SSOTF/ HQ annual NOTF of secretariat technical report to technical consultative committee (TCC): Jan 2007 through Dec 2007

South Sudorn Oncho Taslc Fo rce Coordination office I I I I i I COUNTRY/: South Sudan Approval year: 2003 Reporting Period (MonthrYear\: Jan 2007 through Dec 2OO7 Project year of this report: (circle) 3) 45 67 8910\t L2 13 14 Date submitted: August 6,2008 ORIGINAL: English ssoTFrHQ ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Januarry for March TCC meeting To APOC Management by 31 JuIy for Sgptember TCC meeting, AFRICAN PROGRAN{ME FOR ONCHOCERCIASIS CONTROL GPOC) {e lLO l fvt cs$(op Alit Bfo €o For h;ig r::ilOn Tor -\ r1- I 5 sEP. ?tlrj6 --., -.i ii I I I ANNUAL 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. Sam son P y)?fba signatur.' .b. 5l Date: oo NOTI'Chair Name: Dr. Majok Y Signaturs!... Date: This i'eport has been prepared by: Name: Dr. Baba/Fasil/Lazarus De signation: NationaYNGD O rd./TA Signature: Date... 0 WHO/APOC, December 15, 2004 TABLE OF CONTENTS FOLLOW UP ON TCC RECOMMENDATIONS. EXECUTIVE SUMI\,IARY SE CTION 1 : BACKGROUND INFORJ\,IATION........ 1.1. GpNnnaIINFORMATION 1.2. PopulauoNAND Hnelrs SYSTEM SECTION 2: SUMI\{ARY OF CDTI IMPLEMENTATION 2.1. DrsrRreurroN pERIoD............. ......7 2.2. AovocecyaNr SBNSITIzATIoN .....................7 2.3. INT.onuatToN, EouCATIoN AND CoMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT 2.4. Coun,IuNITIES, INVOLVEMENT IN DECISION-MAKING 2.5, CapaCIry BUILDING 2.6, OnopnINC, STORAGE AND DELMERY OF IVERMECTIN............ ....... 11 1 1 2 2 6 7 8 9 9 2.7. TRpervrpNrs 2.8. SuponusroN ..........13 ..........18 2.9. ConauuNrry sELF-MoNrroRING aNo StaxpHoLDERS MrprINc.................. 19 SECTION 3: OTHER ACTIVITIES OF THE NOTF ............20 4.7. 4.2. 4.3. 4.4. 4.5. FTNeNcTaL CoNTRIBUTIoNS OF THE PARTNERS Otupn FoRMS oF coMMUNrry suppoRT.......... Rpsouncp MOBILIzATION EFFORTS ExpnNoItURE PER ACTTVITY BY THE NOTF SECRETARIAT 25 26 26 26 28 SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDEI{T MOMTORING AND OTHER REVIEWS 29 5.1. INopppNoENTPARTICIPATORYMONITORINC/NVRIUeTTON 29 5.2. SUSIaINaBILITY OF PROJECTS: PLAN AND SET TARGETS (n,mNoetony et Yn 3) 30 5.3. INrpcReuoN 5. 4 OPERATIoNAL RESEARCH ......30 ......31 SECTION 6: STRENGTHS, WEAKNESSES, CIIALLENGES AND oPPORTUMTIES ..................31 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MoH NGDO NGO NOTF PHC REMO SAE SHM SRRC SSOTF TA TCC TOT UNHCR UNICEF USAID I-]-TG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed Distributor 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 Advisor(WHO/APOC) 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 ll WHO/APOC, December 15, 2OO4 Definitions (ii) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84Vo of the total population in meso/tryper-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/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: 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 CDTL (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 mobilized by the community and the government. iii WHO/APOC, December 15, 2004 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) Executive Summary Overall, CDTI total population in the five projects of Southern Sudan was 5,853,243 in 2007. This represents a 6l.5%o increase over the 2006 figure. The increase was based on population refinement, inclusion of some county populations mainly in West Bahr El Ghazal project that were not in 2006 and refugees home fluxing. West Bahr El Ghazal CDTI project has the highest total population of 2,670,680 persons. The Ultimate Treatment Goal GnG) and Annual Treatment Objectives (ATO) across the projects within the period were 4,916,720 persons and 1,528,967 persons respectively. The total number of communities in all the projects was 7, 103 in 2007 and this shows an increase of 31.07o when compared to 2006. Of this number of communities, only 6I24(32.L7o) were targeted for treatment (Aro). Total persons that received treatments in 2007 were 1, 422,325 against 936,375 in 2006 representing 485,950 (51.97o) increase. These treatments occurred in 1,965 communities compared to 1,335 communities in 2006. Coverage recorded in 2007 for geographic, therapeutic, UTG and ATO were 27 .68Vo , 25 .00Vo , 84.00Vo and 93.03Vo respectively. Actual CDTI training and refresher courses started in July through September 2007. 37 project staff, 472 health staff, 151 TOTs and 2,509 CDDs were trained and refreshed in the reporting period. The figure for CDDs trained was less that of 2006. The population/CDD ratio was 1: 2333. Integration of CDTI into PHC has not been fully realized. Most CDTI projects operating are not perceived as PHC as staff in these projects are not ministry's staff. Project coordinating officers were volunteers and not health staff. Apart from the national coordinator, all other CDTI staff at national and project levels were not part of PHC. The Strengths of SSOTF lies on easy accessibility of SSOTF office by all projects due to its Strategic location in Rumbek, joint presence of SSOTF and CBM in the same office has led to effective CDTI coordination and support from other NGOs in Southern Sudan towards mectizan distribution. Number of Recommendation in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY NOT APPROPRIATE WHO/APOC, December 15, 2004I The main weaknesses experienced are high attrition rate of project staff at all level, available manpower is not well knowledgeable in CDTI, non payment of salary by the government, census update not completed in virtually all CDTI projects, number of total villages in the projects not yet known. Opportunities identified which could improve CDTI include peace and normalcy in project areas, easy and free movement, and improvement in the road network in South Sudan. The challenges facing the CDTI implementation in Southern Sudan are low level of available knowledgeable manpower in the project area, high attrition rate of CDDs at community level, non integration of the projects and non absorption of CDTI staff into the ministry of health, intensifying health education and community mobilization, non availability of community data base collection,, ratio of CDD to total population in the entire country is still high, community census registration is a still a problem in all the projects, problems of transport due to bad roads conditions and broken bridges account for vehicle wear and tear plus fuel consumption and finally modern communication facilities are not yet available. Key activities undertaken by the SSOTF during this reporting period are procurement of 4,625,500 ivermectin tablets from Mectizan Donation program in collaboration with CBM, training and distribution of work support items. There was no activity on vector elimination performed by SSOTF during the period under review SECTION 1: Background information 1.1. General information 1.1.1. Description of the country program -CDTI and vector eliminalion (brielly) The South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The 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 prograrnme which requires the implementation of CDTI strategy was earmarked for five (5) CDTI projects in East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile have all been launched. Vector eliminotion The projects have no vector elimination component. However, surveys of breeding sites were being considered. Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.9, Adequate heahh facililies, ts system decentralized or not, etc), logistics, administrative structure. The National Plan is being implemented through the involvement of national staff (lay people and health workers) appointed by Ministry of Health government of South Sudan, and the State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National and lnternational 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. WHO/APOC, December 15, 20042 The total population at risk of being infected with onchocerciasis in Southern Sudan was 5,853,243 people. There are a total of 5 CDTI projects and 1 Headquarter project being implemented in Southern Sudan. The available statistics on health facility situations across the five CDTI project areas in Southern Sudan showed a total of 589 health facilities which comprised 133 primary health care centres (PHCC), 441 pimary health care units (PHCU) and2L rural hospitals. I, 530 (36.2Vo) health workers were involved in CDTI out of 4,223 health staff in Southern Sudan. The SSOTF headquarters is situated in Rumbek town. Rumbek airstrip is 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 southem Sudan. Rumbek is strategically linked with Western Equatoria, East Equatoria and other parts of Bahr el Ghazal through road network. The administrative structure has four levels in Southern Sudan namely: The State, the County, the Payam and the Boma at the grassroots level. The States form the first level of administration followed by the Counties, Payams and Bomas. State is administered by governor; county by commissioner, the payam by payam administrator, and the Boma by Boma liberation council. The five projects have a total of 32 counties and 7,103 communities where mectizan treatments were implemented during the period under review. Health system & health care delivery $tate any problems related to health system thal impede p r o gram imple m e nt ation). The PHC system is still emerging from years of conflicts hence health care delivery remains a great challenge in Southern Sudan. The coordination of the system is still poor, lacks adequate trained manpower, medicines and equipment. The CDTI staff non absorption into the health system of the Southern Sudan and non budgetary allocation of funds to run the Primary Health Care (PHC) in general and the CDTI in particular were the major issues that impede CDTI implementation. For instances, among the SSOTF staff at headquarters' level, only.the national coordinator was absorbed into the ministry of health ,and also at the CDTI level, only one project coordinating officer was part of the ministry in West Bahr El Ghazal project. 3 WHO/APOC, December 15, 2OO4 Provide map localing all projects (CDTI and Vector Control, if any) within country. Southern Sudan Itdql 5: CDTI ar:cas anil frrrccasbd CDTlprujects with thcir rcspectiw coordinrtion and srrycn'ision officce/ccntcs ffi ect 2: Bahr El Ghazal Eastct 1: Bahr E! GhazalWestP t ,to-te i , P 3: West E uatoria ect 4: East E flaP i-- \:\[ Ki, llganda 0 100 200 Legend Erqrty or udntebitetcil zoru Rctr rc CDTI Priority areas NO CDTIerrcrc REIIO tobeperfrrrncd Etfriopit lltnya WHOIAEEI lJul!2E01 tNorttrot$ Sudfln tl,entra t Afrita n Repab lit OTF HQ, Project Coordination oflice (PCO). Project Surpervision Centre(PSC) Proiect coordination ofiice (PCO) I Proiect euperuasaon cerrtre (PSC) lfP}lroDr,ltrr; t<P-PEoIiC Of cOngo f; * fr t.oi""t Supereision centre (PSCJ only T,1lr trf lr rcrJudrqrrly lr louro'rr.i ,rlr rlrlE'rf,d.iy d* .sS OIFFaTE g lI Calslar-dar,.ddt IPOC lw Indicate the partners involved in project implementation at all levels (MoH, NGDOs -national, international) 1. At MoH level SSOTF Secretariat Five CDTI projects. Though they are not fully integrated but still work with ministries 32 county health departments. l74PHCCIPHCU. The staff are mainly payam supervisors 2. At community level.7,103 affected communities are involved 3. At NGDO level: o Chirstoffel Blinden Mission. The lead NGDO group 4 WHO/APOC, December 15, 2OO4 ,,i$ I I{ a o a a a 4. At external support level. APOC/WHO 5. Other level. NGO partners as at2007 are shown in the table below Name Region(s) : "'" r' 1 - 'i ".': l' : ;:,''^ i' CoUnfY;i^'' i':q':rr'r,.ii;-'*' J'' AAH Equatoria (West) Maridi, Mundri, Yei ARC Equatoria (East) Kaiokeii, Nimuli DOR East Bahr el Ghazal Toni, Yirol, GOAL West Bahr el Ghazal Twic ICRC consortium East Bahr el Ghazal Yirol IMC West F4uatoria 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 NCA West Bahr elGhazal Gogrial Samaritans Purse West Equatoria Mundri (Lui only) SIDF Ease Bahr el Ghazal Mvolo SI.IHA East Equatoria Kaiokeii, Juba ZOA East Equatoria Juba, Terekeka Describe overall working relalionship among partners, clearly indicaing speciftc areas of project activities where all partners are involved (plnnning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or sumeys etc). The overall working relationship among various partners is satisfactory hence the realization of the basic objectives of information dissemination, trainings and mectizan distribution 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 o Ministry of Health monthly 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 meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activity plans. Ministry of Health monthly Coordination Meeting: The coordination meetings take place in Juba in which SSOTF HQ is represented by the National coordinator. There is a representation of health NGOs in South Sudan, including LINICEF, WHO, UNFPA and the Multi Donor Trust Fund (MDTF). The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. Quarterly operational planning :( RegionaUCounty SSOTF meetings) are normally done jointly 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. The PCOs, COSs, CHWs, and' POS carry out advocacy, mobilization and sensitization. For the management of SAEs cases the CDDs will refer the cases to the nearest level of health facility. 5 WHO/APOC, December 15, 2OO4 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 prograrns 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 plans to handle such issues as follows: a. The first step is to investigate the issues and determine the root cause. b. Identify appropriate officers and designate such persons to follow up on the issues and then report back. c. Maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field and the office so that quick timely intervention is applied on any issue pertaining to the CDTI implementation. 