WEST BAHR EL GHAZAL(WBEG) CDTI PROJECT tssgAI.!es$s ORIGINAL: English 'q C' o dJ$o Jl It r-( j u,, I COUNTRY/i.,IOTF: SOUTHERN SUDAN Proiect Name: WEST BAHR EL GIJAZAL CDTI Approval year z 2004 Launchins year: 2005 Reportine Period (Month/Year): JANUARY - DECEMBER,2008 Proiect veat of this report: (circleone) I 2 (O 4 5 6 7 8 9 10 Date submitted:27 July 2009 NGDO partner: Christoffel Blinden Mission l, : lt,r'\l \ :. t l- ,\ li r o c. 'J-aU WHO/APOC, 24 November 2OO4 ANNUAL PROJECT TECHNI.CAL RBPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) t.- DEADLINE FOR SUBMISSION: \ To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNcHocERCrASrS CONTROL (APOC) I ll WHO/APOC, 24 November 2004 IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Southern Sudan National Coordinator Name: Dr. M hristo Luga Signature Date:21"t July 2009 APOC Technical Advisor ; Lazarus Nweke Signature Date: 20'h July 2009 This report has been prepared by Name : Daniel Umido Designation : Project Coordinating officer S 9 J s GDc ("tAx=*afr,G Nq$< F u*,t ( S,1,,r,fu" brt" Tin --t*\ ? ro 7 Date 2}th Table of contents ACRONYMS VI 1.1. Gnruener rNFoRMATIoN............. 1.1.1 Description of the project (briefly)..... 1.1.2. Partnership 1.2. Popur-erroN............... 2.2 Apvocecy. l1 2.3. Monu-znuoN, SENSITzATToN AND HEALTH EDUCATIoN oF AT RISK coMMumrres I I 2.4. ComvrrnurY IIn/oLVEMENT.. L4 2.5. CapecnyBUrLDrNG 2.6. TnrartvmNTs........... 2.6.1 Treatment figures ..... 2.6.2 What are the causes of absenteeism? .. 2.6.3 What are the reasons for refusa\s7...........,... 222.6.4 Briefly describe all k4own and verified serious adverse events (SAEs) that ...22 2.6.5. Trend of treatment achievement from CDTI project inception to the current year24 2.7 . OnorRwc, sroRAGE AND DELTvERy oF TvERMECTTN ...........25 2.8. Corvnnnrury sELF-MoMToRTNGAND STAKEHoLDERS MBeruvc ............26 2.9 SupnRvrsroN..... .......27 4 4 5 7 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.s. 2.9.6. Provide aJlow chart of supervision hierarchy. ............27 What were the main issues identified during supervision? ..............................28 Was a supervision checklist used? .............28 What were the outcomes at each level of CDTI implementation supervision? 28 Was feedback'given tb the person or groups supervised?................ ................28 How was the fgedback used to improve the overall performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............29 3.1. Equnvmx-r 29 3.2. 3.3. 3.4. FwRNcmt coNTRTBUTToNS oF TIIE pARTNERS AND coMMUNrrIES... Orrmn FoRMS oF coMMUNrry suppoRT ............. E>cpxptrrnr PER ACTryITY .... of the following which are applicable)...........4.1.2. What were the recommendations? ,n 'l(t .........30 .........30 .........30 .,.,,...,31 ...32 ...32 SECTION 4: SUSTAINABILITY OF CDTI...............:......... ..........31 4.1. INrrnNer; TNDEpENDENT phnncpAToRy MoNrroRrNd; EveruerloN.................... 314.1.1 Was Monitoring/evaluation carried out during the reporting'period? (tick any 32 4.1.3. How have they been implemented? .. 32 4.2. SusrerNasrr-rry oFrRoJECTS: nLAN AND sET TARGETS (MANDAToRv AT...... ..........32 Yn 3) 4,2.1. Planning at all relevant levels... .,,..,.....,.. 324.2.2. Funds 1V WHO/APOC, 24 November 2OO4 4.2.3 4.2.4. 4.2.5. Tran sp o rt ( repl ac embnt and maint enanc e ) .............. Other resources To what extent has the plan been implemented............... .,.'.,32 .,..,' 32 ,,,,.,32 4.3. INrrcnerroN 32 4.3.1. Ivermectin delivery mechanisms............... ...................32 4.3.2. Training.... ..............32 4.3.3. Joint supervision and monitoring with other programs.... ............. 32 4.3.4. Release of funds for project activities ........ 324.3.5. Is CDTI included in the PHC budget? ............ ............. 33 4.3.6. Describe other healtlrt programmes that are using the CDTI structure and how this was achieved. What have been the achievemenls?.............. .................... 33 4.3.7. Describe others issues considered in the integration of CDTI. ..... 33 4.4. OpenITToNALRESEARCH ......:........... .....33 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. ........ 33 4.4.2. How were the results applied in the project?.... ........... 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTLJNrTrES....... ................ 33 SECTION 6: UNIQUE FE+TURpS OF THE PROJECT/OTHER MATTERS...........34 v WHO/APOC, 24 November 2OO4 I Acronyms APOC."itll African Programme for bnchocerciasis Control ' ATb;fr#j.i'- Anntfal Trealqrq4t Objeqtive ATlA;ti;, AnnualTrainingObjective CBOi.l.lii.,. Community-Based Organization @AGaDistributor- CDTI:I : i Community-Directed Treatment with Ivermectin CSM - l;,io Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Devblopment Orgqqization NGt): rypJFt;fu: National Onchocerciasis Task Force PCO officer health care health care Centre health care Unit Rapid Procedure of loa Loa REtt[O, .,'. [.apid Epf4elqglqgiqal Mapping of Onchocerciasis Sfn{i,;;:il: Stakeholdersmedting : SSgEi'l!: Southern Sudan Oncbgc-gqq!4sis Task Force , ',.iti . group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization vi WHO/APOC, 24 November 2OO4 i Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 847o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/tryper-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 UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: 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 qxpressed as a percentage). (vii) Inteeration: delivering additional health interventions (i.e. vitamin A supplements, albendazole foi LF, sgreening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower corrmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are 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) Community self-monitoring (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. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. ;q I vii WHO/APOC, 24 Novemb er 2OO4 FOLLOW UP ON TGC 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 _28_ 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC.APOC MGT USE ONLY Report related Clarify whether or not a year I report was submitted to TCC I was not the PCO at the time and there was no information available regarding the year I report Provide data and missing information in Tables l, 2, 4, 7, 11 and 12 D i The data were not available then but it has been collected and filled appropriately as shown iil ttris present report Provide clarification on why expenditures is less than the amount disbursed by APOC and CBM Most of the expenses were made by SSOTF and Agnes and no information was available to the PCO on how much was budgeted. All documents related to the budget are kept in Rumbek or Nairobi. The financial figures were filled in by Nairobi office and CBM officer. I only provided information on expenditure made by the proiect. Provide details on the financial/in kind support by other NGOs No any other NGOs are supporting the . project '' Provide information on the number of communities with female CDDs I became the PCO in March 2007 and the project was not able to produce the data. In 2008, this is provided as shown in the report. WHO/APOC, 24 November 2OO4 Project related Conduct CSM and SHM to improve community involvement and supervision This will be included in 2009 CDTI activities as the project was also unable to do it in 2008 due to fund. Conduct participatory monitoring of the project since the project is in year 3 This is the responsibility of APOC in collaboration with the project. Train more CDDs to reduce the CDD : Community ratio In 2008, the number of CDDs has "- increased from 512 in 2007 to2625 in2008, thus reducing CDD/community ratio to l:1017, Though, this is still high against the backdrop of APOC standard of lCDD: 100persons. The project has planned to improve on this in 2009. Effort should be made to improve treatment coverage , The workload in the project is huge; we tried during the reporting period in increasing the treatment coverage from7.6Vo in 2007 to 22.2Vo in 2008. More efforts are to be made in 2009 as this is still very low. (Please add more rows if necessary) 2 WHO/APOC, 24 November 2004 Executive Summary This is the report of CDTI activities implemented by West Bahr El Ghazal CDTI project, Southern Sudan covering the period of January - December 2008. The project is in its third year of APOC funding phase. The project's partners are health services, NGDO, WHO/APOC and communities. The project has a total population of 2,670,680 persons, a IJTG of 2,243,368 persons and an ATO of 786,905 persons during the reporting period. The project is made up of three states namely West Bahr el Ghazal, Warrap and Northern Bahr el Ghazal altogether consist of a total of ten counties and 2518 communities. The number of health staff involved in CDTI shows that only 586(42.03Vo) persons were involved in CDTI activities out of 1394 health staff in the project areas. On treatment, 1918 communities were treated and thus giving a geographic coverage of 76.2.7Vo. A total of 593,862 persons received mectizan treatment during the period under review more than double the number rn 2007. This treatment figure represents a therapeutic coverage of 22.2Vo as against 7 .67o reported, in 2007 while UTG coverage and ATO coverage are 26.5Vo and 7 5.57o respectively. Population movements are very common in the project area potentially due to the fact that they are predominantly nomads and farmers. This accounted for high level of absenteeism and also refusal due to their missihg of hi:alth education sessions. On training, 2625(104.27o) CDDs were trained out of Annual Training Objective (ATro) of 2518. The population/CDD ratio in 2008 was ICDD to l0l7 compared to ICDD: 5116 population in 2007. Female CDDs trained constitute 434 (ll.9Vo) while villages with female CDDs are 380(15 .l7o). The number of payam supervisors/trealth staff was 1116(102.8%o) out of 108 targeted health staff. The project had series of challenges that include o Dealing with absentees and refusals: The project-has planned to intensify effort in community mobilization, awareness campaign, health education and use of posters in 2009 to address this problem. . Irregularity in record keeping by CDDs and payam supervisors: The project had to direct the county supervisors to step up training of payam supervisors and also supervise all trainings at the lower levels. This is still a problem but the project is planning to guide communities on criteria of CDD selection especially on the basis of literacy. . Problem of accurate community census registration: Effort was made to tackle this but it remEins a bit hard due to problems ranging from funds to en vironmental, factors, and time. . Inadequate availability of knowledgeable manpower in the project area: The project tried to shift CDDs to cover other communities as well as involving payam supervisors in other payams to ensure distribution in those areas. This will further be address in 2009. ' Difficulty in covering three states in the project area: The project has planned with the Technical Advisor and SSOTF to have a focal person in each state MOH in2009 for effective coverage and implementation of CDTI activities. ' Understanding CDTI ownership by coinmunities is still a problem: The project made effort to educatg community members on ownership of CDTI but this will take some time bbfore communities get this proper understanding. ' Lowering population / CDD ratio in the project: Although the project remarkably reduced this from 5116 in 2007.to 1017 in 2008, this is not still enough. More CDDs are to be recruited and rained'in2009. 