Mission Report: Working session with onchocerciasis control parteners, South Sudan, 22nd – 30th March 2009

South Sudan Onchocerciasis Task X'orce (SSOTF) and APOC Management Working sessions with onchocerciasis control partners South Sudan, 22"d - 3O'h March 2009 Mission Report By Dr. M. Noma, CEV/APOC Mr. K.B. Agblewonu, BFO/APOC Mr. N. Lazants, TAiAPOC Mrs. A. Wanyoike, AAF/APOC t , ::.;*;, h^t i { l 1(t t n It a , , ,I ta -.1 .J-/+ ) r a qat..' : "',. Table of contents 1. TERMS OF REFERENCE OF THE MISSION......... 2. SETPS IN CARRYING OUT THE MISSION........... 3. FINDINGS AND OUTCOMES.... 3.1. Programme coordination: SSOTF and projects .. 3.2. Financial and administrative issues........ 3.3. Projects: operations, experiences and challenges 3.4. Capital equipment of projects 4, STATUS OF DISEASE MAPPING............ 4.1. Completion of disease mapping 4.2. Funding and managing the approved budget of disease mapping 5. OTHER IMPORTANT MATTERS........... 5.1. Government's financial contributions............ 4 4 5 ..,6 ...8 ...8 .10 ....10 5.2. Mechanism of releasing funds for Technical advisor: request approval, TA and claims..10 5.3. Regular supervision activities by WHO/South Sudan-APOC Management-AAF/APOC 10 6. CONCLUSIONS. ACTION POINTS AND RECOMMENDATIONS ........ ll ANNEXES 12 2 .......3 .........3 1. TERMS OF REFERENCE OF THE MISSION 1. Transferoffunds r Past and current experiences o Action for improvement of the transfer of funds 2. Release of funds r Collaboration and Support of WHO Office, CBM and SSOTF/HQ to projects e Financial structurc in place at national, state, county and project level o APOC manual and procedure: Project team o Plan ofAction and Budget and submission r Availability oftrained project accountants o New mechanism of releasing of Trust fund to WHO office, Projects, Stafl members, other suppliers r GSM requirement -Bank account details r Signature ofproject bank accounts o Financial reports using the format of GSM o Financial rehrms :Channel from Project to APOC Technical reports (endorsement, submission dates, technical format, project years) Pending retums and pending pa),ments for year 2008 3. Support to country r Inventory of capital equipment . Status of disease mapping funds and results of the exercise (Data o1 REMO/RAPLOA) o Operationalization ofthe SSOTF: Chair and South Sudan Oncho Coordinator 4. Other Affairs and Business 2. SETPS IN CARRYING OUT THE MISSION APOC delegation (Dr. M. Noma, Mr. K.B. Agblewonu, Mrs. A. wanyoike, Mr. N. Lazarus) WHO/South Sudan, (Juba,24 March 2009) Government of sourh Sudan (Goss) Ministry of Health (Juba,24-25 March 2009) Banking institutions (Juba,25 March 2009) South Sudan Onchocerciasis Task Force (SSOTF) HQ and CDTI Projects (Rumbek, 26-27-28 March 2009) GoSS MOFVDirector of Finance (Juba, 28 March 2009) Debriefing of the Head of the office/WHO/South Sudan (Juba, 29 March2009) Meeting with CBM Regional Director in Nairobi was not possible for conflict of agenda a 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 3 Findings 3. FINDINGS AND OUTCOMES 3.f . Programme coordination: SSOTF and projects Partners recognized that there is no functional South Sudan Onchocerciasis Task Force (SSOTF) Onchocerciasis Control is now under the leadership of the General Director of Preventive Medicine SSOTF chair and Onchocerciasis National Coordinator to be nominated Location of the SSOTF HQ not clarified (Rumbek or Juba?) Project team composition assessed and it was noted that 2 Project Coordination officers (PCOs) out of 5 are not Goss MOH staff members SSOTF HQ and projects' team members insufficient and not trained on APOC financial procedures 3.1. L 3.1.2. 3.t.3. 3.r.4. 3. 1 .5. 3. 