Annual West Bahr El Ghazal CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

WEST BAHREL G}JAZAL (WBEG) CDTI PROJECT wh owb egp roi ect@ gmail. com I ":tit ?.,- t t @,y ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSTON: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting ["-liC AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) OzuGINAL :Enslish COUNTRY/NOTF: Republic of South Sudan Proiect Name: West Bahr El Ghazal CDTI Anoroval vear: 2004 r- Launchins yearz 2005 Reportine Period: (Month/Year) ( wtqq!!{Ye4IL APOCfundinsvear: I 2 3 4 5 (6) 7 8 9 10 1l 12 13 APOCProiectimrrlementationyearreport: 1 2 3 4 S (6) Z S 9 t0 t1 12 13 Date submitted: m"g"tt r01, Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Christoffel Blinden Mission - 3,226 communities SHDNJ <r- nds -"- I E)- -"-'Q<0c< C+- < I I I I I I I I I \.' 'r'rjcr{NrcAl- coNSULTAI]VE COMMIT'|EE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Republic of South Sudan +r/ National Coordinator: Dr. Lucia WilliaSisnature: .. .. ,,=8.. u"ut., lY..rnug u*tzdii ' Zonal Oncho Coordinator: NGDO ltepresentative: John Ujwok 'l'his report was prepared by: Paulino Kuol Akok North Ilahr el Ghaz,al State Focal Person: Paulino Kuol Akok 3:T:Br? rffi;,oi, warrap Srare l:ocar person: Gabrier H::,lX,i* Mpu't., adt"r*Ir t/20t2Date:. . DYlau gtst/ i West Bahr el Ghazal State Focal Person: E,dmon X2Sa,aanSebit Signature: ..|fi/o?. Date: .?*lKsustl2ol2 NI nf) Ilpnrespnfqf irro' [nh^ I lirrr^L l Designation: North Bahr el Ghazal State Focal PersonSignature: W Gabriel Mabith Malek Designation: Warrap State Focal Person Designation: West Bahr el O#rstate Focal Person Signature: ;./rrt. Datc: .. f.X, gust/2012 E-L,tt\". 3;*.\o.a w.* s3J...^.- LL o'e..%^t tl .t Table of contents SECTION 2: IMPLEMENTATION OF CDTI 2.1. TrvBlrNp oF ACTrvrrrES ............ 2.2. Apvocncv .......................9 2.3. MogtLtzartoN, sENSrrrzATIoN AND HEALTH EDUCATToN oF AT RrsK coMMunqrrtps l0 2.4. Corrn,txrry rNVoLVEMENT......... ..... 11 2.5. Cnpacrrv BUTLDTNG .......l2 2.6. TRpervpNrs.............. .....l4 2.6.1. Treatmentfigures.......... ........... 14 2.6.2 What are the causes of absenteeism?.......... ..................... 17 2.6.3 What are the reasons for refusals?................ ................... 17 2.6.4 BrieJly describe all lcnown and verffied serious adverse events (SAEs) that....... l7 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year l9 2.7. ORpeRINc, sroRAGE AND DELIVERv oF IVERMECTIN ...........20 2.8. Covuuury sELF-MoNrroRING eNr SrarpHoLDERS MpertNc ............21 2.9. SupeRvrsroN............... ......................22 2.9.1 . Provide a /low chart of supervision hierarchy. ............ 222.9.2. What were the main issues identified during supervision? .............................. 22 2.9.3. Lf/as a supervision checklist used? ............. 23 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 23 2.9.5. Was feedback given to the person or groups supervised?................................ 232.9.6. How was the feedback used to improve the overall performance of the project? 1az) SECTION 3: SUPPORT TO CDTI ..............23 3.1. EqurrueNr .....................23 3.2. FrNaNcral coNTRTBUTToNS oF THE pARTNERS AND coMMLrNrrrES............. ..............24 3.3. OrHEn FoRMS oF coMMUNrry suppoRT............... ................ 28 3.4. ExppNorruRE pER AcTrvrry ............. 28 SECTION 4: SUSTAINABILITY OF CDTI........ .........28 4.1. INrrnNer-; TNDEIENDENT pARTICIpAToRy MoNIToRTNG; Ever-unttoN ............... .....28 4.1.1 Has the project ever been evaluated/monitored? (fick any of the following which are applicable) . ......... 4.1.2. What were the recommendations? . . ... ... 28 4.1.3. How have they been implemented? ............. . . . ..28 4.2. SusrarNRerLITy oF IRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT...... ..........28 Yn 3) .......28 iii Number of health staff in project area and number of health staff involved in CDTI activities As shown in the table below, a total of 934 health staff are in the project areas and out of this number, 249 were involved in CDTI activities, representing a percentage of 26.7% of the available staff. Table 1: Number of health staff involved in CDTI DistricULGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staff involved in CDTI B, Percentage B3:B2/ Br *100 Aweil Centre 63 t6 25.4 Arveil East 90 23 25.6 AweilNorth 43 9 20.9 Aweil South 59 t5 25.4 Aweil West 84 28 JJ.J Gogrial East 66 l3 19.7 Gogrial West 73 26 35.6 Twic 94 34 36.2 ToniNorth 83 9 10.8 Toni South 76 2l 27.6 ToniEast 72 3l 43.1 Raia 75 l3 11.3 Wau/Jur river 56 11 t9.6 Total 934 249 26.7 1.1.2. Partnership Indicate the partners involved in project implementation at all levels The partners that were involved in implementing the CDTI activities in the project area in 201 I were the health care service providers - three state ministries of health, 13 county health departments and the primary health care centers/units in the project area; the 3,226 communities; CBM and APOC/WHO. There are no local NGOs supporting the implementation of CDTI activities at either the state or the county level in the project area. Describe overall working relationship among partners The overall working relationship among partners was good. Planning was done together with all partners, NGDO, SSOTF and the APOC staff. The Project staff at all levels worked in collaboration with the SSOTF to conduct training, advocacy, mobilization and superuision at state, county and community levels. Advocacy meetings were held with the state ministers of health, Director Generals and Directors of Primary Health acare in the project areas specifically to address the issues ofstaffabsorption and support to CDTI. Similar processes took place at the County, Payam and Boma levels. There was joint supervision of mectizan distribution through checking the records of county supervisors and CDDs for correctness of information. