Annual NOTF secretariat technical report to Technical Consultative Committee(TCC) : January to December 2009

SOUTHERN STIDAN ONCHOCERCIASIS IASK FORCE (SSOTF) whoh pro iect@,gmail.com ORIGINAL : Enelish ANNUAL NOTF SECRETARTAT TECHNICAL REPORT SUBMITTED TO ^Actlcn TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SION: To APoc Management by 31 Januarv for March rcc rneeting F io I I -lIot I l'rftrrr*ettort 5rR fi gqlr"l To APOC Management by 31 Julv for September TCC meeting AFRTCANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) COUNTRYAIOTF: Southern Sudan Proieqt Name: Southern Sudan Onchocerciasis Task Force Headquarters Apnroval year: 2003 January 2009 To: (Month/Year) December 2009 ( Month/Year) Reporting Period: From: APOC fundins year: I 23(4)s67891011t213 January 201 IDate su bmitted: 31 i :, , i0ll ApociDtR RECII LE WHO/APOC, l4 September 2009 I I I I : I I ANNLTAL NOTF SECRF]TARIAT TECHNICAL REPORT .IIO 't'HCI IN IC'AL (IONSI.J[. l A'l'lVi) ('OIvlMI'f'l'l1i: ('l'('(]) trNDORSTMtrNT Please confirnl y()u have rcad this rcport b),siguing in the appl'0p riute space. Ol'F-l(.liRS to ,.'-ign the report: Countn,: Southcrn Sudan National Coor-c'linator Nirntc: Dr Motrnir ( hrist() [.Lrgga 5 igtrat rrrc l)atc: 3l'' .lzrnuar'\ 20 I I iou/ Narnc: Dr .lolrn ltp I \ YV, N()-l'l' Chair nl LlnLr SignitLurc I rt"( I)atc: 3 l'' Januarx, 20 N(;tX) Ilcpr'..scntalivc Nanre: liasr) (,hirn l)atc: 3 l" January 201 I t'his rcpurL hus bccn prcplrccl br : Nunrc. I)r. llurr.ialtrin .,\tu.inc l)csi grrirt i on.'.|'cchrr i caJ,\d v isor-. n P (X' S irlnaturc Signaturc Datc: 3- l'( .lanuiuy 201 1 Nr__ ll \\ I l() At'( lt.'. l-l Se ptt'rrrllir l(t(tt) P Table of contents ACRONYMS v DEFINITIONS.......... VI FOLLOW UP ON TCC RECOMMENDATIONS VII EXECUTIVE SUMMARY......... . ERREUR ! SIGNET NON DEFTNI. SECTION 1: BACKGROUND INFORMATION......... ERREUR ! SIGNET NON DEFINL l.l. GpNeRnl rNFoRIvrATIoN........... . ERneriR ! StcNBr NoN DEFINI. 1.1.1 Description of the project (briefly).,... Erreur ! Signet non ddfini. 1.1.2. Partnership .. Erreur ! Signet non difinL 1.2. Popu1arroN............... ERRnuR ! SrcNnr NoN DEFTNI. SECTION 2: IMPLEMENTATION OF CDTI ERREUR I SIGNET NON DEFTNI. 2.1. TrrrrEr-rNE oF ACTrvrrrES ............ ERRBUn ! SrcNo'n NoN DEFrNr. 2.2. AovocRcy ERRoUR ! SrcNnr NoN DEFrNr. 2.3. MoelLtzaloN, SENSITIZAI'IoN AND HEALTH EDUC/\TIoN oF AT RrsK coNrNruNITrES ERRBUn ! SrcNsr NoN DEFrNr. 2.4. Courrr,ruNrry INVoLVEMENT............ ERRoUR ! SrcNpr NoN DEFrNr. 2.5. Cepncrry BUrLDrNG................:.... ERnnuR ! SrcNor NoN DEFINT. 2.6. TRparH.,rpNTS.............. ERRnun ! SrcNor NoN DEFrNr. 2.6.1. Treatntent figures.. ... ....Erreur ! Signet non ddfirti. 2.6.2 What are the causes of absenteeisnt'? .... ...... Erreur ! Signet non diJirti. 2.6.3 Whal are the reasonsfor refusals?...... Erreur ! Stgnet non difirti. 2.6.1 BrieJly describe all known and y'erified serious adverse events (SAEs) that Erreur ! Stgnet non ddJini. 2.6.5. Trend o.f treatment achievementfr"ont CDTI project inception to the currenl year Erreur ! Signet non ddJini. 2.7. ORopRtNc, sroRAGE AND DELTvERy oF TvERMECTTN. ERRoUR ! SrcNer NoN DEFrNr. 2.8. Coprvr-rNrty sELF-MoNrroRrNG eNo SrareHoLDERS Mpprmc.....ERRBun ! SrcNBr NON DEFINI. 2.9. SuppRvrsroN............... Ennrun ! SrcNpr NoN DEFrNr. 2.9. I . Provide a Jlow chart of supervision hierarchy. .... ... Erreur ! Signet non ddfini.2.9.2. Wlmt were the main issues identified during supervision? . Erreur ! Signet non ddJini. 2.9.3. Was a supervision checklist used? ..... Erreur ! Signet non difini. 2.9.4. lVhat v,ere lhe outcomes at each level of CDTI implementation supervision? Erreur ! Signet non ddJini. 2.9.5. Was feedback given to the person or groups supervised?... Erreur ! Signet non ddfini. 2.9.6. How was the feedback used to improve the overall per.formance of the project? Erreur ! Stgnet non difini. SECTION 3: SUPPORT TO CDTI ERREUR ! SIGNET NON DEFINI 3.1. EquteueNr ERnBun ! SrcNpr NoN DEFrNr. 3.2. FmaNctnI- coNTRIBUTIoNS oF THE pARTNERS AND coMMLTNITIES..ERREUn ! SrcNBr NON DEFINI. 3.3. OIHER FoRMS oF coMMUNITy suppoRT..................... ERRnUR ! STGNET NoN DEFrNr. 3.4 ExpeNottuRE pER ACTIVITy ... ERRBUn ! SrcNBr NoN DEFrNr. SECTION 4: SUSTAINABILITY OF CDTI ERREUR ! SIGNET NON DEFINI. lll WHO/APOC, 14 September 2009 4.1. INrenNnr-; TNDEeENDENT pARTrctpAToRy MoNrroRINc; EvalunroN........ EnnBun ! StcNpr NoN DEFINI. 4. l.l Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) . . . Erreur ! Signet non ddjlni. 4.1.2. Whatwere the recommendations? .........Erreur ! Signet non ddfini. 4.1.3. How have they been implemented? ............. Erreur ! Signet non ddfini. 4.2. SusretNnetlrry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT.... Ennnun ! Srcxpr NoN DEFrNr. Yn 3) ERnBUR ! SrcNrr NoN DEFrNr. 4.2. l. Planning at all relevant levels... . Erreur ! Signet non ddfini. 4.2.2. Funds........ ........ Erreur ! Signet non ddfini. 4.2.3 Transport (replacement and maintenance) .........8rreur ! Signet non ddfini. 4.2.1 Other resources ....Erreur ! Signet non ddfini. 4.2.5. To what extent has the plan been implemented ....... Erreur ! Signet non ddfini. 4.3. IN'rEcRerroN ............... ERRBUR ! SIcNsr NoN DEFrNr. 1.3. I . Iv,erntectin delivery rnechanism.r . .. ..... ... ... Erreur ! Signet non ddfini. 4.3.2 Truining... . .. . ..Errertr ! Signet non ddfini. 1.3.3 .loinl sttper"yision und monitoring v,ith other progt'ams.. . Erreur ! Signet non ddJini. 1.3 4 Release of.funds Jor project octivilies . .... Erreur ! Signet non ddfini.1.3.5. Is CDTI included in the PHC budget? ......,........ ..... Erreur ! Signet non ddfitti. 4.3.6. Describe other healthprograntntes thot are using the CDTI struclure and how this v,as achieved. Vfrhat have been the achievements'? . ......... Erueur ! Signet non ddfini. 4.3.7. Describe others issue.s considered in the integration o.f CDTI. .. Erreur ! Signet nort ddfitti. 4.4. OpenerroNAl RESEARCH ERRrun ! SrcNBr NoN DEFrNr. 4.4.1. Summarize in not ntore than one half of q page the operational research undertaken in the project area u,ithin the reporting period..... Erreur ! Signet non ddfirti. 4.4.2. Hou, were rhe results applied in the project?........... Erreur ! Signet non ddfini. