South Sudorn Oncho To,sk Force Coordinstion office "a I I I I I I I I I I COUNTRY/: South Sudan Approval vear: 2003 Reporting Period (MonthrYear): Jan 2006 through Dec 2006 Project year of this report: (circle) 72 73 74 3 4 5 6 7 8 I 1011 Date submitted: Dec 30,2006 ORIGINAL : English ssoTF/HQ ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRA{ME FOR ONCHOCERCIASIS CONTROL (APOC) .hr '-! TccJs ?it4 cs-bb? iHE n 3 AVR ?tiiii i' 2 E AVR, 'nn' R ccelvc d coo B D A POC t ,-a B t-'-- ! I I { I ,, .::.::l:iiOn R\ ANNUAL NOTF SECRETARIAT TECHMCAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country : South Sudan National Coordinator: Name: Dr. Signature: Date: 2010312007 NOTF Chair: Name: Dr. Majo Signaturet ..r... Date: 2010312007 This report has been prepared by: Name: Dr. Baba/Fasil Designation: Na GDO Cord. Signature: Date. ..2010312007 d'u , WHO/APOC, December 15, 2004 I I I I t_ TABLE OF CONTENTS ACRONYMS II DEFIMTIONS........ ....... III FOLLOW TIP ON TCC RECOMMENDATIONS.. ..............TV E)GCUTIVE SUMMARY .................V SECTION 1: BACKGROUND INFORMATION..... 1.1. GpNpnal INFoRMATIoN............ L.2. PopulatloN AND Hpalrs SYSTEM .'.' SECTION 2: SUMMARY OF CDTI IMPLEMENTATION 2.1. DrsrRrsuuoN PERIoD ,"""""""7 2.2. A-ovocecv aNo SpNstrIzATIoN.. """"""""7 2.3. INT'ORUETTON, EIUCATION AND COMMUNICATION STRATEGY AND MATERIALS DEvELopMENT .......... """"" 8 2,4. COITTT'TUNTUES,INVOLVEMENT IN DECISION'MAKING ....."'""""""9 Cepectrv BUILDING 1 1 6 7 ............... 102.5. 2.6. 2.7. 2.8. 2.9. ORopRtNc, sroRAGE AND DELIVERY oF IVERMECTIN..........'.""' Tnp.trupNTs............. SupnnvtstoN.........,.. COUrvlUNtrY SELF - MoNITORING eNo SIRXpHOLD ERS MBnttNO 13 16 19 20 32 SECTION 3: OTHER ACTIVITIES OF TIM NOTF .............. ,""........23 SECTION 4: SUPPORT TO CDTI....... 28 4.1. FINeucIal coNTRIBUTIoNS oF THE PARTNERS"""""' 4.2. OrHpR FoRMS oF ooMMUNITY suPPoRT...'.."""' 4.3. RpsouRcp MoBILIZATIoN EFFoRTS ...'..........' 4.4. EXPNNOTTURE PERACTIVITY BY THE NOTF SECRETARIAT....... 4.5. EQutpuPNT............... SECTION 5: EVALUATION FOR SUSTAINABILITY INDEPENDENT MOMTORING AND OTHER REVIEWS .,,.28 oo ....29 ....30 ....31 5.1. 5.2. OF CDTI, INoop pNoENT PARTI oIPAToRY MoNlro RlNcipva.lueuox ....32 SustatNasILITy oF pRoJECTS: pLAN AND sET TARGETS (trleunaroRY Ar Yn 3) 33 5.3. INtpcneuoN............, 5. 4 OPERATIONAL RESEARCH SECTION 6: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUMTIES. oo ......,.. oo .........34 o Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MoH NGDO NGO NOTF PHC REMO SAE SHM SRRC SSOTF TCC TOT UNHCR UNICEF USAID UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community'Based Organization Community-Directed Distributor Community'Directed Treatment with Ivermectin Community Self'Monitoring Local Government Area Ministry of Health Non'Governmental Development Organization Non- Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sudan Relief and Rehabilitation Commission Southern Sector Onchocerciasis Task Force Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations High Commissioner for Refugees United Nations Children's Fund United States Agency for International Development Ultimate Treatment Goal World Health Organization ll WHO/APOC, December 15, 2004 a Definitions (il Total population: the total population living in meso/hyperendemic communities within the project area (based on REMO and census taking). (iil Elieible nopulation: calculated as 84% of the total population in meso/hyper-endemic communities in the project area. (iiil Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment GoaI (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). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverase: 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). (viil Intesration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximize cost' effectiveness and permit free and equal association. For example 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 maximize 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 CDTI. (viiil 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 service, with strong community ownership, using resources mobilised by the community and the government. lll WHO/APOC, December 15, 2004
a FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fitl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session - Number of Recommendation in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY 1 a Focus on training more CDDs and Community supervisors in every community SSOTF has intensified CDDs and Community supewisors training in all CDn project areas and achieved 65% of. the Annual training objective. ) a Continue advocacy and supervision at all levels SSOTF coordination office has carried out advocacy and supervision visits in Rumbek/?ochalla/lVauftei/ Yambio prolect coordination offices. 3 a Continue polishing the population data The overall OV population data has not been polished as yet. We are awaiting the mass measles campaign result, which is being carried out in tlae whole South Sudan, and the results will be released in early january 2007. However, the arurual treatrnent objective of the population data has been revised accordingly. 4 t Try to attain a good therapeutic and geographical coverage next vear The SSOTF has achieved a better therapeutic and geographical coverage in all CDTI projects in the year 2006. 5 ! Train health workers and CDDs in the management of SAEs SSOTF has carried out SAEs management training for Health workers, supervisors and CDDs in co-endemic OV and RAPLOA areas. This was possible after APOC sent expertise. 6 a Add Vit A supplementation to CDTI activities At this stage the SSOTF is of the opinion that introduction of Vit A distribution at this moment will be confusing to the CDDs since they are sending signals of payment instead of volunteering. The introduction of Vit A distribution will be considered where CDTI is lv WHO/APOC, December 15, 2004 relatively well established. (Please add more rows if necessary) o Executive Summary Prepare an Executive summarJr of the report in not more than one page. 1. Suamary af Aeatueat aad populatioa data oapariag pmjecta heads in trcatmeat over tiae i.e.' Tbtal auabu of oamuaitieq aaauditiee' t eated, tohl populatioa, UIG, A|t) aad pereons trcated. There is marked increase in project areas populations due to refugees returning back home as well as internally displaced persons. The population movement in South Sudan is so dynamic that the actual population will only be established after general census. The CDTI projects for the South Sudan (SSOTF) were Iaunched successively as follows. In the year 2005 the SSOTF has managed to launch the East Bahr el GhazaVHQ and West Equatoria CDTI project. In 2006, East Equatoria, Upper Nile and West Bahr el Ghazal CDTI projects were launched. The SSOTF coordination office oversees the East Bahr EI Ghazal, West Equatoria, East Equatoria, West Bahr el Ghazal and Upper Nile CDTI projects that targets 3,625,332 people over a five-year period. In these five CDTI project areas an estimated 4,138,848 people are at the risk of being infected with OV and therefore the SSOTF has set up its annual treatment objective of 1,050,624 people in 1,623 communities in 2006. The overall OV treatment data in the year 2006 shows 936,375 people have been treated, 89% of the ATO and 260/o of the UTG have been achieved in the frve CDTI project areas' In July 2006 the APOC management availed technical expert to help SSOTF carry out SAEs management training in Yei. Participants were from aII 5 CDTI project areas and who were specifi.cally selected to be TOTs. In June 2006 APOC/CBM carried out harmonization on principles and CDTI strategy in Rumbek. treatment table CDTI PROJECT POPULATION 10o/o N.B. East Equatoria, West Bahr el Ghazal and Upper Nile CDTI projets treatment figures for the year 2005 only reflect clinic based treatment and hence the false high percentage increase. These projects were launched in 2006 using CDTI principles' TREATMENT 2005 TREATMENT 2006 % INCREASE 2005 - 2005 247,653425,751 226,131WEST EQUATORIA 151,475 64o/"92,816EAST EOUATORIA 505,934 412,021 49"/"276,422EAST BAHR EL GHAZAL 778,920 713%70,4601,508,733 9,894WEST BAHR EL GHAZAL s4,766 908%405,994 6,033UPPER NILE 936,375 154Yo3,625,332 611,296TOTAL WHO/APOC, December I 5, 2004 2. Summary of trai"ing data of projects (nationally) for: - hoject Officer ftrabng of trainere aad/or other specific truining), total number of CDDs aad healtJt worketr trained, total population per active CDD trained. Actual CDTI training and refresher courses started in February through September 2006. 