1.2. Population and Health system Table 1: Projects and population al risk in the entire country whether they are trealed or not during the add more rows NB-The available number of communities in the projects is not yet comprehensive and it is hoped that in the years ahead this will be realized. Source: From Oncho Project reports: Other source, specify REMO Year of source: @! UTG: Calculated as the maximum number of people to be treated annually in meso/tryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). National census: 6 Name of CDTI Project Total communities in meso/hyper-endemic zone Total population in meso/hyper-endemic zone [Jltimate Treatment Goal (UTG) by 2010 East Bahr el Ghazal CDTI Project 1 00 I 927,285 778,920 West Equatoria CDTI Project 697 506,848 425,752 West BEG 3,219 2,670',690 2,243,368 East Equatoria 948 L,133,436 952,086 Upper Nile 1238 614,994 5t6,594 TOTAL 7,103 5,853,243 4,916,720 WHO/APOC, December 15, 2004 Distribution Period Oct Nov Dec Project Name Jan Feb Mar Apr May Jun July Aug Sep x xEast Bahr el Ghazal x x West Equatoria x x x x East Equatoria x x Upper Nile West Bahr el Ghazal x x SECTION 2: Summary of CDTI Implementation 2.1. Distribution period Chart the actual distributian period for each CDTI Project in the country in the table below. Overview of distribution undertaken insert rows as needed. Briefly note any problems/issues (one paragraph). There was no distribution of mectizan in one county in Upper Nile CDTI project due to flooding that cut off the Kormuk County and moreover distribution was generally delayed in all projects due to late transfer of projects funds. 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the national and lower (stale and district level) during the current year; the reasons for the sensitizption and outcome. Eight policy/decision makers were mobilized and sensitized at the national level. These were undersecretary in the Government of Southern Sudan, five officials of the presidency, director general of Primary Health Care in the ministry of health of GOSS and the Minister of Health Government of Southern Sudan. At the State level the National/NGDO coordinators met with four Ministers and their four Director Generals of Health on matters pertaining to CDTI in East Equatoria, East Bahr el Ghazal, West Bahr El Ghazal and West Equatoria States. Basically, the reason for mobilization was to solicit for support to CDTI especially in areas of providing salary to CDTI staff and counterpart funds to CDTI implementation. Although no fund was released, the officials expressed willingness to work closely with the SSOTF and the projects. They promised to assist in controlling onchocerciasis when the situation in Southern Sudan improved. b) State progress made towards internal resource mobilization. The SSOTF followed up the budget submitted to the Government of Southern Sudan since 2006 for implementation of CDTI activities. Unfortunately there was no positive outcome as it was not approved within the reporting period. 7 WHO/APOC, December 15, 2004 c) Describe any policy-related constraints being faced by any particular project and describe what was done to assist the project (outcome). Explain any phns on how to improve advocacy. The only major policy related constraint faced by the all projects was the issue of absorption of CDTI staff into the ministry of health system. SSOTF made effort to present this to health authority but without success. The issue will still be followed up and addressed in 2008. To improve on the advocacy, SSOTF has planned to involve all key members of SSOTF in the next meeting with the Government of Southern Sudan and to make use of new WHO/APOC technical Advisor being proposed for the Southern Sudan CDTI projects. 2.3. Information, Education and communication strategy and materials development Brtelly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audtence, and where they were distributed. SSOTF coordination office in Rumbek produced a number of IEC materials for the Southern Sudan Oncho Control Program in 2007. The materials were distributed to Project offices for onward distribution to 32 CDTI counties for further distribution to lower cadres. The following were produced: 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 durability under field conditions. . Simplified CDTI instruction manuals for community distributors. How were the IEC materials developed? o These materials were initially developed by Health Net International and in 2007 reviewed and reproduced by SSOTF coordination office. Are the malerinls reviewed to address upcoming rsszes (like decreasing refusals, sustainability, maintaining compliance to long-term trealment, SAEs)? o Yes, the materials were reviewed with emphasis on maintaining compliance to long term treatment and other upcoming issues such as sustainability. - Report if any KAP surveys have been done and how their resuhs were used? o No KAP surveys have been conducted in the whole project areas in 2007. Summar ize info rmation o n : - The use of appropriate and innovative media and/or other strategies to disseminate information among the projects; o Modern media such as local radio stations are now available in some project areas. For instances, East Equatoria project made use of Spirit and Liberty FM radio stations in Yei and Miraya FM station based in Juba, East Bahr el Ghazal project uses FM radio in Rumbek and West Bahr el Ghazal relies on FM and radio station in Wau. Upper Nile and West Equatoria projects have no FM and radio station.- o In addition, East Equatoria and East Bahr el Ghazal have based project radio. o [n most cases, 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. Mobilizatton and heahh education of communilies including wotnen and minorities This was carried out in all projects before mectizan distribution to create awareness about the mectizan. Community leaders were contacted to ilrange for the meeting with community members which comprised men and women including the blind people. Key messages were on the cause of onchocerciasis, symptoms, who should not take mectizan as well as the dosages and 8 WHO/APOC, December l5,2OO4 possible side effects after taking the drugs by individuals with heavy infection. Such meetings were organized in all projects. In some areas, women attendance surpassed that of men especially in Mvolo and Yirol counties of East Bahr el Ghazal. Response of target communitie s/village s A lot of people participated in receiving the mectizan tablets to the extent that the entire drugs allocated were all used apart from unused drugs in four counties of West Bahr el Ghazal. M aj o r ac c ompli s hment s ; o More communities participated in the treatment with Ivermectin in 2007 thanin2006. o Increase in the number of CDDs. o The negative attitude towards the usage of Ivermectin has reduced o Increase in the number of Female CDDs that participated in drug distribution in 2007. Weakne s s e s/Constraints ; . High attrition rate for CDDs due to non-support and also due to attractive incentives paid by NGO's and UN agencies for special campaigns o The number of female CDDs still low o There is frequent turn over of project field staff and at SSOTF coordination office. o lnformation dissemination is still inadequate. Suggest ways to improve mobilization of the target communities among projects. . Integrating CDTI into the ministry of Health. o Full participation by local authorities and support from the Government organs. o Involvement of women groups, youth and religious groups in campaigns. 