3 WHO/APOC, 24 November 2004 SECTION 1: Background information 1.1. General information I ,t \ 1.1.1 Description of the project (briefly) Ge o grap hic al lo catio n, top o graphy, climate Population : activitie s, culture s, language Communication systems (roads...) Administratio n s tru c ture Health system & health care delivery Qtrovide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and'number of health staff involved in CDTI activities. Geographical location, topography, climate The West Bahr El Ghazal CDTI project is located on the latitude of 7.69727o and longitude of 27.99882". The elevation of the project is442m above Sea level. The project is made up of three states and ten counties. The states are West Bahr el Ghazal with two counties, Northem Bahr el Ghazal with five counties and Warrap with three counties. The topography of the project has tryo marked characteristics, namely mountainous and rocky soil zone in the West Bahr ei Ghazal state, and flat and muddy soil zone in both Wanap ani Northern Bahr el Ghazal. The climate of the project is cold during the rainy season between May and September but with the hebviest rain in July through September. It is hot during the dry season but a maximum temperature of about 40 degree centigrade. Population: activities, cultures, language The population in the project area is estimated to be 6 million people in the three states. Only 2,610,680 people are estimated total population in the project area. The activities of the people in this project area are mainly cattle rearing (nomadic farming), farming and hunting. There are cultural differences in the three.states. In the West Bahr el Ghazal state, the two spoken languages are Arabic and English w{th about 30 other local languages. In the other two states, Northern Bahr el Ghazal and Warrap, the three major languages used are Dinka, Arabic and English. Communication systems (roads...) Communication Systems are by road and air. There are network of roads within the project and these interconnect with county areas. The roads are still very bad and movement is really difficult during the rainy season particularly in Northern Bahr el Ghazal and Warrap where roads in county areas are muddy and prevent free vehicular movements. However, government has started improving, on roads through ongoing massive road construction connecting Wau to Raja and also-to Aweil with heavy bridges. The project is accessed through air by planes and helicopteri from Khartoum, Juba, and Rumbek .The Wau airstrip is the second busiest airstrip in Southern Sudan and an artery connecting to all other points in the project areas. The project has modern mobile telephones and internet networks that makes for easy communication within and outside the project. Administration structure The Administrative structure consists of four distinct.levels, namely (i) State, administratively in charge by Governor; (ii) County by Commissioners; (iii) Payam by Administrators and (iv) : ,1 4 WHO/APOC,24 November2OO4 Boma by Councils. Boma is the least administrative unit with many villages. The project has a total of ten counties and 2518 communities (Bomas). Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). For each state in the project, there is ministry of health which formulates and directs all health policies. The system is composed of state hospitals, county hospitals, primary health care centers (PHCC) and Primary Health Care Units (PHCU) as well as dispensaries. From the available statistics in the,ten counties, there are 48 PHCC and 177 PHCU, totaling 225 primary health care facilitisslplus i,.state hospitals situated in Northern and Western Bahrel Ghazal states. The one in West Bahr el Ghazal state is a teaching hospital. Also, there are 3 military hospitals, 2 pohce hospitals and2 county hospitals. Almost all health facilities are run by nongovernmental organisations. Number of health staff in project area and number of health staff involved in CDTI activities As shown in the table below, a total of 1,394 health staff are in the project areas and out of this number,586 are involved in CDTI, representing42.OTo. This is an improvement over last where scanty information was availqble. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health stalf involved in CDTI Bt Percentage Br=BrlB' *1(X) Aweil North !.1 86 33 38,4 Aweil South 52 23 44.2 Aweil East rt2 47 42.0 Aweil West ll8 45 38, r Aweil Centre 158 76 48.1 Wau 26'7 t02 38,2 Raja 80 32 40.0 Gogrial West l6l 79 49.1 Gogrial East 170 67 39.4 Twic 190 82 43,2 Total 1394 586 42,O 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaUinternational), communities, local organizations, etc.l The partners involved in CDTI in the project are the health services (three state ministries of health, l0 county health departments and225 primary health care 5 WHO/APOC, 24 November 2004 centers/units); Communities which include the payams, Bomas and 2518 villages; CBM and APOC/IVHO. There are no local NGOs supporting the state or the counties. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. The overall working relationship among partners is satisfactory. Planning was done together with all partners especially NGDO/SSOTF and the WHO/APOC. Also PCO in conjunction with the technical advisor was involved in^training, advocacy, mobilization and supervision at both state, county and community levels. Advocacy visits were paid to the ministers, Director Generals and director of primary health care in the project areas specifically to address the issues of staff absorption and support to CDTI. The outcomes are usually replicated at the lower levels. There was joint supervision of distribution through checking the records of county supervisors and CDDs for correctness of information. lr State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project has mapped out plans to mobilize various decision makers in the three states and their various counties. There is one international NGO that is showing intention of assisting the project in Raja and Aweil West Counties where the project has high rate of onchocerciasis. The project is preparing to work with the team coming from Germany. 6 WHO/APOC, 24 November 2OO4 c $Oo c.l (.) € o z$N o0. o B c, B q) o tr C) o) B o o I B C') o o)o o F o z =l I C,) o +. Lq) a u0 , aq) L o o0 L E o 9(l) L q) L tr o (n v,Eq)0)q(Jcg cla(t) P^ cEx UE r- o\) '=. 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'6:ev =u 6 ?o)L h =IiGULYGl- -. q) iE. 3' E : =i 5 s Z ; oo an doH) o U) lro o +lol ol -olcEl oO =Asu c)lEI EI cdlotctlEI q)-l ?8(v (,ts 2z(ro E=3 >qr' j z -+F oo SBCTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 24 Novemb er 2004 .+oO c..l C) -o (.) o z$N A o *{ B O cn o) oI trq) L!otuz CA ts oaA. cn (€ o (! (H d oq)a(h ,t o o0(! o .A o .; Eo -ooli .I ooGttr AExoooq)E He a; i9 o9tr:(HO E9 cs6 ox TR Jboas a=6l> trq)ot .l( e !jd otr tr>r oo 9.H -.2o: , tt) .1t=U tsoE =.9€IEe .i()(dgEE cs E'n .9 ;.d '9 :wtrrg o 9!zdPUEHilO E - qq v U L U't > \) o \ ! \Jq S a0 li(g o >t ot<li o (.) C) c)lr .t) (D L(n o lr € U)(.) o o C) c) F c.ir ol -oldlFI th trq) a 9: EE(J () .o tr c)o C) H o .o E() z 6) E o oz o .o oa C)A q) -o q) ooo o Eq) o() o o -o q) oq) o Eq) ! Eooq) o o! E oo a) o o! 