East Bahr El Ghazal (EBEG) CDTI project annual project technical report submitted to Technical Cosultative Committee (TCC): January to December 2008

EA,ST BAIIRELGIIAZAL (EBEG) CDTI PROJECT COUNTRY/NOTF: South Sudan Proiect Name: EBEG CDTI Approval vearz 2003 Launchinq l/eaf: 2004 Reporting Period(Month/Year): F.Z\ January To: December,2008 Proiect year of this report: (circle onel fi+) S 6 7 8 9 10 Date submittedz 27 July,2009 NGDO partner: Christoffel Blinden Mission ,TL BFo FO rOgo OzuGINAL :English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO For TECHNICAL CONSULTATIVE COMMITTEE (TCC) To: DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting for Tor r{ To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) b)rortL 0 .t A0iii ZucE APOC / DIR WHO/APOC, 24 Novemb er 2004 I ko */,l,$tt NELU LE ANNUAL PROJECT TECHNTCAL REPORT TO TE CI-INIC AL C ON SU LTATI VE C OIVTN,IITTEE (T C C ) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFI'ICERS to sign the report: Country: South Sudan National Coordinator Name: Dr Christo Luga Signaturc: . Date: 23rd Iuly 2009 APOC Technical Advisor: Liuarus Nwe[+.c Signacure: Date:22"d July 2009 NGDO Representative Name: Fasll Signature: l)ate:22nd July 2009 This report has been prepared by Name : Chol Miu:yiel "w Pdeqt Cpqrdinating o tliccr W;;1 Designati<ltr Signature: . Date: l7t1' Juty 2009 IT a Table of contents ACRONYMSV DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2, 2 2, 2 2, 2.7. 2.8. 2.9. 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3.1. 3.2. 3.3. 3.4. VI I 3 3 ,4 4 6 .8 1.1. GpNpRar- rNFoRMATIoN............. 1.1.1 Description of the project (briefly) l.1.2. Partnership 1.2. Popu1e,uoN............... SECTION 2: IMPLEMENTATION OF CDTI 10 Trvpr-lNp oF AcrrvrrrEs ............ ....... l0 Aovocecy .....................12 MosrltzanoN, sENSrrrzATIoN AND HEALTH EDUCATToN oF AT RrsK coMMuNtrtps l2 CouvuNrry INVoLVEMENT........ ......14 Cepacrrv BUTLDING.. ...... 15 TRpatraeNTS.............. ..... 17 6.1. Treatmentfigures.......... ........... 17 6.2 What are the causes of absenteeism?.......... .................21 6.3 Wat are the reasons for refusols?................ ............... 216.4 Briefly describe all known andverified serious adverse events (SAE) that...2l 6.5. Trend of treatment achievementfrom CDTI project inception to the current year23 ORoERTNG, sroRAGE AND DELIVERv oF TVERMECTIN ...........24 Couvlwrry sELF-MoNIToRING nNo SrarpHoLDERS MpBrmc ............25 SupeRvrsroN 26 Provide aflow chart of supervtsion hierarchy. ............ 26 Wat were the main issues identified during supervision? .............................. 26 Was a supervision checklist used? ............. 26 What were the outcomes ot each level of CDTI implementation supervision? 26 Was feedback given to the person or groups supervised?................................ 27 How wos the feedback used to improve the overall performance of the project? 27 SECTION 3: SUPPORT TO CDTI 26 EqurrueNr Fn.IaNcIeL CONTRIBUTIONS OF THE PARTNERS AND COMMLINITIES Oruen FoRMS oF coMMLrNrry suppoRT ............... ExpeNorruRE PER ACTIVTTY 27 28 28 28 SECTION 4: SUSTAINABILITY OF CDTI 29 4.L INreRNRr-; TNDEeENDENT pARTrcrpAToRy MoNIToRINc; Eva1uarroN....................29 4.1.1 Was Monitoring/evaluation caruied out during the reporting period? (tick any of thefollowingwhich are applicable)............ ...........29 4.1.2. What were the recommendations? ............. 30 4.1.3. How have they been implemented? ............. .................30 4.2. SusrnNesrlrry oF IRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT................ 30 lll WHO/APOC, 24 November 2004 Yn 3) 4.2.1. Planning at all relevant \eveLs......... 4.2.2. Funds....... 4.2.3 Transport (replacement andmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented. 4.3. INrecRauoN............ 4.3. I . Ivermecttn delivery mechonism,s ...................... 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs diftni. 4.3.4. Release offunds for project activities .... Erueur ! Signet non ddfini. 4.3.5. Is CDTI tncluded in the PHC budget? ..................... Erreur ! Signet non ddJini. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ........... Erreur ! Signet non ddfini. 4.3.7. Describe others issues considered in the integration of CDTI. .. Erreur ! Signet non ddfini. 4.4. OppnnrroNAl RESEARCH ..... 31 4.4. 1. Summarize in not more than one half of a pqge the operational research undertaken in the project area within the reporting period. ........ 31 4.4.2. How u,ere the results applied in the project?.... ... ....... 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 32 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 32 lv WHO/APOC, 24 November 2004 Acron s/Abbreviations APOC African Programme for Onchocerciasis Control APOC TA African Programme for Onchocerciasis Control Technical Advisor ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CBM Chirstoffel Blinden Mission CDD Communiry-Directed Distributor CDTI Communicy-Directed Treatment with Ivermectin CHD County Health Department CHWs Community Health Workers COS County OV Supervisor CPA Comprehensive Peace Agreement CSM Community Self-Monitoring EBEG East Bahr el Ghazal GOSS Government of Southern Sudan LGA Local Government Area MoH Ministry of Health NGDO Non-Governmental Development Organizatio n NGO Non -Governmental Organization NOTF National Onchocerciasis Task Force PCO Project Coordination Officer PHC Primary health care POS Payam OV Supervisor RAPLOA Rapid Procedure for loa loa REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOH Secretariat of Health SSOTF South Sudan Oncho Task Force TA Technical Advisor TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal wHo World Health Organization v WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%;o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (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 ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: 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. (ix) Community self-monitoring GSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. VI WHO/APOC, 24 November 2004 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 28 Number of Recommendation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Address the problem of attrition of health staff and CDDs and improve the curuent CDDs: population ratio by selecting/training more CDDS and health staff. The project has started addressing this issue as contained in this report but will strive to train more CDDs/HWs as planned in 2009. The CDD/population has reduced to l:456 in 2008 Retrain all staff on all aspects of CDTI This is in fact going to happen in the 2009. All staff willbe train. Commence CSM and SHM CSM and SHM will be treated as part of CDTI activities in 2009. Increase the number