33 project staff, 592 health staff, 137 TOTs and 3,281 CDDs have been trained and refreshed in this reporting period. The CDDs available in the project areas are 4,L76. The ratio of one CDD to the population being 1:868 3, Erteil of integration of CDTIpmjects into the health ssntem. Integration of CDTI into PHC is being implemented. However, the administrative levels of South Sudan are undergoing major restructuring of the health systems. The restructuring also involves adjustment of borders and appointment of senior management staff. This is still ongoing and is likely to spill over to next year. 4. Strengths and weaknesses of the national onchocerciasis contrnl prugrami challenges and how they were overcomei and opportunities that will strcnglhen the prugram. Strengfrhs o The SSOTF has a newly well'constructed modern office for all SSOTF coordination unit staff and East Bahr eI Ghazal CDTI project coordination staff. This is a good step forward. . All the CDTI projects in South Sudan have now been launched and the project coordination office is consolidated. . The Government of South Sudan has now officially recognized OV as one of the major forgotten and neglected diseases as it appeared in the "Presidential 200 Day Action Plan" which mentions OV as a problem to be addressed. Both therapeutic and geographical coverage has shown increase in the year 2006. The SSOTF has a strong partnership with other stakeholders, especially with the local administrative authorities and endemic communities. Challenges The SSOTF coordination offrce has witnessed considerable turnover of staff in the SSOTF/HQ and various CDTI project offi.ces, which draws back the projects in general. This is being addressed by inclusion of the SSOTF staff and CDTI project staff in the Government of South Sudan budget for 2007 and onwards. The budget has already been submitted to the council of Ministers for approval and thereof to the parliament for final endorsement. The attrition rate of CDDs is increasing as paid practices/salaries replace volunteerism. This is due to high expectations in terms of remuneration and less volunteering. As more Government offices are set up, UN agencies bilateral offices and NGOs spring up which offer higher pay, there is vi WHO/APOC, December 15,2004 o a a a aa a always a drift to greener pastures. This is partially addressed by training more CDDs to offset the attrition. The Upper Nile CDTI project offrce has a major problem due to lack of of6ce space. Therefore, the SSOTF ofEce is an able to supply fragile and delicate offrce equipments e.g. Computers, printer, photocopier machine etc. This matters has been raised with the State Authorities of Upper Nile. The SSOTF coordination office seriously exploring and considering the relocation of the PCO office from Pochalla to Akobo where office facilities are avai-lable in 2007 Communication is a challenge but there is an improvement in some locations. South Sudan as it is still emerging from war and modern communication facilities are not yet available. To address the issue of communication SSOTF has allocated VHFs long'range radio, a satellite phone to the CDTI project offices for regular communication. Transport is another challenging issue. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Air transport, which is the available means at the moment, is very expensive. It is hoped that the road infrastructures shall be maintained as soon as possible and in fact work has started in some sections. Transportation in general in South Sudan is not adequate. The vehicle in West Equatoria CDTI project is grounded for the last two years and cannot be maintained. Women's participation in the program is still very low due to some cultural barriers and influences. Relatively a good number of female CDDs trained and participated in the current year. a Weaknesses . The capacity of the project Coordination Officers and subordinate staff is Iow and hence are unable to produce required reports leave alone the APOC Technical Reports, which is quite demanding. This has resulted in all technical reports being produced by the National coordinator and NGDO coordinator. . Computer illiteracy is a weakness in a1l projects, which hinders efficiency and speedy data entry and reporting. To overcome this problem, the SSOTF had trained project staff on eomputer training in the coordination and project areas. However, a few of them have already deserted. Opportunities . Wltft the Comprehensive Peace Agreement (CPA being in its second year, a considerable stability in peace has been achieved. Internally displaced and, refugees are being rehabilitated and resettled. With time as this process continues the population figures become stable. However, it also introduces the element of population increase, which needs to be captured and planned for. . The Government of South Sudan has already considerably contributed towards provid.ing a modern newly constructed office for SSOTF/HQ. o The West Equatoria CDTI project office in Yambio has been offered office space in the newly constructed State Ministry of Health headquarter premises. vii WHO/APOC, December 15' 2004 aa a The contribution of the Government of South Sudan towards the CDTI project is to be realized probably in fiscal year 2007. Key actiuities uadertakea by the SSOTF duriag this reporting period. The SSOTF coordination office launched the East Equatoria, Upper Nile and West Bahr el Ghazal CDTI projects. With support from APOC management the SSOTF is able to conduct SAEs management training in Yei which, involved participants from all CDTI projects in South Sudan. The SSOTF coordination offrce in collaboration with APOC/WHO and CBM organized a 3-day workshop in June 2006 at AFEX compound in Rumbek. The main theme of the workshop wasr "THE PIIYLOSOPHY AND HARMONISATION OF CDTI". The SSOTF in collaboration with Chirstoffel Blinden Mission processed the annual Mectizan application to the Mectizan Donation program in November 2005. In early January 2006, 2.704,000 Mectizan tablets were received and distributed to all CDTI project areas through the Project Office, County Health departments and NGDOs (National and International). Different types of CDTI trainings organized and facilitated by SSOTF for different groups of trainees such as: Trainers of Trainees (TOT), County supervisors, Payam supervisors, health staff, CDDs and Community leaders. a a a a . In this reporting period, the SSOTF coordination office procured and distributed work support items to the CDTI project areas through the proj ect coordination offices. Progress on vector elimination actiuities (where applicable) The SSOTF is now planning to request APOC management to assist in the assessment of vector foci with an intention of ultimately developing a proposal for vector elimination. v11l WHO/APOC, December 15, 2004 o SECTION 1: Background information 1.1. Generalinformation 1.1.1. Description of the country program -CDTI and vector elimination(brietly) The South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The climate of South Sudan is tropical with average annual temperature of about 29'C (about 85F). The rainy season months are April' October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from typical rainforest in the southern part to Guinea or derived Savannah in the northern area. There is a vast swampy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile. Human settlement seriously affected by rnany years of civil war and is basically rural. The main occupations of the rural communities are farming and 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 second phase of the Onchocerciasis control programme which requires the implementation of CDTI strategy was earmarked for five (5) CDTI projects in East Bahr EI Ghazal, West Bahr EI Ghazal, West Equatoria, East Equatoria and Upper Nile have all been launched. Vector elimination At the moment we do not have vector elimination component. We are considering vector elimination options that are cheap and sustainable through appropriate surveys of breeding sites. The situation has not changed much after the CPA - Status of National plan implementation, population at risk, number of prcjects being implemented, other rclevant actiuities, and infrastructurc G.