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Eo o c)(n o -o o o c)(h abo abo o -o o o 0)(t bo bo 60 .Hs 1jE d= 0) C) o C)a o .o () a 0.) v) a) tro o.o(h !() -o o o.o V) a bo) hoa (.)p q) oq)(n a ao ao Do vuD r(D i5= !r9a o 9: EE(.) a ao bo aao abo a a ! c)p Eq) o.o(r, a a Eo -c lJE ct= 60 bo =bo bo o a o ao c) = o o (, -l I L th L z o , oa c) B C, rI] o 3 q) B c) B o ()(J o) B 'a& o > 6 oo o E] d bo o(, otF Fl E-r o Er 2.2. Advocacy Stste the number of policy/decisian makers mobilized at each relevant level during the cunent year; the reason(s) for undertaking the advocacy and the outcome. Describe difficuhicslconstraints being faced and suggestions on how to improve advocacy. State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advo_cacy At the state level, the project mobilized 9 policy/decision'officers namely three ministers, three Director-General, directors of public health and finance. At the county level, 4 commissioners and 6 medical directors were mobilized before distribution. Also at Payam level,12 Payam administrators were met and mobilized. The reason for the undertaking this advocacy was mainly to seek for their supports to CDTI implementation, absorption of CDTI staff and support the CDDs to distribute mectizan effectively and getting quality report from the CDDs. The outcomes Both the project coordinating officer and 8 out of 10 county supervisors were absorbed into the health system with monthly salary pay. However, issue of community support to CDDs is still a problem as no incentives were provided. Describe difficulties/constraints being faced l. lnadequacy in funding to facilitate undertaking advocacy. 2. Problem of not meeting some of the officers"during the initial visit or not all was experienced. 3. There were insecuritiesrthat prevented undertaking advocacy to some payam administrators and community leaders especially.in part of Qogrial East and Gogrial West counties. 4. Flooding in most areas affected planned advocacy. Suggestions on how to improve advocacy 1. Sufficient funds should be provided for fueling of both motorcycles and project vehicle. 2. Calendars and T-sliirts coyld be given to top policy makers as a means of winning their hearts to towards suppoiting the project. 3. Extra posters should also be provided for use during advocacy. 4. CDTI activities such as advocacy should be carried out in dry for easy accessibility. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other lbcal systems to disseminate information Types of IEC materials used Mobilization and health education of communities including wdamen and minoritics Re sp o ns e of target c ommunitie s /villag e s Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. 11 WHO/APOC, 24 November 2OO4 The use of media and/or other local systems to disseminate information The project relied on the Southern Sudan FM radio and Wau Radio to disseminate information. Also local means were used such as meetings, announcements and passing oral information through community leaders. Types of IEC materials used These are laminated posters, flip charts, comic books for school and manuals Mobilization and health education of communities including women and minorities Intensive mobilization and health education were carried out in all 10 counties of the project area. The county supervisors contapted the trained community leaders and they assisted in grassroots mobilization and education of community members. Both women and minorities were included in the mobilization and health education. The health education messages were on the importance of taking mectizan and for many years and full participation during the campaign. Selection of more CDDs by various communities and their supports were stressed at the mobilization meeting. Response of target communities/villages The community members agreed tp appoint more CDDs and also those CDDs that have dropped were replaced with riew on{s. Persons who have not received treatment before agreed to p-articipate in ihe ,r.ut*.nJ. : Accomplishments 1. Many CDDs including female CDDs were trained and participated in the distribution. 2. All the counties participated unlike last year when only 6 participated. 3. The number of treated villages sulpassed that of 2007 4. There was a great improvement in mectizan treatment coverage compared to all past year. The therapeutic coverage increased fromT .67o in 2007 to 22.2 7o in 2008. Suggest ways to improve mobilization and sensitization of the target communities. - Provision of adequate logistics and'fueling to covering vast areas. - Provision and use of megaphones for effective information dissemination at community level. - Production of more posters and handbills to cover all villages and strategic areas. - Involving schools for faster information dissemination. !{ 1 t2 W.I{O/APOC, 24 Novemb er 2OO4
cooo c.l Ho -o (.) z$N U o B $ +j o Oi o o o rh oa U) cn Liso0trtr€5r-90q, (-)tra{ L oa)5hcEc9(B ooL c) .nE39 cs6 >: (.) .'-E li (J 9!q{) oii <lD * UEEHg9 6toE-O EE tr-,0) v9d 9.EeEEe =9al9e!=u<> q s,tQ E*trE !== r!0),-!Eitra0 ZF ll i. H: c)bo(q q) L c) o, 9oN a? c) oq @ 9 N oq N O o @ <i Itif Ro. rj Eg* t Egez e', $ ca o\N r-\n o.lln \.)$ $CO r-$ $ \o \nc\ o@(r) o U q) z c + I (t: Fr r- ca c{ \ooc\ \o ca co r- ca o\F- a.l € *N I(a @!t (\t€ NF- 1r)NaN 9qEO c) ri \n ca cf) oo\o \o ln €ca ot\n F*v coN o\N $co$ F le q Q q) CE 2 6l N \n f- €\oN \o\n c.l o\N al o ci 00t at o o\ to$ o N =? ,g 8'F uDx6x >o --: aEid ,Eq tro Cq,!tr .!.a zt) O ll * laIQ > te o o0 c! q) Lo q o,(o Nd(D ds IN(O q r\N q oLo c.js c! ss Nro N <, € oq CDsil le fane i1,,i r- \orn N€ OOr o\\o @F- t @\oN € o\ \o@ No E Y?a)df.Y tr OEEE I -5e,i'l .T E:.E @ r* s No F @f.r$t (o roN (o ro NsfN (oo(o Ns a) o)N @ roN J q L z o B o(h (); dr! q) B c) B o , o c)O o) C!B (g 'a & a) B E oo o rI] (g bo o o .E F c! F h qq \0Q\)(- %: q) L N ! q \J &v F U o -O oc0ta 6)() o(n Laa '-o s= Etr ,q(, $t ol RFI6r Fl $ N ro .o o z$N O 0r o 'JrB \.) 3 v '7, (h a.i(J..:?)t\ tr =h a)g eE :AeCer-!E .EP 9 .2 q€ 'E € == Eqa Eb 8 L= --q) tro) .- 5> co; 59 .Etr oa E! 1-E 8: p = 3E o.E 09 ! -,J6dC)E H; e A? r'E H exb €E u tra € ne I ;U ch PZ * = OP s: E :iB '5 = = E 66q c-rii e 6trY -O'5 Y^. r o)tr ^ 6 .