SSOTF/HQ annual NOTF secretariat technical report submitted to Technical Consultative Committee (TCC): July 2004 through June 2005

South Sudorn Oncho To.sk Force Coordinqtion office COUNTRY/: South Sudan Approval year: 2003 Reporting Period (MonthrYear): July 2OO4 through June 2OO5 10 11 L2L3t4 1(circle)of this renortiProi vearect 2 3 4 5 6 7 8I Date submitted: JuIy 22,2005 ORIGINAL : English SSOTFIHQ A}INUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting ."f,pi- n.-i,. '.'fufr,x toli i AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL GPOC) 2 7 ,Jljii ,nn. .qiL 'i <>r To. r,l i '-: '-it ,-_ll I It J ornrotion i$c fi,,II i i I t t) TABLE OF CONTENTS DEFINITIONS.... III FOLLOW UP ON TCC RECOMMENDATIONS ry EXECUTIVE SUMMARY v SECTION I: BACKGROUND INFORMATION 1.1. GeNpnalrNFoRMATroN............. 1.2. Popur-luoN AND Hpar.ru sysrEM............ SECTION 2: SUMMARY OF CDTI IMPLEMENTATION 2.1. DrsrRreurroNPERroD 2.2. AovocecyeNo SBNslrrzATroN........ 7 2.3. INnoRvteloN, EpuceuoN AND coMMLTNICATIoN sTRATEGy AND MATERIALS DEVELOPMENT ....8 ....9 ....9 .. 11 2.4. CouuuNrles' nqvoLvEMENT IN DECISIoN-MAKING...... .{ { i I I 5 7 7 2.5. CapecrryBUrLDrNG.. 2.6. ORoenlNG, sroRAGE AND DELIVERv oF IVERMECTIN 2.7. TRparveNTS......... 2.8. SupenvrsroN......... 14 l8 2.9. Couuulrrry sELF-MoNrroRING RNo SrareHoLDERS MeerrNc ............ l9 SECTION 3: OTHER ACTMTIES OF THE NOTF............... .....21 SECTION 4: SUPPORT TO CDTI ..............26 4.1. FneNcnL coNTRTBUTToNS oF THE pARTNERS ..... 4.2. Oruen FoRMS oF coMMUNrry suppoRT............... 4.3. Rpsounce MoBTLIZATToN EFFoRTS....................... 4.4. ExppNorruRE pER AcTrvrry By THENOTF sECRETARTAT 4.5 EqunveNr.. 26 27 27 ..27 ..29 SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER REVIEWS ........... ........30 5.1. INopppNteNT pARTICTpAToRy MoNrroRrNc/EvllueuoN ............ ......... 30 5.2. SusrarNaglLITY oF PRoJECTS: ILAN AND sET TARGETS (MANDAToRv Ar yR 3) ........... 3l s.3 INrpcRauoN.... .'.......,,.,.'.,.,.,. 32 ...................... 335.4 OppnnuoNAl RESEARCH SECTION 6: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES 33 ANINUAL NOTF SECRETARIAT 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 : South Sudan National Coordinator: Name: Dr Signature Date: 2210712005. NOTF Chair: Name: Dr. Date. ..2210712005 Signature Date: 2210712005. This report has been prepared by: Name : Dr. Baba/Salah/Fasil gull\o Ahoy Ngong 6r\-;J D e s i gnation : _NationaUD e p uty/N GD Q<Oord. sig,,ut,,""H $*k % aul Baba WHO/APOC, December 15, 2004 I I I I a Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MoH NGDO NGO NOTF PHC REMO SAE SHM SRRC SSOTF TCC TOT UNHCR I-]NICEF USAID UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-B ased Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sudan Relief and Rehabilitation Commission Southern Sector Onchocerciasis Task Force Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations High Commissioner for Refugees United Nations Children's Fund United States Agency for International Development Ultimate Treatment Goal World Health Organization WHO/APOC, December 15, 2004ll a Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo 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/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coveragc (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe 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 expressed as a percentage). (vii) Intesration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximize cost-effectiveness and permit free and equal association. For example 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 maximize 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) 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. lll WHO/APOC, December 15, 2004 a FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) Number of Recommendalion in lhe Report TCC RECOMMENDATION ACTIONS TAKEN BY THE NOTF SECRETARIAT FOR TCC/APOC MGT ASE ONLY There were no recommendations made for SSOTF/HQ Project. The project is in its first year of implementation. The SSOTF Secretariat launched and the coordination office consolidated. lv WHO/APOC, December 15, 2004 . Executive Summary Prepare an Executive summary of the report in not more than one page. L Summary of lreatment and population data comparing prujecls, trends in treatment ovq time i.e.- Tolal number of communities, communilies'lreated, total population, UTG, ATO and persons trcated From 1995 to 2002, Rapid Epidemiological Assessments (REA) were used by NGOs to assess the levels of OV infection by skin snip examination and /or nodule assessment in 285 villages in Southern Sudan. These assessments were done in areas where the NGOs had access and provided health services. The results showed high levels of endemicity (85% prevalence) and this led to Ivermectin distribution programs. The limitation of REA was that it was not conducted according to the REMO sampling techniques and was limited to areas that were accessible and secure. Also, there was little information on the endemicity levels of the majority of the areas, especially on communities that are historically known to be severely afflicted with blinding forms of onchocerciasis. Between March and July 2003, and to have a better understanding of the areas that require mass treatment and levels of endemicity, a combined team of external advisors, APOC management and members of the SSOTF including NGOs carried out Rapid Epidemiological Mapping of Onchocerciasis (REMO). The APOC team validated historical epidemiological data, the REA data and consolidated all the information along with REMO results. In September 2004, the second phase of the onchocerciasis control programme which entails the implementation of community-directed treatment with ivermectin (CDTI) through five CDTI projects in South Sudan was launched. Two of the f,rve projects are now operational. In May 2004, CBM took on the role as coordinating agency for South Sudan from HealthNet International and subsequent letters of agreement was signed. The SSOTF coordination office oversees the East Bahr El Ghazal and West Equatoria CDTI projects which targets 11203167l people over a five-year period. In these two CDTI project areas an estimated 11434,133 people are at the risk of being infected with OV and therefore the SSOTF has set up its annual treatment objective of 4721712 people in 1411 communities. The preliminary results in this first year of treatment shows 322,556 people have been treated, 68,2" of the ATO and 26.7oh of the UTG have been achieved in the two CDTI project areas. 2, Summary of training data of projects (nationally) for: - Proiect Offtcer (training of trainers and/or other specific training), total number of CDDs and health workers trained, total population per active CDD trained. Since the launching of the second phase of OV treatment in South Sudan in September 2004, there has been delays in transferring funds for the planed activities as such most of the activities started in late December 2004. Actual CDTI training and refresher courses started in February through April 2005. 9 project staff, 194 health staff, 20 TOTs and 1,841 CDDs have WHO/APOC, December 15, 2004 been trained and refreshed in this reporting period. The ratio of one CDD to the population being 1:1,000. 3. Extent of integration of CDTI projects into the health systeftL Integration is being implemented on a limited scale since the PHC system is still being strengthened after the peace agreement. A major restructuring of the health system in the near future is being planned. 4. Strengths and weaknesses of the national onchocerciasis control program; challenges and how they were overcome; and opportunities that will strengthen the program- Strensths o The SSOTF is fully functional with all the Secretariat staffs 100% present in the headquarters. o The SSOTF has a strong partnership with other stakeholders, more especially with the endemic communities. This strength has led to the smooth implementation of the CDTI strategy. o Treatment coverage compared to past years has improved and more inaccessible areas are now accessible leading to increment of the therapeutic/geographical coverage. o Management of APOC and CBM trust funds for CDTI projects and the HQ project are now closely monitored and utilized for the intended purposes. o The presence of SSOTF coordination office in Rumbek along with CBM as a lead agency within South Sudan has led to effective coordination; unlike in the past where HealthNet International did it in Nairobi far from the field. This has led to easy supervision and monitoring of all project activities in the field. o More communities and minority groups have been sensitized and people know that onchocerciasis is a disease of public health concern. The safety of Mectizan@ and its effectiveness is gradually being appreciated Challenses o There is a high illiteracy rate in the project areas. Getting skilled personnel is difficult. The accepted practice of advertising, short listing and then screening short listed candidates is rigorously followed. However, due to the high demand of literate and qualified persons there is always movement of staff from low paid jobs to high paid jobs. This has been a major challenge to SSOTF coordination office with frequent turn over of the project staff which draws back the projects in general. The dilapidated office structures in Rumbek and Project Office in Yambio are posing a real problem of security to the assets of the SSOTF. The windows, doors and the ceiling have been destroyed by ants and collapsing roofs and walls. Despite the fact that there are guards we can not guarantee the safety of the property of SSOTF. The project office issue in Yambio has been addressed through the efforts of the SSOTF to have the PCO office included in the general maintenance of the CHD in Yambio by UNHCR. In regards to SSOTF/HQ office, discussions have taken place and there is a possibility of this structure being maintained through USAID funding. a a Communication is a challenge to the projects in that South Sudan as it is still emerging from war and modern communication facilities are not yet available. The only equipment currently in use is the long range VHF radios and Satellite phones which are quite expensive to run. Transport is another challenging issue. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Vehicle wear and tear plus fuel consumption are quite high. It is hoped that the road infrastructures shall be maintained as soon as possible and in fact work has started in some sections. a vl WHO/APOC, December 75, 2004 aTransportation in general in South Sudan is not adequate. The vehicle in West Equatoria is seven years old and is becoming a liability. It is quite difficult to find literate females to compete effectively with men. In case a lady is successful to take over a job the husbands normally do not consent. This is even true in some cases where wives and girls have been selected to be CDDs. Women's participation in the program is still very low due to some cultural barriers and influences which need continuous community sensitization and awareness campaigns to overcome the challenge. Weaknesses The capacity of the Data Manager and Financial Managers desires a lot. All of them are unable to produce normal reports leave alone the APOC Technical Reports which is quite demanding. This has resulted in all technical reports being produced by the National coordinator, Deputy National coordinator and NGDO coordinator. Computer illiteracy is a weakness in all projects which hinders efficiency and speedy data entry and reporting. To overcome this problem, the SSOTF has started on site computer training in the coordination and project areas. a o o Opportunities o Comprehensive Peace has been signed after more than two decades of brutal conflict. This is an opportunity to strengthen the projects in all aspects with the anticipated government contributions as per APOC philosophy. . The OLS Quarterly Health Coordination Meeting which used to be conducted in Nairobi are now being conducted in South Sudan (Rumbek).This is another opportunity to advocate for OV control since SSOTF secretariat is represented and is good for exchange of views, coordination and advocacy. o The approval of the remaining three (3) CDTI projects of West Bahr el Ghazal, East Equatoria and Upper Nile is another opportunity to increase the annual therapeutic and geographical coverage in South Sudan. . The road network in South Sudan is being worked out and therefore, links with the neighboring endemic countries e.g. Ethiopia, DRC, CAR and Uganda will be of advantage for inter country coordination and collaboration. Key activities undertaken by the SSOTF during this reporting period. The SSOTF in collaboration with Chirstoffel Blinden Mission and Health Net International processed the annual Mectizan application to the Mectizan Donation program in August 2004.In early October 2004,1.759,000 of Mectizan tablets were received and distributed to all CDTI project areas through the Project Office, County Health departments and NGDOs (National and International). Stringent new measures introduced by the Mectizan Donation Program have been implemented to ensure proper procurement and delivery of Ivermectin and follow up of stocks in the field. CBM (the lead NGDO) has assisted the SSOTF in procurement and also providing a technical support through its coordinator who is on the ground. The SSOTF coordination office in collaboration with APOC/WHO and CBM organized a 5 day workshop from 31st August to 4th September 2004 at AFEX compound in Rumbek. The main theme of the workshop was: "THE PHYLOSOPHY AND HARMONISATION OF CDTI". It was attended by the Deputy Administrator of SPLM in Rumbek, the Director General of Health, the South Sudan SSOTF secretariat a a vlr WHO/APOC, December 15, 2004 c aas well as 26 participants drawn from various County Health Departments in South Sudan, international and indigenous NGOs and OV supervisors. A 2"d workshop on financial management was subsequently held at the same venue from the 5th-8th September 2004.20 participants who attended were introduced to the WHO Imprest Accounting System for utilization of project funds. Participants were given knowledge and skills in management of the Project funds, accountability procedures and record keeping. The Deputy National Coordinator in conjunction with the CBM Coordinator jointly prepared an emergency operational plan and budget for 3 months to initiate activities at the SSOTF Coordination office. East Bahr el Ghazal and West Equatoria CDTI projects were launched in October 2004 and early December'2}}4 respectively. The CDTI project offices in Rumbek and Yambio have been consolidated at all levels. Assignment of responsibilities was done and roles clearly defined. Different types of CDTI trainings organized and facilitated by SSOTF for different groups of trainees such as: Trainers of Trainees (TOT), County supervisors, Payam supervisors, health staff, CDDs and Community leaders. Having launched only two of the five proposed CDTI projects in South Sudan, the SSOTF coordination office carried out a fact finding assessment missions in the three remaining CDTI project areas of Upper Nile, East Equatoria and West Bahr el Ghazal. The objective was getting communities perception of onchocerciasis as a disease and whether they are ready to own and sustain the project. The possibility of establishing a viable CDTI project office was assessed as well as finding appropriate manpower in the areas. Communication and road infrastructure was assessed for accessibility purposes. From the onset ofthe second phase ofocnhocercisis control program in South Sudan in early September 2004, the SSOTF filled all the remaining vacant positions by recruiting qualified personnel through a competitive and critical selection. In this reporting period, the SSOTF coordination office procured and distributed work support items to the CDTI project areas through the project coordination offices. a a a a a o The Equatoria region of South Sudan falls within the Loa-loa belt. Some of this information was derived as far back as the 20th century as drawn in Anglo-Egyptian condominium maps. With the support of APOC, RAPLOA experts and the SSOTF coordination office organized a RAPLOA trainings and field exercises in West Equatoria and East Equatoria CDTI project areas. The main objective was to veriff co- endemicity of Loa-loa and Onchocerciasis. This is important so as to decide the strategy to be used for Mectizan distribution in co-endemic areas as recommended by WHO. In more than 90%o of the areas randomly selected for RAPLOA, results were collected and sent to APOC management for analysis and the necessary feedback and advice. Progress on vector eliminotion activities (where applicable) Due to the fact that South Sudan has just come out of war, the vector elimination components have not been considered so far. Issues of landmines need to be addressed followed by survey of the breeding sites, foci etc before projects are initiated and developed for vector elimination. Yllt WHO/APOC, December I 5, 2004 o SECTION 1: Background information 1.1. General information 1.1.1. Description of the country program -CDTI and vector elimination (briefly) The South Sudan covers anarea of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. Thc climate of South Sudan is tropical with average annual temperature of about 29'C (about 85F). The rainy season months are April-October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from typical rainforest in the southern part to Guinea or derived Savannah in the northern area. There is a vast swampy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile. Human settlement seriously affected by many years of civil war and is basically rural. The main occupations of the rural communities are farming and livestock production. Exposure to infection in South Sudan is by way of village proximity to breeding sites and occupational activities. The major ethnic groups are the Azande, Bari speaking groups, Dinka, Shilluk, Taposa, Lutuho and Nuer people. The second phase of the Onchocerciasis control programme which requires the implementation of CDTI strategy is earmarked for five (5) CDTI projects in East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile were launched. Two of the five projects in South Sudan namely East Bahr El Ghazal and West Equatoria are already operational. The CDTI strategy is the guiding principle. The Letters of Agreements for the two projects mentioned above were signed in May 2004. Due to administrative delays and the process of working out the flow of funds from APOC to Nairobi and onwards to the CDTI project areas in