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 cotnrnuntty participation making comparisons among proiects - Pafiicipation of female and youth members of the community al health education meetings; - In general, how do you rale the participation of minority groups and female members in community meetings, decision-making, (attendance, participalion in the discussion etc.) other issues. o Youth attendance is fairly commendable in public gatherings in all CDTI projects. 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 in all CDTI projects. 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 in all CDTI projects. o Comparison of various projects shows that female participation ii rated 45Vo in East Bahr El Ghazal,low in East Equatoria, fair in Upper Nile, very low in West Bahr El Ghazal and low in West Equatoria. 2.5. Capacity building Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) Briefly describe any training done by the SSOTF/NOTF for specific CDTI or Vector Control P r oj e ct s ( O bj e ctiv e s, particip ants, o ut c om e s, any follow - up n e e de d ). 9 WHO/APOC, December 15, 2OO4 Though there was high attrition of all types of staff from the various project locations, SSOTF has continued to train staff at all levels in CDTI strategy in 5 CDTI project areas. 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 GTNO/NOTF the boxes where was carried out the Type of training Project staff MOH staff Opinion Leaders Others (specify) Program management How to conduct Health education Management SAEs of CSM SHM Data collection Data analysis Report writing Others (specify) Computer training Briefly describe any technical assistance provi.ded to the CDTI projects. Efforts were made to provide projects with various assistances among which are data collection and analysis, development of work plans, mectizan estimation based on population, establishing ultimate treatment goal(UTG), drawing up timeframe of activities(plan of action) and imparting programme management skills and mechanism of Mectizan@ distribution. 10 WHO/APOC, December 15, 2OO4 3o c.l ,ri Eo ooq) o (J IJ P" o B U --d 9-g€E;s :3e#; S !'! o .O = di LE'=6e'Qe=- eiE e EEE;8 8 a.rortsoPFrr-F- F!EoB- ^b E i" I:=[L-v o= ?E r a{EeiTE s"Ep $:d=ES= sttEx 'E '.]?^ o l.i EE?E? -vatr"g !- u . \v S = eE e '5 ii o_ csgETE€ g uJ! ah CE E: gEtJ?J.ER E E E* IE EEri*? e&i--6= !L-AHet .'-- EF E >'>\O E € d'= 9€ 0 '- n.i - U!'i--OF ui^ i€E€3E -= - = d a!Y=oo..o E:._N ? ='EB ; E Z gEE tr H } b3b 3 I a; oo,i.H E.92:E o 3 o.r'E 0Z E 3 E E I f H +e gu 5 9 0 t.lz-Eb6e € E o =E: =BEE EE EEE;EU E cE (J l- 'i.99.=s€8;5 HE !E Yq qEi E q8€f I3E ; H ; € .EtE g3'.E -ACn aio-= chq) oI q) o 0 c) a0 909sFr9; :- t, =e)r€ oli Eoq) '-E@EE GtN o) !:'fg0u 5eUB ^oODE LE0).F !rg)5E oIA o .AE bi) SI t) ,s S\ S U, q) c){ q) V2 q) *a .B\ q) E as la\tsat q) B bO P S)s aaq) .L $' F\ B iq) F Be q) aa H \J -s o\ o 4 U \) 4 \) .v A !o B 4 $ P U Qp OO v \) ?2 \J .L q U = Vj tr) h 44\) a \J q l S * \)?, \) q. o oo 'a s C) o$E 3o oo Q..= h'=$i: s! s= rli 'S 7lB ..h$l E€I\FI E'ut, f, ddd \)' --ia<9 = (n $@ F- co@ N @ .+ @$ $ \o c- t'- co \o N \n oo$ NN\a NN fa) o\ \nN \o rn N \oN q) CElr (a U Lq) z Q tr Er oo$ o\rn !n oo\o oo (n rn\o co trq) q) o) I s l,n\o 6\o E ut -9t-U()() .L $' -\a<l) as =U cn s \o \os \o$ t-r * NN \n c.l o\ c{ r- o\ o\ \a N rn o o\ a0 tr 6lL L(Da Ett :F tsF ieE6J =Gz! a(J LH<o $ \o$ (--\o \o .+ c.)( N q) 9 q) I s €\? o\to E ut.E-QQQ N\v a< a e t) o\ t*- inN $\n NN NN \o\o \oN .+ tn o\ t-r @ N \oN \oN ca( co NF- * o\ 6 *c) cgL v) 0 oS -o rr A9 N tN coco o\@ N \o\o\o() L3<o 0) q) o I s F-6 r- (J +NQ \ a< .qr > $z E,rE-Q $ \o oo \o \o tr) \n N co \o f- co \nN N q) L ? o Iq) L Fr Lq) z 11 Er (J \o co t-. r- \o \o\o c) tr 9q) ,i 9r 0) H (! N Oll cdI rrl O (! L o E] 0 C) B (! tr d I! U)(! H o z oaq o ! CqN c0(! At\ B Fl F F 0) q) q) I s \o \oin A, o z6 li=FiN\J52E;i r- -t a.isil at >.= x: AO E-e Orn -6 0)B€ (nL() c 9 Er o(h 9 Er ca(t) fr Er o(n a tuF o(h a tr Er o(a a oq) Lr o (r) fr Er o Ch U) Er a Ch trF oa C') la Er a U) frF oa U) 0Lq)EL h-Ere 86 rh h- -e 86 C') E--laZ o!eal)a hrHEOHal)(r) h- -e 8Ech. U' o ! c!F @ 6N I c)lrA hq) z UI 6 q)il \o \o Eq)L XH 0,) IA in o\ NN F- o o Fl ($ N \ot6t 1,q) thp \otn \o \n $t-c! oo\a o\ o\ o\f-. oi co\o € c-q o\ r aA \o$\ot t 0) e)I c)il r- \o (n @ €( o\ oo 8 \o cO ia iaN\ot 0) IA o) q) * oF. \o \n 6 @in o\ oo \oco ia inN\o{ 0)EL cg L h Eg 'tH *z o L Fas H.EEt(, CE L o :d o= =d 6, L (t) ) ri ri () rd Qq) B q) z L(,)a p cg F $ ol ,ri E c) -o C)o(,) H U 0" *r B c.l E (! cg Nd rI] fr (! ca O o B € d tn(gI! (alro oo o ,.o li o E o o €oa E(d 0 bo F{ € o -o lr q) 'd r- N C) bo li E E!) o(! B o o oL C) B (n N (J 0) E on; riXrySg..qJ.o Lss8,S"o ect\oD()ca _ SoqpXE.H -=Ebv Q{{c tr H (! 0 0) B h o o cn = . \ c{ o C) o -C jI'c -9olO(H 'Fo Er' l-.a e9 Cq t, 0C9';EhE; .Xo$troE 9'aa\o X sEo.roan;; 'S.:n ; -agc) F o.ltE- - :r b: s ss 5 3So; Pd€ p ic's 6 b\68 4It-c iQ- o shYrr\% q.)_E .aEi I @* s R S 6'= NHEE N U *Eg 3Q'Y - U *-ai+ .== tr v .StrE hS# P E \ruO!-'l ()6Y >ts o =!' i! d ,.! lot @I.= q t! .='ir Stcue'-iE$ gB.^tr A k y: ,;i1%5 ;.i otS;,8 Ela.<(, Ft qaOa)0a >r -OCl'.F >E tr'oo,-LHEH =vJZdrJ -0)AP oi:bo9 6JH )rr ,^a9ri6o -E!= (!tr !3EC! I] (J -G-cBX> =-vq Q.= -xo)b€E =!100ooxv)- Y E o= ,;>_ Eob *'.r €ilE"r -6)dE o.r ci3 'd tr'tr6.;.e >rdE H-C d o-o '-:o)tr'-sr()tr=Es9(, >\E >r- =b bo> o.= =>oo=-q!o- -! Eq0ooa) =,*EE a -^bO6JY5 .-=L E.- v9.g 9 oo= c.r 9EFba .:7 aj1 -AR:9 8.e . .E EIo F^Oc ti} Yo.E I oQc <J'rY <g(Dv9bsH -C'-O,Ed' bnEuia- E bog .= L+ c!-a = >,.= .,.2u =-Ht€t LiS a J3I q) =S\ B B a B q)s SS 5,O%'u hq)fsl- ts r"BSh \s, .EE u*hy$Ys;\: o\b.s .SE 'xSQ$ ioo .Sj s.PBI 'S oo SE 3sls 1S\ .sr()>$sEt9s \h ssSF$\) *e *.ssS: ri $? S:i 9T $\S%^.BX t,x $ O c-t ,ri 0)! C)o 0) o o0. o OIol ;l!l C'I cdl ol :t(.)l b0dl >l >t()l 9l EI EI EI ol ol r!l :l ol EI5l zl doE cU oo 'a La o ' o C) o o (.) o .o o IL. 0)a >. or > ata -l oxl E rl sol .r El s!t'i ol= oltrolo 6)l '5Ol cg ol 6.Hl o Rl a lrl d =l ozt? V)\)Q\) c.| c)(! l.{ o o0(! Lr 0.) oo (!() a(!l- oo oo o C) l-r C) oo(!k C) oo o- oad L< C) F ol 'ol bo cdl!l dj)l 3l ol EI ol -ctoldlLI hrl ol c)l btr!l trl cdl c.rl =lol o.L(!l LIol €l $ '51 -lOI EI ol(Jl rl €l dt =l EI ol tLl h p p U B !o U) s\) J1q ! cg o cn 0)L d o sl v) ct 6) (! 0)lrF qAF ^-.-ev -,i EsL - .i @g.s3-atsi9 !JL!.-\L ='tr > o{cll ar ?298 BeEE &r ,0 eEl#< =u)zz z co co $m(n z t-(a6 q) L0)o 0.) EC) -azzH E ? E EI ?^^2 5 ETEEEcE z o\r- o\r- r- rn n r ta) \oq o\N \o r- o\ e.iN in6lll -*GFh 8.s s:a"s o ko '?iooE 0= .J ;) (.)z aE F r- cO\ o\\o$ \nN t-* @ N @@ rn co co $@t- c.) N o\+ cO raNt) NNt tr-o6)2 =:8 o'F<HO € \o q ooN$ \o €q(-' N ca tn co @ co Nr- ,rI F.N €\o € 0\ F-\o o\ €Nro o (! a 0r OLrE.C C)O-Fc.r 'E 4'=d!Hi:\\!