Southem Sudan Onchocerciasis Task Force Headquarters annual project technical report submitted to Technical Consultative Committee (TCC): January 2009 to December 2009

SOUTHERN STJDAN OI{CHOCERCIASIS TASK FORCE (SSOTF) whohqproiect@gmail.com I I ! I : I ! I I i I I a" OzuGINAL:Enelish ANNUAL NOTF SECRETARIAT TECHNICAL REPORT SUBMITTED TO i-------- I For ^Action TECHNICAL CONSULTATIVE COMMITTEE (TCC) iol i A,& DEADLINE FOR SUB ION: lntrrrr*el*ofi To APoc Management by 3l January for March rcc meeting To APOC Management by 3l Julv for September TCC meeting I lcn Tq .brR ', ll.Bta,honl i AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) COUNTRYAIOTF: Southern Sudan ect Name: Southem Sudan Onchocerciasis Task Force Headquarters Proi Approval year: 2003 January 2009 To: (Month/Year) December 2009 ( Month/Year) From:Renortins Period: APOC funding year: l31 2 3 (4) 5 6 7 8 9 10 ll t2 Date su bmitted: 3 I't January 201 I i ,. lclt ApociDtR RECTI LE WHO/APOC, l4 September 2009I ANNUAL NOTF SECR!]TARIAT TECHNICAL REPORT 'l'0 't'HCl IN l('Al, CIONSiJ[. I A l'l Vi, (lolvlMI'f'l'] jt: ('l'C'(l) trNDORSEMENT Please conlirnr y()u h:rve rcad this rcport b),siguing in thc appl'0priute spitce. OF t-l('liltS trr sign th t Countn,: Sotrthcrn Sudarr Nalionul Cocx-cJinator .Nanrc: Dr Mounir ('hristrr l.Lrgga (Sigrratrrre r.v I)atc: 3 l" .lztnuarr 20 I I N()-l-lj C'lrair Narne: Dr.lol rn I{ LINLI I lov Si-{uaturc: I)atc: 3 l'' Januarr, 20 P I r( i N(;tX) Rcplt'scntatir,c Nlrnrc: liasi) C.han S irlnaturc: l)atc: 3 I't JanLrat')/ 20 I I I'ltis rcltorl hus bccrr prcplrrccl br : Nlnrc: [)r. l]urr.larnin .,\tu.irrc I)csiurration.'J'cchrricaJ,\dvist,r'. nP(X \'. S ignatu rc 3 l:' Januirr'), 20l1 N\__ ll Dutc \\ I l() At'( lt' l-l Se prt.rnh ,r''(,(rt) Table of contents ACRONYMS ................. v DEFINITIONS.......... VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY......... ....... ERREUR ! SIGNET NON DEFTNI SECTION 1: BACKGROUND INFORMATION......... ERREUR ! SIGNET NON DEFINI 1.1. GeNpRnl rNFoRrvrATroN............. ERRBuR ! SrcNBr NON DEFrNr. 1 1.1 Description o/ the project (brie.fl1') Erreur ! signet non ddfini. 1.1.2. Partnershilt .... Erreur ! Stgnet non tldfini. L2. Popu1arroN............... ERRBt.in ! SrcNolNoN DEFrNr. SECTION 2: IMPLEMENTATION OF CDTT ERREUR I SIGNET NON DEFINI. 2.1. TrlrrlrNn oF ACTrvrT'rES ............ ERRpriR ! srcNB'r'NoN DEFrNr. 2.2. Aor,'ocecr . Ennrun ! SrcNB.r NoN DEr.-rNr. 2.3. MostltzartoN, sENSITIZA'iloN AND HE.\L'fu EDUCI\TIoN oF AT'RISK coNtNruNIT'tES ERnoun ! SlcNol NoN DEFINr. 2.4. Cotr'tvtuNtrY INVoLVENIENT.......... ERRBuR ! SrcNBl NoN DEFrNr. 2.5. capncrr-v BUrLDrNG... ERRBTiR ! srcNsr.NON DEFrNr. 2.6. TREerH,rpNTS.............. EnRsuR ! srcNpr NoN DEFrNr. 2 6. l. Treatment figLtres .... Erreur ! signet non ddJirti. 2.6.2 ll/hat are the causes of absenleeisnt? Erreur ! Signet non ddfini. 2.6.3 lllhat are the reasons.for refusals?... ... ...... .... ..Erreur ! Signet non difini. 2.6.1 llrieJly describe all htotvn and verified serious adverse events (SAEs) that Erreur ! Signet non ddfini. 2.6.5. Trcnd of treatment achievement.from CDTI project inception to the cltrrcnt ),ear Erreur ! Signet non ddfini.2.7. ORopRtNc, sroRAGE AND DELIVERy oF r\/ERr\,IECTIN. ERnruR ! SIcr,rBr NoN DEFINT.2.8. CoHavLrNttY sELF-NIoNIToRTNG eNo SrnrsHoLDERS MpprrNc.....ERnpuR ! SrcNBr NON DEFINI. 2.9. SupgRvrsroN............... ERRouR ! SrcNBr NoN DEFrNr.2.9.1. Provide a.flow chart of supervision hierarchy......... Errettr ! Signet non dt\fini.2.9.2. IVhat v.'ere the main issues idenlified during supervision'? . Erreur ! Signet non ddjitti. 2.9.3. Was a supervision checklist used? ....... Erreur ! Signet non drifini.2.9.4. What were the outcomes at each lerel of CDTI implementation supervision? Erreur ! Signet non ddfini. 2.9.5. Wasfeedback given to the person or groups supervised'?... Erreur ! Signet non ddfini. 2.9.6. Hov'v'as thefeedback used lo improve the overall per.formance of the project? Erreur ! Signet non ddJini. SECTION 3: SUPPORT TO CDTI 3.1. EqurrveNr .. ERREUR ! SIGNET NON DEFINI. ERRoUR ! SlcNBr NoN DEFrNr. ....... vII 3.2. FtNRNctaL coNTRIBUTIoNS oF THE pARTNERS AND coMMLfNITrES.. ERREUn ! SrcNor NON DEFINI. 3.3. OIUER FoRMS oF coMMLfNrry suppoRT..................... EnRouR ! SrcNor.NoN DEFrNr. 3.4. ExpENorruRE pER AcTrvtry ... Ennpun ! StcNBr NoN DEFrNr. SECTTON 4: SUSTAINABILITY OF CDTI. ERREUR I SIGNET NON DEFINI. lll WHO/APOC, l4 September 2009 4.1. INTeRNaL; INDEeENDENT IARTICIpAToRy MoNrroRINc; EvalualoN ........ Ennpun ! SrcxBr NoN DEFrNr. 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) .. ..... ........Erreur ! Signet non ddfini. 4. 1.2. What were the recommendations? ......... Erreur ! Signet non ddfini.4.1.3. Hou, have they been implentented? ... .......... Erreur ! signet non ddfini.4.2. SustRtNnetLITy oF PRoJECTS: PLAN AND sET TARGETS (MANDAToRY AT.... EnnBun ! SIcNer NoN DEFTNI. Yn 3) Ennpun ! SrcNBr NoN DEFrNr.12.1. Planning at all relevant let,els .....Erreur ! Stgnet non ddfini. 4. 2.2 Funds ..... . Erreur ! Signet non ddfini. 4.2 3 Transporl (replacentent and maintenance) ... ... .Erreur ! Stgnet non ddfini. 4 2.1. Other resources Erreur I Signet non dtifini.4.2.5. To what exlent has the plan been intltlcmented . .Erreur ! Signet non tldfini.4.3. INr-rcne1roN............... ERRpuR ! Srcner NoN DEFrNr.4.3.1. Ivermet'titt deliverl, mechunisrnr . ... .. ..... Erreur ! Signet non ddfini.4.3.2 Troining Erreur ! Signet non cttifini.4.3.3 .loinl .stqtervision ttnd monitoringwith other progrLu,ts. . . Erreur ! Signet non ddfini. 4.3.4. Relea.re oJ-.fund,s for pro.ject uc'tit'itie s ... Erreur ! Signet non ddfini.4.3.5 Is ODTI ittcluded in the PHC budget'? .. .. Erreur ! Signet non ddfini.1.3.6. Describe other healthprogramrnes lhat are u.sittg thc CDTI strLtctm'e and hov, tltis trct,s ochieved. U/hat lrut,e been the achievements'?.. ........Erreur ! Signel non dd/ini.4.3.7. De.rcribe olhers i.vsues considered in the integrution of C'DTI. .Erreur ! Signet non ddfini. 4.4. OppnnrroNAL RESEARCH ERnnuR ! SrcNBr.NoN DEFrNr. 4.4. I . Summarize in not ntore than one half of a page the operational researclt undertaken in the project areo v,ithin the reporting period .... Erreur ! Signel non tldfini.4.4.2. Hov'v'ere the results applied in the project?...... .. . Erreur ! Signet non ddfini. SECTION 5: STRENGTHS, WEAKNESSES, CI{ALLENGES, AND OPPORTUNITIES ....... ERREUR ! SIGNET NON DEFiNI SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS .. ERREUR ! SIGNET NON DEFINI IV WHO/APOC, l4 September 2009 Acronyms i APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTII PHC REMO SAE SHM TCC TOT LINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment rvith Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Govermnental DeveIopment Organization Non-Governmental Organization National Onchocerciasis Task Force Primar-v health care Rapid Epidemiological Mapping of Oncliocerciasis Severe adverse event Stakeholders meeting Teclnical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatrnent Goal World Health Organization WHO/APOC, l4 September 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso,/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultirnate Treatment Goal (UTG): calculated as the maximum number of people to be treated annuallf in meso/hyper endemic areas rvithin the project area, ultimately to be reached when the project has reached fult geographic coverage(norrnalll'the project should be expected to reach the U'l'G at the end of tlie 3tu year ofthe project) (r') Therapeutic coverage: nurnber of people treated in a given ),ear over the totalpopulation (this should be expressed as a percentage). (vi) Geographical coverage: Irunrber of courrnunities treated in a given year oyer the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a pcrcentage). Integration: delivering additional health interventions (i.e. vitamin A supplernents. albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maxirnise cost- effectiveness and empower communities to solve more of their health problerns. This does not include activities or interventions carried out by community distributors outside of CDTI. (vii) (viii) Sustainability: CDTI activities in an area are sustainable rvhen they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, rvith strong community orvnership. using resources mobilised by the communitl,and the government. (ix) cornmunity self-monitoring (cSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any comrnunil.;,- based health intervention programme), with a view to ensuring that ihe