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNTTIES.... . ERREUR ! SIGNET NON DEFINI :::: :: ) :. .,-Y:: ::i:::: : * : :: :::i: 8ffi";[H1 t,Xft ;T ",.,ti, D E F rN r lv WHO/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF U'fG 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 Sel f-Monitoring Local Government Area Ministrl, of Health Non-Goverrunental Developrnent Organization Non-Gol'ermrental Organization National Onchocerciasis Task Force Prirnary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Teclmical 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). (i i) Elisible calculated as 84%o of the totalpopulation 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 u,ith ivermectin in a given year. (iu) ate Treatme calculated as the rnaximunt number of people to (") be treated annually in rneso/hyper endemic areas rvithin the project area. ultimatell' to be reached when the project has reached full geographic coverage(norrnalll'the project should be expected to reach the U fG at the end of the 3'd year olthe pro.ject). Therapeutic coverage: number of people treated in a given )/ear over the total population (this should be expressed as a percentage). (ui) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Intesration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problerns. This does not include activities or interventions carried out bl,community distributors outside of CDTI. (viii) Sustainabilit-v: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership. using resources mobilised by the community and the government. community self-monitoring (cSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibilitv of ivermectin distribution and make appropriate modifications when llecessary. (ix) vl WHO/APOC, l4 September 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 29 Number of Recommendatio n in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY Report related: (i) Project to correct the data in executive sumntary on communities targeted for treatment The data in the 2008 repoa was corrected and that in this report has been carefully vetted. ( ii) Improve on quality of map provided under general informatior-r. Done ( iii) Correct /account lor 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 treatment in Upper Nile CDTI. Inventory has been corrected. (i t') Should also provide explanation for lorver total population in 2008 as compared to 2007. The 2007 population figure that was presented was not correct and it has beer-r 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. Efforts are being made to make this happen by ordering the mecticzan early. However delays in fund disbursement delay,s commencement of implementation. ( ii) TCC reiterates that training on CSM and SHM should be carried out as parl of CDTI training, as these activities are parl and parcel 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. vll WHO/APOC, l4 September 2009 Executive Summary [n2009, the total population in the five CDTI projects of Southern Sudan was 5,605,726; which is an 8%o 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 3,012,058 persons received treatment in 2009, a 48.7%o increase from the 2008 figure of 2,029,828. An overall geographic coverage of 87 .7o/o was achieved in 2009 as compared to 69.8 in 2008. The therapeutic, UTG and ATO coverage were 53.7Yo,64.\Yo and 99.7Yo, increases frorn the 2008 percentages of 39.|yo,46.60 and93.2%o respectively. West Equatoria had the highest therapeutic coverage of 72.6%. New CDTI training and refresher courses for the staff took place between July and September 2009. 9.268 CDDs, I ,094 health staffs and 1,253 community leaders were trained in this reporting period. The total number of CDDs trained w'as 44.loh higher, 2,865 more CDDs than the 2008 figure of 6.403. The overall CDD/population ratio. though not y,et to the recommended level, has gradually come dorvn to I CDD/605 people in comparison to the 2008 and 2007 figures of l 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 l3 county supervisors were absorbed during the reporling 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 rvould be recalled that CDTI projects' staff rvere mere volunteers and not previously ministry's staft-. The SSOTF strength lies on both the technical support provided by APOC through the deployment of technical advisor to SSOTF and projects, sheer determination of available staff to get work done, irnprovement 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 programrne by APOC. The major challenges facing the programme include the lack of capacity to man CDTI project by some project coordinating off-rcers, inadequate staffing and knowledgeable manporver in the project area, non integration of all projects and non absorption of some CDTI staff into the ministry of health, correct and timely 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 reporling period include facilitating the monitoring of treatment coverage, procurement of ivermectin tablets from Mectizan Donation program in collaboration with CBM, holding series of meetings and trainings, printing of IEC materials and ensuring distribution of mectizan and 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. vlll WHOiAPOC, l4 September 2009 SECTION 1: Background information 1.1. Generalinformation 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 rvith 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 part. There is a vast swampy/marshy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile CDTI project. The years of civil war 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 way of village proximity to breeding sites and occupational activities. The major ethnic groups are the Azande. Bari speaking groups. Dinka, Shilluk. Taposa, Lutuho and Nuer people. The southern Sudan Onchocerciasis control progranme consists ollrve CDTI projects naniely, East Bahr El Gliazal. West Bahr El Ghazal. West Equatoria. East Equatoria and Upper Nile. East Bahr el Ghazal and West Equatoria are in tlieir llfth vear rvhile East Equatoria, West Bahr el Ghazal and lJpper Nile are in fourth year in this present reporting period. Southern Sudan as a countrv has ten states and project composition 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 onll,state: East Equatoria has East Equatoria and Central Equatoria states rvhile West Bahr el Ghazal. the largest is cornprised of West Bahr el Ghazal, Northern Bahr el Ghaza| and Warrap slates. Vector elimination Presentlv, there is no vector elimination programme in all CDTI project areas in Southem Sudan. Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.g. Adequate health facilitics, is system decentralized or not, etc), logistics, administrative structure. Basically, the National Plan is implemented bl,Southern Sudan Onchocerciasis Task Force, which comprised of national health staff of Ministry of Health goverrunent of Southern Sudan, WHO/APOC staff in Juba and Rumbek as well as Non - Government developmental Organization (NGDO) which has CBM as lead NGDO. It is also being implemented through various State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National and InternationalNGOs, and Community based organrzations 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 total population at risk of being infected rvith 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 comprised of 213 primary health care centres (PHCC), 684 primary health WHO/APOC, 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 Southem Sudan. The administrative structure in Southem 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 similar cultural/social traditions like marriage, funeral rituals and usually make communal decisions about the general rvelfare of their community. The number of communities cited in this reports are as per these society nonns. The five projects have a total of 38 counties and 6,473 communities rvhere mectizan treatments were implemented during the period under review. Health system & health care delivery (state an1, problems related to health s1'stem that impede program implementation). PHC remains the cornerstone of the health system and needs to receive rnore political commitment and supporl for its successful irnplernentation. The health system and health care delivery in Southern Sudan focused 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 hospitals. The prolonged civil strife in Southern Sudan had its toll on the health care delivery systems and infrastructure and hence quality health care delivery to the general population rernains an ellonnous task. The health system 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 tlie public government institutions. This also has a direct impact on the CDTI program since the frontline health facility staffs that are predominantly goverrunent employees. Inadequate budgetary allocation for Primary Health Care (PHC) services has also directly aff-ected CD'fl rvork since most of the CDTI staffs have not been absorbed into the health sy,stem of the Southern Sudan. 2 WHO/APOC, December | 5, 2004 Map of Southern Sudan showing the states in which the CDTI projects are located. LEGEND --l State SOI]-f I{ERN STJDAN (200J) Scele Da te I 3 r!14 000 Goographrc F AO/HIi F S June 2m3 Afhrs nrrp dccs n.r rhrplT otficral Lrll endorscnrcnt ro0 Additional information to clarify the location of the CDTI projects on the nrap above o East Bahr el Ghazal CDTI is composed of Lakes state, . Upper Nile CDTI is composed of Upper Nile and Jonglei states. o West Equatoria CDTI is cornposed of West Equatoria state; . East Equatoria CDTI is composed of E,ast Equatorra and Central Equatorra (marked as Bahr el Jabal above) states. o West Bahr el Ghazal CDTI is composed of West Bahr el Ghazal, Nofthern Bahr 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: . 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 . County Health Departments. o Frontline health facilitv staff. J l-, : ,- -l N W Bahr el-Ghazal Lakes ir, .fldiii; .jbnqtei Bor WHO/APOC, December 15, 2004 -.. ;, ' .' t^-'_ _ At community level: . The Payam and Boma Administrative structure . The community leaders . The beneficiary community members . Frontline health facilitv 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 rvell as preparing reports. Before commencement of this year distribution. there rvas training of project coordinator at SSOTF secretariat in Rumbek (currently located in Juba) organized by SSOTF, WIJO/APOC and NGDO; these activities were 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 goverrunent for the funding of CDTI activities. Statc plans if any to solve anf issues arising as regards CDTI implementation. The SSOTF has plans to solve an1, issues that may arise in the course of implementing CDTI activities as follorvs: a. The first step is to investigate the issues and determine the root cause such as finding out why some people refused treatment with ivermectin 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 necessary rneans to the task. d. The fourth step is to report back after investigation. 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 intervention is applied on any 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/hyper-endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (urG) East Bahr el Ghazal 1,963 761,917 640,010 West Equatoria 903 689,419 519,l12 West Bahr el Ghazal ) \)) 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 4,708,810 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 Southem Sudan. Source: From CDTI project reports: I'+atienal-eens*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, Decernber I 5. 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' problems/issues (one paragraph). Three major problerns affected mectizan distribution in the projects and these werc insecurit\,, heavy rains/flooding and delay in receiving funds for implementing 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 e[ Ghazal (in Gogrial East and Gogrial West), East Equatoria (Magwi 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 May cannot be emphasized further. 2.2. Advocacy and Sensitization a) State the number and type of policS, / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the scnsitization and outcome. At the national level, 5 key officials of ministry of Health of Government 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 May 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 government 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 government 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 efforts rvere made towards getting the government to appreciate the roles regarding counterpart contribution to onchocerciasis control. Despite not having received funding from the goverrunent. the OV program is recognized as one of the key areas in NTD control arrd hopefully rvith continued advocacy,, funds rvill be allocated to it soo11. c) Describe any policy-related constraints being faced by an1' particular project and describe what was done to assist the project (outcome). Explain any, plans on hot' to improve advocacy. The majorpolicl'related constraint faced by allprojects rvas the issue of CDTI staff absorption into the ministry of health system. Sending letters, emailing and physical visiting and following up to key government officials were the approaches adopted and this u,orked out in some projects in the past when coordinating olficers 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 [ull1, 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 two states, and West Bahr el Ghazal rvith three states. SSOTF has proposed that each state should have a focal person for effective CD-l-l implementation and this cadre of staff is expected to work under the respective project coordinating officer. