Eastern Equatoria CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

ci f oel ,tS EASTERN EQUATORIA (EEO) CDTI PROJECT whoeeqpro ie mail.com t APOCiDtR RECU LE I{JI.J ublic of South SudanR OTF:cou NTRY/N Proiect Name uatoria CDTI ectEastern EApproval vear: 2003 Launchinq vear: 2006 To: December 20i2 onth/Year Month/Yea riodRe rtinq F rom: January 2012 (circle one) 13 P 10 11 12 13 123456 89101112circle one 123456(7) 8e Qate submitted 9"'August2013 Ministry of Heatth African Programme for Onchocerciasis Control (APOC) Mectizan Donation program (MDp) Ch ristoffel Blinden Mission 560 communities Partners: Ib: For Pao rci \k; G"lcona Hss ORIGINAL: Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) D DLI EFO S I ISS N: To APoc l\4anagement by 31 Januarv for March rcc meeting APOC lt4an ement by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CoNTROL (APOC) y APOC fundinq vear: ANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSULTATTVE COTV|MITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I I Country: Republic of South Sudan National Coordinator: Dr. Tong Chor Malek Signature: ... .. Date:......../August / 201 3 Zonal Oncho Coord inator: East Equatoria State Focal Person: Emmanuel Ezama Alejo Signature: ... .. Date: ./August/2013 Central Equatoria State Focal Person: Atiya Jogot Morgan Signature: ... .. Date:. .. . .. ../August/201 3 NGDO Representative: John Ujwok Signature: ... .. Date: ./AugusU2013 This report was prepared by: Emmanuel Ezama Alejo Designation: East Equatoria State Focal Person Signature: ... .. Date:... ... ../AugusU201 3 AND Atiya Jogot Morgan Designation: Central Equatoria State Focal Person Signature: ... .. I ilollzF '1,'.'l ; ,:I *-_l--.. noitrmohl I .--j ro{[ ol-II ! I I I I I+---. J I I Date usU201 3 ll Table of contents ACRONYMS......... DEFtNtTtoNS....... ........... v! V 1 FOLLOW UP ON TCC RECOMMENDATIONS SECTION 1: BACKGROUND TNFORMATTON 1.1. GeruERnl tNFoRMATIoN............... 1.1.1 Description of the project (briefly) . .1.1.2. Partnership 1.2. PopumrroN............... SECTION 2: TMPLEMENTATTON OF CDTI.... 2.1. TruELrrue oF ACTtvtlES............. .......g2.2. Aovocncy ....102.3. MogtLtznrtoN, sENStrlzATroN AND HEALTH EDUCATToN oF AT RrsK coMMUNTTES 10 2.4. Coruuumry tNVoLVEMENT...........2.5. CRpncrry BUtLDtNG 2.6. TREnrnlEruTS............. 2.6.1. Treatmentfigures 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasons for refusals?..... 2.6.4 Briefly describe ail known and verified serious adverse events (SAEs) that .3 .4 5 .7 .8 11 12 14 14 16 16 16 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear......... ............172.7. ORoeRrruG, sroRAGE AND DELtvERy oF tvERMECTtN ......1g2.8. Con,Iuururry SELF-MONTTORTNG RruO srexeHoLDERS Mrrrrruc... ......1g2.9. SupeRvtsroN.............. ..............1g2.9.1. Provide a flow chart of superuision hierarchy. ....202.9.2. what were the main issues identified during supervision? ...................202.9.3. Was a supervision checklist used? ................. . ... ............202.9.4. what were the outcomes at each levet of cDTt implementationsuperuision?.......... ..............202-9-5. was feedback given to the person or groups superuised?............. ....202'9'6' How was the feedback used to improie the overalt performance of theproject? 20 Eourpnae rur FtttRructel coNTRTBUTToNS oF THE pARTNERS AND coMMUNTTES Ornen FoRMS oF coMMUNtry suppoRT .............. ExperuotruRE pER AcTtvtry.... 3.1 3.2 3.3 3.4 .21 .21 .25 .25 SECTION 4: SUSTAINAB|L|TY OF CDTI.. ............2s4.1. lrurenruRl; TNDEpENDENT pARTrcrpAToRy MoNrroRrNo; EvntunroN ........... ......2s4'1'1 Has the proiect ever been evaluated/monitored? (Tick any of the fot6wing which are applicable)........ .. lll I 4.1.2. What were the recommendations?... 4.1.3. How have they been implemented? .......... 4.2. SusrRtxnatltry oF eRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT........... Yn 3)........ 4.2.1. Planning at all relevant levels.... 4.2.2. Funds 4.2.3 Transport (replacement and maintenance)..... 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented............ 4.3. 1rurecRnrroN............... 4.3.1. lvermectin delivery mechanisms.............. 4.3.2. Training 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Re/ease of funds for project activities. 4.3 5. ls CDTI included in the PHC budget?....... 4.3.6. Describe other health programmes that are using the CDTI structure and how fhis was achieved. What have been the achievements?. 4.3.7. Describe othersissues considered in the integration of CDTI. 4.4. OpTnnTIONAL RESEARCH 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporling period. 4.4.2. How were the results applied in the project?. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS.........'. 