West Bahr El Ghazal CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

^'?-[ "8lnS - qc-- WEST BAHR EL GHAZAL (WBEG) CDT! PROJECT wh owbeq p roiect@q m a i l. com (- -?' I lr \ ORIGINAL: Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMTTTEE (TCC) DEADL NEFQB. UBMISSION: To APOC Management by 31 Januarv for March TCC meeti To APOC Management by 31 Julv for September (9} AFRICAN PROGRAMME FOR oNcHocERCtAStS CONTROL (APOC) Republic of South Sudan OTF:COUNT Proiect Name: West Bahr El Ghazal CDTI Approval vear: 2004 Launchinq vear: 2005 APOCfundinqvear: 1 2 3 4 5 O (71 8 9 Monthl/ea ar rero im 7 : From: January 2012q PeriodReporti 123456 8910111213 To. December 2012 Monthf/ 10 11 12 '13 Date submitted - African Programme for Onchocerciasis Control (APOC) Mectizan Donation Program (MDP) Christoffel Blinden Mission 3,226 communities Partners: - Ministry of Health h+t-ro1i I CO,?4 I i i I I For Ic: *ss Bq) APOCIDIR REC UL E il$iji z0t3 l1 I WEST BAHR EL GHAZAL2Ol2 TECHNICAL REPORT TO TECHNTCAL CONSULTATTVE CO|UtM|TTEE (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 National Coordinator. Dr. Tong Chor lVlalek Signature: ... Date. ../Augustl2013 Project Coordinator: Dr. Edmon Ramadan Sebit Signature: ... Date: ../AugusU2013 NGDO Representative: John Ujwok Signature: ... Date: ../AugusU2012 This report was prepared by: Dr. Edmon Ramadan sebit Designation : Project Coordinator Signature: ... Date: ..t usU201 3 ll Table of contents ACRONYMS.......... DEFtNtTtONS ........... FOLLOW UP ON TCC RECOMMENDATIONS V VI 1 EXECUTIVE SUMMARY............ ..2 ..3SECTION 1: BACKGROUND INFORMATION 1.1. GrruERRl tNFoRrvlATtoN........ 1.1.1 Description of the project (briefly) 1 .1 .2. Parlnership ... . 1.2. PopuurroN....... SECTION 2: IMPLEMENTATION OF CDT|.... 2.1. TrrurLrNr oF ACTtvtlES..... 2.2. Aovocncy ........92.3. MoetLtzAttoN, sENStlzATtoN AND HEALTH EDUCATIoN oF AT RtsK coMMururrtrs.g2.4. Corrltnrturutry INVoLVEMENT............ ........ ... .. ...11 2.5. CRpncrry BUILDING .........122.6. TRrRrurrurs............... .....................14 2.6.1 . Treatment figures .......14 2.6.2 What are the causes of absenteeism?..... .....17 2.6.3 What are the reasons for refusals?........ ...............17 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that 17 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear......... .........182.7. ORDeRrruc, sroRAGE AND DELtvERy oF tvERMECTtN ......192.8. Cor,ltrlururry sELF-MoNtroRtNG Rr.ro SIRTTHoLDERS Mrertruc... ......202.9. SuprRvrsroN.............. ..............21 2.9.1. Provide a flow chart of supervision hierarchy. ..........212.9.2. What were the main issues identified during superuision? ...................212.9.3. Was a superuision checklist used? ....................212.9.4. What were the outcomes at each level of CDTI implementation supervision? ............ ......212.9.5. Was feedback given to the person or groups supervised?...................21 2.9.6. How was the feedback used to improve the overall performance of the project? 22 SECTION 3: SUPPORT TO cDT!........ ..................22 Eoutplaerur FrrunrucrnL coNTRtBUTIoNS oF THE pARTNERS AND coMMUNIIES OrHen FoRMS oF coMMUNtry suppoRT .,............ ExperuorruRE PER ACTtvtry.... SECTION 4: SUSTAINABILITY OF CDTI.. ............26 4.1. lrureRruRl; TNDEeENDENT pARTrcrpAToRy MoNrroRrNc; EvRluaroN........... ......26 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable)...... .... 4.1.2. What were the recommendations?... ..................264.1.3. How have they been implemented? ............ .. . ..264.2. SusrRtNRatltry oF nRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT............26 3 3 4 6 3.1. 3.2. 3.3. 3.4. .22 .22 .26 .26 lll Yn 3)........ 4.2.1. Planning at all relevant levels.... 4.2.2. Funds 4.2.3 Transport (replacement and maintenance)..... 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented......4.3. lNrgcnnloN............. 4.3.1. lvermectin delivery mechanisms......... 4.3.2. Training 4.3.3. Joint superuision and monitoring with other programs4.3.4. Re/ease of funds for project activities... 4.3.5. ls CDTI included in the pHC budget?.....4.3.6. Describe other health programmes that are using the CDT: structure and how this was achieved. what have been the achievements?...4.3.7. Describe othersissues considered in the integration of CDTI. 4.4. OpennloNAL RESEARCH 4 4.1. summarize in not more than one harf of a page the operational research undertaken in the project area within the reporting period.4.4.2. How were the results applied in the project?. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND .26 .26 .26 .26 .26 26 .26 27 .27 .27 .29 29 29 OPPORTUNITIES sEcrloN 6: UNIQUE FEATURES oF THE pRoJEcr/orHER MATTERS........... 