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategl, 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 where they were distributed. The SSOTF coordination office in Rumbek (currently relocated to the MoH office in Juba) produced a number of IEC materials for the Southern Sudan Onchocerciasis Control Progran.r in 2009. The materials were distributed to Project offices for onward distribution to CDTI communities. The following were produced: o Manual for CHW's and PHC for the control of onchocerciasis rvith Mectizan'" . Manual for CDTI provided by APOC through the technical advisor and distributed to five proj ect coordinating offi cers. o Illustrated OV training flip charts (OV Oncho in Sudan) . OV poster sets (3 posters per set; "What is OV", "How do you get OV", and "Horv to treat OV"). These posters are laminated in plastic for durability under field conditions. 7 WHOiAPOC, December 15,2004 . Simplified CDTI instruction manuals for community distributors. . On the spot training guide for health workers and CDDs o f- 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 reviewed to address upcoming issues (like decreasing refusals, sustainabili[,, maintaining compliance to long-term treatment, SAEs)? Yes, they were reviewed rvith emphasis on maintaining compliance to long term treatment and other upcoming issues such as sustainability. Report if an1'KAP surveys havc been done and horv their results t,ere used? There was no KAP survel, in all the projects in 2009. Summarize information on: The use of appropriate and innovative media and/or bther strategies to disseminatc information among the projects; . Modern media such as local radio stations are available in most project areas. For instances, East Equatoria project made use of Spirit and Liberty FM radio stations in Yei and Miraya FM station based in Juba, East Bahr el Ghazal project uses FM radio in Rumbek and West Bahr el GhazaI 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 community 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 rvomen 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 with 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. AIso 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 with Ivermectin in 2009 as compared to 2008. 8 WHO/APOC, December I 5, 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 Weaknesses/Constraints . 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 would have a visible impact in the communities for which they are intended. . The number of health staff and CDDs required for providing information to communitl, members is still inadequate. . High rate of absenteeistn due to involvement and occupation in grazing cattle bv adult men and male teenagers resulting in missed mobilization and health education. Suggest n'ays to improve mobilization of the target communities among projects. . Availability and use of more posters during mobilization and also their placernent in each village and strategic places to attract community rnembers is highly suggested. . Engaging rnore health rvorkers by integrating them into the health sl,stems is ideal. . There is need to recruit more CDDs and communitl, supervisors in order to facilitate Irealtli education and mobilization activity in the communities. o Wonten groups, youth and religious groups should be involved in the campaign. . Health education messages should be intensified in all corumunities . 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 15 years. . Regular radio programme on disease situation and on treatment rvitli mectizan 2.4. Communities' involvement in decision-making Comment on communify participation making comparisons among projects. Participation of female and youth members of the community at health cducation meetings; ln general, how do y'ou rate the participation of minority groups and female 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 of villages with female members and also female CDDs had increased. The report shows that percentages of villages with female CDDs was 27 .3oh in Upper Nile, 24.3o/o in East Equatoria, 25.9% in West Bahr el Ghazal,15.3% in West Equatoria and 13.4Yo 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. Capacify building Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) 9 WHO/APOC, December I 5, 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 was 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: T),pc of training undertaken at national level b1, the NOTF Type of training Project staff MOH staff Opinion Leaders Others (specify) Prograrn manager.nent Hou, to conduct I{ealth educatiou Managernent SAEs of CSM SHM Data collection Data analysis Repoft rvriting Others (specily) Briefly describe any' technical assistance provided to the CDTI projects. The key technical matters on CDTI were provided to them. 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E i L -l o(,X^91, E l'-6t - .. ! a ol O-Y-\ oLl^.'9! :I TqAU =l -* - tr o-Qle: a - vol eE c ai9l hts'-.J5 n?! -l itrqiPl trtr8= =l ! =9 o,!l _e.r ! :Al|>aa = ;.9- o(]O F-L 3Ue,lt o o& aO>'o rIrol!cJ.o E !E- EFO -Eonicr aLo r try.a :, q E ^ .=()-.6 i oc.Y Ullllc!l- ^ -- L\ (JU' bO .. r_-l E; <J oo If the projects are not achieving 100'h geographical coverage and minimum of 65,h 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 comrnunities since the distribution was conducted in the rainv season. o 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 cornrnunitv members ar-rd militiamen. . Inadequate available knorvledgeable rnanpower especialll, CDDs in Raja and Arveil West counties in West Bahr el Ghazal. Plans to remedy'this: . Improving and strengthenir-rg comnlunitl' participation through mobilization and health education as rvell as motivation of CDDs. r Increasing capacity building of nerv staff and CDDs. . Conducting distribution of mectizan in dry season . Improving logistics to projects at county and pavam levels. 