1 .6. Outcomes 3.1.7. Agreement to keep the SSOTF HQ office in its current location in Rumbek. Offie building was renovated and have enough office rooms 3.1.8. Chair of SSOTF is the Director General of Preventive Medicine, Dr. John Rumuni 3.1.9. National Coordinator is the Director of NTDs, Dr. Christo Muniri 3.1.10. Deputy National Coordinator to be identified, nominated and based in Rumbek 3.1.11. The new management team (SSOTF Chair and National Coordinator) demonstrated willingness of transparency and commitment to enhance CDTI activities in South Sudan Follow Up actions 3.1 .12. Official nomination documents of the Chair of the SSOTF and the National Coordinator to be communicated to APOC Management and WHO/South Sudan 3.1.13. Terms of reference (TOR) of project team members including SSOTF HQ Finance officer for integration in Goss MOH personnel will be available by end of April 2009. APOC Technical Advisor in South Sudan was requested to assist in elaboration of the TOR. 3.1.14. Estimated budget for training/retraining on financial and administrative management of all the project team members should be submitted to APOC Management as soon as possible. 4 3.2. Financial and administrative issues Findings 3.2.1. Only one (l) commercial bank is functional in South Sudan, Kenya Commercial Bank (KCB). Banking in Juba/Rumbek is not yet efficient. KCB could be used for few need of dollars and for pound transactions, 3.2.2. Existing agreement between WHO/South Sudan and DASHBILL (for transfer of funds between Nairobi and Juba offices) 3.2.3. All parbrers' funding to government programmes should be domiciliated at the Bank of South Sudan (BoSS) according to GoSS' financial regulation 3.2.4. GoSS/MOtVUndersecretary and General Director of Finance are the principal signatories of these types of accounts. Withdrawal of funds based on the request of the Programme Manager (SSOTF/Chair, National Coordinator, Deputy national Coordinator) with co-signing of NGDO Coalition chair. 3.2.5 Lack of capacity of project teams to manage 70oh of approved funds under direct financial contract (DFC) Need to split 2009 budget approved by state covered by CDTI projects Eight months of delay in submission of financial reports as at 30'h March 2009 Outcomes 3.2.8. Agreement to open six (6) sub bank accounts at Bank of South Sudan (BoSS) in Juba for (5) CDTI projects and (1) SSOTF HQ 3.2.9. Consensus obtained for release of funds per sub-installment based on micro-planning of the CDTI activities to be submitted to APOC technical advisor for South Sudan, 3.2.10 TrainingonfinancialmanagementofAPOCTrustFundtobeorganizedforprojectteams,mainly for new staff 3.2.11. Project team members bnefed on GSM, mainly the bank information for suppliers (projects, individual partners) and on the technical, financial DFC reporting format Follow Up actions 3.2.12. Bank details for the six accounts and specimens of authorized signatories from GoSS/MOH will be communicated to APOC Management and WHO/South Sudan within the first week of April 2009 3.2.13. Project Bank account name should be structured as follows: MOH / GoSS/ xxxxx CDTI Project 3.2.6. 3.2.7. 5 3.2.14 3.2.15 3.2.16 3.2.17 Findings MOH/Director of Administration and Finance (DAF) will share with APOC Management all financial relevant regulation documents of GoSS Based on micro-planning budget submitted by SSOTF/HQ via WHO/Juba, APOC Management will indicate the portion of the approved amount to be released to projects by WHO/Juba With the assistance of the SSOTF, 2009 budget approved will be split per state covered by a CDTI project. 2010 budget should clearly indicate the requested amount for each state by using the new plan of action and budget format. AAF/APOC will liaise with the project teams for submission of the pending returns within the first week of April 2009 3.3. I . 3.3.2. 3.3.J. 3.3.4. 3.3.5. 3.3.6. 5.5. I . 3.3.8. 3.3.9. 3.3. Projects: operations, experiences and challenges 3.3. 