29 29 lv Acronyms APOC ATO ATrO CBO CBM CDD CDTI CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commu nity-Based Organ ization Christoff Blinden Mission Commu nity-Directed Distributor Community-Directed Treatment with lvermectin Commu n ity Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organ ization Non-Governmental Organization National Onchocerciasis Task Force Onchocerca Volvulus Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization TCC TOT UNICEF UTG WHO v Definitions (i) Total populatiotr: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking) Eliqible population: calculated as 84% of the total population in meso/hyper-endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO)' the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG). calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coveraqe. number of people treated in a given year over the total population (this should be expressed as a percentage) (vi) Geoqraphical coveraqe. number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REIVIO in the project area (this should be expressed as a percentage). (vii) lnteqration. delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-monitorinq (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. ii VI FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session _ 35 _ Number of Recommendatio n in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report related (i) Provide further clarification on CSM. Table 6 indicated that CSM was implemented while section 2.8 stated that CSM was not done. CSM was not done ( ii) Clarify whether or not evaluation of the project was carried out in 2011. Evaluation of the project in 2011 was not carried out. Project related (i) Project explained that coverage improved but drug balance remained high. Further investigation on this is recommended. The project acknowledges this inconsistency. On checking this again it was found that there were recording errors. More effort has been put in this report period (2012) to ensure that the records are more accurate. ( ii) Ensure that training targets are realistic. This has been done ( iii) lmprove community participation through CSM and SHM. Although this recommendation has not yet achieved; the Project acknowledges the importance of CSM & SHM and is working towards implementing this recommendation. (iv) Census updating is recommended before the next treatment cycle. The project is more than willing to have this done. The challenge of having it implemented is the lack of logistical and financial support needed to supervise this activity. I Executive Summary This report covers the CDTI activities implemented by West Bahr El Ghazal project in the period from January 2012 to December 2012,the seventh year of APOC funding. The project area had a total population of 2,966,286 an ATO of 2,373,029 during this reporting period. The project covered the three states of West Bahr el Ghazal, Warrap and Northern Bahr el Ghazal altogether consisting of a total of 13 counties and 3,226 communities. 165 health staffs were involved in CDTI activities this reporting period, representin g 16.30/o of the 1 ,013 health staff that were available in the project area. During this reporting period, 1,522 out of 3,226 communities received mass treatment with mectizan covering a total population of 1,022,403 thereby achieving a geographic coverage of 47.2 %, a therapeutic coverage of 34.5%, and ATO coverage of 43.1%. A total of 5,477 CDDs were trained in 2012, of these 1,116 were newly trained while 4,358 attended refresher training. 2012was the last year that the project was implemented over the 3 states. lt is hoped that with its breaking up to three autonomous projects, the management of the CDTI activities will be much better in coming years. The major challenge faced by the project included: . Gross underfunding. The amount of funding received in 2012 was far less than what project required (less than 8o/o of needs). This caused a huge challenge to reach out to have key activities and this was a key contributor for the poor performance in 2012. . The logistical, human resource and access issues were faced in 2012. The project vehicle was erratically functional with frequent breakdowns and could not be used effectively. . The other challenges were project management-related are about record keeping by CDDs and availability of adequate knowledgeable manpower in the project area. 2 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project Geographical location, topography, climate The West Bahr El Ghazal CDTI project is located between latitudes 6.5'N and 10.5"N and longitudes of 24"E and 29.5"E. ln 2011 , the project covered three local government authorities (states) and 13 counties. The states are West Bahr El Ghazal, Northern Bahr El Ghazal and Warrap. The topography of the project is mountainous and rocky in West Bahr El Ghazal state, and flat and muddy soilzone in both Warrap and Northern Bahr El Ghazal. The climate of the project is cold during the rainy season that runs between May and September; and it is hot during the dry season that runs from October to April with temperatures going above 40'C. Population: activities, cultures, language ln 2012, the population of the CDTI project area was 2,966,286. The main activity of the people in this project