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation The meeting of different decision makers in the three states and the various counties continued as an on-going activity in the project area. These officials met included state Ministers of Health, Director-Generals and Public Health Directors. The issues discussed included provision of direct funding for the implementation of CDTI activities, the absorption of CDTI staff into the various ministries of health and integration of CDTI work into the routine primary health care services. The community leaders were also reminded of their roles of mobilising the communities for health education sessions; agreeing with the communities on the times, venues and mode of delivering the mectizan; arranging for the collection of the mectizan from the frontline health facility; and also to encourage the communities to provide motivating enabling environment for the CDDs to perform their duties. o n I '1.2. Population f4[!g!: Communities tnd populatiotr rt risk in the entire project area whether they are treated or nol during the reportitrg period ATG.= cahulaad as the n@inum nunber ofpeople to be treated anmta y in neso/hyper endemic oreas wirhin rhe proiecr area, uanotay ro Oe reacttea w*en *e proiect nas reachedfu.ll geogaphic coyerage (rcma y the Wject sho ld be expected to rcach the UIC at the end ofthe 3,1 yar of the project) LGA - Countv Total population in the entire proiect. area Number of communities/villages in Population of Meso-endemic zone in the project area At Hyper-endemic zone in the project area At Total in meso/hyper- endemic zone A3 = A7* i.2 Meso-endemic zone in the project area A.r Hyper- endemic zone in the project area A; Totalin meso/hyper- endemic zone A6 = A;* A5 Ultimate treatment Goal (urG) Aweil Centre 329,777 t54 0 154 329,777 0 329,777 277,013 Aweil East 404,393 t82 0 182 404,393 0 404,393 339,690 AweilNorth 271,425 0 178 t78 0 277,425 271,425 227,997 Aweil South 195,215 l4r 0 141 195,215 0 195,215 195,215 Aweil West 470,384 0 445 445 0 410,384 410,384 344,723 Gogrial East 256,480 347 0 347 256,480 0 256,480 215,443 Gogrial West 286,003 606 0 606 286,003 0 286,003 240,243 Twic 150,596 t29 0 t29 150,586 0 150,586 126,492 Tonj North 90,408 350 0 350 90,408 0 90,408 75,943 Tonj South 68,973 139 0 r39 68,973 0 68,973 57,937 Tonj East 63,640 202 0 202 63,640 0 63,640 53,458 Raja 297,116 0 247 247 0 297,116 297,116 249,577 Wau/Jur river 141,896 0 106 106 0 141 ,886 141,886 119,184 TOTAL 2,966,296 2,250 976 3,226 1.845.475 1,120,811 2,966,296 2,522.915 ttt r (-r 6 a, Was a census for the project done during the reporting period? No. If No, what is the source of the data in the table above? * Source : General population census figures Other source, speciff: Year :2006 Ifyou are usitrg the term community or vilhge' define what constitutes the coEDunity or village. A village in the South Sudan context is defined as a given geographic area that is under the jurisdiction ofa given local Executive Chief. The boundaries ofevery such community are defined by the chiefsystem oflocal authorities. In this such community, it is common to find that the people speak a common laflguage, have similar culturaysocial traditions like mardage, funemt rituals and usually make communal decisions about the general welfare of their community. The number of communities cited in this rcports are as per ihese society norms. Is there any other information ofinterest about the population in the project area? Ifso, include it here. None l) SECTION 2: Implementation of GDTI 2,'1. Timeline of activities Table 3: Timeline of activities for the areas treated in the current year Comments - None. District/LGA Mobilization of communities Trainins Census/Update Drug distribution Supervision Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Starting month Completion month Aweil Centre August August September September September September September December August December Aweil East August August September September September September September November August December Aweil North August August September September September September September November August December Aweil South August August September September September September September December August December Aweil West June July August August August September August December June December Gogrial East June July August August August October August December June December Gogrial West June July August August August October August December June December Twic June July August August August September August December June December Tonj North August September September September September October September December August December Tonj South June July August August August October August December June December Tonj East August August September September September September September December August December Raja August August September September September September September November August December Wau/Jur river August August