EAST EQT]ATORIA (EEQ) CDTI PROJECT whoeeq pro i ect@ gmail. co m ORIGINAL. Enclish COUNTRY/NOTF: Soutl'rern Sudan Arrproval year:.2003 Proiect Name: East Equatoria CDTI Launching year:2006 T I I I Reporting Period: From: January' 2009 ...To: (Month/Year) ( Month/\'ear) AP@; .,\POC Proiect implerncntltion year rcport: (circlc one) I 2 3 (4) -5 (Cl 7 I 9 l0 ll Dirte subnritted: Pa rtners: - lt4inistn'ol'Hc-alth - ,,\liican Prograurnre lbr Onchocerciasrs C]ontrol (,\t)O(') - IVlectizan Donation Progrant (MDP) - Clhristoflel Blindcn Nlission - 560 comurunities :S() ANNUAL PROJECT TECHNICAL REPORT -,*r5s<x.k 'A;sr.d.#ti.,** il SUIIMITTED TO ,r"fior // ! TECHNICAL CONSULTATIVE COMMITTEE (TCC) *1,!#1' $vqwyl I ' fa*r*4 $ i ' I DEADLINE FoR SUBMISSIoN: t '4:-t-*'i ::\r i.:r=.l;d:t1or i To APOC Management by 3l January for March TCC meetingic'-b'i(, ,l ,? f,'bk^i i t" APOC Management by 31 July for September TCC meeting':t r'lrg lq# tTTgTNPR,GRAMMEFoRONCHOCERCTASTS CONTROL (APOC) Ap_oclplr WHO/APOC, I4 Septernber 2009 0 2 Ffy. 20tt ANNUz\L I'lt0.lEC't' l'l,CI IN ICA I CONST il.'l' 't'lict r N lcAL Itti t,o trT t'( ) A tlVlr ClOMNlll ll.[: ('['('C') ['leasc con fir'rn L'orlttt'r Soillhgl-1t Srrclitn Ntrtrortirl ('orrrrlirrelor N:lr.nc: NiloLLnir S i-utrat ttt',.' [)a[c: .] I '' ENDORSEVItrNT )/otr have read this report by signing in a[)propriatc space. OI.FI(ll,-ltS to sign thc rcport: the ., t,r-,**,, i.'4t\/ r" \ ll 'l his t'cPil1-{ luts becu prcparcri ir),\Lllnc : f]tnnrantrcl I:z,anta-F '/.onaL Orrclro Coordirraltr' Nanrc: I.,rllnnnueI IJ.rarna $-< *- Sierrarurc: . 1+> I)utc; i l" .lirnualr 201 N( ilX) IlcpresertLt)lr vc I)utc: 31" .larrtritlr, l0l \\ l l(),\l)()1. l.l 5r'l.rr:rh.r' 1009 [ )c s i r]rtit Iitr rt : S i gnat urc: Signutttlc: . [)ltc BXECU'TIVE SUN,INTARY SECTION I : BACKG RO tJN D INFOITN'IATION........ I I (iENt,R.ql tNlut{Nt{ IIr)N . . . I I 1 Dt'st rtltlrort of tltt 1tr ctf ac't thrttllt ) -) -) -/ (t 11) t.2 P ttrt tta t',s lt i1t P()t,t rt..\ I-loN SECl'lON 2: INIPLIIN II'N I"\1'IoN OF C'DTI 2 | l'tirtt.t.lxl, ot' \('t't\ IIIL.s)) ADr,oc',rCt IVlonlt tz.r Ir( )N. stNSn-r,/-.-\'t'to\ -\NI) IIhALfH I:l)tr(',\1-t()N ()F Al'ItISK CONlNlt-rNllll:S 10 ..........8 I l0 21 21 . 14 2.4 Cotrtrrtr NI'f\ INvot.\/ENIDN I- ll 2.-5. C;\P.\CII'\' ULIILDIN(]...... ...... l-l 2.6. TRe,rr HrrN rs....... .. . . . .. . l(' 2 61 l'r'autntent figures 16 2 6 2 ll/hut ure the c'uusas of-absenlaei.snt) 19 2 6.3 l4/hal ure tlte reuson.s.lbr refir.sals? . .. 19 2 6.-1 Briell.l'dcscriba ail knotvtt ond rcrified,scrious'udvcrse cve nts (SAEs) tltut . l9 2 6 5 Trencl of'trealntertt uchieremenl /ront ('DTI pro.iect inception to the currcnt 1'eur2l 2.7. ORognrNc. sroR.AcE AND DELI\/L:RI oF rvDRN,rEClrN ........22 2.8. CoHrHtrrNrry sELF-NroNrroRrNC ,AND STAKEnoLDERS Mee'rtNc . ..........23 2.9. SupeRr,rsroN..... ..........24 2 9 I Providc a.flou' c'hurt o.f .supcrvisiott hierurchy. 2 9 2. Il'ltal v'era llta marn l.ssac.l' identiJied cltring superri.sion'? 2 9 3 Ll'os cr supcrt'rsion checkli.st used? . 2.9.1 I'l/hul were the outcornes at aach level o/'CDTI intplenrcrLtatton supe rvrsion? 25 2 9.5. ttla,s /bcdback given to lha per,\'ot1 or groups supcrvised?...... . 25 2.9.6. LIott, v'a.s the /bedbuck used 1o rmprove the ctverall perJbrnrunce o.l'tlrc project'? 25 SECTION 3: SUPPORT TO CDTI ..............2s 3.1. EqureureN-r.......... ..........25 3.2. FtNaNcrnL coNTRTBUTIoNS oF THE pARTNERS AND coNIrvluNITIES...........................26 3.3. OruEn FoRN,rs oF coMNluNrry suppoRT............... ................ 30 3.4. ExpeNorr-uRE pER Acrr\/rr\' .............30 SECTION 4: SUSTAINAIIILITY OF CDTI. ................30 4.1. INrenNer.: TNDEpENDENT pARr-rcrpAToRy NroNrroRINcl Evn1unrroN.................... 30 1 I I Has tlrc projcct ever lteett evalualed/ntonitorcd? (7'ickany o.f the follotringwhch are applicablc) Erreur ! Signet non ddfini. 4 1 2 W'hat vere thc 1. I .3. Hnw huve thct rccomtne ndctt ions? been intplemanled? 30 .30 lll WI{O/APOC, l4 September 2009 4.2. SusratNagtLITv oF pRoJECTS: eLAN AND sET TARCETs (ntnNonloRy AT................ 30 Yn 3) ..... . 30 1.2. I Plannirtg at ail rclevuttt lcvt,ls. .. 12 I Funds.... -1.2.3 Transporl (rcplaccment and maintenance) J 2.1 Otlrcr resottt'c(s . 1 2.5 To v,httl cxtenl lns lhe plan baen implantentctl . .. 4 3. 1 lvermectin deliverv nrccltani.sntr .. .. .. 31 1 3.2 Training... . . Erre ur ! Signet non ddfitri. 4.3.3 ./oint supu'visiort ctnd rnonilorins v'i/h othe r Ttrogrems. .... Erreur ! Signet non ddfini. -/.3 1 lleleu.;e c5/-.furuls /itr projcc't ctctivittc.s I 3 5 Ls CD7-l incluclad tn tlte Pil(' btrdgar') JI JI 31 31 JI Erreur ! Signet tton ddfini. Erreur ! Signet nort ddfini. 1 3 6 Dc,st'riba ollrcr ltattltlt protruntnta.s lhut trre tr.sing rlta CDTI .\'tt'uc'tut'e ontl hotr l/ti,s y'ct,s ut'hicyt'tl l['hut ltuya hcctt lltt,ttcltiayatttattl.s'') 3l I 3 : Da.ttribt'olhar,si.s.vrrcr c'on.s'rdt'rcd ttt tlta irttcgt'utton ol'('l)T'l Erreur !Signet nott dd.fitti. J .1. Ot,L.,tt,r-iloN,A,t- IlF.sEAtt('tl I -/ L\trttrtrtut'i:a itt rtot t)tora tltun orta lutlT ol u ltuta llta opct'ttlionol rc.saurt'lt trrtdarlukt'n in lhc ltr.rticc'l rtt'ctr t,itltitt tha ra2xtt'ttttt pcriod . J-t 1 I I l-knr trc,t'c tlta ra.strlt.s ttpltliad irt tlra ltroiac't). jj S BC.f I ON 5: STRE NGTtIS, WEA KNESS IiS, C I IA LLM(; IiS,,\NI) OPPORTUNI-| IES .....35 SECTION 6: UNIQUE FEATUI{ES OF'tIIE PRO.IECT/OTHER MATTERS...........35 3_\ WHO/APOC. l4 September 2009iv Acronyms APOC Afiican Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Comn-runity-Based Organization CDD Comrnunity-Directed Distributor CD-fI Con-rmunity-Directed Treatmetrt u'ith Iverurectitr C'SM Comrnunity Self-N{onitoring I-GA Local Ciovertrtnent Area I\,IOH Nlinistrl' of IJealth NGDO Nou-Goverutnc-tital I)eve[oprttettI Orgatttzatitlti NCi( ) Non-Goverutncntal Organizatiort N()'il' National Otrchoccrctasis Task I'-orcc PIIC' Plinrarv health care Rlrl\ I( ) l{apirl Epridc-nriolouicaI Nlapping o1'( )ttchoccrciasis S,,\l., Scr e re aclvcrsc cvct-tt Sl lN I Stahcholdcrs t.t-tccttus I C'(' 'l-ecIurcal ConsLrltativc ('onrurrttec (.,\PO(' scrcntitlc arlr isorr gt-ott1t) 'fO I l'raine r of trainers tINICITF United Nations Children's Fund UTG Ultimate Treatment Goal WFIO World I-lealth Organization WHO/APOC, l4 Septcrnber 2009 Definitions (i) Total population: the total population living in rneso/hyper-endemic comnrunities rvithin the project area (based on REMO and census taking). Eligible population: calculated as 84Yo of the total population in meso/hyper- endernic communities in the project area. (ii) (iii) Annual Treatment Objectit,e: (ATO): the estirnated nurnber of persons living in rneso/hypet'-endemic areas that a CD'fl project intends to treat r,r,ith ive rrnectin in a giverr vear. (ir ) Llltiurate -l-reatrrent Goal ([J'fG): calculatecl as thc'nraxirnunr nunrtrer oIpeople ttr be treated annuallr in Ineso/h\/per endernic areas u,itl.rrn the project arcil. ultirrtatclt'to bc reached rvhen llte project has rcache'cl firll gcoslalthic covcriigc (ntrrnrallr' thc pro-ject shoLrld be expected to reach thc LITG at the cncl ol'rhc i''r \ e'lu' ol tltc prrr.lce t ) (r ) -l'he rerr-reutic ctl\ eraec: nunrtrcr ot' people treatcd in ir givc-n yciir ()\re r the- tottrl 1-ropLrlation (this slrould be exprcsscd as a pc'rcentagc) (r i1 Ccographical cov'cragc: ttutlber ol cclururunities tlcatcd in a given \'ear ovcl the total nunrbet' ol'uresrr/h1,pcr-endemlc colunrunitic-s as iclcntifled b1 I{LiNlO irr the plojcct area (this slioLrld be expressed as a ltercentagc-). (vii) Integration: deliverirrg additional health interventions (i.e. r,itar-nin A supplenre nts. albettdazolc fbr LIr. screening lor cataract, etc.) through CDTI (using the same svstenrs. training. supervisiott aud personne l) iu order to rnaxiutisc cost- eff-ectivencss and eurpo\\'er comurunities to solve rnore of their health problenrs. This docs t-tot include activities or inLerverrtions carried out bv cornrnunity distribulors outside of CD'l'1. (r,iii) Sustairrabilit_t': CDl-l activities in an area arc sustlinablc rrhen [he_\'continue to lut-tction effbctivel)' lbr the lbreseeable futLrrc. w'ith high treatrnent coverage. integrated irrto the available healthcare service. with strtrns cortrrnunity orvnership. using resources rnobilised b1' the contrnunity and thc governrrrent. (ix) Community sell-rnonitoring (CSM): The process bt rvhich the cornrnunitf is etnponered to ot,ersee and rlonitor the perfonnance ot'CDTI (or an1, communitl,- based health iutervention programnie), with a view to ensuring that the progranlne is being executed in the rval,intended. It encourages tlre cornmunity to take lull responsibility of iverntectin distribution and rnake appropriate modificatiorrs rvhen Itec e s sar\/. WHO/APOC, 14 Septernber 2009VI FOLLOW UP ON TCC RECOMMENDATIONS Using the table belolv, fill in the recommendations of the last TCC on the proiect and describe hou' they have been addressed. TCC scssion 29 Nunfier of Rec o nutrctt tlu I io tt itt lltc Rcoorl TCC RECOMXIENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT T]SE ONLY (r) Pro.iect to intensil_r' aclvocacv to Goverrunent at alI lc'r'c'ls to absorLr C'D1'l staf'l'into ]\lOII/PI{C' I'i:,'fcct r,i' niiiir.r intesration ol' ('L)'l I activities into l)[I(' Adl'ocacv u'ork has beerr done at all levels ,{lI the Countl' Supert,rsors have becn absorbcd into the NIoll/l'HC'. It is thc [)ro-;cct Coordrrtatrug Ollicer that is strll to be absorbed r\dvocac-r on tltis rr ill continue. (il) -fhe FLHF stafft have been seusitizcd n the need to have CDTI as part ol-the PFIC activities and have been trained on CDTT. (rrr) MOI-I and NGDO to assist in rnaintaining equiprnent The Governrnent contributiou has not been a reali['; horvever the NGDO contributed torvards ma intenance of eq uipmer.rt. ( rv) r\POC should arrangc fbr parlic ipatorv independeut rnonitoring and rnid-ternr sustainabilitl' er altntion of the proicct This was done, but reporl is not yet cornrnunicated to the SSO-[F and the CD1'l project. ( r,) Project shotrld conduct CSM and SHM This has been initiated and it is still u,ork in progress. (rr) Project should sensitize communities on need to select and support rnore (lDDs The cornrnunities were sensitized on the need to select rnore CDDs and this happened. However, the communities still have a challenge to supporr their' CDDs. The number of CDDs fbr 2009 was 1, 192 as cornpared to 163 in 2008. (r rr) Project to encourage communities to pafticipate more activelr in CDTI activities. This was done and the conrnrunities iuvolved in selecting CDDS and decided on the tirne and rnethod of nrectizan d istribution WHO/APOC, l4 Septernber 2009 Executive Summary l. Ilackground on treatment and population data 'fhis report presents the CDTI activities implernentcd by the Eastern Equatoria CDTI project fronr January 2009 to December 2009. Tlie project is in its fourth year of APOC funding and with four partners that include the comrnunities, urinistry of health the NGDO partner (CBM) and APOCi WHO The project cover tu,o states, central Equatoria state rvhich has six (6) counties out of rvhich flve counties are endemic and Eastern Equatoria state has eight (8) counties out of which the tr.vo endernic counties that n,ere treated rvith mectizan. A The REMO/RAPLOA exercise was conducted in East Kapocta coLtnt)/ ol Eastern Equatoria state in December 2009. preliminarl, results indicated that this cotrntl'also qualifies tbr treattneltl.. IJo'u'"'ever. the llnal rcport has not been reccired anc'l iuclusiou o['this countl'lor treaturent is strll pending. 1-lre lrro.ject hacl a population ctf 963.727 lbr the vear 2009 in -560 eudernrc conrn"runities. a LTTG of I 809.-il I persons antl urr ,.\'l'O of 616.161 persons. 2. llackground un po;rulation nrovenrcnts. '['lte popLrlation nrorcnrent \\as a conlnrol] occurrcncc rrr thc pro-jcct areu and thrs w.as urarrnlv clLre to thc clisplaccurent olpeople causecl by'the insccurrtr caused ir {lrolrl] o1'unned rebel soldiers 'lherc rvzrs nlso poprtlatron l.llovcn)ent due to pcclple that ucr-c rcturning home lj-onr neighbounng cor-rutrics u'here thci had livc as rclirgecs durinq thc rcars ol ciril strrlb. 3. '[ raining clat:r ln trainings. tlie total nuntb.-r OICDDs thaI u,ere traincd u'as 1.192 both nerr'll,tratncd and retrained; this gave a population o1'1108 people per C'DD rvhicli t-ell short of the recommended 100/CDD. The total nuruber of health rvorkers trained in 2009 rvas 254. In addition. a total ol 230 cornrnunity leaders were also mobilized and trair-red. 4. Challcnges and horv they'll'ere o\/ercomc. o The available national ceusus data is not up to date and the pro.iect does not f'eeI that it is reliablc. The pro-icct tricd to improve its population data throtrgh the CDDs by rnaking use of house l-rold books during the treatment period in the courniuuitics to improve the available data. . Some ol-the stafl-that had been absorption onto thc sovemr-nel1t payroll rvas removed, thinking that APOC rvas pal,ing their salaries. In order to resolve this. rneetings u,ere held rvith the decision/ policy makers in rninistry of health at state and countv levels to consider the re-absorption of this CDTI staff back to payroll. . The low level of education ar-nong the CDl'l personnel at county. Payam, Boma and community levels. The project conducted continuous training and capacity building to make the personnel maintain good report rvriting, record keeping; however rnore rvork needs to be done on this. . Frequent breakdorvn of the pro-f ect vehicle and 6 motorbikes is a major problem. The project vehicle was handed over to the SSOTF chainnan since the repeated repairs were too expensir,e for the project to handle; this greatly affected the implementation of CDTI activities that required use of a vehicle. For the r.notorbikes. spare parts wcre ordered and repair done. WHOiAPOC, I 4 Septernber 2009 SECTION l: Background information 1.1. General information l.l.l Description of the project (briefl1') Geographical location, topography', climate The East Equatoria CDTI project is located betu,een the longitude of 29.5"E -36.0"E degrees and betu,een the latitude of .1.5'N -6.0'N. The project office is located