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structute. The National Plan is being implemented through the involvement of national staff (lay people and health workers) appointed by Ministry of Health government of South Sudan, and the State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National and International NGOs and Community based organizations have also been supporting the implementation of the national plan by providing technical assistance/guidance through their freld medical coordinators. They also facilitated the logistical needs for the smooth running of the planned activities. The total estimated population at risk of being infected with OV in South Sudan is 4,138,848 people. 5 CDTI project and l Headquarter project in total 6 projects are being implemented in South Sudan. According to UNICEF mapping databnse of 2003 in the three rnain regions of the southern sector and the SPLN{ controlled portions of the three contested areas of Abyei, Nuba N,lountains and BIue Nile; there are a totai of 788 PHC facilities. 783 aro said to bc currently functional. Of these facilifies 99 or about 13% arc PHC ccnter,s and 6116 (gtX) are PHC units or m<.rbile outreach clinics. The remaining WHO/APOC, December 15, 2004 18 oy 60/o are rural hospitals or specialized treatment facilities. The distribution of services is not equal throughout the regionsl Eqtratoria with 26% of the population accounts for 48% (aAf) of the facilities, Bahr el Ghazal rvith 49% of the population has 2L% (t6f) of the facilities whi.Le Upper Nile with 19% of the population has 23% (128) of the facilities. The health system is fragrnented and disjointed. The Federal Ministry of Health of Government of South Sudan is curre ntl."- e mb arki ng o n re structurin g proce ss. The SSOTF headquarters is situated in Rurnbeh town. Rr.rmbek airstrip retnains the lerrgest and the busiest airstrip, capable of receiving differer-rt types of aircrafts. This airstrip is currently being tqrgraded to an all-weather airstrip and is a rnajor airstrip for OLS operations in southern Sudan. Rumbek is strategically linked vi ith Western Equatoria, East Equatoria and other parts of Bahr el Ghazal thlough road netrvork. 'l'h(' adrninistrzrtive struct,ure levels al'e undergoing chzlnges after the Conrplehensive l)eace Aglreement. There are fbur administrative levels in South Sudan as fbllorvs: The State, the Count5,', the Payan and Bomzr at the grassroot, Iovcl. 'lhc Stzrtcs fornr the first Icvel of adnrinistration follorvcd by thc Countics, l'trf anis lrnd Bomts. Statos ule aclmrniste'r'ed bv governors (Admrnistrattvr: supcrvisors as of Julv 200i-l): r:otrnty-by-count-v- sccretary (fcrrmerl5, comntissionct') br:rng tho adrnrnistrativo and polit,ical head of the cottnty. Thc payam b5.'pay'arn irdministrator and Boma b5, Romzr liberation council. Ctu'r'ently, 14% of won)en hold seats in the SPLM National Liberation Council which is the parliament. Health system & health care delivery (state any problems related to health system that impede program implementatioil. The PHC system has been badly disrupted by the wari its coordination is poor and lacks trained manpower. Until the Ministry of Health GOSs and State Ministries develop a budget to run the Primary Health Care (PHC) these obstacles will continue to impede CDTI implementation activities to a considerable degree. aL WHO/APOC, December 15, 2004 Prouide map locating all projects @DTI and Vector Control, if any) within,country. e ct 1: Bahr E! Ghaza i , 3: West E uatoria 4: East E uatoriaP Southern Sudan M4 5 : CDTI arcas and frrecestcit CDTI pnjects wlth thclr rcqrectiw coordinefion eni sr4rcwision ofEces/centres Legend I f.nqlty o" urtinhzbitebil zoncs fufirc CDTI Priority arcas NO CDTIareas EETIO bbeper6rnrcil Ethiopia l{e rya tNortfietn Sililrn ittr: ,. tlr:tAn .R.tgnblrc Q t=ott HQ, Proiec't coordtnation offrcc (Pco), Projec't Surpcrvision Cerrrtre(PSC) ft e.o;"4 coordination office (PCO) & Proiect euPeruision c:^Tllf ,.ff;I ff ttoi.* Supervision cerytre (Psc)only ru ryE D.)stu ry b blr,@Dt rrE.EErdly tu ss dFPDE u ffitu *fr poc M lit of {ongo t(M W;tnd.t 0 100 200 wloaffi tJuFr![t - Indicate the partners involved in project implementation at all levels (MoH, NGDOs'national, international) Secretariat of Health (MoH) o SSOTF Secretariat o East Bahr el Ghazal CDTI Project Secretariat o West Equatoria CDTI project Secretariat o East Bahr el Ghazal County/Payam health staff e West Equatoria County/Payam health staff . East Equatoria CDTI Project Secretariat . The affected communities J WHO/APOC, December 15, 2004 r E! Ghazal East ii I l I % The lead NGDO group o Chirstoffel Blinden Mission Members of the SSOTF: . SPLM Health Secretariat o Chirstoffel Blinden Mission (NCO Coalition Chair) o Carter Center . WHO, Southern Sudan o International Medical Corps (West Equatoria CDTI lead NGO) . International Rescue Committee . Sudan Health Association* . Sudan Inland Development Association*(East Bahr eI Ghazal CDTI lead NGO . Mundri Relief and Development Association* . Sudan Medical Care* . County Health Department " County OV Supervisors" (2), Equatoria o County Health Department "County OV Supervisors" (2) Bahr el Ghazal . County Health Department "County OV Supervisor" (1) Bahr el Ghazal NGD partners and regions/counties, 2006: Nahfiri .. r,i:j. ,.: ,i.,-..,ri.,i*&* AAH Equatoria (WesQ Maridi, Mundri, Yei ARC Equatoria (East) Kajokeji, Nimuli DOR East Bahr el Ghazal Tonj, Yirol, GOAL West Bahr el Ghazal Twic ICRC consoruurn East Bahr el Ghazal Yirol IMC West Equatoria Tambura, Ezo, Yambio IRC Bahr el Ghazal (Esat & West) Rumbek, Aweil World Relief Upper Nile (Jonglei) Bor (South) World Outreach Ministries Foundation East Equatoria Yei (Morobo payam) MRDA West Equatoria Mundri NCA West Bahr el Ghazal Goerial Samaritans Purse West Equatoria Mundri (Lui only) SIDF Ease Batu el Ghazal Mvolo SUHA East Equatoria Kajokeji, Juba ZOA East Equatoria Juba, Terekeka - Describe overall working relationship among partnerc, clearly indicating speci.frc areas of pruject actiities wherc all partners ate involved (planning, superuision, advocacy, resounaes mobilization, endemicity mapping / assessment, development of IEC materials, studies or suweys etc). The stakeholders plan, monitor, supervise, mobilize and apprise CDTI activities of the previous year through the below indicated meetings and workshopsi . Annual SSOTF Meeting . Ministry of Health monthly Coordination Meeting o Quarterly operational plans o Regional and County Mini SSOTF Meeting o County specific planning with NGOs. o Village health committee meetings 4 WHO/APOC, December 15, 2004 Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activity plans. Ministry of Health monthly Coordination Meeting: The coordination meetings take place in Juba in which SSOTF HQ is represented by the National coordinator. There is a representation of health NGOs in South Sudan, including UNICEF, WHO, UNFPA and the Multi Donor Trust Fund (MDTF). The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. Quarterh operational planning :( RegionaUCounty SSOTF meetings) are normally done jointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the County Health Department while at the Payam level is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. The PCOs, COSs, CHWs, and POS carry out advocacy, mobilization and sensitization. For the management of SAEs cases the CDDs will refer the cases to the nearest level of health facility. County specific planning meeting with NGOs: The CDTI project office works closely with these groups to promote CDTI in the communities. Each endemic county has a designated county onchocerciasis (OV) supervisor. Each Payam (local district) within the county have a Payam onchocerciasis supervisor who is also known as(Community supervisor). Most of