= E i f I H -YVHi.rLF ao tr Y d o tn @c! r-N o\ @$ oo \o |,n \o ca$ ca ca @\o r-\o N $ o\q * \o (atN ta ro6 ra ll - ()() '= o0 tro)Fot O "xori-o\ s n co q o\\o o\ol c.) \ ca Ncl @ .+ \o\o F-N x 'EsU)-At.-U -str>OE E}-E2E 8 g 9" t (co\o F.oo* \oN N c-o\\n ro\o o\ tr-o6)2E E'F =HU= ()'F{i5 d c\.lr- cOo\\ \o o\Nca !c N \o oo b0d U) 0) O ts B'E -r 'Ee un 1 - >,.9!l -Ef,o >tr.-E iS " r€ d --9.H-dLL^F - >= tr O (!trl r-o\\o €to\ o\ c{ cO @ co c{ cr) r\ o C) 'a L -cd6N caE rfit BE -oHf=d E] L oYq(g I!= H rsC0(! Eo 5' a) o z Fr C)ga FI Er F o bo(!a oo .o tt)o0)LE u0tr .,E ? 6) c): !aia.;l6lC!-oo)H ..i Hr- r- 0) oioiE illl toON ,ri Eop o C)(,) o() o. o B s s boq) .\ F't\ .q)bs$_ -isr5- ^'io\S 4. 9:Et H Hi* 'd.i t' Ets N \ 's:St CBEC)E P .rS E E Nb - E llxfftpS IS RS E ET dtr s'-LI \.=bErEsi8 atUsPS EE ISE S'B* 81 8g I i $ ;l srl{S*S EIEEIS $}E sl6slHF.iE flEfl8stE flEfli SES €lE El! $: s z14z1- E B S ,, [S$br !L'S = r:s \!\ o,l .SSP il E sHI E E€ i S E8 !, lirrtP 5 PPE c! OL(! o C) 'a a C) o z E]d hs !O C) € o U) 0) oo(J c)E ?L oa o o E Lo3 F s If the projects are not achieving 1007o geographical coverage and minimum of 65Vo therapeutic coverage rale or if coverage rate is fluctualing, state reasons and plans being made to remedy this. Reasons for not achieving the above-stated figures: o Three projects out of the five CDTI projects in Southern Sudan are in the second year of implementation. o The quantity of drugs procured was based on the projects annual treatment goal (ATO). o There were cases of insecurities in some project locations that affected distributions. o Attrition of CDDs and other CDTI staff due to low or zero remuneration. o Mobilization and sensitization of community members has not yet gone project wide as people are still emerging from years of war. o Flooding affected distribution in some areas especially in Kurrmuk County in Upper Nile. Plans to remedv this: . lncreasing the quantity of mectizan allocated to projects. . Improving and strengthening community participation through mobilization and health education as well as motivation of CDDs. . Increasing capacity building of new staff and CDDs. 2.7.2 I I I I In general, what are the causes of absenteeism and refusals and how is the The absenteeism is traceable to cattle migrants who follow their cattle and had to stay in the cattle camps during the period of distribution. People traveled outside their communities in search of job during the period of distribution. People still feel shy to take the drugs due to poor knowledge of mectizan distribution. Due to side effects of the drugs. 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. o There was no report of any SAEs in the entire project during the period. 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 Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period (Please add more rows * SAEs should be verified by project coordinator Sequelea is defined as those cases that have not recovered fully from the SAE and are lefi with lasting neurological or other debilitating effects. \ x Name of project Number of verified* SAE cases reported Action taken sequelea Number of cases with ofNumber deaths 15 WHO/APOC, December l5,2OO4 sO c.l ,ri o -o (,) oo n oA 'lB \o ai (.) oo(! (.) .g d C) d o 0) 'd H o. (.) a) o0 o C! C) o (.) F oiq (.) xo aHd o o .o o -o 0) F q)E(.) 'd o rbo o s o € B a !l\I B o B t q) .s Sa I asi B a4 B b aa q)s .a \J t\ P Eiq) q)s q) hBq) U 6jqlL G I 6) '= Lo 0) li q) C) L € Lr(! C) >\ LIdl!l EI cdl ol >l -ol obodlr 0) o(,) ! (A 6) oLF cicit ol5l cdlFI Lr clq) trq)LL I q) o I() tr Er O (A , aq) I Iq) Eaflo.rJ ta \ol6) F{laql E$lq)trct.El. otr =9 =o 6) q)Etro !c) 6)!LL r-r ,aY E'Xtrtnq) !b9tr != lrr :\oE Gd 7]c) o UiH t- t-Git >=|.rr* C) o FooF 6\\o e- s $ s6tn s$\o N o.l sNt'- Bar- € Ba$\o s o\\o N\f, f-. s o\ oo co r.i o\ g I t G o 'E o.l =boO GaO, r- *od -oJ o- ooE(JF s N s o\N s\n c{ s\n c.l Ba o\N s\n co s co s n o\ s @ s\oN incn ts.^ b 8E EHE = Q.!z € N o\q$00 co\oq c.l c.l\n r-. r- r- \oF \o @ oi$N \o\o \o" t-- co$ tn(nq \o oo co (-' N f-N ca \o o\N \o TN r- co \o co o\ tnN c.} NNq :c) cd O.=5tr1i i !)-o' FIJ F * \n @ @" €ON !n @ € 6 N @ €\oN @ ( $@ c\ @ ( $$ co @ o] \n \o \o r-. ,ri N oo F- (n N@ $N\o in r-\oq. @N v'I o (! ao b *H - E E.h cd .Y .' >r ..6Ei€'x HrVU. 1 U€V'FALT c) € \n(n $ 8vl ( $ \n I-r@\o \n oo r- \n oo\o @ d TNc! \.) ooN c\ c.)\o" \o F-q ca N cnq \o E.q cO c.l co c"} \nN\o- ca c.)$c\ co TN @ in ITd o 8ils< e- z z z z z s\o(n s\o stF- sIt'- sN c'i@ o\ c.i co >=fr'! * Eoabo cB- (!a Eof, bBa 8 - 3-ri(J z z z z z sr-N Baco N Ee -i s\o +N \o9r-N E.9 .^ b'E 8i"8 a EE#E5 =tr>!z6 z z z z z c\\o r-. rn @$ Nf- r.) (n co m tn o\ ts o.rE 6.2 = tr !r.a < 94',FL.) N z z z z z C-l c.l rn rn\o ta)$@ coN \O- sN \o -o obod o 0) t o(-) alrrod!-af :E s, *'E r- E E.&'€EE H5u--r- E'- 6) (l) o 00 @ NNN coN @ coN o\@ol N o\ oool c-.1 t-*r-\$ oo \n $Nq rn co c- & gl r- o\ o\ oo o\ o\ o\ o\ o\ N c\ N N co 8 c.l x5N \a N \o N r- N so c{ ,.i r 6) .o oo C) H U \J B a- 2.8. Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) sion undertaken the NOTF Please add more rows Project Name Supervisor Date ofObjective supervision Outcome/follow-up needed Dr.Baba,/FasiUAgnes t8t0711 To assess the quality of CDDs and other health personnel trained. To follow up on funds disbursement to the project. More CDDs were trained and there is need to follow up on those communities without CDD on their selection and training. Prompt compilation and timely returns of imprest vouchers was stressed. East Bahr el Ghazal Dr.Baba/Fasil 22t9t07 To ascertain the level of Mectizan distribution in selected communities. The East Bahr el Ghazal CDTI project has distributed Ivermectin in all endemic counties. Communities without CDDs were followed up. East Equatoria Dr. Baba./Fasil 2y07t07 To determine the level of CDTI trainings and mectizan distribution Different type of CDTI trainings conducted as planned. The East Equatoria CDTI project has placed Ivermectin in the endemic counties. West Equatoria Fasil t7t9t07 To find out whether mectizan has been sent to communities and adequacy of CDDs. Ivermectin sent to various counties, payams and communities. Some communities lack CDDs. l8 WHO/APOC, December 15,2OO4 West Bahr El Ghazal Fasil tUt0t07 To find out the extent of mectizan distribution and trained staff availability. Distribution was ongoing in some counties where training had been carried out. All trained CDDs were involved in distribution. 2.8.1. a o a a a What were the main issues identiJied during supervision? Non training and treatment in four counties of West Bahr El Ghazal. Difficult terrain to operate in and poor communications. Some communities were without CDDs Record keeping and poor filing system was noticed at all levels Imprest and return forms were poorly kept and thus making fund reconciliation difficult. 