September September September September September November August December lll la 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy At the state levels, the CDT1 project staff spoke to five decision makers that included two state ministers of health and ihree Director-Generals for health. At the county level, 8 County Commissioners and 10 out of the 13 County Medical Officers were mobilized before distribution. At the Payam level, 21 Payam administrators were met and talked to about CDTI activity implementation. Reason(s) for undertaking the advocacy The reasons for the undertaking this advocacy was mainly to: o Seek for the involvement and support of the decision makers for CDTI activity implementation. o Advocate of the absorption of CDTI staff into the PHC systems and get them to government paYroll . Seek for support to the CDDs in the distribution of mectizan. The outcomes . All the officials met had a positive outlook towards CDTI work and they pledged to support CDTI work . Improved awareness of the implementation of CDTI activities. Describe difliculties/constraints being faced . The project area is quite vast and some areas would not be visited by the team because it was simply practically impossible' . There is only one project vehicle that had repeated breakdowns and thus causing get difficulty in moving from one point to another' o Some of the officials that we had planned to meet did not honor prior appointments made. o Some parts of the project area could not be reached due to a number of reasons that included poor roads, floods, and insecurity' Suggestions on how to improve advocacy o Decentralize advocacy work and empower the County Supervisors to take lead at county level as opposed to having the project coordinating officer and the state focal person taking lead at project level. . Have the members of the community that are passionate about the program joining the teams so that the message sent out is much stronger and probably it will be better responded to. . The bulk of the CDTI activities should be conducted in the drier times of the year so that climatic hindrances can be avoided. D o 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information The project used FM radio stations like Radio Wau to disseminate health education information. Radio stations have also been opened up in Aweil Qllorth Bahr El Ghazal state) and Kuajok (Warrap state). However, there was limited use of these radio stations to disseminate health education messages on onchocerciasis because of limited resources. Audience communication at community meetings, community announcements and use of community leaders were also used to pass on information. Types of IEC materials used There was limited use of IEC materials because of limited availability. Mobilization and health education of communities including women and minorities Community mobilization and health education were carried out in all l3 counties of the project area. The county supervisors contacted the trained community leaders and they assisted in mobilization and education of community members. Both women and minorities were included in the mobilization and health education. The health education messages were on the importance of taking mectizanand for the recommended duration. Selection of more CDDs by the communities was stressed so that their work load can be reduced and thus have better coverage. Response of target communities/villages r The community members agreed to select more cDDs and also dropped out. replace those that had ' The people that had previously declined taking the medication before agreed to take it this time. Accomplishments ' More CDDs as compared with the previous years, including female CDDs were trained and participated in the distribution. o There was an increase in the number of individuals receiving treatment as compared to the previous year. Suggest ways to improve mobilization and sensitization of the target communities. o Provision of adequate funding for logistics and fueling to covering vast areas. ' Provision and use of megaphones for effective information dissemination at community level. o Production of more posters and flyers in a language that is read by the community to cover all villages and shategic areas. e Involving schools and places of worship for faster information dissemination. 10 2.4. Gommunity involvement Table 4: Communities participation in the CDTI Attendance of female members of the community at health education meetings The attendance of female members at health education meetings is still generally low and still needs to be improved by doing more corlmunity awareness on their need to participate in these meetings. Social and cultural factors are still quite strong and are a major factor in hindering the female participation in CDTI activities. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses Again, the attendance of female members at community meetings is low; but the few that attend participate in the discussion of CDTI issues. Incentives provided by communities for the CDDs No incentives were provided to the CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Attrition is a problem and it is being addressed by teaching the community about the CDTI philosophy and asking the community to select more CDDs so that they have a fewer number ofpersons to treat. l1 ounty - LGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B, Number with community members as supervisors B. Percentage Br= BJ B, *IOO Male CDDs Bz Female CDDs B" Total B"= B"+8" Number of communities with female CDDs 8," Percentage Brr= B',r/Br* 100 AweilCentre 154 28 t8.2 1,038 I t0 I ,149 43 27.9 Aweil East t82 l7 9.3 820 188 i,008 49 26.9 AweilNorth 178 34 19. I 560 140 700 5l 28.7 Aweil South t4l 21 14.9 727 146 873 76 53.9 Aweil West 445 56 t2.6 76t 98 859 65 t4.6 Gogrial East 347 273 78.7 696 t2 708 124 35.7 Gogrial West 606 s35 88.3 982 20 1,002 423 69.8 Twic 129 97 75.2 614 23 637 123 95.3 Tonj North 350 242 69.r 557 10 567 124 35.4 Twic 139 135 97.t 513 22 535 120 86.3 Tonj East 202 100 49.5 507 t9 526 58 28.7 Raja 247 47 19.0 97 48 t4s 34 13.8 Wau/Jur river 106 25 23.6 156 30 186 23 21.7 Total 3.226 1,610 500 8.028 866 8,894 1.313 4lo/o o C Other issues - None 2.5. Gapacity building Describe the adequacy of available knowledgeable manpower at all levels. Generally, the knowledgeable manpower available is not adequate: o At the overall project level, one project coordinating officer cannot supervise the entire project area singlehandedly. The state focal persons in Warrap and North Bahr El Ghazal states are also trying to bridge the supervision gaps in their respective areas. . The available health staffs are generally knowledgeable on CDTI activities. . The newly hired CDDs still have to get experience with the treating and data management. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. There were no staff transfers, so this was not an issue for the project. t2 ) a- Table 5: Training at the different levels of CDTI implementation ar Coun8 - LGA Number of DistrictsllGAs staff trained Number of Health center/post staff trained Number of other trainers of trainees ( TOTs) Number of CDDs trained ATrO C. New Relr Total Cr= Cz+ CrCt Cs ATrO C. New Ca ReIt Cz Total Cs= C"* C, ATrO C" Nev i Re/r C,, i Ctr Total Crr= Cro* C, ATrO C,. New Refr Total Cre= Crr+ CCt, C,t Aweil Centre I I I 2 63 33 30 63 0 0 0 0 1,t28 678 450 : 1.128 Aweil East I I 1 2 90 45 45 90 0 0 0 0 I,008 I,008 0 1.008 AweilNorth I I 1 2 43 16 27 43 0 0 0 0 685 425 260 i 68s Aweil South I I I 2 59 J) 26 59 0 0 0 0 795 375 420 795 Aweil West I I I 2 84 43 4l 84 0 0 0 0 859 784 75 859 GogrialEast I 0 I I 23 22 1 23 4 0 4 4 169 201 468 669 Gogrial West I 0 I 1 30 9 t7 26 8 3 5 8 993 308 : 587 895 Twic 1 0 I I 34 19 15 34 1 2 5 662 260 330 590 Tonj North I I 0 I 1l 11 20 31 6 2 4 6 588 389 173 562 Tonj South I 0 I 1 I 8 l3 21 5 0 5 5 550 374 : 156 s30 Tonj East 1 I 0 1 9 7 2 9 5 1 4 5 526 348 t70 518 Raja I 0 0 0 58 0 0 0 0 0 0 0 1,616 0 t45 t45 Wau/Jur river I 0 0 0 47 0 0 0 0 0 0 0 1,040 0 186 186 TOTAL 13 7 9 t6 559 246 237 483 35 8 27 35 ll,2l9 5,150 3,420 8,570 7o Achievement l23.l"h 7o Achievement 86.40 7o Achievement 100"h 7o Achievement 76.40h * 'Nev', 'Re/r' f detarl not avarlable, prowde the correspondmg total only Make sure that there s no double counilng t3 o Trainees Type of training CDDs Other Community members e.g Community suDervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others (specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analvsis Report writing Others (specifr) Table 6: Type of training undertaken Any other comments - None. 2.6, Treatments 2.6.1. Treatment figures If the project is not achieving l00oh geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project is not yet achieving I00% geographical coverage ard650/o therapeutic coverage and the reason for this was mainly logistics related. The project had no functional vehicle and it was quite difficult to access a number of communities in the wetter months of the year. Plans to remedy this situation include: lobbying for more funding to improve the transport situation, conduct the bulk of the CDTI activities in the drier months of the year and closely monitoring and supervision of the CDTI activities. l4 t, Table 7: Treatment and SAEs by district/LcA in all areas at risk l' a LGA - County Communities/Villages Population Number of persons rvho refused the treatment Numb er of absent ees Number of communities with < 80% therapeutic coverage Numb er of SAEs Number of serious adverse events (SAEs) referred to the heatth post/hospital Totat # of communities/ villages in the meso/hyper- endemic areas Dr Annual Treatment Objective Dr Number of communit ies/village s treated D, Geographical coverage (%) Dr= D3/ Dl*100 Total population of the mesoftryper- endemic areas D. Annual Treatment Objective D6 Number of persons treated Dr Therapeut ic coverage (%) Da: D7l Ds*100 Aweil Centre t54 t54 115 7 4.7 329,777 250.206 246,852 74.9 0 0 0 0 0AweilEast r82 182 t82 100.0 404,393 306,97 5 298,679 73.9 0 0 0 0 0Aweil North 178 178 178 100.0 271,425 205,979 198.977 73.3 0 0 0 0 0Aweil South t4t t4t 120 85. I 195,215 l48,lg2 130.082 66.6 0 0 0 0 0Aweil West 445 445 445 100.0 410,384 311.365 299,t68 72.9 0 0 0 0 0Gogrial East 347 347 273 78.7 256,480 194,720 190,965 74.5 9 191 0 0 0Gogrial West 606 606 535 88.3 286,003 217,193 245,096 85.',l 8 317 535 0 0Twic 129 129 97 7 s.2 150,5 86 1t4,254 96.547 64.1 t7 114 0 0 0 Tonj North 350 350 242 69.1 90,408 7t.449 71,208 78.8 91 125 0 0 0Tonj South r39 139 135 97.1 68,973 5 I,450 47.935 69.5 7 303 0 0 0Tonj East 202 202 100 49.5 63,640 48.020 32.886 51.7 87 214 0 0 0 Raja 247 247 56 22.7 297,116 229.639 21.696 7.3 0 0 0 0 0 Wau/Jur River 106 106 38 3 5.8 141,886 107 ,771 26.635 18.8 0 0 0 0 0 TOTAL 3,226 3,226 2,516 78"/" 2,966,286 2.257.213 1,906,726 64" 2t9 1,324 5J5 0 0 Formulae for computrng theraoeutrc and geographrcal coverage Therapeutic coverage rate = Number ofpeople treated x 100(%) Total populatron lrvrng in meso/hyper-endemrc communitres wrthrn the project area 15 G@g6phicil coveaee 6t = Numb.r of omruniri.vvill@B Led.d x 100 lvd Total nuhbcr of mso/hyFFcrdmc colmudti* a dcnxfi.d bv REMO in lhe prol.ct ea ATO €v.dge raie = Nmb.r of EopL trElr.d r 100(/.) Annual Trcatn@lobjcct e % UTO ach'ded = NumbdofEopleE atedx100 Tot l numbcr ofpcopl. io t tEd.d in d6o/hyp.r<nd.nic m6 wftn ih. ptoFct eca (UTC) ATO= Th. e$ittut4l hb.r ofp.0,pL litt g h Mahwqantk nc a'!ot rhat d CDTI ptukd bt nb to tftdt eith bq"@cnn in a Sied !.M. *pect tlto tu@h.h. aTO ttthe dd olit / !