of community supervisors This has improved as shown in this report and the community with supervisors is 32.9% which is an improvement over 2007. More supervisors will be trained in2009. Supervise CDTI activities in Rumbek North and Awerial (where supervision was not carried out) The project through APOC TA pushed drugs and institute training in Rumbek North early in 2009 to avoid being cut up by rains as it was in 2008. For Awerial, this will happen if the funds for 2009 come very early before rains Intensify advocacy for support at all levels Advocacy was conducted last year at all level but still it will be done the same WHO/APOC, 24 November 2004 I in2009 Promote integration of CDTI into PHC and other developmental programmes APOC TA intensively followed it last year 2008 with the project by meeting SMOH top officials. By March 2009 this year. all CDTI and its staff were integrated into MOH. Lakes state. Update census This is in the Project top agenda in 2009 as all villages will have community registers. Identify all endemic village The project worked to get this last but will complete this year 2009. 2 WHO/APOC, 24 November 2004 Executive Summary This is the report of CDTI activities implemented by East Bahr El Ghazal CDTI project, Southem Sudan from January to December 2008. The project is in its 4th year of APOC funding phase. The project is also being supported by CBM, an Intemational NGDO coordinating CDTI in collaboration with Southern Sudan Onchocerciasis Task Force. The project has a total population of 972,285 persons, UTG of 778,919 persons and an ATO of 649,099 persons during the reporting period. It is made up of three states namely Lakes, Warrap and West Equatoria with a total of twelve counties and2,513 communities. Some of these counties are joined together and the community figure was not comprehensive. Data on the number of health staff involved in CDTI shows that only 365(37 .1%) health workers were involved in CDTI activities out of 983 available health staff in the project areas. On treatment, only 1970 communities were treated thus giving a geographic coverage of 78.4%. A total of 570,630 persons were treated with mectizan. This treatment figure represented a therapeutic coverage, UTG coverage and ATO coverage of 61.50/o,73.3o/o and 87.9% respectively in 2008 Population movements are very common in the project area as they are potentially nomads and farmers. This accounted for high level of absenteeism experienced by the project. Internal insecurity has created imbalance in the total population. On training,2034 (80.9%) CDDs (Males: 1897, Females: 137) were trained out of annual training objective of 2513. The population/CDDs ration was lCDD to 456 people. The number of health staff/payam supervisor trained was 79(91 .9o/o) outof 86 targeted persons. Major challenges in the project during the reporting period include the following. o Attrition of knowledgeable manpower in the project area is due to low top up. The project therefore made an effort to get more CDDs, payam supervisors and county supewisors and even health workers and also encouraged them to remain in the project. o Vast area to cover and coping with effect of wet season. Suggestions were made to commence alt CDTI activities in dry season preferably |anuary - M"y but funds were not available. . Coping with Iate release of Funds by APOC. The project has planned to request APOC through the SSOTF for early release of CDTI activity funds in ]anuary so that difficult- to- reach places in rainy season could be overcome. o Intensifying health education and community mobilization. The project has planned to sustain this activity do deal with the issue of community participation, ownership, and reduce refusals rate. o Identitring various cattle camps so that cattle keepers do not miss mectizan. The project tried to identify various cattle camp locations but due to rains/floods and fuel problem not much work was done but the project is making effort to improve in treating cattle keepers year by year. o Non availabiliry of communiry data base collection. The project was not able to compile this due to the situation in the project areas and is on the top agenda in 2009. o Ratio of CDD to total population in the project is still high and community census registration is still a problem. The project is trying to reverse the trend in 2009. J WHO/APOC, 24 November 2004 SECTION 1: Background information 1.'1. General information I Description of the project (briefly) Geographrcal locatton, topography, climate Populatton actNilrcs, cultures, language Commurucatton systems ("oads ) A dmt rus tratrcn s truc ture Health system & health care delwery (provide the number ofhealth posts/centers m the project area ifthe mformat rcn i s av a i la b I e). Number of health staff m project area and number of health stafi involved in CDTI activitrcs Geograpbical location, topogrdphy, climate The East Bahr el Ghazal CDTI project is located on the latitude of 6.80961o and longitude of 29.67870'. The project has an altitude of 424m above Sea level. The East Bahr el Ghazal CDTI project office is based in the State Ministry of Health and sharing the same block with SSOTF secretariat. The project is made up of three states, namely Lakes, Warrap and West Equatoria. It is bounded on the North by Uniry and'Warrap states, on the South by West and Central Equatoria states, on the East by Jonglei and on the West by West Bahr el Ghazal state. The topography of the project area is made up of Sudan savanna and Guinea savannah to rhe west and flood region to the eastern part. In the western Part of East Bah El Ghazal, the soil tlpe is a basement complex resting on iron stone plateau. In the western part of East Bahr El Ghazal, the soil type is made up of superficial clay' Rainfall ranges from 750mm - 1200mm. The climate varies from wet monsoon to medium wet monsoon in the west and dry monsoon to long dry monsoon' Populatioru: dctioities, cuhures, language The projecr has an estimated population of 1,729,275 with at- risk total population of g2Z,ZgS (53.620/o) for onchocerciasis infection. This increase in figure was as a result of the rerurnees from the neighboring countries. The National census in 2008 will provide a clear picture of the population figure. The dominant ethnic group are the Dinka who are agro- pastoralists whereas the minority |ur Bel are agriculturalists. But through socioeconomic interactions, the communities have gradually begun to exert influences on one another' Languages spoken are Dinka Agar (the majority), ]ur Bel, Bongo, and Juba Arabic (written in English alphabets). Engtish is spoken as the official language. Kiswahili is now also spoken mainly my returnees, refugees and the traders. 