25 25 25 25 25 25 25 25 25 25 26 26 .28 28 28 28 28 a lv Acronyms APOC ATO ATrO CBM CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM African Programme for Onchocerciasis Control An n ua I Treatment Objective Annual Training Objective Christoff Blinden Mission Commu nity-Based Organ ization Commu n ity-Directed Distributor Community-Directed Treatment with lvermectin Commu n ity Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmenta I Organization Natlonal Onchocerciasis Task Force Onchocerca Volvulus Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical consultative committee (Apoc scientific advisorygroup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization rCC TOT UNICEF UTG WHO V Definitions (i) ( ii) ( iii) (iv) (v) (vi) Total population: the totar population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eliqibl-e population: calcurated as g4% of the total population in meso/hyper-endemic communities in the project area. nnnuat rreatment o : (Aro): the estimated number of persons living in meso/hyper-endemic areas that a cDTl project intends to treat with ivermectin in a given year. Ultimate Treatment Goal (UTG): calculated as the maximum number ofpeople to be treated annually in meso/hyper endemic areas within theproject area, ultimately to be reacheo wnen the project has reachedfull geographic coverage (normally the project should be expected to reach the UTG at the end of the 3,d year of the project). fherapeutic coveraqg: number of people treated in a given year over the total population (this should be expressed as a percJntage). Geoqraphical coveraoe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identlfiedby REMo in the project area (this should be expressed as apercentage). lnteqration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataraci, etc.) through cDTl (using the same systems, training, supervision and personnel)-in order to maximise cost-effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of cDTl. Sustainabilitv: 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 servic-e, with strong community ownership, using resources mobilised by the community and the government. communitv self-monitorinq (csM): The process by which the cornmunity is empowered to oversee and monitor the performance of cDTl (or any community-based hearth intervention programme), with a view to ensuring that the programme is being execu]ted in ihe way intended. lt encourages the community to ta[e full responsibility ofivermectin distribution and make appropriate modifications when necessary. (vii) (ix) (v ii i) a VI 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 -35-Number of Recommen dation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Re rt related (i) Clarify the number of CDDs trained: the Executive summary stated that 585 CDDs were trained; table 4 gives a figure of 74 while table 5 gives a figure of 589. The total number of CDDs that were trained was 589 as stated in table 5. However, there were an additional 559 CDDs that were available for the MDA even though they were not re-trained in 2011 as shown in table 4. Table 4 had an error; the sum of CDDs available from the counties was 1,148 & not 74 as stated. Correction has been made in table 4 and also in the executive summa ( ii) Explain how supervision started in June for a CDTI activity cycle that started with mobilization in July according to information provided in Table 3. That was a typing error that has been corrected. Supervision started in JulY. ( iii) Provide information on communities with less that 80% therapeutic coverage as required in table 7. This has been done as recommended. (iv) Clarify whether or not CSM was implemented. Table 6 indicated that it was implemented while on page 21 it was stated that it was not implemented. CSM was not implemented. Table 6 does not mention that CSM was conducted. The Community SuPervisors reported in table 6 were Boma level Supervisors of CDDs that were communitY members. P related (i) Update census in all benefitting commun ities The project would reallY want to have this done but there are huge funding I challenges in regards to having this activity supervised. ( ii) Train more CDDs to reduce CDD/community member's ratio which seems to be about 1:852. This is again a funding issue. The number of CDDs trained is limited to the availed funding. ln addition all other trainings (like for health workers & community leaders) were suspended to give priority to CDDs in 2012. ( ii) The project location, which borders the Democratic Republic of Congo (DRC), Uganda, Ethiopia, East Bahr-el- Ghazal, Jonglei, UpperNile and Western Equatoria state to the west places an important demand to strive to achieve 100% geographical and more than 80Yo therapeutic covera This is stillwork in progress Recommendation to APOC Mana (i) Any particular reason for further budget cut up in 2011. ( ii) Any update on capital equipment replacement. (iii) Will Kapoeta East County be included in the subsequent rounds of mass treatment as aCDTI project as requested by the team in their report? 