@ oIL\. proiect), 16 at 2.6,2 What are the causes of absenteeism? Absenteeism is reported to be due to: ' The nomadic way of life of the majority of the target population; they are hard to get by since they move from place to place to graze their livestock. ' The agriculturalists miss out on treatment when they go out to the gardens and are not available at home when the mectizan is being distributed. ' Some people may have genuinely moved out of their villages in search ofjobs and the CDDs may have not yet updated their registers. 2.6.3 What are the reasons for refusals? o Some community members were not convinced of the presence of the disease in their communities and saw no reason why they should continue swallowing medicine. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. There were no cases of serious adverse events reported to the CDTI staff during this reported during the period Parasitologist trained? None has been trained Existence of microscope? None is available Has the project reported all SAEs to Mectizan Donation Program (MDPX Please tick one. Not applicable since SAEs have not been reported. XNo In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. None was reported No SAE case to report t7 Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period Not applicable since there were no SAEs reported. SA{* Age Sex Village of origin Date Mectizan was taken Date I't symptom S appeared Symptoms Health stafus before taking Mectizan Date of admission in health facility Date of dismissal fiom health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involveme nt or not 0 NA NA NA NA NA NA NA NA NA NA NA NA NA 18 J. aa 2.6.5. Trend of treatment achievement from CDTI project inception to the current year Table 9: Treatments and coverage bv calendar year for the entire project area Please indicate the UTG for the project areaz 2,491,680 (for 201i) aa YEAR Communities/Villages Population Totat # of communitiesivillag es in the meso/hyper- endemic areas Er Annual Treatment Objective E, Number of communitie s/villages treated E, Geographi cal coverage (%) Er-- E3l Er*100 ATO coverage (%") Es= Erl Er*100 Total population of the meso/hyper- endemic areas E^ Annual Treatment Objective Ez Number of persons treated EE Therapeutic coverage (%) Ec: E*/ E""100 ATO coverage (%) E,u-- EE/ E?*100 UTG Coverage (%) 2006 3,219 3,219 55 1.7 t.7% 1,508,733 271,572 70,460 4.7 25.9 3.1 2007 3,219 3.2t9 120 3.7 3.7% 1,509,733 271.572 13 l,043 8.7 48.3 5.8 2008 2,518 2,519 1.918 76.2 76.2% 2,670,690 786,905 593,862 22.2 7 5.5 22.2 2009 2,522 ) \')) 2.112 83.7 83.7% 2,702,724 1,066,667 1,045,169 38.7 98.0 46.1 2010 3.009 3.009 2,s34 84% 84% 2.966.286 2,193.600 1,104,720 37 50.3 44.3 20tt 3226* 3226* 25t6 78.0 78.0 2.966.286 2,257.213 1,906,726 64.3 84.s 76.s * Number ofvill.g€s increased by cre.tion of new settlemefts by the retum hohe oI South Sudanes€ th.t returned hom€ from Sudsr just bcfore itrdGpendence. 19 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by ,,rnn E ,u"n E on,,.r, tr NGDO tr Other (please specifu;: Mectizan@ delivered by **_--tr- wHo tr uNreep E rteBs tr Other (please speciff): Please describe how Mectizan@ is ordered and how it gets to the communities . The Project Coordinating Officer provides data to the SSOTF secretariat on the total population available in the project area and also data on the usage, wastage and remaining stock of mectizan available after the cycle of treatment. . The SSOTF then compiles all the data from other sites and prepares the order for submission to MDP. o MDP reviews application, approves and forwards the application to MERCK. . The mectizanshipped to South Sudan and it received by the WHO Country Office. o In conformity with the data that had earlier been received from the Project Coordinating Officer, corresponding amounts of mectizan are supplied to the project. . At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for collection. . The Payam Supervisors on collection notiff and invite Boma Supervisors to collect supplies for their corresponding communities. . The Boma Supervisors, some of who are CDDS share this information with other CDDs and the communities. . The community members then decide on the time for the mectizan distribution to the rest of the community members. Table 10: Mectizan@ Inventory State /District ILGA ffiabt"ts In stock from nrevious Year Requested Received Used Lost Wast ed Expir ed Remaining Aweil Centre ss0,066 728.619 728.619 751.446 16,980 0 0 5t0.259 Aweil East 894.973 320.926 320,926 899.97s t3.675 0 0 302.249 Aweil North 447.463 269,937 269,937 597.93r 12,039 0 0 r07.430 Aweil South 30,357 379.577 379.577 39t,416 1.815 0 0 t6.703 AweilWest 219.076 715.019 715,019 879.504 '1,612 0 0 46.979 Gogrial East 