area is predominantly nomadic cattle rearing, with the minority engaged in subsistence farming and hunting. ln the West Bahr El Ghazal state, the languages spoken are Arabic and about 30 other local languages. ln the other two states, Northern Bahr El Ghazal and Warrap, it is mainly Dinka and Arabic that is spoken. Communication systems (roads...) Road networks exist within the project area and they interconnect the different counties. Some of the roads have been resurfaced; though there are others that are very difficult to use in the rainy season particularly in Northern Bahr el Ghazal and Warrap states. The project area can also be accessed through air by planes and helicopters from Juba, and Rumbek. TheWau airstrip is one of the busiestairstrips in South Sudan and a connecting hub to all other points in the project area. The project area is covered by the available mobile telephone networks; making communication with the national coordinating office relatively easy. Administration structure The Administrative structure follows that set by the government of the Republic of South Sudan; that is tiered through the state, county, payam, boma and village that are administered by a Governor, County Commissioners; Payam Administrators; Boma Local Councils and localVillage Chiefs respectively. Health system & health care delivery ln each of the three states that comprise the project area, the specific state ministry of health is responsible for formulating and directing the implementation of all the health policies; however, there varying degrees to which this function is actually realized. There are two state hospitals situated in Northern and Western Bahr El Ghazal states; and a teaching hospital in West Bahr El Ghazal state. ln addition there are 52primary health care centers and 191 Primary Health Care Units totaling to a 243 front line health facilities. 3 Number of health staff in project area and number of health staff involved in CDTI activities 1,0'13 health workers existed in the project area in 2012; of these 165 (16.3%) were involved in CDTI activities. Details are as shown in the table below. Table 1: Number of health staff involved in CDTI DistricULGA Number of health staff involved in CDTI activities. TotalNumber of health staff in the entire project area Bl Number of health staff involved in CDTI B2 Percentage Bs=Bzl 81 t100 Aweil Centre 67 15 22.4% Aweil East 95 22 23.2% Aweil North 50 10 20.0% Aweil South 63 13 20.6% AweilWest 98 17 17.3% Gogrial East 72 11 15.3% GoqrialWest 81 12 14.8% Twic 93 15 16.1% Toni North 88 I 10.2% Toni South 81 13 16.0% Toni East 76 11 14.5% Raia 80 I 11.3% Wau/Jur river 69 8 11 6% Total 1,013 165 16.3% 1.1.2. Partnership lndicate the partners involved in project implementation at all levels All levels of the health care system (state ministries of health, county health departments & primary health care centers/units), beneficiary communities, cbm and APOCA//HO were the partners involved in project implementation in 2012. Describe overall working relationship among partners The overallworking relationship was cooperative and satisfactory; challenges faced were understandable to all partners involved and there were no conflicts or accusing fingers pointed about the challenges and limitations. State plans, if any, to mobilize the state/region/districUlGA decision- makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation These meetings have become an annual ritualthat have not yielded much government financial support, but are still conducted faithfully with the hope that 4 the government financial situation will change in the near future. The key officials met were the state Ministers of Health, Director-Generals for Health, Directors of Preventive Health and the County Health Directors. 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy Three state ministers of health, three Director-Generals for Health Services, three Directors for Preventive Health and 13 County Health Directors. Reason(s) for undertaking the advocacy The reasons included seeking for the involvement and support of the decision makers for CDTI activity implementation, and to advocate of the absorption of CDTI activities and staff into the state and county PHC systems. The outcomes The officials met were reminded of the need to have CDTI fully integrated into PHC and thus better support and performance in future. Desc ri be d iffic u lties/co nstra i nts bein g faced The only available project vehicle was grounded for most of the implementation period and there was no funding to have it fixed. This caused great difficulty to move with the project area that is quite vast. ln addition some project areas could not be accessed due poor roads, floods, and insecurity. Suggestions on how to improve advocacy Provision of means of transport for each of the states so that there is movement from one point to another, continued decentralization of advocacy work and empowerment of the County Supervisors to take lead at county level, continued identification of community members that are passionate about CDTI to be part of the advocacy teams, and trying to target conducting the bulk of the CDTI activities in the dry season. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information FM radio stations exist in the project area, however since these are owned by private business persons, they were not able to air health education messages for free; and so were not used. Dissemination of information was mainly done at community gatherings/meetings, and through the communication channels of the community leaders. Types of IEC materials used There limited use of IEC materials because of no production due to lack of funds. The few that were used were those that were produced more that four years ago. Mobilization and health education of communities including women and minorities Community mobilization and health education with emphasis placed on women and minorities. The messages were on the importance of taking mectizan and selection of more CDDs by the communities. However, not all communities could be reached as desired. 9 Response of target communities/villages Of the communities met, members generally appeared to understand the need to select more CDDs that are willing to volunteer as opposed to demand for payment Accomplishments Having a better-informed community on CDTI that will be able to sustainably select more CDDs and thereby contribute to having an increased number of individuals that will receive treatment in future. Suggest ways to improve mobilization and sensitization of the target communities. The challenges faced are mainly due to funding, logistics, the right number of human resources and access difficulties. lf these are addressed then it is anticipated that there will be significant improvement in reaching out to target communities with mobilization and sensitization. l0 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Attendance of female members of the community at health education meetings No significant changes in female attendance; it is still quite low. Social and cultural factors are still quite strong hindrance. ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses It is stillquite low. lncentives provided by communities for the CDDs No incentives were provided to the CDDs Attrition of cDDs. ls attrition a problem for the project? lf yes, how is it addressed? Attrition is still a persistent problem. This is being addressed by asking the communities to select CDDs that are willing to volunteer; in addition whenever there is an opportunity to speak to the community, they are reminded of the CDTI philosophy. Other issues - None County - 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 Ba Number with community members as supervisors Bs Percentag e Be= BJ Br -100 Male CDDs Bz Female CDDs Ba Total Be= B7+Bs Number of communities with female CDDs Bro Percentage Brr= Bro/Ba*1 00 Aweil Centre 154 25 16.2% 431 83 514 41 26.6%o Aweil East 182 14 7.7% 672 142 814 47 25.8% Aweil North 178 28 15.7% 554 1 2 1 675 48 27.0o/o Aweil South 1 4 1 19 13.SYo 612 112 724 76 53.9% AweilWest 445 51 11 .5o/o 557 71 628 66 14.8% Gogrial East 347 27 7.8% 682 42 724 40 11.5% GogrialWest 606 53 8.7o/o 632 22 654 20 3.3% Twic 129 21 16.3% 581 27 608 25 19.4% Tonj North 350 51 14.6% 491 19 510 19 5.4% Tonj South 139 45 32.4% 487 23 510 22 15.8% Tonj East 202 62 30.7%o 501 27 528 25 12.4o/o Raja 247 46 18.6% 104 51 155 50 20.2% Wau/Jur river 106 23 21.7% 147 26 173 24 22.60/0 Total 3,226 465 14.4% 6,451 766 7,217 503 15.6% tl 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. Generally, manpower availability is inadequate. Some state levelfocal persons and County supervisors have opted to leave the program and new one took a while to be selected in North Bahr el Ghazal state. This greatly affected performance of the project. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. This was more an issue in North Bahr el Ghazal as mentioned above. t2 *ErrO Ed*=(J .t&d ],Pd s cos c)o t-(e lr) O) rr) .ir O(o cq @ O) (o(r) c.) |--(o N @(o (o cO$ O tr) c.) (o @ (o @ Cr) It-O cf) o, F- co Nv @ CO cf) lf) @ (o(o s N co c.) co @ r.- s @ N c.) o) @ N N N @N r ss @ N (f) - t- @ rr) @ N O)NN r--lr) olr)(o cf) (f) lr) (o N$@ Nlf) N llf l(, @lo(,,t @ - E o '6 L .o o o o o L o -o E z e:ko o o) N lr)lr)(o (o @v (o cr)(o @ tr) tr) ro r(o lr) o)(o (o O) rr) cr)N cf) rr) ro N (o $ or- o) (os o) tq)i- sq (D(o c o E o .g o s = .t- tt t-> Ed*=o ;" *d O o O O o O o o o o O ; o O o o o O o o o o o O o o O o o o o o o o O o o o o o o o .Zo!!FEO o l.- +Ul6E o.= LGO.!ll+Eo J z o o F o o o o o o o o o o o o o o so o E o .9 o s o o +q)q oe a-,, d Fd+-F() O o o o o O o o o O ; o O o o o o o o o o o o o o o O O a o o o o o E' o -ce(EOE o5 *(! oo .88aELE- 2E oIJ o o F o o o o o o o O o o O o o o so o E o .9 o s o () Erd F o'+- F() * oq > o2 o o o o o o o o o O o o o o o O o o o o o o o O o o o o o o o o o O o o O o o o o o @ o 9too Uto oe o(! boll E z ooF o o o o o o o o o o o o o o (9 J I c =o o o L C oO c) = o G TU o 3 E oz o B -c =o U) o = a o =o = tt)(5 r.rJ E L o)o(9 al, o =(E 'tr o)o(, o = F -c.E oz c oF -c f o U) c oF a(5 tu c oF (! C't L G) L L) -f(! = F oF so tr o E o .g (, s Otq oo cn e5 .4 o a((! 