=; F-.c .P ac ?E s-s5 =E n! sEE FA':t Efl,o 5u =.= =:! HT E.. BHE *E -E gfrH O.O !E U= =E qoi? '0€ J,; .EE:'i >'a () o >r'5X*5'Eh.=sE Pr'E= s'jE i-? Et L= -e EE 5.8 eiE 7: QP, ;E ie ii et E! .e; gE e€ -}.}'E.9 r c E s g'E :i3 Es E* i.EE€ CE .cE EEf g o P 'E c 9si= E.3 EE xl EE :aE Pt QE3.8 EI i.E EE €5 E- Ex =:= E c f 't= or 99a o. u (u ol..l E -5ti EE *E bE s Eg I? EE Ei g 2 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. At the state project level, the available manpower is knowledgeable. However, there is need to have assistant PCO in event the PCO is not available. At the County level, most of the county supervisors are new and not well knowledgeable on CDTI activities. At payam primary health care center level, very few of them were health staff but complemented by payam supervisors who are still not adequate and knowledgeable. Though the number of CDDs has increased but still is not adequate and most of the CDDs are just new and therefore not too versatile with recording data in community summary form. Where frequent transfers of trained.staff occur, state what the project is doing, or intends to do, to remedy the siluation. (The most impofiant issue to describe is what measures were taken to ensure a-dequate CDTI implementation where not enough knowledgeable n anpower was available or if staff are frequently transfened duing the course of the campaign). Transfer of staff do not affect the project because they are only rotating at the health facilities within the same communities. And generally there is no transfer of staff at state level and even at county level in the project. PCO has been trying to cope with works at the state level and CDDs workload was increased to cover communities without CDDs. fr , 16 WHO/APOC, 24 November 2003 (n ci o -o o z t a.l o0. o tlr B r- A' E (c an a nU(* o bo '= Lr o Eo th ,.,b3i\ ovo EeENLO o! rr!Eq tfo c!tr OL rjE o) =(h*i '= -C!I] ?il(l)_c e)F U)CE u,c)HE3 E9 cE q.L2 sdoaE o.) 6! U)(l)E(l)c E(g 5t- oo?U (|) l+ltr() clE ! pP ,ooo>(, -'dF BE - - - -.J OO o() \J .s l) q \) \J B \)L 4 \) "ra\ g. o o OO \ \) U \) q)\ p ^: .a ! ! a \) \' lr ts F h B4q\)(J L q U \) o t \J4 \,)q o (! o 0.) A. tr F aU(H o(, q) q) otr 0)(! o (! bo CdHF .iit o)l -ol(nl FI E 0) 6lL l,h n aQ o Lq)E z tlt +. €9!F F rirS<; *p a< \r ivt$ r- c.)N a r- c.)N \o N \o ol O; \o ca cn \o co cO r- F{ ea O F- cn o\F- a{ 00 € o\ @s c.l $\o ;6 o c.) c.l\o 6 cA N @t CO t-.t-. tr-N N @ t'- c.l NF- $\n oo 1oN €N * NN ooO$ BsN ! q) q) c) (J s FO oo F- $ N€ \ot-- ol \o rnN \o!n t'-$ol \oO\o r-$ c.) o\ o] @ roN o(t)Lq) .='tr' cl FrLh bF ii t) oq) rHg t- C! o)L z ?tt +9doF F ciciP *:q\r S>q) z N N O N N .+ (.t C\l co c.) co co a $ !+ O t s t s (?) o\N s raF q) q) 0) I s6()io $ s !t .+ .+ $ $ s t $ o!+ q) dl Eg EH.tr> z$o oI rQ + I() NQ .b il €Q C! oF t.$' a< A)z \o O \o $ : \t o o o ( rn \o .+ N o\ o\ t-- r- c..l : t @ i+ N F- € a N q) 0) €) I s(.)io t'- O (\l cft !n c.l t-- € tH c! t) o ,) 9q) Ecs Lq) z sl [v E "=,3 $ t a< ] q) z O a O a O o O a \o t s q) o q) I s ()Er rl I L (a a E oz C) 3 = ch o > d r! o > o B c) = o tr C)U c) ' 6, B cq 'a & o B c, bo o dql 6 E hI) o EF FI E< Er (\.l N c.) Table 6: Type of training undertaken (Tick the boxes where speciftc training was carried out during the reporting period) Any other comments No 2.6. Treatments 2.6.1. Treatment figures If the proiect is not achieving 1007o geographical coverage and a minimum of 65Vo therapeutic coverage or the coverage rate is Jluctuating, stale the reasons and the plans being made to remedy this. The reasons for not achieving the coverage are l. The quantity of drugs available is not enough given the population of the project. 2. Distribution takes mostly in rainy season which does not permit easy access to endemic communities due to floodings 3. Delay in releasinq activities fund to the project especially second installment. 4. Although there is'an improvement, the project still experienced inadequate manpower at all levels most particularly CDDs at community level and most especially in Raja County. Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Polltical Leaders Others(specify) Program management { { \i How to conduct Health education { { { \i { Management of SAEs { { CSM SHM Data collection ^/ ^/ { { Data analysis { { { { Report writing ^/ { Others Census registration (specifv) { { { { 18 WHO/APOC, 24 November 2003 5. Insecurity in Gogrial East and Gogrial West counties grossly affected distribution following communal clash between communities and militiamen. l- Plans being made to remedy the situations . Activity fund needs to be released on time by APOC. r Greater focus on Raja county during the next distribution r Community members to be well mobilized to ensure the selection of more CDDs and to also support them. . Ensuring that training and distribution take place in dry season. t9 WHO/APOC, 24 November 2OO4 I .+Oo c.l Ho ,o C) z$N U o O. + B N (! C)L(d 6o 'a lia o ; rt U 't rt) 0) I .E d H F oo o !Htroto)ol €ilExl .r El691A. dl € JJI 6t81 8J*lE sl ol xl - ;.1g El; ;l ol 6l tr .ilBl sl:= Elol ol- )lEI BE EIEl 8l H 8lOl ,*l i ,*llnl ol a. ol 5l ge El9d EIE EI El zl1 2l crtl I .9t =I8l ilil(nl Ll(t)l €l 6)bd.gF .EI E ; =l obnEI F' H5l I aol o(J r-l o= .ol o- U:I E5 E -l (D* =t o. sqEI B Sol roIrrl F O A€ E9( c-c'E { EE E S9d o69 0 ! c) o o3 az a O O 9r!t< =u)zz O o o O bs3trco a-oz.n c\l € o\N o\ N (\I ca \o@ o\\o ol$ 00 rn c.l$N €$ $rn N ^=-vaIE E t ei HJ 6! O HEK}982a E r oor- c.to\ o\ $ olo\ C\lc.) cor- c.) 00rn t--O ) ano tu ll* ,TA oEq) =boO claSbs ooF()F ro o. 9 c/) q (/) oq N 9 @s q rtr) q (f)$ q N q(r)$ N c.iN d o o-bFU ETE = o.!z (a)\o$ rn !o ca o\\nN $(\l ol ot sh$ ol c-$ Ot-. t co t-.\o c-. C.)aF- to r* o\ \oN ot co TA c- co co\o ol\o 00 ca o\\n A tso? 6.22E6 < 94Fe @@ €NN 1o N@ ro ro €sN rr) oa$N o,@ CDso oos sro @ ro @ ro oi@ o s(f) N o (f)s !nOq. \o@F- .9 .,3: ;io:. EEi5 -?.g E - q€ oF tt C.t$\o ol rnoo o\ co o\\o c.) o\ co rn c! rn o\ o\ co ( N c.) c.l C.) oo ca $!nN o\ €N (n COt+ € r,- c.l .+ o\\o o\$N 9! \o\o$ O@\odt'- \O- ci (n o o0(g (h q) tr oU ll * ^'A (t .9 o.) _c bo ^ G^ F-bEaE"e- ov q sN aNN N oa 9(r) N N(j N crjN o? @ ro @6@ NdN @ oN N <,N E.9 .- otru!.t €ESE fE>!z6 o N co N \oN ca c\l TN o\ .