0 584.500 584,500 572,896 245 0 0 11.359 Gogrial West 0 651,500 651.500 536,574 310 0 0 114.616 Twic 0 342.000 342,000 289,640 359 0 0 52,001 Tonj North 33,215 181.000 1 81.000 1t2.340 6 0 0 86.654 Tonj South 0 154,000 154.000 143,803 54 0 0 1 0.1 43 Tonj East 0 144,000 144,000 98.658 0 0 0 45,342 20 Raja 585,1 5 I 340,000 200,000 69.427 0 0 0 715.124 War.r/Jur River I l 1.468 410,000 250,000 85.232 0 0 0 276.236 TOTAL 2,871,769 5,221,079 4.921.078 5,428,842 53,095 0 0 2.295.695 How are the remaining ivermectin tablets collected and where are they kept? Whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the health facility staff so that they are stored in preparation for the next treatment cycle. The amounts of stock of medicines that remain are communicated to the Project Coordinating Officer that in tum communicates this to the SSOTF secretariat. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: o Training for both new and old CDDs within the communities before the mectizan distribution. . Issuing the CDDs with mectizan tablets and collecting the remaining balance from them for inventory and storage at the health centre at the end of distribution cycle. . Conducting community mobilization and health education on OV program. o Facilitating the process of selection of CDDs by the community. o Management of any person with adverse side effects reactions and keep records. Any other comments None 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so, When? N/A Table 11: Community self-monitoring and Stakeholders Meeting 00 00" _-00-- -00 Aweil West Gogrial East 347 cogiiui woi Twic 00 00 00 00 0000 00 00 00 Tonj North T*J S*th- 00 00 00606 r29 350 County/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self No of Communities that conducted stakeholders 139 2T 00 00 445 00 Tonj East 202 247 00 00 bo 00 00Raja Wau/Jur River 106 00 TOTAL 3.226 00 00 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. Not applicable this reporting period 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? The main issues found during supervision were that: . Supervision of the community level was not being conducted systematically. o Not all communities had CDDs evenly across the counties. . Record keeping was found not to be to standard yet. SSOTF Headquarters Project Coordination OfficerlFocal Persons County OV Supervisors Payam Supervisors Communities 22 Superv Report CDDs tng 2.9.3. Was a supervision checklist used? Yes, Supervision check-list was used. 2-9.4. What were the outcomes at each level of CDTI implementation supervision? ' On-job training on the areas that were found to be deficient was done and practical exercises were done in order to ensure that practise in filling in the registers correctly. t Communities were urged to select CDDs evenly across their communities so that there would be equitable distribution of coverage by cDDs. 2.9.5. was feedback given to the person or groups supervised? Yes feedback was given 2.9.6. How was the feedback used to improve the overall performance of the project? o Ensuring equitable access to cDTI across the communities. o Improved record keeping and thus better project management. o Retter informed work force generally performs better. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment *Conditionoftheequipment(F:Functional,CNFR:C How does the project intend to maintain and replace existing equipment and other materials? If integration of the CDTI activities into the goveffrment PHC was to take place as desired, the state MoH would ideally maintain and replace the existing equipment through the counterpart contribution to the project. Since this is not yet a reality, thenadditional sup-port may requested from the NGDO partner or ApOC. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condrtron No, Condition No Condition No. Condition 1. Vehicle 1 CNFR 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 10 CNFR 0 NA 0 NA 0 NA 0 NA 3. Computer(s) 1 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) I F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) I F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a) metallic cupboard I F 0 NA 0 NA 0 NA 0 NA b) Bicycles t7 F 0 NA 0 NA 0 NA 0 NA c) Radio base 1 F 0 NA 0 NA 0 NA 0 NA 23 3.2. Financial contributions of the partners and communities - Fill tables 13a, 13b and l3c If there are problems with release of counterpart funds, how were they addressed? There are not yet any direct funds from the govemment for CDTI activity implementation. Additional comments - None 24 oa Table 13a: Financial contributions by all partners for the last three years tr Calendar YEAR being reported 2011 GOVERNMENT contribution OTHER partners' disbursement Budqeted Amounts disbursed at the followinq levels ot disbursed NGDOs LocalNGDOs communt ties Others APOCTrust FundBUDGET LINE National Regional District Total l. Mobilization, advocacy, sensitization et health education 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo o.oo o.oo 0.00 -oloo 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 o.oo 0.00 52+.oo i/ifa.si 1,78i.00 +,506.00 -g,-soo.oo 1.'1. Mobilization 1.2. Sensitization , 1.9, n"Qypeg"qy- 1.4. Health education Sub-total I 0.00 o.o0 o.oo ^ -o.db 0.00 N/A N/A 0.00 0.00 0.00 0.00 0.00 0.00 N/A 0.00 0.00 0.00 N/A N/A 0.00 0.00 0.00 0.00 0.00 0.00 !1,lraiqiltg 2. 1 . T r ainin s t r e,! reinlng. _pf Q D. _D---s_. ........ 