2 Executive Summary This is a presentation of the CDTI activities that were implemented by the Eastern Equatoria CDTI project from January 2012to December 2012, the seventh year of APOC funding for this CDTI project. The partners that were involved in implementing the CDTI activities included the beneficiary communities, the state ministry of health, the frontline health facility staff, the NGDO partner, cbm and APOCA/VHO. The project covered two states; Central and Eastern Equatoria. The project had a population of 978,183 inhabitants living with a total of 560 communities and had an ATO of 782,546. A total of 468 of the 560 communities living in the project area were reached with mass treatment with Mectizan in 2012 thereby achieving a geographical coverage of 83.6%. A total of 587,346 people received treatment, achieving a therapeutic coverage of 60.0%. 1,873 CDDs were trained in this reporting period. 181 staffs were involved in CDTI activities in this period. The project did not experience major population movements during 2012, however there were other major challenges faced that included: lack of a functional project vehicle, which greatly negatively impacted the monitoring and supervision of project activities; lack of sufficient resources to implement the planned activities. The counterpart contribution from the other partners was not forth coming. The project requirements were/are far much higher the funding that was available to the projects. J SECTION 1: Background information Geographical location, topography, climate Eastern Equatoria CDTI project is located between the longitude of 29.5'E - 36.0"E degrees and between the latitude of 4.5'N - 6.0'N. The project area covers two states; Eastern Equatoria and Central Equatoria. The CDTI project area borders the Democratic Republic of Congo (DRC) and Uganda to the south; Ethiopia to the east, East Bahr-el-Ghazal, Jonglei and Upper Nile states to the north and western Equatoria state to the west. The vegetation cover ranges from savannah, to woodlands and also rainforests with a number of fast flowing rivers. The landform is generally plateau. The amount of rainfall received in the area ranges between 600 and 2000 mm per year. The wet season begins in April and continues until October while the dry season runs from November to March. Population: activities, cultures, language The project had a relatively stable population this year as compared to the previous years. With general occurrence of peace this year, there was more movement of traders from the neighbouring countries like Uganda, Kenya, DRC and Ethiopia to transact cross-border trade. Eastern Equatoria cDTl project area is home to the Bari speaking groups e.g. Kakwa, Kuku, Mundari, Nyaangwara, pojulu, as well as the Achoii, Madi, Lotuko, Didinga, Boya, Toposa, Lugbara, Lulubo and Lokoya. The Bari and roposa are the majority of the ethnic groups. Majority of these people practice subsistence farming, hunting and fishing. Communication systems The project area is readily accessible from Juba the capital city of the Republic of South Sudan by both road and air transport. lt is atso accessible from north-western parts of Uganda via the towns of Arua and Moyo. Regular flights also exist from Entebbe in Uganda to major towns of Juba, Yei, Torit, and Migwi. Accessibility from Lokichokio by road is via Narus to Torit, Budi, and Kapoeta counties. The major roads are in relatively good condition compared to those in other parts of South Sudan since they are passable throughout the year, though with some occasional manageable difficulty during the rainy season. lnternet communication system exists in the project area and this permits easy communication between the project office and the national coordinating office. A number of different mobile phone networks exist in the project area thu-s enabling easy access to all project staff at any one time. Adm inistration structure The Administrative structure of the Eastern Equatoria CDTI project is in line with the established government of the Republic of South Sudan structures. The State forms the highest level of administration followed by the Counties, payams and Bomas. States are administered by Governors, Counties by County Commissioners, and Payams by Payam Administrators, and Bomas by -Boma councils. Health systems and health care delivery The government health facilities are the main means of delivery of primary health care services. Most of the health facilities in the project area are run by non-governmental organisations and are thus fairly better managed as compared to those 4 in most parts of South Sudan. However, persistent challenges like efficient coordination, shortages of qualified manpower, drug stock outs and lack of medical equipments still exist. There are a total of 275 health facilities which composed of 1g1 PHCUS, 71 PHCCS, and 13 Hospitals (5 county hospitals,4 state hospitaland 4 private hospitals). Both local and international organizations are partners in the health care service delivery. Number of health staff in project area and number of health staff involved in CDTI activities. The project area had2,261 health personnel, and of these 181 (8%) were involved in CDTI activities. Table 1: Number of health staff involved in CDTI LGA - County Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B1 Number of health staff