7 tr 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No lf so, When? N/A Table 11 : Community self-monitoring and Stakeholders Meeting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cYcle. Not applicable this reporting period County Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Raja Jur river Wau 247 106 321 00 00 00 00 oo 00 TOTAL 674 00 00 t8 SSOTF Headquarters Project Coordination Officer/Focal Persons / / )ounty OV Supervisors Payam Supervisors / 7 CDDs / 7 Communities 2.9. SuPervision 2.g.1. Provide a flow chart of supervision hierarchy' Supervis Reporting 2.g.2. What were the main issues identified during supervision? The main issues found during supervision were mainly: . lncomplete data compilation for treatment reported to have been done; . Lack of registers in a number of communities visited; . lnadequacy of staffing levels as compared to the expected/required. 2.9.3. Was a supervision checklist used? Yes. 2.g.4. What were the outcomes at each level of CDTI implementation supervision? Face to face discussions were held with staffs; and they were expected to have a better understanding of the importance of the issues found out during the suPervision exercise. 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? It was ensured that the staff supervised practically exhibited better knowledge in areas of cDTl work that they were supervised on. t9 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? Gradually as the state ministries of health increasingly take on more responsibility of CDTI activities then they will provide some level of maintenance and replacement of equipment. 3.2. Financial contributions of the partners and communities - Fill tables 13a, 13b and 13c lf there are problems with release of counterpart funds, how were they addressed? There is no counterpart funding allocated within government PHC budgets to support direct funding for implementation of key CDTI activities. Additional comments - None Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtron No Condrtron No Condrtron No Condrtron 1. Vehicle 1 WO 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 1 F 0 NA 0 NA 0 NA 0 NA 3. Computer(s) 1 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 1 F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a) metallic cupboard 1 F 0 NA 0 NA 0 NA 0 NA b) Bicycles 35 F 0 NA 0 NA 0 NA 0 NA c) Radio base 1 F 0 NA 0 NA 0 NA 0 NA 20 co o C{ E ot o o. o E') '6 .cl t lrJ (U!, o rso o E ooL a -o ..2E^ o L ocE(! 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G EeECsoa> 'to EgR5 CS5tOl!!Io Ebo>>(, Ib Z, or *Ht dJe 'rJl g .l ro{t a ,l ,; ao o .n tr o 9.o Ei E .9i 6 .El (E EI '<l r rl ' IJJz J F UI oof @ co .F -6E':g Ei ilE =l or .cl/,ioi=cl>,(l,6.rl E: (Dal< T ".il oi <;l-i-l! o tr o GN tt so Vt *o Go o !-oB SH 'sg s€soEso< =3 G o IaI U, c o (! s -oo : I I I s o G5 slu 6tr o o E E o ot oaS u, , !.' o)]T ,o B ' o'Eig: Eo: r o,o o, o! .El .E'c'c ie; Eioio' r\l\i idl(,i u.- Ei Fl = 'S: Ei El E .=l Fi Fl o Si ;l "rl ill "ri *l a .n o G o(? E o o o o l! cn c.l t, o 5 E o o 't o oE o o fi, 3 o o .Ct o e) o E G .= o o E" o .c,t- aL(! o o) c) - as oE L o a L oCE(E o- (! _o ac .o) -o L c oo Eoc(! ir o c., o E GF I I I I (ol(")lo(o ,o) l@(.) ,(o .t-S :- it() o 'N lol +loirlr i- io'o o rl 3.3. Other forms of community support Community support included provision of training venues, collection of mectizan from the frontline health facilities and occasional provision of meals for CDDs during training. 3.4. Expenditure per activity lndicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. The exchange rate used was 3.8 SPP per US dollar. Any comments or explanations? None SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year 1 Partici patory I ndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners What were the recommendations? Not applicable How have they been implemented? Not applicable 4.2 Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _No- Was a sustainability plan written? _No When was the sustainability plan submitted? - No What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.1.2. 4.1.3. 