5 o (u o o' 'b o a- too q) op Q a. o o (U c o E -g o o! :\ o E >q) = .E troo o I o (, c o o EE o (E .s c (E : lt GF o o o o o o o o c, Comment: Due to funding challenges, training was prioritized for CDDs and the other cadres were left out and the project had to rely on the knowledge they had received in previous trainings. T T of traini undertaken Any other comments - None 2.6. Treatments 2.6.1 . Treatment figures lf the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The reasons for not reaching 100% geographical coverage and 65% therapeutic coverage are mainly due to gross underfunding of activity implementation, lack of basic logistics to reach out to communities, access difficulties (roads and flooding), inappropriate timing of activities since activities depend on release of funds from APoc rrust Funds and implementation being done in the rainy season. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Politic al Leader s Others (specify ) Program management Health education X lvlanagement of SAEs X CSM SHM Data collection X Data analysis Report writing X Others (specify) t4 Esusseet ;sEdeteE (o O o o o o O o o o o o o o o !s </)tr otu 2a6 O o O o o o O o o o o o a o o.= v = o.) gE;Hg"g .f tr) N@ @f.- .t lr)ss f.-$ cv) (oo(o o)N olr) c) o) cf) NoN r.-$ c! (oo (o olot c/) (l)= Eb I3f --o o z(g (o F- o OJ N @(o (otr) N@ rON N co(o rOO) o)oN \r f.- O)lr) o,cf) @$(0_ 5= aEt:E; o o o o o O o O o a o o o o o\o dI-- o sq O)N s o) o cO sN ri c.) s[r) u-,s s o) o cY) s tr) co cY) s ns c9 sq o cr) s nN(t) s r o) cf) sq 1r)(9 s oq t- CE sN oi CE s 1() +(n N$ f.-_ rO O) N$ r.O N C\,If.* rO u) o) |r) tr)\ @ @ N o) F.-(o N (0 f.- r.-- @ o) tr)(o $_ @ O) N c) (os r.- CE a) o)N $@ o)(o N t- @_ NN $ rO o{ N tr)(o (o_ tr)lr) cl,ot-(\t f{ o_ NN @_ C9(o N $ rr)_ cv)N C9 o$ t- N Nf.- (o(o r t-o (f)_ aN(e tf @ lr,oN No @_ @N6t o)(.o s- oN (o N CE NN @ r.- lo ro N O)_ olo (.) o)(o_ f.- (f) c\l O)o rf) co o) otq co fo- N oi- - (l)rrL ^.=Q..= o )H ili €E5EE H!+ (,)o otr o o (L s o c o (6 Oc,)O-(o(EoLLE (D(I)l> EOFO !poq69!o5Ebc z* cOEe= :?Eo E E.o. < E*F\J o f.-f.-t- o,N co C9 O) CE sos lr) N$_ f.*N lo N. lr) o) $@(9 o $ o @t_(o tr) N c.)oo(o @N (o @ lr)- o tr) @o s_ o o, c9f.- o) @(o ot(o_ (9(o (o F- o, c! (o @ @_ $ (o G) e\l (.o(o or N sq alo s u? o rn s n o)s s o? @$ so +$ sq o$ s nN$ s @d .if s c? @$ s a? @ rO s c.j$ s dlf) s c? (o s$t l-tf o t-t- No, @@ o,(o f.-O) $ t-roN (9(o o,(o r @ r-.@ (o (f) lo(o o{ C{ ro- o $ rO N @ @f.- $ lOs$ t'-$(f) (oo(o o, c\t oro (f) o) cf) No c\l F-$N (oo (o 6tot CY) g FU)C) =(E E E" EE rfi2 O(I) -b()E =.6.s tir ., uE$*;S eFb> (l)o) E U) o E cc o E (g o) F o(D -o-o : @ o .E f E E oo c oo 'F o);(U s-'b:eFe-doOE oo rr f oo o o $ 1o r N @ @N rt ro$lif t- .t(9 (oo(o o)N olr) c) o)(t) No ol r*$N (oo (o N sl c.t aye <=ooJ(J o _L 'oE Eo)<o o o ul o B EE oz o) = E f, o U) o = 6q) 3 o 3 o(g LU (U o) o(9 o ^U,x'odB o =F coF c fo U) 'E. oF U'o[! EoF o .o- t. 5 a =o(l,> =E F o tr) ol FI xt ol ol EI ol:t HI-J EI EI slbl --l rlot ot =El5 d ol ol ot :l6l ol r :t olddl ol<l o ;IE €ls elE plE olo ollGl o =ld:t cBbolrLIF J o L (! o(u o G (U ; oJ o L .9.E o IU U' t,c(E o E o o t-IIt Gt- \o ! o q o o' o. o 5 G E\ os o U, E o o o G .c a G U, o o Et 5 ! o o C o\q G E o '6'\ 3r oo >€ --Et II ot . 5c9I ='I o-: 3S 3 6 -P" O- b E€ G d =r oI o g::d < o-e x -- oEg s 5 ::Ea > E!=e P E5'- = :- ,^oqE -a (:e - - Yia qE C 35IE E HEi = 9 ixa. = - E5oE o Y'dsE 3 f.i.s6 = .atrsEEIE }3IS:lE E:EFEI: .se hEsIE E;.! telis-flfiif*e 51 9olEul o ..E 5 6 'iEffi EIsEIBE * $32lEol=olK-9s sElt"lEBrlE:E olL olE olLS F.cotodtodoi.=: Etl€ tlP bl€ B x g. eH z Elr Elz : ErE EIE EI E EIE'= 5 o e zP:tE:tP.P3 f 'loo --E Q-qoOOo o o! r r rr {Qs ooG b bPao\ o E EJE Sse I usc;' o:o6 e EEB .5-S-E ;'Ii5E.3'.: : 5 Ea 9 H fsIS I O rriI o i ood3 k s tSl 2.6.2 What are the causes of absenteeism? The main was due to having left the homestead and being out in the field cultivating or grazing livestock. A few other absent were reported to have travelled out of the village. 2.6.3 What are the reasons for refusals? Not appllcable 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. There were no cases of serious adverse events reported. Parasitologist trained? None has been trained Existence of microscope? None is available Has the project reported all SAEs to Mectizan Donation Program (MDp)? Please tick one. Not applicable since SAEs have not been reported. XNo ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. None was reported No SAE case to report x t7 oo oN o)Nq. cf) F.* N id o (E o o o oFl o o (U .9E .; o(U o o. L(E o tr oL(g =Eo(!96io o'd co.oo 'E .= 86tro o.o= O'r! o.(E -oF>hsl5sl EtrIbol&31 cxo3lEooo)>(! .eb -c>ooGc) 9; ioc:Eb +rE oE E'O o' F orl ui gld€lNFI E o L o o. E') E o o. o o o) .E E !, o o o o EEeE aYr!d <LUt .n - Lllo< -c u) oo>c@cl flsa'>p E.Eq; .0P b'aoa oi; .o .9O=(,* lU=o:: ..o@lz. ol -ololFI q) sEg O c.j @d c! c!N (o$ o? $$ q(o|.