Western Equatoria CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January to December 2013

WESTERN EQUATORIA (WEO) CDTI PROJECT whoweqproiect@qmail.com rl ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNcHocERcrASIS CONTROL (APOC) I t._ COUNTRY/NOTF: Republic of South Sudan Proiect Name: Western Equatoria CDTI PROJECT Launchinq vear: Dec 2004Approval vear:2003 ...To: .. . December 2013 ( Month/Year) From: January 2013 (Month/Year) Reportinq Period: APOCfundinqvear: 1 2 3 4 5 6 7 8 APOC Proiect implementation vear report: 1 (9) 1o 11 12 13 2345678(9)10111213 Date submiffed: 31't July 201a Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Christoffel Blinden Mission - 904 communities t I tWESTERN EQUATORIA 2013 ANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSULTATTVE COMMTTTEE (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 Tong Chor tVl ek Signature Date:..r3.1 :I lJulyl2Ol4 Project Coordinating Officer. David Jacob Bido PPsisnatur", ...F..1Y1 b"b Date:..*15trlyt2o14 Cro-t^h' Signature: . Date: .lJulyl2)14 This report was prepared by: David Jacob Bido epresentative: John Alal Ujwok PP Designation: Project Coordinating Officer sisnature' ...D*** B#" Date:.E.glhrr 't2014 NGDO R ,1 fuot Table of contents ACRONYMS V DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS 1 SECTION 1: BACKGROUND INFORMATION 1.1. GerueRRl rNFoRMATroN............... 1.1.1 Description of the project (briefly) .., 1.1.2. Parlnership 1.2. PopulRtroN....... SECTION 2: IMPLEMENTATION OF CDT!... 2.1 . Trtrlrlrrur oF ACTtvtlES............. ....................7 2.2. Aovocncv .................8 2.3. MoatLtzRrtoN, sENSrlzATtoN AND HEALTH EDUCATIoN oF AT RtsK coMMur.rrtrEs.8 2.4. Corrrruuurry INVoLVEMENT.......... ................10 2.5. CnpncrrvBUrLDrNG ...............11 2.6. TReRruerurs............... ..............13 2.6.1 . Treatment figures . Error! Bookmark not defined. 2.6.2 What are the causes of absenteeism?....... ............15 2.6.3 What are the reasons for refusals?............... .........15 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that 15 2.6.5. Trend of treatment achievement from CDTI project inception to the current year ......... .....16 2.7 . ORoenrruc, sroRAGE AND DELtvERy oF tvERMECTtN ......18 2.8. Cotrruururry sELF-MoNrroRrNG AND STAKEHoLDERS Merrrruc... ......20 2.9. SuprRvrsroN .............. ..............21 2.9.1. Provide a flow chart of superuision hierarchy. .......... .. . . ....21 2.9.2. What were the main issues identified during supenrision? ...................21 2.9.3. Was a superuision checklist used? ....................21 2.9.4. What were the outcomes at each level of CDTI implementation supervision? ............ ......21 2.9.5. Was feedback given to the person or groups superuised?...................21 2.9.6. How was the feedback used to improve the overall peiormance of the project? 22 SECTION 3: SUPPORT TO CDTI Eeutpr'aENr FrruRucrRr- coNTRTBUTToNS oF THE pARTNERS AND coMMUNTTES Ornrn FoRMS oF coMMUNtry suppoRT .............. ExperuotruRE PER ACTtvtrY.... SECTION 4: SUSTAINABILITY OF CDT|.. 4.1. lrurenrunl; TNDEeENDENT pARTrcrpAToRy MoNrroRtNo; EvRt-uR1oN........... ......26 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?... ........ ........26 22 22 22 26 26 26 3.1 3.2 3.3 3.4 lu ;;;;; i Ci o,ii, i ix n oi iiit i "i. ,.......5 ..................6 4.1.3. How have they been implemented? ............ 4.2. SUSrntNRetLtTY OF PROJECTS: PLAN AND SET TARGETS (UnruOnrORY AT............ 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. 1rurEcnRrtoN.............. 4.3.1. lvermectin delivery mechanisms........ 4.3.2 Training 4.3.3. Joint supervision 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. OpTnnTIONAL 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 .26 .26 .26 .26 .26 .26 .27 .27 .27 .27 27 29 29 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........29 lv Acronyms APOC ATO ATrO CBM CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Christoff Blinden Mission Commu n ity-Based Organ ization Commu n ity-Directed Distributor Commu n ity-D irected Treatment with I ve rmectin Commu nity Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Orga n ization 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 