programme is being executed in the way intended. [t encourages the community to take full responsibility of iverrnectin distribution and make appropriate modifications rvhen necessary. VI WHO/APOC, l4 Seprember 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fiIl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 29 Number of Recommendatio n in the Report TCC RECOMMENDATION ACTTONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY Report related: (i) Project to correct the data in executive summary on communities targeted for treatment The data in the 2008 report was corrected and that in this report has been carefully vetted. (i i) Impror,'e on quality of map provided under general inlormation. Done ( iii) Correct /account for the shortfall of 2,000 tablets in table 5. It has been corrected and it was noted as a balance of mectizan that remained in the 2008 treatrnent in Upper Nile CDTI. Inventorv has been corrected. (iv) Should also provide explanation for lower total population in 2008 as compared to 2007. The 2007 population figure that was presented was not correct and it has been amended in our records. The population presented as to have been treated in 2008 rvas also corrected. Both figures have been amended in this report. Project related: (i) Activities should be carried out in the dr1, season and priority should be given to training of health centre staff. I efforts are being made to I make this happen by I ordering the rnecticzan I early. However delays in fund disbursement delavs commencement of implementation. (ii) TCC reiterates that training on CSM and SHM should be carried out as part of CDTI training, as these activities are part and arcel of CDTI This has been incorporated and it now occurs in the CDTI trainings (iii) There is need to maintain some presence in states which do not have CDTI offices to improve interest. funding and commitment to CDTI State Focal persons were identified. VII WHO/APOC, l4 September 2009 Executive Summary 1n2009, the total population in the five CDTI projects of Southern Sudan was 5,605,726; which is an 8% increase from the 2008 population of 5,189,269. The West Bahr El Ghazal CDTI is the biggest of all the CDTI projects and accounted for 48.2% of the total at risk population. The Ultimate Treatment Goal (UTG) and Annual Treatment Objectives (ATO) across the projects within the period under review were 4,708,810 and 3,019,766 persons respectively in 6,47 3 communities. A total of 3,012,05 8 persons received treatment in 2009, a 48.7%o increase from the 2008 figure of 2,029,828. An overall geographic coverage of 87 .7'/o was achieved in 2009 as compared to 69.8 in 2008. The therapeutic, UTG and ATO coverage were 53.7o/o, 64.0Yo and 99 .7o , increases from the 2008 percentages of 3 9. 1oA, 46 .6yo and 93 .2%o respectively. West Equatoria had the highest therapeutic coverage of 72.6%. Nerv CD'fl training and refresher courses for the staff took place between July and Septembcr 2009. 9,268 CDDs, 1,094 health staffs and 1,253 community leaders u,ere trained in this reporting period. The total number of CDDs trained vvas 44.lYo higher, 2,865 more CDDs than the 2008 figure of 6,403. The overall CDD/population ratio, though not yet to tlie recommended level, has gradually corne dorvn to lCDD/605 people in comparison to the 2008 and 2007 figures of I CDD/8 l0 people and I CDD/2,333 people respectively. There was an improvement in integrating CDTI into PHC in 2008. Two project coordinating officers and 13 county supervisors were absorbed during the reporting period. The process of integrating and absorbing the remaining projects and their staff had commenced and there is prospect of their full integration in 2009. It would be recalled that CDTI projects' staff were mere volunteers and not previousll, rninistrl,'s stafi The SSOTF strength lies on both the technical supporl provided by APOC through the deployment of technical advisor to SSOTF and projects, sheer determination of available staff to get work done, improvement in communication network in Southern Sudan and the continued support of CBM to SSOTF. The main weaknesses are the politics of the leadership at the national level. available manpower are not rvell knowledgeable plus their inadequacy, non government counterpart contribution and delayed activity fund release to the programme by APOC. The major challenges facing the programme include the lack of capacity to man CDTI project by some project coordinating officers, inadequate staffing and knorvledgeable manpor,ver itr the project area, non integration of all projects and non absorption of some CDTI staff into the ministry of health, correct and tirnely data reporting, and problem of handling missed treatment of cattle owners. The emergence of NTDs control programme in Southern Sudan offers a potential opportunity to utilization of CDTI structure and thus leading to popularity and prosperity of mectizan distribution and coverage. Key activities undertaken by the SSOTF during this reporting period include facilitating the monitoring of treatment coverage, procurement of ivermectin tablets from Mectizan Donation program in collaboration rvith CBM, holding series of meetings and trainings, printing of IEC materials and ensuring distribution of mectizanand work support items to the projects. Under the vector elimination, SSOTF did not carry,out any activity as this was not applicable in Southern Sudan. VIII WHO/APOC, l4 September 2009 SECTION 1: Background information 1.1. General information 1.1.1. Description of the country program - CDTI and vector elimination The Southern Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands includingthe Sudd swamps and mountains. The climate of Southern Sudan is tropical with average annual temperature of about 29"C (about 85F). The rainy season months are between April and October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from rainforest in the southern part to Savannah in the northern par1. There is a vast swampy/marshy region "The Sudd" and or flood plain in the Jonglei area of the UpperNile CDTI project. The years of civil rvar affected the human settlement pushing communities into clusters of settlements. The main occupations of the rural communities are subsistence farming and nomadic livestock production. Exposure to infection in South Sudan is by rvay of village proximity to breeding sites and occupational activities. The major ethnic groups are the Azande. Bari speaking grollps, Dinka. Shilluk. Taposa, Lutulio and Nuer people. The southern Sudan Onchocerciasis control prograrnnle consists o1'flve CDl-l projc-cts natnell,; East Bahr El Ghazal. West Balrr El Ghazal, West Equatoria. East Equatoria and Upper Nile. East Bahr el Ghazal and West Equatoria are in their fifth vear rvhile East Equatoria, West Bahr el Ghazal and Upper Nile are in fourth year in this present reporting period. Southem Sudan as a country has ten states and project coniposition based on states are as follows East Bahr el Ghazal CDTI comprises of Lakes state; Upper Nile has Upper Nile and Jonglei states; West Equatoria is the onl1, state; East Equatoria has East Equatoria and Central Equatoria states while West Bahr elGhazal, the largest is comprised of West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap states. Vector elimination Presentlv, there is no vector elimination programme in all CDTI project areas in Southern Sudan. Status of National plan implententation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. Basically, the National Plan is implemented by Southern Sudan Onchocerciasis Task Force, which comprised of national healtli staff of Ministry of Health government of Southem Sudan, WHO/APOC staff in Juba and Rumbek as well as Non - Goverrunent developmental Organization QliGDO) which has CBM as lead NGDO. It is also being implemented through various State Ministries of health, Iocalauthority at CDTI project level. county, Payam and community levels. The National and International NGOs, and Community based organizations have also been supporting the implementation of the national plan by providing technical assistance/guidance through their field health coordinators. They also provide logistics support to facilitate the smooth running of the planned activities at project and county levels. The totalpopulation at risk of being infected with onchocerciasis in Southern Sudan rvas 5'605,726 people. There are a total of 5 CDTI projects and I Headquarter project (SSOTF) that is located in the Ministry of Health premises in Juba, the capital city of Southern Sudan (previously located in Rumbek) . There were a total of 933 of health facilities across the five CDTI project areas in Southern Sudan and these cornprised of 213 primary health care centres (PHCC), 684 primary health WHOiAPOC, December 15, 2004 care units (PHCU) and37 rural hospitals. 