0.00 o"'do 0.00 0.00 o.oo 0.00 "o.oo -* d-o? 0.00 0.00 bog 0.q0 0.00 o:oo 0.00 0.00 o.o0 0.00 4,043.66 t o,2r 9.93 'tt,iii.6o N/A N/A 8,986.00 0.00 0.00 ?,2,...!f q.in.yL.gtt-e-J.1?ining-of Heallhworkers 0.00 0.00 0.00 Sub-total.l_l lll. Supervision, monitorinq, Evaluation N/A 8,986.004 0.00 0.00 - 3_.1. $ypervision " 9 ?, Msnilg!:ins _-9-a.Eye!gg!9! Sub-total lll 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 o.0o 0.00 o.oo -"- 0.00 0.00 0.00 o.oo o.0b 0.00 N/A '1,988.00 0.00 0.00 0.00 0.00 0.00 0.00 2,543.33 3,7oO.OO '1,970.00 a,zr 3.se N/A 0.00 0.00 0.00 0.00 0.00 N/A N/A 0.00 0.00 0.00 1,988.00 0.00 0.00 lV. lvermectin distribution and management .-o_f Se-v_e"f"_e_..pCy""-eJ,-ge.q"v""gnf g 4.1. lvermectin distribution " 4,?,.Mqn"?ggp..e_nl of Sgy*g adverse events Sub-total lV 0.00 0.00 0.00 0.00 0.00 0.00 --o:ob 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,946.67 0.00 a,b+e.s7 0.00 0.00 0.00 N/A N/A 8,420.00 0.00 0.00 0.00 0.00 0.00 N/A 8,420.00 0.00 0.00 V. Ad.ditional expenses .... 9, :1. Q"e"[erie.q.. 5-2. Equipment Sub-total V 16,278.60 0.00 16,278.60 0.00 0.00 0.00 o.0o o.0o 0.00 16,279;9 0.00 16,278.60 I6,278.99 0.00 16,278.60 100% 0.00 o.0o 0.00 +o,g2o.oo 14,35b.00 55;27o.OO 0.00 0.00 0.00 N/A 0.00 0.00 0.00 1O0o/. 0.00 0.00 0.00 GRAND TOTAL 16,278.60 0.00 0.00 16,278.60 16,278.60 100% 19,394.00 0.00 0.00 0.00 92,187.60 25 Table l3b: Financial contributions by all partners for the last three years One (1) year previous to Calendar YEAR being reported 2010 GOVERNMENT contributior OTHER partners' disbursement Budqeted Amounts disbursed at the following levels National Regional District Total olto disbursed NGDOs LocalNGDOs Gommuni ties Others APOCTrust Fund BUDGET LINE l. Mobilization, advocacy, sensitization et haalth cducation 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 1.1. Mobilization 1.2. Sensitization .1=.Q, AQvoggqy ... 1.4. Health elg.qglign sub-total I 0.00 o.bo 'o.oo 000 0.00 0.00 o.o0 o.o0 0.00 0.00 0.00 0.00 o.oo N/A N/A 0.00 0.00 0.00 1 ,616.33 3,534.75 2,s4f .sii " vi,qFn;"s 22,552.74 0.00 0.00 0.00 N/A 0.00 0.00 0.00 0.00 0.00 N/A N/A 0.00 0.00 0.00 0.00 0.00 0.00 !!, Training 2.1. Training/reltelnltg" pr CDPS . ._"?,_?. "J-f gin i n S/retra i n i ng of H e a lth wo rke rs su-b-total ll ll l. Su oertrision. mon itori no. Evalu atio n 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 o:oo 0.00 o.ob o.oo 0.00 0.00 0.oo 0.00 0.00 0.00 0.00 sbtia.zs ti,iio.io i,zia.Bs N/A N/A 8,986.00 0.00 0.00 0.00 0.00 0.00 N/A 8,986.004 0.00 0.00 - 3.1. Supervision ...3.2. Monitollg._ . --9.a=-Evelgetren Sub-totallll 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.bo 9oo 0.00 0.00 o.0o *-." o.'oo 0.00 0.00 o.o0 0.00 0.00 N/A 1,988.00 0.00 0.00 0.00 0.00 0.00 0.00 4,346.25 1,054.38 1,054.a8 6,455.di N/A 0.00 0.00 0.00 N/A N/A 0.00 0.00 0.00 1,988.00 0.00 0.00 lV. lvermectin distribution and management af scvcrc advcrso events 0.00 0.00 0.00 0.00 0.00 0.00 - ti.oo 0.00 0.00 o.bo 0.00 0.00 0.00 0.00 0.00 17,048.44 o.0d tt")oia.44 4. 1 . lvermectin distribution _ 4.2. _\4anagemgnl gf _S-.gygre.adverse evqllg . Sub-total lV 0.00 o.do 0.00 N/A N/A 8,420.00 0.00 0.00 0.00 0.00 0.00 N/A 8,420.00 0.00 0.00 V. Additionel expenses .-5.1 . Salaries 5.2. Equipmenl Sub-total V 16,278.60 0.00 16,278.60 0.00 o.oo 0.00 *0.00" *o.oo 0.00 ro,2zp go " 0.00 16.278.60 16,278.60 0.00 16,278.60 100% o.o0 0.00 0.00 st,wq.i1" 9,283.75 64,258.00 0.00 0.00 0.00 N/A 0.00 0.00 0.00 100% 0.00 0.00 0.00 GRAND TOTAL 16,278.60 0.00 0.00 16,278.60 16,278.60 100% 19,394.00 0.00 0.00 0.00 127,543.10 t.. 26 lir Table l3c: Financial contributions by all partners for the last three years Two (2) years previous to Calendar YEAR being reported 2009 GOVERNMENT contribution OTH ER partners' disbursement Budgeted Amounts disbursed at the following levels disbursed NGDOs LocalNGDOs Communi ties Others APOCTrust FundBUDGET LINE National Regional District Total l. Mobilization, advocacy, sensitization et fr"99!!11.,e-{u catlqq. .. ". .. . 1.1. Mobilization 1.2. Se_nsitization .. J.,.9, 49"-v--9cggy . . 1.4. Health edu-cqlion Sub-total I 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 o.ob 0.00 0.00 0.00 0.00 o.o0 0.00 "-" -0.00 5,600.0o r,+ba.ob 0.00 o.0o 0.oo 0.00 0.00 o.oo 0.00 0.00 o.oo N/A N/A 0.00 0.00 0.00 0.00 0.00 0.00 N/A 0.00 0.00 0.00 o'90 0.00 0.00 0.00 0.00 0.00 N/A N/A 402.38 0.00 0.00 1,609.50 6,egz.-s-o402.38 0.00 0.00 !1...Tr1illiltg 2.1. Training/retraining of CD"Ds ...-f ,?.,.T r.ai119 !.[elf iil' iI' g. ql H.e ?!th".W9 il(e F- $11b_-tot7t | . ll l. Su pervi si on, mon ito ri nq, Eval u ati o n 0.00 0.00 0.00 0.00 o.o0 0.00 o.bo b.oo 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 23,006.00 N1A N/A 8,305.64 0.00 0.00 0.00 2,420.00 0.00 0.00 17,424.00 i-r,*r 990.00 N/A 10,725.64 0.00 0.00 3_.'l . Supervision 9,2,. M-o_njlgflng.. 0.00 0.00 0.oo 0.00 0.00 0.00 o.ob 0.00 0.00 'b.oti 0.00 0.00 o.oci 0.00 0.00 N/A 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 10,710.00 +,ooo.oo0.00 0.00 N/A 0.00 0.00 0.00 3.3. Ev_aluation- Sub-total lll o9o 0.00 N/A N/A 0.00 0.00 0.00 7,350.00 ii,osb.oo0.00 0.00 0.00 lV. lvermectin distribution and management g!-. s.ev.e.f S .el.ygf--s-g ey- eI f f _4. L_ryglq9g11 distribution . -1.?,.Maneg_gtr'9nt o,t _S_gygre gdygpe- gygnl_s- . 