10 Training of CDDs and distribution of ivermectin during raining season Long distance between counties and from village to village, Lack of primary health facilities No maintenance of vehicles because of non allocation of budget line Delay in disbursement of APOC Trust Fund Delay in payment of Top up Delay in ordering of the Mectizan Non availability of office supplies and stationeries in South Sudan (to purchased in Nairobi) Non involvement of Project Coordination Officers (PCOs) in specific activities e.g. November 2008 REMO exercise (PCOs not involved in appointment of enumerators, training and implementation of REMO/RAPLOA survey) carried in their areas of responsibility. No collaboration between Project coordinators, NGDO partner and APOC Technical Advisor in management of REMO exercise (funding, implementation and follow up) Problem of autonomy of East Bahr El Ghazal CDTI project from HQ/SSOTF, mainly in allocation of capital equipment PCOs (2/5) non integrated as staff members of MOH Most the PCOs have never seen or received Letter of Agreement of their projects Need the increase of CDD Supervisors for new counties due to the fact that the CDD refuse to distnbute ivermectin out of their areas 3.3. I I 3.3.12 3.3.13 3.3.14 6 3.3.1s 3.3.20 3.3. 16. 3.3.17 . 3.3.18. 3.3.19. Onchocerciasis control programme (OV programme) has operated without referring to any MOH structure; CDTI activities are carried without involvement of local MOH structures and control data was not shared with county and state health authonties Claim of incentives by the CDDs Migration of population from DRC and increase of population to be treated Some of the CDD supervisors are not MOH staff The forum was informed that disease surveillance officers will be appointed for Malaria, Tuberculosis, and NTDs (onchocerciasis control included). These officers will be in charge of data management. These officers will be recruited based on selection tests. Projects' financial and implementation years were discussed: there was not misunderstanding between projects' coordination and APOC Management Outcomes The projects made the following suggestions: 3.3.21. To receive funds and start the distribution at least in April 2009 to avoid treatment during raining season 3.3.22. Need cross boarder collaboration between Northern and Southern Sudan for treatment of communities located on the borders 3.3.23. Need a letter from the MOFVDirection of Preventive Medicine notifying to the projects the focal structure at state MoH. 3.3.24. Projects should report to the GoSS/MOH the status of their staff members regarding GoSS MOH payroll. 3.4. Capital equipment of projects Findings 3.4.1. Lack of equipment inventory 3.4.2. No insurance of project vehicles 3.4.3 Availability of companies of insurance in South Sudan 3.4.4. Transfer of some projects' equipment to Government (MOH) is been assessed by WHO staff Outcomes 3.4.5. Inventory cards to be submitted before end April 2009 7 3.4.6. Quotation for insurance of APOC vehicles should be communicated to APOC Management for action 4. STATUS OF DISEASE MAPPING 4.1. Completion of disease mapping Findings 4.1.1 4.t.2 4.t.3 4.t.4 Outcomes In November 2008, the Management of APOC assisted the SSOTF to refine the rapid epidemiological mapping of onchocerciasis and to assess country-wide the endemicity of Loa loa. Three temporary advisors were provided to assist in training of nationals and implementation of the disease mapping. A budget of 51,699.85 US $ was allocated to fund this important mapping exercise As at 27 March 2009, the disease mapping were partially completed A total of 140 villages were sampled for refinement of the rapid epidemiological mapping of onchocerciasis (REMO) and completion of rapid assessment procedure of Loa loa (RAPLOA). 61 villages were covered for REMO and 62 for RAPLOA. Follow ap actions 4.1.5. 2008 REMo'results (figure A-1) did not provide more details on onchocerciasis status compared to what was already known. Figure A-2 revealed the update status of onchocerciasis in South Sudan 4.1.6. The disease mapping carried out 2008 provided more information on Loa loa endemicity in South Sudan. Before November 2008 mapping (figure B-1) the status of Loa loa endemicity was known only for the Equatoria regions. The update map of Loa loa endemicity reveals that counties out of the Equatoria regions (figure B-2) are not in the Loa loa belt in Sudan. 4.1.7. The SSOTF HQ and APOC Management should urgently complete the mapping of the outstanding selected communities (79 villages to be mapped) with the available funds. 