South Sudan; and also due to the fact that there are no banking institutions, the process of resolving the flow of funds resulted in time loss which almost translated to 4 months delay. The projects were therefore, launched in September 2004. SSOTF coordination office had already developed a Plan of Action immediately after the launching workshop in Rumbek and was subsequently submitted to WHO Nairobi, CBM and copied to APOC Headquarters for subsequent release of funds. Finally this matter was resolved towards the end of October 2004. The two projects being implemented are showing very encouraging results as per the data and achievements in this report. Considering the time lost which amounts virtually to six months the SSOTF has done extremely well despite the numerous challenges and weaknesses. Vector elimination At the moment we do not have vector elimination component. We are considering vector elimination options that are cheap and sustainable through appropriate surveys of breeding sites. - Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. This project is beginning a new phase with a fully functioning Task Force (SSOTF) and unrestricted access to most of the endemic areas. These conditions did not exist in the past years. In the new CDTI projects, the National plan was implemented through the involvement of national staff (lay people and health workers) appointed by the SPLM secretariat/local authority at CDTI project level, county, Payam and community levels. WHO/APOC, December 15, 2004I The National and International NGOs and Community based organizations have also been supporting the implementation of the national plan by providing technical assistance/guidance through their field medical coordinators. They also facilitated the logistical needs for the smooth running of the planned activities. There is an estimated 4,138,848 people at a risk of being infected with OV in South Sudan. Five projects were drawn for the South Sudan, Two projects namely West Equatoria and East Bahr el Ghazal CDTI/HQ projects are already operational. The other remaining onchocerciasis endemic areas which have been defined as three CDTI project areas and not yet launched, the distribution of Ivermectin is still being carried out as in the past by NGOs on a small scale not following the CDTI strategy. Their activity has not been intemrpted anC SSOTF coordination office continues to supply them with Mectizan. CBM has availed additional funds to support CDTI training activities in East Equatoria CDTI project which has not been launched. According to UNICEF mapping database of 2003 in the three main regions of the southem sector and the SPLM controlled portions of the three contested areas of Abyei, Nuba Mountains and Blue Nile; there are a total of 788 PHC facilities. 783 are said to be currently functional. Of these facilities 99 or about 13% are PHC centers and 636 (81%) are PHC units or mobile outreach clinics. The remaining 48 or 6Yo are rural hospitals or specialized treatment facilities. The distribution of services is not equal throughout the regions; Equatoria wfih26% of the population accounts for 48%o (381) of the facilities, Bahr el Ghazalwith 49%o of the population has 2lo/o (165) of the facilities while Upper Nile with l9Yo of the population has23o/o (178) of the facilities. The health system is fragmented and disjointed. The Federal Ministry of Health of Government of South Sudan is currently embarking on restructuring process. The SSOTF headquarters is situated in Rumbek town. Rumbek airstrip remains the largest and the busiest airstrip, capable of receiving different types of aircrafts. This airstrip is currently being upgraded to an all-weather airstrip and is a major airstrip for OLS operations in southern Sudan. Rumbek is strategically linked with Western Equatoria, East Equatoria and other parts of Bahr el Ghazal through road network. The administrative structure levels are undergoing changes after the Comprehensive Peace Agreement. There are four administrative levels in South Sudan as follows: The State, the County, the Payam and Boma at the grassroot level. The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered by govemors (Administrative supervisors as of July 2005); county by county secretary (formerly commissioner) being the administrative and political head of the county. The payam by payam administrator and Boma by Boma liberation council. Currently, l4Yo of women hold seats in the SPLM National Liberation Council which is the parliament. Health system & health care delivery (state any problems related to health system that impede program implementation). The PHC system has been badly disrupted by the war; its coordination is poor and lacks trained manpower. Until the SoH develops a budget to run the PHC these obstacles will continue to impede CDTI implementation activities to a considerable degree. Provide map locoting all projects (CDTI and Vector Control, tf sny) within country. 2 WHO/APOC, December 15, 2004 Southern Sudan Itd4t 5: CDfi arces eri frrccasbil CDTIpnjects with tlcir rrcspectiw coordimtion end er4renrision officesl'ccntcs n ect 2: Bahr E! Ghazal East t nfire t , P 3: West E uatoria atoriaPro ect 4: East ofCongo KM llgtndt 0 100 200 Legend Enqtty or unfuhebitetcil zoru RDtrITG CDTI Priority arruas NO CDTIarees REIIO to be perfirrncd Ftttiopia I(+ay.r WHOTAFEC,I lJul1200t Iiltortrtertt Sadsa ct 1: Bahr El GhazalWest ontr a I f, frrc*z ReparD/ic ) SSOTF HQ, Pro,ject Coordinetion offtce (PCO), Project Surperuision Centre(PSC) ;' Proiect coordanf,tion ofiice (PCO) I Proiect superuieion centre (PSC)L,gftol'rat]|D RepuDlic f Project Supervision centre (PSC)only lrd, fi,E ,r er-udra'Jry l, louaarrag, ,rL .lrlarrldly dt S.l OTF,oarmrg ltr Ca|lr!o'-4an ddr IPOC rw - Indicate the partners involved in project implementation at all levels (MoH, NGDOs -national, internotional) Secretariat of Health (MoH) . SSOTF Secretariat o East Bahr el Ghazal CDTI Project Secretariat o West Equatoria CDTI project Secretariat o East Bahr el Ghazal County/Payam health staff o West Equatoria County/Payam health staff o The affected communities The lead NGDO group o Chirstoffel Blinden Mission: Members of the SSOTF: . SPLM Health Secretariat o Chirstoffel Blinden Mission (NGO Coalition Chair) o Carter Center o WHO, Southern Sudan o International Medical Corps (West Equatoria CDTI lead NGO) 3 WHO/APOC, December 15, 2004 % ?i :.i' I f 1 (.' -*i : )'1 *, o International Rescue Committee o Sudan Health Association* . Sr;dan Inland Development Association*(East Bahr el Ghazal CDTI lead NGO o Mundri Relief and Development Association* o Sudan Medical Care* o County Health Department " County OV Supervisors" (2), Equatoria o County Health Department "County OV Supervisors" (2) Bahr el Ghazal o County Health Department "County OV Supervisor" (l) Bahr el Ghazal NGD partners and regions/counties, 2004/2005 : NaitrHj'i":F*rt"t-t;.:f'"'':,;.ftlrr..-*f i,.*[ AAH Equatoria (West) Maridi, Mundri, Yei ARC Equatoria (East) Kajokeji, Nimuli DOR East Bahr el Ghazal Toni, Yirol, GOAL West Bahr el Ghazal Twic ICRC East Bahr el Ghazal Yirol IMC West Equatoria Tambura, Ezo, Yambio IRC Bahr el Ghazal (Esat & West) Rumbek, Aweil World Relief Upper Nile (Jonglei) Bor (South) World Outreach Ministries Foundation East Equatoria Yei (Morobo payam) MRDA West Equatoria Mundri MSF-B West Bhar el Ghazal Wau, Gogrial NCA West Bahr el Ghazal Gogrial NPA East Equatoria Magwi, Budi Oxfam-GB East Bahr el Ghazal Cuiebet Samaritans Purse West Equatoria Mundri(Luionly) SIDF Ease Bahr el Ghazal Mvolo SUHA East Equatoria Kajokeji, Juba ZOA East Equatoria Juba, Terekeka - Describe overall working relationship omong partners, clearly indicating speciJic areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). The stakeholders plan, monitor, supervise, mobilize and apprise CDTI activities of the previous year through the below indicated meetings and workshops; o Annual SSOTF Meeting . OLS Quarterly Health Coordination Meeting o Quarterly operational plans o Regional and County Mini SSOTF Meeting o County specific planning with NGOs. o Village health committee meetings Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair and the Carter center meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activities. OLS Quarterly Health Coordination Meeting: The SPLM Health Secretariat coordinates the quarterly health coordination meeting in Rumbek in which SSOTF HQ is represented. The 4 WHO/APOC, December 15, 2004 health NGOs (80) in South Sudan, UNICEF, WHO and other UN agencies normally attend. The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. In this forum the SSOTF/HQ introduces the CDTI strategy, update on CDTI activities and an opportunity for stakeholders to address issues. General information on health, nutrition, EPI and security and forgotten diseases such as Buruli ulcer, Kala Azar, Sleeping sickness, Guinea worn, Trachoma, Lymphatic filariasis etc are updated. Quarterly operational planning :( Regional/County SSOTF meetings) are normally donejointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the county health department while at the Payam level is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. Advocacy, mobilization and sensitization are carried out by the PCOs, COSs, CHWs, and POS. For the management of SAEs cases the CDDs will refer the cases to the nearest level of health