these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of the communities within their locality. Village Health Committee meetings All plans for implementation and monitoring are developed in close consultation with the Bomas Liberation Councils(communities), these being the grassroots arms of the administrative system of South Sudan. AII health and developmental programs in the communities must receive the formal approval of the Boma Liberation Councils. Community health workers and Traditional birth attendants are the lowest cadre of health service providers who are supervised by Village health Committees. The communities elect these groups. - State plans if any to solve any issues arising as regards CDTI implementation. The SSOTF has a strategy to mitigate issues arising. a. The first step is to determine the level of the issues arising in the hierarchal set up of the management. b. Determine the nature of the issue i.e. is it managerial, organizational, or participatory etc c. The principle approach to problem solving is by giving a chance to all parties to the dispute to air out their views and grievances in a relaxed atmosphere. d. Solution to problems is not by pointing fi,ngers and blames but by an accepted consensus agreement 5 WHO/APOC, December 15, 2004 Name of CDTI Project Total communitiee in meso/hyper' endemic zone Total population in meso/h5per' endemic zone Ultimate Tleatment GoaI ruTC) by 2010 East BEG CDTI Project 1,001 778,920 778,920 West Equatoria CDTI Project 4r0 425,751 425,751 West BEG 3,219 1,508,733 1,508,733 East Equatoria 438 505,934 505,934 Upper Nile 332 405,994 257,294 TOTAL 5,400 3,625,332 3,626,382 1.2. Population and Health system Table 1: hojects and population at risk in the entire country whether they are treated or aot during the reporting period. (Please add morc mws if NB-Because of the prolonged conflict in South Sudan reliable figures on the number of communities/villages is not available. Whichever figures are given are always estimates. Source: From Oncho Project reports: National census Other source, speci$ REMO Year of source: 2003 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 futl geographic coverage (normally the project should be expected to reach the UTG at the end of the 3"d year of the project). 6 WHO/APOC, December 15, 2004 a SECTION 2: Summary of CDTI Implementation 2.1. Dietributionperiod Chart the actual distribution period for each CDTI Project in the country in the table below. Overview of distribution undertaken (insert rows as needed) Brielly note any problems/issues (one paragraph). There was a delay in the transfer of projects funds, which kept the projects stalled for six (6) months. The scheduled planned activities could not take place. In addition to this, the third quarterly operational plan and budget (April through June 2006) for CDTI activities, which were submitted to WHO for subsequent release of funds, were only received on 28th December 2006. 2.2. Advocacy and Sensitization il Sate the number and tSrye of policy / decision makere mobilized at the national and lower Gtate and dietrict level) duriag the curent yeari the reasons for the s ensi ti za tion an d outcome. At the national level 3 policy/decision makers were made and sensitized on OV magnitude in South Sudan. The first visit was with the officials of the presidency, which resulted in OV being mentioned as a priority in the hesidential 200 days plan of action. Advocacy meeting with the Minister of Health Government of Southern Sudan was held. At the State level the NationaUNGDO coordinators met the Governor of West Bahr eI Ghazal and his Minister of Health on matters pertaining to OV. In East Equatoria and East Bahr el Ghzal States the Ministers of Health and their Director Generals were visited and discussions on OV were held. The entire visits were fruitful and the officials met have committed themselves to work closely with the SSOTF and the Ministries of Health towards control and eradication of OV. 7 Dietribution Period Mav Jun Julv Aus Sep Oct Nov Dec Project Name Jan Feb Mar Apr Eart BEG x x x xWeet Equtoria x x x xErst Eouatorit Uooer Nile X x x x West Babr el Ghzal x x WHO/APOC, December 15, 2004 b) Sate pmgrcss made towatds intenal rcsource mobiUzation. The SSOTF has already submitted a budget to the Government for activities related to OV control in southern Sudan. Results are being awaited. c) Describe any poliq-rclated unstraiats being hced by any particular prcject and describe what was done to assist the prujut buteomd. Explain anyplans on how to imprcve advocacy. The SSOTF has so far not experienced any policy related issues. On the contrary the government of Southern Sudan is coming out strongly in support of activities that will reduce the prevalence of tropical neglected diseases. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTf. 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. A minor review of IECs materials were conducted during CDTI harmonization workshop in June 2006 in Rumbek. The following also reproduced by SSOTF coordination offrce for the South Sudan Oncho Control Program in 2006. The materials were distributed through the SSOTF coordination office in Rumbek to Project offices for onward distribution to nine (tg) supervision centres, payams and communities. . "Procedure Manual for Ivermectin Distribution Programs" (WHO) . Manual for CHW's and PHC for the control of onchocerciasis with Mectizarr'" o Manual for CDTI provided bv WHO/APOC and distributed to partners o Illustrated OV training flip charts (OV Oncho in Sudan) . OV poster sets (3 posters per seti "What is O\I', "How do you get OV', and "How to treat O\f). These posters are laminated in plastic for longer life under field conditions. o Illustrated educational booklets "What is OV Oncho" for primary school age children. . Simplified CDTI instruction manuals for community distributors. How were the IEC materials developed? o These materials were already developed by HealthNet International and partially reviewed and reproduced by SSOTF coordination office. Are the materials reviewed to address upcoming issues (ti*e decreasing refusals, sustainability, maintaining compliance to long-term treatmen t, SAEil? o The CDTI activities in Southern Sudan are on the first and second year of implementation. With current dynamic population movement due to rehabilitation and resettlement of displaced persons and refugees the SSOTF feels that currently the activities requested are premature. Report ifany KAP surveys have been done and how their results were used? . KAP surveys have not been conducted in the whole project areas Summarize information on: - The use of appropriate and innovative media and/or other strategies to disseminate information among the projectsi 8 WHO/APOC, December 15, 2004 o Modern media such as television, Iocal radio stations are not available in most of the project areas. In some counties in East Equatoria project, information is being disseminated through FM radios. In most cases, 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 women and minorities - method and response . The method used to sensitize the women and minorities is through home visits to the communities and focus group discussions in villages, health centers, worship places, and market gathering. Special attention is paid to the men in order to sensitize them so as to understand the role that women and minorities can play in the control and eventual eradication of OV. o Communities now know that onchocerciasis is a disease of public health concern and have accepted full participation and contribution in all onchocerciasis treatment activities in the project areas. They know Ivermectin is the only drug that can reduce and eventually eliminate the burden of onchocerciasis from their communities. . Communities do appreciate the fact that Mectizan is safe and has other health benefits. Major accompl ish m en ts i . The Therapeutic coverage increased from 18% to 26% in 2006. o The number of drug distributors trained has increased. (The ratio of one CDD to the population being reduced from 1:1,000 - 1: 868 . The negative attitude towards the usage of Ivermectin reduced o Relatively a good number of Female CDDs trained and participated in drug distribution in 2006. Wea k n e s s es/Con s tra i n t s i . High attrition rate for CDDs due to non-support and also due to attractive incentives paid by NGO's and UN agencies for special campaigns o The number of female CDDs still low . There is frequent turn over of project field staff and at SSOTF coordination office. Suggest ways to improve mobilization of the target communities among proiects. o Integration of CDTI activities into Primary Health Care network. . Full participation by local authorities and support from the Government organs. o Involvement of women groups, youth and religious groups in campaigns. . Increased health education sessions in the communities o Increased training and refresher courses for CDDs, CHWs and OV supervisors. 