Northern sector CDTI project six months technical report to Technical Consultative Committee(TCC) : 1st January to 30 th June 2004

,RESERVED F OR PROJE CT LOGO/HEADIIYG ORIGINAL : English I I COUNTRY/NOTF Sudan Proiect Narue: Northern sector CDTI Project. Approval year: 1996- 1997 Launch ns vear: 1997 Renorting Period (Month/Year): J 1't 2004 - June 30th2004 Date suUrnittCIt Sdn.fuly 2004 NGDO partner: Global 2000 - Carter Center SIX MONTHS PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) h (uooUo li 20040 2 AOUI /i I \1, tbi ..i \ +,r .f AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL, (APOC)tt,:, ,illl I WHO/APOC, 26 September 2003 i I l- I I I SIX MONTHS PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country ' Sudan National Coordinator Name: Prof. Mamoun Homeida Signature: Datc: July l4'n 2004 Provincial/Commissioner Health Inspector Name: Dr.Ahmed Bilal Osman. Signature: Date: Julyl5th 2004. This report has been prepared by Nanle : Dr. Tong Chor Malek, Designation : Senior Field Officer Signature: Date July 1Oth.2004. This report has been revised by Nun-,. : Prof-. Manroun Horr-reicla Designation : National Coordinator Signature: Date Jul v_I ll 10rh.2004 WHO/APOC, 26 September 2003 Table of contents ACRONYMS DEFINITIONS. FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY............. SECTION I : BACKGROUND INFORMATION.. Ll. GeNpRelrNFoRMATroN................... l .l .l . Description o/'the project (briefly) I . I .2 . Partnership .... .... 1.2. PopulerroN AND Hpalru sysrEM.. 2 .... ERREUR ! SIGNET NON DEFINI. ERRBuR ! StcNrr NoN DEFrNr. Erreur ! Signet non ddJini. Erreur ! Signet non dd/ini. IV V I 5 6 2.1. Peruoo oF ACTrvrrrES............. ............ 6 2.2. ORoeRrNG, sroRAGE AND DELTvERv oF IVERMECTTN ............. 8 2.3. Aovocecy aNo SeNsruzATtoN ......... 9 2.4. Moert-tzeloN AND HEALTH EDUCATToN oF AT RtsK coMMUNrrrES .........9 2.5. CoUvUNtIESINVoLVEMENTINDECTsToN-MAKTNG 2.6. Cepacrry BUILDTNG 2.6.1. Training.... 2.6.2. Equipntent and hunrun resources CoNorrroN oF THE EeutpMENT x PLpasE srATE 2.7. TREerH,rpNTS.............. 2.7.1. TreatntentJigures.......... 2.7.3. Trend of treatntent achievententfr"orn CDTI project inceptiort to the curuent )'ear ........Erreur ! Signet non ddJini. 2.8. SupBRvrsroN............... ...................... 20 SECTION 3: SUPPORT TO CDTI SECTION 2: IMPLEMENTATION OF CDTI....... 3.1. FrNeNctel coNTRIBUTtoNS oF THE pARTNERS AND coMMUNITTES 3.2. Orunn FoRMS oF coMMUNrry suppoRT............. 3.3. ExpBNotruRE PER Acrtvrry SECTION 4: SUSTAINABILITY OF CDTI 4.1. INreRNal; TNDErENDENT pARTrcrpAToRy MoNtToRING; EvALUATIoN........ 4.2. CovuuNrry sELF-MoNrroRrNGello SrarpHoLDERS MeErrNc 4.3. SusretNaetLITY oF PRoJECTS: rLAN AND sET TARGETS (MANDAronv ar yn 3)4.4. INrpcnarroN............ 4.5 OpgnauoNAl RESEARCH SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES.. 2t 21 2t '',1 )) 22 22 22 22 22 23 lll WHO/APOC. 26 Septenrber 2003 Acronyms AMST APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo Academy of Medical Sciences & Technology African Programme for Onchocerciasis Control Annual Treatment Obj ective Annual Training Obj ective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivernrectin Comrnunity Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization IV WH()/APOC, 26 SepteurbeL 2003 Definitions (i) Total ulation: the total population living in nreso/hyper-endemic cotttnlunities (ii) within the project area (based ort REMO and census taking). Elrgible pspu.lalan: 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 Ivertnectin itr a given year. (iv) Ultimate T nt Goal (UTG) calculated as the maxitnum number of people to be treated annually in meso/hyper endenric areas within the project area. ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identrfied by REMO in the project area (this should be expressed as a percentage). WHO/APOC. 26 Septenrber 2003 FOLLOW UP ON TGG REGOMMENDATIONS TCC session: 18th. TCC recommended: 1. The project: a. Provides details on CDTI Implementation, training, integration, monitoring and supervision. 