SSOTF/HQ annual project technical report submitted to technical consultative committee (TCC): January 2008 through December 2008

Southern Sudan Onchocerciasis Task Force ORIGINAL: English v5D j I'ri |tr:{tt CEv EPI Brrtr .fl- COP UDTo c ,$ i1 (, t i1r>r l;,1+:"r:.:iion Tor g( *4. 6.konr. COUNTRY/: Southern Sudan ssoTFrHQ Approval year: 2003 Reporting Period (MonthrYear\: Jan 2008 through Dec 2008 Project year of this report: (circle -Q""mr") 2 (!) 4 5 6 7 8 9 1011L21314 Date submitted: JuIy,29,2009 't{.i\ 'l ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 January for Marc]n TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRA}4ME FOR ONCHOCERCIASIS CONTROL cAPOC) ANNUAL NOTF SECRETARTAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confim you have read this report by signing in the appropriate space. OFFICERS to sign the report: ( '\ !. I Country : South Sudan National Coordinator: Name: Dr. Signature: Date: 23'd July NOTF Chair: Name: Dr Signature: Luga /TA unu Date: 23'd July 20 This report has been prepared by: Name: Dr. Mount / F asrl/ Lazarus Designation Signature: .. /NG Date:23'd Jlly WHO/APOC, December 15, 2004 TABLE OF CONTENTS ACROI{YMS II DEFIMTIONS m FOLLOW UP ON TCC RECOMMENDATIONS. ..................ry EXECUTI\.E SUMI\,IARY V SECTION 1 : BACKGROUND INFORI\{ATION...:.... 1.1. GpNpnel rNFoRMATIoN................ 1.2. PopurauoN AND Hpelru SYSTEM 2.4. CoirauuNITIES' INVoLvEN,IpNt IN DECISIoN'MAKING . 2,5. Cepeclry BUILDING 2.6. ORopnINc, SToRAGE AND DELIVERY oF IVERMECTIN. 1 I 5 6 6 6 SECTION 2: SUMIVIARY OF CDTI IMPLEMENTATION 2.1. DrsrnrsurroN pERroD.............. 2.2. AovocacyaNo SpNsrrIzATroN 2.3. INronuauoN, EoucATIoN AND coMMUNICATIoN STRATEGy AND MATERIALS DEVELOPMENT .8 10 10 ........... 13 2.7. TRsarN,IpNts 2.8. SuppnvrsroN ...........15 31 2.9. ConannuNITY SELF.MoNIToRING euo StaxpHoLDERS MpprTNc 24 SECTION 3: OTHER ACTTVITIES OF THE NOTF 25 SECTION 4: SUPPORT TO CDTI....... 4.I. FINeNcnL CoNTRIBUTIoNS oF THE PARTNERS 4.2. Otnpn FoRMS oF CoMMUNITY SUPPoRT 4.3, RnSoURcpMoBILIZATIoNEFFoRTS 4.4. ExpBNoTtURE PER ACTTVITY BY THE NOTF SECRETARIAT 4.5. EqurrunNr SECTION 5: EVAIUATION FOR SUSTAINABILITY OF CDTI, INDEPENDEI{T MOMTORING AND OTHER REVIEWS 36 5.1. INnBpptroENT pARTICIpAToRy MoNrroRINc/nvRLuarIoN .......................... 86 5.2. SusrarNeBILITY QF PRoJECTS: pI"AN AND sET TARGETS (uaNoetoRy ar yn 3) 37 5.3. INrncneuoN ...............:1........ .....87 5.4 OppnaTIoNAL RESEARCH .......38 SECTION 6: STRENGTHS, WEAKNESSES, CTIALLENGES AND oPPORTUNITIES .................38 2t 31 32 32 32 34 Acronyms WHOu #: I ll WHO/APOC, December 15, 2OO4 Definitions (r) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (iil Elieible population: calculated as 84o/o of the total population in meso/hyperendemic communities in thle project area. (iii) Annual TreatmentiObjective: (ATO): the estimated number of persons living in meso/tryper-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 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). (vil Geosraghical coverage! number of communities freated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (tfris should be expressed as a percentage). (vii) Inteeration: The bringing together of two or more health programs, removing bapriers 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. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to functio,4 effectively for the foteseeable future, with high treatment coveragd, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. lll WHO/APOC, December 15, 2004 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, frll in the recommendations of the last TCC on the project and describe how they have been addressed TCC session 28- (Please add more rows if necessary) 'i Number of Recommendation in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY Report related: 1 Information on funding should be provided I The current report has addressed this. 2 Provide responses to previous TCC recommendations and/or confirmation that the year I report was actually submitted I The report was submitted to APOC but there no apparent response or no further communication from APOC. Proiect related: 1 Training on CSM and SHM should be carried out now as part of CDTI training, as these activities are part and parcel of CDTI This is noted and would be incorporated in the future training on CDTI. Already projects are being sensitized on this. 2 Activities should be carried out in ;the dry season This is very ideal and good but it would depend on fund availability during the period. lv WHO/APOC, December 15, 2004 Executive Summary i The total population in the five CDTI projects of Southern Sudan was 5,189,269 in 2008. This represents an ll.37o decrease over the 2007 figure. The decrease was based on the census population outcome in some areas. The West Bahr El Ghazal CDTI project accounted alone for 5l.5Vo of the total population. The Ultimate Treatment Goal (UTG) and Annual Treatment Objectives (ATO) across the projects within the period were 4,358,982 persons and 2,L77,344 persons respectively. The total number of communities in all the projects was 9,429 and this shows an increase of 32.77o when compared to 2007. Of this number of communities, only 6124(321%o) were targeted for treatment (ATO). Total persons that received treatments in 2008 were2,029,828 as against L,422,325 in2007, thus representing 607,503 (42.7Vo) increase. These treatments occurred in 6,576 communities compared to 1,965 communities in 2007. Coverage recorded in 2008 for geographic, therapeutic, UTG and ATO were 69.8Vo,39.1Vo, 46.6Vo and 93.27o respectively. The greatest achievement on treatment came from West Bahr el Ghazal CDTI project. Actual CDTI training and refresher courses started in July through September 2008 just like in 2007. 38 project staff, 494 health staff, 211 TOTs and 6,403 CDDs were trained and refreshed during the reporting period. The figure for number of CDDs trained increased by 3,894 (155.2Vo) when compared to 2007 figure. There was general increase of trained personnel across all categories in 2008. The population/CDD ratio was reduced by 65.37o from 2333:1in2007 to 810:1 in 2008. There was an improvement in integrating CDTI into PHC in 2008. Two project coordinating officers and 13 county supervisors were absorbed during the reporting period. The process of integrating and absorbing the remaining projects and tlleir staff had commenced and there is prospect of their full integration in 2009.It would be recalled,that CDTI projects' staff were mere volunteers and not previously ministry's staff. The SSOTF strength lies on both the technical support provided by APOC through the deployment of technical advisor to SSOTF and projects, sheei determination of available staff to get work done, improvement in communication network in Southern Sudan and the continued support of CBM to SSOTF. The main weaknesses are the politics of the leadersllip at the national level, available manpower are not well knowledgeable plus their inadequacy, non government counterpart contribution and delayed actiyity fund release to the programme by APOC. The major challenges facing the prqgramme include the lack of capacity to man CDTI project by some project coordinating officers, inadequate staffing and knowledgeable manpower in the project area, non integration of all projects and non absorption of some CDTI staff into the ministry of health, correct and timely data reporting, and problem of handling missed treatment of cattle owners. The emergence of NTDs control programme in Southern Sudan offers a potential opportunity to utilization of CDTI structure and thus leading to popularity and prosperity of mectizan distribution and coverage. Key activities undertaken by the SSOTF during this reporting period include participation in REMO/RAPLOA exercise, facilitating the monitoring of treatment coverage, procurement of ivermectin tablets from Mectizan Dohation program in collaboiation with CBM, holding series of meetings and trainings, printing