facility. County specific planning meeting with NGOs: The CDTI project office works closely with these groups to promote CDTI in the communities. Each endemic county has a designated county onchocerciasis (OV) supervisor. Each Payam (local district) within the county have a Payam onchocerciasis supervisor who is also known as (Community supervisor). Most of these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of the communities within their locality. Village Health Committee meetings All plans for implementation and monitoring are developed in close consultation with the Bomas Liberation Councils (communities), these being the grassroots arms of the administrative system of South Sudan. All health and developmental programs in the communities must receive the formal approval of the Boma Liberation Councils. Community health workers and Traditional birth attendants are the lowest cadre of health service providers who are supervised by Village health Committees. The communities elect these groups. - State plans if any to solve any issues arising as regards CDTI implementation. The SSOTF has a strategy to mitigate issues arising. a. The first step is to determine the level of the issues arising in the hierarchal set up of the management. b. Determine the nature of the issue i.e. is it managerial, organizational, or participatory etc c. The principle approach to problem solving is by giving a chance to all parties to the dispute to air out their views and grievances in a relaxed atmosphere. d. Solution to problems is not by pointing fingers and blames but by an accepted consensus agreement 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not the add more rows 5 Name of CDTI Project Total communities in meso/hyper- endemic zone Total population in meso/hyper- endemic zone Ultimate Treatment Goal(UTG) by 2010 East BEG CDTI Project 1,001 778,920 778,920 West Equatoria CDTI Project 410 425,751 425,751 WHO/APOC, December I 5, 2004 West BEG 3,219 1,508,733 1,508,733 East Equatoria 438 505,934 505,934 Upper Nile 50 257,294 257,294 TOTAL 5,118 3r476,632 3,476,632 NB-Because of the prolonged conflict in South Sudan reliable figures on the number of communities/villages are not available. Whichever figures are given are always estimates. Source: From Oncho Project reports: National census: Other source, specify REMO Year of source: @ 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 ofthe project). 6 WHO/APOC, December 15, 2004 a SECTION 2: Summary of CDTI Implementation 2.1. Distributionperiod Chart the actual distribution period for each CDTI Project in the country in the table below. Table 2: Overview of distribution undertaken rt rows as Brietly note any problems/issues (one paragraph). There was a delay in the transfer of project funds which kept the project halted for about four (4) months from the scheduled period that activities were to kick off. In addition to this, the third quarterly operational plan and budget (April through June 2005) for CDTI activities which were submitted to WHO for subsequent release of funds have not yet been received in full which hinders implementation of planned activities. If the funds were availed on time the activities would have been carried out as planned. 2,2. Advocacy and Sensitization a) State the number ond type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the sensitization und outcome, In September 2004; not long after the launching of the second phase of Onchocerciasis control program in South Sudan, courtesy calls were paid by the SSOTF Secretariat to several SPLM offices in Rumbek, East Bahr el Ghazal and West Equatoria SPLM offices. Seventeen (17) policy and decision makers were briefed and sensitized as part of an advocacy to the CDTI strategy. The SPLIWA offrcials have accepted to participate in the implementation of the program and to sensitize their communities by using the available SPLM/A administrative aflns. b) State progress made towards internal resource mobilization, Mobilization of resources internally is being made through inclusion of all OV staff in the chapter 1 budget for salaries in 2006. This will boost the top up from APOC which will enable the projects to retain staff and even replace non performing staff. Subsequent requirements will be considered when the government structures and its departments are established. c) Describe any policy-related constraints being faced by any particular project and describe what was done to assist the project (outcome). Explain any plans on how to improve advocacy. The SSOTF has so far not experienced any policy related issues. 7 ,rultr Project Name Distribution Period Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun East BEG x x x x X X West Equatoria x x X x x x x WHO/APOC, December 15,2004 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strqteg/ being used in the country for CDTI. Note if qny new IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. The following materials were reproduced by SSOTF coordination office for the South Sudan Oncho Control Program in 2005. The materials were distributed through the SSOTF coordination office in Rumbek to Project offices for onward distribution to nine (9) supervision centres, payams and communities. o "Procedure Manual for Ivermectin Distribution Programs" (WHO) o OV/CDTI training video tapes that were provided by APOC o Manual for CHW's and PHC for the control of onchocerciasis with Mectizan'" o Manual for CDTI provided by WHO/APOC and distributed to partners o Illustrated OV training flip charts (OV Oncho in Sudan) . OV poster sets (3 posters per set; "What is OV", "How do you get OV", and "How to treat OV").These posters are laminated in plastic for longer life under field conditions. o Illustrated educational booklets "What is OV Oncho" for primary school age children. . Simplified CDTI instruction manuals for community distributors. - How were the IEC materials developed? . These materials were already developed by HealthNet International and reproduced by SSOTF coordination office. - Are the materiqls reviewed to address upcoming issues (like decreasing refusals, sustainability, maintaining compliance to long-term treatment, SAE|? o In the current fast changing situation in South Sudan review of materials is not advisable due to rapid increase of population and its movement. Review will be considered after the communities have settled and rehabilitated. - Report if any KAP surveys have been done and how their results were used? o KAP surveys have not been conducted in the whole project areas. The SSOTF will carry out the KAP survey in the new CDTI areas which would be launched in the near future. Please, refer to the reasons given in the preceding question. Summarize information on: - The use of appropriate and innovative media qnd/or other strategies to disseminate information among the projects; o Modem media such as television, local radio stations are not available. Information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, women's groups, village health committees (if exists and functional) are used to disseminate information. Mobilization and health education of women and minorities - method and response o The method used to sensitize the women and minorities is through home visits to the communities and focus group discussions in villages, health centers, worship places, and market gathering. Special attention is paid to the men in order to sensitize them so as to understand the role that women and minorities can play in the control and eventual eradication of OV. o Communities now know that onchocerciasis is a disease of public health concern and have accepted full participation and contribution in all onchocerciasis treatment activities in the project areas. They know Ivermectin is the only drug that can reduce and eventually eliminate the burden of onchocerciasis from their communities. o Communities do appreciate the fact that Mectizan is safe and has other health benefits. Maj or acc omplis hments ; WHO/APOC, December | 5, 20048 . Negative attitude towards the usage and its effects of Ivermectin is minimised. Communities have known and accepted Ivermectin as the drug to fight onchocerciasis o The number of drug distributors trained has increased. o Increased annual treatment coverage attained. o Female CDDs now participate actively in drug distribution though a few of them. ll e aknesses/C o ns lraint s ; o The number of female CDDs is low o There is frequent turn over of project field staff and at SSOTF coordination office. o The attrition rate for CDDs is increased due to non support and also due to attractive incentives paid by NGO's and UN agencies for special campaigns. Suggest ways to improve mobilization of the target communities among projects. o Greater involvement of women and lay groups o Full participation by local authorities and support from SPLM organs. o Increased health education sessions in the communities o Increased training and refresher courses for CDDs, CHWs and OV supervisors. 