2. Revised report to be submitted to APOC management in accordance with the above recommendations. Actions Taken b the Pro ect FOR TCC/APOC MGT USE ONLY TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT Number of Recommendalion in tlte Report(l) (2) WHO/APOC, 26 September 20031 Executive Summary Sudan has experienced Onchocerciasis as a public health problem for a long tirne. APOC management conducted REMO in 1991, which had shown the high er-rdemicity in southern Sudan, particularly in Western & Northern Bahr el Ghazal, Waraba, Lakes, Western & Eastern Equatoria and Bahr Al Jabal states, and Southern Darfour in Radourn area. There is also a focus in Abu Hamad area in the far North. APOC management approved two CDTI projects, one served from Khartoum for GOS controlled areas and another one served from Nairobi for OLS and this serves the areas under the control of SPLA. In 2003 APOC managed to cornplete REMO in the endcmic regions wliich were out reached dr"rc to conflict in Sudan, and which were only accessible througli OLS. As a result, other 5 CDTI projects were approved and will be launched in Septen-rber 2004. NOTF is taking the lead in contacting SSOTF, Global2000-THE CARTER CENTER, & CBM to plan for a joint coordinating meeting in order to join efforts for the implementation of the existing & new CDTI projects in Sudan. Activities started this year in January, & run smoothly according to plan, up to now the number treated is 253,089. These figures show a much better performance in comparison to that of last year with therapeutic coverage of 45o/u out of total population . & 66% out of ATO. 357 communities were covered with 58% out of our target 618 communities. ln training: 396 new CDDs were traine d 143% of Target 915), & retraining: 666 CDDs. One advocacy workshop were conducted in Juba for community leaders, which was very successful and has immediate result in term of coverage, 80,892 persons were treated in two months time in Juba town alone compare with 28,000 last year for the whole Juba area. This year a very refined data base was developed to enhance the quality of reporting systelll, more break down of communities is available r-row [326 of last year became 618] assuring easily tracking of information. APOC new data template requested more information which is being used now. APOC management conducted Impact assessment in Raja in the period Aprill4th -MaylZth 2OO4; the Objective of the study was to evaluate the long term impact of CDTI on transmission of Onchocerca volvulus. The final result of the study is yet not out but the preliminary result shows the reduction in cases of the infected persons. We have not received any funds from APOC for the year 2004's activities. Treattneut is still ongoing. The present format does not allow comparisott with previous year. A joint coordinating meeting of River blindness and Tracholna was held in Khartoum on the 27th.June 2004; it was attended by NOCP members, Cater Center Global 2000 in both Nairobi and Atlanta This year a very refined data base was developed to enhance the quality of reporting system, more break down of communities is available now [326 of last year became 618] assuring easily tracking of information. APOC new data template requested more information which is being used now. 2 WHO/APOC, 26 September 2003 Sectionl : background information 1. I General information : 1.1.1 The project area: Onchocerciasis is mainly found in five major different areas in the country the most affected area is Greater Bahr Al Gbazal region, endemicity here varies from almost 80% to l00o/o, Wau, Raja, Aweil and Kalthok in lakes another part is greater Equatoria which includes Juba, Terekeka, & Toreit, and Radoum area in southern Darfour another focus ts in the far north in Abu Hamad, with the displaced camps in Khartoum. 