of IEC materials and ensuring distribution of mectizan and work support items to the projects. Under the vector elimination, SSOTF did not carry out any activity-as this was not applicable in Southern Sudan. {' )l ;. WHO/APOC, December 15, 2004 SECTION 1: Background information 1.1. General information ,,, 1.1.1. Description of the'country pnogzam -CDTI and vector elimination(txeay) i The Southern 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 S5F). The rainy season months are April'October with annual rainfall of more than 1000 mm (+0 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'lthe Jonglei ayea of the Upper Nile. Human settlement seriously affected by many 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 southern Sudan Onchocerciasis control programme consists of frve (S) COII projects namelyi East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile. East Bahr el Ghazal and West Equatoria are in their fourth year while E'ast Eqiratoria, West Bahr el Ghazal and Upper Nile are in third year in this present reporting period. Southern Sudan as a country has ten states and project composition based on states are as follows East Bahr el Ghazal CDTI comprised Lakes, Warrap (one county), and West Equatoria (one county) statesi Upper NiIe has Upper Nile and Jonglei statesi West Equatoria is the only statei East Equatoria has East Equatoria and Central Equatoria states while West Bahr el Ghazal has West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap (three counties) states. Vector elimination Presently, there is no vector elimination programme in all CDTI project areas in Southern Sudan. Status of National plan implementation, population at risk, number of projects being implemented, other releuant actiuities, and infrastructure G.g. Adequate health facilities, is system decentralized or not, etd, logistics, administrative structwe. Basically, the National Plan is implemented by Southern Sudan Onchocerciasis Task Force, which comprisedr'of national health staff of Ministry of Health government of Southern Sudan, WHO/APOC staff in Juba and Rumbek as well as Non ' Government developmental Organization (NGDO) which has CBM as lead NGDO. It is also being implemented through various 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 field health coordinators. They also provide logistics support to facilitate the smooth running of the planned activities at project and county levels. WHO/APOC, December 15, 2004I The total population at risk of being infected with onchocerciasis in Southern Sudan was 5,189,269 people. There are a total of 5 CDTI projects and 1 Headquarter project in Southern Sudan. The total number of health facilities across the five CDTI project areas in Southern Sudan was 933 and this comprised 213 primary health care centres(pUCC), 684 primary hehlth care units (pUCU) urrd gZ rural hospitals. 2, 540(Sg.gX) health workers i*.r"'involved. in CDTI out of 6,386 health staff in Southern Sudan. : The SSOTF headquarters is situated in Rumbek town. Rumbek airstrip is capable of receiving different types of aircrafts. This airstrip is currently being upgraded to an all-weather airstrip and is a major airstrip for OLS operations in southern Sudan. Rumbek is in the middle of Southern Sudan and it has road connection with Western Equatoria, East Equatoria, Central Equatoria, and other parts of Bahr el Ghazal and Warrap states. The administrative structure has four levels in Southern Sudan namely: fhs State, the County, the Payam and the Boma at the grassroots level. The States form the first level of administration followed by the Counties, Payams and Bomas. State is administered by governori county by commissioner, the payam by payam administrator, and the Boma by Boma liberation council. Boma consists of several villages and mectizan distribution is based on villages in Southern Sudan. The five projects have a total of 33 counties and 9,429 communities where mectizan treatments were implemented during the period. und.er review. Health system & health ,u3 delivery (srtatu any prublems related to health system that impede program iuplementation). PHC remains the cornerstone of the health system and needs to receive more political commitment and support for its successful implementation. The health system and health care delivery in Southern Sudan focused on five levels of facilities/services and these are community based health activities, primary health care unit, primary health care centres., county hospital and county health department. The long standing civil war in Sudan has affected the health systems and infrastructure in Southern Sudan hence health care delivery remains a great challenge. Tiie health system is fragmented, few functional health facilities but in poor condition, lack of basic facility equipments, Iimited trained manpower, medicines and poor and irregular salaly and general lack of motivation to attract the few qualifred staff to work in government institutions.. The above rehearsed problem thus impedes CDTI as most'of CDTI staff have not been absorbed into the health system of the Southern Sudan due to non budgetary allocation of funds to run the Primary Health Care (PHC). For instances, among the SSOTF staff at headquarters' level, only the national coordinator was a staff of the ministry of health ,and also at the state CDTI level and county level, only tw6 proj6ct coord.inating officers and 13 county supervisors were absorbed. into the health slstem respectively.. 2 WHO/APOC, December 15, 2004 houide map locating all prujects (COru and Vector Control, if any) within country. Southern Sudan lVIry 5: CDTI anas and frrrccasbd CDTlprrjects with tftcir rrspcctirrc coordinrtion ani srpcnrision ofEbes/ccntrce ir Pro ect 1: Bahr El GhazalWest ect 2: Bahr El Ghazal EastP mre rr , etc 3: West E fla 4: East uatoriaP KM lJgtnda 0 100 200 Legend Errryty or uninhebitatcd zoru RGfirrc CDTI Priority arrces NO CDTIarres REIIO to tc pcrfrrmcril Etkiopit ftenya WIOTAFE]l lJul!20!l Il{ofthetn Sudan t )' E t r,] I Atr ica tt RepE b |ir O SSOff HQ, Project Coordinalion office (PCO), Project Surpervision Centre[PSCJ f Proiect coordindion office (PCo) I Project superuisionocerrtr*er1[i!]rr_ of Co*so fa roject Supervision centre (PSC)only Itl, pS ,i ErrudE ry l, .bour6.rD.9, ,rl9.lr!or-nd!y dr. SS OIF,ESE g ltr CoItlaEdarr drr IrOC H 3 WHO/APOC, December 15, 2OO4 I iI I % ' -i'' I 't, +,. 'r-it.'.'x' -!: .I- " l( Indicate the partners involved in pruject implementation at aII levels (tVton, NGDOI -national, internationaD 1. At MoH level . SSOTF Secretariat . Five CDTI projects. o 33 county health departments. . 897 PHCC/PHCU. The staff in these facilities are mainly payam . .rr""risors 2. At community level g,42g affected communities are involved. 3. At NGDO level: a Chirstoffel Blinden Mission. The lead NGDO group 4. At external support level. WHO/APOC 5. Other level. NGO partners as at 2008 are very limited Describe overall working relationship among partners, clearly indicating specific areas of project actiuities where all partners' are involved (planning, superuision, advocacy, resounces mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). The overall working relationship among various partners is satisfactory hence the overall improvement in all activities such as advocacy, trainings and mectizan distribution. The stakeholders plan, mobilize, train and supervise CDTI activities as well as retrieve report. Before commencement of this year distribution, there was training of project coordinator at SSOTF secretariat in Rumbek organized by SSOTF, WHO/APOC and NGDO. The same activities were replicated at all levels. The partners jointly participated in conducting REMO mapping in all five projects and also assessment of household treatment coverage in two projects with APOC providing all the funds. Resource mobilization for projects in terms of meeting with the authorities of MOH by WHO/APOC and NGDO over soliciting for counterpart contribution was