in Yei in Central Equatoria state. l-u,o states rnake up tlic project area and they are East Equatoria and Ceutral Equatoria East Equatoria state is in tl-re south- eastenr region ol Southerr-r Sudan. The project areaborde'rs to the SoLrth u'ith thc Deurocratic Republic of Congo (DRC) and Uganda. u'hicll zrc knorvu Oncho-endemic areas; to the east tvith Ethiopia. to the Norlli rvith East Bahr-c-l- Ghazal,.lons.lr-r 311d Iipper Nilc states ancl to the rrest u'ith u'est Ilquatoria state. -l-lte reqctatl()lt cr)\cr rangcs ll'out savanuah. to uoodlatrd atrcl aIso ratnfbrest.'fhere arc luLuncr()us nrtlLrntair.rs ancl trrst f'lr)rvinc rivers iu the arca.'l'he lancl ltlntr is getrerallr plateaLr u'rtli rainla[[ r'itrring li'onr 600-2(X)ntrn pcr ]'car.'fhe w'ct scrlsolt begins in r\pril aud cotttittttes Lrutil Octobcr ultile tltc clrl seilsolt rutrs ll'tttlt Novenlber ttl N'larclt I'opulirtion: activities, culturcs, languagc Thc project has ltopulatit-rn not stable clue to returr-iees 1rom tl-re neighbouring coutrtries. Pcople lionr thc neighbouring countries like ilganda. Kcnl'a. DRC. Ethiopia Tauzania. Eritrea. and Sclmalia conduct cross border business activitics and thus iucreases populatiort movetneut in the project area: thus fluctuating the population in the CDI'[ courmunities. The current settle ment patlerns have been severely af tected by and are rctniniscent of tl-re prolonged r'var. East Equatoria is home to the Bari speaking groups e.g. Kakwa, Kuku, Ivlundari. Nyaangrvara. Poiulu. as rvell as the Acholi, Madi, l-otuko. Didinga, Bo,va. 1'oposa. Lugbara, Lulubo and I-oko-va. The Bari and Toposa are the ma-ioritv of the ethnic groups. Ma.iority of these people practice subsistence larming. hunting and fishing. Corn munication s1'stems The project is accessible frorn .luba the capital o1'southern Strdan by air. It is also accessible lion-r north-rvestern parts of Uganda via Arua and Mot,o. Accessibility fiom tlie DRC is via Abba. Therc are regular flights frorn Entebbe in Ugandato major torvns of Juba, Yei. Torit, and Magwi. Accessibilitl, 1o,rl Lokichokio by road is via Narus road to Torit, Budi, and Kapoeta counties. Four irnportant roads criss-cross Yei torvu connecting it to Juba, DRC, Rurnbek anci Yanibio. -fhese roads are relatively good compared to those found in most of Southern Sudan since they are passable though rvith difficulty throughout the year. Internct communication system exists in tl-re project location and this permit ernail communication. Mobile phone netrvork exists in the pro.iect area and cotnpanies like Gerntel. I\4TN. Zain provide mobile phone services. Administration structure 'fhe Administrative structure of the East frquatoria project is according to the Government of Southern Sudan structures. l-he State fonns the highest level of administration lbllowed by the CoLurties. Payams zrnd Bomas. States are adurinistered tluough Governors, Counties by County Cornmissioners, and Payams by Pavam ,Adnrinistrators. and Bornas by Boma councils. The project rvas irupleurented in 7 counties rvhich are also the supervision cetttres. WHO/APOC, l4 Septenrber 2009 Health systems and health care delivery The government primary health care system is the main health care service delivery. Though relatively better than in most parts of the country, it has faced persistent challenges like efficient coordination. shortages of qualified manpower, drug stock outs and lack of medical equipments.Thereareatotal of 275 healthfacilitiesrvhichcomposedof 191 PHCUS,TI PHCCS, and l3 Hospitals (5 cour-rt1,hospitals,4 state hospital and 4 private hospitals). Both local and international organizations are paftners in the health care service delivery. Number of health staff in pro.iect area and numtrer of health staff involved in CDTI activities. The entire project area has more tlran 2,451 health personnel. Horvever only 254 (10%) staffs are recorded are have been involved in thc CDTI activities Talrlc 1: Nutnber of hcalth st:rff involvctl in CD'tl (Pleuse udrl ntore rox,s i,f ncccssur.l') LG,\ - C'ourrtv Nunrlle r of health -l'otal Nurnbcr- of health staf irr the entrrc project areA al'f'rrrr olr e<l in ( D'l'l uctrvi(rcr. Number ol health Percerrt:rgc st:rff irrvolr etl rrr CDl'l i B: llr=11,, O, ' t,,,, Juba 215 29 l0 5 Kajokcj i 113 il 6.5 Lainr,'a 352 r8 5.1 Terekeka r87 l5 40. I Yei/Morobo 45-t 38 8.4 Magu'i 291 22 1.6 Torit 4t9 4l 9.8 Total 2..15 I 253 10.4 1.1.2. Partnership Indicate the partners involved in project implcmentation at all levels Four main partners are involved in CDTI implernentation in East Equatoria. The partners are the government health services comprising of GOSS/State ministries of health, countl, health department and payarn prirnary health care centres/units), communities (560 CDTI cornrnunities). CBM (NGDO coordinating CDTI) and WHO/APOC (external donor). Describe overall rvorking relationship among partners, clearll, indicating specific areas of project activities rvhere all partners are involved. The partners tltat are involved in implerrenting East Equatoria CDTI project are APOC. CBM, and MOFI, rvhich includes CIID giving primarl'care health, services in centres and units and the 560 cornrnunities. The others NGOS operating rvith the project area have u,ithdrau,n their support. WHOiAPOC. CBM and health sen,ices jointll' carried out planning and advocacy before the distribution. APOC/SSOTFiCBM provided training of project coordinating officer that is then cascaded to tlie county and payam supen,isors and llnally to thc CDDs. The stafls at the health facilities ensure tliat rnobilization of community menibers takes place. Charns of drug WHOiAPOC, l4 September 2009 B distribution are follou,ed u,ith thc actual drug distribution b1'communities through their CDDs. Statc plans, if an1,, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. This is one of thc- continuous on-going activities that the project does. Advocacy visits to the state and countl,ministrl'o1 health decisior-r makers simple to discuss direct funding of CDTI activities. on intcgration and absorption of CD'fl project stalf lbr proper implemcntation rvill continue to be donc and hopefully'this ri'ill lead to sustair.rability olthis project in both Central and l-.asterr1 states in the near tuture. WHOiAPOC, l4 September 2009 o\OO c'l o -o =O o(n 1 U o o- cI b0 E a) oq) a) c) (,) bo L 0) bo (a) () L .; U CJ a)a ad) (g= o)o -@_o cg dJ 0)! -c- Cr I I Idl -ol I0Ji I '*lOI I0JlUI /t oJl -t .33 -!:Poc,r :>a?' oZ (! -J( l I l I I I I I I I a !(, 0) -.o .: O C. o 'x (_) oI.) 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I J cd -o 'i -9.o 'a v (! cO J () -v,() 0)F o _a a L a o 't bo oF q 0-) c E oU I t- q) 9 q) Ll- I() d ! vq) I I F! oFr cif ) o)VL l# L' 6) F E!oOL5O.o Hqv +,+r ,a -?to.=e)GE O-lrtroE Oc, -E_ 61 6rzgELLT \JL -fa'..1f . cll{l--lV^lE] IIIr/]^NFI