4.2. Funding and managing the approved budget of disease mapping Findings 4.2.1. Funds transferred by Western union: 51,699.85 USD 8 4.2.2. 4.2.3. 4.2.4. 4.2.5. Funds received by WCO/Mrs Agnes WANYIOKE: 50,006.00 USD, lost of 1,683'85 USD in exchange rate Lack of collaboration between APOC Technical advisor and PCOs in implementation of REMO/RAPLOA survey Management of 52o/o of mapping funds by Mr Lazarus has led to unnecessary problems among the team (PCO, SSOTF/Accountant and Enumerators) Balance available for the remaining for completion REMO/RAPLOA exercise: 17'660.20 USD td$ ardr; 2001 iElO I4". l4arir , . ," ' ,' ' lli'li r. t r&: U9.r.l ido orltr o llertt I ued -*. Figure A-l: Results of November of 2008 REMO Figure A-2: Udpate REMO results &.ff Lrdr: iAtl'OA..|trlE -.1gfl 2004 lrlt! Figure B-l: RAPLOA results before November 2008 Figure B-2: Update RAPLOA results 9 l,+- 6rmse$stne, .t -: .r tl hh s{ds: RA'IOA t.s{. 6 at !4., 2007 -l t' I-n Outcomes 4.2.6 Status of the REMO funds established and balance available rendered to the SSOTF/Accountant (usD 10,168.70) Advice provided to Mr Lazarus regarding (i) his TOR; (ii) to avoid conflict situation in team work and to safeguard the transparency management of APOC Trust Fund and (iii) to never use unjustified (US $ 5,991.50 to recovered) 4.2.7 5. OTHER IMPORTANT MATTERS 5.1. Government'sfinancialcontributions Senior staff of GoSS MOH sensitized on govemment's financial contributions to CDTI activities. Senior Staff agreed to track government's financial contributions. 5.2. Mechanism of releasing funds for Technical advisor: request approval, TA and claims Senior staff of WHO office in South Sudan sensitized and agreed on the mechanism to handle the cost and the approval for field visits of APOC Technical Advisor. 5.3. Regular supervision activities by WHO/South Sudan-APOC Management-AAF/APOC The Head of WHO office in South Sudan recommended frequent visits (every three months) to the project teams. He decided himself to undertake more frequently such visits which will be supported by his ofhce. 10 6. CONCLUSIONS, ACTION POINTS AND RECOMMENDATIONS The main conclusion, actions points and recommendations are listed below (") Officiat nomination documents of the SSOTF Chair and National Coordinator to be communicated to APOC Management and WHO/South Sudan,' (b) With assistance of APOC Technical advisor, terms of reference should be available by end of April 2009, for projects' staffmembers, including the SSOTF Finance Officer, not part of Goss MOH payroll; (c) Budget should be submitted to APOC Management for the training of all of the project team members as soon as possible; (d) Bank details for the six accounts and specimens of authorized signatories from GoSS/MOH will be communicated to APOC Management and WHO/South Sudan within thefirst week of April 2009; (e) Project Bank account name should be structured as follows: MOH / GoSS/ xxxxx CDTI Project; (fl With the assist(tnce of the SSOTF, 2009 budget approved will be split per state covered by a CDTI project. 2010 budget should clearly indicate the requested amount for each state by using the new plan of action and budgetformat; (g) MOH/DAF will share with APOC Management all financial relevant regulation documents of GoSS; (h) Based on micro-planning budget submitted by SSOTF/HQ via WHO/Juba, APOC Management will indicate the portion of approved amount to be released to projects by llHO/Juba; (i) AAF/APOC will liaise with the project teams for submission of the pending returns within thefirst week of April 2009; (j) Inventory cards to be submitted before end of April 2009 and quotation for insurance of APOC vehicles should be communicated to APOC Managementfor action. 11 ANNEXES Sqlth Soudrn: StrtGs Csnmunitci dirccttd tr..tm.nt with ivcrmactin prcticct3 COll prq.