involved in CDTI B2 Percentage Bs=Bzl81 "100 Juba 297 I 3.0% Kajokeji 371 21 5.7o/o Lainya 349 33 9.5o/o Terekeka 192 27 14.1% Yei/Morobo 382 16 4.2% Magwi 296 24 8.1o/o Torit 374 51 13.60/o Total 2,261 1 8 1 8.0% 1.1.2. Partnership lndicate the partners involved in project implementation at all levels The main partners that were involved in CDTI implementation included the government health services at state, county, payam & boma levels; the 560 beneficiary communities; cbm and WHO/APOC. Describe overall working relationship among partners, clearly indicating specific areas of project activities where ail partners are invotved. The overall working relationship of the different partners in the project activities was satisfactory. However, the drastic shortage of funding was a majoi inherence to thegood intentions of the different members of the partnership The prerequisite activities like planning and advocacy before the distribution exercise, refresher training/reorientation of the project coordinating officer and the county supervisors could not be conducted smoothly/or at all in most places. 5 State plans, if any, to mobilize the state/region/districULGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. This was mainly limited to the easily accessible state level authorities; and some counties that coincided with other activities. The key message was that of direct funding of CDTI activities, integration and absorption of all CDTI project staff into the routine primary health care structure. 6 c- o O) 'h a_ 0) o (U q) D(.) 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Reason(s) for undertaking the advocacy The reasons for conducting these advocacy meetings included: being able to get information out to all the decision makers about the extent of onchocerciasis in their areas and ways of controlling it; getting their support in regards to planning for activities counterpart funding for CDTI activities; reiterating the need of integration of CDTI activities into the routine primary health care system; and to lobby for community level administrators at Payam and Boma Administrators and the wider community leadership to offer support to the CDDs and the implementation of CDTI activities as a whole. The outcomes It is hoped that the leaders and authorities have more information for decision making; gradually there will be commitment by the health authorities to include CDTI as part of the routine primary health care activities in the states and counties; and that the communities will gradually completely support to support the CDTI activities in ways within their possibilities. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. The problems faced included: logistics (transport) was a major constraint since the project still has no functional vehicle and that the fact that the decision making process to allocate funds in the government primary health care system is understandably not an instant one, but rather a long bureaucratic procedure. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information There were a number of FM radio stations at the project's disposal, however these were not utilised due to funding constraints and efforts to have them air free(corporate responsibility) messages were not successful. Messages were mainlypassgd on through the traditional means through village health committees, local chiefs, headmen and community leaders during meetings and other community gatherings. Mobilization and health education of communities including women and minorities There was no specific reach out to women and minority groups. The available efforts targeted the general community members in the project irea. Response of target communities/ viltages The response noticed included community participation at individual and community leadership levels. 10 Accomplishments There was some level of community involvement and participation in CDTI. Suggest ways to improve mobilization and sensitization of the target communities. Funding from all partners cbm, government & APOC needs to be increased since there were numerous activities that could not be implemented due to lack of funds; then there efforts being made to lure other organisations in the CDTI work so that there are stronger partnerships. 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Comments on: Attendance of female members of the community at health education meetings The number of female members who attended health education meetings is reported to be generally improved. ln general, how do you rate the participation of female members of the community meetings when cDTl issues are being discussed? Participation and attendance of women is rated fair. Social- cultural reasons are still hindrances. lncentives provided by communities for the CDDs Most communities still have not yet come up with any incentives for the CDDs. Attrition of CDDS is attrition a problem for the project if yes how is it addressed? This is still a huge problem. This has and will continue to be addressed by educating the community on the CDTI philosophy. LGA - County Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDsTotal no. communities in the entire project area Br Number with community members as supervisors Bs Percentag e Bs= Bs/ Br -100 Male CDDs Bz Female CDDs Ba Total Be= B7+Bg Number of communities with female CDDs Bro Percentage Brr= Bro/Br*100 Juba 59 '16 27.1% 53 34 87 18 30.0% Kajokeji 104 21 20.2Yo 65 87 152 45 43.5% Lainya 53 19 35.8% 59 39 98 20 38.3% Terekeka 103 17 16.5% 111 55 166 29 27.8% Yei/Morobo 110 23 20.9% 147 67 214 35 31.7% Magwi 61 29 47.5% 175 51 226 27 43.5% Torit 70 25 35.7% 236 49 285 25 36.4o/o Total 560 150 26.8% 846 382 1,228 199 35.5% l1 Others issues: None. 2.5. Capacity building Describe the adequacy of available knowtedgeabte manpower at at! levels. There adequacy of knowledgeable manpower to run the CDTI activities in project area is still quite wanting. Whereas there are persons responsibte for the running of CDTI activities at the state, county, payam and boma levels, the quality of expected outputs are higher than what their capacities can produce. This generally affects performance of the project. Where frequent transfers of trained staff occur, state what the project is doing or intends to do, to remedy the situation. There were no noticeable/significant staffs transfers reported. t2 E o .st! q oo o o olt E J z Ptro E.i*=o i. *d (o @ lo!t !t r (f) r-N @ o) t-l\- rr) CON N @ (f) r.o NNN lr)o NN N cf)N t- o) rr)(f) o)N o,(o N(o N O)Ns lf)o .: !t N co (9 @_ o) @ ro ----t tlolql s t : o E o .gt o se!ko cf, co oN(o (f,o f-cf,N o O) @ N@ rr) o co o) l(, olrf- (9 an o ,= th(!F .:O o-5ooo *!Po.= r(lldl!-ll.:- EE =z :Errc) E J.=o &d \. *d o o o -----l O O O O o o o o o o o o O o o o o o o o so o E o, >lol -etol <t sloio o o o o o o o o E' o €(6(E.= Os *l! oo s8 eQ-E- !0)1-= o a E,, d Fd+- -(J o o + Q)q \ ID a l' o .l o o o o o o o o O o o o o o o o o o o o o so tr o E o .9 o so o F o o o O o O o o E o G fi, o o (, o ott E J z o o +q)q =o = o o o o o o o o o O o o o o o o o o o o o so tr o E o .9 (,) s o o o o F o o o F o o o o o o o o (9 J tr3 o ol G -oJ - ,6 .Y o (5Y o .s oJ oY o .Y E oF oo o L o -\o) = (,)(! LoF o) oo ce .no o C) o o) .c '6 L o E o .a .=L o .E o_ a(5 =o) .E a,c o -os(u (! os o E E o o o q Eo G eiq !q)2 ; tr o (E c o Eg o. tr =Foo o L o g tr o o E o G cn :E(! F riil ol .clI(ElFI 5 o o o () € op Q a. o o o! o Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Politic a! Leader s Others (specify ) Program managemen t How to conduct Health education Managemen t of SAEs CStvl SHIVI Data collection Data analysis Report writing Others (specify) of trainin undertaken Any other comments - None 2.6. Treatments 2.6.1 . Treatment figures lf the project is not achieving 100% geographicat coverage and a minimum of 65% therapeutic coverage or coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The specified targets of 100% geographical coverage and a minimum 65% therapeutic coverage were not achieved due to a number of reasons that include: levels of commitment of key partners in activity implementation, funding and logistical challenges. t4 tr) ! E o q o '6. o. o \ C E oc o Er G o o a a- G EI o o E ! ! o a o a € o 'd ta.Co scoo >a Ort AE ^o .:G EE!oEA oo to ig:EastE od €f rs te.oo '6.S i..s FC o'so; !G .ca o':C!00 C: .9 bciE{o51e.! *e'5€ q .. ooI3-sSEb\cro'- G6t ooo\EII .:t oFoS .\as>^o ooX Q-Q.Ooooo ec e. a.rbbE 5 bEoai :=o ! E€ tiR ,=x^u!so Et rlg FF onils OO r,l- l.- o<aa Iol Ov!rB6 ooH*" H6-.9 o-?g9 EPH EEh fr E6o ,tEa ai=Cs gEre EEg rlct E:lE P.i9l c : E IUIE Uxll o E ^,E dl 9 ^,o f e Els E:li El:;l B .qde *l#lE?t?glE H s Elt EIE Er =i'.9€ ElE"lE clitli HE cl; =,'='* Bl ztt ol EIrl zl E o .Y C' o -c(, .Y o L G o Go (E (! .s oJDo .9,!, ll o uJ U' Etr G o E G o r-f ol -ol(El FI e* LO oO Filod>6uisislsH ; --1- $ -EsEsg#.gEi : orE Eg6f;EEEg EsE6e€eA1 --A o o o o o o o o -os (/)tr ouJ Ea6 o o O o o o o o o f :* X $ ;Ea*g"H O) rr) $o cerr) COOr o r @ o F.- o(o l(, -o* tFOCDq!ia.gE(5 N ce @ f-- Cf) O) f-N N@ COo o)lr) r t E-8eE,E-E o lrt l.c (o c2 g'E-g O O O o o o O o L o (5 =o- o o- oo ll r o-d o ,0)Oo)O- (5^([ () L\oLE (DO-o >-EO FO sq co sq r.o sq s(o s CO $lf) sq o @ sq @(o s n @(o sq o(o o o o-- c69!o6 EoYJOPz (f) ro- @ N (o f.- co slr) O)f.-(o- 6 o) N(o CO sl.o @- cf) rr) f- Or- N r (o rt* r @ (ot e)- o l() o COts o.ZItr() F 6.a, < e*Fv N(o s- r- (o co(o_ s@ s(o co- cf) N (o(o o- $lr) N F- s_ cf)oN r- r- o)- N cf) r oN rr)- N N (0tq(\t € o o r:. - (! <,> gEeiE HE oo)OE t-N CO o @ lr) O)\|r)o lr)oN- O)N (f) @lr) F-(o o$ cf)_ $ rr)N rNN-(o(o N t-- rO(o N fitoF- @ o) U' o o)s = a .9 .= C) E E oo oo ll r o'd o (UooFo) '=6 E6S H',6 -(r- s\s@ s\N@ sq s@ sq o)r- sq o @ sq(o @ sq o O) sq co @ oEEgcttr>g) : EE' olr) (o@ lo$ N@ o)@ COlr) (f)(o @@t o co =t iiE6-6tE 8 O)(o $o - (o tr) (oo or r(o ot- o(lo lo e E g-EE *" O)lr) $o (orO Cf)o r o r (o or- o(o ro E< E9o- (E-of - := o .Y o (E Y (o E '6 J (6 .Y o .Y oL o)F oL o oo >-o ; o)(! .