80% of the population affected is in the southern part of the country, out of which 40oh is found in the GOS area, another 40o/o in OLS area and approximately 20uh is inaccessible by both sides [gray areas]. In GOS areas access to affected persons has been only through the major towns and its environs. South Sudan is a savannah area rich with heavy rain falls and many fast running rivers containing rocks, which provide the perfect paradise fbr the black fly. The geographical pattern of the area during rainy seasons affects transport negatively leading to complete blockage of some roads, isolating some communities for a period of 6 months and sot.ne areas could only be access through air which is very costly and not possible to all destinations. 2 million persons are at risk of Onchocerciasis. They mainly depend on agriculture, keeping cattle with a few fine hands crafts. There are several tribes speaking nlany languages and dialects with different nonns, traditions and customs. Sudan is divided into26 states, The states are divided into localities and localities into administrative units. In its health system, each state has a minister of health, a comminisioner as the head of the locality, and an executive director as the administrative figure in the administrative unit, where, under locality falls local committees which are mainly a village set up following a common clan ancestry and / or some similar culture group. The village is headed by traditional sultan with some assistants and advises from elders and some wise persons in the clan. Most people respect the chief and execute all his instructions. The situation differs in urban areas where people live in quarters whicli are lead by chairmen of popular committees with some elected members. Federal Minister of Health State lVIin nf Health I ocalifvI ocalitv I ocalitv Adnrinistrative rrnit Adminisfrative rrnit Administrative rrnit First T,ine Health Facilitv First Line Health FacilitvFirst T.ine Health Facilitv Community Community Cornmurnity Community Community Health system J WHO/APOC, 26 September 2003 Ideally there should be state ministry of health, and state hospital in each state and in the locality there should be locality hospital, while there should be rural hospital in administrative units & some FLHF serving group of communities in the surrounding, but due to the effect of War, health system has been disturbed and even no government infrastructure existed in some areas, so Oncho Program became an entry point for health services, or NGOs working in the areas partially filled the gap providing health services to the communities. This had affected negatively the CDTI implementation, in the sense that some of the NGOs will say that they have specific mandate. and to implement CDTI they need approval from their various HQs. On the otlier hand CDDs arc beirlg spoiled by the practice of the NGOs paying their volunteers, which reflected a wrong coucept of voluntary work. NOTF had introduced CDTI strategy according to APOC philosophy, and involved the local communities in the implementation of CDTI, that is in decisiort making, plottttittg, selection of CDDs, ntode & tirne of distribution of lvennectin. They are made to understand the mode of transmission of the discase, the vector and how to control the disease. The NOTF / NOCP had facilitated the implementation of CDTI activities by involving ministry of Health at the federal and state levels, and involvement of the local communities through the localities & the administrative units. And made it clear in advocacy workshops that the success of the program depends on the partnership, planning, training, mobilizing, & distributing Ivermectin together. 