Western Equatoria CDTI annual technical report to Technical Consultative Committee(TCC) : January to December 2011

II I I I I I I I WEST EQUATORTA (WEQ) CDTI PROJECT whoweqproi ect@,gmail.com L..-.,-. I I I --.t t ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) RECU tE 3 1 iUtL, 20t2 I ( I I Republic of South SudanCOUNTRY/I.{OTF: Proiect Name: Western Equatoria CDTI PROJECT Approval vearz 2003 Launching year: Dec 2004 Reportins Period: From: January 20ll...To: ...December 201 1...... (Month/Year) ( Month/Year) APOCfundinsvear: (circleone) | 2 3 4 5 6 (7) 8 9 APOCProiectimplementationvearreport: (circleone) I 2 3 4 5 6 (7\ 8 9 l0 1l 12 13 l0 ll t2 13 Date submitted: 3l'h July 2ol2 Ministry of Health African Programme for Onchocerciasis Control (APOC) Mectizan Donation Program (MDP) Christoffel Blinden Mission 904 communities Partners: For Act|on rcc ?ED tu Ib zr Itr.r :t\l I 1 i./-l,{ i I !i' .,,* For To: Apoc/DtR I ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICE,RS to sign the report: Country: Republic of South Sudan fr National Coordinator: I)r Lucia William Kur Signature [)arc: . .]q.h J July 12012 7nnal Oncho Coordinator: David Jacob tlido Signaturc: .. [)ate : . ).59.11u ly 120 t2 NGDO Representative: John tJjwok Signature &* r'{tr Dare:.?.lTr.lu lyt2otl 'l'his report was prepared by: I)avid Jacob Bido Designation : Projcct Coordinating Of'fi ccr Signature: Date:..l*llr lyl2o12 g-.rN- S,'.tA.o.^^ ,.J .f,^ t 8....... L\rl "",,\ Table of contents ACRONYMS V DEFINITIONS. VI FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY 2 SECTION l: BACKGROUND INFORMATION........ .....................3 1.1. GeNeRnr- rNFoRMATroN............. 1 .1.1 Description of rhe project (brieJly) 1.1.2. Partnership 1.2. PopulerroN 2.2. Aovocecy .10 2.3. MostI-tzarloN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMultrrps l0 2.4. COVvtt-WtrY INVOLVEMENT........ ......12 2.5. Cepecrry BUTLDTNG ....... 13 2.6. TRearprpNTS.............. ..... 15 2.6.1. Treatmentfigures.......... ........... 15 2.6.2 What are the causes of absenteeism?.......... .. .................. 18 2.6.3 What are the reasons for refusals?................. .................. ,/8 2.6.4 BrieJly describe all known andverified serious adverse events (SAEs) that ....... l8 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year20 2.1. ORoentNc, sroRAGE AND DELTvERv oF TvERMECTTN ...........21 2.8. CoNaNaLrNrtry sELF-MoNIToRTNG AND STAKEHoLDERS MpprrNc ............22 2.9. SupenvrsroN............... ......................23 2.9.1. Provide aflow chart of supervision hierarchy. ............ 23 2.9.2. What were the main issues identified during supervision? ................. ............ 23 2.9.3. Was a supervision checklist used? ............. 24 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 24 2.9.5. Was feedback given to the person or groups supervised?................ .. .. . 242.9.6. How was the feedback used to improve the overall performance of the project? 24 SECTION 3: SUPPORT TO CDTI...... J aJ 4 6 24 24 25 29 29 29 3.1 3.2 3.3 3.4 EeurpveNr FnaNctal coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES............ OrgeR FoRMS oF coMMlrNrry suppoRT ............... ExppNottuRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI........... 4.1. INTERNnI-; INDEIENDENT pARTICIpAToRy MoNrroRrNG; EveuuetroN............... .....29 4.1.1 Has the project ever been evaluated/monitored? (fick any of the following which are applicable) ........... 4.1.2. Whatwere the recommendations? .............29 4.1.3. How have they been implemented?.............. ...............29 111 4.2. SusrerNaerI-rry oF eRoJECTS: ILAN AND sET TARGETs (ueNonroRy AT...... ..........29 Yn 3)...... 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels... Funds....... Transport (replocement and maintenance) Other resources.. To what extent has the plan been implemented 4.3. INrecnerroN ....29 .... 29 .... 29 .... 29 ....30 .... 30 ....30 4.3.1. Ivermectin delivery mechanism,s............... ................... 30 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs.... 4.3.4. Release offunds for project activities4.3.5. Is CDTI included in the PHC budget? .............. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. IYhat hqve been the achievements?............. .................... 30 4.3.7. Describe others issues considered in the integration of CDTL 4.4. OppnaloNAl RESEARCH .....34 4.4.1. Summarize in not more than one half of a page the operationol research undertaken in the project area within the reporting period. ........ 34 4.4.2. How were the results applied in the project?.... ........... 34 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... 