2.4. Communities' involvement in decision-making Comment on community participation making comparisons among projects - Participation of female and youth members of the community at health education meetingsi - In general, how do you rate the participation of minority groups and female members in community meetings, decision-making Gttendance, participation in the discussion etc) other issues. 9 WHO/APOC, December 15, 2004 o Youth attendance is fairly commendable in public gatherings in all CDTI projects. They actually form the most influential entity in terms of mobilization and implementation. . The youth tend to pick up messages faster than the rest of the community and this is obviously due to their age learning capacity. . The youth disseminates information much faster and effectively to their parents and siblings . Women attend public information sharing meetings in fair numbers in aII CDTI projects. . Members of the village health committees are predominantly men . Women's participation at decision'making meetings is very low as men dominate decision'making process in all CDTI projects 2.5. Capacity building Training of national, district Ievel staff in CDTI and general management skills (computer applications, project planning, etc.) Briefly describe any training done by the SSOTF/NOTF for specific CDTI or Vector Control Proj ec t s (O bj ec ti ve s, p ar ti cip an ts, o u tco m e s, a ny foll ow - u p n ee d ed). Though there is high attrition of all types of staff from the various project Iocations SSOTF has continue to train a staff at all levels in CDTI strategy and general management and computer skills in 5 CDTI project areas. The main objective of the above mentioned trainings are to build capacity at the national, county, payam levels. The other objective is to inculcate into the staff the importance of the principles of CDTI, the required managerial capacity for implementation including participation and ownership. This has resulted in marked improvement in terms of participation and commitment. Table 3: Type of trarnmg undertaken at national level by the GTNOA'{OTF (Tick the boxes where was carried out the Briefly describe aay technical assistaace ptouided to the CD?Ipruiects. The SSOTF coordination units assisted the CDTI projects, on program management skills, data collection and analysis, drawing joint operational plans, plan of action and preparation of Mectizan@ distribution plans were some of the technical assistance given to the projects. Time management was also 10 WHO/APOC, December 15,2004 Type of training Project staff MOH staff Opinion Leaders Others (specify) Program management How to conduct Health education ofManagement SAEs CSM ./ (NGDo partners) SHM Data collection Data analysis Report writing Others (speci&) Computer training emphasized. 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The East Equatoria CDTI project drug distribution activities were delayed until the SAEs management training conducted and referral health facilities identified for any possible SAE cases after mectizan treatment. . The West Bahr el Ghazal CDTI project was launched in August 2006. The delays occurred due to the outbreak of meningitis in the project area o Population figures are changing by the week as the result of internally displaced persons and refugees returning to their homes. o Despite the conditions above, the five CDTI project has made tremendous achievement in both geographical and therapeutic coverage. There is no fluctuation rate in the project areas, instead the therapeutic and geographical coverage's increased. The OV treatment data for the year 2006 indicates 89% ATO, 26o/oUTG and24.60/o Geographical coverage. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the o Since the CDTI project has not conducted a household registration census, it is quite difficult to have the numbers of people who have refused treatment and those who were absent during the campaign, However, in areas where the household registration is being conducted the SSOTF has not experienced refirsals but in agro-pastoralist and pastoralist communities seeking pastures make it difficult to locate them during distribution. 2.7.3. Briefly describe all known and veri-fi.ed serious adverse events (SAEs) and provide in table 7 the required information when available. . The CDTI project has not reported SAEs 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 Table 7: Cases of Serious Adverse Events (Sens) that occurred during the re eriod (Please add more rows if * SAEs should be verilied by project coordinator Sequelea is defrned as those cases that have not recovered fully bom the SAE and are left with lasting neurological or other debilitating effects. x Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea ofNumber deaths t7 WHO/APOC, December 15, 2004 '+oo c..l ,ti E!,)5 tr(u(J o o Uo o. o J. d -o o od d d 0-) d(-)rd oo 'a o. 0) ^o^ € O o d () o (J F ai o oxo z,I!il 0) () L o .6 op (! () o (!(! (J o.dE bo oo o (!)o o o< o T o oHoF 6B\ -o s \f N @tn s 3 sN\o sNt-t Ba c-6 s s s o\\o str- s o\@ - * I fh0 OGagFe ootoF soN s o\N st.) 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Supenrision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow'up neede0 Table 9: Supervision undertaken by the NOTF (Please add more rows if n Project Name Supervisor Date Objective supervrsron of Outcome/follow' up needed Dr.Baba/FasiUAgnes 0215106 *To assesg progress of CDTI implementation *To assess the overall performance of the CDTI project. *Follow up financial management "The concept of CDTI picked by the project implementers e.g. The ICRC consortium, SIDF, did a commendable job. *Demand for more treatment created "Emphasis was made on prompt compilatron oi imprest vouchers by all concerned. East BEG Dr.Baba/Fasil 25t9l06 *To follow up CDTI trainings and d*g distribution *The different type of CDTI trainings conducted as planned. *The East Bahr eI Ghazal CDTI project has distributed Ivermectin in all endemic counties. *High attrition rate of CDDs was noted East Equatoria Dr. Baba/Fasil 13/10/06 *To monitor possible SAEs cases *To follow up CDTI trainings and drug distribution * No SAEs cases reported in the endemic counties and payams. * Drfferent type of CDTI traimngs conducted as planned. "The East EquatoriaCDTI project has drstributed Ivermectin rn the endemic counties- l9 WHO/APOC, December 15,2004 West Equatoria Dr. Baba8asil 2014106 *To review the first quarter CDTI implementation activities. *To review disbursement of funds * To assess pro*r"r. of CDTI implementation *Most of the activities were executed as drawn in the first quarter *Due to delay il releasing funds, some training activities had to be rescheduled & followed up. *Funds were disbursed to the endemic counties and accounted for. * There is good progress towards CDTI strategy implementation 2.8.1. What were the main issues identifred dwing superuision? o Accessing Counry OV supervisors due to lack of roads and transportation. o Difficult train to operate in and poor communications. o Poor recording, wrong addition and poor failing was noticed at all levels . Most of the planned CDTI activities were carried out in an appropriate manner o Poor reconciliation of accounting 2.8.2. a 2.8.3. a a a Was a standard supervision checklist used? Yes. Wat were the outcomes at each level of CDTI implementation supervised? The concerned individuals were coached on the job. Improved performance noticed at the supervision centers. There is demand and need for refresher courses at all levels. 