2,8.2. Was a standard supervision checklist used? o Yes. 2.8.3. a a a 2.8.4. a What were the outcomes at each level of CDTI implementation supervised? The concerned individuals were given on the spot training and guide. Improved performance noticed at the supervision centers. There is demand and need for refresher courses at all levels. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? On the spot discussions were done and later on feedback communicated where necessary. 2.9. Community self-monitoring and Stakeholders Meeting self- and Stakeholders add more rows 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. Project Name Total # of LGAs or districts in the entire project area No. and 7o of LGAs or districts that carried out self monitoring (CSM) No. and 7o of LGAs or districts that conducted stakeholders meeting (SHM) 04 5 0 0 0 East Bahr el Ghazal _wqs1-Egelgle_ paqq Eqgqqo_ria_ West Bahr el Ghazal ile 7 6 10 Not tlone Not done Not done Not done Not done 0 TOTAL 32 0 0 t9 WHO/APOC, December 15, 2OO4 Not appropriate 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 ol.d) Not appropriate as all projects are below four years Activities that treatment with ivermectin SECTION 3: Other activities of the SSOTF 3.1 Describe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). No additional activities were undertaken 3.2 What was done to coordinate CDTI Project activities? The SSOTF coordination office operational plans are drawn in consultation with the 5 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 Ministry of Health monthly 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 meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activities. Ministry of Health Monthly Health Coordination Meeting: The Ministry of Health coordinates the quarterly health coordination meeting in Juba in which SSOTF HQ is represented by the National coordinator. UNICEF, WHO, other UN agencies, and both National and International health organizations attend. The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. In this forum the SSOTF/HQ introduces topics of CDTI strategy of implementation, updates CDTI activities and gives an opportunity for stakeholders to address issues. Quarterly operational planning :( RegionaUCounty SSOTF meetings) are normally done jointly 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 CffWs, CDDs and the community leaders. The PCOs, COSs, CHWs, and POS carry out advocacy, to Obiective Specific Activities Proiect tarseted L Promote Integration of CDTI with other health care services 2. Maintain high therapeutic(>65Vo) and geographic (L00Vo) coverage 3. Promote strong community ownership 4. Promote high government commitment 5. Support strong partnership 6. Put in place a strong IEC strategy that encourages continued treatment Other 20 WHO/APOC, December 15, 2004 mobilization and sensitization. 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 participants, outcome, and constraints faced follow-up needed) addressed, date, Only one meeting was convened for the SSOTF. The meeting took place in Juba, capital of Southern Sudan in the premises of MOH - GOSS on 5h October 2007. The aim of the meeting was to include onchocerciasis as one of the neglected tropical diseases in Southern Sudan and to include CDTI in the government work plan in 2008. Providing salary to CDTI staff was also discussed including possibility of directing each community to provide incentiVe to their CDDs. The participants included Director General PHC and medical Services, Director General for Preventive Medicine, Director General for Finance and Administration, the Undersecretary, National SSOTF coordinator and the NGDO coordinator. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. Both the National and the NGDO coordinators attended meetings in the two projects of East Bahr el Ghazal and East Equatoria project offices to provide a technical input on community data collection and management. There was no inter - country meeting. O 3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, financial), - Reports forwarded to APOC managemen4 - Administrative assistance or trouble shooting for projects. The first and the second financial quarterly reports were submitted to APOC managementin200T SSOTF assisted the various projects in preparing and forwarding200T TCC reports to APOC. 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities OV which were )roject Name - SSOTF YEAR (3), ,,007 yIAIN ACTIVITIES 'SSOTF coordination office 'R 'rnal .C 'Stakeholders 'SSOTF coordination office ect area 'SSOTF coordination office ofCDDs of sors of leaders of health staff/ Nov Dec Jan Feb Mar Apr May June Jul Aug sep Oct Nov /,,' ,1,"-. i'r'i'l ''. , i- rr,li- x x x x x x i"-':- ' ,'i '; '{i:: ,; x x x ,'t;?1,;: r'ih{!.'-, . r' in-t '; - r,''i\!H i \.t r.l',;:,{,:;; '' i i :'':., l- (r"j i- ri x x x x x x x x x x ,x :t:ll': - -,- '--f. j $i:,; x x x x x x x x x x x x x x x x x x x x x x x x x x x x x ' ;{;t- ' ,.-r;l , ,iiliJlr.- lt1 F;,t '; "l': t. i- ,^ ". | "li -;:,' .$ ]., ii', -,f r..:, ,: De ' KAP studies in new areas 2t WHO/APOC, December 15, 2004 , ..: irif meettnss 'r4f i ' .,,.,: i * x , - , '| | x x 'Review of IEC materials x x a ' School health educ 'Churches lenius' lensus U (Iectizan uests for SAEs 'Ivermectin Distribution 'Distribution of minor side effect Health .NGO '1 of CDDs and others 'Local Health s 'CSIWSHM in treatment. S AEs/IVlinor side effect x x x x i:r T' x x x x ) x Pa CDD 'SSOTF coordination office 'PCOs/RTF 'Data collecfion 'SSOTF coordination office 'PCOs R 'P,-s CDDs financial',rep"o$nE 'SSOTF coordination office )COs / RTF 'SSOTF coordination office ,CO / RTF 'SSOTF / PCOs S x x x x x x x x x 1." 1 t\,1 t -ri-.rv lr!,tr iB: L:,:, 1 . --- ,1 f-.;li.t: 'S:E ' t'#"f:i 1 ! i:':r' ':;:-:"i,, ,, i i.,r.j-' y-. ,, rlt ,. -., i. ,,r'. .i ,,''f ii-\. , ..f r..- , X x x x x x x x x x x x x x x x x x x x x x x x x x x :,1 :'\ 1-,nt. r ,,,r1, i1, j 14titl.r i€J'i; - +l;!.tl: 11-'.'ij x x x ' . ik' ,t,,:-!, ri lt r; x x x x x .i:.,it:-l trI li,r::r, ,l ,li/ .r{! -:1-,- *f x x x x x x x x x x x x x x x x x x :e3 a'; .i;?,'t ' i;', ",'i'\\{ ', x X x x X x x x x x x x x x '.' , r\ ': ^' - ,.iJ,x,i. lt't' t:-i;' '-'l' r 'f'fsf +"":'-'i:' 'il}'i' x x x x x x x x x x x x as!.r?" t?c '.,'friii.' '.rii'15':*#F* .'.; - ir.;:.fi+'r': r't 'il,:a'. ,' : ,_-- ', . =i-;l i:'-; t-,;, '. j .r. ,-'' ,:: 'i1t'',,1t #="' "r,{qt Sll , C_r,i__ *s,fl.rujr.fri- et!e -,'j lr: ,;i*.6 .;1,{.,.+ioi"t ii':i:.:irr-, , x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x X x x x x x x x x x i i.. ' - ..r:. f,-...,., ,,'l1r'i\r -f:$ 1' '' i,i1; ', x x x x x x x x x x x x x x x x x .t ,',, ' - _l ',-, '\ :'i .' .- i-/-i ' i:\rr' \;.t,lir x x x x x x x x x x x x x x x x x ,r,r'.t",,',1 ,..ir r. l. ' !11,1,', .'i-". ' " I 'l'rr r"," 'i./ - -:\- :"''i, ' x x iY;-"!4i x x .-!j ir i + .i., 'r,4,... niff .- \i:r,r'1 "'f if .,,,,] , ,i. . ; ,11,1:;i,l',j',(+'.G,, ',rq{:'l. . . p ."1, : 'SSOTF/PCOs/RTF 22 WHO/APOC, December 15, 2004 .,;_ r - ,,, ,ir, 1', ,:,il ,".i ,1,1i.; ?- DN. ' TE.E.-].','f:.i'iI {r:l' r , '1:i.l -+r- :.1 ' ".- ';$!t$.,'l i],}*tf,l {,ri, , ''. ;i.'