- e"j.t o o)r-) (o^ r-: O o- o oo tr;- ui uJ u.l q tr) N c? @s q tr) r.- q @ o) q O LO q rt @ c.js Eo)fo) o(E 6-ES;; o-ioFo oo rr I- UJ IIJ uJ N + \ @ c! NN f.- @ c.) f... c.) CE .t(o q .t(r) IJJ ! *9o(tr -oo.: =aEcfOze o o_ o(o $_ Of.- cr)$ o^ C9 N @- cf) O)lr) O)(o N- rOs o_ oN\$o (o N\(o O Or_ cr)o$_ NN o- Nf.* tr)- f.-N N r.- rO_ F-N tr)o O)-(o @f.- tr(o @_(o(o o_ oO(o- CO o) N cr) N- r.- rr) N. N O)N o_(ot- co_ N u.t cO o o.> ?EOE6e. "86 C .9 o o o o- OL c 9.-> = o *c (/}lgE o F h (u .Pg€EI H'!+ oo o_E cf) C9 r--_ @o rr)_ C9 c.) r.-- @olr)- o @ @_ of.-(o- N $N f.-_ No\ c\l (o @ ry(o(o Or- N (o @ c\l(o(o o)- N (o @ ^L(o(o o)- N sf.- c.j s c.l(o r.- s\ (f) @ ss@ q @ f.- s c! F.$ o o,a) (5^I EEoo oo rr I- uJ ul UJ s\ r €-s 3 3s E s;'q oollJ \ \ CE c\,1(o t- r.- c.j @ s$@ q @ f-- sN t-$ 1r)lr) o c! co o)- N N $(r) lo_ N (o rJ)_ N NNlf,-Lu EEq. E E:'*ttr>o : EE' @ rr) N NN lr)_ N o)o o- co (o NN co (o N c\{ c) UJ cOEo>?tro €95 O) N co O) N co (o N ry co al, o) o,(u aU' 0) '- f E E oo so =i.h;E: ti5 e6iE;€ E, .oco9aoF-: U)9oE EC80, o) N. (f) O) c\t (f) @ ro_ N NN 1r)_ N O)o o-(9 (o NN co t LU (oooN t-ooN @ooN O)ooN o o c\t oN N oN o)C-bb9 -C>-8! b?.s z z ta 3, s,3C.= C =69yo@ C^L9EaX^L ru 6'6 z o.9 a5PoR -O(Joo_ z a u)q) eE o6 .9EcE:< o o()OoE trt=-0) z o vAOrn-> @ F c=-: A€EEE z c .OgY.i=v(/)(5>'(I)'= o'= Ef;:S z c(! €oP6.N 6-J o.= ()#gEig z U' E o o_ E U) z d6E;E E E Fe S- z c(E .N -l9OoOitr o (trYo> =g z o oo)coEi >o z xoa z o)(cr z z a o 2-7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by NGDO Other (please specify) Mectizan@ delivered by """--tr WHO trOther (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The Project Coordinating Officer submits mectizan requirement to the SSOTF; who then compiles this data with that from the rest of the CDTI projects and makes submission to MDP. After the reviews and approvals from MDP and production by It/ERCK; the mectizan is shipped to South Sudan and is received by the WHO Country Office. Mectizan is then supplied to the projects based requirement and balances that remained form the previous distribution. 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; and cycle cascades to Payam Supervisors, then to Boma Supervisors and then to the different Bomas and villages. Table 10: Mectizan@ lnventory State /District /LGA ffi ln stock from previous year Requested Received Used Lost Waste d Expir ed Remaining Aweil Centre 510,259 228,500 228,500 286,747 0 182 0 451,830 AweilEast 302,249 604,000 604,000 387,940 0 201 0 51 8,1 08 AwEil North 107,430 501,000 501,000 267,602 0 91 0 340,737 AweilSouth 16,703 421,000 421,000 220j23 0 32 0 217,548 AweilWest 46,979 872,500 872,500 377,507 0 198 0 541,774 Gogrial East 11,359 563,500 563,500 254,838 0 46 0 319,975 GogrialWest 114,616 526,000 526,000 280,656 0 31 0 359,929 Twic 52,001 28s,500 285,500 124,557 0 59 0 212,885 Tonj North 86,654 1 16,000 1 16,000 83,610 0 3B 0 1 19,006 Tonj South 10,143 144,500 144,500 75,906 0 52 0 78,685 Tonj East 45,342 97,500 97,500 71,289 0 78 0 71,475 Raja 715,724 0 0 314,321 0 92 0 401,311 Wau/Jur River 276,236 42,000 42,000 147,596 0 48 0 170,592 TOTAL 2,295,695 4,402,000 4,4O2,ooo 2,992,692 0 1 1, 48 0 3,803,855 l9 ,nn E *nn E 0n.,.=, tr How are the remaining ivermectin tablets collected and where are they kept? The CDDs collect all balances of mectizan tablets, quantify them and then submit them to the health facility staff for storage until the next treatment cycle. The health facility staff also rely this message of stock amounts to the Project Coordinating Officer through the respective Payam and County Supervisors. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health facility staffs train CDDs; issue mectizan tablets for mass distribution and collect balance after distribution; keep a mectizan inventory of available mectizan at the health facility; and manage any severe adverse effects to treatment. Any other comments None 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No lf so, When? N/A Table 11 : Community self-monitoring and Stakeholders Meeting County/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorinq (CSM) No of Communities that cond ucted stakeholders meetinq (SHM) Aweil Centre Aweil East Aweil North Aweil South AweilWest Gogrial East GogrialWest Twic Tonj North 154 182 178 141 445 347 606 129 350 139 202 247 106 00 00 00 00 00 00 00 00 00 00 00 00 oo oo 00 00 00 00 00 00 00 00 00 00 00 00 Tonj South Tonj East ni;a Wau/Jur River TOTAL 3,226 00 00 20 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. Supervision Reporting 2.9.2. What were the main issues identified during supervision? The main issues found during supervision were: inadequate and incomplete data compilation for treatment reported to have been done; some evidence of misuse of resources and assets assigned to different levels; inadequacy of staffing levels as compared to the expected/required. 