2.4, Communities'involvementindecision-making Comment on communiQt participation making comparisons among projects - Participation offemale andyouth members of the community at health education meetings; - In general, how do you rate the participation of minority groups and female members in community meetings, decision-mqking, (attendance, participation in the discussion etc.) other issues. o Youth attendance is fairly commendable in public gatherings. They actually form the most influential entity in terms of mobilization and implementation. o The youth tend to pick up messages faster than the rest of the community and this is obviously due to their age learning capacity. o The youth disseminates information much faster and effectively to their parents and siblings o Women attend public information sharing meetings in fair numbers o Members of the village health committees are predominantly men o Women's participation at decision making meetings is very low as men dominate decision making process. NB.In both project areas implementing CDTI the points mentioned above hold. 2.5. Capacity building Training of national, district level staff in CDTI and general management skitls (computer applications, project planning, etc.) Briefly describe any training done by the SSOTF/NOTF for spectfic CDTI or Vector Control Projects (O bj ec t ives, p ar t ic ipa nts, outc o mes, any fol I ow -up nee ded). From January through April 2005, the SSOTF conducted a number of trainings ranging from CDTI strategy, health education, data collection and analysis, supervisors' training, CDDs' training and facilitated RAPLOA/REMO and on site computer trainings for the project staff, The main objective of the above mentioned trainings are to build capacity at the national, county, payam levels. The other objective is to inculcate into the staff the importance of the principles of CDTI, the required managerial capacity for implementation including participation and ownership. This has resulted in marked improvement in terms of participation and commitment. Table 3: Type of training undertaken at national level by the GTNOAIOTF Qick the boxes where specific training wos carried out during the reporting period) Type of training Proiect MOH staff Opinion Others(specifu) 9 WHO/APOC, December 15, 2004 staff Leaders Program management How to conduct Health education Management SAEs of CSM SHM ,/ (NGDO partners) Data collection Data analysis Report writing Others (specifo) Computer training RAPLOA/REMO ./ (Ncoo partners) BrieJly describe any technical assistance provided to the CDTI projects. Trainings in the WHO imprest accounting system, data collection and analysis, drawing joint operational plans, plan of action and preparation of Mectizan@ distribution plans were some of the technical assistance given to the projects. 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F- e.l+ t q r-00 to\N t{ a.l N ra\o \o F-t(.) o * ail- = .9 *o E'sp 9pbU:G L/ oi/ ^\o\ + cl \o s o o (! o z o o (! o ! C) o d z s\ot- GI (: q; LEoo = 00- = E: o z6>E cl st orEOo>C s o6€z= (d !o o (€ z o\?a) o 6> EEE = o'F<-5 s ooo\ o o Cg z o o rd z !o o Cd o z iia b- € oadoEi_oJ *'=.; o =E-5..E9^<trE H:f 9 6 ^ =i q: -F o > tr oH + o\ e.l 6 + 6 in oo 'a rl] E] d *! -oEaia t! (! 1:O 6dll]= or! o dii c0d gQ B c) z Eo o. o. tl t< F If the projects are not achieving 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is Jluctuating, state reasons and plans being made to remedy this. The project area has not achieved the above mentioned figures for the following reasons: o This is the first year of the project lifecycle based on CDTI principles. o Population figures are changing by the week as the result of internally displaced persons and refugees returning to their homes. . Despite the conditions above, the two CDTI project has made tremendous achievement in both geographical and therapeutic coverage. The preliminary OV treatment data for the year 2005 indicates 68.2%o ATO, 26.7%UTG and 27.60/o Geographical coverage. o It is quite diffrcult to make a statement to remedy the situation at the moment. When the process of resettlement and rehabilitation is over and the anticipated general census for the whole of South Sudan takes place; then that will be the time for us to talk about remedial measures. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the o Since the CDTI project has not conducted a household registration census, it is quite difficult to have the numbers of people who have refused treatment and those who were absent during the campaign. 2.7.3, Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. The CDTI project has not reported SAEs during the periodo 2,7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period 'lease add more rows * SAEs should be verified by project coordinator Sequelea is deJined as those cases that have not recovered fully from the SAE and are left with lasting neurologicol or other debilitating effects, Name of project Number of verified* SAE cases reported Action taken Number sequelea CASES of with ofNumber deaths t6 WHO/APOC, December 15, 2004 $ o c.l ,ri L o) o(,) o o () 0. o > o -oq o C)oo o d o (l)r cl o(.) 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Some supervisors have not yet understood CDTI strategy. The misconception is that NGO are the ones in charge and the project is NGDO owned and driven. Poor recording practices which resulted in inaccurate repofting. Project Name Supervisor Date ofObjective supervision Outcome/follow-up needed Mike Salla 28/31',05 *To assess progress of CDTI implementation *To carry out supervisory check list in Mvolo County. tThe concept of CDTI picked by implementers e.g. partner NGO (SIDF), county/payam supervisors. *Partners well sensitized on CDTI principles *Demand for more treatment created *On site training carried out during supervision to improve capaci8. East BEG Longa Cessar Mike Sala 3l13l'05 *To assess progress of CDTI implementation *To carry out supervisory check list in Rumbek/Cuiebet. West Equatoria Dr. Baba/ FasilChane/ Mike Salla 8l4l'05 *To review the first quarter CDTI implementation activities. *To review disbursement of funds. *To monitor whether CDTI strategy is being implemented in Yambio and Maridi. tThe concept of CDTI picked by implementers e.g. partner NGO (SIDF), county/payam supervisors. *Partners well sensitized on CDTI principles *Demand for more treatment created *On site training carried out during supervision to improve capacity *Most of the activities were implemented as drawn in the first quarter *Communities co llected drugs from the central county stores as planned. *Due to delay in releasing funds, some training activities had to be rescheduled & followed up. *Funds were disbursed in a transparent manner accounted for along APOC financial rules. +The funds were utilized lor the planned activities +Anomalies detected were corrected. * There is good progress towards CDTI strategy implementation o l8 WHO/APOC, December 15,2004 o oa Materials procured locally in most cases lack receipts since most rural areas do not issue receipts. This presents a problem in accounting. Most of the planned CDTI activities were carried out in an appropriate manner. 2.8.2, ll/as a standard supervision checklist used? o No. It will only be done in the next treatment cycle. 2.8.3. a a a a a a What were the outcomes at each level of CDTI implementation supervised? The concept of CDTI was picked up by the supervisors. More supervisory visits were demanded by the supervisors at all levels. Need for refresher courses realized at all levels. Most of the activities were implemented as drawn in the first quarter of operational plan Funds were utilized for the planned activities Minor mistakes corrected 2.8.4, lVas feed-back given to the supervised, and how was thefeedback used in improving the overall performance of the project? . On the spot discussions were done and later on feedback communicated in writing and sent to the supervised. 2.9. Community self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if neces, 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. 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with long-tenn mass treatment with ivermectin? (For projects 4 and above years old) Table I 1: Activities of that promote compliance to long-term treatment with ivermectin Objective Specific Activities Project targeted Project Name Total # of LGAs or districts in the entire project area No. and % of LGAs or districts that carried out self monitoring (CSM) No. and % of LGAs or districts that conducted stakeholders meeting (SHM) Not done Not done East BEG West Equatoria 4 5 Not done Not done TOTAL 9 l9 WHO/APOC, December 1 5, 2004 l. Promote Integration of CDTI with other health care services 2. Maintain high therapeutic(>65%) and geographic( I 00%) coverage 3. Promote strong community ownership 4. Promote high government commitment 5. Support partnership strong 6. Put in place a strong IEC strategy that encourages continued treatment Other NB, This is not applicable since the project is still in year one 20 WHO/APOC, December 1 5, 2004 . SECTION 3: Other activities of the NOTF 3.1 Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). The South Sudan falls within the Loa-loa belt. Some of this information was derived as far back as the 20th century as drawn by Anglo-Egyptian condominium maps. With the support of APOC, RAPLOA experts and the SSOTF coordination office organized RAPLOA trainings and f,reld exercises in West Equatoria and East Equatoria CDTI project areas. The main objective was to verifu the co-endemicity of Loa-loa and Onchocerciasis. This is important so as to decide the strategy to be used for Mectizan distribution in co-endemic areas as recommended by WHO. In more than 90o/o of the areas randomly selected for RAPLOA, results were collected and sent to APOC management for analysis and the necessary feedback and advice. o a Having launched only two of the five proposed CDTI projects in South Sudan, the SSOTF carried out a fact finding assessment missions in the three remaining CDTI project areas of Upper Nile, East Equatoria and West Bahr el Ghazal. The objective was to get communities perception on onchocerciasis as a disease and whether they are ready to own and sustain a project. The possibility of establishing a viable CDTI project office was assessed as well as finding appropriate manpower in the areas. Communication and road infrastructure was assessed for accessibility purposes. 