1.2 . Partnership: The partners implementing CDTI in Sudan Nortliern Sector are under the urr-rbrella of NOTF, which is comprised of FMOH, International NGO [Carter Center] & some local NGOs, Scientists from universities and members from affected contntunities. NOCP-Staff are the executive body implementing the polices & plans of the NOTF with technical & financial assistant from the NGO Global 2000 - Carter Center. They camy out the mobilization, training, and advocacy workshops at the state level, states to locality level, and locality to administrative unit level, and administrative unit with FLHF to comntunity / village level. . For the last five years the Carter Center - Global 2000 worked closely with NOCP secretariat providing administrative and logistics support. States' plans were not done in proper way before, but this point was raised during the evaluation, so in the year 2003 all areas were asked to draw up their plan for the year 2004, which they did with some assistance from NOCP members. 4 WHO/APOC, 26 September 2003 V-) cO a-l o E O o() a Nj o- Y i$' .9gE tv I,o=)-L.rP- .',Cq) lB(, :!:a \ (.)y\ -uL ia i-';.= =\(-).= 2d86 FPUE.a qrgE o9E =()t-x .o : -- -a='.F.|,OEa t9 r oitr J.r-'.] ) ; q €9 itlqJO A^ -dL-O .r N *! -'^v - uP)N c) fv o0 qp b' -s.-v - w S(,) c-D t- y *= r) (J:/^LUi;6 thY()-: t- 19 g .F- ar s a- :'i * .,Zs A\trboo' n, L€; Uh^ -w! L T= =? -,y:{ < :iJl: x\oL^- .='t = s *t= !2 Sd^ogjREEd ': ..': Q .c v .\u_)ts-ao Sb-L H ! L^;i=\ Fi"l-q t.- !\A !L;.boo :\.-6 i \v a) ulcn6!2S \.F - u ^v .. A LQCCooxr, a'-\ .r d --:=..0.)\J =-q)oraiEwi3i=c?R!.o == 9\i o-r\\ 0) =(,\OV-rLa)\ ..= .\!'l l\ * I! o L oc os# o E a-L3E *a o E L o E o# IE otsg oL G ot# L oE# o -] G oL o g(, o 'd Lc oL a-fl E o oE# .= T or-L g G E -O -ar -gg.g0r AB .EeEzGEgr! *O EEIE 'EE5o= a-- +,EcvO ,!irE'l ot -lr-l6! flFFI c.l C.l OO N@ ca \o @ aa O v^) O oo $$ co oo ca F =\> =8.) o.l @ $ tr) aaN t-- @(r) N \o sN \o o\ rr) N N@ $ o\ N ca eaN\ o\ eoN ca \a)N\o^ o\N t--\o 00 oo n" .t N tr-$\$ o\ tr) N odtr) @ \o N ao o\ tr)\o\@ ca\o .t $ t-- <. q, Lrn d :€EIr * E rr * D F Ir-r) o\ ca oo- t--(r) tr) .6) -qro .= o-N ri\ EooiF 3d N t-- c.) =J: F- r- @ t-- ca ca(\ caN tr) \o- \o ca a.)tr) oo^ .t co \o o\ ca @ @ N F-\o$ lr)\o o* oo\o @ oo Ir- c.l c.l t-- tr- c.iN tr-\oq (r) \o c* @ v @ o\ ca ro" ca\o ca , qE E tr-!- &8.=5 >. E €., qJ r:.:!o' -sL v c.l tr- .O n" tr- t-- oo t-- ca $ t--- s o\ cg qrE Et.r!- a-t!E,E; E2 t a,'= -xi ca N cO N r.r) \o ca cO(r) @ $ cA \o ca @ @ N @ tr- a-lN F-Ir- N c.l tr-|r) o\ .O N t-- o\ tr) t-- $ @ \o IL - >iE Y oo:NFTU \o (a)o.l o\ N cA tr) cA $N $ $$$ o .,i"1 i N 9'_P.9 = U -i -L,aE o dE,3: \o (r)N o\ ca N tr- o\ -f, t-- U) o) OT G (t) o I L 0) z 5I3',*o.= ^ Q)q) - ELt=trqJdZqE !! N ca lr) co $N $ V) tr- $ -9c!:.= s) =EEC(iicEqlrf E: iA-9 .-* N r- c.)q tr- t-- oo tr- cO cO N cA N r) \o \o aA catr) oo^$ aa \o o\ a.) oo oo N F-\o$ (l,)\o o{ @\o @ oo F- NN t-- tr- c.lN tr-tr) o\ ca oo ri(r) tr) =0)i E oE Gu '= q,(, U' (\t Y (g E GI .= Eo oJ :o G E GI :(E o, U' a tt(E E(, I o o 't IJJ o0 o o 't o c o oF oc o 't c ul oo N -) (EJ o -t 0) 6)F I o =(,Y (o .Y(, (E dl .g o(g dl a E s oo ri(EJ o .9 .9 = t oF (o 0) Fr U f l! = o ot SEGTION 2: lmplementation of GDTI 2,1, Period of activities The CDTI activities started at different time in the various areas, here are the activities according to the plan. See tasble 2. 6 WHO/APOC, 26 September 2003 O c.l:u -c =u o U) a.l (_, o o :E (a) q) a *o U C) o!_cr 1itr Hq o z oo a () -oo O L() -oo - L q) OT tr trE (, OI o \J tr r- o o c{ o() o bT o o o c{ tr o o o o bo o r'.,) - bI ,E o o o o o o 5T '5 o c o{ c(, o oD_ 1itr a- z o!d z C) ! o. = z (.) o !a q) -o E 0.) o-oa Lo .o (J o.() U) o) G .t) q) q)(J o.5 U b0 o o oo o(, o bo oc c(J (J Cd 2 ox o - - bx o -l b{ '= O o or'l o{ 5 tr o ox o ! a. oo_trl 1-tr Z. r 2. z () L z z. z Z. (d z a q 4 !() -o () o()a a.) .o E() o.()a OI L3 EO U o0 o -) o! o - b0 o o o{ .E o(, o o(, oo a!d z 5TtrE :tr a- (.) d a I I ro cO z a () tr !