- 'l }'-fi - ,,t, - t',-'; ).,,...' : r.r: ',lr j,!', Pro.iect Name SSOTF HO Years Year Four (2008) MAIN ACTIVITIES Q1 Q2 Q3 Q4 * Planning/Review meetings XSSOTF x *Regional x *County x x *Stakeholders meetings/community x x x x Procurement of materials x OV supplies x x tAdvocacy *Regional x x *County x x *Payams x x TRAINING * Training of CDDs x x * Training of supervisors x x * Training of community leaders x x x Training of health staff/ x x Management / SAEs x x ASSESSMENTS * KAP studies in new areas x xReviewof IEC materials x HEALTH EDUCATION SESSIONS * Community awareness/targets x x x x * School heatlh education/targets x X x x * Churches x x x x Census Census Update x x x Drug Delivery/Supplies Mectizan requests x *Drugs for SAEs x x Setting up of referral systems *Strengthen up referral systems b/w communities, PHCUs, PHCCs and hospitals for SAEs x x IVERMECTIN DISTRIBUTION *Ivermectin Distribution x x *Management of SAEs x x Introduction of CSIW SHMs *SSOTF partners x x *County Health Departments x x * NGO partnership x x * Training of CDDs and others x x * Local Health systems x x *CSIWSHM in community x x Mop up treatment. Mop up treatment. x x Management of SAEs x x *Supervision of CDDs, P. supervisors and County Supervisors) SSOTF x x x x 1 3.7 Insert the Plan of Action for next 23 WHO/APOC, December 15, 2004 x x x X* Payam supervisors *Data collection x x x x * SSOTF x x x x *PCOs x x x x x Payam supervisors x x x x * CDDs x x x x *Reporting/ drug management * SSOTF x x x x *PCOs x x x x * Payam supervisors x x x x * CDDs x x x x Monthly financial reporting expenditure x x x x SSOTF x x x X PCOs / RTF x x x x Preparation of mid term/ annual technical report x x SSOTF x x PCO / RTF x x *Application for Mectizan x *SSOTF/ PCOs x INDEPEI\DENT MONITORING *SSOTF/PCOs/RTF x x *Mid term review + SSOTF / RTF x xEvaluation * SSOTF/ RTF s/RTF x x x x 24 WHO/APOC, December 15, 2OO4 $OoN ,.i Hos C)o(.) n \J o lJr l- ,l B rn ot ci \) o \J >' .s \ U2 !') ! U2 4 CJ U2 .\a 4 o .F Q $ v 4 v1p OO v = bot troooL lro! - L(! 0) 0) 9 L ok o9(.) o 'a L Fr F U d o9 q l-< 0) Ii(!a a>\L tr91i!!HL)EE o€ - vorv) v ;iH5Ev=(! ,Lj5titE €9ahEoEUh Pci ,.EEv)9F PFA=J,EV)A1iOtuoirt-lF- ",1U;IH.:Fl(h s F.l Eq)t) 6l c) q) L E ,}l (n o) L (D o h (J (A Lro o o U) t-.1 .o M € v 'o V id V tr v o caU (A o (-)FQ5io E M V tr E v E M E v Lr C) li o n z o\ Nq 00\o cr} co @ N ooq o\ @ coIN €- ca caq rn o\\o- o\ c-l s+ $ o\\n +Nq co@ rr} -+ q CT, o tt o H (r) z 1J M tr 'd V '1c V E V tr E V () o 'a lr (! o o z cn N(! o C) E (! m O(g E] o d 5 E] U) o B (! L o d E] o r! G) z l-i 0)aa N cd 0) <! cq U) 0)t ILF a U) 6 Er If there are problems with release of counterpart funds, how were they addressed? Comments: o Government of Southern Sudan has no budget for the Ministry of Health and that also affects CDTI projects. State the number of projects that had no funding from APOC Trust Fund? o None. All the five CDTI projects plus the Headquarter project received funding from APOC. State the number of projects that had no funding from any outside source? o None. All have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? o None 4.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities tf any) o Provision of venues/shelters for community leaders meetings and CDDs training. o Some communities do the mobilization and sensitization of their own people. o Communities collect firewood, water and also cook for CDDs during the training. o Some communities store drugs and provide good security awaiting mass treatment. 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. o Re-submission of budget to the Ministry of Health, which includes salaries to the project offices and headquarter and other support of CDTI activities. The outcome was negative as there was no release by the government. 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 13: Indicate how much the NOTF secretariat project spent for each activity listed below during the Activity of NOTF secretarint Expenditure ($ US) and Source(s) of fundine APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc Monitoring and supervision of CDTI Training of Project officers, TOT, NOTF staff, etc. Advocacy visits to health and political authorities at national level _pp__K_AP"s!94!9!,pqle_qal!49y9_l_qprn9!!, Annual review workshops Bi annual NOTf11rgglggs_ Fuel and maintenance of Vehicles, Maintenance of office equipment Stationery 26 WHO/APOC, 24 November 2003 Others TOTAL 0 $141,583 0 Total number of persons treated 1,422,325 - Comments APOC fund for SSOTF activity expenditure is merged with East Bahr El Ghazal project 27 WHO/APOC, December 15, 2004 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if necessary) Cash safe *Condition of the equipment (Functional, Currently non-functional but repairable, Written ffi. How does the project intend to maintain and replace existing equipment and other materials? This will come from government counterpart funds which is hoped would be available in very near future as the system is stabilized. - Describe the adequacy of available knowledgeable manpower at all levels. 1) The SSOTF coordination office: There is deficit in manpower i.e. Deputy National coordinator, Finance officer, Data Manager. 2.) The CDTI project offices: There is general shortage of manpower in the project coordination offices. The project coordinating officers are so weak and unable to produce annual technical report 3.) Project supervision centers: Most of the CDTI project County supervisors (COS) have worked as CDDs in the past and hence promoted to supervisors. However, they don't have a basic education background and therefore, a lot ofcoaching is required. 4) Community level: Though the number of CDDs has increasedin2007, this figure is still low compared to the total population. - 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 what measures were taken to ensure adequate CDTI implementalion where not enough knowledgeable manpower was available or staff ofien transfened 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. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state Functiona l Currently Non Functional but repairable Written off 1. Vehicle 01 0 0 0 0 01 0 0 2. Motor cycle 0 0 0 0l 0 01 0 0 3. Computers 01 0t 0 0 0 02 0 0 4. Printers 02 01 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others 0l 0 0 0 0 01 01 0 01 0 0 0 0 0 0 0 c)Lap top 01 0 0 01 0 02 0 0 28 WHO/APOC, December 15, 2OO4 co oN Eo -o o z$N U o 0r o * B o\ c.i Eo(! o () troI o 0d o <€ C) C) o o oo o C) F ,r; N d 2 o (!F L: o ! oE(! C) o o cd o (! L C) x otrH Cq .F E({ .oE 'i(JH0) u(a! IIitLF e*,u) a)o€FnH; V2 p \ B V2 \)q oJI((,ti oE J o (! C) € C) B! B 0) 0) o +. ro Lq) 00 Lr oaq)L q) a0tr L o q) LL I c, G q) L E 6 AD L L cg I h c! 0) c) o GI to :.;z ro t) = 0) q)!r Lq) o cl o0 q) €)aq)trEO Fi cE Hc! -e)L'b -L3a '=tr+o EE cg f. QO EH E:g oc! 6Er =e)>=rd6 ..4l,r)q) AE ErQri -:(h .o g\. q) q) t: n.s%s. E:-B "IS ESaitrE Q.. FSYq)x€ s0 $:c\.\!r%9i:i -'li s) €1ss6s -.S o EPiq) $rS $$v0000h Qt< 6lci\ !n tri ,.; o uEo.