3.2 What was done to coordinate CDTI Project activities? The SSOTF coordination office operational plans are drawn in consultaion with the East Bahr el Ghazal and West Equatoria CDTI projects. There is close consultation which enables each project to follow what the other is doing. The below mention meetings also act as consultative meetings for coordination o Annual SSOTF Meeting o OLS Quarterly Health Coordination Meeting o Quarterly operational plans Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair and the Carter center meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activities. OLS Quarterly Health Coordination Meeting: The SPLM Health Secretariat coordinates the quarterly health coordination meeting in Rumbek in which SSOTF HQ is represented. The health NGOs (80) in South Sudan, UNICEF, WHO and other UN agencies normally attend. The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. In this forum the SSOTF/IIQ introduces the CDTI strategy, updates CDTI activities and gives ai opportunity for stakeholders to address issues. General information on health, nutrition, EPI and security and forgotten diseases such as Buruli ulcer, Kala Azar, Sleeping sickness, Guinea worrn, Trachoma, Lymphatic filariasis etc are updated. Quarterly operational planning :( Regional/County SSOTF meetings) are normally donejointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the county health department while at the Payam level is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. Advocacy, mobilization and 2l WHO/APOC, December 15,2004 sensitization are carried out by the PCOs, COSs, CHWs, and POS. For the management of SAEs cases the CDDs will refer the cases to the nearest higher level of health facility. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up needed) The Chair of the SSOTF, the National coordinator and NGDO coordinator were heavily involved in Vision 2020 for Sudan which was organized by CBM in February 2005 in Nairobi. A number of specialized eye care NGOs participated. The objective of the meeting was to pave way for eye care NGOs which are interested in operating in Sudan to express their interest. The out come of the meeting was a good number of NGOs expressed their desire in working in South Sudan through training, surgical interventions to reduce blinding diseases. First week of August 2005 will see the meeting with Sight Savers in Nairobi. There was an impromptu meeting which took place with senior APOC management, the chairman of SSOTF, national coordinator, CBM medical advisor, CBM NGDO coordinator, head of WHO in South Sudan in Nairobi in April 2005 at the Intercontinental. The objective of the meeting was to see how the South Sudan CDTI projects were progressing and the way forward. Issues addressed were treatment and geographical coverage, procurement of capital equipment and challenges being faced in the field. SSOTF coordination office was advised to carry out house hold census during distribution to improve on population figures which in turn will improve therapeutic and geographical coverage. The issue of capital equipment was resolved. a 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. None so far 3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, financial), - Reports forwarded to APOC management, - Administrative assistance or trouble shootingfor projects. One biannual narrative/Financial report Three annual technical reports which are being submitted as a part of this report. The SSOTF coordination office under went a series of resignations and replacement of staff, for example the Deputy National coordinator was replaced, his tenure of office did not a month for social reasons. The former Data manager was appointed to be the Deputy National coordinator. In a spell less than one year we have witnessed three financial officers resigned as a result of discontent with the APOC top up package since there is no salary from SoH. 3.6 Insert the Plan of Action for the NOTF activities for the current year indicatin activities which were Proiect Neme - SSOTF Yf,AR (l) Ycars (Scotcmbcr 2004 throush June 2005) 2005 MAIN ACTIVITIES Julv Aus Oct Nov Dec 2004 Sep Jan Feb Mar Apr Mav June .rrroiitiiii*iji;Iihrs'r' I r " : r, 1''" r ".''l .. .l ,_ l 1r .*fi'. , | '.1' ', \it,:iF' ll*&iiiEr,1ti'r;/l: 1 trn:r'il,: i:--' .r! rt'f\ii.t.:!l':l*;:i.. r,r-t.\ I'.n,:'n; *SSOTF coordination offi ce x *Regronal (Defined prolect area) x *Countv x x * Stakeholders meetings/communiW x x Procuicmcdf6r drtdrteil ]' ;' ' n,; I i ',-l 22 WHO/APOC, December 15, 2004 111.i': les x -ae"obidi l'"r':lr1 :'a'i':'i'1:.'"' 'i i:;:";:l,,. ''j ";:'j,""';; .4- ,,,: ' [t'r:,'ii, i'.: f, ,. . i+iri r'-5 t, -'", :,, *SSOTF coordination office x x x x *Resional (Defined proiect area) x x rCounW x x *Payams x x -"il'srdii . !:'$ il: i lt'i. Jttr *ir$,,1,,1d1; iii,e:i{lris ,r ' il*#lliii {s$F [j,''' :: ^:.i,i , itt :l. l.'.. .' *SSOTF coordination office x x * Trainins of CDDs x x x x x * Trarning of supervisors x x x * Training of community leaders x x I Training of health staff/ x x +ir.*i{r .J:-ir..aASSESSMEII{TS' :.l :.,'i r'.'.;iIt';'- i"il;*, -: : J?L-,,'t.ijj.rf:'. -' ;':?- iwi,ji. 4qE _.:-- /.J1;', ":,1,i;,i....., 'tr a:*. ,: ,+,j5, ., ,,.^.] $ifl,'g 'i:'.1;;;jr.i--l"li': * KAP studies in new areas *Review of IEC materials x i.r#4lfiF.rHl.l f,,tAl.#upL.rrnrnuCia1bN,s.nSSrtipS.,:,,, .:::j:S ir.r, ,"r 'r. i.,:" ..;',r."I-E g.'-q* lri'.. "i, tr:I*l+thsk a:r .. i:," !!.. I Communrty awareness/targets x x x x x x x x * School health education/targets x x x x x x x * Churches x x x x x x x x x Ccnsui -i..i!.";""1:'i.: i , rl'.' '.! i ,.,,ijy .l -i_1 i{ (. ' '.: 'j Y.1' d{ + . .rri i.il,t;5i., Census Update orusDlfficfti/soifii#,,"' .' . 'tt\)./, ::; . ; ,5,,:' ,: ,;.'_ l :: c{ri't .s,tt( : ,\ .r-,,r- ),tt, ,. ,.:;,,_;.;. t'*'iI' x *Drugs for SAEs ; . .:.' IVEBMECTINDISTRIBUTION , ,:,:. , .],, . ti:t '.ritrt i .- ." 11"<- ., ' . i.\i,.r -i .: {, 'ii,, rr . 'tili:+iii 1i+fri,t +.'; ;iiil lliu.l j i i i.; * Ivermectin Distributlon x x x x x x x rDistributron of minor side effect drugs x x x x x x al lntrodirctlbn of CSM/'SEMs ' : ' ' I ,,r,: '' .', ', ''' -- i-,, ;':r.r r.' :iisBr; :' , .11: ::*+t'; t",.. ;; :r'*lia'i !hr;i,ijri ' ,[idr.]:6 H,r i:ii= 'iliili,i. '' L.sil"ri-, ,-'.t.' *County Health Departments * NGO partnership * Trainrng of CDDs and others x x x x * Local Health systems x *CSM/SHM in community rrr.p tltr.iril3;t l ]r "::ji;i': :: lr]riu':' ;''.''::,\''- '' -''-'' "5'<,++i 'r")'-*'.;:: -: ir*}-.'r! i:i.# f,r.fflri if '1i;.rt"'- .'*-. :.fv: t- T:'j'jsi dJ,.'4t! r:_.41i{1riait*F Mop up treatment x '.t., -1ii',.:t':,l.i*lsupcriiiliin,iicooot:l,i* boun6,surrt''',,'' ,.4,.-;,irE. :; l.i'tt1;1 +1rr#-J \Ld ri\t'-' :i1,\TJilii''*,i+Ii, ,'t;.1i ir..Fr,', rti,ii r,im'i *SSOTF coordrnation office x x x x *PCOs/RTF personnel x x x x x x ,)ffiri'*Drtr'collcction',,..1 .',:. ': ,.' -l:',.'';,::::::fi- , .li. l t ;."';lS: .'' t;ii: !"';t\i'a ,i :,.i TSSOTF coordination offi ce x x x x x x x *PCOs x x x x x I Payam supervisors x x x x x I CDDs x x x x x r!+ i-AlX;trirUriitifr i'mi1 jtcrrint,.,' ;. 5".,1i' -g;;:r' i :. 1;1 iql '., "lls 'i6Jlil;.4.r1t;,i r. ,- .,..1s . ,],.!.,: ,:r!:I:,i :s1:[7" *PCOs x x x x x 1 l4yu. supervrsors x x x x x x * CDDs x x x x x x i.... !11 f.',, :irl*roiifitlv nuenciit ilDlitiii.'ocnfr'turc .'' i-' , 'jl:1 'r *liir,r !1.i1r,*i,1 . ,r,.;rF['- ,.,, ) /;,4 -; ,'1i"..r.1 S''.rt [!,s *SSOTF coordinetion oIfi ce x x x x x x x x x x Mectrzan SAEs 'lsors 23 WHO/APOC, December 15, 2004 x r tl,*l " :,., .;i l: x ., ,_ jij\i, x ;--r, {.,:'.i.' H$i\l.'-J ;'i5#ts,1 PCOs/RTF *SSOTF/PCOs/RTF x 3.7 Insert the Plan of Action for next x x x xx x x x x ;;.*;",; {dr : n}.lJr' iir.l:.:] :LS'1' iirr.$fl4 *SSOTF coordinrtion oIfi cc x PCO / RTF x -:r'.fh:" tj,:;,.#i.Abilri;ti"dfrirtft;fun' ;'' .,'":: j:'-,',:': i r;q q-i:itrJ ^i , ;lt-,i.,j, f.J"'tr' - .r':';,*{,r'-' .'1-.._';Ai ':StE! ilJilg:l 6 a' '';frl;i { *i s-al!.i$,lii.