(o z OI oo = (') ii= r- c)2, trE U o z z tr =a- Z or a0EE 6: (h- !a. z. oH z, z. z. d o. z 2 o(! z, a o{ oo Gq) Lr 5G = c, (ot =o! E f oE(\, u 'tr o o o ll c,Y E(o E GI ftt =Eo o :(\, 0, ah t(, E Gr Il (! I! - (E! 0) .yq, oF .Y o =GY o o 't t! € ooc 't o o q, oF (g .Y(! (E o .9 o(o o E s l! .n d GJ G .9 .9 = t-- a. C) o bo ! oo oo o bo o otr ao a? C4 o)n r () L o C)tiL o() q) C)tr c,(n(.)fr o L € a C) o q< o 0) 0.) E F oil ot -ol(Bt FI I 2.2. Ordering, storage and delivery of lvermectin Mectizan@ ordered/applied for by - Qtlease tick the uppropriate answer) MoHE wHo n uNICEF tr Other (please specify) Mectizan@ delivered by - (pleuse tick tlte appropriate onswer) MOH E WHOE UNICEF E NGDO tr NGDO E Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities After Mectizan@ is shipped to Sudan, it is received by MOH/WHO, and then stored by FMOH - NOCP HQ in the Academy of Medical Sciences & Technology, then distributed to the states by NOCP / NGDO paftner (Global 2000), to make sure it reaches it's destination, because some areas are not accessible except by air, then frorn state will be sent to localities, then to administrative units, & then each community will collect their ratio from the FLHF or administrative unit, or taken to them by the administrative units authorities. Table 3: Mectizan@ Inventory Areas Number of Mectizant tablets Last Year Balance in Field Requested Received Used Lost Waste Expired Balance Remaining in Field Wau 60,548 210,000 210,000 210,548 Raja 4,9t0 80,000 80,000 36,997 41,913 Aweil 12,482 45,000 45,000 51.482 Radoum 16,225 70,000 70,000 55,956 30,269 Abu Hamad Al Kab/Sheeri t3.751 71.000 11,000 90.751 Abu Hamad Locality 678 74,000 14,000 74,678 Abu Hamad Al Sheraik 3.1 00 24.000 24.000 21.100 Juba s,800 181,912 t87,912 t78,499 t5,273 Terekeka 0 55.000 5s,000 17,621 31.319 Kalthok 0 18,000 18,000 18.000 Toriet Province & Environs U 66,000 66,000 66,000 Al Baraka 0 70.000 70,000 48,064 21,936 Al Bashier 14,789 t4.189 Al Salam 2,380 2.3 80 Michigan Lab. 0 TOTAL 134,663 976,972 976,972 337,137 0 0 0 774,498 Mectizan@ is requested & ordered by NOCP / NOTF, & stored in the academy of medical Sciences & technology stores. States make their requests, the NOCP will then send accordingly, and will be stored in SMOH, at PHC stores, then send the ratio to various localities, administrative units, FLHF then eventually communities will make their reqLrest & collect their ratio from the FLHF, & store Mectizan@ at either House of the Chief or CDDs. 8 WHO/APOC, 26 Septernber 2003 2.3. Advocacy and Sensitization In April this year an advocacy workshop was conducted in Juba, attended by l7 members from each administration units [Juba, Kator. Monoki], state Oncho coordinator & the director of PHC in the MOH Bahr Elgabel State and the Senior field officer, the workshop was conducted under the auspices of Bahr Elgabal Locality Commissioner. The out come of this workshop appear clearly in the CDTI understanding by the participants & their willingness of taking all of their responsibilities. For the coming half of the year we are expecting to conduct similar workshops in Wau & Abu Hamad. 2.4. Mobilization and health education of at risk communities Provide information on : The concern communities Supervisors are conducting health education sessions before & during the Ivermectin distribution, which has assist in elimination of the previous wrong concepts about Ivermectin. New HE Package is being developed by the NOCP/ Global 2000, which will be tested in the coming half of the year. Volunteers & Supervisors T-shirts & bags are produced & being distributed with modified HE massages "One Dose Yearly Prevent blindness really" 9 WHO/APOC, 26 September 2003 Oal L(J -o Eo c-(J U) \c c\l :^E tr o bo O o a t- ,oH l-) o a C) o -o a o o a) o r .oH a) o (.) tr a) L a (H € o co o c.) oU o E IIJ G EI E .9 ,9t, oE ,= #-EiOHtl)Ec)o€l.sOtr >.etrErr Il o:gOErrXflur lI q) -o -.i5.: ==LtrEEO.?(,Y $l . o'lnEl| (BlNFI ?A 5-9 9- zl o oo cg o o\ s a] z z \o \o o\ o\ sZ {Z Z z z z Z E.g * i E EXE =EEE Esuz e', c.l z z o, Z Z z 4 z z z z z F 2- E O f r U 2 o o L= 6!'oZ nU Z $ s $ $: a GI c.l N * Z z Z z Z z aO 4 z \o z \o \o c\ \o @ 6l z $ z z \o\o an F- z @r- € {Z {Z Z {z -1Z Z Z aaaDi >o r-e !