Report on the evaluation of the sustainabilify of the East Equatoria CDTI Project

tAFRICAN REGION African Programme for Onchocerciasis Control (APOC) 01 B.P. 549, Ouagadougou 0'1, Burkina Faso Tel: (226) 50 34 29 53; 50 34 29 59; 50 34 29 60; 50 34 36 45/46 Fax: (226) 50 34 28 75; 50 34 36 47 World Health Organization ln reply please refer to SDD/APOC/41012011/GF/pm South Sudan Onchocerciasis Task Force (SSOTF) Secretariat Ministry of Health Juba South Sudan Attention: Dr Lucia Kur E-mail: luciaku55@,yahoo.com Ouagadougou, Dear Dr Kur, Re: Report on the Evaluation of the Sustainabilify of the East Equatoria CDTI Project The East Equatoria CDTI project has been supported by APOC since 2007 and is in its fifth year of funding. lt is routine and necessary that after five years of treatment service to the endemic communities the project be evaluated to identifu its strengths and weaknesses, opportunities and threats, its adequacy, impact, effectiveness and efficiency. ln June 201 I (five years later) APOC constituted a team of evaluators with a mandate - To evaluate the sustainabilify performance of the project. - To support the implementers of East Equatoria CDTI project in developing sustainability plans The overall conclusion of the evaluators based on the 7 aspects and 5 critical elements of sustainability is that the project is NOI MAKING SATISFACTORY PROGRESS TOWARDS SUSTAINABILITY. The analysis of the indicators at each level (State, County, Payams, and Bomas) shows the following results: PLANNING: One coordinator manages the Central and East Equatoria projects. No written CDTI plan was available and planning was generally weak. At the county level, planning was moderate and written CDTI work plans were available but there was no evidence of integration ofactivities and use ofchecklists. The staffs at the Payam level were dependent on higher level to initiate activities. Decentralize project msnsgemenl to State level; appoint separate project coordinators for Central and East Equatoria States to facilitate CDTI implementation. Integrate CDTI into the over all State Health Department plans. The project co-ordinator should verify treatment coverage for informed decision making and before sending them to the nationul level. INTEGRATION: There was no integration at the project level but some degree of integration was observed at the county, payam and boma levels. o Strengthen integration of CDTI into PHC at all levels. e Develop an integrated checklist for use by staff at all levels. 0 9 DEc 2011 a a Explore innovotive ways of integration with other sectors (education, agriculture etc). LEADERSHIP: Leaders were neither aware of the problems in the projects nor up to date with treatment and reports. Focal persons at the county were unskilled in CDTI and delegated responsibility with out adequate supervision due. Ownership by the FLHF team was weak and was dependent on the higher level to determine quantity of Mectizan@ tablets required. The leadership has not established CDTI and health workers were yet to empower community leaders on the CDTI strategy. A comprehensive list of all villages should be prepared and census data of each village conducted and updated annually. Empower health staff at all levels and community leaders to promote ownership. MONITORING AND SUPERVISION: There were neither plans for supervision, nor evidence that supervision was being carried out. Monitoring and supervision is ineffective, it did not identifo and address issues and detect the passive treatment by FLHF instead of CDTI. Although the reporting process was within the government systern, coverage and financial reports were scanty. CDDs were submitting their registers to the supervisors at the health faciliry. Develop integrated ntonitoring and supervision plans ond checklists at all levels and ensure d o c umentat io n of activiti es. a a o a a MECTIZAN PROCUREMENT AND DISTRIBUTION: Supply of Mectizan@ tablets was within the government system levels, it seemed effective and uncomplicated, although there were delays in procurement. There were no inventories and FLHF with expired tablets did not know what to do. Tablets were either delivered by FLHF staff or collected by CDDs and transportation was a constraint to both. Supply of tablets was not based on population figures and FLHF decided the quantity. CDDs should corry out census, update it onnuolly and Mectizan@ tsblets are to be supplied based on census population. TRAINING AND HSAM: No evidence of training and HSAM were available at project level At the pyam level, training appeared to be targeted and based on need. IEC materials were not seen in most FLHFs. There was also [enerally lack of awareness on CDTI in