4 wHo/APoc,24 Novemb er2oo4 1.1 Communication system (road...) The roads in the project area were constructed by Civicon and Haya rwo years ago and they lead to Tonj, Yirol, Mvolo and Cueibet counties. These roads are dilapidated due to impact of heavy rains and floods. All the roads in the project areas are not tarred. Places Iike Awerial and Maper counties have never been having a proper road link. These places are accessible in dry season only. Airstrips are also available in counties like Yirol, Rumbek and Tonj. Rumbek has one of the busiest airstrips in Southern Sudan. The WFP flight and other private airlines make use of it. The telephone communication system is the commonest means of communication in Rumbek, Yirol and Tonj counties. The available ones are GemTel, MobiTel, MTN and Zain. Other counties such as Mvolo and Cuibet will have in 2009 as the telecommunication companies such as GemTel, MobiTel and MTN have begun work there The other communications systems are satellites phones and long range radio calls, these are used mainly to communicate to places like Awerial, Thiet, Makuac and Maper or any other place that do not have a telephone communication system. Administration structure The administrative structure of the East Bahr El Ghazal State follows the Government of South Sudan structures. The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered through Governors, Counties by County Commissioners, and payams by Payam administrators, and Bomas by Boma councils. The project has 5 counties, which are used as supervision centers but there is a plan to increase the number to 1.2 in very near future for better coverage due to new counties created in the project. Healtb system C, bealtb care delioery (proztide tbe nwmber of beahh posts/centers in the project area if tbe information is aoailable). The project has a total of 118 health facilities which composed of 78 PHCUs, 35 PHCCs, and 5 rural hospitals and one state hospital. The five rural hospitals are situated in Billing, Adior Mapourdit, Yirol ard Bungagok while the state hospital is based in Rumbek, the capital of Lakes state. The rural and state hospitals are referral centers for PHCCs. The Primary Health care system is gradually developing but still experiencing shortage of qualified manpower. However, qualified people are coming back from exile where they went for refuge during the war. The other qualified southern Sudanese who were in the Northern part of the country have also come back home. 5 WHO/APOC, 24 November 2004 Number of health staff in project area and number of health staff involved in CDTI activities. In the project area, there are a total of 983 health staff, of which365(37.102) were involved in CDTI as shown in the Table below. Table 1 : Number of health staff involved in CDTI (Please qdd more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staffin the entire project area Br Number of health staff involved in CDTI B2 Percentage B 100 Yirol/Awerial 2t9 100 45.7% Rumbek 237 85 34.4% Cueibet 2tl 69 32.7 Tonj 276 t3 26.4% Mvolo 40 38 9s.0% Total 983 365 37.1o There was an increase in the number of health facilities, number of health staff as well as number of health staff involved in CDTI in East Bahr el Ghazal project in 2008 when compared to 2007 figures. 1.1,2. Partnership - Indrcate the partners involved m project tmplementation at all levels [MoH, NGDOs (national/mternational), communilrcs, local organizations, etc. J - Describe overall *oiking relationshtp among partners, clearly indicating spec(ic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved - jnt" plins, tf any, to mobilue the state/region/district/LGA decision-makers, NGDOs, NGOs' CBOs' to assist in CDTI implementation Indicate tbe partners inaoloed in project implementation at all leztels (MoH, NGDOs ' national, international) The partners involved in CDTI activities in the project area are the communities (2,513 villages across 5 counties), health sery-ices especially at the county and health faciliry Ievels though partially, NGDO - CBM and APOC/WHO. The NGO - Norwegian Red Cross (NRC) has stopped their suPPort. Describe ooerall working relationsbip dmong pArtners, clearly indicating specific dreds of project dctioities (planning, super,trision, adaocacy, mobilization, etc) ubere all partners are inoolaed. The overall working relationship among partners is very cordial as all work towards ensuring that ivermectin gets to communities and that the affected communities select their own drug distributors. Before the commencement of mectizan distribution, partners engaged in planning, advocacy and mobilization. And while distribution of mectizan is underway, supervisory visits are carried out by partners to ensure success of the entire 6 WHO/APOC, 24 November 2004 proiect activities. At the end, a review meeting is organized to assess activities and then identify areas rhat need improvement. The EBEG project is also lucky to have APOC Technical Advisor's office next door in the same block that has been helping the PCO in carrying out advocacy and planning in collaboration with SSOTFNGDO. State plans if any to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project has plan to meet the three ministries of health officials such as ministers of health, Director-Generals and public health directors for Warrap, West Equatoria and Lakes srate on absorption of CDTI staff into the various ministries of health and also on full CDTI integration into the health services. The commissioners of health in the five counties will be approached and mobilized for support to CDTI activities in various counties, payams and Bomas especially directing their communities to provide any kind of morivarions to CDDs. 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's- i c-'scd ^0Jsh \e su.bo' A LhI+ s3BP$ r EdE.i eP\6cJ= N;) .E aLHQOq)O. \rri tsqJYe\ a.i 5Bu;'So .s $t€SEsutp\9ss$gSaF!() \ \V s $ sE ,S.E.EEtvEF .x i s€i"r S:N \J'. o 'i* s€tSSBb *t\\>,\sscQ\\(d 0) L< .. oS € 3 SECTION 2: Implementation of CDTI 2.1, Timeline of activities Fip in table 3, trmeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. l0 WHO/APOC, 24 November 2004 $oo c.l Lo -o 0) o zs c.l U a') * o0 E o o g E o ,i bo =c/) 0.)Lr >.o9 ) H .E Pd ..gCEA(JC'6aoU3E -.1q).=ntr s E'-8 = gxi.dT €i8 -U2 bE b; E= E(rfrlH =\)qtoH +(82J 5'.E ql v!!l'Fo Ht.= 2*'E *38 = Er (d H EE=tr a x -.''tsl a6'=t gaE +. FO H .U =; I'{Jv52E --i-N E;Efl 99, Eo a-'! 6! #6EO-3-;E f F :ETE!I9-dV 0(.) Q"tr - I6 E': H t) = H.9 5 q,)rrv.i-jrHHE'F9sl o ('E H E2,n91- .g s;. 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En- .ri E(!:iitr >, Dr tst Ft >, x Fi . ,,!1..i| ,i < u. -:\I() .ih . .. sl.. : . :tD 'i 'l -ri. , iA'' ':..1r '11 ' d t{ o) j o...4$t.i *t '.i{ op ,iE .5 H +, 0) -o ,.- Q;, o Er o A 5.) ul. 5D' ' .5. 