intensified.. State plans if any to solve any issues arising as regards CDTI implementation. The SSOTF has plans to solve any issues that may arise in the course of implementing CDTI activities as follows: a. The first step is to investigate the issues and determine the root cause such as finding out why some people refused treatment with ivermectin or reasons for absenteeism. b. The second step will be to identifr appropriate officers to deal with the issues. c. The third step is to empower such offi.cer through providing necessary means to the task. d. The fourth step is to report back after investigation. e. Finally, maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field I 4 WHO/APOC, December 15, 2OO4 L.2. Population and Health system Table 1: hojects and populatiqn at risk in the entire.country whether they are treated or not during the reporting period. (Please add more mws if and the office so that qirick timely intervention is applied on any issue pertaining to the CDTI implementation. NB-The line listing of villages project by project is still ongoing and this would provide information on the actual number of communities existing per project. Currently only two projects have a comprehensive village list. Source: From Oncho Project reports: ./ National census!- Other source, specify REMO Year of source: 2003 UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas withiu the project area, ultimately to be reached when the project has reached full gebgraphic coverage (normally the project should be expected to reach the UTG at the end of the 3.d year of the project). 5 I I Name of CDTI Project Total communities in meso/h;ryer' endemic zone Total population in meso/h5per' endemic zone Ultimate Tleatment Goal (UTG) East Bahr el Ghazal CDTI Proiect 25t3 927,285 778,919 West Equatoria CDTI Project 683 506,847 425,75r West BEG i 2,518 2,670,680 2,243,369 East Equatoria 532 602,302 505,934 Upper Nile 3 I 80, 482,155 405,010 TOTAL 9,429 5,189,269 4,358,992 WHO/APOC, December 15, 2004 SECTION 2: Summary of CDTI Implementation 2.L. Distributionperiod Chart the actual distibition )eriod for each CDTI Project in the country in the table below. : Overview of distribution undertaken ct (insert rows as needeil Briefly note any problemslissues (one paragraph). Three major problems that affected distribution in the projects are insecurities, flooding and delay in remitting fund. Insecurities hampered smooth distribution of mectizan in East Bahr el Ghazal (in Wulu and Yirol of lakes state, Tonj East and North of Warrap state), West Bahr el Ghazal (in Gogrial East and Gogrial West), East Equatoria (Maguri and Terekekd and West Equatoria (Mundri and Maridi counties). Flooding restiicted flight from landing in Akobo of Upper Nile resulting to misplacement of mectizan and thus eventual non distribution. Non release of projects' second installment within the reporting period is a factor. 2.2. Advocacy and Sensitization il State the number and tspe of policy / decision makers mobilized at the national and lower (state and district leveD during the'cunent yeari the reasons for the sensitization and outcome. At the national level, 5 key officials of ministry of Health of Government of Southern Sudan were mobilized and sensitized. Amongst them are the Undersecretary, three Director Generals of the Primary Health Care, the External assistance and coordination, and the Preventive Medicine. The Undersecretary and the DG for External assistance and coordination further mobilized the Minister of health through a letter sent by the Technical Advisor on absorption of CDTI staff and integration of all CDTI staff from SSOTF level to county level. 6 Distribution PeriodProject Name Jan Feb Mar Apr May Jun JuIy Aue Sep Oct Nov Dec East Bahr el Ghazal x x x x x x West Equatoria x x x X x East Equatoria X x x x X Upper Nile x x x X x West Bahr el Ghazal x x X x x WHOiAPQC, December 15, 2004 I I At the State level, four ministers of health of Lakes, West Equatoria, West Bahr el Ghazal and Northern Bahr el Ghazal states including their Director Generals and their Directors of primary health care were visited once or more regarding CDTI projects in their various states. The reason for undertaking the advocacy and mobilization exercise anchored on absorption and integration of CDTI staff into the health system of Southern Sudan in order to facilitate their getting government salary instead of over dependence only on APOC top r1p. It would be recalled that most of CDTI staff in Southern Sudan are not ministry of health staff. Provision of government counterpart funding to CDTI activities was addressed at the meeting and a copy of budget plan for 2009 for both SSOTF and CDTI projects were made available to them. The major outcome was the absorption of some CDTI staff in their states especially in West Bahr eI Ghazal and West Equatoria where the project coordinating officers (pCO) were absorbed. Additionally, 13 county supervisors were absorbed in four out of five projects. There was also assurance that more staff would be absorbed in 2009 as government budget and allocation to states improved. Earlier the whole Iist of CDTI staff was given blanket approval by the Council of Ministers while the frnal approval by the National Assemble was still being awaited. The government has understood that CDTI should no longer be regarded as a vertical project in the Ministry of health. b) State progress made towards internal resource mobilization. Within the reporting period, efforts were made towards getting the government to understand their roles rega[ding counterpart contribution to onchocerciasis control and there was a follow up to submitted budget plan but fund was not internally generated. c) Describe any policy-related constraints being faced by any particular pruject and describe what was done to assist the pruject (outcomd. Explain anyplans on how to improve advocacy. The major policy related constraint faced by all projects was the issue of CDTI staff absorption into the ministry of health system. Sending letters, emailing and physical visiting and following up to key government officials were the approaches adopted and this worked out in some projects suoh as West Equatoria and West Bahr el Ghazal projects where their- coordinating officers were absorbed. Lakes state has promised to absorb all CDTI staff in 2009. Also states where CDTI offices are not located don't understand the structure of CDTI and thus no least of support to onchocerciasis control. This is applicable to projects that cover more than one state like Upper Nile with two states, East Equatoria with two state3, East and West Bahr el Ghazal with three states each. SSOTF has proposed thht eadh state should have a focal person for effective CDTI implementation and this new category of staff are expected to liaise with the project coordinating offrcer. I 7 WHO/APOC, December 15, 2004 (' The new SSOTF leadership that would be in place in 2009 and the WHO/APOC Technical Advisor are to be utilized to stimulate and intensify the advocacy. AIso at the meeting betwegn the SSOTF and top functionaries in the Government of Southern Sudan such importa4t policy matters are to be presented and discussed. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. Note if any new fEC materials were developef, or reuised, the tspe of the material, the message and target audience, and where they were distributed. SSOTF coordination offiJe in {,umbek prod.uced a number of IEC materials for the Southern Sudan Oncho Oontrol Program in 2008. The materials were distributed to Project offi.ces for onward distribution to 33 CDTI counties for further distribution to health facilities and communities. The following were produced: . Manual for CHW's and PHC for the control of onchocerciasis with Mectizan* . Manual for CDTI provided by APOC through the technical advisor and distributed to five project coordinating offrcers. . Illustrated OV training flip charts (OV Onchc, in Sudan) . OV poster sets (3 posters per seti "What is O\I', "IIow do you get O\I', and "How to treat O\f'). Thesel posters are laminated in plastic for durability under field conditions. . Simplified CDTI instruction manuals for community didtributors. . On the spot training guide for health workers and CDDs o T' shirts for health workers and other partners with inscription'OV control in Southern Sudan' How were the IEC materials'developed? . Most of the IEC materials were developed during the time of Health Net International and! laterl reviewed ,rrd ,.p*oduced in 2008 by SSOTF coordination office and while one originated from freld situation and APOC manual. Are the materials reuiewed to address upcoming issues Qi*e decreasing refusals, sustainability, maintaining compliance to long'term treatment, SAEil? . Yes, they were reviewed with emphosis on mointoining complionce to long term treotment ond other upcoming issues such os sustoinobility, - Report if ony KAP surveys hove been done ond how lheil rcsults werc used? . There wos no KAP surver/ in ott the projects in 2008. Summorize informotion on : - The use of opptoptiote ond innovolive medio ond/ot other strolegies to disseminote informolion omong the prciecls; o Modern medio such os locol rodio stotions ore ovoiloble in most project oreos. For instonces, Eost Equotorio project mode use of Spirit ond Liberly FM rodio stotions in Yei ond Miroyo FM stotion bosed in Jubo, Eost Bohr el Ghozgl Orqiect uses FM rodio in Rumbek ond West Bohr el 1' 8 wHo/Apoc, December r5,zoo4 i I Ghozol relies on FtV ond rodio stotion in Wou. Upper Nile mokes use of Molokol FM while West Equotorio project hos no FM ond rodio stotion, ln oddition, Eost Equotorio ond Eost Bohr el Ghozol hove bosed project rodio, At community level, informotion is possed by word of mouth through troditionol systems of villoge chiefs, sub chiefs, ond heodmen. Church groups, women's groups, villoge heolth committees (if exists ond functionol) ore used to disseminote informotion, Mobilizption and health education of communitics including women and minorities The five projects corried out this octivity before mectizon distribution to creote oworeness obout the mectizon, its ovoilobility, ond selection of CDD. Community leoders were responsible in contocting ond orronging for the meeting with community members whicfr involved the porticipotion of men ond women including the blind people ond other minorities. Key messoges included couse of onchocerciosis, heolth/sociol/economic implicotions, symptoms, r,riho should not toke mectizon os well os the dosoges ond possible side effects ofter toking the drugs by individuols with heovy infection. Community members were encouroged not to be obsenting themselves during the distribution or refusing the drug outright, Also benefits of mectizon were oddressed during such mobilizotion. Re s p ons e of target c ommunitic s /villag e s There was high response of community members during the mectizan distribution as those who previously refused treatment turned up. Major accompli shm en ts i o More communities participated in the treatment with Ivermectin in 2008 than in 2007. . More persons came out for treatment with meciizan in 2008 than in 2007 . Community selected more CDDs than in any other year. o More women were involved as well as increase in female CDDs in 2008 than in 2007 . Weaknesses/Constraintsi i . Community support to CDD is still poor. . Community mentality oniCDTI ownership is quite low. . Health education posters are very limited given the number of communities that need them. . Inadequate number of health staff and CDDs to provide information to community members. . High rate of absenteeism due to involvement and occupation in grazing cattle by adult men and male teenagers resulting in missed mobilization and health education. Suggest ways to improve mobilization of the target communities among projects. o a 9 i t, WHO/APOC, December 15, 2004 . Availability and use of more posters during mobilization and also their placement in eaclr viIIEge and strategic places to attract community members is highly suggested. . Engaging more health workers by integrating them into the health systems is ideal. . There is need to recruit more CDDs and community supervisors in order to facilitate health education and mobilization activity in the communities. . Women groups, youth and religious groups should be involved in the campaign. . Health education messages should be intensified in all communities . More funds should be allocated for this activity. o Mounting of billboard in strategic positionb in each state urging people to take mectizan once a year for 25 years. o Regular radio programme on disease situation and on treatment with mectizan 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 meetings; i In geniral, how do you rate the"participation of minority groups andfemale members in community meetings, decision-making, (attendance, participation in the discussion etc.) other issues. In 2008, there was a general improvement in community participation as reflected in the total number of people treated across the five projects. This may have been attributed to more involvement and participation of female members. The number of villages with female members and also female CDDs had increased. The report shows that percentages of villages with female CDDs arc 2.8%o in Upper Nile, 21.8% in East Equatoria, Ll.lyo in West Bahr el Ghazal, 14.7o/o in West Equatoria and 5.1% in East Bahr eI Ghazal. Overall, female and youth attendance including minority is fairly commendable given the previous high dominance by men in participation in discussion in matters of CDTI. However, important decision making still lies with men. 2.5. Capacity building Training of national, district level staff in CDTI and general management skills(computer applications, project planning, etc.) Briefly describe any training dong by the SSOTF/NOTF for specific CDTI or Vector Control Proiects (Objectives;rparticipants, outcomes, any follow-up needed). A three - day training was ofganized by SSOTF for five project coordinating officers including some of their county supervisors in Rumbek. The objectives of the training were to improve the performance of participants on project management, to provide them with capacity to apply basic CDTI strategies, process and APOC philosophy, to acquaint them with partnership between the communities and the health services, and to maintain community information data base. There was an improvement in the understanding the basic CDTI strategies but there is still a long way in meastiring up with data management and report writing due mostly to their low level education and therefore a serious 10 WHO/APOC, December 15, 2004 need for regular follow up and closer coaching and a general training on TCC report writing for all PCOs. Table 3: Type of training undertaken at national level by the GTNO/NOTF (Tick the boxes where was caruied out the Brietly describe any techiTical assistance pruuided to the CDTI projects. The key technical matters on CDTI were provided to them. These are determining population/CDD ratio, maintaining community information data base, data calculation and analysis, monthly report writing, annual technical report writing, field supervision using checklist and accurate and complete filling of all field forms. Type of training projecdl staff MOH staff Opinion Leaders Others (specify) Program management How to conduct Health education ofManagement SAEs CSM SHM Data collection Data analysis Report writing Others (specify) i 1 ll WHO/APOC, December 15, 2004 I t 8 c.l ,ri Eo -o ooo t-.t U o 0. o B N $ *s sI e .ci € oq .\ta g o .s *l $h a) "l({E s.t' *r Es B(a \ * $ R H N $ .s $ Lqj "stjIa € \q s \ * .Lt B .s *l $ ta $ * -a € oq .itr) pt *E p a q)&{ \t o c)p p \o .s s s! 