2.2. Advocacy State the number of policy/decision makers mobilized at each rclevant levcl during the currcnt 1,ear Eastern Equatoria CDTI project discussed advocacl, related issues rvith three policy,/ decision nrakers in Eastern Equatorra state Ministry of Flealth, this took place in'lorit.'lhe personnel talked to rvere the Dilector for Neglected/Endernic diseases, Adrninistrator for Health services and the Disease Surveillance Officer. At the county level, four Countl,Commissioners. eight Executive Directors, and seven County Medical Officers w'ere talked to. At the Pa1'am and Bonra levcls 1(r Pavarn z\clministrators. -12 Bonra,\dr-ninistrators 169 Cornnrunit),Leaders u'crc nrct. llcason(s) for undert:rking thc advoc:rcy -[-hc leasor-rs lirr condr-rcting thesc aclr ocacr nre-etiur.ls rr L-rL' tL)' . Gct inlbrnralion out to irll thesc pcoplc alrout tlre c.\tcnt trl'the drscasc iu thcir arcas ol' iurrsdiction. thc u'avs aud utc-aus ti['controiling it and also to get thcir supptrlt in resards to planning Ibr activities and provicling the rcqLrired lirncling olthese actiritics . To rcquest the State Nlinistry of Ilcalth und Countv Nleclical ol'llcers to absorb the' CD I't stal'l'u'ho are absorbc-d in 2008 ibr salarics and laid o1l-rn lf)09 inclLrrling thosc n'[ro are not absorbed lbr salaries Irom the govenrment bcfbrc. . 'l'o make propei integration ol-CDTI project in State N'linistrv ol'Health Svstem. . 'fo advocatc' fbr support fiour l)n1'anr and l]oma r\clnrinistri.rtors ancl tlre u'icler comrnunitv to ofter support to the CDDs. . To make the community understand that CDTI concept and philosophl,. The outcomes Sorne out colnes w'ere realised' . The couut),OV Supervisors for Magrvi, 'l'erekeka and Lainya counties u'ere absorbed orr the governrnent payroll and a regularly receiving their rnonthlv salaries. o There rvas an increased number of traincd CDDS as compared to the previous year and rt mav have contributed to an irlproved theraperrtrc coverage. Describe difficulties/constraints being faced and suggestions on hou, to improve advocacl,. The problems faced included: . The logistics (transport) \vas a major constraint. The pro.icct vehicle had fi-equent break down during the travels across the vast distances across the CDTI project. A complete engine overhaul or purchase of nerv project r,'ehicle r.vill alleviate this problem. o For in Southern Sudan the top down approach is still the dominant way of irnplernentation of a number of programs and this could be taken advantage of in thc advocacy campaigns. While discussions went on. it 'uvas clear to the officials that there was a need for them to be involved, but they also in turn shared with the team the difficulty faced in having a say in how the available government lunding gets apportioncd. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local sl,stems to disseminate information There were a nurnber of FM radio stations at the project's disposal. These included FM Kajokeji in Kajokeji town, Torit FM in Torit town, Spirit FM, Liberty FM and Easter FM in Yei town, and Bakhita FM and Miraya FM in the city of Juba. These local FM radio stations 10 WHO/APOC, 14 Septernber 2009 were used in the project area lor passing messages to the people on CDTI activities. The otlier r.vays of passing messages was thougli village lrealth cotnmittees, local chiefs. headmen and community leaders during meetings and other cornmunity gatherings at e.g. school. churches. women-groups and at fuuerals. IEC rnaterials rvere also used dtrring mobilizatiotr and these included posters rvith pictorial messages, tlipcharts used during trainings and a number ol-OV T-shirts rvere printed to increase project visibility. Mobilization and health education of communities including w'omen and minorities The coutprulity members in the project area \\,ere u'elI niobilized thror"rgl-r comtnuuitl' leadcrs preetings /u,orkshops. In Yei the CDTI statT perlbrmed a radio dratrla that "r'as aired on Sprrit IrN,l and it covered topics like thc inf-ection cvcle of Otrchocerciasis. irtlbrrlratiotl aboltt the btack ti1,. the dangers o1'the clisease and the inrportance of taking ttlectizatt antlr-rirlll'lbr l0-1-i )'ears Ip Juba \\'cst Countr rrhere thc drsease rs aIso qutte contt.ttttti. sclrtlol head t.-achcrs alItlri.-tl CDTI stal'[-to tcach ut-rout O\/ discase as ()nc o{'the rouLinc ltealth eclttcatiott tt)l]lcs to thc- schooI childrcn. Colductilg (rrect tacc to lace discussion n,ith rndri idtral colull'lttllltv lllL'lllhers durrtlg thc Itouse to housc treatulcltt lteriod b1'thc CDDs u'as alstt stt't'rtlglr ettcouragecl . Response of target cotntnunities/ r'illagcs -fhere \\,crc sontc 1-rositir r- respoltses nt'rticecl in thc projcct at'ea: . ]-heconrnrunitiesol'N,lagu'i Count)'inl:astEcluatoriaandKlgoke.ji Courltf inClcntral Eqr.ratoria states becar-ne aware of tire rreed to deuratrd for treattncttt r','[tcn it is not given at sorne point. they requcsted fbr more mectizan tablets because their population increased due to nerv retttrnees entering tlie Project area. . Communitl, 1.u6..r, cliiets, wolnen groups also activell' participated in encouraging these ner,r,returnees to select CDDs fbr tlieir commuuities. . The rise in therapeutic coverage in Juba Wcst Courtt), fl-om 62.8o in 2008 I'o 6l.2ol, may be attributed to tlte fact that there rvere urore comtlrunitl" tnembers and scliool children that w'ere able to give health educatiou to thetr orvn local comtnunitl' nrembe rs. Accomplishmcnts . The communitv involvement/ participation improved itr thc selectiott of treu'and replacement of dropped out CDDs- . The turn up of people for treattnent improved. o A gradual increase in fernale CDDs has been noticed. Suggest rvays to improve mobilization and scnsitization of thc target communities. . Some increase in the funding fbr the pro.lect running costs especially since the coptribution of the goverrunent is not yet forth coming. This is mentioned because there are a pumber of incidences rvhereby trips to far off locations (like Terekeka) were cancelled due to budget constraints. o Strengthening the school health component since health education given to scho<-rl children u,ill in most cases influence their behaviour atrd attitude to this disease and care seeking behar,iour always trickle down to their parents and thus to the wide community. . llave additional funding tbr things like megapltones that are used ir.r conlrnunitl' mobilization ald also for T-shirts artd other visuals like posters and flip charls so that project visibility is improved. 