(ll Er B*r EJGhutl f wuerrEtaur I ExEcrc,r !weocou I uppMo 0 137 5 2t5 550r----R.t APOC€O/$dV230!09 States and counties covered by CDTI projects 1 0 States 25 Counties5 CDTI projects West Equatoria )per Nile West Equatoria Mundri, Maridi, Yambio, Ezo, Tambura East Equatoria Magwi Juba, Yei,Kajo Keji, Terekeka East Equatoria Central Equatoria Wau, RajaWest Bahr El Ghazal North Bahr El Ghazal Aweil South, Aweil East, Aweil West Twic West Bahr EI Ghazal Unity Rumbeck. YirolEast Bahr El Ghazal Tonj, Grogorial Lakes Warab t2 Upper Nile Renk Jonqlei Pibor, Pocholla, Akobo, Diror WORLD HEALTH ORGANISATION . REMO/RAPLOA Summary of REMO fund - Persons involved in the management Summary of REMO fund - Breakdown of expenditure and the balance Petty Cash (USD) Balance 17 Date Totals from previous page or Balance from last month Petty Cash (USD) Received Managed 11t7t2008 FROM APOC - KSH 3,850,437.41 50,006.00 Funds Manaoed bv [Vr Lazarus 25,991.00 52% Funds Managed by Mr Sala, SSOTF Accountant 15,350.00 31Yo Funds Manaqed by Mrs Aqnes 8.665.00 17Yo Total 50,006.00 50,006.00 100% Date Totals from previous page or Balance from last month Received Spent 111712008 FROM APOC - KSH 3,850,437.41 Funds Manaoed bv Mr Lazarus 2s,991.00 8,330.80 Funds Manaoed bv Mr Sala, SSOTF Accountant 15,350.00 15,3s0.00 Funds Manaoed bv Mrs Aqnes 8,665.00 8,665.00 Total 50,006.00 32,345.80 17,660.20 a 13 Financial Transactions Chart for SSOTF / CDTI Proiects CDTI Project teams in South Sudan Technical reportRetums Release of funds Submission Micro-Plan Transfer of funds Reviewed retums Rivised Micro-Plan WHO/Juba&Nairobi WHO/APOC& GSC - Secretary - Data Manager - Book keeper -Deputy Coordinator 5 Available & trainedHQ/SSOTF Available & trained4 YESEastern Equatoria Not available5 NOWestern Equatoria NO Not available4Upper Nile Secretary5 YES Available but not availableEastern Bahr El Ghazal Not available4 YESWestern Bahr El Ghazal a t4 MOH / DAF Signing of cheques ssor / HQ Request of withdrawal offunds CDTI Project Request of funds Project Project year PCO Status (MOH staff) Trained accountant Other team members missing Status of financial report submission as at 30th March 2009 LIST OF PERSONS MET DURING THE MISSION Project Last month of financial returns submission fengtn ofdelay as at 30ft March 2009 HQ/SSOTF June 2008 8 months Eastern Equatoria June 2008 8 months Western Equatoria June 2008 8 months Upper Nile June 2008 8 months Eastern Bahr El GhazaL June 2008 8 months Western Bahr El Ghazal June 2008 8 months N o NAMES DESIGNATION EMAIL ADDRESS TELEPHONE NUMBER 1 Dr. Abdi Mohamed Head of Office - WHO mohameda@nbo.emro.who. int +24992736t44 0 2 Mr. Neiib Youssef Administration Officer nei ibO I youssef@vahoo.fr +24992604359 9 3 Dr. John Rumunu Director General Preventive Medicine irumunu@vahoo.com +25647710841 7 4 Dr. Mounir Christo Lado Lugga Director for NTDs - National Coordinator moloionq@yahoo.com +2567643561 2499260019 5 Dr. Samson Paul Baba Director General External Affairs samson baba@vahoo.co.uk +25647712579 9 6 Mr. Adwok Laa Aiak Director of Finance aiak3000@vahoo.com +24912276768 8 7 John Ndungu KCB Manager - Juba Branch i uba@kcb. co.ke/i nduneu@klb.aa.kq +25647713060 5 Mr. Fasil Chane CBM NGDO Coordinator fbchane@yahoo.com +25647718395 2 9 Mr. Lazarus Nweke Technical Advisor nnabdkelaz@yahoo.com +25647719847 7 l0 Daniel Anthony Umido PCO - West Bahr El Ghazal Proiect danielumido@yahaa.aa +25647717833 2 1l David Bido PCO - West Equatoria Project bidodavid@yahoo.co.uk +25647720050 2 12 Chuol Both PCO - Upper Nile Proiect chuoboth2006@yahoo.caiu.nile@ymail.co m +25647718988 0 l3 Emmanuel Ezama PCO - East Equatoria Proiect iane oleva@vahoo.com +25647714055 J t4 Chol Manyiel PCO - East Bahr El Ghazal Proiect chol@fastermail.com +25647714055 3 15 Salah Michael Finance/Admin Officer - HQ mikesallahO2 @vahop.pq4n +25647717833 2 16 Agnes Wanyoike Finance/Admin Assistant wanyo ike a@.obq.qlua.wh o in! +25472281697 5 15 8 Key staff of OV programme in South Sudan SSOTF Chair Dr Rumunu John SSOTF National Coordinator Dr Mounir Christo NGDO Coalition / CBM Country Rep. Mr Fasil Fane Upper CDTI Mr Chuol Both West Bahr ElGhazal .-I Dr. Daniel Anthony Umido West Equatoira Mr. David Bido East Bahr El Ghazal Mr. Chol Manyiel Equatoria Mr. EmmanuelBzama ilrr SSOTF Accountant t I !6*o,. "..',*,* Mr. Salah Michael 16 a I flrt' b l \ il HQ