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Reasons for not achievins the above-stated fisures: o The quantity of drugs available to projects was calculated based on Annual Treatment Objective (ATO) instead of Ultimate Treatment Goal (UTG). o Heavy flooding stalled treatment in most projects especially West Bahr el Ghazal, East Bahr el Ghazal and Upper Nile. o Insecurities marred distribution in West Equatoria due to Ugandan Lord Resistance Rebels mostly in Maridi and Mundri counties, East Bahr el Ghazal due to fight between cattle owners and community members and West Bahr el Ghazal due to communal clashes between community members and militiamen. o Inadequate available knowledgeable manpower especially CDDs in Raja and Aweil West counties in West Bahr el Ghazal. Plans to remedv this: . Increasing the quantity of mectizan allocated to projects based on UTG. ' Improving and strengthening community participation through mobilization and health education as well as motivation of CDDs. . Increasing capacity building of new staff and CDDs. . Conducting distribution of mectizan in dry season r Improving logistics to projects at county and payam levels. 2.7.2 a I ! a In general, what are the causes of absenteeism and refusals and how is the The absenteeism is traceable to cattle migrants who follow their cattle and had to stay in the cattle camps during the period of distribution. People traveled outside theirpommunities in search of job during the period of distribution. New returnees have 1oo, t np*ledge of mectizan distribution and it benefits and thus refused. Due to side effects of the drugs. 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. o There was no report of any SAEs in the entire project during the period. 2.7.4. In case the country has hqd no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x t7 WHO/APOC, December 15, 2004 Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period Please add more rows nece, * SAEs should be verified by project coordinator Sequelea is defined as those cases thal have not recovered fully from the SAE and are lefi with lasting neurological or other d.ebilitating efficts. Name of project Number of verifiedx SAE cases reported Action taken Number of cases with sequelea Number of deaths 18 WHO/APOC, December 15, 2004 .+ooN ,.i E(,) -o oo C) o Q tu :\L' B o\ d -oqq o(,) o C! (! C) d q(!I o C) 'd ra C) tr (.) b0 O o0 d C) c) C) F d (.) Hox(.) o a rrl& C) I € C) € 0) .od (! o C,)Ho , (g ! o o. kbo o c) o B a s B a !l\i 8 B B B\ a) .s a I a) Ssi B E4 B o a e) \3\\q) Si P q) .s q) la Bq) U 6i o)li G Io L q)L o o Ho tr(! o >t LI(dlrl trl ol dl olJ -ol o oo(!lr 0) o (! ar) o C)LF #r ol -olc€lFI tr 6l OJ c)LL I o 9() o'L F ) U'tr c)9 ,a I '3 $t = o\l -€16 lRto. ''{ utl 9ct. 9b .E9- a=d5CE C)tr 9b !)Yf,il L!= :EO9ts -ooF.EEii(g(rrP o5 cEFtrE d9 a dE f- i-oiu I >=!'.rl tT -F *i o o $ooF 6E\d >v o s $ s@ rn s$\o sN\o s e{r- sr-@ s$\o s o\ s$r- s o\ 00 q ca o\ ol c.) o\ +$\oH *r 6H * () '5 c) =ooC) cUaO- Li ro E 9eooto s c\I s o\ ot s\n N s\nN s o\N s rr) c.l sO c.t s n o\ s oo s\oN oq rnN G(9 (H Q -- c6.g EBE = o.!z €H *i N o\q. s oo ca\oq e.l N\n Or- r- r- \or- \o oo oi$N \o\o \o" r- cav \n\nq \o oo ca r- c.I r-N ca \o o\ot \o \n r-("I \o ca o\ (n olq N C{q @ ol o_ o\ol o- ot ts o.rE 6.25tr.ln < 9€'FU FH \r) @ oo^ @ c\i \n oo oo- oo N @ oo\o ol @o\n +@N @ vI $$ ca O@ N TN Oo \o \or- ,rtN € \or-q TN 6l@ .+ N\o \n r-\o o\ @N ,rI !{s(O FJ!\ c{ o (€ =) o.,lo Or qi U)A ,' cg .\ q - i\ lfc6Ei o ?<-lo (!-q<'=fi=-OE' d. 3e a. -6 \ol+lH o\n \n Fl$ \n rn $ O l.n r- €\o rn oo r- \n oo\o oo OO ca\n c\I \n ooN N ca\o" \or-q eo N ca\o" \or-q cl^) N ca c"l \n C\I\o" ca cr)$cl c.)\n oo" \n O.\o(\t- o\@ d t&N hl *i 0) o $ooF 6B\< B-o z z z z z N\o\n s\o s$r- s9r-\o sN c.i oo o\q N ca 00 oi@ frl * rt Eo)obo cB- (!a FoX bsag - a-oo z z z z z sr-N s ca s s -.: s\o + c..l \o\? r-N @ c\o <*OO'r5 a E E $Ea!r-d- E EE gU JH-->oaH(J z z z z z N\o r- \n @$ Nrr\n \n ce ca l.n\o o\ \ot\lo- \o E q.lE6Z5trH ==c)tsa N * z z z z z N N rn\n\o \n$ oo caN\o^ +N \o ol(r)- t\ -ra o.) oo s Bo .E E , otr {l-.-.i:iA € U 'tv ,= (r) O_.=+ 5 9no 5E HrE E _q€ * g I E E FE T E --tv\ ()catr o@ a NC\I(\.l caN oo ca(\] o\ €ol N o\ oool C\ r- c-\s 00 \n $N n\n co r- \o(\tt- o\ & sl r- o\ o\ @ o\ o\ o\ Or o\ N N c\I o c.l coO N voOOI (n ON \o C\I r- N oo ol t I $ o o] ,ri Eo -o ooo o() H It B (\l 2.8, Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) 9:S ision undertaken thE TA/SSOTF add more rows neces, Project Name Supervisor Date ofObjective supervision Outcome/follow-up needed East Bahr el Ghazal Lazarus Nweke 17 June, 2008 To assess the training of payam supervisors in Rumbek East county and also the existing health facilities. Payam supervisors were properly trained and mectizan distributed to them and the list of health facilities validated. There is need to follow up to ensure that all communities select their CDDs and that CDDs are trained. East Bahr el Ghazal Lazarus Nweke 23 Sept 2008 To assess mectizan distribution in Wulu county The distribution was going on well except in Kuel Kwac village where no distributor was on ground. Community members were quickly mobilized and told to select CDDs for training on an agreed date. A follow up was done and 3 CDDs and 4 community supervisors were trained and drug issued to them to commence distribution. 2L WHO/APOC, December 15, 2OO4 East Bahr el Ghazal Lazarus Nweke 2t 28 October 2008 To validate and collect village Iisting, monitor distribution and retrieve treatment and training data List of villages was collected from county supervisor. CDDs in Abiriu and Maloupec villages were seen but their records were full of irregularities. Treatment and training reports were collected from County supervisor. Need a follow up due to insecurity situation in Tonj and flooding in Doung village at the time. West Ghazal Bahr el Lazarus Nweke 10- 10 July 2008 To assess the quality of training of the remaining county supervisols and to determine the extent of mectizan distribution ip Wau,Twic and Gogrial where distribution had begun. The participants were trained and they understood the importance of community census, use of checklist during supervision, need for proper CDD training and use of all relevant forms. Also it was found that distribution was going on well and that some villages have completed distribution. More follow up is needed especially in areas where distribution started late. West Ghazal Bahr el Ali Ngor Sept 2008 To ascertain the distributors' extent and quality of distribution Distribution was going on but complaints of inadequate mectizan in many places visited. 22 WHO/APOC, December 15, 2004 West Ghazal Bahr el Lazarus Nweke 29 3t October 2008 To collect village listing, monitor distribution and retrieve treatment and training data List of villages as well as treatment/training data was collected from county supervisors of Twic, Gogrial East and Gogrial West. Need a follow up due to severe flooding that prevented reaching some planned villages. West Ghazal Bahr el Lazarus Nweke 25Nov-2 Dec 2008 To complete REMO/RAPLOA exercise across l5 villages in three states of West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap. REMO/RAPLOA conducted and result collected. Need for a follow up to get the remaining result from Aweil East County. Eat Equatoria Lazarus Nweke L6 t7 Nov 2008 To faci litat e, or ganize and arrange REMO/RAPLOA exercise in East Equatoria and West Equatoria projects. Training took place and participants moved to the field for the exercise. Need for a follow up in villages where the exercise has not been completed. 2.8.1. o a o a o o O What were the main issues id,entifud during supervision? Insecurity and flooding and thus delayed / non distribution in some places. Poor communications within counties and distances are very far apart from one village to another. Some communities were without CDDs and therefore not receiving treatment. Inadequate number of CDDs hence long time in completing distribution. Wrong figures and irregularities in treatment data in most records and registers. Poor filing system and irregular records were noticed in some places. Community treatment registers not available in all villages rather 3-6 Bomas share one register thereby delaying treatment, difficulty in filling community summary form and thus late reporting back. 23 WHOiAPOC, December 15, 2004 2.8.2. Was a standard supervision checklist used? o Yes. 2.8.3. What were the outcomes at each level of CDTI implementation supervised? o The concerned individuals were coached on what to do. . Improved performance noticed during follow up visits. o Community not willing to provide registers. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? o Yes, on the spot discussions were done and the findings were.. shared with them through email and phone. 2.g. Community self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if Descrtbe how the results of the compunily self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Not appropriate 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 projects comply with long-term mass treatment with ivermectin? (For projects 4 and above years old) t Project Name Total # of LGAs or districts in the entire project &ro& . No. and 7o of LGAs or districts that carried out self monitoring (csM) No. and 7o of LGAs or districts that conducted stakeholders meeting (SHM) East Bahr el Ghazal 5 0 0 0 0West Equatoria East Equatoria 5 7 0 0 6 0 0U Nile West Bahr el Ghazal l0 0 0 TOTAL 33 0 0 24 WHO/APOC, December 15, 2004 Ob.iective Specific Activities Pro.iect targeted 1. Promote Integration of CDTI with other health care services Meeting wit(r policy/decision makers on absorption of CDTI staff into health system East Bahr el Ghazal and West Equatoria 2. Maintain high therapeutic (>657o) and geographic (1007o) coverage Increase in the number of CDDs and community mobilization and health education East Bahr el Ghazal and West Equatoria 3. Promote strong community ownership Involvement of more Community members especially women groups. East Bahr el Ghazal and West Equatoria 4. Promote high government commitment Aggressive Advocacy to key government policy/decision makers. Meetings with government officials with a prepared work plan. East Bahr el Ghazal and West Equatoria 5. Support partnership strong Addressing the issue ofpartnership between enderyic communities and healtfl system and their roles in CDTI East Bahr el Ghazal and West Equatoria 6. Put in place a strong IEC strategy that encourages continued treatment Not yet done extensively due to limited resources. East Bahr el Ghazal and West Equatoria Other 11: Activities that ance to -term treatment with ivermectin SECTION 3: Other activities of the SSOTF 3.1 Describe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). SSOTF with APOC support conducted REMO and RAPLOA exercise in all the five project areas. A total of 126 villages were targeted during the exercise. Results of 8l villages have been received by SSOTF. Most of the remaining villages are in Upper Nile. There is plan to conclude the exercise in 2009. Also, an assessment of treatment coverage was conducted by two-man APOC consultants assisted by SSOTF in the two projects of East Bahr el Ghazal and West Equatoria between September and October 2008. Their findings as at the time of the assessment for year 2008 shows th4t East Bahr el Ghazal and West Equatoria have average therapeutic coverage of 37 .77o and 58.6%o respectively. 3.2 What was done to coordinate CDTI Project activities? These were mainly through joint budget development plan, holding planning meetings before distribution, exchanging information as appropriate, requiring projects to submit monthly reports to SSOTF of their monthly activities under the guidance of technical advisor. Also SSOTF shares with other partners CDTI activities during meetings or conferences. 25 WHO/APOC, December 15, 2OO4 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up needed) There was no formal meeting convened for SSOTF in 2008. It was only one -on- one meeting to discuss issues confronting CDTI in Southerh Sudan especially the absorption of CDTI staff into health system and also including onchocerciasis control in the health budget. APOC Mission in February 2008 convened for SSOTF was on the issue of deploying a technical advisor to assist SSOTF1 and CDTI projects. Present at the meeting includes Dr Baba, Fasil, Dr Noma and LazaruslefOC team). ihe outcome was the eventual deployment of the technical advisor in May 2008 and he has been performing well since his arrival. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. A number of meetings were attended by SSOTF officials within the period under revlew Other sector: These include NTD stakeholders meeting convened by Malaria consortium and MOH - GOSS in Juba on 8-9 May 2008., CDTI was identified as a structure to be used in NTD control in Southern Sudan. At that meeting, there was a presentation on update of onchocerciasis control in Southern Sudan by SSOTF. Also in April 2008 and September 2008 at the eye care meeting in Juba, onchocerciasis control was among the papers presented and oq this occasion the NGDO partner represented SSOTF. A meeting of NTD technical committee members took place in Juba in August 2008 and SSOTF was represented. This meeting confirmed the piloting of integrated I!D,$ (mectizan + albendazole) in three counties of West Equatoria (Ezo, Tambura an{ Yambio) using CDTI structure. Other country: SSOTFA{OH- GOSS was represented at the 14th JAF meeting that took place in Uganda in December 2008 by the Director General of Preventive Medicine. Other projects: The Technical advisor and the NGDO coordinator participated in meetings in East Bahr el Ghazal project including West Bahr el Ghazal project. The project coordinating officers were provided with APOC manual and various issues on community data collection, improving on both therapeutic and geographic coverage were explained. Other project officers came to Rumbek for similar technical inputs. 3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, fi4ancial), - Reports forwarded to APOC managemen4 - Administrative assistance_or trouble shooting for projects. The financial reports were submitted to APOC management in 2008. SSOTF and technical advisor assisted the various piojectsrin preparing and forwarding 2008 TCC reports to APOC. The Technical advisor's SSOTF moqthly reports were submitted to APOC and partners. 26 WHO/APOC, December 15, 2OO4 3.6 activities Project Name - SSOTF YEAR (4), 2008 MAIN ACTIVITIES *SSOTF coordination offi ce Insert the Plan of Action for the NOTF activities for the current year indicating which were Dec ;f )t rl. ect *Stakeholders Procuremerit6f *ov les *Pa *SSOTF coordination office T :NING *- - - TF coordination office * Trainin ofCDDs x Train of * Train of leaders * ofhealth staff/ * KAP studies in new areas *Review of IEC materials HEALTH * Comm * School health x Churches Census Census _ur +l for SAEs uests^-'tzan *lvermectin Distribution *Distribution of minor side effect Introduction of )t( Health * NGO * Traini of CDDs and others * Local Health s *CSIWSHM in treatment. nt SAEs/lvlinor side effect *SSOTF coordination office *PCOs/RTF x X X x x Nov Decr JuneJan Feb Mar Jul Oct x x x x x x x x x x I x x x x x x x x x x x x x x x x x x x x x x x x x X x x x x x x x x x x X x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x X x x x x x x x x x x x x x x '-:r:':i x x x x x x * Payam supervisors 27 WHO/APOC, December 15, 2OO4 Etr' :..:. -,i.i*i.al;.: Sep l{ft Novffi i.Til'r.' i .i- hJ rs- ii€{ t*I"r.l E"'-:ffi t; ffi t$'*lld' ' .H'i*'. wF*lli+.'::\ '!^l^Uv:' ffiff daid$tls@ ffiiM# -l ffi :i':';;$*: ffi,wlwk ffiT #"9 nffiiffi [,ffi t"- a,sllEIt.f,i,t{X w,,$ fuI,,.ffi *l!!ry- $;ffnr ffi-l'fi.: - .l .' trir*t.l:!tDs' 5i{tr - , ;I[:d k{i!',il'l 8"ffi '{ xr1{'iG'. :ffii' ffi ffiffi ffi i;,+'-..i:.d ffi i:F,{1 ffi 1- lrtrL-i&a I.F.TB-ii,:.rit r:i-{mf;ElEt ,'; ii:'i r'. j,i\l Ftsi."iffi'! [;: ,],.li-'.t l'f i3{ ii'.