'r 1', a a a a a In general, rvhat arc the causes of abscnteeisnr and refusals and hou,is thc The nomadic lifestyle for a bid proportiou of the population. Travel outside their communities in search ofjob during the period of distribution. New returnees have poor knou,ledge of mectizan distribution and it benefits and thus refused. Lack of clinical ir-rdication lor medical as perceir,'ed b1, the beneficiaries Fear of side effects. 2.7.3. Briefl't' describe all knorvn and verified serious adversc o'cnts (SAEs) and provide in table 7 the required information rvhen availablc. There was no repofl of any SAEs in the entire project during the period. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x 16 WHO/APOC, December 15,2004 Name o[ project Number of verified* SAE cases reported Action taken Number of cases rvith sequelea Number of deaths NA NA NA NA 1 I NA 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 Scquelea is delined as those cases that have not recovercd fully from the SAE and are left rvith lasting neurological or other debilitating effects. t'7 WHO/APOC, Decernber 15, 2004 $ N ri o -o () oo O p. o a) -o 0)I o ; .d F OL d o oo '= o ; $oo(dH o o a (d Eo o () F d o o xo o q d, o q) o -o =(( (d (d o C) OJ (d o o. d0 o o o 6 ol 0<l o oH- .oo\ v o\ ootr) o\ si-\o \oo\ c-l\o \e c\ c- \o tr- oo o\s\o .o o\ o\\o o\ .{- r- o\ o\ oo o\ oo c'l c.) o\ t-. O. o\ '!o =coqG^ d qo\L>vooE9F .o o\ O C\ \oo\ N .o o\tn c.l o\ rr) N .o o\ N .o o\ ca \o o\ O ca .o o\q o. roo\ @ .o o\\o(-.l -o o\q oo aa ; ca \ C' oi2- !Oz? 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OO "I( .J- OO v} <. r/-) c- oo\o \r) oo t-- t/.I oo\o co OO o^ ca ta) c\ OO o" coC\ N aa\o. \o r- =l: ca C\ CN ro^ \o t-- n" aa N aa ca t/-) C\\o ca C\C. c1 lt-) C\ ca Ol\o c.l oo ./) \o(..l\ \o. 0o ul CE an 0) Q o bo L e 9-- F z z z Z z o\ \c \o -o o\ <1' r- .o o\ a-\o -o o\ n(\ @ o\ ..i @ O. oo oo +O 9o '= Do =dF 6s Ma- o z z z z z o\ r-- c-l \oo\ c.) .o o\ A .o o\ -1 o\\q *N \o\q r-C\ oo \o \r- co 't-!> ueo: i.! q^ E;3J zE&" q z z z z z a.l\o trr (a) oo -i- (\(-- caC. \c)o\ \ot-- ti r- d o.= -Cr =ra: ;.9 z9r.a F9 Z z z z z N C\O - (r) rn\o ra)$ co co c\\c) $(\ \o c-(\ ,-'I r- @ .s^ <-,'.ft ,qraaO.9E: L rt.: e ic^F.--'U- Q = 4\ -*e-ooev o E boo oF Es 3= uq co oo NNN ca(...l oo ca c! o\ coc\ N oo a.l N r- c--\$ oo $N =J: caO (-- \o ol s^ o\ car- n\o & ri c- o\ o\ @ o\ o\ o\ o\ o\ c.,l OON N c.l ca N $ ON rn O N \oO N r- N @ N O N I q) U) h l-trClr 0,)N rJcq e'o :o) o.= v A= Utr ?= Lo co o :''l .=G tra 0..) Gor I :-rl I(J6l* .aol s Lf-le 3*1 Eo aJ^Q+. E o' ! >>! l.E!54HG!-E-- ;3*E .9 e;EF L l.- <.r 'E Il Ec! tr.3l :e q) !l - F qr bl 6; f "l €5 r- el trI € il'; l- - -l:!c!oX(H o bO.=o bod o' 'o-k!r€Y* F E 3- -l,r-!ts-.^q; cEfa -( q) EU (H- oogcq -9lrFCE X Ets F VE - V -.- Y -rL!€- EJq)i:JarLa -A,E-E 4 ..6,) -.2cEl c I .- -!d)l;iia c =l =.F!lHR-_tH '. >.rYl oN;>FI(,) 2.8. Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by 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/follow-up needed National Coordinator and NGDO Coordinator. February 2009 To ensure that clean and updated data for 2008 from the counties and planning lbr the supply of the next treatment c1'cle. Data collected and the mectizan needs for 2009 was prepared and ordered. FinanceiAdtnin Assistant Julr'2009 To {bllou'up on fund disbursenrent to the project and monitor for proper use Prompt cornpiIation and tirnely' subrnission ol' returns of vouchers r.l'as stressed. and on job coaching took place National Coordinator. NGDO Coordinator, Technical Advisor 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 fbr implementation of CDTI activities. 'fhe trainings were found to be going on as planned. The pro.iect liad already, placed the mectizan in the CDTI communities ready fbr treatrnent. Some of the trained CDDs had begun getting involved in distribution more training still liad to follow. Finance/Adrnin Assistant August 2009 To follorv up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers was stressed, and onjob coaching took place West Equatoria National Coordinator. Technical Advisor November 2009 Discuss with 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 training data Some staff got enrolled onto the government employment system. The required data was received and compiled for project use. l9 WHO/APOC, December 15, 2004 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 was stressed, and on job coaching took place East Equatoria NGDO Coordinator, Technical Advisor October 2009 Follow up of mectizan distribution and treatment coverage Disbursement of capital equipment (bicycles) to the cornrnunitv fbcal persons. Project information was received for future planning. Work support items were delivered to the intended end users. thus fulfilling their intended purpose. Upper Nile NGDO Coordinator. 'feclinical Advisor Mal'2009 Delivery olmectizan and u,ork support items to the project s ites Follorv up of training activities and conducting advocacy visits to the government authorities. Enabling environment fbr project implenrentation created. Have CDTI ir-rtegrated or-rto the PllC s1'stenr Finance/Admin Assistant May 2009 To follow up on lund disbursement to the project and monitor for proper use Prompt corlpilation and timell,subrnission of returns of vouchers rvas stressed. and on job coaching took place 2.8.1. What were the main issues identified during supervision? In addition to the objectives that the supervision teams went out with. a nurnber of additional issues were identified: . Insecurity and flooding rvere delaying mectizan distribution in some places. . Poor communications rvithin counties and distances are verv far apart from one village to another, . Some communities were without CDDs and therefore not receiving treatment. . Inadequate number of CDDs hence long time in completing distribution sirrce each CDD has to cover more people. . Poor data management and inaccurate population figures and irregularities in treatment data in most records and registers. . Community treatment registers not available in all villages 2.8.2. Was a standard supervision checklist used? It was not being used universally by the Payam Supen,isors. 