=o EO L<s7 ze o bo o oa O @ I r cl i 6 f- +C\ 7 Z C\ F v r- n rc $ <. z z @ \o E >.g p ,'ze2 E EE'i EsZl -'.Y L oLEE: - = (r: SEgU -vF!o o\$ N F- N o. N a.t $ r t-N o, F U o .- Z! c! L 0, z o OD o o ..RE=E-tr >^ E! Oa) = f, >- z z.= z z z z z Z Z Z z z o\ ol ol € \o z z 7 z z Z z Z r-rr s z z N z z 3E g 3EEEK2=iF, 6l:€ O- z z z z a.t z o =o E ru 'a t =o ' E f oE Gt }:o)tr0)o-cTO ,-oll ct <Y ! o E} =3.oo <J (! trE:I(E fq,lt .tr <@ o oL 't IJJ od G -, o .Y oL o oF ta o =(I,Y 06 o o 't 9oftr -oo.: 'tr>otrF IIJ GL G Go .9 -co odl Es G ah -oGJ o .9E .9 = F 2.6. Gapacity building 2.6.1. Training Training is the core stone of CDTI, We are targeting 915 new CDDs in our plan of this year, up to now 396 new CDDs were trained in the various ateas l43oh ), 666 CDDs receive refresher training, & l2 Community Supervisors were trained ourt of 88 four annual target]. *: WHOiAPOC, 26 September 2003 C c.l ! C) .o C) (J a € -t (-, c f @ -a € o B br, o a- a s t { \ s< e o cd 0) () F t-.1(-) +r o cn o () ofr ,G) +i 0) (n c.) F O \o O O O O O rna aa d F z N c..l atN O O O O q,) o) Q q) Z O(..lN ca O ra o\ 0) q) cot OO co O O $ o.l 6I a< e q) 0) a o\ t O E, .a =c) d) !Y z L $ o\ N \o @ @ 6@ d F a< .U () !ij H3 tr'> zE c)I F 0) 0) o\ F a< I -a c{ a o0) c)- =E !q. Z>q) cq a F oj (E (ogl .9 o(! o E s Go ri oJ (o .s, .9 = -] F 3 0) 0) q) o\ z (! 3 (E 6 u =oi E =ot,(!t E.-): o)trG)G-tr -U' fttltG <Y E Go oJ E(E E(I, I Il :(E 0, o t,(! E(E I -o G -o a (u .Y 0)!q) oF .Y ot =(!Y .9 oF Table 6: Type of training undertaken 2.6.2. Equipment and human resources Table 7: Status of equipment *Condition of the equipment key: F= Functioning, NF: Not Functioning, WO: Written Off i),t', Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program managenlent How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Disease Signs & Symptoms Source Type of equipment APOC MOH State/ Locality NGDO Others AMST Condition of the equipment * Please state 1. Vehicle 5lF 2lF 2. Motor cycle 6 [l^rFl UF 3. Computers 2IUWOI r0 [5/NF] UF 4. Printers 2n{F 5 t3lNFl UF 5. Fax Machines tlF llF 6. Photocopier llF a) Camera IA{F UF b)O/H projector s f la{Fl l(MM)/F c)Laptop Computer 2 I1lwol UF I,F WHOTAPOC. 26 Septernber 2(X)-.1 The FMOH is now promising to maintain the vehicles, although the running & maiutenance is being met by The Carter Center Global 2000. We have just received a letter of agreement form APOC nlanagement to be signed by MOH. NGDO partner, to meet the cost of some capital cquiprnents. 2.7. Treatments 2.7,1. Treatment figures appear in the following table t4 WHO/APOC, 26 Scptember 2003 O N !o .o =(,) c- o a c\ o I V) (.) o O C) E (.) L. (ts o C) 0) -o (.) li CJ -o a a () 9- € aooOJE 0J ,-a.2 C)bo Lboj EP boh9? -a .?- i: <rEA €osz fls I U) $r U)(n()$r(g (o OJ () ! ch s (h E] a (! (.) E olrF #r ,l -ol(6l FI ! o -E ^!=:r Z ii a rn-- O- # = ! E? HgE = gE 6?2..e 9i Z'o- E'! o zE<S.oTl .a ff-s- z-o E T: E = i, r:: - (! ZE.Hg o!oJOOO <!-Q!:rod !ro- oo -qoF b Pa -:o ="rEz o! Earcoz t9D' F9 -i. ._ - o !2,a9;eeEs .v =a >€ L - o-o E E 6900 o (! o. @ o\ @ o\ o.t s o\ r- F. \o a.t o\r- a.t \o o\ c- \o o\ o\ $ r- oor- $ + ol 6 \o N @ $C\ al @ @ (\ @ o, € cl C\@ <f c.lr- @ (\ \tN \o O ol @ O \o (\(\l rc € s+dl \o 6 O \o cl r- nt-- F- @ t- N a.l \o @ s o\ t-\o$ \o..I @\o € ca € N @\NN r-F- NN r- o\ @ 1-j 9E^ 7 o^ li oo\ooi- 6o O o.:;ir tr h0'Eo56q ! F- d =5>-Z-aa) Eo d o .= n' I -o'FU -oLb :E 3 8-.g : =E'€FE ffi: c >.=; c <di Et E e o bo o .: E(, o\ o\\o o\ o\O o\ o\ \o o\ o'. <- tr- c\O o\& o\ o\ c\O \o @ ol$ $N o\ ON Ir--c.l @ r- \o a{ o\ (\ $cl a\ t-- + F- .:f & \o c.l N o .{. N C\ a- o\\t r- $ @ GoL a o E cd LU!o) Ltn =><v =oJ E T -o a E .il ad E9 <6 .:zo o oF -to =V o L F !,6 o Es a -o ,-.1 bt F ce an () -o a() c- a al l-, c o- 'r \o Qb.\'\ u\ i \0. s 0O \rh t YaJFS -)q!U LE= CC\ <)i(J'\ L\Ysc.A! Crai -E!=; et .; .: aJB_=t 'IG -UqJo::LSU(!Sa .9i:F<$6.:3 I :1S.: 6:: *\: .ef s ,^iFA:UI 'i '+FFi F \Y c .