*i,,i Pf,.tl,H$r\.. I '-B,Tl+zr t-,;li x x xt x x x x * *Datg collection *SSOTF coordination office *PCOs SOTS * CDDs *PCOs isors * CDDs Monthly *SSOTF coordination oflice PCOs / RTF Preparatlon *SSOTF coordination oflice PCO / RTF *Anolication I )TF / PCOs *SSOTF/PCOs/RTF x x f,ffiflr *t#;' 'ffiI.5j $rl*4 'fr;, x x x x x x x x x x x x x x x x x x x x x x X X #h;i t. f*ffi$ x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x t{|tr.|!.' : .":ri L, . 1 i+;'. ffi:1 i:ff*+*i x {tffi ffiH ffi 'l:4fitiI ffi ffi xffi ffi ffi ffi ffiEffitffig;, ffi ffi x x ffi-r{ 28 WHO/APOC, December 15, 2004 sffif3r.."ij Project Name SSOTF HQ Years Year Four (200e) MAIN ACTIVITIES Qr Q2 Q3 Q4 *Planning/Review meetings XSSOTF x *Regional x *County x x * S takeholders meetings/community x x x x Procurement of materials * OV supplies x x *Advocacy *Regional x x *County X x xPayams X x TRAINING x Training of CDDs X x * Training of supervisors x x * Training of community leaders x x * Training of health staff/ x x Management / SAEs x x ASSESSMENTS * KAP studies in new areas x *Reviewof IEC materials x TIEALTH EDUCATION SESSIONS * Community awareness/targets x X x X * School heatlh education/targets x X x x * Churches x X x x Census Census Update x x x Drug Delivery/Supplies Mectizan requests x xDrugs for SAEs x x Setting up of referral systems *Strengthen up referral systems b/w communities, PHCUs, PHCCs and hospitals for SAEs x x IVERMECTIN DISTRIBUTION xlvermectin Distribution x x xManagement of SAEs x x Introduction of CSIW SHMs *SSOTF partners X X +County Health Departments x X t NGO partnership x x * Training of CDDs and others X X * Local Health systems x x *CSN,I/SHM in community x X Mop up treatment. Mop up treatment. x x 3.7 Insert the Plan of Action for next 29 WHO/APOC, December 15, 2OO4 of SAEs x x *Supervision of CDDs, P. supervisors and County Supervisors) SSOTF x x x x x x x xPCOs/RTF x Payam supervisors x x X x *Data collection X x x x X SSOTF x x x x x x x x*PCOs x Payam supervisors x x x x * CDDs x X X x tReporting/ drug management * SSOTF X x x x +PCOs X X x x x X x x* Payam supervisors * CDDs x x x x Monthly financial reporting expenditure x x x x SSOTF x x x x PCOs / RTF x x X x x xPreparation of mid term/ annual technical report x xSSOTF PCO / RTF x x *Application for Mectizan x *SSOTF / PCOs X INDEPENDENT MONITORING X x x xxSSOTF/PCOs/RTF *Mid term review X SSOTF / RTF x *Evaluation * SSOTF / RTF 30 WHO/APOC, December 15, 2004 x N ,ri o -o (.) oo o U 0. o ,l B ca U \) \i \) A -a\ B $b 'I \l\JU BA Va\!o "su(.) \.- {8 'lt 'S 6\xs .TN s.{ .s!'l< s\ UL "stSs St\xBSSB 4U eFr Stootrq.,9 $F ooE() bo 4 tt tr oO. 0)Lr L o)! d J H Cgq) >t 0)4 9 Hol* .A9oq) 'd liA F aU (€ o9 C,)tr 0) ! li cd A. (c AIE3:L.Y6'= ) --oH9'E7-9FTFArHOxooVu2=oEi; €.-d ta= €tlva-IOAq=Ats!=t(J rz-E cgH]EEAEC,)V2-HITNI3-luslFI .i €lA+FI anti C) o o .i U) a o O oEu6 ()FOE l<o ! A 8ai; (n ZJ rn oi\o \n \n oi o\$r- oo \nN N o\$ oi OI \n\o\o € o\ tr-\o m Eo cn q) q) L & (r) q) tr o q) o L Q n ct') (! o (H o >.lr (n Ea N o\rnN o Nv \o\o TNO \o o\N \o Or\o" $\n O\o a ol.nq o\ (_) q) 'a L O.(t o ed z dN(€ o o l-< (! m U)(g IJ] (! Lo (€ d r! cn C) B (c 'tr o Cd H ch E] o z Lo Ora N cd o o ! (n ta t)q) 6 I! t-r o C,) cr) 6l Er If there are problems with release of counterpart funds, how were they addressed? Comments: o Government of Southern Sudan is only addressing few staff salary in the budget and no fund is budgeted for any programme activities including CDTI projects. State the number of projects that had nofundingfrom APOC Trust Fund? o None. All the five CDTI projects plus the Head{uarter project received funding from APOC. State the number of projects that had no funding from any dutside source? o None. All have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? o All 4.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) o Provision of venues/shelt6rs for community leaders meetings and CDDs training. o Some communities do thd mobilization and sensitization of their own people. o Communities collect firewood, water and also cook for CDDs during the training. o Some communities store drugs and provide good security awaiting mass treatment. 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. o Submission of work plan to the Ministry of Health, which includes salaries to the project offices and headquarter and other support of'CDTI activities. The outcome was negative as there was no release by the government. 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency ; Table 13: Indicate how muchjthe NQTF secretariat project spent for each activity listed below the Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry to jects, districts, etc Monitoring and supervision of CDTI Projects 0 0 0 0 0 0 999.00 9966 0 Training of Project officers, iIOT, NOTF staff etc Advocacy visits to health and political authorities at national level IEC KAP studies, materials 0 0 0 0 0 2139 0 0 0 0 32 WHO/APOC, 24 November 2003 development, Annual review workshops 00 0 0 Bi annual NOTF meetings/conferences Fuel and maintenance of Vehicles, 1,870.00 0 5704 0 0 0 0 0 Maintenance of office equipment 0 0 0 0 Stationery Others/Salary by MOH-GOSS 10,331.45 0 856 0 1,800.00 18,600 0 0 TOTAL 13,5 I 1.00 18,600 1866s 0 Total number of persons treated 2,029,929 Comments None JJ WHO/APOC, December 15, 2OO4 4.5. Equipment Table 14 Status of equipment of NOTF Secretariat Project (Please add more rows if necessary) [. Printers 5.Fax Machines *Condition of the off). equipment I I I (Funciional, Currently nen'-functional but repairable, Written How does the project intend to maintain and replace existing equipment and other materials? This will come from government counterpart funds which is hoped would be available in very near future as the system is stabilized. - Describe the adequacy of availnble knowledgeable manpower at all levels. 1) The SSOTF headquarter office: Apart from National coordinator, Deputy National coordinator, and administration and finance officer (with.secondary school certificate) and one driver, other staff such as Data Manager, Secretary, logistician etc are lacking. 2.) The CDTI project offices: There is general shortage of mlanpower in the project coordination offices. Only PCOs are involved in technical matters as they have no assistants at state project level. Most project coordinating officers are not yet good in producing good annual technical reports due to their low educational level. This is considered a serious matter for good CDTI management at project level. East Equatoria project coordinating officer has the least ability to produce readable report though he is striVing but highly limited. 3.) Project supervision centers: Mpst of the CDTI project County supervisors (COS) have worked as CDDs in the past and herice promoted to supervisors. However, they don't have a basic education background and therefore, a lot of coaching is required and the number per county should be at least 3 persons for good supervision. 4) Community level: At the end of 2008, the population / CDD ratio is 810 persons per CDD. This is an improvement when compared to 2007 although the figure is still high compared to APOC standard of 100 persons per CDD. Source Type of equipment APO C MOH DISTRICT I LGA NGDO Other s Condition of the equipment * Please state Function al Currently Non Functional but repairable Written off l. Vehicle 0l 0 0 0 0 0t 0 0 2. Motor cycle 0 0 0 0l 0 01 0 0 3. Computers 01 01 0 0 0 02 0 0 02 0l 0 0 0 03 0 0 0 0 0 0 0 0 0 0 6. Others a) Photocopier 0l 0 0 0 0 01 01 0 b) Cash safe 01 0 0 0 0 0 0 0 c)Lap top 01 0 0 0l 0 02 0 0 34 WHO/APOC, December 15, 2004 - Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure a.dequate CDTI implementation where not enough knowledgeable manpower was available or staff ofien transfeted during the course of the catnpaign). This is not the situation in Southern Sudan at the moment because staff transfer does not occur. However, in cases where a gap has resulted as a result of sudden staff movement, members from the nearest CDTI are asked to cover. I 35 WHO/APOC, December 15, 2OO4 c.) o c..l E c) -o 0) o z t(.l Q 0* > \o ca o l* o !o Lo (ll Ho(t o C) (n tr{F o V) V) = ooO N (/) oo 'a lia B o o OHod(ag(!