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eliqible 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 Tre 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'o 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). (vii) 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. (viii) Sustainabilitv: 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) Communitv se itorino (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. TCG session _37 Number of Recommen dation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Recommendations to improve the project (i) Please address the reasons for the low levels for health staff engagement in CDTI. Efforts have been made through the leadership of the County Health Department Directors to ensure there are more staffs engaged in CDTI. There is some improvement in this report compared to 2012. ( ii) Lack of census data is problematic as the quality of the substitute source is unclear. Conducting community census is still a challenge. The population used in this 2013 report is a calculation of successive annual population projection using an annual population growth rate of 3.0% to the official 2008 National Census statistics to get the 201 3 population figures. ii)( Low levels of sensitization and mobilization needs to be addressed, also with a view to the inclusion of women in CDTI. This is stillwork in progress and the project will continue working on this as recommended. (iv) Please address the prerequ isites for conducting CSM and SHM. This is stillwork in progress and the project will continue working on this as recommended. (v) Training is a precondition for progress. Under current conditions, the ATO may be "realistic" (as postulated previously by TCC) but a contingency plan. The project agrees with TCC on this comment. (vi) It is obvious that the project context determines problematic coverage rates. The project agrees with TCC on this comment. (vii) TCC kindly requests to be informed in detail about the The delay in re-launching is due to resource reasons for the delayed CDTI re-launch and proposals. constraints. The proposed budget for the re-launch is much higher than the current available resources. Whereas the project would desire to have the re-launch, the reality is that without the needed financial, logistical, human resources; it will not be a reality. Recommendation to APOC management (i) APOC/HQ and SSOTF should follow up and develop a joint action plan to address the project's serious problems. From the SSOTF side, the National Coordinator is working closely with the Director General of Health in Western Equatoria to come to a solutlon on the Project Management issues. 2 Executive Summary This is the ninth year report on the activities implemented in Western Equatoria CDTI project from January 2013 to December 2013. The population at risk in Western Equatoria CDTI project for this reporting period was 717,624 across 10 counties and the annualtreatment objective was 574,099. The population was fairly stable within the project area with no record of displacements of the population since the security situation was quite good during this reporting period. Out of the 717,624 people that lived in 904 communities in the project area in 2013, 378,913 people residing 750 villages received treatment with ivermectin; thereby achieving geographic and therapeutic coverage of 83.0% and 52.8o/o respectively. A total of 567 new CDDs were newly trained and 1,721 got refresher training, bringing the total number of CDDs available for CDTI work to 2,279 in this reporting period. Of the 868 health facility staff that worked in the project area in the period under review, 139 (16%) participated in supporting the implementation of CDTI activities in their catchment areas through activities like management of mild side effects, training of CDDs, supervision of CDTI activities and reporting. Numerous challenges were faced during the reporting period; the glaringly major ones included that: . The cost of implementation of activities was very high due to the high costs of program inputs and long difficult distances to travel. What seemingly appeared to be adequate funding in other situations/countries was grossly inadequate in the South Sudan context. . The lack