+ $$ \oNrn car- c.l coo 00 Or =o? 6.> zEU c cE.= < 94FI' carn oc\l o\n oco c.T \nON C\IN 6I rn \n o\N TN @ON \oqoF-rd :.9=5 d I *E;5EO E EBE-E u'r tr 3 oor- + N@ (ot-N (olo$l (o rO Nrt$t (oo(o Nt(f) o,N @ rON .E<;vE< L z o , aoa c) , cd r! () o B o , c) tr c)O c) ' c, CE 'a & o B ho o d rq d oo o(.) o BF FI Er o E-( 4q q) o q > \) o \ q)q ! \,) q. t/) .F t)(n C)L(! oJ () ! c/) -o an r! (n o (s 0)LrF r-f ol -ol(€l FI $aO ol o -o E o z * c.l U o0r N q) Eo EIsq) E a.I 00 oq) 0o :loqla\3l- q) -)s,vq c!so\L%CgB !€()! .oEp' 'BEs \e In =*sttool' Bxl.sS3ES!:?\(!Ss oE.s '=$oH:S C)-SlEET9:SLll'SEPEpt .E Se oSFE i $etrE\.X E G- '{s- 8s E" Er;l q u ;t xl ! \! g I .ol a E Su^ st ; s ;.,)EIE $ SS -l 6) ! \h *1.3 .I $!5lo E \S Bl E t s*blE i Er EI = N EPtsl S .sb zIE E EI .S EE6a qrls s- 'i oI " ! ^rE * G'$E RS ,* \c) : L.()t $*: sal !l \= s ='llB S i;r t EsE .S'E\ d ai E'c 9 S SS,tr rr rrEr s 9!s ! ss (g c)L(! o C) t- A- C) z sl& -o o(ir oE a, an o o o 0) ooltAlLr YlC)-l arE xl i = lrluZ RIBo El i^!tv H (t)l =A-l HH Ol 0): ol trb 9l E -o -l :Yc, l=l U5 :tFtr ol =At !v tuHtr itHo =l trF Zl< g C)boF^ 9E oo oF s il 2.6.2 What are the causes of absenteeism? 1. Most of the population targeted is nomads. They travel from place to place with their cattle for grazing during the period of distribution and thus missed treatment. 2. Farmers due to their farm works in rainy season are not available at home during distribution. 3. Those looking for jobs to do or greener Pasteur also missed treatment. 2.6.3 What are the reasons for refusals? 1. Some people think the drug causes severe illness. 2. Some think it aggravates the blindness disease. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report { 22 WHO/APOC, 24 Novemb er 2004 = N E C) .ot o z t c.i Ootr o E B coN \) \0 (+.- o' \0 -a L\) W) h qq\)\)\J q oL \) \ \,)q \) o. ! o .F o Ar oo ii A.(.) C) b0 !) !oF)(-)() o c/) r! c/') C,) O c.) 0) anLo U) o Lr C) rh(! o ar) o(n(! O #r()l -oldlFI o -tr!o99 -EE 54 c2 L - aoc)9Ptr'9 CgCJo == E E E.3XAE rr.t u'6 o o.=E? 9E9q0 oE o o{)+ UY 99 - 6.= (1)OE trded rd '*i;o-o.9 -c ao d tr= dO-(JOEEE o ^6>eOEa)' n 9 Y.63 d € . I ep.! =5^EargEEtg a o, (n rl]J ca 9 .J 5&z< Fr;=c) _YL o=0.) *l)qq<l tsC' N= H8=o>; o Oooc €.- =t)oao xo U) obo * z U) obo P Es rO O c.) o\ u-1 \o c..l tr o (! ao0i rt +^ trint E o o BooF 6B\< B-() q rnN q !nt- n rnr- t ll *. cl{ ri oEoJ500O (E-$bs ooEOF q(.) 9('- e!c.l c.l E] ,,(J oct uQ 9- z-i o O\oq O(t. $ oo\ cnO c.l N\o 00- CN o\(n t{ =o? 6.25 tr:.a < 94F9 o{ a-!n F- C\l N c-(n r-N (a) o\ \o € F- aq ^-rd-Xo - A *€E.ior)o- .os€s'Eri ' d. 39 o \o o\t'- @\o O t-- \O- c{ o 0|o \O. O t-r \O" N 0o o0 (.) E tr C) t ll * EI rd F] c) o &ooF dE\< e-o v? c.) \c-l c1N o\ .cOJ-qbo= $e E Lj,t;r (,0H n c.) \co c-.i\o F- ri q(I)oE 8-b E 9PU = Et !z8' t N @ o\ ri =o? E.z E (!.Y. < 94' til. o\ N co o\ c.l co @ N bo cll =qtB g E-E+.9 = b;: -?.= tr <.= rdi: tr'- o E € E 3 E€ EC) () o\ c.t cf) o\ c{ c.) @ rn N & H F- o\ o\ 00 o\ o\ o\ o\ o\ ao c.l O c.l ol 8 c{ c.) N s C.l !n 8 c{ \ooo C.l l-. 8 c.l 00 oN o\ C.l O O c{ too c.l o -o (.) z sN U o H tJr B $N -(r)t vt/ I CE - -9 -GI q) o0 -IULo BOEe\9\-$i-L-l 'S= B. c! rrI.=CE:L9Eo ,-a --:.sE6N'=!55tv-03b odE €Ee ov= -;ch LUbg;;Scrl P9Jq)9a09.gtE .= o' q)E EE .g9q)9'.=2l-)AS.v rolrrogeh€{f \ L (.lvA= -dolIILAJO€rL0)I €lGltEl IEEI E0el E .0 3l .s €BX -E6g - !v-9d!r 96(arfi6rhs, \JLU:jtrl =cu); e= 3tr()rgtr0) l-g -Ecg e.9a-E o,i o\l ';()l u) =l GtP-l o,)!vtFl 0r 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer) MOH ./ tr WHO tr I.JNICEF N Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer)MOH tr WHO{ d I]NICEF NGDO ./ NGDO Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The project collects from the SSOTF office in Rumbek and later in the project office in Wau shares the drug according to the size of the counties. Due to poor means of transportation, the project sends to the county supervisors in their various counties from where the health staff/payam supervisors come to collect drugs or alternatively the county supervisors used their motorbikes to send to health staff/payam supervisors. At the health centres or from the house of payam supervisors, the Boma supervisors who are also CDDs will come and collect the community's drugs to share with other CDDs for distribution to community members. Table 10: Mectizan@ Inventory (Please add more rows if necessary) Number of Mectizan tablets How are the remaining ivermectin tablets collectetl and where are they kept? Health facility staff or Payam supervisors collect the remaining drugs from the CDDs and send them to county supervisors. The PCO receives'from the respective county supervisors and then keeps them in the project office store in the ministry of health. Sometimes drugs are kept with county supervisors due to difficulty in reaching the PCO. Remainin 36981 40006 5230t 80804 537 34290 103802 80000 19806 307 State/District/LGA Numberin stock Requested Received Used Person treated Lost Wasted Expired AweilNorth 185500 185500 t46663 5t465 1856 0 0 Aweil South 120000 120000 79805 25935 189 0 0 Aweil East 457500 457500 40489r t22240 308 0 0 Aweil West 134,500 134,500 73696 24564 0 0 0 Aweil Centre 187000 187000 186342 70147 t2t 0 0 Wau 243500 243500 20921Q 67t34 0 0 0 Raja 152000 I 152,000 48198 17037 0 0 0 Gogrial West 44000Q 440000 359,295 t19704 705 0 0 GogrialEast 120000 1200000 100,000 3226r 194 0 0 Twic 160,000 r60,000 159383 63375 300 0 0 TOTAL 2,220,000 2,220,000 1,767,493 593862 3673 0 0 25 WHO/APOC, 24 November 2004 List and briefly describe the activities under ivermectin delivery that are being carried out by health ca.e personnel in thQ project area. The activities of primary health care'personnel are as follows: -Management of adverse reactions: Health care personnel keeps record of cases of adverse reactions and treat minor side effects and refer the severe effect cases appropriately. - Training of CDDs: They are responsible for training CDDs - Record keeping and Collection of summary form from CDDs: After distribution by each CDD, they collect report and later sepd to county supervisors after checking for any enor. -Collection of mectizan: They collect mectizan from county supervisors, store and then distribute to CDDs. - Community mobilization: Before distribution and on drug availability, they mobilize community members especially the leaders on drug availability and remind them to the community to select their CDDs and send them to collect mectizan for distribution to members of the community. Sometimes, they send for CDDs who come and collect mectizan - Collection of remainder oi mectiBan tablets: Any remaining drugs are collected from CDDs and stored in the health facility and later send them to county supervisors. Any other comments No. 