=LoF o 2.6.2 What are the causes of absenteeism? The commonest reported was the coincidence of the treatment with gardening time. 2.6.3 What are the reasons for refusals? No refusals reported 2.6.4 Briefly describe all known and verified serious adverse events(sAEs) that occurred during the reporting period and provide (in table 8) the required information when available. No severe adverse events reported. Parasitologist trained? None has been trained Existence of microscope? None is available Has the project reported all sAEs to Mectizan Donation program (MDp)? Please tick one. Not applicabre since sAEs have not been reported. XNo !yes ln case the project did not have any cases of serious adverse events(sAE) during this reporting period, ptease tick in the box. None was reported No SAE case to report x t6 (! o tr oF(E =Eo(U (, G a_ o o q) a E c E o L o o. U' E o o. o o U) .T ! E' o o o o (Ec -c o)vE ox uJ ai <Lq)av LL,llo< EU)oo>soo flso)'>g)E'Xoi o*:8 b'aoo o6 o.9O=o*(U=o): .. o @lz. ol -ol sl r- o o o o o o Etr G o o E (u o o; o o o o o o(, ; o o o o tro o E o o E o .9 o(E o E (E o o E o "iq(\t o) .-(U(', LI 0 a'-oL- > -o-)-o C) s o) o;N s 1r)d(o s (f) + r-- s aO @ s oi @ s a O)(o s rri F- so oi o) so t- @ s oi o) s @ oo s ro oo q Nt- s tri 1.- s co CA s CO oiN s n N(o sq F.-(o s @ +f-- s a? @lo sq o(o 1r)t-$_ tr) @ @ tr)_ c.) cr) Lr)sO-(o f.- CY) N ro(o c.) o) t-_ CO r.- r-N ro_ O f..- rJ) @s(o_ N @lr) o @ It-_ rr) .r) cf) @ Cf) lr) $_ cr,f.- CE r.-(.o (os(o cO co_ @Nf.- sv ro- N@ It- (o\t lr)_ N @t- bJ- c 9<.>Es.xE3 E€5EE H!+ oo o-E u, lrJ c .9 (U o o_ -E0.,(UoZ :ltroE6() < 9!FIJ o c,)a) (tr^ - (Do\ oo oo ui uJ u.t i;o)fo,(l)(o 3US6 6-EO F <.> oo tr I- trJ LlJ uJ E o o(tr LOo.59a 2A o o_ v C9 O)_ tr)o r() (o (f) s_ c) C9 - NO(o_ c\to(o t.*Nt- co(o o, (o @ co r- o) Cf) @ @t\ O) Cf) @ @ F- O) o o)r)6^ k eE oo oo tr f UJ uJ IJJ s c\{ @t- sq N s a (f) @ so o O) sq oo o) c.j @ q(o @ €oo!+o)o $e Ue*;3s E sO c"j ro s(9 co s ro o @ s(o F* @ so oo o? CO6 q co @ IJJ \Ebu = C)- s Es*tstr>o288* rr)!t N (o N @N$ o) @$ o(olo of-rt @(os uJ cO)o o.> iEo E 6.e. "86 CY) (9 oo(o (, [r) oslo O(o to o(o Ir) o(o ro o o(,, o eo o) '- f E E o() .oo ; i_(obb 9 q E 1.!Qi fo --.= C-C O rE 5';b E-f E gU3tr Ec8q) N(o til @$ o) N CA lJ) o(olo o(o 1r) o(o rO o(o ro tr [! (oooN r-ooN @ooN O)ooN o oN oN N oN oF- ooYr>-8g b <.s E z :.h LeB =69:yo(,C; Eo F=, -COfi8; z o -u'65Pq6, =O(Joo- z I <t) o)PEb8 .9Ec =Y Ouro0)oE trE =6 z (o z8 -c>@ C e=E E€EEE z c .Osv^ a=vo(tr> o = o.=,--.-(E;- oo 6.c.E z c oSo9or.N(5 .= O.: i:)o G;it 0)r6;g> z o E o o_ E a z d6E (t, o!+ o E Fe S- z co NaE-6(tr o (IJ-Yo= = a z o 0)o)cs.o >b z x o)a z C,)( o.t z z U) o 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by NGDO ! Other (please specify) Mectizan@ delivered by - (p/ease tick the appropriate answer) WHO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The Project Coordinating Officer submits mectizan requirement to the SSOTF; who then compiles this data with that from the rest of the CDTI projects and makes submission to MDP. After the reviews and approvals from MDP and production by MERCK; the mectizan is shipped to south sudan and is received oy ine wHo Country Office. Mectizan is then supplied to the projects based requirement and balances that remained form the previous distribution. At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for colLction; and cycle cascades to Payam Supervisors, then to Boma Supervisors and then to the different Bomas and villages. Table 10: Mectizan@ Inventory County/ LGA Number of Mectizan tablets ln stock from previous Requested Received Lost Expir d ed Juba 124,705 80,000 80,000 79,897 0 87 0 124,731 Kajokeji 74,343 160,000 160,000 159,140 0 61 0 75,142 Lainya 5,399 60,000 60,000 53,235 0 39 0 12,124 Terekeka 45,039 1 10,000 1 10,000 107,597 0 122 0 47,330 Yei/morobo 171,309 260,000 260,000 429,253 0 93 0 1,963 Magwi 1,900 385,000 385,000 335,524 0 46 0 51,330Torit 63,725 555,000 555,000 522,343 0 159 0 96,223 TOTAL 486,419 1,500,000 1,500,000 1,696,969 0 607 0 298,944 How are the remaining ivermectin tablets collected and where are they kept?The CDDs collect all balances of mectizan tablets, quantify them and then submit them to the health facility staff for storage until the next treatment cycle. The healthfacility staff also rely this message of stock amounts to the project 6oordinating officer through the respective payam and county supervisors. l8 ,*,.=, E *.rn tr Used Waste Remainin g List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The health facility staffs train CDDs; issue mectizan tablets for mass distribution and collect balance after distribution; keep a mectizan inventory of available mectizan at the health facility; and manage any severe adverse effects to treatment. Any other comments None 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No lf so, When? N/A Table 11 : community self-monitoring and stakehorders Meeting Describe how the results of the community setf- monitoring and stakehotders meetings have affected project implementation or how they would be utilizedduring the next treatment cycle. N/A County/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Juba Kajokeji Lainya Terekeka Yei/morobo Magwi ___.1 Torit 59 104 53 103 110 61 70 00 00 00 00 oo 00 00 00 00 00 oo 00 0000 TOTAL 560 00 00 19 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Supervisio Reporting 2-9.2. what were the main issues identified during supervision? The main issues -found during supervision were: inidequate and incompletedata compilation for treatment reported to have been done; some evidence of misuse of resources and assets assigned to different levels; inadequacy of staffing levels as compared to the expected/required. 