34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 lv Acronyms APOC ATO ATrO CBM CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Christoff Blinden Mission Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Onchocerca Volvulus Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84Yo of the total population in mesolhyper- endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin ln a glven year (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper 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 p.oi."t;. (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). ("i) Geoqraphical coveraqe: 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) Intesration: 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) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-monitorine (CSM): 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. vl FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 33 Number of Recommend ation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report related (i) The project to ensure that the acronym list is updated Done. Project related (i) Intensiff effort to achieve and maintain 1 00% geographic coverage as well as 80% therapeutic coverage. The project is working towards archiving these targets in all oncho line listed communities, but due to insecurity incidences in 201 1, this could not be achieved. (iD Ensure that haining targets are realistic and achievable Advice taken and realistic targets are being set. (vi) Investigate and address the issue of high refusals This is being done. I Executive Summary This is the seven year report of Western Equatoria CDTI project activities implemented from January 201I to December 2011. The population at risk in 201 1 in Western Equatoria CDTI project was 699,760 across l0 counties. The project had an ATO of 516,803 people and a UTG of 587 ,798 in this reporting period. Population displacement disrupted project activities in this reporting period. The population was not stable along the shared border of South Sudan and the Democratic Republic of Congo due to insecurity caused by the resurgence LRA rebel activities. Out of the 699,670 people that lived in 904 communities in the project area in 2011,473,026 people in 827 communities received treatment with ivermectin; thereby achieving geographic and therapeutic coverage of 9l .5%o and 67 .6% respectively. A total of 1,319 new CDDs were freshly trained and were newly trained and 911 received refresher training, bringing the total number of CDDs available for CDTI work to 2,230. A total of 73 FLHF staffs were trained in data collection, drug distribution, health education and management of severe and minor side effects of mectizan. The project continued to face a number of challenges, the major ones included: o Insufficient funding due to the progressive expected planned reduction of APOC & NGDO Partner funding and complete lack of direct counterpart program implementation funding from the government. . Insecurity in some parts of the project area. o CDD attrition since they still persistently demand for incentives despite having been told at the time of selection that they are expected to work as volunteers. 2 SEGTION {: Background information 1.1. Genera! information 1.1.1 Description of the project (briefly) Geographical Iocation, topography, climate Westem Equatoria CDTI project is located between latitude 4.0"N - 6.5"N and longitude 26"8 - 3l'E in the south western region of South Sudan. The project office is located in Yambio town in Western Equatoria state. The state borders to the North with Lakes, Warrap and Unity states, to the East with Central and Eastern Equatoria states. The southern and western parts of the project area share international boundaries with Central African Republic (CAR) and Democratic Republic of Congo (DRC) respectively. River Nile traverses the Equatoria region dividing it into Eastern and Western Equatoria. The topography of the state is plateau, and the project area transects two hydro-topographical zones of the Nile and Congo watershed that is characterized by fast-flowing rivers of Yei, Yale, Bahr-Naam, Era, Maridi, Lesi, Sue, Yubu/Ringasi/ Ibba, Biki, Mbungu and Duma. All the rivers drain northeast to the Jur and east to Bahr el Jebel, which form a confluence at the White Nile. It is because of climatic and topographic conditions that the disease prevalence rates are high, as the black fly thrives in such an environment. The vegetation of the project area is mainly savannah with woodlands and then rain forests to the southern parts. Population: activities, cultures, language The majority of the inhabitants of Western Equatoria were settled agriculturalists and they practice subsistence farming; current settlement patterns have been impacted by prolonged conflict. In this community, the population gets dispersed into seasonal farmsteads whereby temporary settlements crop up in areas that are intensely cultivated. There are vast