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for gommunity self-r.nonitoring been done in the project area? i No CSM training has ever been conducted in the project area. If so, When? 7, 26 WHO/APOC, 24 November 2OO4 DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) Aweil North 178 0 0 Aweil South t4t 0 0 Aweil East 182 .l 0 0 Aweil West 276 0 0 Aweil Centre 256 0 0 Wau 156 0 0 Raja 247 0 0 Gogrial West Gogrial East 606 0 0 347 129 0 0 Twic 0 0 TOTAL 251 I 0 0 Table I 1: Community self-monitoring and Stakeholders Meeting (Add-rows if needed) 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 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Reporting SSOTF IUq WHO/APOC, 24 November 2004 ' {11 ii:'. ;;:.. t. ; r r1\ifr't lir: t f:\ il I(':I;}'iI "u'-. .-t "Yl'.,'"r-iT- -r i. J l,,lt;{ ii 2.9.2. What were the main issues identified during supervision? l. There were mistakes and irregularities in some county sup6rvisors level2 forms. 2. Difficulty in movement due to very obvious bad terrain due to flooding and most houses were submerged. 3. CDDs forms were not enough and thus making data compilation difficult. 4.Lack of treatment registers in many villages. 5. County supervisor did not collect community summary data forms from health facility staff/payam supervisof"s in most instances. 6. Delay in distribution in some villages due to sharing of one registers by multiple villages under one Boma. 7. Non distribution in many villages in Gogrial East and Gogrial West counties due to communal clashes that led to insecurities. 2.9.3. Was a supervision checklist used? Yes, checklist was used during supervision 2.9.4. What were the outcomes at each level of CDTI implementation supervision? At county level, there was no distribution in the insec..ured and heavy flooded areas to avoid mectizan loss. Also, the'county stipervisors corrected and resubmitted their reports and some were able to collect community summary data forms from lower level. At health facility/payam and cominunity level, they were given more community summary forms and promised of more registers in 2009 and mistakes in entries data were reduced. j, 2.9.5. Was feedback given'to the person or groups supervised? Yes, feedback was given to them on the spot verbally. 2.9.6. How was the feedback used to improve the overall performance of the project? The mistakes that were noticed during the supervision were used as main points during the meeting with county supervisors with a view to pass on the message to other areas where supervision was not carried for overall improvement in the ploject performance. 28 WHO/APOC, 24 November 2004 { I SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable,WO=Writtenoff). . .. How does the project intend to maintain and replace existipg equipment and other materials? It is expected to come from the government counterpart funds in future when budgets are released to the project. '! Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 1 F 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) l0 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) I F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 0 NA 0 NA 0 NA 0 NA 7. Others 0 NA 0 NA 0 NA 0 NA a) metallic cupboard 1 F 0 NA 0 NA 0 NA 0 NA b) Ceiling fan 0 NA 1 F 0 NA 0 NA 0 NA c) Bicycles t7 F 0 NA 0 NA 0 NA 0 NA d) Radio base 1 F 0 NA 0 NA 0 NA 0 NA 29 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years Contributor Year I (2006') Year 2 (2007') Year 3 ('2008') TOTAL AMQLINT (cAsH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOUNT (cAsH) Budgeted (us$) TOTAL CASH Released (us$) TOTAL AMOI.INT (cASH) Budgeted (US$) TOTAL CASH Released (us$) MOH (Central + Provincial/State) 0 0 0 0 0 s4696 MOH (District/LGA) 0 0 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 26,620 26,620 27,495 27,695 2t249 21249 a) b) Communities 0 0 0 0 APOC Trust Fund 71340.00 54481.00 74940.00 59574.00 87,850.00 63,180.00 TOTAL 97960 8l 101 102435 87269 109099 I 391 25 Others \GDO partner(s) If there are problems with release Lf counterpart funds, how were they addressed? There are problems with the release due to the prevailing situation in the whole Southern Sudan. Nevertheless, the project has planned to continue meeting with the ministry of health authority for counterpart funds release for CDTI activities. Additional comments No direct funds are being released by other partners to the project apart from the APOC fund.J1 3.3. Other forms of comrirunity support Describe (indicate forms of in-kind contributions of communities if any) No community support to CDDs except to assist in cooking food for CDDs during training 3.4, Expenditure per activity Indicate in table 14, the amount expended during [he reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here_ 30 WHO/APOC, 24 November 2OO4 Table 14: Indicate how muchlthe project spent for each activity listed below during the reporting period. I Any comments or explanations? No SECTION 4: Sustainability of CDTI 4.1. Internal; independentparticipatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (Tick any of the following which are applicable) Irt N Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Activity Expenditure/ Source - APOC ( USD) Expenditure/ Source - CBM (usD) Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs 2,030.00 8,416.00 7t3l 2709 Training of health staff at all levels 3565 !upqJvpln and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials 5,531.00 64t7l1,100.00 Summary (reporting) forms for treatment Vehicles/ Motorc maintenance Office Equipment (e.g. computers, printers etc) 8,593.00 3,000.00 Others/plus 54696 USD BY MOH 24,5lO.OO 1427 TOTAL 79,2M.00 21249 Grand total amount 139,125 Total number of persons treated 203,784 Cost per treatment 1.46 USD -N 3t WHO/APOC, 24 November 2OO4 4.1.2. What were the recommendations? NA 4.1.3. How have they been implemented? NA 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) ir Was the project evaluated during the reporting period? Was a sustainability plan written? NA_ When was the sustainability plan submitted?