2.9.3. Was a supervision checklist used? yes. 2.9.4 2.9.5 what were the outcomes at each level of cDTl implementation supervision? Staffs that are supposedly better understanding in terms of data management, and resource utilization, and this was done through on- the-job coaching. Was feedback given to the person or groups supervised? Yes SSOTF Headquarters Project Coordination Officer/Focal Persons 7 )ounty OV Supervisors / Payam Supervisors 7 CDDs / 7 Communities 2t I 2'9.6. How was the feedback used to improve the overatl performance of the project? It was ensured that the staff supervised practically exhibited better knowledge in areas of cDTl work that they were supervised on. SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment "Condition of the equipment (F=Functional, CNFR= Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? Gradually as the state ministries of health increasingly take on more responsibility of CDTI activities then they will provide some level of maintenance and replacement of equipment. 3.2. Financia! contributions of the partners and communities - Fill tables 13a,13b and 13c lf there are problems with release of counterpart funds, how were they addressed? There is no counterpart funding allocated within government PHC budgets to support direct funding for implementation of key CDTI activities. Additional comments - None. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No Condrtron No Condrtron No Conditron No Condrfuon 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) 1 F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 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 17 F 0 NA 0 NA 0 NA 0 NA c) Radio base 1 F 0 NA 0 NA 0 NA 0 NA 22 !()r olrIE F oo o Ol Ol O:oOi r.)i col- toi di r-;citf)' f'-' @,OlN-i -l -iri'i-i' I 61' 6i51 Ij si Filo I : di -ici i, (o, o),(o ,I col o;@ I , _, (otco : oiotDi(, <o:o;o),t\ vilonid oi oici qi c.li oj oi 6.oi oi N; -r o c o) rO co O:Ooio oir ,(D ;lo lc) oq |-.(o @-(o oloq:q @ jloF- tVO io) -io' i c\t ro @ o, o- lo o o o o oq o oq o oq o oq o oIo oo o oo oq o oq o oo o oo o oo ci oo o oo o oq o q o oo ci o co oq o .E co =G,Ev oo oooooooooo ooooc; oooooo ooc; oooooooo oooci oooooo o-o c; oooooo ooci oo ci o rt-Oq8 -z oq o ololoiooroloiodicilolci oioroiolorol oioicjj oq oo o oq o o o oq o oiooio oo oo olooio o,o oq o o E ooL .ll e o L t! 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I I oiooio oio oo C; oo c; oq o oo o oo c; oq @N c\l(0 oq o oi(ol d;N:N: @:F! o(o d N N @ oo o oo o oo CJ oo o oo c; oo o oo o oq o oo o oo o oo o oq o oo CJ q o oo ci oo o oo o oq o oq o oq o oo CJ oo CJ oq o oq o oo o oo ci oq o oo c; oq o oq o oq o oo o oo o oq o o co oo CJ oq o oq o ! o o cDt,f c0 oq o oq o oq o oloo:o olo I oq o oo o oo c; oq o oq o oq o oq o oiooio o,o i oo c; oq @t-ot(o oo ci oi(O: Or t'- iN: (O! ri i oq €t- ol d UJz J F UJ oofo o s .9 G tn co tn s(, Go o E-Gb Ei'8, - ^Gi o.<oi NStl Eso: oQs <o=,E3:{{, c o, 6i.\ .NE =ootOc: >o' ic,@,< c.l' { c oEoo fEo E =o oI a G o a5 ar, oc tr Gt ooo o o ol .E .g(E o o:c :E(l, F -oi o ot o =E. =(\, o -' o, o) .glc '6 o' c,Ic,- (E, !! 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C,i|l, tr)_ 6t o{ l.r) F-dlr)!c- s 16r; is) ir iiolNioi :(o :$ lN : '- .(r) ,s I ;@ lro io I rr ,(o ,c\t r Lo:oilJ)F.- lr 16d ici i€do .N ,(\to iN i(\r tO :N rF- @(.J + ro o- Fq ra, ra,$- @ tol@c! lc?(o:s$ ,to(f)io \lt- ;v io ir :$ :C) lrl :@ :o t@ '$, ,tloi ;o iF\ , ,t\ -itl)16(f)iN:o .q id ia;NrO,6O, IN IN !t ,o) ,\t lr): i(ll :i oI c)t lo_ NN oL o o oq o oo o oq o oq o oq o oq o oo c; oq o oo C)i oco oo o oq o oo o oq o oq o oq o oq o oq o oq o .E =co =oE€ o o o o o,o oqqcq q ooooo oooqq q ooo oooooooo oooo oooqq q ooo oooooc ooo oo ci 6EOq8 -z oio;oioiooioloioiod lo'id 'd I c; oioloiolo:old'd;d' ololoiooloio;o o'o 'o 'o oioiooloro olo c; oq o oo C; oq o oq o tr o EooL =lt .!2E^ o L oct Gq t IIJ -F o o oo oz oooooqqcqe ooooo ootoooddq@(oo, Go coq @ ooooqqqq @ooco@aoo)_ o)- ooooqq oooN(\ls_ -t_ @@ oooqqq ooo oq t o) o) E 0) o lt o o\ tt l<t<i<t<i< i =i =i ='t=i= z z zz z z z z z soo sooz soo ooo,o o,o I OrOo:o olo oo o o,oq:q O,O oq o oq o oq o o co oo C; o eo oo o oq @t- c{ d o; o@: o oi o F-;Ni <crl -i oI @ t^-6{d oq o oloolo oio oloclqoio lolo :o oo o oq o oq o oq o oo o o co oloioqlolq oio:o o(o ct;N C\l(o ol oql q co: c)t-:N: @: -l I o(o d 1'.01(0 oo o oo o oo o oo o oq o oo o oo oq o oo o oo o oo o oq o oq o oo o oq o oo o oo o oq o oq o I o s3 EtotrF 't o O.'J o€ =i56t,o(!oc!.elt tr)oo8tr, o =6 :o z oo o oo o oo o oo o oq o oq o oo o oq o oo ci o co oo o oq o oo C; oIo oq o oq o oq o oq o oq o o oN E o '6 -ot lIJ GE' g (t, o o th o = o tr o 4t L c o o z lrJ Ezt uJ o o I E' :' dt oq o oq o oo o oq o oq o oo ci oo ci o co oo o oq o oioolooio oq o oo ci oq o cri ol cr(oi o; @ @rOi6Ni , t\Ni i(\(O! ! (OFi l- o(o d F-6{(o UJz J F TU oof m o s o (! t4 co 14 so Go o E-obi'E6(! 'r3 s€\oEso<E8 c o =(\, N 5 o : c oEh .N6 --oo.oE>OE@< .'i "? co (l, o Do E =(I, oI a (tI olttotrl(/tl otc c G Fl o (D * o B E =(U o)I o OI c .s(, o OIc- (UG l--' o e,I .Q c.i I ,v, aooo o o)c C 6 F -6i o GI G lrJ dtr o o E E o 10toa5q o)cEO .E 'E oo oY c.i c"j c"i r.i c .9o E o o. fa - r"i G o alq o o trt Gc G E s(! EeFC5(l,Q> 'to ESE5SSEIOG9o sbo>>o\oIb c o f ! 