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels - No plans made yet Funds - No plans made yet Transport (replacement and maintenance) - No plans made yet Other resources - No plans made yet To what extent has the plan been implemented - Not yet applicable 24 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms The lvermectin delivery mechanism is not yet integrated in the national medical supply system. WHO ensures that the mectizan is delivered to the state ministry of health; and then the state ministry of health is then supposed to be responsible for releasing the mectizan to the County Health Department stores in the Counties. The effectiveness of how this happens varies from county to county. ln most cases, WHO still has to make inquiries on whether this has happened or not. From the County Health Departments, it is then dispatched to frontline health facilities in the Payams. Then from the Payams the mectizan is sent to the Boma level Primary health Care Unit and then finally to the communities. 4.3.2. Training: The funding arrangements/cycles and different implementation plans are a constraint in having integration of training done. Despite this, there is general willingness of other community based health care programs to cooperate in training activities. 4.3.3. Joint supervision and monitoring with other programs This has not yet begun happening. 4.3.4. Release of funds for project activities There were no funds released from the PHC system to directly fund the implementation of CDTI activities. 4.3.5. ls CDTI included in the PHC budget? Not yet. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Not applicable since there are no additional programs using the CDTI structure yet. Explain what are the combinations of interventions co-implemented? Co-implementation is not yet happening in project area. How were the interventions implemented? (at the same time?) Not applicable. 4.3.7. Describe others issues considered in the integration of CDTI. This is not yet applicable in this project. 25 ao (g (!oc .9 .9 o (L o o, o o to o, L !,cc -Y gl t o o-q,t 'tro= = dtu,5o = .; t.0 = ttt o = €c .:oU'P E o9 9= E,gVrB .9 I Eb E 8 oooo tr o (! g o E o o. .E te !o 'EEe o= otro,= o E' o E Eo L o CL .; o .E E E o o o o E o2 o s o, .E= EO E oo :E o(E a a a a a a c o tr o) E o .E o o CL 6 c o(, o o CL E oF o o C, E otL o tr o o LOEo-o oo .(E6e -o- E z oI(! = E oF o o (g E oll o o o o, t, cLo toeoi LL3s E z oo o = E oF (! c &E ooooE E.:gOqr> -otrE'- z og ag =!, o o(! 0,E ob.g d,L !=pE fEzo o t,o o cD GF !, o o(u ot ovl bE -cl LEO 2E !,o o E')L(U F E'l o 6S.S E-u"3 38*&g' *.9oE t9 >t l-r-O .= a a a oo 0l+.O.C>ol-o \o C.l q O) a. EGxq) i .p q Q(! o aG o e bo t4 .a coto .s oL o L o9 OEOE or9 .6@ :,F oQOvEC)L_C EP orP 9,2CLE -EOo)FO +.=o; ..c(ro -Le3 €PFF q e(E o) ao q) c b Q) ? q oE ()to c o) € a? o +, G{.,? o E o CL E '5 s,(J '= c) '-' o_So-gtEE9rg> lU6l-z a a4.4. Operational research 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. None has been done. 4.4.2. How were the results applied in the project? Not applicable SECTION 5: Strengths, weaknesses, challeng€s, and opportunities Strengths: . The project has staff at the State, County and to some extent the payam levels that can be strengthened to improve their performance . There are a number of health facilities in the project area and the staff in these health facilities can be used more in supporting the implementation of CDTI activities. Weakness: . Low literacy levels at community levels causes great challenges in the recording of the community level data; . The inability to supervise the conducting of a community census; . lmplementation of the bulk of the CDTI activities during the rainy season greatly affects coverage rates due to poor access to the communities during these times. Challenges: . There was no counterpart funding for direct implementation of CDTI activities in the communities from either the government or the supporting NGDO. . The available funds from APOC were received in September and this led the project into a rushed implementation in the remaining last months of the year. Opportunities: . There were no opportunities identified in the project that can be cited for the purpose of this report. SECTION 6: Unique features of the projecuother matters No unique features/matters to report. 27