_N What alrangements have been made to sustain CDTI after APOC funding ceases in terms of? 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2,5. To what extent has the plan been implemented ,} 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1, Ivermectin delivery mechanisms: The mectizan is currently distributed through the PHC structure, the PCO who is a staff of the ministry receives the mectizan and sends it to county health department who in turn to PHCC at payam level. All the county supervisors are staff of health ministry. However some payam supervisors are not health staff but the projeit is working towards ensuring total integration into the PHC at payam level. There is no common drug delivery system for all projects in the MOH. 4.3.2. Training: There is no joint training of CDTI staff with other staff due to difficulty in organizing it considering the situation in which the project found itself all these years. In future, the project hopes to do integrated training. 4.3.3. Joint supervision and monitoring with other programs: This is also not yet the case. However, some county supervisors who are involved in guinea wofln eradication combine CDTI work under this activity. 4.3.4. Release of funds for project activities: No fund was released to the project with other projects in the ministry of health. Government has no budget for now except mere allocation of salary of health staff. 32 WHO/APOC, 24 November 2004 4.3.5. Is CDTI included in the PHC budgett There is.no budget for now in the entire ministry and whenever the PHC starts having budget, CDTI will definitely be included. 4.3.6. 4.3.7. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? No health programme is currently using the CDTI structure. However, there is possibility of its use for othqr health programmes such as NTDs since it is community driven. Describe othe,rs issuiis considered in the integration of CDTI. Nili{ 4.4. 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. No operational research was undertaken by the project during the reporting period 4.4.2. How were the results applied in the project? Not applicable (NA) SECTION 5: Strengths, weaknesses, challenges, and opportunities Ust the strengths and weaknesses of CDTI implementation proces.s Strengths of CDTI 1. Absorption of PCO and 8 county supervisors into the ministry of health. 2. Frequent supervisory visits to project locations by the Technical Advisor and his general present in Southern Sudan. 3. General commitment bf courity supervisors especially those of Twic, Gogrial East and Gogrial West counties. 4. Availability of project vehicle and motorcycles to most of county supervisors Weakness 2. Mectizan distribution during the rainy season affected coverage. 3. Delayed fund release to the prqect. 4. Most villagers do not have adequate number of CDDs. 5. Shortage of community registers and other reporting forms delayed report submission.)\ List the challenges and indicate ho'iu they were addressed. ' Dealing with absentees and refusals: The project has planned on intensifying effort in community mobilization, awareness campaign, health education and use of posters in 2009 to address this problem . Irregularity in record keeping by CDDs and payam supervisors: The project had to direct the county supervisors to step up training of payam supervisors and also supervise all trainings at the lower,levels. This is still a problem but the project is planning to guide communitied in CDDs in 2009 on CDD criteria especially on literate pDDs. ' Problem of ac6urate iommunity census registration: Effort was made to tackle this but it remiins u U'it n*a dul to problems ranging from funds to environmental factors and time. 33 WHO/APOC, 24 November 2OO4 Inadequate availability of knowledgeable manpower in the project area: The project tried to shift CDDs to cover other communities as well as involving payam supervisors in other payams to ensure distribution in those areas. This issue will be address in 2008. . Difficulty in covering three states in the project'area: The project has planned with Technical Advisor and SSOTF to have a focal person in each state MOH in 2009 for effective coverage and implementation of.CDTI activities. . Understanding CDTI ownership by communities is Still a problem: The project made effort to educate community members on ownership of CDTI but this will take some time before communities get this proper understanding. . Lowering population / CDD ratio in the project: Although the project remarkably reduced this from 5116 in 2007 to 1017 in 2008, this is not still enough. Mor3 CDD; have been planned to be recruited and trained in2009. rI SECTION 6: Uniqub feaiures of the project/other matters REMO/RAPLOA exercise was conducted in 15 villages of the project. All the results have been received except the missing REMO result from three villages from Aweil West. The exercise took place in November/December 2008. In November, the Technical Advisor visited the Northern Bahr el Ghazal state of West Bahr el Ghazal CDTI project, where he met with the Director General (DG) ministry of health - Dr Edward Ayong Abai in his office in Aweil. He briefed the DG on the REMO/RAPLOA mapping in the state. Technical Advisor solicited for his support to the exercise and also to the mectizan distribution. The DG in his response appreciated the Technical Advisor and pl'edged government support to onchocerciasis control programme. The DG called for the establishment of CDTI project office in Northern Bahr el Ghazal and noted that West Bahr el Ghazal state where the CDTI project is located is far from them. Technical Advisor admitted the need for a focal person in the ministry and asked him to appoint an OV focal person for thg ministry who would be liaising wiih the CDTI project office in Wau (West Bahr el Ghalal state) pending the outcome of the REMO/RAPLOA exercise. t t 34 WHO/APOC, 24 November 2004