2.8.4. Was feed'back given to the supervised, and how was the feedback used in improuing the overall performance of the pruject? o On the spot discussions were done and later on feedback communicated. Follow up supervisory visits not take place due to delays of APOC fund. 2.9. Community self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if necess, Project Name Total # of LGAs or districts in the entire project area No. and % ofLGAs or districts that carried out self monitoring (CSM) No. and % of LGAs or districts that conducted stakeholders meeting (sHI\{) 20 WHO/APOC, December 15, 2004 East BEG 4 Not done 4 West Equatoria 5 Not done 5 E4st Equatoria r Nile West Bahr el Ghazal 5 Not done 3 3 Not done 3 6 Not done TOTAL 23 16 Describe how the results of the community eelf- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. From the SHM, the following resolutions were made: o a The decision the stakeholders meeting could not be implemented due to lack of funds. Funds were delayed by APOC for half a year and the amended budget has not been received fully, In most of the CDTI project areas the stakeholders addressed the need to train more CDDs to help the few trained CDDs and CHWs. As soon as the budget is availed more CDDs will be trained in the next reporting period possibly. o In few CDTI proiect areas the period of drug distribution was not appropriate. The community will decide on the period/method of distribution on the coming treatment campaign. Sufficient Mectizan is being requested. . In most CDTI project areas the stakeholders meeting as not yet effective. During community sensitization and community leaders meetings, effort will be made to impress the significance of CSM/SHM and encourage community participation 2.10 Compliance to long'term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projech comply with long'term mass treatment with ivermectin? (Fot projects 4 and above years old) Table 11: Activities of that promote compliance to long-term treatment with ivermectin Objective Specific Activities Project targeted 1. Promote Integration of CDTI with other health care services 2. Maintain high therapeutic (>65x) andgeographic (roox) coveraqe 3. Promote strong communitv ownership 4. Promote high 2l WHO/APOC, December I 5, 2004 t government commitment 5. Support partnership strong 6. Put in place a strong IEC strategy that encourages continued treatment Other NB. This is not applicable since the project is still in year one 22 WHO/APOC, December 15, 2004 o SECTION 3: Other activities of the SSOTF S.lDescribe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). The SSOTF with the support of APOC expert organized SAEs management training in Yei. Participants from aII 5 CDTI Project areas were selected and trained as TOTs. The remaining three CDTI projects were launched in Yei, Wau and Pochalla. The Upper Nile and East Equatoria CDTI Project offrces have been consolidated. However, the consolidation of the West Bahr eI Ghazal project is in the process. 3.2 What was done to coordinate CDTI Project activities? The SSOTF coordination office operational plans are drawn in consultaion with the 5 CDTI projects. There is close consultation, which enables each project to follow what the other is doing. The below mention meetings also act as consultative meetings for coordination . Annual SSOTF Meeting o Ministry of Health monthly coordination Meeting o Quarterly operational plans Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activities. Ministry of Health Monthly Health Coordination Meeting: The Ministrv of Health coordinates the quarterly health coordination meeting in Juba in which SSOTF HQ is represented by the National coordinator. UNICEF, WHO, other UN agencies, and both National and International health organizations attend. The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. In this forum the SSOTF/HQ introduces topics of CDTI strategy of implementation, updates CDTI activities and gives an opportunity for stakeholders to address issues. Quarterly operational planning :( Regional/County SSOTF meetings) are normally done jointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the County Health Department while at the Payam level is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. The PCOs, COSs, CHWs, and POS carry out advocacy, mobilization and sensitization. For the management of SAEs cases the CDDs will refer the cases to the nearest higher level of health facility. 3.3 Note meetings convened for the NOTF. (Obiective of meeting, issues addressed, date, participants, outcome, and constraints faced follow'up needeO There was two meetings were held in Rumbek in June 14 and August 23 2006. The participants were drown from the Government of South Sudan Ministry of 23 WHO/APOC, December 15,2004 t a aHealth, State Ministry of Health, Local authorities, contractors and SSOTF coordination unit staff. The objective was to review the progress of the construction of the offices of SSOTF headquarters in Rumbek. In August 8, 2006 a meeting was held in the Ministry of Health Government of South Sudan premises. The participants were Director General PHC and medical Services, Director General for Preventive Medicine, Director general for Finance and Administration, the Undersecretary and the NGDO coordinator. The objective of the meeting was to explore the possibility of the Government taking over the payment of salaries and inclusion of budget for CDTI activities. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. The NationaUNGDO coordinators attended meetings in West Equatoria, East Bahr el Ghazal and East Equatoria project offices to provide a technical input on data collection and management. So far no meeting attended with other countries. a 3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed ftechnical, financiaD, - Beports forwarded to APOC management, ' Administrative assistance or trouble shooting for projects. The first and the second financial quarterly reports were submitted to APOC management in 2006. Due to delay of funds project CDTI activities and SSOTF coordination office activities have not been executed as planned. Due to this delay the submission of the 5 annual TCC report could not take place in 2006 as expected. However, the SSOTF and CDTI project offices are now forwarding the 5 TCC reports.. 3.6 indica Insert the Plan of Action for the NOTF activities for the current year activities mon which were ted. Project Nrne - SSOTF YEAR (2), 2006 MATN ACTIVITIES Nov Dec Jan Feb Mar Apr Mav June Jul Aue Sep Oct Nov Dec *SSOTF coordrnatron office x rRegronal (De[ned project area) x xrCou nty x r OV suoolice keholdcrs xffi x ffi x x x ffi ffi ffi 4ffi ffi Xffi *SSOTF mrdrnatron oIEce x x *Regronal (Defrned protect area) x x x x x x*County TSSOTF coordrnatron ofEce x TE xI xI x x x E ffiffi x* Trarnrng of CDDs x x x x x x x x x x x x xl!rarnrng of eupervisors x x x x x x xr Trarning of community leaders al WHO/APOC, December 15, 2004 :l Iirli?,; T {:lr-'j fi5:i-f-'aE;-i ' -r-rlliTlqi .,,- -ll. , 'r, tli fr r, 1. ,* -i{! , :;u ,. 'ot-..'-i .i @44 strIfl x x*Rev iel of IEC matcruls *^r,g-bi,tft.ffi #ffi :'t;L:?rIr;= x x x x x x x x x x* Corrt4!!{I awarene!s/targets x x x x x x x x x x*Sc xil x x xH #xH xffiffi ffix ffix xffi xm x%o"".,"t t' tt'-'"'l'iffiG'GffiCens u q UPdete ,.r. nu"#ls,ibirri I i't''-':;:;'. ii'li; r;"*;,i-;,'j ffi +1ffiffi x x ffi-j4Edgf.iat?.t x x x*p1q gs for SA-Es #ii-{::iri -rb -.!A jill . , .i.,^,.L,, , r." ."j:.i,,1.,,!. rVEB1\{ECUNDIS"IIXBLTilON r, i,. x x x x x xx x*lver mactln Drstnbutron *:lffiHi -T xffi x x x xffi# -T x x i', -i *Dstributron of minor srde effect drugs Introductioaol0SWSHM! ". . .ry;;,i *Cou n ty Health DepartmenLs x t{j$1 x:Iti'l-r*r.; .ill-.:i*r - #i,L's ffi * NG O partnershro xx x x x x xr Tra rnrng of CDDs and othere * Loc a I Herlth syetems xffi x xffi xm ffi x 5ffiiE.,i. xMoo u D trcrtment. ffi .*il*e;, !3!bl& x ffi 'l!i!,fia& x ffi tH#ffi xffi x xx ilffi* ' ffi x x x x xffix:iffitE*shl X x x x x*SSOTF mrdrnation ofEce x x xx x x x 'PCOsETF pereonnel xm x xH x xffi x x x x ilE:'E ,:-f: i-: ; +1.Si'n" ffi ffi ffi x x ffi iirii-{fi# ffi xffi xffi office x x x x x x x,PCOS x x x xx x x x* Payam suDen,Eors x x x x x xx* CDDs ;i'[r* &;t.'",rReoortinr/drue mrirruefiadd '.