of counterpart funding from either NGDOs or government for direct implementation made the issue raised in the point above even worse. J SECTION 1: Background information 1.1. Genera! information Geographical location, topography, climate Western Equatoria CDTI project is located between latitude 4.0"N - 6.5'N and longitude 26"E - 31'E in the south western region of South Sudan. The project office is located in Yambio town in Western Equatoria state. The state borders to the North with Lakes, Warrap and Unity states; to the East with Central and Eastern Equatoria states; the southern and western parts of the project area share international boundaries with CentralAfrican Republic (CAR) and Democratic Republic of Congo (DRC) respectively. The topography of the state is plateau, and the project area transects two hydro- topographical zones of the Nile and Congo watershed that is characterized by fast- flowing rivers of Yei, Yale, Bahr-Naam, Era, Maridi, Lesi, Sue, Yubu/Ringasi/ lbba, Biki, Mbungu and Duma. All the rivers drain northeast to the Jur and east to Bahr el Jebel, which form a confluence at the White Nile. The vegetation of the project area is mainly savannah with woodlands and then rain forests to the southern parts. Population: activities, cultures, language The population of Western Equatoria CDTI project for this reporting period was 717,624; with the majority of the inhabitants being settled agriculturalists that practice subsistence farming. The population gets dispersed into seasonal farmsteads whereby temporary settlements crop up in areas that are intensely cultivated. There are vast expanses of grassland that are occasionally competed for with pastoralists from neighbouring communities/states leading to domestic population conflicts and displacements. The languages spoken by the people of Western Equatoria are Balanda, Zande, Moru, Baka, and Morukodo; the Zande is the most populous ethnic group. Communication systems (roads...) The project area can be accessed through north-western Uganda and Central Equatoria state. There are also scheduled UNWFP flights between Yambio, the state capital and Juba, capital of the Republic of South Sudan. A network of roads to all counties exists, though their maintenance is irregular and may be difficult to use during the wet times of the year. There are two FM radio stations in Yambio the State Capital and one in Maridi County. Mobile phone communication exists in the area with the presence of Gemtel, MTN and Airtel companies. lnternet communication can also be readily accessed. Adm inistrative structure The Administrative structure of the Western Equatoria project is according to the government of South Sudan structures. The state forms the highest level of administration followed by the counties, payams and bomas. The states are administered through Governors, counties by County Commissioners, and payams by Payam Administrators, and Bomas by Boma councils. Health systems and health care delivery The government primary health care system is the main health care service delivery There are five functional rural hospitals located in Yambio, Maridi, Lui, Nzara and Tambura. There are 29 Primary Health Care Centres (PHCCs) and 186 Primary Health Care Units (PHCUS). 4 a aNumber of health staff in project area and number of health staff involved in CDTI activities. A total of 139 (16%) health staff were involved in CDTI activities in this reporting period; out of the total 868 health facility staff in the project area. Table 1: Number of health staff involved in CDTI 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 B2 Percentage Br=Bzl Br *100 Ezo 66 13 19.7% Maridi 118 21 17.8% lbba 57 11 19.3% lirlundriWest 1 0 1 16 15.8o/o lVundri East 94 14 14.9% Mvolo 52 I 17.3o/o Tambura 65 10 15.4% Nagero 63 I 14.3% Yambio 129 19 14.7o/o Nzara 123 17 13.8o/o Total 868 139 16.0o/o 1.1.2. Partnership lndicate the partners involved in project implementation at all levels ln Western Equatoria CDTI project, the partners that were involved were the health services providers at the state ministry of health, county health department and primary health care centres and units; 904 communities; cbm and wHo/Apoc. Describe overall working relationship among partners, clearty indicating specific areas of project activities The working relationship among partners was satisfactory. The partners were involved in planning, training, supervision, monitoring and reporting on the CDTI activities. State plans, if any, to mobilize the state/region/districUlGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project conducted advocacy meetings with decision /policy makers at state and county levels. The different stakeholders and community leaders were mobilized to participate in community mobilization and awareness campaigns. 