-}Hc ol H ho e\ > (')Oa-:ttroo-c cg -o9."ebO (! l- v.d €liCr-(): frr6ra ./) \(!9 o <5 €\.\q) e) r.Sra Q. Et' ES$Q.SS Fs:Y q) TS s0 $-g\.\\r%3SE :'S q) BISSaSss s *S*S tTTb$ $!S q)Q)Ybo\oh t{< q v p t \)q \) a. 0)Jz(s li C) o (€ o (! o C) B(lr o Bo Lo o 6. Lq) 00 tr ()L q) o0 L Eq) L!trtr Ug -.ootr CE r- = .0) cl 2>h0) |e o! cEg a0-trg !! '= c) E.E >rHLV 6tsaa. 9q) .-(l) cl=Fre -9 c-r =>0)= iio .-O >.HE rr'l cEa cnOFZ , ra (n B() q) L L e) {a o 6! a0 L L o q) q) H -F{ ii o q-r Gl >. !!9i> .rl O) c! .= SE00 u)- .rJ O o;i 6E =cEir Or!E->E rd€ ,fi6z*AE\1 tr -(tErUfrl ...A.n 6I?n\ vi ti vi o .- Cr) . Hh E(!E o6& h -o bo .,1 cU Or. s 5bE EZ ,y \n >\ cdb3 -= -q6E U 'E(!tr c! Eu :.ir(gfi7E Lo €d6ry tr!r-o!?dQ.= a)Otr>r! o- dF=il tr$ co =EE 5iitr:;*i'E JaEAEE<i=>0)AchA>\ ! o . )r-RbEx; -gE E E:g FE; HE 9 -> 4..= tr (.) E cd z o c) 'a lrA 5,2. Sustainability of projects: plan and set targets (mandatory at Yr 3) o There was no plan yet even though all the five projects have reached three years. This is because of the situation in Southern Sudan. What arrangements have been made to sustain CDTI afier APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. 5.2.2. Funds 5.2.3. Transport and equipment (replacement and maintenance) 5.2.4. Human resources 5.2.5. Which projects have submitted sustainability plan? 5.2.6. To what extent have the plans been implemented? 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms Ivermectin delivery system is separate from other drugs in the PHC system as a result of non integration. The Ministry of Health of Government of Southern Sudan is yet to have an integrated drug delivery system involving all drugs. There is a plan in a feasible future of overhauling the PHC drug delivery system probably in 2009. 5.3.2. Training There was no integrated training yet with other prograrnmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff are not ministry of health staff and the CDTI has not been taken fully over by all state ministries of health. There is a sign that integrated training of programmes such guinea worrn eradication and onchocerciasis control and other NTDs would be a reality in2009. 5.3.3. Joint supervision and moniloring with other programs There was no joint supervision and monitoring with other programmes yet. There is a very high prolability of NTD integrated supervision and monitoring for cost effectiveness. Already, UNICEF and WHO and Ministry of Health are trying to bring this through the mass measles and polio campaign. 5.3.4. Release offunds There are no funds available or released to any programmes but with stabilization of health system, there is chances that common budget and release would be possible in Southern Sudan over time especially through joint NTDs fund release. \ a a a o 37 WHO/APOC, December 15, 2004 5.3.5. Is CDTI included in the PHC budget? \.| Yes, CDTI is included iq the PHC budget. 5.3.6. Describe other health programrnes that are using the CDTI structure and how this was achieved. What have been the achicvements? No other health programmes in the Ministry of Health are using the CDTI structure. However, it is being considered for the implementation of Integrated Essential Child Health Care (IMCI), and distribution of impregnated nets as well as other neglected tropical diseases control. a a 5.3.7, Describe other issues considered in the integration of CDTI o The CDTI strategy could be used in management and control of lymphatic filariasis through albendazole drug distribution alongside ivermectin. 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) i , o No integration yet but there is plan to pilot integrated Multi Drug Administration in three counties of West Equatoria with the integrated NTD control programme for the control of lymphatic filariasis using albendazole. 5.4 Operational research o No operational research carried out 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. o Not applicable 5.4.2. How were the results applied in the project? o Not applicable 5.4.3 Note the issues that have been identified by the NOTF for future operational research. , it KAPs in the new CDTI afeas o There is no identified new CDTI areas yet hence no KAP studies. 38 WHO/APOC, December 15, 2OO4 SECTION 6: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. Strensths - o Presence WHO/APOC technical advisor to SSOTF and projects. o Sheer determination of available staff to get work done o Improvement in communication network in Southern Sudan o Support of CBM to SSOTF facilitates drug procurement and delivery o WHO/APOC office in Nairobi hastens fund disbursement to SSOTF and projects. Weakness o Available manpower is not well knowledgeable and inadequate. o Nonpayment of salary of most CDTI staff by the government. o Census update not completed in virtually all CDTI projects. o Line listing of villages has not been completed in three projects. o Non availability of registers in most communities o Poor state of roads with resultant high wear and tear of the vehicle. o Frequent insecurity in project locations disrupts treatment and thereby leads to low coverage. o Distribution during rainy'season renders many areas inaccessible o Frequent break down of motorbikes and project vehicles due to poor maintenance. o Irregular and delay in fund release imparts on field activities Challenges and how they were addressed. o a Some CDTI project staff lack capacity to man project. Those affected mostly were encouraged to engage in private studies to improve their knowledge and power of writing. Inadequate staffing and knowledgeable manpower in the project area. There is deficient staff strength across all levels and SSOTF has planned to radically address this in 2009. Non availability of CDDs in some communities. This matter was discussed at a meeting with community members as discovered during SSOTF supervision and new people were later recruited and trained. Non integration of all projects and non absorption of some CDTI staff into the ministry of health. Effort has been towards this through meetings with and letters to government top policy/decision makers in Government of Southern Sudan : Intensifying health education and community mobilization. This was used to defuse beliefs on the mectizan and those who previously refused now accepted treatments. a 39 WHO/APOC, December 15, 2OO4 C rI Problem of maintenance of community information data base. The SSOTF has planned to print centrally the community summary .forms to reach all communities as well as making available treatment registers to all villages. Population/CDD ratio in the entire country is still high. Although this has been reduced but communities without CDDs are being encouraged to get CDDs and those with less number of CDDs to get more CDDs. Community census registration is a still a proNem in all the projects. SSOTF noted the difficulty but epcouraged projects to conduct this activity. Internally Displaced persons who are returning affected the activity as projects had to go back several times. tl High cost of Transport system in the whole South Sudan. The road condition is still very poor with consequence huge cost of vehicular maintenance due to frequent break down. Problem of handling missed treatment by cattle owners. SSOTF has planned to use cattle camp as a treatment centre in order to deal with the issue of missed treatment.. Indicate how opportunities can be utilized to improve CDTI. The continued peace and stability in southern Sudan has offered platform for community penetration and further improvement in both geographic and therapeutic coverage. NTDs control offers an opportunity for utilization of CDTI structure and thus leading to popularity and prosperity of mectizan distribution .\, List the strengths, weaknesses, opportunitics and threats of the vector elimination proj e ct (where qpplicable ). This is not applicable since there was no vector elimination component in Southern Sudan. o O a a a a o o fi 40 WHO/APOC, December 15, 2004 Acronyms { i, WHO/APOC, December 15, 2004I ll