2,854 (44.7%) health workers were involved in CDTI out of 6,386 health staff in Southern Sudan. The administrative structure in Southern Sudan is comprised of four tiers namely: The State, the County, the Payam and the Boma the lowest community level of administration, The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered by Governors; Counties by County Commissioners, the Payams by Payam Administrators, and the Bomas by Boma councils. Boma consists of several villages and mectizan distribution is based on villages in Southern Sudan. A village in the Southern Sudan context is defined as a given geographic area that is under the jurisdiction of a given local Executive Chief. The boundaries of every such community are defined by the chief system of local authorities. In this such community, it is common to find that the people speak a common language. have siniilar cultural/social traditions like rnarriage, funeral rituals and usually make cornmunal decisions about the general rvelfare of their community'. The number of communities cited in this reports are as per these society' norms. The fir,e projects have a total of 38 counties and 6,473 communities rvhere mectizan treatments were irnpletnented during the period uuder rcvierv. Health sl,stcm & health care delivcrl' (state any problems related to health s1'stem that impede program implementation). PHC remains the cornerstone of the health system and needs to receive n-rore political commitment and supporl for its successful implementation. The health system and health care delivery in Southern Sudan fbcused on f-rve levels of facilities/services and these are community based health activities. primary health care unit, primary health care centres, county hospital and state liospitals. The proloriged civil strife in Southern Sudan had its toll on the health care delivery systems and infrastructure and hence quality health care deliverl, to the general population renrains an enonllous task. The health systern is fragmented, few functional health facilities but in poor condition, lack of basic facility equipment, limited trained manpower, stock outs of medical drugs and supplies and meager, irregularly paid salaries and general lack of motivation to attract the few qualified staff plagues the public goverrunent institutions. 'fhis also has a direct impact on the CDTI program since the frontline health facility staffs that are predorninantly go\/erilnent employees. Inadequate budgetary allocation for Primary Health Care (PHC) services has also directly affected CDTI rvork since most of the CDTI staffs have not been absorbed into the health system of the Southern Sudan. 2 WHO/APOC, December I 5, 2004 Map of Southern Sudan showing the states in which the CDTI projects are located. F.i -- -^ LEGEND El State 100 0 1,r0 r.rlD,nFrEr\ .-- SOT]1'IIERN S[ID.\N (2003) Scale Date r 3 t30 ODf G6ographrc F AO/HI1F S Jud€ ?Sl-r fhrs ^i3p dccs n.t rniFl/ ofrc 1l Ull endorlcn)ent i\ W Bahr el-Ghazal -- '-r:- Rrn{Er-cil.rl+l i 1 Lakes Additional information to clarift,the location otthe CDTI projects on the map above o East Bahr el Ghazal CDTI is cornposed of Lakes state; . Upper Nile CDTI is cornposed of Upper Nile and Jonglei states; o West Equatoria CDTI rs composed of West Equatoria state, o East Equatoria CDTI is contposed of East Equatoria and Central Equatona (marked as Bahr el Jabal above) states: o West Bahr el Ghazal CDl'l is composed of West Bahr el Ghazal, Northern Balu el Ghazal and Warrap states. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - national, international) At National level. the partners involved are: o The National Ministry of Health. o Chirstoffel Blinden Mission, the lead NGDO o WHO/APOC At the State and County levels: . State Ministries of Health o County Health Departments. o Frontline health facilitv staff. J WHO/APOC, December I 5, 2004 -l \, -Jonglei At community level: . The Payam and Boma Administrative structure . The community leaders . The beneficiary community members . Frontline health facility staff. Describe overall working relationship among partners, clearly indicating specific areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). The overall rvorking relationship among various partners was good hence the overall improvement in all activities such as advocacy. trainings and mectizan distribution. The stakeholders plan, mobilize, train and supervise CDTI activities as well as preparing reports. Before colnlnencement of this year distribution. there rvas training of project coordinator at SSOTF secretariat in Rurnbek (currently located in Juba) organized by, SSOTF, WHO/APOC and NGDO; these activities rvere then cascaded out to the lower levels. WHO/APOC and NGDO jointly participated in conducting meetings rvith the MoH authorities over soliciting for counterpart contribution from the gor,'ernrnent for the funding of CDTI activities. State plans if any' to soh'e any issues arising as regards CDTI implementation The SSOTF has plans to solve any issues that may'arise in the course of irnplernenting CDTI activities as tbllorvs: a. The first step is to investigate the issues and determine the root cause such as finding out why some people refused treatment with iverrnectin or reasons for absenteeism. b. The second step will be to identify appropriate olficers to deal with the issues. c. The third step is to empower such officer through providing llecessary means to the task. d. The fburth step is to report back after investigatior-r. e. Finally, maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field and the office so that quick timely inten,ention is applied on an)' issue pertaining to the CDTI implementation. 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not during the reporting period 4 Name of CDTI Project Total communities in meso/h1,per-endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (urG) East Bahr el Ghazal I , 963 761,917 640,010 West Equatoria 903 689,419 579,112 West Bahr el Ghazal 2 ) 5 22 2,702,724 2,270.288 East Equatoria 560 963,727 809,531 Upper Nile 525 487,939 409,869 TOTAL 6,473 5,605,726 4,708,910 WHO/APOC, December 15, 2004 NB: The list of communities/villages keeps being updated at project level bearing in mind of the dynamic nature of population movements in Southern Sudan. Source: From CDTI project reports: +'lationa+eeltst+s= x Other source, specify Year of source: 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). 5 WHO/APOC, December 15. 2004 SECTION 2: Summary of CDTI Implementation 2.1. Distribution period Chart the actual distribution period for each CDTI Project in the country in the table below. Table 2: Overview of distribution undertaken by project Briefly, note an1' problemsiissues (one paragraph). Three major problems affected mectizan distribution in the projects and these were insecurity. heavy rains/flooding and delay in receiving funds for irnplementing project activities. Insecurity hampered smooth distribution of mectizan in East Bahr el Ghazal (in Wulu and Yirol of lakes state. Tonj East and North of Warrap state), West Bahr el Ghazal (in Gogrial East and Gogrial West), East Equatoria (Magrvi and Terekeka) and West Equatoria (Mundri and Maridi counties). The heavy rains and flooding restricted air travel to Upper Nile for the delivery of project supplies. The airfields in the Upper Nile areas have clay-like soil that gets very sticky on even the slightest rainfall. Road transport to this project area is not an option especially in the rainy season. The issue of the need for early receipt of project funds before the rains begin in Ma1'cannot be emphasized further. 