5 aq) Pa >J>a 'oc Pq)tO(oP(o30 !(5iz 'fi3 trosNEB Eu$ #(Ea. oEe c)o.- -cdb P\i e P9, \otsBig cr) .=\ r+3a os; eQ6 SU(Uo rrQ -C .=!EE } €sr Ist o)(I)Jb3 , 5t'!- >*oo DE z Aoo (\. 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The reason to undertake advocacy The reasons for undertaking the advocacy included to: . To discuss how mass treatment campaign was to be conducted and the involvement of government institutions and the community based organisations. . The role and responsibility of stakeholders and other community leaders in CDTI activities. . The importance of having full integration of CDTI in the government health system. Outcome of the advocacy The state health authorities expressed their commitment to support the implementation of CDTI activities. The constraint experienced . There is no proper budgetary commitment to support CDTI activities from the Ministry of Health authorities. Suggestion on how to improve advocacy Some of the suggestions to include advocacy include: . Community empowerment workshops to be conducted for awareness rising. . Adequate IEC materialfor HSAM to provided. . School children should be involved in mobilization and treatment campaign. . Community Leaders workshop should conducted in all counties. . Organize planning and review with Stakeholders and County Health Directors to share challenges and achievements. . Public announcement on all FM radio station and conduct talk show on the CDTI activities. . Mobilization and sensitization at the grass root level. . Health Education in allthe PHCCs/Us and at all community gatherings. . Organize annual Onchocerciasis awareness day to attract the attention of the general public. . lnvolve people affected by onchocerciasis in the mobilization campaigns. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information The project used the three FM radio stations in the project area during this reporting period for disseminating information. Most community information was done through announcements made at community gatherings and at places of worship. 8 Mobilization and health education of communities in including women and minorities Women and minorities were actively participating in the mobilization and health education in the communities. Health education sessions were carried out in schools and in all health centers and units. Response of target comm unities/vil lages The communities understood the benefit and importance of taking Mectizan Accomplishment Communities understood the benefit of taking mectizan; they have begun requesting for treatment in the communities and are participating in the planning for their annual treatment. 9 County Number of comm unities/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 Br Number with community members as supervisors Bs Percentag e Be= Bs/ Br *100 Male CDDs Bt Female CDDs Be Total Bs= Bz+Ba Number of communities with female CDDs Bro Percentage Brr= Bro/Ba*100 Ezo 95 56 58.9% 70 15 85 15 15.8% Maridi 63 53 84j% 160 22 182 22 34.9% lbba 45 35 77.8% 80 10 90 10 22.2o/o MundriWest 95 62 65.3% 81 19 100 19 20.0% Mundri East 90 59 65.6% 59 11 70 11 Mvolo 220 98 44.5o/o 85 5 90 5 Tambura 45 0 0.0o/o 45 18 63 0 o% Nagero 29 18 62.1o/o 59 6 65 6 20.7% Yambio 132 93 70.5% 224 30 254 30 22.7o/o Nzara 90 55 61.1% 124 16 140 16 17.8o/o Total 904 529 58.5% 987 152 1,139 134 14.8% 2.4. Community involvement Table 4: Communities participation in the CDTI Attendance of female members of the community at health education meetings There is some improvement in attendance of female members in the health education meetings in the community even though it is stillquite low. !n general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses The attendance and participation of female members in CDTI issues is still low However the few that attend usually participate in decision making at the CDTI meetings. lncentives provided by communities for the GDDs Communities are not providing incentives by the CDDs Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? Yes attrition is big problem. The CDDs are still requesting for cash incentives. The project emphasizes on CDDs selection by the community and convincing the community members to assist CDDs with non-cash incentives during distribution period. Other issues None. 12.29 2.3% l0 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. There is no adequate manpower at all levels; the project lacks adequate staffs for effectively implement CDTI activities. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. There no transfer of trained staffs occurred this reporting period. l1 a.l FoF oE -c3 c oa(5 oL o -C .9. (E -c E (! FoF a o o) .c(5 L o a o .c(5 L o -c a G !o -o oE oa(! 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L = -o E(5 F oL G) o)(u z .o -o E c, (E L(I, Nz J F oF Table 6: Type of training undertaken Any other comments - None 2.6. Treatments 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 the 100% geographic coverage include: . Poor motivation and reluctance of CDDs to conduct treatment . High CDD to population ratio . Lack of government support i.e. complementary funding to APOC funds Plans to remedy this are: . Considering lobbying for funding from other sources like NGOs. . Continued sensitization of the community members about the CDTI philosophy. . Ensuring that adequate community mobilisation for involvement in CDTI activities. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Politic al Leader s Others (specify ) Project managemen t How to conduct Health education Managemen t of SAEs CSM SHIVI Data collection Data analvsis Report writing Others (specify) l3 .1- h L b D t oL5 6 s b ti d: o- P.:d=!.!8co=iEsOii EeP=SA$rbN>98oEoa.og'6 9CBo =o-a:o5g EEE 9 -og; Ehs6t*F E .g !)s (,5ic o;3s s8:E q)EsH H € Es EI bs obl: L4st; 0) €5E =pE= p seu 6E€: EEEU (,tso E 8Et b+ .gd's EU oEc =o- -dtE A sr? srBE: U ;IE;IE T E g EIEEI€TE .B9r9e ES E oli! @lE s * 6 HEfleE5 F EI€IH$ E EI EI EE .!:l :l $5 E FC:a q)PE8>o L eQ og* (EEB. 3bb toEEESS EcE !9E E o -g= 6,Eas ES tr .oCi ; !^ EgEEEEE > TU Ets < L8 o ,r3 Po5opEoksQStz o E g' 9o65 o- a>PU go EPaEob c- Eo bE9iEE EEt9 qE o=l @ Eol a ool o ^,5 ol I ;IE EIE Fl6 SIo6l= 514 EAqE 616 El?i El' El';l tlIrl ul16l OlIEI EI l2l 2l J o (E o G o (E (E .E oo Eo o o IU o t,tr G o E (g oI I6 o e @ s3s E Eo Eoo o(, o o o o oo o o o o o ?gao":*E E€ g EH gE^E ! ax asEtE o o oo o o o o o C) o lls 0)F OUIf r{zoo oNN rOs o)N N(f) oO) \to o)tr)O) cf)(o lr)s roO) oO) .-6oEv tsr EE;Hgi st(o(g@N o OJ N(o O O @N O @CO uO32EE 6 o -O2€ f.-(O N o o o o o o o o o o!'[;r*E= O s (o$ sq f.-lr) s a o)s s d(o so o s n t- sq @(o s(r) ritf s @ cri ro Eog oED= o- !E^r i e.e gedS troo s : $ s 1'- cc;(o o (o$ co_ @ (o @o N (f)(r) ro_ !t(r) e) oI @ (Y) s(') ro_ @(9 t-(o(o- lf)(o lo o)(9- NN O) @_ NN lo(o(o- f.-N (o o, o) F-(o o E r_ E;* EEEz @_ s .t o$(o- tt$ (o$ co_ rO (o$ eo_ o) (oo c\l .f N * o) o(o o)(Do$ to o ?o6 o.Z? 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L f -o E(oF o o o) Gz oE E (U oL(5 Nz G oF oN LU E (E o _o e J oo 2.6.2 What are the causes of absenteeism The main causes of absenteeism in the areas where it was reported was due to the seasonal migration of community members to cultivation areas in rainy season where they build temporary shelter and remain at their gardens to take care of their crops until the harvesting season. There were also cases where it was reported that community members had gone out to hunt and collect wild honey. 2.6.3 What are the reasons for refusals? Not applicable 2.6 Briefly describe a!! known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. Not applicable 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 l5 oCU oo:c>-8g 5 <EE z :(/) J, s'8C=L EEgCE tr9E3 LlJoo z o PQ-EOOC -!l orrO :L\JO z o o9o o5 A6^ =Y (u(,qq)or trt-dd z _c _t(I,(!so(Do (,-c >\ O) g c: doaoooE,E z -:E'6O(u: a*v aE o)'= =:E(u!uo oIl (E-C z c G 5o9or.NE.f o.cEf#EEg z o Eo o E U) z eE6= I er gq; o[Joo(E z cco)(!l< N(I, .cE;(6O(6o> 3 z o oo)c(5'o) >o z xoa z o o) z z o o \o E' o L o o. o) .E o o. o o -g E,, c E 1' o o o o G=r -g(D*rt AY uJ6 <L UDAv LLIo<Eooo>c@o fls e6 EEq; .oP b'aoo) oft o.9o=o* s5 ..o@lz ol .crl(El FI so) c,r e55B o sq @(a so c.i$ s o? ro(o s ol o) ro s @ t-(o s (f) l- @ s ol (f) @ sq Nt- sq(o(o o s ao o(L oo ilF ui rrJ lrJ C.) 