1l WHO/APOC, l4 Septernber 2009 2.4. Communitl,involvemcnt Table 4: Communities participation in the CDTI Comments on: Attendance of female members of thc communitl, at health education meetings The uurnber of fcnrale rnembers rvho attended health education meetir.rgs has improved because of holding rneetings with rvonren groups. More of these wolnen are now involved in rnobilising the conrrnunit,v. This happened mostly in Yei. Terekeka. and Kajokejicounties. The fear that pregnant rnother had about taking the treatment has also gradualll'decreased. ln general, hon' do you rate the participation of female meetings when CDTI issues are being discussed? The participation and attendance could be described tairly' rvith female CDDS keeps on increasing yearly, the number members of the community rvell since the number ol villages increased tion.r I l6 in 2008 to 136 lemale CDDS in 2009. The encouragement of female community members to mobilise for CDTI activities tluough \\'olrlell groups has made thern practice expressing themselves in public meetings without l-ear. Flowever, open discussion is still an area of improvement since it is not occurring among all \vomen universally across the projectl there are still some societal/cultural hiccups to this. lncentives provided bl,communities for the CDDs This is still an area of weakness since communities still have not yet come up with any incentives for the CDDs. Ocasionally CDDs are invited to share the larnily meal during the treatrnent period. Attrition of CDDS is attrition a problem for the project if yes how is it addressed? This is still a problem in the project because some of the CDDs still demand for payment and expect a salaried job. 'l'his has been addressed by trying to ''bias" the communitv to select middle aged rvomen as C'DDs and also by infonning the cornmunity rvhile the CDDs are being selected that this role is purely on voluntary basis and that the persons selected should not later expect to receive any rnonetary gain from it. t2 LCA - Countl Number of communities/villages with communitl members as supervisors Number of CDDs and the communities involvcd Num ber of cc /villages rvith f rmmunities enralc CDDs l'otal no. comnrunities in the entirc project area 8, Number witlr community members as s u perv iso rs Bs Pcrcentage Br: 85/ B{ * 100 \'Iale CDD B Female CDDs B Total Be= Br+Br Number of communities with fenrale CDDs ll ,,, Perccntage Brr= Il rollJ1* 100 Juba 59 25 ,12.4 95 t2 101 t2 20 _) Ka.iokcj i l0+ 19 4lt l2l i) r56 -j) ri 6 La irrr a 3l 69.8 107 6 ill 06 lll -[crckcka l0.l i5 ,ll 9 l19 )2 lll )2 ll l Y'c r, I\ lorobtr II0 6t )).1 381 1.1 Jtl l-l r09 I\lasri i 10 21 I iB 6 r09 l1 [6 t1 -+) I'orrt (rl 29 1l ) l)) IO 132 10 l6 -1 Total s60 232 .l 1..1 1,056 r36 I L92 136 24.J WHO/APOC, l4 September 2009 Othcrs issucs: The general community literacy levels are still quite lorv and also thc arvareness among wolleu is to gct invoh'ed in communitl, level rvork is quite lori,. The few'tha1 have gone against the odds participate quite rvell in CD'fl rvork. l3 WHO/APOC, l4 Septernber 2009 2.5. Capacity building Describc the adequacy' of available knorvledgeable manpower at all levels. The nurnbers of staff are not quite adequate; the other challenge is mainly on the quatity of the available staff. . There are some gaps in the number of knorvledgeable manpower to run the CDTI activities in project area. For example Morobo County has no OV Supervisor. o Eastern Equatoria CDTI co\rcrs 2local adrninistrative areas (Central and East Equatoria states) and this has challenges associated rvith it in regards to stafl nlanagelnent and supervision. . The lJast Equatoria project area is also quite vast and canuot be adecluately slrp.-rvise.cl eff-ectivclv bv one project coordinating olficer; hos,ever ttre SSOTIT is trf ing to n,ork u,ith thc state ntrnislries ol'liealth to address this. . There liave also beett sot't.tc resignations bt,stafilikc- the colrnt\, OV supervisor lbr Lainva Count\,: lhis one rr,as later replacccl and traincd. . Thc C'DDs uho tcfusecl to uork uerc inrnrediatelv replaced by'the neri'C'[)l)s seleclcrl by thc cor-nnrurritr zutd trained bv CDTI staff. \\/here frequent transfers of traincd staff occur', state u,lrat thc projcct is doing or' intcnds to do, to remedt' thc situation. '['ltere \\'el'c l]o staff transli:rs ar)rong the CD-fl statf durins this repolting pc-riocl. l4 WHO/APOC, 14 September 2009 e) L O (J 0) Z dil\, :1 >! r-O s\o cat \o (-- ca $ ooO C' - c- =j- a- a.l(..l \o c\ c-\c o.tr) a.l o\ .o$\o v|r) aj o\ tr- o O o x t-- tr- oo r- : CI -r O O ca ca@ ,.! l< LF 7) .o) OJL !: z -lv 3.- l - I rl r rl C - O O C C c O O C O O c ^\ .\ O C O a L 0) () (,) dL Lq) z ?rr v a.ii FU &v o c\ $ c.l ca (-.l co c- O t-- @(_r @ c.l(-.l $ (a) \o c.) v ra al co ?o \o t.t o\ € \o a{ ar 6' Eo () q) -\ ca t-- Fi) o\ c.la..l tr- (r) @ r-l L !r d o 04 rtj z ?rt w F(J &! stJ.?_ O O r- a\ o E(] qJ t) c\ O O \o O o FU r- J Q -o ' or' o 'a (!J d :zq) -vO L()F o -oo ! o Z- () 50 AJ z oF 3 F oc cl ! _a C! --t J- J U c c- !. T 04 o s € o tr t . 1 o s o so\ o * o t o\ s € c q g o a *\, q q) F U U) q) L c) bo rnl o.r I al dl FI i N C.) a'l a- o, c c'.1 Table 6: T1'pe of training undertaken Ani, other courments - None. 2.6. Treatments 2.6.1. Treatmcnt figures If the projcct is not achieving l00o/o geographical coverage and a rninirnum of 65%r thcrapeutic coverage or coverage rate is fluctuating, state the reasons and the plans being made to rcmedv this. Some of the reasons fbr not achieving [00%o coverage include: . lnadequate cornrnunity mobilisation in some conllnunities. . Lack of a vchicle. . lnaccessibiliry of sorne conln.lr.lnities that rvere displacccl by,rusecurilr,arising fi'onr LRA rebel activity in the area. . Tlte alnoultt of mectizan that u'as received u,as not adequate for certaru counties [ike Magu,i. . Iuaccessibility of sonle comn'runitics in the rainl'season, these include Genteze. Mangala. lvlini and Tornbek in Terekeka count\,. Plans to remedy this are: . Ensuring that adequate cornrnunrty rnobilisation for in,''olvernent in CDTI activities. . E,nsuring tltat relatir'elv accurate tigures are subrnittcd for quantification of rnectizan . Workirrg rvith SSOI-F to ensurc that the bulk of the CDTI activities are conducted in the drier parts of the year rvhcn the roads ar.e more passable. o Request APOC Matragemetrt to consider purchasing a neu,vehicle for tlre project Trainees T)'pe of training CDDs Other Cornmunity mernbers e.g Community' supervisors Health Workers (frontlirre health facilities) MOH staff or Other Political Leaders Others(specify) Progranr rnartaqetnent x x x Ilorv to concluct Health ed ucatiou x x x x X N'lanagernent of'S,,\Es X X C'S N1 .\ SIIN,l [)ata co llcction x x x X Data arral_r'sis x x x x Report rvritinc, X Others (specify) l6 WHO/APOC, 14 September 2009 OON Lo -o Eo o U) : U o o- otr tr- C) L U A) 'a d= ,* =nL ='J- 'a LV ') l1) aa .= <, -- 4) O/r- ta u= .: a) --a d(t - -a =o().= ,Ja ) i-td6 5I E -o '.-t tr ;.,1 Oo') --l o ' 'rJl : 6Jl uu st .-o- (dl F:> 91 6 >-^l-Bf eiF B,?l -l E :l q -l q,Ll tl= =l + xl>i'l -ol.= <l a -ol'i :11 el ,, 3l* gl 3 -"1 6l c.-l v6l =6l Elt :lu el8 vt t_ -t F _.1 _ _l 0)l =l .* ut =Gl El= El: A1 a _ul ol .Y El : ol = =I gI E PI b HI Td .--1 '= -"1 -oEl EI a ,EIE tsiEbJJ ul O ul 3 sl ' -l (Jl o (.)l c oJl = -l -ol _ -ol _ .ol :c4 EIs Els il= -l =l . =l - =lEEl zl; zl; zl< cal I(Jt --l =lC,Ixl ililll dtLl dJl 'il s?bdgtrcl tr: =l oboll brl 9r :isdt6rFI E>Eol >uL ol ouv ul o=3Ilol u ^ )i ^ tr ^:l Es =s Q;(J, 2 r---l c) = c)lq:wotrl S50Hbdo5l idF i z L<'- = e,{<eC*-q3 ! ! -!; o =rZ-?iFai,f"a;=2 z 9'i o2UCOL O O O O O o P'= ,'{; ZQV: O O O O O O O ,*-3", ---!-"^6 c€ d F Fa-)e> =;-ua -==-QL a j= r- ooj oo\c (-I O 0lot =-,it7_ '=, c O O O C O C O C C C o o o o- -t @ aa o.t-- q -a 6 c-) r- c.: --l r- Q aa ca\o e.l r- c n- i=f, ,)J z- cl \o -.1\o cl @ \, -f a.1 --f a :1- -i- \o -f ca (-r oo c- o. tr- \o .a rn ca r-v 7u } DD*: c, r- : O\o -i O @ OO c.l O O c-\o ol c-l ca c.) r-\o\o\o : r.