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for thc scnsitization and outcome. At the national level, 5 key officials of ministry of Health of Goverrunent of Southern Sudan were mobilized and sensitized. Amongst them are the Undersecretary, three Director Generals of the Primary Health Care, the External assistance and coordination, and the Preventive Medicine. The Undersecretary and the DG for External assistance and coordination further mobilized the Minister of health through a letter sent by the Technical Advisor on absorption of CDTI staff and integration of all CDTI staff from SSOTF level to county level. At the State level, four ministers of health of Lakes, West Equatoria, West Bahr el Ghazal and Northern Bahr el Ghazal states including their Director Generals and their Directors of primary health care were visited once or more regarding CDTI projects in their various states. The reason for undertaking the advocacy and mobilization exercise anchored on absorption and integration of CDTI staff into the health system of Southern Sudan in order to facilitate 6 Project Name Distribution Period Jan Feb Mar Apr Mav Jun July Aug Sep Oct Nov Dec East Bahr el Ghazal X x X X X X West Equatoria x X X X X East Equatoria X X X X X Upper Nile X X X X X West Bahr el Ghazal X X X x X WHO/APOC, December 15, 2004 their getting govemment salary instead of over dependence only on APOC top up. Most of CDTI staffs in Southem Sudan are not ministry of health staff. Provision of government counterpart funding to CDTI activities was addressed at the meeting. The major outcome was the absorption of some CDTI staff in the states; 7 more county supervisors were absorbed across the five projects. There was also assurance that more staff would be absorbed in 2010 as govemment budget and allocation to states improved. The goverrlment has understood/appreciated the impact that the OV disease has on the quality of life of the people affected is gradually no longer considering it as a vertical project in the Ministry of health and hopefully counterpart funding will be received in the near future. b) State progress made torvards internal resource mobilization. Within the reporting period, continuous eftbrts rvere made towards getting the government to appreciate the roles regarding counterpart contribution to onchocerciasis control. Despite not having received funding fiom the goverrunent. the OV program is recognized as one of the kel' areas in NTD control and hopelully rvith continued adr,'ocac1,. funds u,ill be allocated to it soo11. c) Describe any' policl'-related constraints being faced by, an1' particular project antl describe rvhat lvas done to assist the project (outcome). Explain any plans on horv to improve advocacl'. The rnajor policl'related constraint laced by all projects rvas the issue of CDTI staff absorption into the ministry of health system. Sending letters, emailing and physical visiting and following up to key governnlent officials rvere the approaches adopted and this rvorked out in some projects in the past r.r'hen coordinating officers were absorbed. Lakes state promised to absorb all CDTI staff in 2009, but this did not fully happen. Also states where CDTI offices are not located within the state ministry premises do not fully understand the CDTI structure and thus offer minimal willingness to support to onchocerciasis control. This is applicable to projects that cover more than one state like Upper Nile with two states. East Equatoria with trvo states, and West Bahr el Ghazal rvith three states. SSOTF has proposed that each state sliould have a focal person fbr eflective CD'l'l implementation and this cadre of staff is expected to work under the respective projcct coordinating officer. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audience, and rvhere they rvere distributed. The SSOTF coordination oflice in Rumbek (currently relocated to the MoH office in Juba) produced a number of IEC materials for the Southern Sudan Onchocerciasis Control Program in2009. The materials were distributed to Project offices fbr onward distribution to CDTI communities. The following rvere produced. . Manual for CHW's and PHC for the control of onchocerciasis with Mectizan'" . Manual for CDTI provided by APOC through the technical advisor and distributed to five project coordinating offi cers. o Illustrated OV training flip charts (OV Oncho in Sudan) . OV poster sets (3 posters per set; "What is OV", "Horv do you get OV", and "Horv to treat OV"). These posters are laminated in plastic for durability under field conditions. 7 WHO/APOC, December 15,2004 . Simplified CDTI instruction manuals for community distributors. . On the spot training guide for health workers and CDDs o J- shirts for health workers and other partners with inscription 'OV control in Southern Sudan' How were the IEC materials developed? Most of the IEC materials were developed during the time of Health Net International and later reviewed and reproduced in 2008 by SSOTF coordination office and while one originated from field situation and APOC manual. Are the materials revievt'ed to address upcoming issues (like decreasing refusals, sustainability, maintaining compliance to long-term treatment, SAEs)? Yes, they were revieu,ed rvith emphasis on maintaining compliance to long term treatment and other upcoming issucs such as sustainabilitl,. Report if an1'KAP sun,eys have been done and holv thcir results l,ere used? There was no KAP surve), in all the projects in 2009. Summarize information on: The use of appropriate and innovative media and/or other strategies to disseminate information among the projects; . Modern niedia such as local radio stations are available in rnost project areas. For instances, East Equatoria project made use of Spirit and Libertl, FM radio stations in Yei and Miraya FM station based in Juba, East Bahr el Gliazal project uscs FM radio in Rumbek and West Bahr el Ghazal relies on FM and radio station in Wau. Upper Nile makes use of Malakal FM while West Equatoria project had no FM radio station. In both East Equatoria and East Bahr el Ghazal FM radio stations exist that can be used to transmit health messages. o At comrnunitl' level, information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, women's groups. village health committees (if exists and functional) are used to disseminate information. Mobilization and health education of communities including lvomen and minorities The five projects carried out this activity before mectizan distribution to create awareness about the mectizan, its availability, and selection of CDDs. Community leaders were responsible for contacting and arranging for the meeting rvith community members which involved the participation of men and women including the blind people and other minorities. Key messages included cause of onchocerciasis, health/social/economic implications, symptoms, who should not take mectizan as well as the dosages and possible side effects after taking the drugs by individuals with heavy infection. Community members were encouraged not to be absenting themselves during the distribution or refusing the drug outright. Also benefits of mectizan were addressed during such mobilization. Response of target communities/villages There was high response of community members during the mectizan distribution as those who previously refused treatment turned up. Major accomplishments . More communities participated in the treatment rvith Ivermectin in 2009 as compared to 2008. 8 WHO/APOC, December 15, 2004 . More persons came out for treatment with mectizan in2009 as opposed to 2008. . Community selected more CDDs than in any other year. . More women were involved as well as increase in female CDDs in2009 than in 2008 Wea knesses/Cons tra in ts . There still needs to be a lot of improvement in the Community support to CDD. . The CDTI philosophy has not yet been fully embraced by the community members and thus their mentality on CDTI orvnership is not yet to the levels expected. . The budget allocated to the production of health education posters is not sufficient for them to be produced in numbers rvould have a visible impact in the communities for ',vhich they are intended. . The nutnber of health staff and CDDs required lbr providing infbnnation to community rnembers is still inadequate. . High rate of absenteeistn due to invoh.'ement and occupation in grazing cattle by adult men and male teenagers resulting in rnissed mobilization and health education. Suggcst rval's to improve mobilization of the targct communities among projccts. . Availability and use of more posters during mobilization and also their placement in each village and strategic places to attract communitv rnembers is highly suggested. . Engaging more health rvorkers b),integrating thern ir-rto the health sl'stcms is ideal. . There is need to recruit more CDDs and cornmunitl'supervisors in order to facilitate liealth education and mobilization activitl.in the cornmunities. o Women groups, youth and religious groups should be involved in thc campaign. o Health education messages should be intensified in all cornmunities . More funds should be allocated for this