'tr .9o c ooC o -$ Ic o) o oo o E(! I o oa o c o E,g>(l,\ 6S N,Q+d z o)Et#s uJ, g c.i .6 'ri Ivt lt, o a,q oexo' EI E .9; 6 .!ar 6 Ei ? <,r. Jj - J FoF oz tr(9 rrl(\ a L(! o o) o L E a(tr o -c. L o5 aL o)cE(! o_ (tr -o oc .9 J -o C o() Eoc(! .c TL i:i(r) I -o(E F I I Ioiioijoi 3.3. Other forms of community support Community support included provision of training venues, collection of mectizan from the frontline health facilities and occasional provision of meals for CDDs during training. 3.4. Expenditure per activity lndicate 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 3.8 SPP per US dollar. Any comments or explanations? None SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 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? _NoWhen was the sustainability plan submitted? - No What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.1.2. 4.1.3. 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. What were the recommendations? Not applicable How have they been implemented? Not applicable Planning at all relevant levels - No plans made yet Funds - No plans made yet Transport (replacement and maintenance) - No plans made yet Other resources - No plans made yet To what extent has the plan been implemented - Not yet applicable 4.3. lntegration Outtine the extent of integration of CDTI into the PHC structure and the plans for complete integration: 26 4.3.1. lvermectin delivery mechanisms The lvermectin delivery mechanism is not yet integrated in the national medical supply system. WHO ensures that the mectizan is delivered to the state ministry of health; and then the state ministry of health is then supposed to be responsible for releasing the mectizan to the County Health Department stores in the Counties. The effectiveness of how this happens varies from county to county. ln most cases, WHO still has to make inquiries on whether this has happened or not. From the County Health Departments, it is then dispatched to frontline health facilities in the Payams. Then from the Payams the mectizan is sent to the Boma level Primary health Care Unit and then finally to the communities. 4.3.2. Training: There is goodwill and willingness of other community based health care programs to cooperate in training activities. However the funding arrangements/cycles and different implementation plans are a hindrance to this actually being 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. ls CDTI included in the PHC budget? Not yet 4.3.6. Describe other health programmes that are using the GDTI structure and how this was achieved. What have been the achievements? Not applicable since there are no additional programs using the CDTI structure yet. Explain what are the combinations of interventions co-implemented? Co-implementation is not yet happening in project area. How were the interventions implemented? (at the same time?) Not applicable. 4.3.7. Describe others issues considered in the integration of cDTr. This is not yet applicable in this project. 27 a oc o an OE o. q) oo .(E6p E z E oF ang (E E oll og(! E o o oLo!cLo b3, LL o)(! !e E z E oF og (! E oII og (! = o oo(! t:ebzgOo> -ocE'- z E oF (! tr .PE og c' E obe 3= EE =Fz6 o ! 0, o6o &. !, o, o, cDL GF oul O.(Jl:t L EOii Eo o6otr !, o o cD .UF B'l o 6 e.s 8.u"3 Estpgo tr ,- .9o: 1gr-O a a a ooLGl+,o-tr>oFo D o (EG'o c .9 .9, oL(L o o) o o o o, c Ec = o) E o ot '.oE .= o)(/)! <-r = 'E. &.e a ttl o €c!o anit g=Ee 68 OE Er E a oooo o G L o E o o -E be =oEEe o)^ otr(,).= o E' o E E o L o CL .; o '= E E o o o o E o o g, .l= eJ-Eo E oq) :T o(U o oIq, .= o o o- F a a a a a a 6 c o(.) o o CL F @ o{ (, a- Eo o i _€) ea o aG q) c !o I oL o L :e,OEOE o3 .-A an_ =FoQ o t*,lE(l)L-E ;P orQ ?,2CLE -SOo)FO *.=o;; PeoI €eFF il) a. E(u Q) io q Q(! () aG q) !q) q o otq) o € aa o +, G+, o E o o. E '5e (J '= o +3g{u -c9;sl>oEl-z a4.4. 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: The project has had a presence of key staff at State at County levels at most times with the single exception of North Bahr el Ghazal. ln addition there is a distribution of fronfline health facilities that can be used more in supporting CDTI work. Weakness: Repeated inability to supervlse the conducting of a community census; the unavailability of adequate manpower at the lower levels i.e. payam and boma levels to confidently follow up on implementation of CDTI activities at that level; and conducting/scheduling of the mectizan distribution often/always during the rainy season, a fact that has a major contribution to the low treatment coverage due to poor access to the communities. Challenges: . There was gross under funding of the project in 2012. . ln addition to being underfunded, the funds were received in the middle of August forcing the project into a rushed implementation in the last 4 months of the yeir. sEcrloN 6: unique features of the projecuother matters No unique features/matters to report. I I 29