-\c .,.iv\o c-O @ @ (-N c] =JO r-r- co c.l v oo .o @ 6 o.l \ \o co\ \o c.l Ir-(\lr- aa\o o\ a o b{,(d q 0) E E oU ll * = o!J- 6o,^ -i. O 6 + cn C \o\o \(-.l v]co co n <J- @ nt- a zt e-u?o c 6rr 'u -s=dEa' 1---Pza \o c-o oc\o ol $ o\6t ?u doa -nY]:.r -v .i- O aa aaO O \o O|.- \orn -ut,/'-|- '* r= -.r = ,^ - o - d - o> -re - at\a =A - A-'h u $O ca caO O \o Or- \c)(a 6-, .4Jo\ d -o .F v o 'a V (d -l )l() 0) (JF -oo! o E *\ o)*o ; oo ! oF rl 3 t-r a C) J r. a a t.l a o) F r-l -l -oldl FI @o. o c..l o -a tr o o- D a -t O o o- o :E ! 34\l ! ! .= i-\ tC !c \ !: (i\9< -< J\ .tf .\ !i -:a: :- :-! LE! ., ! : qr.:: ;:io s '=-< = > :vy *.< .= 's i!\\\ YQ.=!; \ '=< c! t\ =,-or I S ':bol ' \J q\ tY!:! '/-lp : i 1, dl - : .9". :I U E S: 0)t !! i *.*El 3 : ii'()l o .Y Y\ -d.* i i Sol o e \:ol - : =,:c.lo i \ ,16.SE '!l = s " Iel tr X :r. ,l-*\V ol c s' s\!t^\.\v trl G E I u =l E I 3sZ-lf- - !r <\\U *= MU!E .Q\ '= rr * E3 :! :!!!-!: e.i+ ,\ \rt\ !r ia! ^-.S =:s :ii s_<P. \ i;U:!\\€!:. i t':uS'-J Y ! \J \-/ t\ i'- ='l-,,,rrD o sI\o t- F! o_ \ v! 2.6.2 What arc the causcs of absentceism? . Inadequale coordination betrveen the trcatment teams and tlie cotnttrutritv leading to conflicting schedules on the planned treatment daf in some cornmunilies. . Conrmunity mernbers' mo\/ement out of their homesteads especiallv fbr communities that have cultivation grounds that are distant from their hornesteads and lor the pastoralist comrnunities. . Some community members liave Ieft their comrnunities to live in urban areas and yct their nantes are still appearing in the registers.'fhis ri'ill be solved b1' having the registers updated. 2.(r.-l \\/hat are the re:lsons for rcfusals? -l-here \\,1'rc- generallv t'eu,relirsals anci these u'crc Inainl\' anlortg thttsc ltcople that liutl ncrvlr letLlntcd 1l'onr the netghbrturiug ccit-uttrics. -['ltett-fears rrctc ptainlr asst'rciaLecl r,r'rth possible side el'lccts. Lrut this is cotrtiltualll'bcing aclclressctl by se nsrtisation and hc'aith education of thcsc cotrtlt-tLtnities 2.6.4 llricflr'rlcscribc:rll knorvn antl vcrifietl scrious advcrsc events (SL\lis) that occurred duriug the rcporting period ancl prof itlc (in table tt) thc rcquired in f<l rnr:rtirl rt u hcn ava il:rblc. -fhcrc \\,crc no cuscs ol serious adverse cveuts t'eported l}ont tl're beueliciarics to the CD'f l stal'['dLrrirlg this reported during the period Parasitokrgist trained'l None lras been trained Existence of microscope? None is available Has the projcct reported all SAEs to Mectizan Donation Program (MDP)? Plczrse tick one. Not applicable since SAEs ltave ttot been reported. XNo I ves ln case the projcct did not have an1' cases of serious Adt'erse events (SAB) during this reporting period, please tick in the box. None was reported No SAE case to repoft t9 WHO/APOC, l4 September 2009 o\OoN L o 6 o- o .t () o o :E ON ni U nJ -4, q)(/) * L9 oo () o bo L (, Iq) ;s ^o-'a- .a) Et ,^L:i A.l 0(n u->9q)il o>q) L",oi >0) a9. !-or c)0v Oo qa'Jq)o- deu6 .. "7 cal .- oJl -oldl FI (! N oo o aI) :z CO o CJ 0) o-o o o cl I o =.J O OL e o -o o 6 (g D o cr) C o- o = -a o a -c € E o o. E >1 C6 N o o C aI) o o o oo d = o I o o =o a c c O o o O cdo I o- E a OJ o o 6 ! o o or.) =l- I OJ CN () bo * 1a .--l l I I I l l I ..T l Iit ltlttll l 4. 'Z z Z Z, Z z z z Z z z al o o al O -o E o o- o(A =O oA o -O ! d a) <) g bo L <) fr'v ,) I LA I - tF q) !v tq c)L9LL JJ(.) b!q,E lLaJa OJ oLE ef,le d6) Ioa g v c-ol(rLl t)Q. I I L .9ea gL o- 6lt-O -4g FcA(*;i f ) L a/^)VR -Uo\E9P !-l co,& c(lEl dtrtr| 9resl ;E*I !o)vlq)r {.s ,IA Aa)Loboo. 9L - !:-! LLL a) 'u!- rv99tr\,!(gF (Ha= vtro 9I tsd q,, : 4,) :---e -Lt V)FE \- L - a\l(.'l ,l 9 -tald =l o)!ltFl o. o of) F oX -->-- O (-.l vl \o cl =1-F- -$ co o o (rd-llr 4;'- Irq f, lil q o\ q r-- oo ooiO U d^ i>:_!* - q O \o(-.l c. al n N\, t? (-- =. 1 r-l \at & ca ,: -t (-l \I) 7t c co : .: : -co ;1 r- (-- : -t\9 ! ^t- '-.'D r a ., z. o a); -,-=x=L D -t ,/i \o a"1 1 a..l (-I F- a.lt-- o bo6 .9 .= E E oU li r !l (-.l co t-- _ c.l -1 & IO C..l a 'a co ca tr- @ " = a' - Y=dz -Y2- =ah -t a.t C.l @ C.l <. co 'f "-D du.= --Cul>2u E .1 D9 -I:o OO O-1- dl =.'-q>Io e d = a-= ^ - A '- ^t,- = ! a); =FCx.-u o N\o -j- @$ o. c.l O\o r! N (-- O c..l c..l O(\ O N 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by n,n" E __,_ ,,u*,n E ,,n,,.n,, E NGDO tr Other (plcase spccifi ): ___ Mectizarr@ delivered by - Qtlease tick lhe appropriatc ansv,er) *o-E wHo tr ,,n,auo E +€D(J tr Other (please speci l'r') : I'lcasc dcscribe ho*'Nlcctizan@ is ordcred and horv it gets to the conrntunities . -l-he Pro-lcct Cloordinatinq Ol-ficer provides tlata on the total popLrletion availublc tn thc prrject arerr aud also data on the Llsagc. \\asta{te aucl renratuing strick olnrce l.izuu ar ailabl.- afte r the cr cle ol treatnrerlt to thc SSOTF . -l-hc NCDO Jrartner thcu takes leacl in conrprling this rluta liucl ptcparing the orrle'r lbr submission to N,lDP . N.lDP re-r'ieu's applicutiou. appr'()\,'es zrnd lirluards the application to NIIII{C'K - . 'fhe urcctizan sliippcd to the coLuttn and ts leceived br Si HO . In confbrrnitl'r,r,ith the dala that liad earlier lrcen received tiorn thc'Pro.jcct Coordinating Olliccr. corrcsl-ronding anrounts of nrecLizan is suppliecl liour thc SSOTI-/NGDO to thc proicct. . At project level, each county, supen,isor collects thc mectizau liorn the project olflce and then notifies all P21,3111 Supervisors of the mectizan availabilit), fbr collection. . The Payam Supervisors on collection notiti, ar-rd invite Boma Supervisors to collect supplies tbr their corresponding conrnrunities. . The Boma Supervisors, some of who are CDDS sliare this information nitl-r other C'DDs and the cornnruuities. . The cornurunitl, members then decicle on the tirne fbr the rnectizan distribution to the rest olthe comrnunity menrl-rers. Table 10: Mectizan@ Inventorl' flou' are the remaining ivermectin tablets collected and u'here are they' kept? Whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the health facility staff so that they are stored in 22 WHO/APOC, 14 September 2009 Counfy/LGA Number of Mectizant tablets In stock from orevious vear Requested Received Used Lost Waste d Expire d Relnaini ng Juba I 80,500 I 80,500 t80,461 JJ 0 0 0 Kajoke-ii 241,000 241.000 210,930 70 0 0 0 Lainya 70,500 70.500 10,419 8l 0 0 0 Terekeka 150,000 1s0.000 149.878 t22 0 0 0 Yei/rnorobo 396,s00 396.500 396.395 t05 0 0 0 Magrvi 400,000 400,000 194,64e 103 t, 0 5,248 Torit 500,000 500.000 493,672 378 0 0 15.950 TOTAL 1,938,500 l,gl8,50o 1,916,410 892 0 0 21,t98 preparatiol-l lor the next lreatment cycle. The atnounts of stock of medicines that remaiu are contmunicatecl to the Project Coordinating Oftrcer that in turn cotnurunicates this to the SSOTI' secretariat. List and briefly describc the activities under ivermectin deliverv that are being carried out by'health care personncl in the project area. The activities tliat are carried out by the health care personnel include: . Training lbr both neu, and old CDDs rvithin the comnrunities before the tttc-ctizatl distribution. . IssLring tfte CDDs ii,itlt ptectizan tablets and collecting the renraitring balattce frorlr tfuept fbr ipvcntttrl'and storage at the health cetrtre at the er-rd ol'distribution c1'cle . Conducting couutrtruiLr nrobilizatron and hcalth edttcatiou on OV progratll. . Facilitatrng thc l)roccss o[- se Iection ol'CDDs bt' tltc- ct-ltttnrttttit-t'. o N,lunagcn-rcnt tt1'auv person u,ith aclvcrse siclc ellects reactiotrs ancl keep records. ..