\ il'F'P .E= H:t\g x ssU a .F:'\ 6J ! 3S -o E ti o I l: i! s !_:o- i -u.o € ss o. '= Y\ . = srE T H.:b sss € $ 8ttr \ f,rr <Liv -it\Ltr : .sS cd?-\/6 i Ns .s it '=s- € i:? ^.: %c$! \+ ,\ !\,l: Q,UI r€i arx: .AlE SB s -q\ SE .s'8\ -^!s ss I ll s r. \H ii \ v! X (-) (.) li 0) (H c) q) C) \-,F D o\ c.) O C)5o o cd C)lrF (.) L (.) bo !v^6S o C) oF 0) li C)(.) tr o. 0,) Z El >. .o o ti= o tn a o o (-) (.) 0) o o- acs6J C) L()oE LOoo -o a]A qil =o -Lt ol 6tl!tr|uilF2l (.) li() oo H C) oO O- li bo o(J C)lr cn O() k o. 0) a(.) O o C)v !trxo tr()oy -() ,bE cn 6r()cg CIr o L a= otr c! ,o i1 v ^lro.5 c(st- ==FA) x 0.) 0)L C) o (.) (H o k0) 2 CJI od EI()l ol ol -tsl ,il OI(dl!lbrl ol C)l o{ EI (dt ,-, I (Jl ol(tlLI 0)l -clel bd trl 5l OI EI ol :l €l -l EIi-t ol tr.l o H o 00 l<o oo()^ €^\ () (!L(.) F il ll 2.7.3. No SAEs report in this cycle up to now 2.7.4. Incasetheprojecthasnocaseofseriousadverscevent(SAE)duringthisreportilrg period, please tick in the box. No case to report X t7 WHO/APOC, l0 April 2003 CON = l, o- o :E oo a,)\ \ A,) a erJ qJ4 o tr() o. b0 li o P.oh C) oo h oliL oO o (t a IJ] a U) (.) (.) o v) Fr(.) (! a o o(h +i o U)o(t) Q O.f 6.)l -ol(Bl FI ! o () o q () ! o o oo L o oo () x rr.l (.) (.) o oo o oO qr o o.2 E^OEobD \J O. a()7 q9^ a.= Oo-c tr&=a q;;(.)- (J E E;(g@oclA =.!.€HUHH tr ;6>v qEi- vtir ^99dH (E,Eqi (! € . I qp.! EE€.i€ .!.a-o;:A o o. U) trY a66 .Nt Y9a o> B () t-.1 c) bo o C) 00 xoa oo ! o * 1a l + -l T l I I -t- f- ) L Il il i I++ I i l ++ I i l 1I I I l I I a.l L .o tr a) a ,c al o- :E 4) E; 9A. trE) oLr uq)E0) -.eErja)li (s -0)b:lUEI EtrIeelr- dl:-()1 o>lE-ol9o)abo ,=d e() .(> E6 c!(i9., o(]) o(gr.() c') r- Ol ..i -lC)l =ldlFI o oora (i ^F-. uX U o\ o\ @ aa o\ co o\t o\Or- o\ F- o\ o\ cO o. 0i CJ ^ orJ(, F- <, >v o o\ \o @ co o\ o\$ o\ sOF- o\ t-- c\ o\\o\o I ,EO =boO (!^ sEs oo -EoF o\ <. o\ ci cO o\ $ o\O @ o\O\o o\O\o o\N+ o\ $ b ='o =-hez o! O$ @ O\o $ O^ \o N @O & o\ ca \o(-.1 N N co tr- co O @ od$N o\@ -; N ?a? u.z , i"EFU r-N .1 t--N$ F-6t a\ t-- ol$ \o o\$ c.l t--\ caN$ O O O a.l ,"] o\ sf, $$d-I \o @ zEg*irXi:E€ 6 U F o-o;;6 9UO E c{\o C..lO N\o (-.l O $c\ Ir- F- @ s s @ 00 c..l $ C\ cas- t-- @ rc- r- a b0 a(.) oU o U S-F ds41 >J -o o\\o\o 3\ t-- t-- c\ @ c\ @& c\O .c c\ ca t-- o\ @ E .90 - tro o- i6 ,a i] !:o'boa- do \o\o o\ t-- t-- o\ @ o\ @ @ o\O o\ o\ car- o\@ o q-o t_ :oe ==!AE E o @ o) N slr)N O F-N o)t-N @ cf) N r- cn =vuuz t9-a FU O oo aO@ c..l \oO m O a-l @\o Or Fya * )> .\ s*[iYo F 2 o'o =t u o O T aO ooN \cO \cO \c(\ q) ti r- o. o\ oo o\ o\ O a.l N (.I c.l ce c\ $ a.l 2.8. Supervision 2.8.1. Supervision hierarchy NOCP States States States Locality Locality Locality Administrative unit FLHF Comrnunity Ieve 2.8.2. Main issues identified during supervision structure are now put in place problem are identified & being tackled (e.g. treatrnent coverage data is used as a tool for monitoring) 2.8.3. Check lists are used now after it had been raised during evaluation. 2.8.4. Out come of CDTI implementation supervision. The problerns are identified very early and referred to concern authority in order to solve it irnmediately bclbrc tinrc 2.8.5. The community/village are fed back about the positive and negative issue in order to allow them to correct them either immediately during cycle, or the next cycle. 20 WHO/APOC, l0 Apnl 2003 SECTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table 1 1: Financial contributions by all partners for the last three years Comments: Financial report will be presented in the Country Annual reporl 3.2. Other forms of community support Communities are still keeping the sarne sprit of supportir-rg and motivating their CDDs in kind like supplying them with food, & Iooking after their families during distribution,. Contributor Year I /'provtde tlte period') Y ear 2 1 'provrtle tlre period') Year 3 /'provttlc tht' ptertod '1 TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL TOTAL Budgeted Released(us$) (us$) TOTAL Budgeted (US$) TOTAL Releascd (us$) Ministry of Health (MOH) Local NGDO(s) ( if any) NGDO partner(s) District/LGA Others a) b) c) Communities APOC Trust Fund TOTAL 2l WHO/APOC, 26 September 2(103 I 3.3. Expenditure per activity - Expenditure table will be prepared in the Annual report at the end of the year, due to the fact that clearance of the budget allocated is not yet received from the field. Table 12: Indicate how much the project spent for each activity listed below during the SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Evaluation was carried out last year 2003; Recomr-nendations & Responses were presented in 2003 Annual report. 4,2, Gommunity self-monitoring and Stakeholders Meeting Communities are sensitized to conduct their own monitoring activities, & results will be presented in the Annual report. 4.3, Sustainability of projects: plan and set targets (mandatory at Yr 3) 4.3.1 A three years plan 12003 - 20051 was developed & sent to APOC, now we are implementing the second year sustainability plan activities. 4.4. lntegration As a matter of fact The Oncho is a vertical program at the federal level on one hand, and on the other hand is taking a good shape at other lower levels as it is well integrated and getting stronger bond with other sisters' programs. Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels Supervising CDDs and distribution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.g. computers, printers etc) Others Acti Total number of persons treated TOTAL _ S__o_urqgQ) of t'ul4!_ng NGDO (clearance TR) NGDO NGDO 20,297 it q.w)_ NGDO NGDO NGDO 22 WHO/APOC, 26 September 2003 Expenditure __($ uu t12 450 8.626 0 0 0 3,927 0 0 6,395 0 787 ISupervisors combine training and supervision of Mectrzan distribution with activities of other programs in a single trip, the same goes on with CDDs who are involved in other health program eg. Malaria, GW, EPI ...etc. 4.5 Operational research Some ideas came up during the Academy of Medical Sciences & Technology (AMST) I't Intentional conference on Tropical and infectious diseases, to conduct Oncho researches in post peace period. Putting in to consideration the issue of Nodding disease syndronre in Southern Sudan and changing of disease trend which had been influence by imported social behavior of the repatriated refugees and displace persons from neighboring countries. 4.5.1 SEGTION 5: Strengths, weaknesses and challenges Strength: . Peace is at the corner, which is promising better rehabilitation of health infi'astructure which eventually lead to sustainability. ' In some areas the program in the only stand alone health provider. . The program census records became the main reference of community inforrnation for Government and NGO working the area. . Good integration with other program in the state / community levels. . Oncho program transferred the CDTI approach to similar programs. Weakness: . High turn over of trained staff. . Weak health infrastructure in the country . Povefty of the communities. Constrains: ' Accessibility problem due to the civil unrest.(land mines & gunshot cost the project many CDDs). , Continuous reshaping of the population and high dropout of the CDDs. . Poor financial support from the Government. . APOC not committed for further funding. . Poverty of the communities. . CDDs are being spoiled by the practice of the NGOs paying their volunteers, which reflected a wrong concept of voluntary work. Challenges: . Engage MOH to dramatically increase level of support for the program. . Increase involvement and integration of CDTI into tlie State/ provincial level systenr . To train more CDDs to reduce the work load, & provide replacenrent in case of attrition. . Continuing to motivate the CDDs by providing bags and T-shirts and discouraging payment. . To attract local donors and other sources for funding the CDTI activities. 23 WHO/APOC. 26 SeptembeL 2003