-.','^.1,'", i:.-.iit,rd x x x x xx*PCOs x x x x x* Payam supervraols x x x x X Ar CDD8 x x xx xTSSOTF coorlinetion oficc xG ffix x xilPCOo /BTF TSSOTF oordinetion ofEcc xt xTI x xE x x xxffi xffi x d * xil il PCO t E ffi H t E il ilE E I ffi m ffi ffi *..e !rl x I SA-Eg/Mrnor erde effect x 25 WHO/APOC, December 15, 2004 ry -.'t-j "t q r 3-1.iri I t --^ ,','-i :: 1'. x H&ru #HH rgfJ*.t:'iEilE*;" E ::a't{i;; 44 iji*,ir.;'rl:l i ; x )1.-i:i.1-t -inr,+ ni".? j 1.';,1 ,,:.. J: , i ^_,t'.,'9#] rDeta.ollrcdOe.,li +. 1.r",- :,r.1 ;.i'itr1:i i.r.f\'i'l ffi v*t'".!i '';i:!\ l Fs;+a jt.i-,.: i -: .,,1 'l ',- : r', ,1 .:t, ' ii :i,, r1 :' -' 3.7 Insert the Plan of Action for next SSOTFHOProlectNeme Ycars o3QI Q2 Q4MAINAC'TTVITIES rPlanningy'Review mectinqs xTSSOTF xiRegional xxtCounty xx x xiStakeholders meetinqVcommunity Procurerncnt of materials x x+ OV supohes *Advocacv xx+Regronal x x*County x xtPayams TRAINING x x* Training of CDDs X x* Trarntnq of suDervrsors x x* Trarnrng of commurutv leaders x+ Trainins of health staff/ x xManasement / SAEs X ASSESSMENTS xI KAP studres ln new areas xtReviewof IEC rnaterials HEALTH EDUCATION SFSSIONS x x x xt Communrtv awarenesYtarsets x x xi School heatlh educatron/tarqets x xX x x+ Churches Census x x xCensus Update Druq Delivery/Supplies xMectizan requests x x*Drugs for SAEs Settins uD of referral systems x x*Strengthen up referal systems b/w cornmunltles, PHCUs, PHCCs and hospitals for SAEs IVERMECTIN DISTRIBUTION x x+lvermectin Dtstribution x+Manasement of SAEs x lntroduction of CSIVU SHMs x x+SSOTF panners X xtCounty Health Departments * NGO partnershio x x x x* Training of CDDs and others x x* Local Health systerns x xiCSM/SHM rn community Moo up treatsnenL x x x xManagement ofSAEs rSupervision of CDDs, P. supervisors and Countv Supervisors) SSOTF x x x x x x x xPCOS/RTF x x x* Payam suDervrsors x x*Data collection x x x 26 WHO/APOC, December 15, 2004 Ymr Thre (20117' VIoD uD treatment. SSOTF x x x*PCOs x * Payam suoervisors x x x x x x x* CDDs x *Reporting/ drug manegcmcnt xr ssoTF x x x x x x x*PCOs x x xt Payam supcrvisors x x x x* CDDs x Monthly linancial reporting exoenditure x x x x x x xSSOTF x x x xPCOs /RTF x xPreparation of mid term/ annual technical report x SSOTF x x x XPCO / RTF x*Application for Mectizan X+SSOTF / PCOs INDEPENDENT MOMTORING x x*SSOTF/rcOS/RTF *Mid term review x+ SSOTF/ RTF tEvaluation t SSOTF / RTF x x x x 11 WHO/APOC, December 15, 2004 \+ooN t'i oE EIt)(.)() a UoOi o = €ol d o N x q) 'I]s \ \ Ur .P s t4 a c! q(.) a '{ 'c '{ q) tr .R .o -\ cjut ! tr ": o .c(rj hp .!\ !v b! dx .A +)tro6 0) Fr Si 0)rd tr ti(! o Ua +J ! .OI @ €(J q) 'a li [Jr FQ C) I +l afr od +)liAq cd ! a2t{!o9trjjf=x{.?lr{ .5tr9E vl-l +) oOtsi era'rid:E.!i6o'JJta.trHo. -o :-l)-6 t 3trr?!$o= .o:YZ=rHo.sEolC-J .l -rn r) 6l vJ r-t l.iA E SI ol ..=l Fdl .{, Eil E oQ cd 0) q) Fr .d H .14 a Hq) +) iro h o) Ho H o +) .o k +J o() otr 0) €o li Si a a o Fqr) (,vo) +) tr OHc6r-{ c) n5 g i5 .d trg g ! 0)])ti 0'r r- a z N LO t- od ro v, N @ o) D- od d> c- @ c- ro ts- o)N69 ts-(l) c.ilr) @ € a6 0) (g o t{p a a g g g H g t c) 'a ti +i o a) n FT cd z 0) l.i Aa H -a EHdEH(5 (! .dt{ o +) cd C/H +) ch o E tr o +) d fr1 +)(t) 6 trl o z t{ 0)ea 6 Nd .q 0) tsr .qd FA +)a o) F d +)o E-{ Ifthere are problems with release ofcounterpart funds, how were they addressed? - Comments o Up to date the Ministry of Health of the government of South Sudan has not been met. However, approval is expected since a budget was developed and submitted to Ministry of Finance. o CBM as the NGDO partner has always been punctual in releasing its obligated funds. o The APOC has been very irregular in release of funds to such an extent that most planned activities had disrupted. This has resulted in the 5 projects including the headquarter loosing the few trained staff to other agences. This year alone the delay amounted to six month and unfortunately along with it a considerable reduction in the ammended budget with out consultation with the SSOTF. State the number of projects that had no funding from APOC Trust Fund? o The Five CDTI project plus the Headquarter project funded by APOC State the number ofprojects that had no funding from any outside source? . All have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? . None 4.2. Other forme of community support - Describe (indicate forms of in-kind contributions of communities if any) o Provision of venues/shelters for community leaders meetings and CDDs training. . Some communities do the mobilization and sensitization of their own people. o Communities collect firewood, water and also cook for participants. o Some communities store drugs and provide good security awaiting mass treatment. o Selection of the CDDs is a major community contribution in the CDTI strategy. 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. . The NationaUNGDO coordinators have already submitted a budget to the Ministry of Health, which includes salaries to the project offices and headquarter and other support of CDTI activities. The results have been awaited. The SSOTF coordination office has succeeded in mobilizing resources from other donors, which has resulted in construction of a modern offi.ce facility to house the headquarters of the SSOTF and East Bahr el Ghazal project office. Efforts are being made to solicit funds for furnishing the offices. a a 29 WHO/APOC, 24 November 2003 a4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 13: Indicate how much the NOTF secretariat project spent for each activity listed below d the Comments Activitv of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drtrg delivery HQ/entr5, point districts, etc N{onrtoring and supervision CT)'l'l Plojccts Trtrining of Project ofT-rcers. TOT, NC)'f l" stafT. etc. .\clvr.rcacv vrsrts to hc.itlth itnd political atrthorities at nzrtional lcvt,l IIIC KAP sttrdics. rnaterials developrnert1. :\nrr rra I r(rvle!\' rvrlrksht,lls llli annual NO'l'F ntectingsFuel ancl nraint,cnance of N{ainte na nce of offr.ce equip rnent frorn NOTF to proiects, ]_"t igle -- -+ -' I --- -l S-tationery, Othcrs TOTAL Total number of persons treated 30 WHO/APOC, December 15, 2004 --- -t- - - $ource fype of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please etate Functional Currently Non Functional but repairable Written off 1. Vehicle 01 0 0 0 0 01 0 0 2- Motor cycle 0 0 0 01 0 01 0 0 3. Computers 01 01 0 0 0 02 0 0 4. Printers 02 01 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others a) Photocopier 01 0 0 0 0 01 01 0 b) Cash safe 01 0 0 0 0 0 0 0 c)Lab top 01 0 0 01 0 02 0 0 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written ofO. How does the project intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeable manpower at all levels. t) The SSOTF coordination office: There is deficit in manpower i.e. Deputy National coordinator, Finance officer, Data Manager. This poses a chalienge since most of the works are heaped on the NationaUNGDO coordinators. Z.) The CDTI project ofEces: There is general shortage of manpower in the project coordination offi.ces. The project coordinating officers are so week and an able to produce annual technical report. Coaching has been taking place howeveri more and more coaching is to be done. 3.) 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 of coaching is required. ' Where frequent transfere of trained staffoccur, state what project is doing or intends to do to remedy the situation (Ihe most important issue is what measunes were taken to ensune adequate CDTI implementation whete not enough knowledgeable manpower was available or staff often transfefted during the couree of the campaieqi, This is not applicable in our situation because staff transfer does not occur at this moment. However, in cases where a gap has resulted as a result of sudden staff movement, members from the nearest CDTI are asked to cover. Besides this there is acute shortage of knowledgeable manpower in all project areas in South Sudan. t 3l WHO/APOC, December I 5, 2004 c.lo c.l q)5 o z$ c-t U l, o- o c.] ca 0) 0)p +) o l-{ (n cd ,q o +) !9)(!/q) o)t {J +r I q) sH oU +)) o 0) d F roO c\ C!l'{a tr !d I'r .s (d3 S; a h -ag\.