0.00 0" 00 0.00 o.0o 0.00 0.00 0.00 o.0o 0.00 0.00 0.00 0.00 0.00 0.00 4s,zi;:4.o0 o.oo 0.00 0.00 0.00 N/A N/A 6,846.28 0.00 0.00 0.00 0.00 0.00 Sub-total lV 0.00 N/A 6,846.28 0.00 0.00 45,244.00 V. A d d i ti o n a l__expenses _5.1. S_alaries 5.2. Equipment Sub-total V lz,zoa ss 0.00 12,208.95 0.00 0.00 0.00 12.208.95 12,208.95 0.00 12,208.95 100% 0.oo o.oo 0.00 z+,ooo.oo i,zss.oo 28,355.00 0.00 0.00 0.00 0.00 0.00 0.00 " 0.00 12,208.95 N/A 1,550.00 0.00 0.00 'l.00% '1,550.00 0.00 0.00 GRAND TOTAL 12,208.95 0.00 0.00 12,208.95 12,208.95 100% 19,524.30 0.00 0.00 0.00 144,786.50 27 3.3. Other forms of community support The community provide venues for training (like the compound of one of the community members), they have been involved in mobilization of members to take the mectizan, they assist in collection of the mectizan from the frontline health facility stores and have also occasionally provide meals for the CDDs. 3.4. Expenditure per activity Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. The exchange rate used was 3.2 SPP per US dollar. Any comments or explanations? None SECTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Not applicable 4.1.3. How have they been implemented? Not applicable 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _No Was a sustainability plan written? _No When was the sustainability plan submitted? _ No What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - No plans made yet 4.2.2. Funds - No plans made yet 4.2.3 Transport (replacement and maintenance) - No plans made yet 4.2.4. Other resources - No plans made yet 4.2.5. To what extent has the plan been implemented - Not yet applicable 28 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The Ivermectin delivery mechanism used now is that: o WHO delivers the mectizan to the state ministry of health . The state ministry of health in collaboration with the project coordinating officer is responsible for releasing the mectizanto the County Health Department stores in the Counties o It from the County Health Departments that they will later be dispatched to frontline health facilities in the Payams. o Most Payams in the project area have health facilities, so there were no instances of having the mectizan kept outside the health facility. 4.3.2. Training:\ In regards to training there is willingness of other programs to cooperate. These include EPI (Expanded program on Immunization) and GW (Guinea Worm Eradication program). The final implementation needs to be finally planned and executed. 4.3.3. Joint supervision and monitoring with other programs This has not yet begun happening. 4.3.4. Release of funds for project activities There were no funds released from the PHC system to directly fund the implementation of CDTI activities. 4.3.5. Is CDTI included in the PHC budget? No. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . Fill tables 14 and 15 and provide describe other prograrnmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? Explain what are the combinations of interventions co-implemented? There is no clear arrangement for co-implementation yet. How were the interventions implemented? (at the same time?) The interventions are not implemented at the same time. The different programs utilise the same persons in the community to implement the programs. 4.3.7. Describe others issues considered in the integration of CDTI. This is not yet applicable in this project. 29 Table 14: Co-implementation Not yet happening Type of control Type of intervention Roles played by CDDs (explain in bullet points) Number of districts Number of communities Number of CDDs involved Number of persons targeted Number of persons reached fargeted Reached fargeted Reached Males Fema les Total NIales Females Total Males Females Total a a a a a NB; the interventions listed in the table are justfew examples 30 Table 15: Other programmes using CDI structure There are no programs using the CDTI structure yet. Type of control Type of intervention Involvement of communities in Planning SHM Implementation Monitoring CSM Reporting Provision of resources activities period mode selection of implementer s collection of commodit ies storage of commodit ies distribu tion supervis ion In kind financi al a a a a a a a a a a NB: the interventions listed in the table are justfew examples 31 gtF. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None has been done. 4.4.2. How were the results applied in the project? Not applicable. SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: . Key staffs are incorporated into the government PHC system - PCO and the County Supervisors. r Availability of means of transport for the implementation of project work; vehicle and motorcycles. Weakness: . Inadequate manpower especially at the community level affects the quality of work done at this level. . Scheduling of the mectizandistribution often/always happens during the rainy season and this lowers the coverage due to poor access to the communities. o Repeated delayed receipt of funds leading to rushed implementation in the second half of the year. Challenges: . The predominant pastoralist lifestyle is a major reason for the number of absentees. Consideration may be made in future to follow these communities in their grazing zones for them to receive treatment. . Available census data is generally not reliable. Efforts have been made to update it with community data, but it is still not to an acceptable standard. . Understanding CDTI ownership by communities is still a challenge. Efforts have been made to educate community members on ownership of CDTI. ! ! SEGTION 6r Unique features of the proiect/other matters No unique features/matters to report. t i 32