2.2, Advocacy State the number of policy/dec*rcn makers mobil ized at each relevant level during the current year; the reason(s) for undertaking lhe advocacy and the outcome. Descnbe difficulties/constraints beingfaced and suggestions on how to improve advocacy N umb e r o.f p e r s o n s m o b il i z e d/ r e a s o ns -fo r a dv o c a c.v / o ut c o me s At the state project level, 3 key MOH officials comprising the state Minister of health, the Director-General and the Director of primary health care were met by the APOC TA and the PCO for the reason of integrating CDTI into health system and absorption of CDTI staff. The MOH asked for the list of CDTI staff and this was submitted. The process of CDTI staff / project integration was not completed before the end 2008 but there is likelihood that this will be successful in 2009. At county level counties, no Commissioners were found because of their frequent travel to others counties to mediate peace and reconciliation but 6 medical officers were seen on how to facilitate the inclusion of health facility staff instead of payam supervisors in CDTI activities. The use of health facility staff is adopted in place of payam supervisors in some counties for CDTI activities. Advocacy and mobilization became also successful in payams and Boma where 12 payams administrators and 16 Boma secretaries were met for ensuring the improvement in community support to CDTI implementation. Diffi cultie s/co ns tr aint s b e ing -face d! County commissioners are not easily found as they are so much occupied by work. . Insecurity prevents visiting other states or counties . Poor maintenance of project vehicle and motorbikes is also a major factor Sugqestion on how to improve advocaq) . Enough funds to maintain and fuelling vehicle and motorbikes. ' Proviiion of T-shirts, face caps or calendars to the stake holders during advocacy visit. . Updating stake holders on every TCC report or annual report so that they can know the gaps. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on' - The use of medru and/or other local systems to drsseminate informatrcn - Mobtlizatron and health educatton of communihes mcluding women and mrnorities - Response of target communttrcs/wllages - Accomplrshments - Suggest ways to tmproye mobilization and sensrtizatton of the target communties The use of media and/or other local systems to disseminate information The project used its based radio (long rang radio calls) in the MOH Rumbek to communicate to county and payam supervisors for collection of their Mectizan allocation in Rumbek and in different counties respectively as well as other information pertaining to CDTI activities. The methods used were home visits to the communities and focus group discussions in villages, health centers, prayer places, and market gathering. The project also used other methods such as wdtten massages/letters and hires satellites phone calls. However, the project did not use the Radio FM 98 in lakes state due to its high charge which the project did not have 12 wHo/APoc,24 Novemb er2oo4 Types of IEC materials used The only IEC materials used during the reporting period by the project were laminated posters, flipcharts and T-shirts as well as comic books for schools. Mobilization and health education of communities including women and minorities This was massively carried out in the project before Mectizan distribution and during distribution to create awareness about the Mectizan and for more participation.. Community leaders were contacted to arrange for the meeting with community members.. During the health education session, messages such as how one gets onchocerciasis, disease symptoms, eligibility criteria and what should be done in event of side effects and dosage required were mentioned. This activity was organized in all the counties in the project area and attendance includes men, women, young and old. APOC TA was with the project in the Wulu and Rumbek East sessions. Response of target communities/villages Community members' response was high during the actual mectizan distribution. Those people who did not take mectizan in 2007 this time around came and received treatment. Those who were initially ineligible later took the medicine after the expiration of exclusion period. Accomplishments , Those who received treatment increased in 2008. . Better information on refusals and absentees than in2007. . More communities selected CDDs and participated in the distribution than in2007. . There were more female CDDs as well as more villages with female CDDs than in 2007. Suggest ways to improve mobilization of the target communities. o More women should be encouraged to involve in Mectizan distribution as CDDs. o Communities should be made to own the project to ensure their fulI participation. . There is need for more health education sessions in the communities particularly areas where insecurity disrupted CDTI activities. o More Information, Education and communication (IEC) materials must be made available to the target communities. These materials include T-shirts, face caps, posters and handbills. 13 WHO/APOC, 24 November 2004 6N Lop C) o z <- ol U o o. o FJi r+ +jo C) 'e Lra (.) >. -o o\ N .o o 03lr a) -o 0.)H E € (B oo N o (ttrP 0)L Cd ah a Q C) ok 3 a (s F; G)p oHa d q) U) 0) N. \i > q) q) %l al 8l Pl n;!:t > \l'E(x'i c) EI E .El xRl trst d sl 0) sl ! ol > vl Isla\t otl: >l t $c qil tr>l 5 EI E $l E+tu o oodLo Cd o str)(n Eo L .2 'clE El .s -l 'oat I al u :!l out d4l .=\t a srl F !l Esl o '{l '5 sl 8. El:p .$H .st a ElstrlF 4 CO c! N ul ro q @ Fl + r-'l tioo0c! o {) il l' te @ al Or) ca o\ @ N rl 3F .EH 'E \J trd 5e =rri3Btr40 =(!z4 E.E * r =Et5 EEOz3> \oO\o \o c-N oo ao * 00 t(f) N ta + lq il la c! F t co\o o t-?oOc.) (n c.l c.)la 9^ trA OT\ r- o\ CD do\o s\o N 00 $ F- o o 4) tr=(gY U o o z AI o c! 2 ol N(Y) 4r\(n O) +N o) o CO Fl .j cO ln !d(^o o EO 6l oI o Cr e ll * lala FA F- o\ \o dd €cl € € a..l a* E >,2 p i=: E ;EE3 EE o\r- $ o\\o $ co c.) t-- co c.lN t) r,o ai >o 0'=oa Eod >aBr !:o =E EO otr9>r o=EE =oz') e o :=+EES SE;E[KFo (! oF (E o! o o tr & o q) O '= o3 2 () 11 e 4 a)U a) q: L q) L t S q) 4 q) F aQ() € s; .=l ^plo sl \J sl9 ilESl -\t i5 :I E *l E st-E' rl iBt > >l c.r sl E Sl c> st Epla\t99 :lH\I E$l .i RE$l asl O *l gll r. .