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EEg N o, o o)N rf) N(o o$ ro o @ @ (o (f) @ r-N @ (o(o F* olot- ul EoE 6.2 =E6E .E "86 1r) @ lO rf N o r(9 oo(o $@ tfo o, $o O) $o o) to o, EEEiE o $ o $ o $ (f) @(o (f)o o) $o o, $o o) !to o) $o o) tr !.rJ rOooN (oooN t-ooN @oo(\l CDooN o oN oN N oN (f) oN tr- E o oL(E =EOG96toe'g ccLooE.E86co 6: .o6 o' rFh.FoFhc"jR HI 5!r, El NEtrl Lb ol € ,! lql cD -elo)cr9'ol $5 t,h .sbeE! Ec,2(E9EEE.n.qEE 3 :Eqh3!\J(Ev eEbLLrFEoForl F ,ri ol f "t €l ecllFI F 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by ,n, E **n F ,*,.=, tr NGDO tr Other (please specify) Mectizan@ delivered by - (p/ease tick the appropriate answer) -""--! WHO tr ,*,a=, E *ann Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities . After the annual treatment cycle, the Project Coordinating Officer receives information from the community about mectizan usage, wastage and remaining stock. . This information is then sent over to the SSOTF. . The SSOTF compiles this information and uses it to prepare an order for submission to MDP. . MDP reviews application, approves and forwards the recommendation to MERCK. . MERCK then ships the mectizan to South Sudan and it is received by WHO country office. . ln conformity with the data that had earlier been received from the Project Coordinating Officer, corresponding amounts of mectizan is supplied from the SSOTF to the project. o 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. . The Payam Supervisors on collection notify and invite Boma Supe/visors to collect supplies for their corresponding communities. . The Boma Supervisors, some of who are CDDS share this information with other CDDs and the communities. . The community members then decide on the time for the mectizan distribution to the rest of the community members. l8 County ectirano tabtetsNumber of M !n stock from previous year Requested Received Used Lost Waste d Expir ed Remainin s Ezo 9,977 150,000 150,000 1 19,455 0 125 0 40,397 Maridi 21,587 193,000 193,000 203,568 0 166 0 10,853 lbba 15,262 78,000 78,000 69,425 0 0 0 23,837 MundriWest 53,533 64,000 64,000 70,342 0 134 0 47,057 Mundri East 41,453 90,000 90,000 85,762 0 175 0 45,516 Mvolo 1 03,1 54 90,000 90,000 117,788 0 0 0 75,366 Tambura 9,505 103,000 103,000 0 0 0 0 112,505 Nagero 11,795 20,000 20,000 25,873 0 251 0 5,671 Yambio 37,247 360,000 360,000 375,367 0 0 0 21,880 Nzara 14,379 130,000 130,000 107,052 0 126 0 37,201 TOTAL 317,890 1,278,000 1,279,000 1,174,632 0 977 0 420,281 Table 10: Mectizan@ Inventory How are the remaining ivermectin tablets collected and where are they kept? Whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the health facility staff so that they are stored in preparation for the next treatment cycle. The amounts of stock of medicines that remain are communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: . Training: Health workers assist in training of CDDs, planning and implementation of CDTI activities within the communities. . Data collection: Health workers collect CDTI data, submit and also keep a record for future reference . Distribution: They facilitate the issuing of drugs, supervise and monitor the CDDs and also keep mectizan inventory. o Management of minor side effects: Health workers managed the minor side effects to taking the medication. Any other comments None r9 2.8. Community setf-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 stakdholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. N/A County Tota! # of communities/villages in the entire project area No of Communities that carried out self monitorinq (CSM) No of Communities that conducteh stakeholders meetinq (SHM) Ezo Maridi lbba MundriWest trltunOri gast Mvolo Tambura Nagero YamUio Nzara 9_5_ 63 45 eq 90 220 45 29 132 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I l l 0 0 0 Total 904 0 0 20 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy Supervisi Reporting 2.9.2. What were the main issues identified during supervision? The main issues found during supervision were that: . CDDs request cash incentives. . Communi$ registers not well filled. . Poor reports and record keeping at all levels. . Poor motivation of CDDs. . No proper monitor and follow up of the activities. 