{ttii11-.' *SSOTF / PCOs x .1-,i,'.;itl '1'Lli:,-, rl')illY"*i ,.';;#i':.' ! ii':it'- - -1): ji?d;l:!' ,- Proicct Neme SSOTF Hcrd Ouarter Yerrs (Year 2) MAIN ACTIVITIES Quarter I Quarter Quarter 3 Quarter 4 *Phnninq/Revicw mcctinqs *SSOTF x x *Regional x *County x x *Stakeholders meetings/community x Procuremcnt of mrterirls * OV supplies x *Advocrcy rRegronal x x +County x x *Payams x x TRAINING * Training of CDDs x x * Trarning of supervisors x x * Training of community leaders x x r Trarnrng ofhealth stafV x x Management / SAEs ASSESSMENTS * KAP studies in new areas x x *Revrew of IEC materials x x HEALTH EDUCATION SESSIONS * Community awareness/targets x x * School health educatron/targets x x * Churches x x Ccnsus Census Update x Drug Dclivcry/Supplics Mectizan requests x x *Drugs for SAEs x x Setting up of referrel systcms *Strengthen up referral systems b/w communities, PHCUs, PHCCs and hosprtals for SAEs x TVERMECTIN DISTRIBUTION *lvermectrn Drstrrbutron x x rManagement of SAEs x x Introduction of CSM/ SHMs TSSOTF partners x *County Health Departments x * NGO partnership x I Training of CDDs and others x I Local Health systems x 24 WHO/APOC, December 15, 2004 Mop up trcrtmcnt. MoD uD treatment. x x Management of SAEs x x *Supcrvision ofCDDs, P, supcrvisors end County Supcrvisors) SSOTF x x PCOs/RTF x x * Pavam suDervtsors x x *Datr collection x x x x + SSOTF x x x x *PCOs x x x x * Payam supervisors x x x x * CDDs x x x x *Reoorting/ druq manrgcmcnt I SSOTF x x x x *PCOs x x x x * Payam supervisors x x x x * CDDs x x x x Monthlv financial reoortins cxoenditurc x x x x SSOTF x x x x PCOs / RTF x x x x Prcperetion of mid tcrm/ rnnurl technical report x x SSOTF x x PCO / RTF x x *Applicrtion for Mectizen x *SSOTF / PCOs x INDEPENDENT MONITORING +SSOTF/PCOs/RTF x *Mid tcrm rcvicw { SSOTF / RTF *Evrlurtion + SSOTF / RTF *CSM/SHM in x x 25 V/HO/APOC, December 15, 2004 $o N ,ri C) -o oo 0)A O Or \oN C.)E O oI CB L € xL ct) cr)() o C) q) (.) d € o B oq) .,6 P *rd s€ E >-= cd _.^aY 9^ I 5rFr :'F z .iEapd E 3E R S qE !Oa ali (.)s=o) -S -^#;g E\ =*.i o tri '<trE 'i .o -c?3 C\J .Q! x NHL S t <-.1 S 9r: ^.(L)-SBETr-ts s 5.B E=Eo-o =tE 5hcq) N.U tsqi-6 $; €z bo !t !La aotr Ho v tr) L CB 0) >. od P l-i ,o -cr) €o C) I H H F (^J 6d I € (n L o) d E tua d LrJC)(htrc:AL.: LA!ail c)'i HF=EO+r6r) O o o2G rn.995:E -4AIri *a-q)iGaEo +9b t!u ^GttsH'58F,<tr)UEr, Hrr']ENI -t Ir -91: -OlF.:(Bl rFl 0)o cgo ofr I U) q) L o o o o lr +. o U an L(.) o o L (h o ! v ! v V o m(J (h o (g= OFoE FI() ! v v t v Lo f(! Oi o o z 00 o E] N r- o rl] N r- rI] !+ o\ H (! oE(H o b (t) ! v ! V V oo 'a t<A. +i o (D L{ cd z C) L (d o .e N Cdrq.t (, Lr o (B H (n C) (! L o(! r! rh cdH 6+. oF aIfthere are problems with release ofcounterpartfunds, how were they addressed? - Comments Up to date SoH can not meet its obligations due to lack of National budget. This might change in 2006 since budgets are being prepared for the respective ministries of the Government of South Sudan. A budget component for OV control shall be included. NGDO partner CBM has been very punctual in releasing its obligated funds and SSOTF commends it for that. Unfortunately APOC management has not been punctual in releasing funds which havc been approved on time to the SSOTF. It is worth noting that the flow of funds for CDTI activities was delayed by virtually 4 months as a result some planned activities could not be executed due to lack of funds. Right at the moment the fund which was requested for the third quarter of the year have not been received despite the fact that plan of action, budget, and financial report were submitted at the close of March 2005. State the number of projects that had nofundingfrom APOC Trust Fund? o Three CDTI project namely, East Equatoria, West Bahr el Ghazal and Upper Nile State the number ofprojects that had nofundingfrom any outside source? o West Bahr el Ghazal and Upper Nile State the number of projects that qre late in submission of the Jinancial reports to APOC? o None Other forms of community support Describe (indicate forms of in-kind contributions of communities rf any) Provision of venues/shelters for community leaders meetings and CDDs training. Some communities do the mobilization and sensitization of their own people. Communities collect firewood, water and also cook for participants. Some communities store drugs and provide good security awaiting mass treatment. Selection of the CDDs is a major community contribution in the CDTI strategy. 4,3. Resourcemobilizationefforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. o The National coordinator is currently involved in budget formulation to include SSOTF coordination, the PCOs and COS in all CDTI projects to be included in the Federal Ministry of Health budget for 2006 and onwards. o The SSOTF coordination office has succeeded in mobilizing resources from other donors to renovate county health department that houses the West Equatoria CDTI project, 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table l3: Indicate how much the NOTF secretariat project spent for each activity listed below the 4.2 Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding 27 WHO/APOC, 24 November 2003 U o APOC MOH ]NGDO OTHER Drug delivery from NOTF HQ/entry to districts, etc Monitoring and supervision of CDTI -tpjppt-sTraining of Project officers, TOT, N-QTF 9tq_ff,9t9. Advocacy visits to health and political authorities at national level IEC KAP studies, development, Annual review workshgpq Bi annual NOTF meetings materials 1,942.00 iIn kind 3,325.00 -I I I -l-. -t l I Fuel and maintenance of Vehicles, Maintenancg of 9ffi9q equipment Stationery Others 0,t30.00 t,ooo.oo lqzo.oo 900.00 TOTAL 9,072.00 15,195.00 Total number of persons treated Comments 28 WHO/APOC, December | 5, 2004 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currently Non Functional but repairable Written off l. Vehicle 0l 0 0 0 0 0l 0 0 2. Motor cycle 0 0 0 0l 0 0l 0 0 3. Computers 0l 0l 0 0 0 02 0 0 4. Printers 02 0l 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others a) Photocopier 0l 0 0 0 0 0l 0l 0 b) Cash safe 0l 0 0 0 0 0 0 0 c)Lab top 0l 0 0 0l 0 02 0 0 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if necessary) *Conditiort of the equipment (Functional, Curuently non-functional but repairable, Written ffi. How does the project intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeoble manpower at all levels. l) The National Coordinator is a holder of two master's degrees in public health and has vast experience in primary health programmes, including the setting up of CDTI project in Juba and Terekeka Counties. He pioneered the development of the New Sudan Health Policy and produced the blue print. 2.) The Deputy National Coordinator has experience in Community Health and project planning and management. He also acquired a certificate on basic computer packages. The Deputy Coordinator needs training and more field experience in the APOC CDTI strategy. 3.) The Data Manager is a diploma holder in Public Health. He received spreadsheet software training in Rumbek. He needs on-the-job training in data entry and HIS management. 4.) The Finance Manager is a university graduate in Development studies & public Administration and has no work experience. She participated in APOC finance training in Rumbek. 5.) The SSOTF Secretary is a graduate from high school. - Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is whal measures were taken to ensure adequate CDTI implementation where not enough knowledgeable monpower was available or staff often transferred during the course of the campaign). This is not applicable in our situation because staff transfer does not occur at this moment. However, in cases where a gap has resulted as a result of sudden staff movement, members from the nearest CDTI are asked to cover. Besides this there is acute shortage of knowledgeable manpower in all project areas in South Sudan. 29 WHO/APOC, December I 5, 2004 c.lO o.l hq) -o q) o z$ a.l Ci q ir B c.) o9 vO9(d o !l 4)dH H vo d 0)op Io d U)(B 4 4 o I) (€ o (') P(+< o() tH o!) I q) d F ,ri IN x(€ =z s !l ot rt t<(dF L.:n thql# $c)SE ^.* ii%+ ci .lE\ E:t eN$ I ss dY$ 5r.s a Es O)qr-.n.-!:EE :s g 6 sssx ** s - - -U d\\l!!rs(trLLV9\i qi*d dssEo'E& & >,.t -s --Ed)hr{s\ g 5H (i) - t)t&_ ^:a\hE\\\\Ji^ uiduiC/)!1ovi 9 c.r -4!-t€ q > \ L t q) 4 q) OJ4 Cd tiq) .13 ) o cB CB o (B o tr o Bqi o (.) !() ? NZ +. Lo a0 tr q) L q) b0 tr L E o o LL 6lI cl o L 6l a0 lr o L o cl I L cl Fr o rJ o oE c! rr) cll B a Bo olr lr C) -q o ! (d b0 L o o 0) € (,)a C)E -ohEQEqi Clo> -0) .: E0 *l- Cg- thOAEal .bh Xct .= e. 9c)5+.CBL >6t rr.l a tf) tr -c)/-4OF FAr) q) AE a ra >r .o o .tA -90.13€Ex>(B\r(l)Q. >. u0 -lr(d o.- L:-o !-i;^ Q t,7 8-YlF Cd .FfrC-'! ;i9-.o G) '.='cd itd Et- =.5.;lu 'r, (d6aE tro ,tr Pd 8go tr!r8..: E()tr>,! o-E ts+ cO c'F XH =.=6EHf.i= rd2,,^ H .i:;i Lr .=tcgcd\<5>q)Aoo>\ E - - )'sHXHonOr=gi> Q H.tr'_ .!f ;i o ,E€ FE; HE 9 'i 4..= ts O E Cd z o() 'a lr 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceqses in terms of: o This will become clear after the formation of The Federal Ministry of Health of the Government of South Sudan. The Government is in formation at this moment. 5.2.1. Planning at all relevant levels. . The hierarchical levels of administration are currently being worked out. It will be more appropriate for us to elaborate this after formation of Government 5.2.2. Funds . It is expected that the Government will be budgeting to meet its obligations in OV control 5.2.3. Transport and equipment (replacement and maintenance) o As per statements of the Commissioner of Health, the Federal Ministry of Health shall include in their budget components to strengthen the OV control program; so they will be budgeted for by the Government and NGDOs will cover the gap areas. 31 WHO/APOC, 24 November 2003 5.2.4. Human resources o It is very early to talk about human resources sustainability. Once resettlement and rehabilitation has taken place in South Sudan the availability of required human resources will be apparent. The secretariat of public service has already commissioned "Skills for South Sudan" to undertake a human resource survey in all fields in South Sudan. 