$l c) sHE sUlS SI re x tls F Sl.e E \IE cn(,) 9 ll) ts o(, + c) II() E E E Q t .I 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. At the state level, the project lacks assistant PCO and data manger but the project will recruit these staff in future after integration. At the county level, 2 county supervisors are missing in both Rumbek and Tonj counties and of the available ones, 6 are new while 4 are old and well knowledgeable At Health facility level, there is not also adequate and 45 trained siaff (health staff and payam supervisors) are new and more time is needed for them to have more knowledge of CDTI activities. At community level, still the number of available Knowledgeable CDDs is not sufficient. Some villages don't have CDDs. About 70o/o of trained CDDs are new and it will take the project more treatment rounds before it could have knowledgeable CDDs. Each village needs more than One CDDs and the project will improve on this in 2009. ll/here frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures h)ere taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or d staffs are frequently transferred during the course of the campaign). No transfer yet in the project as majority of staff are not government staff. Rather CDTI staff resigned for govemment employment or any other organization where they are paid much better than they used to get from the project. The measures taken were that the project continues recruiting new staff who later need to be trained on the CDTI activities first before they become acquaintance to the work they are given. Moreover, more task is given to available staff especially CDDs where one CDD cover a lot of households. 15 WHO/APOC, 24 November 2003 co ol Eo -o c) o z <.N O op. Tr \o !H d a (h o o. rhk()F C)O (d o Jr v1 l-<oU' t< C) O. (h d (dg rnk C)\*t\o }!l-\) -( = - a') \.rtb\.= -u \)d{! \osq)B.ju'=\= H! 'cn >. Qr<\)' H /1S Uts Stra .S=cd3 Usr a > .H 'E t9B Eq\, 'itsqJ q'r=t4pOS €E\-\ ?6 hi O!sa)3 .<.oiri H A F{ ()-I o.ErJ=O qJv)p\ ^E$ aa} UEioo)b q= bI)qjqld\) rJES-(B .E 3EL. ,1 ,^i. Er,is. tr<b - c./)L-r Er-vhta .\)13 Oo)LOI-{b - 6)r gES [xs 7?-h trs bo oI q) \ 4 q) Lq) q) L q q) *t \ s o o bo \ !-q\rr oU q) q)\ L q) "o v ! ! q) \ .o-\. v 8< t a) IF 0) L o n(J Lq) z LqJ : .\. : qv lr *o + \o o rn .(l. @N \oo\o o € \o N rn \o NN o \o+N € + o f.r o € .+ rn \o a.l * o6l tn \o o\ = s o\ o € q) o (l) () \o?:FU (\cl\ +o\\o 'lr N oNN 1o(\I o ahLq) .=66-ri h, bF oo *9 t-G oJ tr z Ll, = Su: zv c-l .f @ e.l rar N \o N xf o N r.l .f ro + r/) o s n 6 q) () () () s Q a.l C.l o o o t+ rr) q) dh ,9E!s E8 E-> .r 6)ZE q)(J E.'t+F-d --.---. .!P$ Uz \o I.\ o\ @ N rat \o NN o. c\ N rat o\N ro s * .-o q) o o o \o o\ o\ UL @ o\ \rN c{ \o00 .n U) Fl o0) ") !r o L 0) z fi[vE.'i + d Ue .(- 6l a{ a.t o N o o $ \o s -) € () o 0) o \c UL + (\l I rl 0 a ('l q) F a q) € & 9()! c) O oF o o Fl F oF -:, q V)q) Q\) q 5 o\ q) L o t q)q q) 5 CO d(.) o a tr L..]O(H o a() q) tr C)k -o)!+i .o o I (g oo (€trF .iir orl -ol(dt FI Trainees TyP" of training CDDs Other Community members Community supervisors Health 'Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify ) Program management ./ ^i ./ How to conduct Health education { ./ { { ./ Management of SAEs ^/ CSM SHM Data collection ./ { { { Data analysis { { { { Report writing Others (specify) Census update { ./ { ./ Table 6: Type of training undertaken (fick the boxes where specific trainingwas caruied out during the reporting period) Any other commenls: Training was delayed till late November due to flood in the entire project area 2.6 Treatments 2.6.1. Treatment figures If the project is not achieving I 00% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is.fluctuating, state the reasons and the plans being made to remedy this If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons o Delaying of activities to rainy season where communication/accessibility becomes very difficult. This affects counties like Awerial, Maper, and some payams of Cueibet counry i.e. Pagoor, Tiaptiap, Citcok. The three counties of Tonj; North, South and East are hardly reached at the rainy season as well as some payams in Yirol East i.e. Adior and Malek. Awerial centre, Pab, and Mingkaman are also hard to reach at rainy season. l7 WHO/APOC, 24 November 2003 CDDs do not commit themselves to doing the work properly because they are not motivated by their communities. o Poor maintenance of project vehicle as the vehicle is very old and this resulted to restriction of movement to places that are inaccessible during rainy season. o Delayed of funds and this affect the distribution period' o Poor maintenance of project motorbikes. o Inadequate bicycles to some payam supervisor and Boma supervisors. o Insecurity is a major problem affecting distribution in the entire region of East Bahr El Ghazal. This was one time witnessed by the APOC team on assessment of treatment coverage in September 2008. The team and the PCO were caught up by gun fighting in Yriol town. It was a very bad day for us and we were not sure that we would really survive. We left the town by the help of a military land Rover which was also leaving for Rumbek. The olans beine e to remedv this. r Increment of community mobilization and sensitization sessions, advocacy, health education and increase of communities with community members as supervisors. . Proper maintenance of project vehicle and motorbikes. ' Early release of funds. . Adequate CDDs and equivalents work supports items. . Adequate fuel for motorbikes and a vehicle. . Provision of adequate bicycles for payam and Boma supervisors. . Distributing mectizan in hard - to - reached areas during dry season. These places have a higher population also. . Provision of a new vehicle to the project if APOC can approve. a l8 WHO/APOC, 24 November 2004 $ N o -o E() o z N O p. o FJ< o\ r'1 F c! C)Hd oo 'a kg C) .= ad c)L(! o 0.) o I C) o. >.{ oa C) ot .= -t IEXI C) tl t6 ol 0) (!l P 6)l ,, Pl ! o-ll n -t ;tt-e 8l * c..l 6 3t8ol o -oltrl 6) =l -.ozt= = oilF ol -l o.rxl > EI E EIE sl EoL 0)ol trot Eot id rlg rl ' -8lE Et c zl< d 0)L(! oo 'a Lr () : z IJ.]& -o C) r{I C) .; (d U) C) 9l E =l tr*l E El.e rit Hot xjrl € alC ol d) 9fl J.irl q.r >t >- ol > Pl 6 '=l d-) =t tsEl c* El o 8l u - tJbl E LI J6)l csl -trl cE =l ozt? (B(.) r<d oo 'a tiq q) U) C) oo o 0)! C) ILr() o. >. ^,o91 6 ol 6) -l Exl - El oodt c(Dl .- rl > o.rl -P{6 9l ts t*l =ol o-ul ool o-st _trl cd =t Ez ? ll q) o od F s o L c) oo !d^gE o C) oF O o bo cdL() oo Cd -c o\o.v 60L oo o C) o (d H C)bo(! 0) oo O,^ '5 \o (.) o.d lio F o^-. - E.vt'.E E -Og!i >{ o='6.3 H9;* 3E ? e 9 Q€ a; c ** -6 = i 8t e o o o o O rrl +i< \v> z o o o o o EOoo Er E -2€ rn+\o + rn ++ r.l ooc{ o (a(\l t.- 6e S E nE, E5[E€58 A* L L tr)\o 6cO tr)o o\oo o F- o\!f, o d Ak\o o:EO ()d =ooo -troF t-N c! N|r) q @$ cf) o rr, @ N s ul \o o @_bEU Eb9 = Q.-z @(o lr)(o r() F-@(o c.io t- rr) (o(o ro o{ o)o F.- @N(o (f) ra\o r- ra tsod o.= !=o .l I -o' FU o stNN sf Fl rr)(o CO T\ cn ri o cf) sft)ql sf 00 OlFl]n Fl o@oNN Fl o\ o\ o\s\o .Y | .dH q9 = o t+.8iE -?.g E 9E o -6F ooN COoN (o(a N(o o, o,N(f) (o (f) o C\t t- 6I Oo s_ sF- r ra6oI F-.N €\ t)(I) b0d a 0.) H oO ll * ^-Ao\ E .9o E- ss-!od5oi ueo q t-@ \ O)(o oq @ @(o(o r +@ s R6F- E.9 .- u.E U 19 -8 E S*tr tr= o =c>,ao o rn o\F\ t @ .<f I.