2.9.3. Was a supervision checklist used? Yes, Supervision check-list was used. 2.9-4. what were the outcomes at each level of cDTl imptementation supervision? Staff that are supposedly better understanding in terms of data management, and resource utilisation, and this was done through on-the-job coaching. 2.9.5. was feedback given to the person or groups supervised? Yes feedback was given 2.9.6. How was the feedback used to improve the overall performance of the project? Yes. lt was ensured that the staff supervised practically exhibited better knowledge in areas of cDTl work that they were supervised on. SSOTF Staff / 7 Project Coordinating Officers )ounty OV Supervisors / 7 Payam Supervisors / 7 CDDs / 7 Community 20 t I SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment *Condition of the WO=Written off) equipment (F=Functional, CNFR=Currently non-functional but repairable, How does the project intend to maintain and replace existing equipment and other materials? No clear cut means of maintenance and replacement yet; still dependent on APOC Trust funds. 3.2. Financial contributions of the partners and communities lf there are problems with release of counterpart funds, how were they addressed? There were no funds disbursed from either the NGDO cbm or the government for direct implementation of CDTI activities. This problem was not solved and it compromised the capability to implement key cDTl activities. Additional comments - None Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No Condrtron No Condition No Condrtion No Condrtro n 1. Vehicle 1 CNFR 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 4 NF 0 NA 0 NA 0 NA 0 NA 3. Compute(s) 1 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 1 CNFR 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 CNFR 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a) Based radio 2 F 0 NA 0 NA 0 NA 0 NA b) Bicycles 12 F 0 NA 0 NA 10 F 0 NA c) Metallic cabinet 4 F 0 NA 0 NA 0 NA 0 NA d) Metallic trunk 6 F 0 NA 0 NA 0 NA 0 NA 2t Etrof oE tE F oo oN$ oi o; olo ri Ol Olr Nj O: O)l-Nl ! C!,i- col I .fi(o -r I -l -i NltJ:I i r.-: coiro jici cir; i(f)i @lF: , ro,o16 ,i (f); colF ii ,.ri $iod I oi o; olou?i q; o!i\ @i oi Fio)(f)! ro! 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C ir- n(Y) o E GF I io iOto .o io io oo o !,co5 olrIE F tr) i(9\;e@t@(o r(\(o lr.- (f) i(O o:(oilr)O :(.) iN d icd !c"j o:oisF- I$ lo) O)\ o) F-o CO @ oq lr)N s F-q U) ro(\f ao o) o_$ oq F-t- o- N o) r-(r) tr)- oodf.-(f,- (o o;f.- o-(o @(o (o @ $l 0q lr)(D(n d oi-io iF- l- o i<c; !\N :@ l<olr)t(oto <o io,i !61Nir;o: i.,,I' t at-l-alo(o e o o oq o oo o oq o oq o oq o oq o oq o oq o oq o oo o oo o oq o oq o oq o oq o oo CJ oo o oq c, oq o fc,o:oE'E o o oooooooooododoc; o.o oooodoci O:oOOo'o o odcicic; ro;o oooo ocic; o,o.oooo ocio oq o 6EOq8 -z oq o oq o ololoololo o 'ci lc; oloiooloto o lo ici oq o oo C; oq o oq o oq o oq o oq o oq o oloolo oio <,q o c o E ooL Jlt ,9 !, 'o L oc L r! 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N =al, c o @ ..i a? a c o (! of! o { oo o() o .c .E 6 F -6i a o-l< o 3 c!(, oI o o) =6 (D L OI c.- 'Ei -(5r G l-, o c.i .6 c.i I,aa L .oo E d olcco: o,(Ui= =l!\5 Er E>uJg d d; ad c.j, itU) c o :, -o.E o E c o o E o : :l\l so Eo ot G s G E! tro EeES50,a> 'tro EgE5q> rE(,G Eso>>o\o >'b o c o o) oo o)2r(, o o q) U) o c o, E o, o) o,c o e.i .it a4 o t4 so a-x'o G s o !E J oo s o U); c 0)ca> +et.rJ o e{ .Q tril ,q J FoF oz E, o .+ N E o) C C o(J a (5 c) o oL ! o(! o L o aL ogE(! o_ (! -o o L .o J -o L C oo E oE(! .g LL iri(9 o .cl G I ,o; :OI ioi io loio ioid teiti I I I I I 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) The in-kind contributions that the communities made include providing training venues, providing meals for the CDDs during the treatment and collection of mectizan from the health facility. 3.4. Expenditure per activity lndicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US doltars using ihe current United Nations exchange rate to local currency. The exchange rate used was 3.8 South sudanese pounds to 1 US Dollar. Any comments or explanations? - There was no funding provided from the NGDO as indicated in table 13a above. SECTION 4: Sustainability of CDTI 4-1. lnternal; independent participatory monitoring; Evaluation4.1-1 Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation X 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners what were the recommendations? The project needs to be re-launched How have they been implemented? Not yet, but the process is on-going 4.2. sustainability of projects: plan and set targets (mandatory at year 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? Not applicable when was the sustainability ptan submitted? Not applicable What arrangements have been made to sustain CDTI after ApOC funding ceases interms of: 4.2.1. Planning at ail rerevant levets - No plans made yet 4.2.2. Funds - No plans made yet 4.2.3 Transport (replacement & maintenance) - No plans made yet 4.2.4- Other resources - No plans made yet 4.2-5. To what extent has the plan been imptemented - Not applicable 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.1.2. 