communities. SSOTF in collaboration with APOC TA should sensitise policy makers through workshops at all levels on CDTI strategy and philosophy. SSOTF should re-orientate the staff at all levels on CDTI strategy and philosophy Provide sufJicient IEC materials at all levels FINANCIAL: Govemment contribution is low. APOC transactions are cash based; funds are released to the project co-ordinator and the project accountant keeps the money in the office. Despite available banking system the project did not have a bank account. It was also perceived as a well funded NGO project. Community members do not support CDDs. Project should open frn occount at the County. Heads of Departments should be signatories and take responsibility for management of funds, Jinancial and technical reports. Government to budget and disburse funds for CDTI activities a a a a 2 TRANSPORT AND OTHER MATERIAL RESOURCES: Staff members lack transportation to facilitate implementation of CDTI. All capital equipment (vehicles and office equipment) are not functional; there are neither dependable sources of transportation nor are there plans for replacement. Training and HSAM materials were adequate. o SSOTF should as a matter of urgency, Jix up the project vehicles and equipment to facilitate implementation of CDTI. o Adequate plans should be made for maintenance and replacement. o Project should ensure vehicles and ofJice equipment replacement plan. HUMAN RESOURCES: Of all the staff implementing CDTI only the county level ones are government employees. This did not seem to affect their commitment to CDTI. Also technical staff lacked ICT skills. The FHF despite are unskilled despite being in post for 3 - 6 years. There were no CDDs in most of the villages; and where they were available the ratio of CDDs: population was very low. Census was not done and only those perceived to have Onchocerciasis were treated. o Train and retrain all health staff at all levels in the CDTI strategy. . Sensitise communities to nominate additional CDDs based on existing clans on a CDD: population ratin of I to 100 and Jind ways of motivating them. o Train and retroin all CDDs. COVERAGE: There were discrepancies between the treatment coverage figures at National and project levels. Coverage data were not reported by villages which made it impossible for SSOTF and the project co-ordinator to identif, problem villages for action resulting in low coverage. Supply Mectizan to the villages based on census data. Funds should be released whenever necessary to FLHFfor HSAM. Plan to conduct community mobilization and sensitization. Conclusion The evaluation revealed several strengths o Improved disbursement of APOC funds for CDTI activities. o Involvement of some health officers in other health programmes. . lntegration of supply and distribution of Mectizan@ tablets into government drug delivery system o Willingness of FLHF staff to facilitate CDTI. Weaknesses . Inadequate manpower. o Over dependence on APOC funding. . Lack of transport for effective implementation of CDTI activities. . lnadequate census to inform allocation of Mectizan@ tablets to communities. o Poor/lack of planning skills at project level. . Lack of awareness among policy makers on the CDTI strategy. o Poor community participation and ownership of CDTI. . SSOTF's delayed response to the needs of CDTI at lower levels has negatively affected implementation of the project. a a 3 Opportunities o Health system strengthening. o lntegration of CDTI into other health programmes. . NTDs. . Benefits of CDTI. o Benefits of controlof Onchocerciasis. Threats . Unskilled staff. . Poor geographic and therapeutic coverages. o Over dependence on APOC and donor funds APOC management rvould like to recommend that the SSOTF and the project management improve the implementation of CDTI and to put in place appropriate mechanism towards solving the problems raised by the evaluation team. A report on the implementation of the recommendations stated in bold in this letter is to be shared rvith APOC rnanagement and allnational project partners by end of June 2012. Thank you and rve look forr.vard to further collaboration with you on the matter Sincerely yours, Dr Paul-Samson Lusamba-Dikassa, Director, APOC cc - The Head of Office, WHO South Sudan Office, E-mail: mohameda@nbo.emro.who.int; whossudan@nbo.emro.who. int: drabd i_9@hotmail.com - Dr Aston Benjamin Atwine, APOC Technical Adviser, South Sudan - E-mail: afw i n ebenj am in@h otmai l. co m - Mr Fasil Chane Bizuneh, NGDO CDTI Coordinator, Juba, E-mail: fbchane@yahoo.com - Ms Agnes Wanyoike, APOC Finance Administrative Assistant, South Sudan, E-mail: agsieniensina@smail.com - COORD-CSD-CEV_ BIM _COP_ TO-CAO- BFO- FO .r?tu 4