\nt, othcr coInlrtelrts Ntll.tc 2.8. Gommunity self-monitoring and Stakeholders Meeting I{as all' training (of traincrs) for comnrunih' self-monitoring bcen done in the projcct arca? A total of 230 conturur-ritv leaders received lraining il.t ct'rttttttuuity self rnonitoring. lf so, Whcn? 2"d Quarter of 2009 Table 1l: Communi[' self-monitoring and Stakcholders Meeting Describe how, the results of the community self- monitoring and stakeholders meetings hal'e affecte<I pro.icct implementation or horv they lvould be utilized during thc next treatment c1'cle. Countl,/ LCA Total # oI comnrurtities/r'illages in the cntire project area No of Communitics that carrted out self monitoring (CSM) No of Cornmunities that conducted stakeholders meeting (SHM) .luba Kajokeji Lainl,a Terekeka Yei/morobo Magwi Torit 59 104 53 r03 110 61 10 08 12 07 l9 t2 08 09 05 09 04 09 06 04 05 TOTAL s60 75 42 L) WHOiAPOC, l4 Septenrber 2009 It is expected that the communities will: . Gradually take full charge of the delivery of the CDTI activities in their community like have new CDDs selected'"vithout necessarily having the Health staff facilitating. . Demand for mectizan rvhen there are delays or if some comnrunities are inadvertently left out during the distribution of mectizan. o At a later stage begin conducting advocacy campaigns for the CDTI program. 2.9. Supervision 2.9.1. Providc a flow' ch:rrl of supcn'ision hicrarch)' 2.9.2. What rvere the main issucs identified during supervision? The main issues fbund during supervision w'ere that: . There was uo evidence that the County Supervisors were using the superl'isiorr checklists since done could produce one that they, had Lrsed in the past. . The ma.iority of tlie CDDs are not filling in the treatrnent registers and summary forms corrcctly. . Some of the population updates rvere not done. . Some areas were discovered to have not got treatlleut during thc 1,s21 and zt nlop up exercise was then done. 2.9.3. Was a supervision checklist used? Yes. Supervision check-list rvas used. SSOl'F Hcatlquartcrs Pro.ject Coordination Officcrs :rt Pro.jcct levcls Countl,Supervisors Pal,am Supen,isors CHWs/CDDs Endemic communities Supervisio Itcporting 24 WHO/APOC, l4 Septernber 2009 l1 2.9.1. What *'erc the outcomes at cach level of CDTI implementation supcrvision? o Count), Supervisors \\rere found to har,'e not been doing supen,ision o[ their counties. Data collection sheets that they ll'ould have shorvn the Payam or Boma Supervisors horv to fill rvere not filled correctlr'. . Some communities had not received rnectizan. . CDDs rvere not filling out the registers correctly. 2.9.5. Was fccdback given to thc pcrson or groups supen'iscd? Yes f'ccdback tits gil'etl 2.9.6. Flot,n,as thc fccdhack usctl to inrprove thc overall pcrfornrance of the Proje ct'l o ()n ttre iob training uas qiven to the stafl-sLrpervrsed ttn hort trl ultdate thc hor:scliold inlbrn'ration. llII the sLrnrr]arv lorrns and tall1' shcets. o Practicirl sessions u'ere gir'.-rr to poorlt' pertortntnu tudivtduaIs attcl tlrclsc pcrlbrnting relativelt' bettcr u'ere also cncouraged trt coaclt thc-ir colIeaqr-res. o [)osttir c pccl' criticisnt rr as aIso ettcttttraged. SECTION 3: Support to CDTI 3.1. Equipment Table l2: Status of cquipmcnt +Condrtion of the equrpment (F-Functional, CNFR=Currently' non-functional but repairable, WO:Written o[l) Horv does the pro.ject intcnd to maintain and rcplace existing cquipment and other materials? If integration o[the CDTI activities into thc government PHC rvas to take place as desired. the state MoFI rvould ideally maintain and replace the existing equipnrent tlirough the counterpart Source T1,pe of equipment APOC N,IOII DISTRICT/ LGA NGDO Others Nit Condrtron No Corrd rtrorr Ntr Corrd rtrort Ntl C ortdttron No Corrdrtron l. Vehicle I F 0 NA 0 NA 0 NA 0 NA 2. Motor c),cle(s) 4 NF 0 NA 0 NA o NA 0 NA 3. Computer(s) I F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) I CNFR 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 CNI. R 0 NA 0 NA 0 NA U NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a) Based radio 2 F 0 NA 0 NA 0 NA 0 NA b) Bicycles t2 F 0 NA 0 NA 10 NA 0 NA c) Metallic cabinet 4 F 0 NA 0 NA 0 NA 0 NA d) Metallic trunk 6 F 0 NA 0 NA 0 NA 0 NA 25 WHO/APOC, l4 September 2009 contribution to the project. Since this is not yet a reality. then additional support may requested lrom the NGDO partner or APOC. 3.2. Financial contributions of the partners and communitaes - Irill taLrles l3a. l3b and l3c lf thcre are problems rr'ith releasc of counterpart funds, horr *'crc thcv adtlresscd'l'['herc arc no funds bcing disbursed fl'onr tlte sovernnreut tirr direct iurplcrnentation of ('D-l'l activities. i\clditional cornnrcnts - Nonc 26 WHO/APOC, l4 September 2009 o\OO -1 o _o =o o- o a f U o c* o :[ t---(-I a! a.l q, (, o E o o l .9 ^o 0) ts(! o- t ul -Fo ! C)f ou- rg F ooo3E3EE otI)-Xo-'r)- N(\ro ooo5q9rBc)iio- NL-t .N oooqOOOY333E F-C\co: OOooo oooOO a5 (o c\ (f) o.t -) (o OOo5q o-io353- @,;t N oq o(o N(t o o oE o '= C IJ)LOJ tre o o thEOq3 -z OOOOoooq OOOO OOoq ;ioo _(o(oaco@ _- (t oo z ooOOOOOOOOOO OOOOO ()o OOOOOO r.- v c!t@- (J.)- cr_ NCO(O ooo9!'xso - 6 (o@ q Lr) ro r) u-, OI 1) o l ll o o Fz UJ Ezd lrJ o o ! o a -L ! o o\E r-l l- c! q) U o6 06 o)oCF ; o =Oo 6)!?a :o(! !0r(!octo -o oloo !d o iolc :o z o () o a Cd (-) ! o a ! o t- o (s E(1, 0,o!3(Il a o o o O d O (d ! :.) o) UJ z J F1! oo :)(D q) o (! .! t, cq, t4 io Gocoo>= h-(II;c c X o -O^Yf sr 6 s p 6 '-UN;)i- :-Sf -o 2 9 . ;\o (J O E OJ a: P; c.i c"i $ d<d .- sis q 9c(Do :GYJ:r o=luooi:OT EbE Etf) o, cco(tr(oF (IJdJ.: 6oo).: c,=E='3SFFES .:E!-ocl(!S .c!(\,fi =q= COorc0;co Po(!=;i.=J< +ESE NCod crcof)i (n EogFC6eori'(!- E0)(!1, tso !ocoQq) 6s 5 EEc -- o)f o I a 'io .! oEs € z!b . P .S: 6 btH e e,:o-. tr :C\ o o 19 >o c!a Ib s v ; U, ott oax-oc .^ 0) :otr\\Ec,-) .=<uo-ij!(/)[!o!: Ju,rod J F oF o z d(9 -o ra F ac.l o (.) r-l a) U .n () C) El oUJIEO -l o-Flo;ol r> oooq qq o><><ooo::oo o)UUOO)(o o.t co ooo-q oxoo:oOUO O, o, OOOO OHC; -OOOo(-, u-, OOOO OHH=C;3;;;3 NN OOOooo ooc; to 6 06 o)oCFt o Oo L6re -O :6(! Eo6v,c5.9 o io ^LXo z o o G .N .: t4 tr o lr, io GOC9s !- c !! .!b E s Yr--'.:=X>D .Qs s.: H IEi E E 5 = ;\o o (D !l (I) a: g* e.i (.r .r d i{ q a; urLloj \ ooo LL cco(tr'(Etr EE its, E, .9 P:E E = SF:!- .=(U(trG rL .=L-r-o 6GF5t o.inq .N6il li =co= COC,,E 'a-c9 =scoo= artl- *SEE ': q c')(o co c.) be b E f o ) a 'to: o .E3 E -cEb c P .s: E bEH P P: s$ s s E>o\(/t c{ a Ib $ s ; v) ot, o a_x.-OCE3EL.-^) u(6=\ .:tuo-i!E U) LU OE: trllof o1OO CI O _o =o o-oa -t O o o- o = @ N E() o 0) a)! a(d 0) L .o ./) !