>E?E .=>(!L'()or >. ,o bo =H s bbE EZ .\1 \a)l! \iA > li(€ >2 -= 9)65 U(! tr(! :e@C, -<=olll o )' Lo xbo :l.FE-=L ts.E 3otr>! o- ii tr\f ! co c'= xF=.Y otr:ti'I 5ail:5ik .=ir(!d<=>c)AoA>1 L )rgSbEE>EE'E 9-Ah'6 ts-.E ,F'E O tr -LTA<t' ali : X -.) 6..= E 0) (! z oo 'a tr 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) o There was no plan yet even though 2 projects have reached three years. This is because of the situation in Southern Sudan. What arrangements have been made to sustain CDTI afier APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. 5.2.2. Funds 5.2.3. Transport and equipment (replacement and maintenance) 5.2.4. Human resources 5.2.5. Which projects have submitted sustainability plan? 5.2.6. To what extent have the plans been implemented? 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integralion. 5.3.1. Ivermectin delivery mechanisms The Ivermectin delivery mechanism has not been fully built into the drug delivery of PHC system due to non integration. However, the Ministry of Health of Government of Southern Sudan is planning a major overhaul of PHC drug delivery system and ivermectin will not be left out after CDTI full integration. It is during this time that communities can collect their drugs from the nearest health facility. It is hoped that this will begin in 2008. 5.3.2. Training There was no integrated training yet with other prograrlmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff are not ministry of health staff and the CDTI has not been taken over by the health services. When that happens, they become an integral part of the normal PHC training systems. 5.3.3. Joint supervision and monitoring with other programs There was no joint supervision and monitoring with other programmes. However, UNICEF and WHO and Ministry of Health are trying to bring this through the mass measles campaign. 5.3.4. Release of funds No funds were released to any programmes and this made joint release unpractical O a o 5.3.5. Is CDTI included in the PHC budget? Yes. A budget for salaries and other CDTI activities has been submitted but no release during the period under review. o a 5.3.6. Describe other heahh programmes thal are using the CDTI structure and how this was achieved. Whar have been the achievements? 30 WHO/APOC, December 15, 2004 O No other health prograrnmes in the Ministry of Health are using the CDTI structure. However, it is being considered for the implementation of Integrated Essential Child Health Care (IMCI), and distribution of impregnated nets as well as other neglected tropical diseases control. 5.3.7. Describe other issues considered in the integration of CDTI o The CDTI strategy could be used in management and control of lymphatic filariasis through albendazole drug distribution alongside ivermectin. 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?) o No integration yet but there is plan to pilot integrated Multi Drug Administration in three counties of West Equatoria with the integrated NTD control programme for the control of lymphatic filariasis using albendazole. 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 5.4.2. How were the results applied in the project? o Not applicable 5.4.3 Note the issues that have been identified by the NOTF for future operational research. KAPs in the new CDTI areas o REMO in formally sampled inaccessible areas due to insecurity, natural barriers and landmines. SECTION 6: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process, List the challenges and indicate how they were addressed. Streneths o Easy accessibility of SSOTF office by all projects due to its Strategic location in Rumbek o The joint presence of SSOTF and CBM in the same office has led to effective CDTI coordination. o Support from other NGOs in Southern Sudan towards mectizan distribution Weakness o High attrition rate of project staff at all levels. o Available manpower is not well knowledgeable in CDTI. o Non payment of salary by the government to add to top-ups by APOC . Census update not completed in virtually all CDTI projects. o Number of total villages in the projects not yet known 3l WHO/APOC, December 15, 2OO4 Poor nature of roads with resultant high wear and tear of the vehicle Opportunities o Peace and normalcy is being consolidated and movement is becoming much easier. o The road network in South Sudan is being improved generally and hence links with the neighboring endemic counties and states. Challenses and how thev were addressed. o Low level of available knowledgeable manpower in the project area. The SSOTF directed various projects to improve on training of CDDs and other health staff such as payam supervisors and county supervisors and even health workers. SSOTF also supervised some training to ensure that the right messages were delivered. o High attrition rate of CDDs at community level. This matter was discussed with community members during SSOTF supervision and some of those that resigned have been replaced. o Non integration of the projects and non absorption of CDTI staff into the ministry of health. This was discussed at the meeting for the SSOTF in Juba and there was assurance of their absorption from 2008. o Intensifying health education and community mobilization. This was used to defuse beliefs on the mectizan and thus reduce the number of refusals and the SSOTF to strengthen this activity next year. o Non availability of community data base collection. The SSOTF has planned to intensify on it as situation in various projects normalized. o Ratio of CDD to total population in the entire country is still high. Communities without CDDs are being encouraged to get CDDs and those with less number of CDDs to get more CDDs. o Community census registration is a still a problem in all the projects. SSOTF noted the difficulty but encouraged projects to conduct this activity. Internally Displaced persons who are returning affected the activity as projects had to go back several times. o Transport is another challenging issue in the whole South Sudan. 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. Road infrastructures maintenance is now taking place. Transportation in general in CDTI projects in South Sudan is not adequate 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 equipments currently in use are the long-range VFIF radios and Satellite phones which are quite expensive to run. Mobile phone systems are being installed it is hoped that they will be operational in some of the towns a Indicate how opportunities can be utilized to improve CDTI. With the peace in south Sudan the population figures will be properly defined and more people will be treated. Access to endemic communities will increase and hence more endemic communities will be reached and treated. a a 32 WHO/APOC, December 15, 2OO4 u List the strengths, weaknesses, opportunities and threats of the vector elimination proj ect (where applicable ). This is not applicable since there was no vector elimination component in Southern Sudan. a JJ WHO/APOC, December 15, 2004