activity. . Mounting of billboard in strategic positions in each state urging people to take mectizan once a year for l5 years. o Regular radio programme on disease situation and on treatment rvith niectizan 2.4. Communities' involvement in decision-making comment on community participation making comparisons among pro.jects. Participation of female and youth members of the communifl' at health education meetings; In general, horv do you rate the participation of minority groups and fcmalc members in community meetings, decision-making? In 2009. there was a general improvement in community participation as reflected in the total number of people treated across the five projects. This may have been attributed to more involvement and participation of female members. The number ol villages rvith female members and also female CDDs had increased. The report shows that percentages of villages rvith female CDDs was27.3oh in Upper NiIe.24.3% in East Equatoria, 25.9% in West Bahr el Ghazal,15.3% in West Equatoria and 13.4oh in East Bahr el Ghazal. Overall, female and youth attendance including minority is fairly commendable given the previous high dominance by men in participation in discussion in matters of CDTI. However, the rnen still dominate at the time of decision making. 2.5. Capacity building Training of national, district level staff in CDTI and general managemcnt skills (computer applications, project planning, etc.) I WHO/APOC, December 15, 2004 Briefly describe any training done by the SSOTF|NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow-up needed). Continuous on the job training and mentoring rvas done for the PCOs and County Supervisors and this was targeted to improve their performance project management, to provide them with capacity to apply basic CDTI strategies, CDTI philosophy, to provide them with skills that will foster smooth partnership between the communities and the health services, and to maintain community information data base. There was an improvement in the understanding the basic CDTI strategies but there is still more work to be done in regards to data management. Table 3: Typ" of training undertaken at national level b1, the NOTF 'l'ype of training Project staff N{OH staff Opinion Leaders Others (speci[,) Prograrn rlanagernent Hou, to conduct Health education Managernent SAEs of CSM SHM Data collection Data analysis Report rvriting Others (specify) Briefly describe an1' technical assistance provided to the CDTI projects The key technical matters on CDTI were provided to them. These are determining population/CDD ratio, maintaining community information data base, data calculation and analysis, monthly report writing, annual technical report writing, field supervision using checklist and accurate and complete filling of all field forms. l0 WHO/APOC, December 15, 2004 q,) U) U 0) z 3 U slr + FUO dO z9 ON C\ \or-(-1 $s\o \o c.I r- s oo c- cl --l aa$\o o\v O a.lq c.] \o -.: o\ ca c-$ t-- (\\o c.t !f, o\ t-. t v v $ ^\ al 6 .d: o q) q) I c\ L o\ oo oo. (\ \(..l O oo co \o r-- V) o\ 00- a oo .aaFF GJ. AL L(l oJL zl ! 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C, () dlX'=,r oII' E; L *l ooX^ vt!-*v 92t ". : >.-6t _ ,t - I sl *iEs :I IqTU z1; X E 3 9t v+Eo 6l q 3; x "!l : o (/ -:I EE;= Xl LLLa !t : Hx. z-l->^aE;.9 ac)otr= L ?3 a, ll {) O-E *q LO>, eL= Lq):arE E \Fu -Eb-o c! .L q,EtrX. ;, q E ^ .: o -. 6E e -E.e (rilild l- ^,- L\ (Jlr 0n :" k5 $ If the projects are not achieving 100'/. geographical coverage and minimum of 65'/, therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. The reasons for not achieving the above mentioned coverage include: . Failure to access some communities since the distribution was conducted in the rainy season. . Insecurity in some parts of West Equatoria due to a rebel force that rvas there at the time; in East Bahr el Ghazal due to fight between cattle owners and community members and West Bahr el Ghazal due to communal clashes betrveen cornrnunity members and militiamen. . Inadequate available knorvledgeable manpower especially CDDs in Raja and Arveil S/est counties in Wesl Bahr el Ghazal. Plans to remedl,this: . Itnproving and strengthening comrnurritt' participation tlrough mobilization and health educatiou as rvell as motivation of CDDs. . Increasing capacity building of nerv staff and CDDs. . Conducting distribution of mectizan in dry season o Improving logistics to projects at countl,and payam levels. 2.7.2 a a a a a In general, rvhat arc the causcs of abscnteeisrn and refusals and holv is the The nomadic lifestyle for a bid proportion of the population. Travel outside their cornmunities in search ofjob during the period of distribution. Nerv returnees have poor knowledge of mectizan distribution and it benefits and thus refused. Lack of clinical ir-rdication for medical as percei'u,ed by tlie beneficiaries Fear of side eff-ects. 2.7.3. Briefly' describe all knorvn and verificd serious advcrse evcnts (SAEs) and provide in table 7 thc required information u,hen available. There was no report of any SAEs in the entire project during the period. 2.7.4. In case the countrl' has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x l6 WHO/APOC, December 15, 200.1 Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period Not applicable since there were no SAEs reported * SAEs should be verified by project coordinator Sequelea is defined as those cases that have not recoyerctl fullt, from the SAE and are left t'ith lasting neurological or other debilitating effccts. Name of project Number of verified* SAE cases reported Action taken Number of cases with seq uelea Number of deaths NA NA NA NA NA l1 WHO/APOC, December I 5, 2004 $ N -i !(.) -o ooo o O oA o 2 -o O .J =d tro L oL(d (,) 0) '= o- o ; .o^ co d- o E (n Eo L o o F o o o x 0) o z.I!d() q) L o ,o o ,o(g d o .i d 'o o o- d bo o 0,) r') o IMOs= F o6\ -o .o o\ $ yO oon -o o\+\o .o o\ N\o \oo\ N r-- o\ tr-- oo o\$\o o\ o\\c) \o $ t-- \o o\ oo o\ oo c.l ca \ o\ o\ .9 = O,! e G^ G oo\ ,>JooEAF .o a\ c\ o\ c...t .o o\ r c.l o\ ra) c\ .o o\o' c\l \oo\ c.) \oo\ ca o\ =q \oo\ co .o o\ v N .o o\ cd ca O. aa a: aa .o .o 2- Z?o N o\ s oo aa\c A -iN c.l tr- r-O\\o tr- @ o. -t c\ \o ro^ t-- ca$ \\o oo ca a- ..J a- c'.1 aO \o c.I \o tr- co \o ca o\ \o .{-(\ r- a.} ooN @ c!O of co (-.l O aa CA,= -Ee =,4e C.- a?- co oo. @OC\ ra) oo co @ N coO oo v c! ooO v) $@(\ @ v-) $v ca OO oo (-N OOO. Oa\o \o tr- ,j N@ tr-O. tr) c\@ .f c\l .o^ O r O" O $r/) -t <- "1t-- t-. 6i \o\o c- O ca oq 6o:- rOsC -^c>,.. --?a( :! F O "1.(a) $ O n tr) <. t/-) c- oo\o O(/.) co c- O rr) co\o oo OO co ra) c.l OO co c\ c\ ca .o- \o t--q aa N co .o- \o tr- =J:. cr) a.l ca ca (..l aa c\ aa c1 r- c\ ,o^ a7) \o c.l o\ oo C.t\ O\o U) 0) AT eg q) q) Q ob! Lq OY F Z Z Z z z \oo\\o tr) o\\o o\ w a- .o o\9r-\o -o o\ c.j N oo o\ c..i ca oo o\ oo oo + Qo!? '=u0e O-l'^ * ;o : -- 'Jr o* \J z z z z z .o o\ c- N o\ ca .o o\ O o\ -oo\\q $N \o\q r- c\ @ O.\o \ F- oo 't* G):;oai! i.:9= t-a9- =EYZE? a Z z z z z N Oa- co$ N tr-n n ca c1 \oq \o t-- d O c- " E.= <Ee =Ea: E.g < E^E Z z z z z N C\ (a) n .f, @ aoN\o $ c.n \o r-(\ C. r- co ca$ I..,8qo-!o o o= !i L rtEe*1.: s = 3> E3O E Mo &F tr ( 9! os oo @ NNN c.) cn @ ceN o\ @c\ N A @ C\ N t-- t--\$ oo \f,(.n$^ tr) ca t-- \o Nn o\ ca c-n\o ri c- o\ o\ @ o\ o\ o\o\ N N ol N ca N $O N rnOO c..l \o N a- N @ 6l o\ N I C) rh l-tr Ciior= ()6 eE U:,Q.= t-9 F,GJ Utr ?= E 0,' CJ :, tro (HOlI c)6lH .i=1 s L f-l! f =t uc) o^Q.. E o) - ),! LE!t-=-d)=oon:HL!-E - - -x-V U .9 c i.E - L l'-E ! !t : c! Ej:l : ,i '91 E F qr bl dUF-l^tr E cql ;E l- ol tr ^ - l'rUd ll ":L - -r:ec(orXq! o ao.=o a06r oLL9-;i^ -4Y*U 6l'.. -ts -:0) c(EtaE o tr\J! l- c!-(-- oq.)iS€ -!L-atcE X EH-v:rH-aIYHL. a.A ,.rX!9- E=US = c)-L ci rtz.E!iE 4..O) -.261 cl-r .x0)l;.in cq =l =.-!lHt--= 6l : e.i5Fl u 2.8. Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project superuised, date, b1,whom, objective of supervision mission, outcome, follow-up needed) Table 9: Supervision undertaken by the TA/SSOTF West Bahr el Ghazal East Bahr el Ghazal Project Name Supervisor Date Objective of supervision Outcome/follot,-up needed National Coordinator and NGDO Coordinalor. Februarl, 2009 To ensure that clean and updated data for 2008 from the counties and planning lbr the supply of the next treatntent cvcle. Data collected and the mectizan needs for 2009 was prepared and ordered. Finance/Adnrin Assistaut National Coordinator. NGDO Coordinator, Technical Advisor Juli'2009 To lbllorv up on lund disbursement to the project and rnonitor for proper use Prourpt compilation and tirnell, submission ol' returns of vouchers r.vas stressed. and on job coaching took place August 2009 To rnonitor the progress of the level of the level of CDTI training and to assess mectizan distribution and also to find out the numbers trained staff available for implementation of CDTI activities. Tl-re trainings were fotrnd to be going on as planned. The pro.iect had already, placed the mectizan irr the CDTI cornmunitics ready fbr treatment. Some of tlie trained CDDs had begun getting involved in distribution more training still had to follow. Finance/Adrnin Assistant August 2009 To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers rvas stressed. and on job coaching took place West Equatoria National Coordinator. Technical Advisor November 2009 Discuss ivith the state authorities on the need to have CDTI staff and activities integrated into the PHC system. To validate and collect village listing, monitor distribution and retrieve treatment and data Some staff got enrolled onto the government employment systern. The required data rvas received and compiled for project use. t9 WHO/APOC, December 15,2001 Finance/Admin Assistant November 2009 To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers u,as stressed, and onjob coaching took place East Equatoria NGDO Coordinator, Technical Advisor October 2009 Follow up of mectizan distribution and treatment coverage Disbursement of capital equipmenl (bicycles) to the community fbcal persons. Project information was received for future planning. Work support items were delivered to the intended end users. thus tulfilling their intended purpose. Upper Nile NGDO Coordinator. 'l'echnical Advisor Ivlay 2009 Delivery' of mectizan and w'ork support items to tlie project sites F-ollori' up o1' training activities and conducting advocacv visits to the goverrunent authorities. Enabling environrnent for project implementation created Flave CDTI integrated onto the PLIC sy,stern FinanceiAdmin Assistant Mav 2009 To follorv up on fund disbursement to the project and monitor for proper use Prompt cornpilation and timely submission of returns of vouchers rvas stressed. and on.iob coaching took place 2.8.1. What x'ere the main issues identified during supervision? In addition to the objectives that the supervision teams went out rvith. a number of additional issues rvere identified: o Insecuritv and flooding were delaying mectizan distribution in some places. . Poor comrnunications rvithin counties and distances are very far apart from one village to another. . Some communities were without CDDs and therefore not receivir-rg treatment. . Inadequate number of CDDs hence long time in completing distribution since each CDD has to cover rnore people. . Poor data management and inaccurate population figures and irregularities in treatment data in most records and registers. . Community tre'atment registers not available in all villages 2.8.2. Was a standard supervision checklist used? It rvas not being used universally by the Payam Supervisors 2.8.3. What rverc the outcomes at each level of CDTI implcmcntation supen,ised? . The concerned individuals were coached on rvhat to do. 20 WHO/APOC. December 15, 2004 . Improved performance noticed during follow up visits. . Community not willing to provide registers. 2.8.4. Was feed-back given to the supervised, and hon' was the feedback used in improving the overall performance of the project? o Yes, on the spot discussions were done and the findings were shared with them through email and phone. 2.9. Community self-monitoring and Stakeholders Meeting able 10: Communi t1, self-monitoring and Stakeholders Meeting NB Not all rhe comntunities in the C'ounties (LGA) conductcd CSM and SHA,I, but at leost all the counties lrud sorne represenlation of both lhese aclivitie.s happening. Describe hou' the results of the communitl' self- monitoring and stakeholders mcetings have affected project implementation or hox' thet, rvould be utilized during the next treatment cycle. It is expected that the communilies rvill: o Gradualll'take full charge of the deliverl,of the CDTI activities in their comrrunitl, Iike have new CDDs selected without necessarily having the Health staff facilitating. . Demand for mectizan rvhen there are delays or if some communities are inadvertently, left out during the distribution of mectizan. o At a later stage begin conducting advocacy campaigns for the CDTI program. 2.10 Compliance to long-term treatment with lvermectin Mention specific activities in the Table I I that the NOTF has done to ensure that CDTI projects comply u'ith long-term mass treatment with ivermectin? (For projects 4 and above years old) Table l1: Activities that promote compliance to long-term treatment rvith ivermectin Objective Specific Activities Project targeted 1. Promote Integration of CDTI ',vith other health care services Meeting with policy/decision makers on absorption of CDTI staff into health system East Bahr el Ghazal and West Equatoria 2. Maintain high therapeutic Increase in the number of East Bahr el Ghazal and Project Name Total # of LGAs/Counties in the entire project area No. and % of LGA/Counties that carried out self monitoring (CSN{) No. and % of LGAsiCounties that conducted stakeholders rneeting (SHM) East Bahr el Ghazal West IJquatoria L-ast Equatoria tJpper Nile S/est Bahr el Ghazal 4 6 7 6 l0 4 - 100% 6 - t00% 7 - 100% 6 - t00% l0 - t00% 4 - t00% 6 - t009/,, 7 - 100% 6 - 100% t0 - 100% TOTAL 33 33 - 100% 33 - 10001, 2t WHO/APOC, December 15, 2004 (>65%) and geographic (100%) coverage CDDs and community mobilization and health education West Equatoria 3. Promote strong community orvnership Involvement of more Community members especially women groups East Bahr el Ghazal and West Equatoria 4. Promote high goverrunent commitment Aggressive Advocacy to key government policy/decision makers. Meetings rvith gor,'errunent officials rvith a prepared work plan. East Bahr el Ghazal and West Equatoria 5. Support strong partnership Addressing the issue of partnership betrveen endemic comnrunities and health svster-n and therr roles in CDTI East Balir el Ghazal and West Equatoria 6. Put in place a strong IEC strategv that encourages continued treatment Not yet done extensir,'elv due to limited rcsources. East Bahr el Ghazal and S/est E,qtratoria SECTION 3: Other activities of the SSOTF 3.1 Describe an1, additional activities undertaken b1, the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination n'here applicable, etc). There was completion of the REMO and RAPLOA exercise that was begun in 2008 in all the fir,e project areas. A total of 126 r,illages u,'ere targeted during the exercise. 3.2 What rvas done to coordinate CDTI l'roject activities? These were mainly through joint budget development plan, holding planning meetings belbre distribution, exchanging information as appropriate, requiring projects to submit monthly reports to SSOTF of their monthly activities under the guidance of technical advisor. AIso SSOTF shares rvith other partners CDTI activities during meetings or conferences. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues date, participants, outcome, and constraints faced follow-up needed) addressed, . The annual program review and plan meeting took place at the beginning of the vear. . Meetings with project coordinators and the county supervisors to revierv the performance of the CDTI projects and aim at improving coverage. Note meetings attended to provide technical input to other projects, other countries, or other sectors. The rneetings that were attended by SSOTF officials include: . Trvo eye care meetings that took place in April 2009 and a second one in September 2009, both were held in Juba. 22 WHO/APOC, December 15,2004 3.4 a There was also a NTD stakeholders meeting convened by Malaria consortium and MOH - GOSS that took place in Juba. Other country: SSOTF/MOH- GOSS was represented at the 15th JAF meeting that took place in Tunisia and was attended by the SSOTF Chairman, The National Coordinator and the NDGO Coordinator. 3.5 Briefly statc any administrative duties undertaken - Number and type of reports reviewed (technical, linancial). - Reports tbrrvarded to APOC management. - ,{drninistrative assistance or trouble shooting lbr projects. 'fl.re financial reports uere subnritted to APOC managelnent in 2009. SSOTF and-feclnical Advisor assisted the various projects in preparing and lbrrvarding 2008 TCC reports to APOC. 'fhe 'l-echnical advisor's SSOTF nronthlv rcporls rvere subniitted to APOC and partners. 