2.8.3. What n'ere the outcomes at each level of CDTI implementation supervised? . The concerned individuals were coached on what to do. 20 WI{O/APOC. December 15. 2004 2.8.4 a . Improved performance noticed during follow up visits. . Community not willing to provide registers. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? Yes, on the spot discussions were done and the findings were shared with them through email and phone. 2.9. Communi$, self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting NB. Not all the comntunities in the C)ounties (LGA) contlucted CSlvl and SIIM, but at leost all the counties ltad ,sorne reprcsentation of bolh Ihese activitie.s hoppening. Describe horv the results of the communitl' self- monitoring and stakeholders mcctings have affected project implementation or ho*' thel, n,ould bc utilized during the next treatment cycle. It is expected tliat the communities rvill: . Gradually'take full charge of the delivery of tlie CDTI activities in their conununity like have new CDDs selected without necessarily har,'ing the Health staff facilitating. . Demand for mectizan when there are delays or i[some cornmunities are inadvertently left out during the distribution of mectizan. o At alater stage begin conducting advocacy campaigns for the CDTI program. 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table 1l that the NOTF has done to ensure that CDTI projects comply rvith long-term mass treatment with ivermectin? (For projects 4 and above years old) Table l1: Activities that promote compliance to long-term treatment with ivermectin Ob.iective Specific Activities Project targeted L Promote Integration of CDTI with other health care services Meeting with policy/decision makers on absorption of CDTI stafl' into health system East Bahr el Ghazal and West Equatoria 2. Maintain high therapeutic Increase in the number o[ 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 LGAs/Counties that conducted stakeholders meeting (SHM) East Bahr el Ghazal West Equatoria East Equatoria Upper Nile S/est Bahr el Ghazal 4 6 7 6 l0 1 - 100% 6 - 100% 7 - 100% 6 - 100% t0 - 100% I - t00% 6 - t00% 7 - 100% 6 - t00% t0 - 100% TOTAL 33 33 - [00'Zo 33 - 100% 2t WHO/APOC, December I 5, 2004 (>65%) and geographic (100%) coverage CDDs and community mobilization and health education West Equatoria 3. Promote strong community ownership Involvement of more Community members especially women groups. East Bahr el Ghazal and West Equatoria 4. Promote high government commitment Aggressive Advocacy to key govemment policy/decision makers. Meetings rvith govemment officials rvith a prepared rvork plan. East Bahr el Ghazal and West Equatoria 5. Support strong partnership Addressing the issue of partnership betrveen endemic communities and health systenr and their roles in CDTI East Bahr el Ghazal ancl West Equatoria 6. Put in place a strong IEC strategy that encourages continued treatment Not yet done extensively due to limited resources. East Bahr el Ghazal and \[/est Equatoria SECTION 3: Other activities of the SSOTF 3.1 Describe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination lvhere applicable, etc). There was completion of the REMO and RAPLOA exercise that was begun in 2008 in all tlie five project areas. A total of 126 villages were targeted during the exercise. 3.2 What rvas done to coordinate CDTI Project activities? These were mainly through joint budget developrnent plan, holding planning meetings before distribution, exchanging information as appropriate, requiring projects to submit rnonthly reports to SSOTF of their monthly activities under the guidance of technical advisor. Also SSOTF shares with other partners CDTI activities during meetings or conferences. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follorv-up needed) . The arurual program review and plan meeting took place at the beginning of the year. o Meetings with project coordinators and the county supervisors to review 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 meetings that were attended by SSOTF officials include: . Two eye care meetings that took place in April 2009 and a second one in September 2009, both were held in Juba. 3.4 22 WHO/APOC, December I 5, 2004 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 15tr'JAF meeting that took place in Tunisia and was attended by the SSOTF Chairman, The National Coordinator and the NDGO Coordinator. 3.5 Briefly state any administrative duties undertaken - Number and type of reports revierved (technical. {inancial) - Repo(s lbrrvarded to APOC management. - Adrninistrative assistance or trouble shooting lbr projects. The financial reports u,ere submitted to APOC rnanagement in 2009. SSOI-F and 'l'eclnical Advisor assisted the r,'arious projects in preparing and fbnvarding 2008 TCCI reports to APOC. The Technical advisor's SSOTF monthlv reports r',,ere subnritted to APOC and partners. 23 WHO/APOC, December I 5, 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 *SSOTF coordination office Dec * onal efined ect *c +Stakeholders rneeti commun Procurement of materials *ov tes *Ad *SSOTIT coordination offi ce +Re orral (Defined ect *Count * NS TRAINING *SSOTF coordination offi ce + Traini ofCDDs * Traini ofs rsors + Train of cornrnuni leaders * Train of health staff/ ASSESSMENTS * KAP studies in nerv areas +Review of IEC materials HEALTH EDUCATION SESSTONS * Communi + School health educatio Is * Churches Census Census U ate Delive u Mectizan uests a for SAEs IVERMECTIN DISTRTBUTION *lvermectin Distribution +Distribution of minor side effect lntroduction of CSM/ SHMs *Coun Health De nts X X * NGO h t Train of CDDs and others I Local Health MS rCSM/SHM in communrt Mo u treatment. treatment. ment SAEs/Minor side effect 'Supervision of CDDs, P. sup.