() (/) o -o L o O (o IL ca q) F oooq o;<;<o o6 NOOc\r ooooqoq9 OOOO F. 6l q,) o ri q) (.) o q) F ?ooo?LJ 93;;;3 'ro OOOOOq ooo OOOOOOOOco333d(\3^i oOOOot-OF- :-@co OOOOoooq OOOO o 0, o, .lj oo)F ,, o 6.9 ao ! €U (! !EO-g6 ?o!d) Oty J6OcEo tt, o ai o o_x*OC ," q,!aiE-L-^)s(tr=\ .:(o di:E(/)UJOE:{c!a J.,(o; COC,rc ac,o >b6=;=ls *SEE oi c'j d cocrcri q) Eo:2 bpPdco)(!!,E9 Erf,c(!Go) be b Etc = A) =o ) a 'to: o .Es E E![. P'=tE E H,>o-. tr xEY b E S >o c!a Ib $ v ,; o c o (! .\ t4 0, Ct io(!ocoo !^ c Q ;u:lj'- = = > f,bE E N 3 o):S: -; R €ii:b € c ; to ;\o I o D o .: <ii .- - : i€ q a.tIuo*OT oo Doli :!ccco 06F 0)(])F oo.= s==;B; i- i- G .:--oQ,G!5t-Ndq '^;Ar5-' .clNJi = (4,= O c.l o _o E C) ooa( O o o- oI -o() oo 0)() ! (n (J ! C)li 0) H d -o a o -o ! oo cC (J l1 ",.a q) F o r.l a L 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if an1,) . Training veriues . Meals for the CDDs during the treatment . Collection of mectizan tioni the health facilitv 3.4. Expenditure per activity - [ndrcate in table 13. the atnout-tt expendecl during thc reporting period tbr cach actir irr'Iisted \\'rite the atnolttrt expended in US dollars using thc current t-lnited Nations exchanse latc ttr loca[ currencr'. Indicate erchange rate used lrerc. 2.-1 scig ..\nv conrrncnts rlr expl:rnations? - Nonc SECTION 4: Sustainabilitl, of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/ monitored? (Tick any of the follorving u,hich are applicable) Year I Participatory Independent rnonitoriltg Mid Term SLrslainability Iivaluation 5 year Sustainability' Er,'aluatior-r Internal Ir,lonitoring by NOTF Othcr Evaluation bi, other partners 4.1.2. What lvere the recommendations? Not applicable 4.1.3. Hon, have the1, been implemented? Not applicable 4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reportir-rg period? _No Was a sustainabilitl, plan written?_No When was the sustainability plan subrnitted? No a 30 WHO/APOC, l4 September 2009 ao What arrangements have been made to sustain CDTI after AI'}OC funding ceases in terms o1': 1.2.1. Planning at all relevant levels - No plans ntade vet 1.2.2. Funds - No plans made yet 4.2.3 Transport (replacement and maintcnance) - No plarts tnade -v-et 4.2.4. Other rcsources - No plarts urade 1'et 4.2.5. To u,hat extent has thc plan been inrplcnrentetl -Not let applicable 4.3. lntegration Outlinc thc extcnt of integration ol'CDTI into thc I'HC structurc antl tltc ;llans for contltlctc intcgration: -1.3.1. Ivcrmectin clclivcn' rttecha-nisnts I-he fvermectin deltvcr'\' tuechatristrt used trow' is thal: . WHO delivers the mcctizatr to thc state miuistry' of health . The state ministrt of health is then responsiblc lirr releasirt{r the ntcctizan to tltc County Health Departmeut stores in tl-re Cor"utties . It from the Countl, Health Deparlments that they ri,ill latcr be dispatched to fiontlinc health facilities in the Payams . Most Payams in the project area have health facilities, so there were no instances o1' having the mectizan kept oulside the liealth facility. 4.3.2. Training: In regards to training tliere is u'illingness of other plograms to cooperate. These include EPI (Expanded progranl on Lmrunization) and GW (Guinea Worm Eradication program). TIte final implernentation needs to be finally planned aud executed. 4.3.3. .Ioint supervision and monitoring rvith other programs Tlrere is not yet happeniltg. 4.3.4. Release of funds for project actil'ities There were no lunds released frotn the PHC sYstem. 4.3.5. Is CDTI included in the PHC budgetr Not yet. 4.3.6. Describe other health programmes that are using thc CDTI structure and hou' this was achieved. What hal'e treen the achievements? . Fill tables 14 and l5 and provide describe other prograrnrnes that are using the CDTI structure and horv this was achieved. What have been the achievemcttts'/ . For each intervention listed in table 15. explain what u'ere the roles played [r1'the CDDs (census, rnobilizatron. distribution. data collection. storage. collectiort ttl- drugs, relerral of SAEs. etc . . . )? 31 WHO/APOC, t4 September 2009 Explain rvhat are the combinations of intervcntions co-implemented? There is no clear arrangement for co-implenrentation vet. Hox' rvere the interventions implcmented? (at the same time?) 'l-he rnterventior-rs are trot implemented at the same time. The different programs utilise the sarne persons in the community to irnplernent the programs. 4.3.7. f)escribe others issucs considered in the integration of CDTI. This is not ),et applicable in this project. 32 WHO/APOC, l4 Septernber 2009 o.OO c.l o =D o oa 1 O o o. o f ca a-] t-a a\)$ x :^ >) P .a qJ -F CJ >) 4 I i' \) AJ ca e G q) G) I U r+ q)' 6F; O t o,OO c1 L o -o E O o- o U) J U o o- sC.I ';) o)I cll UI ol trl oJl >I ol trl I I I oq -o:() OoLL U J b! () o! 'I- oz- .za o o o. 9o -o_ c= U^ cll= q .L 'EEq 9{] O-qC b, -2 6a cl q) a () o q) F a a a a a a L a () F .lf a I ,. \) a_ kU: ,! a \J qJ -a \) qJ V1 U) a p x) AD rfJ = 0) I a U bo a) U) 0) l- bo ()oo lr& ta(d o6 -o ''' ?z t, I 4.4. Operational research 1.4.1. Summarize in not more than onc half of a page the operational research undcrtaken in the project area rvithin the reporting period. None has becn done. 1.1.2. Hor+'*'ere the results applied in the project? Not applicable. SECTION 5: Strengths, rveaknesses, challenges, and opportunitics Strcngths: . l)resence of dedicatecl u,orktbrce to implenrcnt the CD'f I actrvities . ['hc SS()'l'lr is sittratcd in the project area and can easilv be acccsscd br road as courpared to the other CI)-l-l plo-iccts. . -fhe pro3ect tlltlce is located in the sanie bLrilding as the Yci countr'healtli clepartnrcnt ancl Yei liosprtal and this c:rses coorclinatiorr rrith govcrnnreut aud hospital stal'I. . Ilavc a uell trained ancl c[licient llnuncc itssistrtnt Weaknesscs . Inadcc[rate availabilitr o1'kr-,orn,leclg"able espcciallt, at courmturitr' Ievel . . Poor svste m of nraintenance of equipurent especiallr- r'ehiclcs and motortrikes. . Slo'nv integratiou ol'CDTI staff and activities into the PHC prograrns. . Weak corlmunity involvernent in CDTI activities especially non provision of incentives to CDDs Challenges . Unreliable census figures; though tliis has been gradually, updated. o Lo,uv literacy levels alnong the CDTI personnel especially at county, payam and communitr, levels. Continuous coaching and mentoring rvill hopefully address this. . Pclor data rnanagement at community le'n,el, this aff-ects the final data produced. . Cornmunit)' CDTI ownership has not fully taken root. Persistent preaching oi'the CD'l-l philosophl' has to continue. Opportunities: . 'fhere is tl-re pre sence of othe r WHO programs that work rvith communitl, level persons and there could be better perfonnance and thus efficiency as regards human resources at the cornmunity level and also in rnonitoriug and supen,ision of community level activities. . The location of the project in relative close proximity rnakes it easier to access the SSOTF office for any support required. SECTION 6: Unique features of the project/other matters Nothing to report in addition to u'hat has already been mentioned above. 35 WHO/APOC, l4 September 2009