23 WHO/APOC, December 15, 2004 3.6 Insert the PIan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. Project Name - SSOTF YEAR (5), 2009 MAIN ACTIVITIES *Planni ierv meeti * SSOTF coordination offi ce Dec + ona I ect area) 'Stakeholders tneet commun Procurement of materials +OV lres *Ad * SSOTIT cooril rnatron offlcc *Re onal Defined ro ect area) *Coun +P TRAINING TSSOTF coordination of fi ce * Traini of CDDs * Traini oI * Trainin of cornnrun leaders + Trainin of health staff/ ASSESSMENTS * KAP studies ln new areas *Revierv of tEC materials HEALTH EDUCATION SESSIONS * Commun arvareness/tar * School health education/tar * Churches Census Census U Dr De lies Mectizan + for SAEs IVERMECTIN DISTRIBUTION r Ivermectin Distribution *Distribution of rninor side effect d lntroduction of CSM/ SHMs .C Health nts . NGO h t Train olCDDs and others ' Local Health X X S 'CSM/SI-IM in commun Uo u treatment. treatment. SAEs,/M inor side elfect 'Supervision of CDDs, P. sup.& -oun Su X X X Nov Dec Jan Feb Mar Apr NIay June Jul Aug Sep Oct Nov X X X X X X X X X X x X X X X X X X X X X X X X X X X X X X X X X X x X X X X X X X X x X X X X X x X X X X X X x x X X X x X X X X x X X X X X X X X X X X X x X x x X X 'SSOTF coordrnation office 24 WHO/APOC, December | 5, 2004 *PCOsiRTF ,TP isors *Data collection *SSOTF coordination offi ce +PCOs * * CDDs d *PCOs *P SU ISOTS + CDDs M-onthly financial reporting diture *SSOTF coordination offi ce PCOs / RTF Preparation of rnid term/ annual technical rt "SSOTF coordination offi ce PC RTF *A on for Mectizan *SSOTF i PCOs In dent Monitorin *SSOTF/PCOs/RTF S x X x x X X X X X x X X X X X X x X X X X X X X X X X X X X x X X X x x X X X x X X x x x X X X X X X X X X X x X X X X X X X X X X X X X X X X X X X X X X X X X 25 WHO/APOC, December 15, 2004 3.7 PIan of Action for 2010. ro t Name SSOTF HQ ears Year Six 2010 ACTIVITIES Ql Q2 o'l Q4 *Plannin meetin *SSOTF X onal X Count X X *Stakeholders meetin s/communit x X X X curement of materials *OVsu lies *Advoca X X +Re ional X X Co X X Pa NING X * Trai of CDDs X X + Training of supervisors X X * Training of community leaders X X * Training of health staffi X X Management / SAEs X X ASSESSMENTS + KAP studies in new areas X * Reviewof IEC materials X HEALTH EDUCATION SESSIONS * Community arvareness/targets X x X X + School heatlh education/targets X X X X * Churches X X X X ensus nsus U date X X X Deliv /Su tes ectizan tS X *Drugs for SAEs X X Setting up of referral systems *Strengthen up referral systems b/w communities, PHCUs, PHCCs and hospitals for SAEs X X CTIN DISTRIBUTION * Ivermectin Distribution X X +Management of SAEs X X ntroduction of CSM/ SHMs X X * Cplqty Health Departments X X * NGO partnership X X +Tr of CDDs and others X X + Local Health stems X X +CSM/SHM in community X X 26 WHO/APOC, December 15, 2004 * TSSOTF partners u treatment. Mop up treatment X X Management of SAEs X X *Supervision of CDDs, P. supen'isors and County Supervisors) SSOTF x X X X PCOs/RTF X X X X * Payam supervisors X X X X *Data collection X X X X * SSOTF X X X X xPCOs X X X X * Payam supervisors X X X X * CDDs X X X X *Reporting/ drug managcment * SSOTF X X X X +PCOs X X X X * Payam supervisors X X X * CDDs X X X X X Monthly, financial reporting experfditure X X X X SSOTF X X X X PCOs / RTF X X X X Preparation of mid term/ annual technical report X X SSOTF X X PCO / RTF X X *Application for Mectizan X +SSOTF / PCOs X INDEPENDENT MONITORING X X *SSOTF/PCOs/RTF X X *Mid term rcviqv * SSOTF / RTF X *Evaluation * SSOTF / RTF 27 WLIO/APOC, December 15, 2004 v c.l -i ! 0) -o E oo(.) o (-) o o. o :E @ c.l O (.) 4 0,) -o -o o. ats- oJ= i\Ja 6J-a= a-1d5 to ()(H cn o) .c,a tro J{j .= o) a9 Oo L - (_) (J fr-o =d o - (Jd # o-, at-0j)l<! ootr ttl 0) OJtr ZU oo C) a.) 0) o U) (.) o F U 6 U) q) d c! u)2 oo 0'- LO Ect e= cda tu (.tl;I r< dl+Fl F Q a !+ z FU F]a q) a 0) q) U) c) C) U a q) O O O O a O O O O O O O >.9 (r= Ug O C O O O O o rsA za r: @ o.l tr- n .o^ Oq (n vl O A.\o v O aa +(..l O. Oq $ ao al$ ra@@ ap d c) A) z U)o tr 6a 9-g a a() tr cO a qr cd a ao t<(d cda G+i a a o L cda !Hg 6(n (n o ti cr) !Hw a O -i \o oo oo 'a ! o.(H o o E cg z (d N(d o L FO a(d H li o d ir.l U)() ! o ct fr.l cndr! o =z li C) o. a. D N (.) H (! EO (/) 6) B t!Fc U) a F If there are problems with release of counterpart funds, horv rvere they addressed? Comments: . Government of Southern Sudan is only addressing few staff salary in the budget and no fund is budgeted for any programme activities including CDTI projects. State the number of projects that had no funding from APOC Trust Fund? . None. All the five CDTI projects plus the Headquarter project received funding frorn APOC. State the number of projccts that had no funding from an1' outside source? . None. All have supplementarl, fu.6r from CBN{. State the number of projects that arc late in submission of the financial reports to APOC? . All 4.2 Other fbrnrs of comntunity support Dcscribe (indicatc forms of in-kind contributions ol'communities i1 any) . Provision of venues/slielters Ibr community leaders meetings and CDDs training. . Some communities do the mobilization and sensitization of their orvn people. . Communities collect lrrervood. u'ater and also cook for CDDs during the training. . Some communities store drugs and provide good security awaiting rnass treatment 4.3. Resourcemobilizationefforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. . Submission of rvork plan to tl-re Ministry of Health, which includes salaries to the pro.iect offices and headquarter and other suppofi of CDTI activities. TIie outcome was negative as there was llo release by the government. 4.4. Expenditure per activitl, b1,the NOTF secretariat - lndicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency - 2.4sdg 29 WHO/APOC, 24 November 2003 Table 13: Indicate how much the NOTF secretariat project spent for cach activity listed below during the reporting period Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry' point to projects. districts. etc Monitoring and supervision of CDTI Projects Training of Project offlcers. TOT, NOTF stal1, etc. Advocacy visits to health and political authorities at national level IEC KAP stuclies. tnaterials developrnent. Amual revieu' rvorkshops Bi annual NOTF meetings/conlerences Fuel and tnaintenance of Vehicles. Maintenance ol' olfi ce equipment Stationerl' Others/Salary by MOH-GOS S 434 00 I 1.825 20 0.00 730 00 7.3 89 17 0.00 0.00 7..163 80 690.00 I.l6t 00 13,700.00 0.00 0.00 0.00 10,205.26 000 0.00 0.00 2139 0.00 0.00 fi 00 000 0.00 0.00 0.00 18,600 0.00 12,013.25 0.00 0.00 6.000.00 0.00 0 0 (.) 0 0 0 0 0 0 0 TOTAL 43,393.47 l8,600 28,,278.51 0 Total number of persons treated 3,ol2,o5g Comments - None 30 WHOiAPOC, December I 5, 2004 6. Others Photoco b Cash safe a a 4.5. Equipment Table l4: Status of equipment of NOTF Secretariat Project The SSOTF headquarter office: Apart fiom National coordinator. Deputl,National coordinator. and administration and finance officer and one driver, other stafl such as Data Manager, Secretary, logistician etc are lacking. The CDTI project offices: There is generalshortage of manpower in the project coordination offices. Only PCOs are involved in technical matters as they have no assistants at state project level. Most project coordinating officers are not yet good in producing good annual technical reports due to their low educational ler,'el. This is considered a serious matter for good CDTI management at project level. East Equatoria project coordinating officer has the least abilitl,'to produce readable report though he is striving but highly limited. Project supervision centers: Most of the CDTI project County supervisors (COS) have worked as CDDs in the past and hence promoted to supervisors. However, they don't have a basic education background and therefore, a lot of coaching is required and the number per county should be at least 3 persons for good supervision. Community level: At the end of 2008, the population / CDD ratio is 810 persons per CDD. This is an improvement rvhen compared to 2OO7 although the figure is still high compared to APOC standard of 100 persons per CDD. *Condition of the equipnrcnt (Functiona[, Currentlv non-lunctronal but repairable. Written off) Horv does the project intend to maintain and replace existing equipmcnt and other materials? This will come frorn government counterpart funds rvhich is hoped rvould be available in very near future as the sy,stem is stabilized. Describc the adequacy of available knorvledgeable manporver at all levels a a Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is rvhat measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower rvas available or staff often transferred during the course of the campaign). 