& lou S X X x Nov Dec Jan Feb Mar Apr May 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 X X X X X X "SSOTF coordinatron office 24 WHO/APOC, December | 5, 2004 .,4 X X X X X X X X X X X * *PCOs/RTF ersonnel * *Data collection *SSOTF coordination office *PCOs * ISOTS * CDDs * mana *PCOs S ISOTS * CDDs Monthly financial reporting ex re *SSOTF coord ination oflice PCOs / RTF Preparation of mid term/ annual technical *SSOTF coordination offi ce PCI I.TF * lrcation for Mectizan *SSOTF / PCOs Ind t Monitori *SSOTF/PCOs/RTF 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 I 5, 2004 3.7 Plan of Action for 2010. ro ect Name SSOTF HQ ears Year Six 2010 ACTTVITIES Q1 Q2 Q3 Q4 *PIannin erv meetin *SSOTF X *Re ional X Co X X Stakeliolders meetin communit X X X X curement of materials *OVsu lies *Advoc X x *Re ional X X Coun X X X X NING * Trai of CDDs X X * Trainin of ISOTS X X * Train of communit leaders X X Traini of health staff/ X X nt / SAEs X x SSESSMENTS * KAP studies in new areas X * Reviewof IEC materials X HEALTH EDUCATION SESSIONS * Cornmunity aryareness/targets X X X X * School heatlh education/targets X X x X Churches X X X X ensus usU te X X X ru Del iSu lies zan uests X{,D for SAEs X X ttin of referral tems *Strengthen up referral systems b/w communities, PHCUs, s and tals for SAEs X X VERMECTIN DISTRIB UTION * Ivermectin Distribution X X Mr ent of SAEs X X troduction of CSIM/ SHMs *SSOTF X X *Co Health X X NGO rhi X X Traini of CDDs and others X X Local Health s MS X x CSM/SHM in X X 26 WHO/APOC, December 15, 2004 o u treatment X XMop up treatment Management of SAEs X X *Supervision of CDDs, P. supervisors and County Supervisors) SSOTF X X X X X X X XPCOs/RTF X X X X* Payam supervisors X X*Data collection X X * SSOTF X X X X *PCOs X X x X X X X X* Payam supervisors X X X X+ CDDs *Reporting/ drug management * SSOTF X x X X *PCOs X X X X * Payam supervisors X x X X * CDDs X X X X X X X XMonthly financial reportin g expen'diture X X X XSSOTF X XPCOs / RTF 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 X XINDEPENDENT MONITORING X X*SSOTF/PCOs/RTF *Mid term revieu' * SSOTF / RTF X *Evaluation * SSOTF / RTF 21 WHO/APOC, Decenrber I 5, 2004 v ON ri () -o oo o O o a* o @ N O o # z C) -o 'd p. AH()= A6 a-l cd5 do o(H 'n c) .c,a tro -vt da u)E UO -o+ li qoz(J 6.1() =d (-) 5 '(]A Y (J (g 7, cr aF(-) F ootrr- o) C,)tr ZQ bo t !L 6 oL l- C) v) L cq o o A I i-(* A)!() q,) L t*< L/ l-l U d I I q Lq) €t cq A .a2L!oo H! & A' !C)a .*A !:(k I-J Ul a'; !E r].=6 ! +r=.=L^(* H{-l .1 -ratiO ! oL v)tr IY .C'6E ZEd/a\Iv ':.fu c'rl --l:d)tL/ :lri'.'.tlu)+31 e)0 0,) o U) 0) q) U A) O O U) O O O O a4.9 Uc O O O () rsa ZJ- (ar\ oo N ta) (-- c1 \o \o. Oq ")l/^l O. $ O aA +N r oi Oq $ ca (\I R ca €a \o ap o U) z U)(.) k(d cn lri a ao tr Cd a !H (g a v) 0) k A) 9H cd CN cJ) o li(d (d a 9-9(d (n a(.) lr (d ch !H a O -i \o oo oo 'a rr o.(H () E(d z N cq o L G co U)(d r! li o d d tr.l a 0.) cO L o rrl a CO frl o z t< 0) o. D N c0 o r< LLI Ch o > F o(n a F If there are problems with release of counterpart funds, how 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 from APOC. State the numbcr of projects that had no funding from any outside source? . None. All have supplementary funds from CBN{. State the number of projects that are late in submission of the financial reports to APOC? . All 4.2. Other fbrrns of cornmunity support Describe (indicate forms of in-kind contributions of communities if an1') . Provision of venues/shelters fbr comm.unity leaders meetings and CDDs training. . Some communities do the mobilization and sensitization of their orvn people. . Communities collect firewood, water and also cook for CDDs during the training. . Some communities store drugs and provide good security arvaitiug 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 work plan to the Ministry of Health, rvhich includes salaries to the project offices and headquarter and other support of CDTI activities. The outcome was negative as there was no release by the government. 4.4. Expenditure per activifl' by the NOTF secretariat - Indicate the expenditure on activities belorv in US dollars using the current LJnited Nations exchange rate to local currency - 2.4sdg 29 WHO/APOC, 24 November 2003 Table 13: Indicate horv much the NOTF secretariat project spent for each activify listed belorv 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 ofllcers. TOT. NO'fF stafl etc. Advocacl'r,isits to health and political authorities at national lcvel IEC KAP stuclies. tlaterials development. Amual revicrt' u,orkshops Bi amrual NOTIr meetings/conlerences Fuel and rnaintenance o1- Vchicles. Maiutenancc ol' ol fi ce cquipment Stationery Others/Salar1,' by MOI I-GOSS 434.00 11,825.20 000 730.00 7 .389.41 0.00 0.00 7 ,463.80 690.00 I , 161 .00 13,700.00 0.00 0.00 0.00 10,205.26 0.00 0.00 0.00 2t39 0.00 0.00 000 0.00 000 0.00 0.00 18,600 0.00 12,073.25 0.00 000 6,000.00 0.00 I 0 0 0 0 0 0 0 0 0 0 TOTAL 43,393.47 18,600 28,278.51 0 Total number of persons treated 3,012,058 Comments - None 30 WHO/APOC, December 15, 2004 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project 6. Others Photoco Cash safe *Condition of the equipment (Functional, Cunently non-lunctional but repairable, Written off). Hon' does thc project intend to maintain and replace existing equipment and other materials? This "vill come from government counterpart funds which is hoped would be available in very near future as the sy,stem is stabilized. Describe the adequacy of available knowledgeable manporver at all levels. b a a The SSOTF headquarter office: Apart from National coordinator, Deputy National coordinator. and administration and finance officer and one driver, other stalf such as Data Manager, Secretary, logistician etc are lacking. The CDTI project offices: There is general shortage 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 level. This is considered a serious matter for good CDTI management at project level. East Equatoria project coordinating officer has the least ability 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 ofcoaching is required and the number per county should be at least 3 persons for good supervision. Communify level: At the end of 2008, the population / CDD ratio is 810 persons per CDD. This is an improvement when compared to 2007 although the figure is still high compared to APOC standard of 100 persons per CDD. a a Where frequent transfers of trained staff occur, state lvhat project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower n'as available or staff often transferred during the course of the campaign). 3l WHO/APOC, December 15,2004 Sou rce Type of equipment APOC MOH DTSTRICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currently Non Functiona I but repairable Written off l. Vehicle 01 0 0 0 0 01 0 0 2. Motor cycle 0 0 0 0l 0 0t 0 0 3. Computers 0t 0l 0 0 0 02 0 0 4. Printers 02 0l 0 0 0 03 0 0 5.Fax l\,lachines 0 0 0 0 0 0 0 0 0l 0 0 0 0 0l 0t 0 0l 0 0 0 0 -0 0 0 c)Lap top 0l 0 0 0l 0 02 0 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 +. I I L 0) bo?tr -'-a: v I aECJ 9) .