5.2.5. Which projects have submitted sustainability plan? o None so far 5.2.6. To what extent have the plans been implemented? o Not applicable - Refer above. 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration, 5.3.1. Ivermeclin delivery mechanisms The Ivermectin delivery mechanism will be inbuilt in to the PHC structure system of drug delivery. The Federal Ministry of Health of the Government of South Sudan has already embarked on major overhaul of PHC drug delivery system. Communities will be able to benefit from receiving their Ivermectin in the nearest health facility. This will include side effect drugs. 5.3.2. Training o PHC health workers are an essential source of trainers after having being trained. They are normally well versed with the localiry and act as a source of trainers. 5.3.3. a 5.3.6. a 5.3.4. Release of funds o Handling of resources at PHC level has not been implemented in South Sudan. We neither have the experience nor the budget. 5.3.5. Is CDTI included in the PHC budget? o The budget for Federal Ministry of Health of a Government of South Sudan is still being developed. It is anticipated that the state budgets will include PHC budgets. Ioint supervision und moniloring with olher progroms Integration of CDTI into the PHC system has a lot of advantage since other shared resources could benefit CDTI project. CDTI becomes an integral part of the PHC and hence joint supervision can be very effective through joint plan of action in supervision etc. Describe other health prugrammes thal are using the CDTI structure and how lhis was achieved. Whal hqve been the achievements? The Federal Ministry of Health is considering using the structure of CDTI to implement IMCI which is now modified to Integrated Essential Child Health Care. It is still in the early staBe of planning. 5.3.7. Describe other issues considered in the integration of CDTI 32 WHO/APOC, December 15,2004 o o The CDTI strategy could be used in management and control of malaria which is a major cause of mortaliry. 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) At this moment no other project has been integrated into the CDTI. However, Vitamin A supplement is the most likely program along with integrated essential child health care. a 5.4 Operational research o No operational research carried out 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. o Not applicable - see above 5.4.2. How were the results applied in the project? o Not applicable - see above 5.4.3 Note the issues that have been identified by the NOTF for future operational research. o KAPs in the new CDTI areas . Operational research into the Nodding disease o RAPLOA possibly in Southern Bahr el Ghazal and in Upper Nile along the Ethiopian border o REMO in formally sampled inaccessible areas due to insecurity, natural barriers and landmines. SECTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weoknesses, opportunities qnd threats of CDTI implementation process. Strengths o The presence of SSOTF coordination office in Rumbek along with CBM as a lead agency within South Sudan has led to effective coordination; unlike in the past where HealthNet International did it in Nairobi far from the field. This has led to easy supervision and monitoring of all project activities in the field. . The SSOTF is fully functional with all the Secretariat staffs 100% present in the headquarters. o The SSOTF has a strong coordination with other stakeholders, more especially with the endemic communities. This strength has led to the smooth implementation of the CDTI strategy. o Management of APOC and CBM trust funds for CDTI and HQ projects are now closely monitored and utilized for the intended purposes. ll/eaknesses o The capacity of the Data Manager and Financial Managers desires a lot. All of them are unable to produce normal reports leave alone the APOC Technical Reports which 33 WHO/APOC, December 15,2004 ais quite demanding. This has resulted in involvement of the National coordinator, Deputy National coordinator and NGDO coordinator in production of reports. Computer illiteracy is a weakness in all projects which hinders efficiency and speedy data entry and reporting. To overcome this problem, the SSOTF has started on site computer training in the coordination office and CDTI project offices. Opportunities RAPLOA results might give the CDTI project of West and East Equatoria to access more communities. It could also be a threat to the projects if Loa loa co-endemicity with OV is massive. The reasons being the need a special attention and conditions for treatment that might not be met by the current health referral facilities in the project areas. Comprehensive Peace Agreement has been signed after more than two decades of brutal conflict. This is an opportunity to strengthen the projects in all aspects with the anticipated government contributions as per APOC philosophy. The OLS Quarterly Health Coordination meetings which used to be conducted in Nairobi are now being conducted in South Sudan (Rumbek).This is another opportunity to advocate for OV control since SSOTF secretariat is represented and is good for exchange of views, coordination and advocacy. The approval of the remaining three (3) CDTI projects of West Bahr el Ghazal, East Equatoria and Upper Nile is another opportunity to increase the annual therapeutic and geographical coverage in South Sudan. The road network in South Sudan is being worked out and therefore, links with the neighboring endemic countries e.g. Ethiopia, DRC, CAR and Uganda will be possible and advantageous for inter country coordination and collaboration. -List the strengths, weaknesses, opportunities and threats of the vector eliminotion project (where applicable). . This is not applicable since we do not have vector elimination component. Indicate how challenges were addressed. Challenees o There is a high illiteracy rate in the project areas. Getting skilled personnel is difficult. The accepted practice of advertising, short listing and then screening short listed candidates is rigorously being followed. However, due to the high demand of literate persons there is always movement of staff from low paid jobs to high paid jobs. This has been a major challenge to SSOTF coordination office with frequent turn over of the project staff which draws back the projects in general. The dilapidated office structures in Rumbek and Project Office in Yambio are posing a real problem to the assets of the SSOTF. The windows, doors and the ceiling have been destroyed by ants. Collapsing roofs and walls are evident. Despite the fact that there are guards we can not guarantee the safety of the property and assets of SSOTF. The project office issue in Yambio has been addressed through the efforts of the SSOTF coordination office; this is by inclusion of the PCO office in the general maintenance of the CHD in Yambio by UNHCR. In regards to SSoTF/HQ office, discussions have taken place and there is a possibility of this structure being maintained through USAID funding. o a a o a a a Communication is a challenge to the projects in that South Sudan is still emerging from war and modern communication facilities are not yet available. The only 34 WHO/APOC, December I 5, 2004 aa equipments currently in use are the long range VHF radios and Satellite phones which are quite expensive to run. Transport is another challenging issue. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Vehicle wear and tear plus fuel consumption are quite high. It is hoped that the road infrastructures shall be maintained as soon as possible and in fact work has started in some sections. Transportation in general in CDTI project South Sudan is not adequate and especially the vehicle in West Equatoria is seven years old and is becoming a liability. It is quite difficult to find literate females to compete with men. In case a lady is successful to take over a job the husbands normally do not consent. This is even true in some cases where wives and girls have been selected as CDDs. Women's participation in the program is still very low due to some cultural barriers and influences which need continuous community sensitization and awareness campaigns to overcome the challenge. Indicate how opportunities can be utilized to improve CDTL . The out come of RAPLOA might be addressed appropriately since the Federal Ministry of Health has embarked on major hospital and health facility modernization. Besides this there is a great opportunity for more therapeutic and geographic coverage. o The Comprehensive Peace Agreement will enable the Government to meet its obligation and contribute effectively towards OV control o The OLS coordination meetings will be used by the SSOTF office for effective coordination with partners and as a forum for discussion of project matters. . The approval of funds and launching of the remaining three CDTI projects will go a long way to save sights from the project areas and give an opportunity for the overall CDTI projects objective in South Sudan to be met. . Improvement on road network improves logistical support to the CDTI areas as well as saving costs on vehicle wear and tear and reduces costs on fuel/lubricants. The exorbitant costs on air transport will have been reduced considerably. 35 WHO/APOC, December I 5, 2004 a