4.1.3. 25 4.3.1. lvermectin delivery mechanisms The lvermectin delivery mechanism is not yet integrated in the national medical supply system. WHO ensures that the mectizan is delivered to the state ministry of health; and then the state ministry of health is then supposed to be responsible for releasing the mectizan to the County Health Department stores in the Counties. The effectiveness of how this happens varies from county to county. ln most cases, WHO still has to make inquiries on whether this has happened or not. From the County Health Departments, it is then dispatched to frontline health facilities in the Payams. Then from the Payams the mectizan is sent to the Boma level Primary health Care Unit and then finally to the communities. 4.3.2. Training: There is goodwill and willingness of other community based health care programs to cooperate in training activities. However the funding arrangements/cycles and different implementation plans are a hindrance to this actually being executed. 4.3.3. Joint supervision and monitoring with other programs Not yet happening. 4.3.4. Release of funds for project activities There were no funds released from the PHC system to support CDT activities 4.3.5. ls cDTl included in the PHC budget? lt is not yet inctuded. 4.3.6 Describe other health programmes that are using the cDTl structure and how this was achieved. what have been the achievements? Not applicable 4.3.7 Explain what are the combinations of interventions co-implemented? Not applicable How were the interventions implemented? (at the same time?) Not applicable Describe others issues considered in the integration of cDTl. Not applicable. 26 o (!(E z to FO5e a) -E i' Etrc -= z q) c E o o- od z tr Lo=Eaobo = z 'E- 8..0na o z €c .:oi,E E z g=Ee 68 z o o o ! rEu E E.= o o z c o (! o E o) CL! be =o#EoiJo-o= otro,: z o! o E z E .9 o o. z .; o .E E E o o o o E o .: o tr E') .E= Eo o o o := o(E z .9 o,t o .s o o o. z a a a a a 6 oo o o CL F z f oF z o (E E oII o z o ot, o EL o .ct E z E' o (, G o L 6g G = z f oF z o(! E oIL o z oc o o OEo-obg oGos E Jz og (E = z E oF z Fo6olr(I, z oo oC)! *9,b2 sOo> .QEE'- z o(! = o z o o(E ot ! z ob.g oL -o=EE =Fz6 o o o, cn GFEI z o oG ota z ou) q, .ol:t L EO 2E o o EDL c,FE' z ila $$E!8*&g' z *ob= o;ioi >Lr-o z a a a oo o!CLtr>oFo z FN U) o o. Gxq) =.e (t) e G Q) a(U Q) r ! Q) o q o r o o) q) o = oL. +,() L o 6 o E" o o o E E GL c,, oL CL Lo9 #Eo& .ii * FS o6;>(Eol-z q o a_ Eoxq.) =.e (/) eo q) a(U q) c E Q)q q F o S q)to c q) a = s oz ? o +, G+, o Eg CL E I oo t F -9 .ct(UF a a4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None has been done. 4.4.2. How were the results applied in the project? Not applicable SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: The project area can be accessed by the project staff and the national level staff throughout the year; irrespective of the season and weather; and there is a the skeletal workforce that has worked in the project for a number of years and thus has some institutional memory to implement the CDTI activities. Weaknesses There are still a number of weaknesses that include: lnadequate availability of Knowledgeable staff especially at community level; poor system of maintenance of equipment especially vehicles and motorbikes; the persistently sow integration of CDTI staff and activities into the PHC programs and the generally weak community involvement in CDTI activities especially non provision of incentives to the CDDs. Ghallenges The project still faces a number of challenges that will take a while to overcome since they are long-term in nature. These include: . Low literacy levels among the CDTI personnel especially at county, payam and community levels. . Poor/unreliable data management at community level, this affects the accuracy and correctness of the final data reported. Opportunities: . There is a high possibility the there will be additional funding coming to the project area in 2013 through a DFID grant that will be given to an NGO to support NTD control work in the project area. This is a great opportunity that needs to be seized and taken full advantage of so as to improve the performance of CDTI. . The presence of other community based health care in project area is a great opportunity that can be taken advantage of in regards to working with the same community persons and systems to improve performance of implementation, monitoring, supervision and reporting of community level activities. SECTION 6: Unique features of the projecuother matters None. 28