(J tQi -bD - hU LTI ) t9 qg! bo= aL Loo'i ! -.FEa)4) v E! )E^-t{r:o. r-!o., = ,aE F;ac.H0.)dq,) i:rP *4qr>:(', 79HV -<L de jj a bo.g b7 .Ec 9.LJIi rl o! =!-u'; Eg 5U.r - qv - R IL ,!wU)H* \ra-C; C5 ? =e S.or i !a^Lac.F .=cL Er9-.)t .- U !V '=.: Eg bo ::-d!rlg-2 9 A: 'i) H g.! OU)F9 Eg tr Ea9(UH r 6 9+a.lor^n - V V 'a! !.-cE .=E B4E r,fi ts Er-9 ft9 .P = >A araU ' 6 Z.6rA ;^E i v :S - ,iit -rn'l; . oJl!=llrl i eslA tn F,,l a O al o -o E o o z $ ol (, o o. o iJ. CO c.) ()5 O o. c. o z +. o) o q) q) q) 4) ), ero; Q)o>: :: 4, itr c) :Y o) c^ ol- oo >, i< lut-l-o(E(J o. o. o z +.q () (J q) q,) o q) q) q,) u0 N.a'+ ra t.) ra >\ -o o ./ t/) *90.rO)E (,(-,Q. -o -ti !-F()=^ ,? i-, ; (d a, .n _.a uL= (JO _.o oJ e(tr!6 E,* l-6cg ua>, ! 0) Ego C!p o(Jd Q. .= oroi>. € o-t^= ,: tr sJ- - aa :ietr€ o a,trE r(dJa\ fi!dH .: i, c0 cd\<=>c) AcnQ>, . ).eHhForvUd \du.d - iic ! . .-- 6l v :e a) v g.- ,+:'E o)'c '!LfrA <cO:: .-^!F () z (,) o 'a trg 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 1,et 5.2.3. Transport and equipnrent (replaccment and maintenance) No plans yct. 5.2.4. Human resourccs No plans 1'et. 5.2.5. Which projects have submittcd sustainahilit5' plan? No plans yet 5.2.6. To w'hat cxtent have the plans been implemcnted? No plans 1ct. 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms Ivermectin delivery systern is separate frorn other drugs in the PHC system as a result of non integration. The Ministry of Health of Goverrunent 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 sl,stem probably in 2010. 5.3.2. Training There was no integrated training vet rvith other prograrrlmes. Nevertheless, PHC health workers are an essential sourcc of trainers after having being trained. All this is the plan after integration of CDTI into ministry o1'health. Most staff are not ministrl' of health staff and the CDTI has not been taken fully over by all state ministries of health. There is a sign that integrated training of prograrnmes such guinea worm eradication and onchocerciasis control and other NTDs would be a reality in 2009. 5.3.3. Joint supervision and monitoring n'ith other programs There was no joint supen,ision and monitoring u'ith other programmes yet. There is a very high probability of NTD integrated supen,ision and monitoring for 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 with stabilization of health system. there is chances that common budget and release would be possible in Southern Sudan over time especially through joint NTDs fund release. t 34 WHO/APOC. December 15, 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 implernentation of CD'l'l activities. 5.3.6. Describe other health programmes that are using the CDTI structure and horv this n,as achieved. What have been the achievements? No other health programlnes in the Ministry of Health are using the CDTI structure. However, it is being considered for the implernentation of Integrated Essential Child Health Carc (IMCI), and distribution of impregnated nets as rvell as other neglected tropical diseases control. 5.3.7. Describe other issues considercd in the integration of CDTI The CDTI strategv could be used in lnanagenlent and control of ll,niphatic frlariasis through albendazole drug distribution alongside iverntectin. 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplcmentation integrated and rvhat are the results, is screening for cataract of primary e),e care inten,entions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategr', etc?) 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 ll,mphatic filariasis using albendazole. 5.4 Operational research No operational research w,as carried out 5.4.1. Summarize in half of a page the operational rescarch unclertaken in the countrt, arca within the reporting period. Not applicable 5.4.2. How werc the results applied in the project? Not applicable 5.4.3 Note the issues that have operational research. been identified by, the NOTF for future KAPs in the ne\Y CDTI areas . There is no identified nerv CDTI areas 1,et hence no KAp studies. 35 WHO/APOC, December 1 5, 2004 a 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 office in verl,usetul in hastening fund disbursement to SSOTF and projects. a Weakness a a a I a a a a a a Available rnanpo\\rcr is still inadcquate not rvell knowledgcable. Nonpayment o1'salary ol most CDTI staff by the government. Census update not completed in virtually all CDTI projects. Still there is non availabilitl,of registers in some communities Poor state of roads rvith resultant high rvear and tear of the l'ehicle. Frequent insecurity'in project locations disrupts treatment and therebv leads to lor.v coverage. Distribution during rainy season renders rnany 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 o a Challenges and hgw tlrey were addressed Inadequate staffing and knowledgeable manpower in the project area. There is deficient staff strength across all levels and SSOTF has planned to continue rvorking with tlie state ministries of health on rccruitment of the missing sta1f. Non availability of CDDs in some communities. This matter rvas discussed at a meeting with community rnembers as discovered during SSOTF supervision and new people rvere 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 letters to government top policy/decision makers in Government of Southern Sudan Intensifying health education and community mobilization. This rvas used to diffuse beliefs on the mectizan and those rvho previouslv refused norv accepted treatments. Population/CDD ratio in the entire country 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. The road condition is still very poor with consequence huge cost of vehicular maintenance due to frequent break down. a a a a a a 36 WHO/APOC, December I 5, 2004 Indicate how opportunities can be utilized to improve CDTI The continued peace and stability in southem Sudan has offered platform for communill,penetration and further improvement in both geographic and therapeutic coverage. NTDs control offers an opportunity for utilization of CDTI structure and thus leading to popularity and prosperitl, of mectizan distribution List the strengths, rveaknesscs, opportunities and thrcats of the vector elimination project (rvhere applicable). This is not applicable since therc- u'as r-ro vector elirnination conrponent irr Southern Sudan. a a a a a ! 37 WHO/APOC, December 15, 2004