3l WHO/APOC, December 15,2004 Sou rce Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currentll, Non Functiona I but repairable Written off l. Vehicle 01 0 0 0 0 0l 0 0 2. Motor cycle 0 0 0 0l 0 01 0 0 3. Cornputers 0l 0l 0 0 0 02 0 0 4. Printers 02 0l 0 0 0 03 0 0 5.Fax Nlachines 0 0 0 0 0 0 0 0 0r 0 0 0 0 01 01 0 0l 0 0 0 0 .0 0 0 c)Lap top 0l 0 0 01 0 02 0 (.) This is not the situation in Southern Sudan in the period under review because staff transfer does not occur. However, in cases where a gap has resulted as a result of sudden staff movement, members from the nearest CDTI are asked to cover. 32 WHO/APOC, December 15, 2004 O e ^l o _o d o z i cl O o o- o 0) -o c3 O o. o. oJ '" d"7 Q-() 7i qr .2tr o) qA otrr U9 .a ca O, >) .) E 2Z oea.r9.r3 >cdH c(>rE6E .* I bbobo o0 >, ;i,:< A. I U L C) bo?tr ,F (, 9) r() 4 v9 -bn -v LE J x9 l!9 bo= H g Lq, \JL ! -\rv!IC)dJ A Lrv)' !:* Ll .q, =,9E F;ac, o)dq)U rP ta: rE e -4t./ - .Fq E: 5€ = HL e'; Eg 5U.i - Ll €L /teU)LH >>e( >':3 ={r>L(Jd =e s.o i' ao c! o' IALHE'i r* EH A .- U lY - s 6r a.--LIOO :!tt -EIY*u)oa.*'ir ,d) l- !-: O(n-e Eg Es E L 6 E*a.a o ^ n - I g a! €.-cqE '=E B = q >',.Y (H = r.rr CH o I. g Glfl !Er* -ft9 .P = ,,>A frau - 6ZB AAE -X E '-', ,iil -,,1i oilt7l El Fr etlatn Fl (\r aa !f, ra [a rn -o o ./qELC: ., \J OJ Q. -.o tr1.) -L U =^C 8,7 ,? i., ; a,"q -= !2O-o oJ d E'* :6 lvaco ,-=y L C) Feo OJUdO..= or()c>. € o- d-=E tr$ E ca tr-:J o 6)c;iP.i= rdJ^ .:Lrc0c!\<=>0JAao>, . >r-F53EL >. * H'r p'- Q Y6J v II.i ,?'A a CHL'i^ <cdXX .-,6HF o c! z o 0) 'e p k I 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) . There was no plan yet even though all the five projects have reached three years. This is because of the situation in Southern Sudan. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. No plans yet. 5.2.2. Funds No plans yet 5.2.3. Transport and equipnrent (replaccment and maintenance) No plans y,ct 5.2.1. Human resourccs No plans 1'et 5.2.5. Which projects have submitted sustainahilih' plan? No plar-rs -v"et 5.2.6. To w'hat extent have the plans becn implemented? No plar-rs 1'et 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and thc plans for complcte integration. 5.3.1. Ivermectin deliverl' mechanisms Ivermectin deliverl,systern is separate from other drugs in the PHC system as a result of non integration. The Ministry of Health of Government of Southern Sudan is yet to have an integrated drug delivery system involving all drugs. There is a plan in a feasible future of overhauling the PHC drug delivery systern probably in 2010. 5.3.2. Training There was no integrated training yet rvith other progralnmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff are not rninistrr of health staff and the CDTI has not been taken fully over by all state ministries ol' health. There is a sign that integrated training of programmes such guinea worm eradication and onchocerciasis control and other NTDs would be a reality in 2009. 5.3.3. Joint supen'ision and monitoring rr'ith other programs There was no joint supen,ision and monitoring with other programmes yet. There is a very high probability of NTD integrated supervision and monitoring fbr cost effectiveness. Already, UNICEF and WHO and Ministry of Health are trying to bring this through the mass measles and polio campaign. 5.3.4. Release of funds There are no funds available or released to any programmes but rvith stabilization o1 health systern, there is chances that common budget and release would be possible in Southern Sudan over time especially through joint NTDs fund release. 34 WHO/APOC, December I 5, 2004 5.3.5. Is CDTI included in the PHC budget? Yes, CDTI is included in the PHC budget; some salaries are included. What remains to be included is the direct implementation of CDl'l activities. 5.3.6. Describe other health programmes that are using the CDTI structure and how'this ryas achieved. What have been the achieyements? No other health programmes in the Ministry of Health are using the CDTI structure. I-lowever, it is being considered for the implernentation of Integrated Essential Child Health Care (IMCI), and distribution of irnpregnated nets as rvell as other neglected tropical diseases control. 5.3.7. Describe other issues considered in the integration of CDTI The CDTI strategv could be used in managernent and control of lvnrphatic trlariasis through albendazole drug distribution alongside iverntectin. 5.3.8. Describe the integration of othcr progranls into CDTI in y,our countr.l, and the results of this integration on CDTI (e.g. Is Vitamin A supplemcntation integrated and rvhat arc the resutts, is screening for cataract of primarv eye care inten,cntions intcgratcd in all or some projects, if no integration has taken place, are there plans to pilot test a strategl,, ctc?) No integration yet but there is plan to pilot integrated Multi Drug Administration in three counties of West Equatoria rvith the integrated NTD control programme for the control of lymphatic f-ilariasis using albendazole. 5.4 Operational rcsearch No operational research rvas carried out 5.4.1. Summarize in half of a page the operational research untiertaken in the country arca x,ithin the reporting pcriod. Not applicable 5.4.2. How were the results applied in the project? Not applicable 5.4.3 Note the issues that have operational research. been identified b1, the NOTF for future KAPs in the new CDTI areas . There is no identified nerv CDTI areas )'et hence no KAp studies 35 WHO/APOC, December 15, 2004 SECTION 6: Strengths, weaknesses, challenges, and opportunities Strengths The presence of the WHO/APOC Technical Advisor to support the SSOTF and the CDTI projects. Staff commitment to get their work done. Good working relationship with CBM in regards to drug procurement and delivery WHO/APOC offrce in very, useful in hastening fund disbursement to SSOTF and projects. a Weakness a a a a a a a a a Available nlanpo\\rer is still inadequate not rvell knou,ledgcable. Nonpayrnent of salarl' ol most CDTI staff by the government. Census update not completed in virtualll,all CDTI projects. Still there is non availability of registers in some communities Poor state of roads rvith resultant high rvear and tear of the vehiile. Frequent insecurity in project localions disrupts treatment and therebl'leads to lor,r'coverage. Distribution during rainy season renders many areas inaccessible Frequent break dorvn of motorbikes and project vehicles due to poor maintenance. Irregular and delay in fund release imparts on field activities a a a Challenges and how they were ad Inadequate staffing and knowledgeable manpower in the project area. There is deflcient staff strength across all levels and SSOTF has planned to continue rvorking with the state ministries of health on recruitment of the missing staff. Non availability of CDDs in some communities. This matter was discussed at a meeting with community members as discovered during SSOTF supervision and new people were later recruited and trained. Non integration of all projects and non absorption of some CDTI staff into the ministry of health. Effort has been towards this through meetings with and Ietters to government top policy/decision makers in Government of Southern Sudan Intensifying health education and comrnunity mobilization. This rvas used to diffuse beliefs on the mectizan and those rvho previously refused now accepted treatments. Population/CDD ratio in the entire countrl, is still high. Although this has been reduced but communities without CDDs are being encouraged to get CDDs and those with less number of CDDs to get more CDDs. High cost of Transport system in the whole South Sudan. fhe road condition is still very poor with consequence huge cost of vehicular maintenance due to frequent break down. a a a a a 36 WHO/APOC, December I 5, 2004 Indicate how onportunities can be utilized to imnrove CDTI The continued peace and stability in southern Sudan has offered platform for community penetration and further improvement in both geographic and therapeutic coverage. NfDs control offers an opportunity lbr utilization of CDTI structure and thus leading to popularity and prosperitl,of mectizan distribution List the strengths, t'eaknesses, opportunities and thrcats of the vector elirnination project (rvhere applicable). 'l'his is not applicable since there u,as no vcctor elimination conrltouent in Southern Sudan. a a a a 37 WHO/APOC, December I 5, 2004 a