2.9.3. Was a supervision checklist used? Yes, Supervision check-list was used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? On-job coaching and mentoring was given to the County OV Supervisors that were found to have not been doing supervision of their counties. They were also shown how the data collection sheets should have been filled and it was emphasized that this needs to be cascaded to the Payam and Boma Supervisors. 2.9.5. Was feedback given to the person or groups supervised? Yes feedback was given ISOTF Secretariat staff Project Coordinating Officer at State level )ounty OV Supervisors Payam Supervisors / 7 CDDs / 7 Communities 2l t I I 2.9.6. How was the feedback used to improve the overall perforrnance of the project? On the job training was given to the staff supervised on how to update the household information, fill the summary forms and tally sheets. SECTION 3: SupPort to CDTI 3.1. Equipment Table 12: Status of equiPment of the equipment Functional, CNFR=currently non-functional but , WO=Wntten off) How does the project intend to maintain and replace existing equipment and other materials? The project expects the government and NGDOs partner to support the replacement of existing equipments and materials whenever possible. 3.2. Financiat contributions of the partners and communities lf there are problems with release of counterpart funds, how were they addressed? The project did not receive any counterpart funding from neither the NGDO cbm nor the government of South Sudan for direct implementation of CDTI activities. Additional comments - The project depended on APOC funds only Source Type of equipment APOC MOH COUNTY NGDO Others No Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle I F 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 5 CNFR 0 NA 0 NA 0 NA 0 NA 3. Computer(s) 2 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 1 F 0 NA 0 NA 0 NA 0 NA 5. Photocopier(q) 1 CNFR 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) Laptop I F 0 NA 0 NA 0 NA 0 NA b) Bicycles 32 F 0 NA 0 NA 0 NA 0 NA c) 22 co oN t, oE oo o c,lc o -o t ul IE!,cg Go tr o E o ?, ! .121' ^e otrE a! 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F- o c,l(e |o- i- IIJz J F UJ ool @ G o aIta ,c :.9 (Ulo,= HI E ol .E ol =>l (l,Ei o<i - ,(.,l s -l - ! c o .F(! .N =6c o @ ..i c o (U .N E o .. oq .9 GN ao so aa So G(, o E-cb SE59E€so rs =8{€ s o Gi s ltJ d o s o E o u, E o a,5(t, 2. o .Y o 3 .c. =o'q) I o o! .ci a '6, 9r OIcl -Ei : El sitNt atl a oooo o G l- G o aIta c o 'a(u :(U ul .i o I c,lci 'tr o =c o =c.id c .oo .E oo =o -c'i 6 'ctor>,to :oip,o .>.iE'; (s' -: E .b: 9 =: odi @, El o .9.i -9, 5t a:J! d'rcri o) > ci(Et\ EiEIE>i>lo FlNla$i$l; Eo Eo trt Gs G E Eso 5eStrloar> 'tro EaEb SSEEOl!Po sbo>>o II Z. och>#slt t6ilQrl ,; at, o ut_ tro,$o, Ei s .9i 6El (E El I <l :Jl ' J F oF oz tr o ta)(\ E o) .E c oo al,L(5 o ooL -c as oE L o aLq) CE(! o_ (U -o aC .9) -o L E oo Eoc(! c ir. (, (i,l' o E(gF I I i I I 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) . Communities select their own CDDs. . Community members assist CDDs with bicycles to collect the drugs. . Communities contribute ideas to planning and management of the CDTI activities . Communities provide training venues in secure areas. . Some communities provide food for CDDs during training and distribution. 3.4. Expenditure per activity lndicate in table 13, the amountexpended during the reporting period foreach activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndicate exchange rate used here-3.8 SSPs 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 Parti cipatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Not applicable. 4.1.3. 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?-NoWhen was the sustainability plan submitted? -NoWhat arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - No plans made yet 4.2.2. Funds - No plans made Yet 4.2.3 Transport (replacement and maintenance) - No plans made yet 26 4.2.4. 