\ r-.) c\ o\+c{ rr1 @ F-o\ =od o.a aEo j.o9' FIJ oo o\ .il- r.l\o @o @o\N oNN 6 ra N \Oqoi-rd ts:.E: E H s EsEE' u.; tr g a.t o\ <. o\\o t N oc{ c\l (a in(\I OJ -^ 9- o\ q) F o -(l 5q) ! r'. q) ,o U tr oF o o '-1 Fr oF 4hq) uq) q L q)\ o t q) Ca \) s v t') L< Cd rnd() Lr(d (c o Fl () H (/) ch r! U) E (B C) (g C)LF r-l o.ll -oldtFI +o c.l C) -o o o z s c.l O L.,' o N \) 06 U s{ a. <l' sq) oo qJ s (! F 6' 54.is .i .Eoo3 B\ .sn >U\.t \YuT€ ET PT o$ rsBStsS U-E 'SF' E \.E .P $Xg s3s .sst\ =q-o '1- s' B B9p-siL s ssb :bu $\s bse S.q)s€:I ;sqr qi r\ * \I\s' sbi -.lsk :+ : :bs s* M q,PI' .a^ 'I qr ; sN $ t$ :r Q'qr :" L.Qi 3sE SI i sEaJ Sq) .s'8\3 SS$ e]s {-t rr tt!P PS\ Dg 2.6.2 What are the causes of absenteeism? o Most absentees that occurred during the distribution are traceable to cattle migrants who follow their cattle and had to stay many days in the cattle camps mainly from May to November. . People who traveled outside their communities during the period of distribution. . People who are imprisoned as a result of committing a crime such as killing or cattle raiding. 2.6.3 What are the reasons for refusals? o The refusals have not been taken through health education properly about the drug, as they have been outside their homes for many years. . They claimed that they do not have the disease. o Due to side effects of the drugs. rarellr found in the health facilities because they get exhausted faster than any other drugs in the health facilitir Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required iformation when available. not 2.6.4 a No case of SAEs was recorded during the reporting period In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report X 2l WHO/APOC, 24 November 2004 $ CI L(.) -o o o z s c.l L,/ c'lN =H= -EE b<.E E L ;PoB '.=ES 6oa 9xg rl.t 5'6 (e o o.2E2oE9q0 6E (I)mex(HY qD ^ d.9 uo.C tr&9d !*;O-o.2EA o C e5 d@ooO E,ii,E o ^q^va_E!o'= -g =E ts d'ii o H.Ed d € . g qp.! = =-o.H ogEEtS o o. U) slJ Eq (J J F z trE;=c) -E tC)=o ^^*a0qta =6) .Nf 9Be o> B o c)boE =o0 >5 I 0)a o bo * 4 V) q) tr q) t\ *a \q)4 It a 4q q) vq) q > I\ q)\ t v q) Fi q) 5 E o tr 0) O. oo L q 0.)tr o o0 k E C)Lr! oo o a rI] a U) o o o C) Lr C) Cd v) o k C) U) +r u)o at)dO #r orl -oldtFI $o N (.) -o o o z$N(, Pr o > caN t) tr c! c,) c{I o bo L 0) (,) F D cq L cl A () q) U) cl q) a0 U' q) .a o\ o\ € tr-F- Gq)L6 () q) L o fr F q) {) c!q) q) U) G c) Fr e qJ !., q.} q) * a) A)Ftl 6iq) L Iq) '= fr q) L q) o Lr € k 6d o(t o o b0 cd *io o (d U) o tr 0)HF o,l ol -ol(dt FI L CE 0) olrL I q) o q) <') tr Iq) L F U t- q) q) c) I cl q) c!oL o)L t.( [a \o N C) ooI $s Po (J (o o; N loN o c.) rr) (r) o(o c.) cor- o ) o o< * t-- rd ll - o€ .5 ti - o ^ oI)C) 9!- F Oo\ <.>v o s6t(o rO s crj tr- s(9 o) q N O) q t- oo ll * l-J lr] kl o\ o 'Eo =oood =oooEOF q) Fl \o rJa ,riN s rll f-- o|r) v,) \o 1.1 ,o LiJo.:E- ,o o. rO rO r() Fl co rOa o) H Fl6l @ N ri$ f.-(r) f-- o,(o$ c.t\o or- I! E U.= /Qo J9-O'*Eo O ts- r-l t-(o c\ D- il t- 6t @o$ coN$ @ 6l(o Io o\ o\ oit\o Lq ,rd: bs) - ^ *6E'-i o h- - .oj!E='Er.t 'lqa go- o- 6l o) @ E- D- 6I O) oo f-- tr- aN od tr- D- ro @N F-N o, @C\ t'-N o\ 0.) o0 6d q) oO ll * k: ti II] o ^bo() G^ F Oo\ <.>v -o o \o eO @ Fi N tr- s F- @ rll q) 09 c! oo EO= $r E 8,hI Ooli @(o TO \o6\6l $ \o @ nc6(o n oo F- E] (Hoo.:8- b E 9PU tr E= ii >o6 @ co$ Ora @ TO or-q. E] Eod o.= :tri) e d.= ,1 O3' FU O c-$ OO N tr- N L- O @ ."r C.l bo(d =qts<, E ii * o= t:: t E 3 q€ EO o (o(o ti ri Fi r-{ t-{ r-l co uI N & rI] $oO o] oc.l \oo a.l r- oN oooo c.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH Other wHotr specify) bv - (ptMectizan@ delivered ease tick the appropriate answer) UNICEF trMOH wHo x UNICEF tr NGDO NGDO tr Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The project coordinating officer ordered the mectizan from the SSOTFAIGDO which ruppii.a to the project. The county supervisors collect from the project office in Rumbek and r..d to various Payam supervisors for collection. Payam supervisors on collection notiff Boma supervisors to come and collect their drugs. And on returning, the Boma supervisors who are also CDDs share the mectizanwith other CDDs in the communities for distribution to community members. Table l0: Mectizan@ Inventory (Please add more rows if necessary) x State/District/LGA Number in stock Requested Received Used Persons treated Lost Wasted Expired Remaining YiroUAwerial 582,000 582,000 566,894 156,568 106 0 0 15,000 Rumbek 4 15,500 415,500 353,467 102,387 122 0 0 6 l,9l I Cueibet 255,500 255,500 226,916 66,157 s62 0 0 28,022 Tonj 383,000 3 83,000 379,418 109,251 55 0 0 3,527 Mvolo 350,500 350,s00 341,880 136,267 419 0 0 8,201 TOTAL 1,986,500 l, 986,500 1,968,575 570,630 1,264 0 0 tt6,66t How are the remaining ivermectin tablets collected and where are they kept? The CDDs collect the remaining tablets and send them to their Supervisors and who in turn submit to Payam supervisors who later send to county supervisors and finally to the PCO for storage in Rumbek - project office. Note on 2009 update: 1 all been and reDort su 24 WHO/APOC, 24 November 2004 Numher o List und brielly describe the activities under lvermectin delivery that are being carried out by health care personnel in the proiect area. . Health care personnel in the project area are involved in community mobilization, health education and sensitization. . They are also involved in monitoring drug distribution, management of minor side effects. . They are also trained as TOTs to train new CDDs and payams Supervisors together with county supervisor. Any otlter comments No 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the proiect area? No If so, When? The training of trainers for CSM will be done by the year 2009 because in the previous years it has not been possible for the project to start CSM. Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. NA District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN[) No of Communities that conducted stakeholders meetins (SHn41 Rumbek 694 0 0 -cupilet YiroVAwerial 1t! 912 0 0 Toni 373 0 0 Mvolo 220 0 0 TOTAL 2,513 0 0 25 WHO/APOC, 24 November 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Su Reporting a a a a o 2.g.2. What were the main issues identified during supervision? The treatment registers and summary forms were not filled correctly by CDDs' Census was not completed properly in some areas. Some areas were discovered to have not got treatment' some CDDs have abandon rhe job and decided to go to school. 2.9.3. Was a supervision checklist used? Yes, Supervision check-list was used. 2.g.4. What were the outcomes at each level of CDTI implementation supervision? At counry level the counties supervisors were found to have not been carrying out supervision in their counties and as result the summary forms are sometime not filled correctly by the Payam supervisors, Boma supervisors or by CDDs' At payam level, some communities were found to have not been given drugs by their Boma supervisors because payam supervisors failed to supervise them. a o SSOTF IUq 26 WHO/APOC, 24 November 2004 'li'..1t":u,i .', t,t',1,.i.,it i/i)71 {:I:: f i. ^.e} *rel lqriL i:nliir igf.f.