\E$0)Ed8EE9 e\..g *?iEL C8.S HG:- O{s :8t Es$ *;!s ;cd H$ E Esb'g *r:q i CJ$Et E-sEsE92frr *'{PEFr lSFHA $ $*E8q e i'H s -ssl gE r-lH\\\='E\\\.x =ki'd6ud EoidH*^ FC) CA S v qJ\ t 0u q) ,.lid +)tr o) o +)d cS 0) d H od Sro +) tr 0) B q-r o F a) tr o +. .d o f{oa b0 tr {Jlrog q)ft q)t +) h0 H l.t a .d ) o 0) .E lr cd o tro +) cd CU 0) fio tr cd h0 E . o +) tro E xk o+l(Up () +)f{ C6A +) tr 0)rd tr op. ord E h Acso Ots7 cd 6{ B Fi .j ,4i I a B 0) 's q)ti tr 0) {J c! b! fr o +) o i-) o tr 0) A. 0) FiF-r - IJO <* cdo5 >, Cd .:>H0)Ebc!tr .=Hcgo +)€a'a ;E €9, troo+i .'-l 6:o. 5() 'i +)lvh -<(dlElr ioE >2, O) OEFq)FA3€ cat a ro a Eb .x( . CSL i? p.x>hU q)! b! .= G-E !F f. € L., d,'A Z!6E E:' tr +i otrh 5 E (G, €EHT a.S)da =ij o)!u (,)E (Jfi Ae 3 +)!fi onS tr lr40) o=a..: .-oci'l -o cjjE EH +) E t.gc ,{d+)do.! cd;:fc{5X ':9 SE:J/m €a a QV tr-+)N 5 Eor .vo(J)A a trt .i 6\ I -U^!6\ !r H.Hj3lioc LHH;3a 8. x.E E 0) E(! z +) 0) 'a tr tu '1 5.2. Sustainability of projssgg: plan and set targets (maudatory at Yr 3) o This not applicable for SSOTF since we are in the lat year and 2nd year CDTI implementation What arrangements have been made to sustain CDTI after APOC funding ceases in terms of; 5,2.L. Plsnning at all relevant levelo. 6.2.2. Funde 6.2,3. Traaeport and equfument Gp]acement and maintenance) 6.2.4. Human Fesourceg 6.2.6. Which pmjecte have eubnitted eustaitrability plan? 6.2.6- To what extent have the plaos been implemeuted? 5.3. Integration Outline the ertent of integration of CDTI into the PHC structure and the plans for complete integra tion. 5.3.1. fvermectin delivery mechanisms The Ministry of Health Government of South Sudan has already commissioned a consultant to develop the pharmaceutical logistical supply. This is already in advance stage is being funded through the Multi Donor Trust Fund. Of course the Ivermectin delivery mechanism will be inbuilt in to the PHC structure system of drug delivery, 5.3.2. ?laining ' There are various curricula being developed for various cadres in PHC activities OV as a disease and its economic impact on the endemic communities is being cooperated into the curriculum. 6.3.3. Joint superuision and uozitoring with other pmgzams o |oint integration is being tried with UNICEF and WHO and Ministry of Health in the mass measles campaign. It is expected that resources will be pulled together for joint supervision and monitoring with other programs. a a 5.3.4. a 5.3.5. a 5.3.6. a Release of funds This is not practical at our early stage of setting up systems Is CDTI included in the PHC budget? A budget for salaries and other CDTI activities has been submitted and the results are being awaited. Describe other health pmgrammes that are usiag the CDTI structure aad how this was achieved. What have been the achievements? The Ministry of Health is considering using the structure of CDTI to implement Integrated Essential Chitd Health Care (IMCI), and distribution of impregnated nets as well as other diseases. 5.3.7. Describe other issues considered in the integration of CDTI o The CDTI strategy could be used in management and control of malaria, which is a major cause of mortaliry. 5.3.8. Describe the integration of other programs into CDTI in your countly and the results of this integration on CDTI (e.g. Ie Vitamin A supplementation integrated and what are the results, is ecreening for cataract of primary 33 WHO/APOC, 24 November 2003 a aeye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) Integration only effective once the CDTI principles and strategy have been well understood and successfully implemented. At this moment no other project has been integrated into the CDTI. However, Vitamin A supplement is the most likely program along with integrated essential child health care.a 5. 4 Operational research . No operational research carried out 5.4.L. Summarize in half of a page the operational research undertaken in the country area within the reporting period. o Not applicabie - see above 5.4.2. How were the results applied in the project? . Not applicable - see above 5.4.3 Note the issues that have been identified by the NOTF for future operational research. . KAPs in the new CDTI areas . Operational research into the Nodding disease o REMO in formally sampled inaccessible areas due to insecurity, natural barriers and landmines. . SECTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. StrenErths . A modern office facility has been built and is operational. . The presence of SSOTF coordination office in Rumbek along with CBM as a lead agency within South Sudan has led to effective coordination. . A good number of our partners have now set up offices in South Sudan, which makes issues of supervision and monitoring much easier and cheaper. . The SSOTF has a strong coordination with other stakeholders, more especially with the endemic communities. This strength has led to the smooth implementation of the CDTI strategy. Weaknesses Low Top ups (salaries) and delays of payment have resulted in the following positions being vacant: Deputy national coordinator, Finance and Admin and Data Manager. In adequate educational background is a weakness in all projects, which hinders efficiency and speedy data entry and reporting. a o 34 WHO/APOC, December 15, 2004 r-I Opportunities o Peace is being consolidated and movement is becoming much easier. o The SAns management training was conducted which helps the project to manage possible SAE cases. . The launching of the 3 CDTI project gives an opportunity in South Sudan for sufficient annual therapeutic and geographical coverage in South Sudan . The road network in South Sudan is being improved generally and hence links with the neighboring endemic counties and states. The network to the neighboring countries e.g. Ethiopia, DRC, CAR, Kenya and Uganda is being improved which is advantageous for inter country coordination and collaboration. -List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicabld. o This is not applicable since we do not have vector elimination component. Indicate how challenges were addressed. Challenges o Illiteracy in females in South Sudan is quite high. Husbands normally do not consent to spouses to take jobs. Women's participation in the program is still very low due to some cultural barriers and influences, which need continuous community sensitization and awareness campaigns to overcome the challenge. There is a high illiteracy rate in the project areas. Getting skilled personnel is difficult. The accepted practice of advertising, short'listing and then screening short listed candidates is rigorously being followed. However, due to the high demand of literate persons there is always movement of staff from low paid jobs to high paid jobs. This has been a major challenge to SSOTF coordination office with frequent turn over of the project staff, which draws back the projects in general. This situation is becoming more acute for projects that pay low salaries. The cost of living in South Sudan is now among the highest in the rvorld but with the lowest standard of living. a a a o Transport is another challenging issue in the whole South Sudan. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Vehicle wear and tear plus fuel consumption are quite high. Road infrastructures maintenance is now taking place. Transportation in general in CDTI projects in South Sudan is not adequate Communication is a challenge to the projects in that South Sudan is still emerging from war and modern communication facilities are not yet available. The only equipments currently in use are the long'range VHF radios and Satellite phones which are quite expensive to run. Mobile phone systems are being installed it is hoped that they will be operational in some of the towns 35 WHO/APOC, December 15, 2004 - IIndicate how opportunities can be utilized to improve CDTI. . With the peace in south Sudan the population figures will be properly defined especially after the forthcoming census. . The launching of the whole approved CDTI projects in South Sudan will Iead to increase the Ultimate Treatment Goals (UTG) and geographical coverage o Access to endemic communities will increase and hence more endemic communities will be treated. This is it tme in collaboration with neighboring countries. a ! 36 WHO/APOC, December 15, 2004 I