4.2.5. Other resources - No plans made yet To what extent has the plan been implemented - Not yet applicable a 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 used now is that: . WHO delivers the mectizan to the state ministry of health . The state ministry of health is then responsible for releasing the mectizan to the County Health Department stores in the Counties . lt from the County Health Departments that they will later be dispatched to frontline health facilities in the Payams. . Most Payams in the project area have health facilities, so there were no instances of having the mectizan kept outside the health facility. 4.3.2. Training: There has been a discussion to include onchocerciasis and the other NTDs as part of the curriculum of health training institutions in the state. 4.3.3. Joint supervision and monitoring with other programs Not much progress has been noticed here. 4.3.4. Release of funds for project activities There were no funds released from the PHC system 4.3.5. ls CDTI included in the PHC budgetz 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? There is no Health programme using CDTI structure. . Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc...)? Explain what are the combinations of interventions co-implemented? There is no clear set out arrangement for co-implementation yet. How were the interventions implemented? (at the same time?) The interventions are not implemented at the same time. The different programs utilise the same persons in the community to implement the programs. Describe others issues considered in the integration of CDTI. This is not yet applicable in this project. 4.3.7. 27 .; o '= E E o o o o E o -zo E to FO6g .o) AE(L- o (E(E Etrc -= g, L 'zt- o CL otr c Lo=E AU,bo E c o (! c o Eg o. .E 'E- t.0 =@o €c!oo'u E g=Ee -o8 OE "Et E s oo ,J (, bs !oSErai)o-or^ otro.= c,) .E= eJ-iod o! o E ! o L o CL o .9 .= oG o c ot o .= o (l, CL F a a a a a 6 c o(J o o CL t- otr o o OEo-o oo ..!69 .ct- E z G oF g (o E otLo @I(! = otr o g. ol,cLors 3s E z G oF o (E E oILO og({ = ooo(t t bg rOo>lttr E Jz E oF Fo6olL(, o GEo o E.g O'L !=trE =Ezo o o o(! odp o og) L GFE' Ou, bE -cl Lko iE !, o o .E ot o og) GFE' e'l o 6S.S 8.u"3!8*tgo tr ,- .9oE t9 >rLl-O a a a a ooLo,+, o_tr>oFo @ N t U) o o- E(u xq) =.p o E$ q) a(u q) c Eq) (t) (, o q ot o) tr q) ae oL o L+, o 6o CDtr '6 =o o E E(E L ct oL CL Loq +Jgo& .. o_ro(5!- -r: o6Ei(E0l-z (/) o a Eoxq) =.P q J eo o ao q) q Eo U) q o .E cq)tq) tr Q) a = tr o +, G{-, o Eg CL tr '59 O'= c) Sog(5E9ro>oElz 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. 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 Onchocerciasis control program structure exists in the state ministry of health; however they need to be strengthened. . The Western Equatoria State government authority acknowledges the prevalence rate of onchocerciasis in the state and is willing to support the CDTI program activities. . The project area is not encountering serious security issues as it was in the past. Weaknesses: . The synchronization of funds availability, implementation of planned project activities and the seasonal patterns are not yet in line. This is important because funds are usually available at a time when it is a rainy season and it is quite a challenge to implement activities at this time. . lnadequate resources i.e. staff, logistics funds to cover the whole project area adequately for the CDTI work. Challenge: . The cost of implementation of activities is very high due to the high costs of program inputs and long difficult distances to travel. What seemingly appears to be adequate funding in other situations/countries is grossly inadequate in the South Sudan context. . The lack of counterpart funding from either NGDOs or government for direct implementation makes the issue raised in the point above even worse. Opportunities: . There is developing interest of NGDOs to work on onchocerciasis control activities in Western Equatoria. Sightsavers with their own internally generated funds and Malaria Consortium with DFID/UKAID funds have shown interest. This is an opportunity that should be harnessed for the betterment of CDTI work in Western Equatoria. SECTION 6: Unique features of the projecuother matters None. 29