*i* (:i;tI a At communiry level, CDDs were found to have wrongly filled household registers, tally sheets and summary forms level four. 2.9.5. Was feedback given to the person or groups supervised? . They were coached again on how to do the right work and especially in conducting census, fill summary forms and tally sheets. o 2.9.6. How was the feedback used to improve the overall performance of the project? o Several practical session were delivered to the weak people in order to catch up with sharp minded people who performs better in conducting census and filling reports summary forms SECTION 3: Support to CDTI 3.1. Equipment Table Status of add more rows nece, *Condition of the equipment (F:Funct onal, CNFR:currently non-functional but repairable, WO:llritten ofn How does the project intend to maintain and replace existing equipment and other materials? The ministry of health by it self does not have funds to avail to the project and again the project has not been integrated. If the project is integrated into the ministry of health, the counterpart funds when released will be used to maintain the project as well as replace the existing equipment. NGDO OthersAPOC MOH DISTRTCT/ LGA Conditron No ConditionCondition No Condrtion No Condition NoType of equipment Source No NA 0 NA 0 NA1 0 0 NA 0L Vehicle 0 NA 0 NA 0 NA2. Motor cycle(s) 5 1-F 3- CNFR 0 NA 0 NA 0 NA 0 NA3. Computer(s) 1 F 0 NA 0 NA 0 NA 0 NA4. Printer(s) 1 CNFR 0 NA NA 0 NA 0 NA 0 NA5. Photocopier (s) 0 NA 0 NA 0 NA 0 NA6. Fax Machine(s) 0 NA 0 NA 0 0 NA 0 NA7. Others 0 NA 0 NA 0 NA 0 NA 0 NAa) metallic cupboard 2 F 0 NA 27 WHO/APOC, 24 November 2004 Contributor Year I ('2006') Year 2 ('2007') Year 3 ('2008') TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) 0 0 0 0 2592 MOH (District/LGA) 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 NGDO partner(s) r 8,1 50 1 8,1 50 r 8,750 20,09t 1625t 16251 Others 0 0 0 0 a) 0 0 0 0 b) 0 0 0 0 Communities 0 0 0 0 APOC Trust Fund 125940 66623 r 00885 78609 55,665.00 36,358.50 TOTAL 144090 84773 1 1 9635 98700 71,916 55,201.5 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years If there are problems with release of counterpartfunds, how were they addressed? The project is having problems in getting counterpart funds. The project depends only on APOC funds. The ministry of health has not yet integrated the project into state ministry of health. Additional comments No additional comments 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities f any) . Providing venues/shelters and security during training of CDDs. o Communities collect firewood, water and also cook for CDDs during their training. 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here- 28 WHO/APOC, 24 November 2004 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? No SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) NA_Year I Participatory Independent monitoring NA Mid Term Sustainability Evaluation NA 5 year Sustainability Evaluation NA Internal Monitoring by NOTF Other Evaluation by other partners ActiviE Expenditure/ Source - APOC ( usD) Expenditure/ Source -CBM (usD) Drug delivery from NOTF HQ area to central collection point of communl ty Mobilization and health education of communities 1,767.00 8128 Training of CDDs 6,489.50 APOC(222s) Training of health qliaff at al I levels llrpgl4rjqg QDDs aq{ 4ilqrbution Internal monitoring of CDTI activities Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/ Motocycles/ bicycles maintenance 748.00 7,800.00 10,504.00 APOC(1397) J APOC Office Equipment (e.g. computers, printers etc) 400.00 APOC Others/plus 2592USD by MOH 11,242.00 APOC(856) TOTAL 38,950.5 16251 Grand total amount 55,201.5 Total number of persons treated 570,630 Cost per treatment 10.34 NA 29 WHO/APOC, 24 November 2004 4.1.2. What were the recommendations? Not applicable(NA) 4,1.3. How have they been implemented? NA 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No- Was a sustainability plan written? NA When was the sustainability plan submitted? -NA What arrangements have been made to sustain CDTI after APOC funding ceases in terms of 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: The integration of the project into health system is still an ongoing task being coordinated by APOC TA. Hopefully it will be successful in 2009 4.3.1. Ivermectindeliverymechanisms o The Ivermectin delivery mechanism has not been fully built into the drug delivery of PHC system due to partial integration. So ivermectin delivery is done separately from other drugs. In future this would be possible after integration. It is hoped that this will begin in 2009. 4.3.2. Training o There was no integrated training yet with other programmes. Most of the TOTs are PHC health workers and they help in training CDDs, POSs and BOSs after having been trained. The plans may be when the project is integrated into ministry of health. Joint supervision and monitoring with other programs4.3.3. 30 WHO/APOC, 24 November 2004 a4.3.4. Release of funds o There is no fund released by PHC as the project is not yet integrate 4.3.5. Is CDTI included in the PHC budget? . No the project has not yet been integrated 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. \flhat have been the achievements? No other programmes are using the CDTI structure due to the fact that PHC is not fully operational. However, the State Ministry of Health is considering using the CDTI structure to implement IMCI when it begins to function and operational. 4.3.7. Describe others issues considered in the integration of CDTI. o [n future, CDTI srrategy could be a potential tool to drive other neglected tropical diseases in the project areas. 4.4. Operational research a a This has not happened because the project has not yet been integrated into state ministry of health. 4.4.1. Summarize in not more than one half of a page the operational research undertsken in the project srea within the reporting period. No operational research activities were carried out in the project. a 4.4.2. oNA How were the results applied in the proiecl? 