Annual report year 2, 1999 : GOS Sudan, August 1998 - December 1999

,! African Program for Onchocerciasis Control ( APOC) CDTI Proj ect APOC - Sudan AI\TNUAL REPORT - YEAR 2 (1999) CDTI (GOS) - Sudan August 98 - December 99 n For Action To: 1 ccr trrc ft n ti. D /- rj For lnformolicn To,Ilr( s/ âr,rc crÀ t:ùrS ?i E t; t"t ,/ f,'rf \3- j ILN.(J tr É-àopt: â e /'1\a, @ RqrHK of a--r Ouchocerciesis distriburio oIn Sqdes: -A.reas covered byThe ÀPOC @ Uqud: I(:sfr Kcy to rrq I ' lbrhcmc<lJ _ .?--ÿo , - Gogr-al l0 - luoa 2- - Duptætd ;up! tn ,<hütoutu ,l - [wcil l - Oupl«zd cap, t^ tyvald6-iTa 9 - Tuku sudan is a large country and oncho is endemic (hyperendemic + meso)in areas separated by about a thousand of ,it"r. The total area of oncho activities that need to be covered by Apoc program incrude (see map). 1. All of the south apart from the Upper Nile,2. Abu Hammad focus in the North, 3. Sundus in the East, 4. Radom in the southern parl of the western state (Darfur), and,5' Displaced camps (around Khartoum and in other states in the North). There is a wealth of research on onchocerciasis in the sudan (1g70 _1995) particularly 9n_ immunity of the patients to the parasite and ontreatment (DEC and Suramin). H in lvermectin treatment was started on a small focus in the southbile team) when 120,000 individuals in the south receivedlve ctin (during a ceasefire initiative ) and treatment ceased thereafterfor 3 years until APOC supported a CDTI program in the SudanRegular treatment was then started by the NOTF with ApOC fundi ng lnOctober lgg7 , with support a lso of Global 2000, the collaborating N GO Due to civil unrest, the southern part of the country is divided into almosttwo equal parts between the southern resistance movement (spLA) andthe government of sudan (Gos) Apoc, àppieciating the urgency totreat Sudan focus, accepted the initiation of tw'o programs in the Sudan.(one served from Khartoum Gos and the other served from Nairobi(oLS). ln addition, a secretariat He project wai based in Khartoum. It was fortunate that one Nationar rask Force was formed and ittncluded a representative from the coalition of NGDos working in thesouth (Coordinated by Health Net lnternational). The nationals on bothsides met in a workihop (Nairobi workshop l ggg), and the Nationalcoordinator met with nationals and the chairman of sRRA (theresistance movement NGo) to facilitate the work in contror ofonchocerciasis. This spirit of cooperation was reflected in a letter to the Lancet (4rhlrql:l 1999, page 601 Vol. 3s4) entifled ,,Medrcal Achievements underCivil War Conditions,,. (See annexes). Ïhe present report reflects the activities of the area that served fromKhartoum (Gos)' A separate report will be provided on He secretariatproject ! f. Funds fronr the APoc were first recerved on 1sti' oct. .1gg7. In August 98, the first technical report coverrng the period between August 1't, 1997 and July 31't, 1gg8, was submrtted to the TCC 6 meeting, nuto,n Geneva, and was approved rhe TSA was signed in october gB The first and only installment in year 2 budget wariec"ived on 22lglgg and there were no funds available from ApoC between July ggJspt gg Funds were borrowed during that time from the collaborating NGO and reimbursed in September 1ggg. we are sure that the honorable members of the committee would appreciate the difficulties facing the project in sudan and whrch are summarized in the following 1- The wide areas to be covered by the project, some areas of which are about a thousand of miles away from Khartoum. This is reflected on the time needed to execute a parlicular plan and on the cost 2. The war in the south and in the east (Sundus in the East has still not been surveyed to start treatment due to the state of war). 3 Displacement and famine due to the war. This does not only create new communities for treatment but also disturbs the regularity of treatment. 4 The state of poverty and total need of the communities. This is animpofiant consideration when we request the communities to support the CDDs. 5 The large number of competing NGos and uN agencies working inthe south in distribution of aid and food. The trign salariei ànoincentives paid to their staff and to the volunteers in their progà, causes a big problem to our program. It's worth emphasizing that a community in war zones is a unit, which varies in size. shape and composition depending on the many factors relating to the war. ln the south a community can be as.rrtt as 100people (a small number of families) when an area is deserted. ln more stable regions (Raga, Bahr El Ghazal) the village is made up of many communities based on the normal distribution of a village (since all thepopulation is from one tribe). ln wau the communities broke up twice during the life span of theAPOC project. 70% of the population fled when a rebel faction took the cityfor 12 hours. This and the retaliation thatfollowed almost leftWau a 4 , ,1 deserted city. on the return of the population, new communities were constructed which required complete reorganization of the program. On the other hand, some displaced communities which settled in the North have become established cities, connected with water supply and electricity, schools and dispensaries. They have actually taken part in the national ballot. We are now concentrating our efforts on this displaced-settled population as REA has revealed that prevalence of onchocerciaisis to be greater than 50% Out of the 283 communities eligible for treatment, 219 have actually received ivermectin therapy under APOC. Since ivermectin was distributed only once on a small scale in 1995, these communities are considered as receiving rvermectin for the first time. The project in Sudan is expanding slowly depending on accessibility to the communities and is in turn governed by the prevailing conditions of the war. This year, year 2, we were lucky to have a holding cease fire. Hence, we started cDTl in Torit, Terekaka (Equatoria), Aweil, Gogrial (Bahr El Ghazal) in addition to the Displaced camps in the North. REA has been completed before the stafi of the first round treatment and updated in most of the areas receiving second round treatment (see details of HQ report). This report describes the program activities in treatment coverage, training, health education and integration. lt also describes other health - non-oncho activities - which were executed by our teams in these areas. ln spite of the difficulties due to remoteness of the endemic areas and civil conflict, we take pride in the accomplishments to date. Theprogram is well undenruay, and many thousands of persons have benefitted from the support provided by ApOC. A financial reporl for year 2 is attached. A proposed budget for year 3 is attached. -5