31 WHO/APOC, 24 November 2004 SECTION 5: Strengths, weaknesses' challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process - List the challenges and indicqte how they were addressed. Strensths . leing closed to APOC TA who normally helped in CDTI implementation' o Having an office within state ministry of health as well as being together with SSOTF. o Available workers are committed. '$[eakness High attrition rate of project staff. Available manpower is not weII knowledgeable in CDTI' No salary for CDTI staff from the ministry of health as they not yet integrated. Non availabiliry of motorbikes for some counties. Delayed starting up of CDTI activities as the fund is released very late. Census update not completed in some communities Total list of villages in the project areas not yet fully confirmed. Poor nature of roads with resultant high wear and tear of the vehicle Regular outbreak of insecurities in the project area makes the activities very difficult. Since the CPA brought peace to the country still tribal conflicts arises due to catrle raiding and land demarcation. This issue may be put to an end when government controls illegal fire arms' I a a a a a a a a o Challenges o Attrition of knowledgeable manpower in the project area as due to low top up. The project therefore made an effort to get more CDDS, Payam supervisors and county supervisors and even health workers and also encouraged them to remain in the project. . High attrition rate of CDDs at communiry levei. This matter was discussed with community members and it was to due to no motivation to CDDs thus the project keeps on replacing new CDDs. . There are no salaries to CDTI staff from Lakes state ministry of health as the CDTI staffs are not absorbed. o vast area to cover and coping with effect of wet season. Suggestions were made to commence all CDTI activities in dry season preferably ]anuary - M"y but funds were not available. The project covers three states in Southern Sudan. . Coping with late release of Funds by APOC. The project has planned to request APOC through the SSOTF for early release of CDTI activiry funds in January so that difficult- to- reach places in rainy season could be overcome. 32 wHo/APoc,24 Novemb er[oo4 ao a a a Intensifying health education and communiry mobilization. This was used to defuse beliefs on the mectizan and thus reduce the number of refusals and the project has planned to strengthen this activity continually. Identifying various cattle camps so that cattle keepers do not miss mectizan. The project tried to identify various cattle camp locations but due to rains/floods and fuel problem no much work was done but the project is trying effiort to improve in treating cattle keepers year by year. In addition to this, people who are Put in prisons for a long period were suggested to be treated also and successfully 100 people imprisoned in Rumbek state prison were treated in 2008 and is planning to keep this on continually. Non availabiliry of community data base collection. The project was not able to compile this due to the situation in the project areas and is on the top agenda in 2009. Ratio of CDD to total population in the project is still high. More CDDs will be trained yearly when there is fund in order to adjust CDDs/ population ratio in the project area. Communiry census registration is a still a problem in the project. Many returnees have come back and this has affected the whole plan. The CDDs need revisited the all household to count the new household members again. a a 33 WHO/APOC, 24 November 2004 SECTION 6: Unique features of the project/other matters In 2008, REMO/RAPOLA and CDTI household treatment surveys were carried out in the project area. These surveys were carried out successfully although there were many .hult"ng.r and difficulties in carrying out these exercises due to insecurity and inaccessibility of some place because of flood and heavy rains' In June 2008, the APOC TA in his official visit to MOH, Lakes, the state Minister of health and the DG on integration of CDTI and absorption of CDTI staff into SMOH. The Minister expressed delight to the coming of the Technical Advisor to the Southern Sudan to support in CDTI activities and he specifically thanked WHO/APOC for taking this decision to employ the services of a technical advisor. He mentioned low coverage of mectizan distribution in Southern Sudan and pleaded with the Technical Advisor to see that this was addressed. He assured the technical Advisor that all the staff of CDTI belonging to the Lakes state would be absorbed and accommodated for salary in the 2009 MOH work plan. Also the DG commended the Technical Advisor for his approach to the ministry on the issue of integration and asked that acopy of the letter to DG MOH-GOSS be given to him for a follow-up with the DG MOH-GOSS in Juba and the state minister of health for implementation. A copy of the letter on integration was given to the DG MOH by the Technical Advisor. Furthermore, the DG ministry of health Lakes state was also updated on the East Bahr el Ghazalproject and documents relating to the project such as vehicular and equipment availability were handed over to him by TA/SSOTF as a process of integration of CDTI into the ministry of health in Lakes state and he immediately followed it up by directing for an opening of file in the ministry for the project for the first time. In the company of the Technical Advisor were the SSOTF administration /finance officer and the East Bahr el Ghazal proj ect coordinating offi cer. In September, Technical Advisor undertook monitoring visits of East project and during which community information data base was further stressed on and some reports collected' Corrections were made on some figures by coaching the county supervisors. In September, the Technical advisor in the company of Polio field officer visited two payams namely Wulu and Bahr gel including Wulu Primary health care centre and Kuel Kwac village in Wulu County. Altogether, 102 people were mobilized and health educated on the need for mectizan treatment. A CDD in Bahr gel payam was seen distributing mectizan. It was noticed in Kuel Kwac village that treatment has not started and there was no CDD. The community elders and other community members gathered were told to select at least 2 or more CDDs and who would be trained in early October. Cases of lymphatic filariasis were reported in Kuel Kwac a 34 WHO/APOC, 24 November 2004 Ivillage during the monitoring exercise and villagers claimed 15 cases but only one was seen during the monitoring. In October, The Wulu county supervisor trained three CDDs selected by Kuel Kwac village members and they corlmenced distribution of mectrzan.It could be recalled that this village was discovered not to be distributing mectizan during supervision by the technical advisor and after meeting with community members, it was agreed that the community members select their distributors who would be later trained. Also, one CDD was given on-the spot training to commence immediate mectizan distribution in Aber village where no distribution was going on during supervision in the area. This CDD is also involved in polio activity in his village and this made it easy for his quick adaptation. Also, visit was made to Abiriu village in Cuibet County of East Bahr el Ghazal by Technical Advisor alongside with the PCO to validate data and collection of data. 35 WHO/APOC, 24 November 2004