expanses of grassland that are occasionally competed for with pastoralists from neighbouring communities/states leading to population displacement. The languages spoken by the people of Western Equatoria are Balanda, Zande, Moru, Baka, and Morukodo. The Zande is the most populous ethnic group. Communication systems (roads...) The roads are still not good and the project area can be accessed through North-western Uganda and Central Equatoria state. There are also scheduled TINWFP flights between Yambio, the state capital and Juba, capital of the Republic of South Sudan. A network of roads to all counties exists, though their maintenance is irregular and may be difficult to use during the wet times of the year. Mobile phone communication exists in the area with the presence of Gemtel, Sudani and Zain companies. Internet communication can also be accessed through the WHO office in Yambio town. Administrative structu re The Administrative structure of the Western Equatoria project is according to the government of South Sudan structures. The state forms the highest level of administration followed by the counties, payams and bomas. The states are administered through Governors, counties by County Commissioners, and payams by Payam Administrators, and Bomas by Boma councils In 2010, the project area was administered over the l0 counties of Ezo, Tambura, Yambio, Ibba, Mvolo, Maridi, Mundri West, Mundri East, Nagero and Nzara. J Health systems and health care delivery The government primary health care system is the main health care service delivery. There are five functional rural hospitals located in Yambio, Maridi, Lui, Nzara and Tambura. There are 29 Primary Health Care Centres (PHCCs) and 182 Primary Health Care Units (PHCUs). Number of health staff in project area and number of health staff involved in CDTI activities. There were a total of 868 health staffs across all health facilities in the project area and 73 (8.4%) were involved in CDTI activities. Table l: Number of health staff involved in CDTI LGA - County Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage BfBzlBr *100 Ezo 66 5 7.6 Maridi 118 10 8.5 Ibba 57 9 15.8 Mundri West l0l l0 9.9 Mundri East 94 9 9.6 Mvolo 52 1 13.s Tambura 65 J 4.6 Nagero 63 6 9.5 Yambio 129 8 6.2 Nzara 123 6 4.9 Total 868 73 8.4 1.1.2. Partnership Indicate the partners involved in project implementation at all levels In Western Equatoria CDTI project, the partners involved are the health services providers at the state ministry of health, county health department and primary health care centres and units, 904 communities; CBM - NGDO and WHO/APOC. Describe overall working relationship among partners, clearly indicating specific areas of project activities The working relationship among partners is good. Before the training were conducted, joint planning was done with the partners i.e. NGDO, SSOTF and APOC and the outcomes later were translated to other levels and the communities where mobilization and distribution of mectizan were carried out by communities through their CDDs. The project in conjunction with NGDO/SSOTF carried out advocacy with a view to attract government and community support. The project has maintained a strong partnership with the affected communities. 4 State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. During the reporting period, the project mobilized the state and county officials to bring CDTI to the attention of all partners involved in CDTI. The communities leaders are were charged with the responsibility of overseeing social mobilization at Boma, village level. APOC/SSOTF/CBM provided refresher training of project coordinating officer that was then cascaded to the county and payam supervisors and finally to the CDDs. The staffs at the frontline health facilities ensured that mobilization of community members took place. 5 \o $ c.l ii (D q) c! Ov)E969,ebo o lr= e= ta s8CBa1,5 a)'E -tr(g -= -ooo-9- o90, o,9 -c \J 0a '-o 6= .tro>a Z l-l * ci uq) :\ a.p : q) () Bp a0 -a o IJ B eiq) :\ q) 'Fo \.9$o' <\ ss .:x 5. bSU!ou.\L\ .gs sb' US U9F*\ ISE ois> Z Sr +. eY9 U .- -5> t}iX q) =e oto a0 dux -v(JS rUuLs* els o) ^.ul-Y-aNx 0) a-! F I *S uo{'a YU./ :9u l-(-y o-\ 1' lt o) -6t tr := s \=s si <.lso c) :.s .+ H$ Isi q) VAISd rl a! L \S (Hui oEs =\YA:sP-a .. 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U) !(.)s () () a q) 6l E U) U2 c) U o oriq.6 EE Q (, bo (h bo a bo h bo 0 bo tn bo a b0 a bo 6 bo a bo EO- 1.tr d: a- h >. >. >. >' h >' at CE!F o o.5EEo() 6 bo a bo a bo a 60 a bo o bo a bo a oo q bo 6 oo P-c 1itr c: () o 0) c.) o) () 0) () () () rC) '5tr s= .atroo =c)a o *oEE U d 2 >' cd z (d z a 2 cd z d z (n 2 z P= 1itr oLd z c) a oE cd o d z ord z o (d z C) oL z ok ct3 oH z U I Fl oNH r< a (d -o! ch o) > L -o a(d rq EE 2 o o z -o (gF oHobod z .o dL(d N z oo c) ,0) az L CB c) () trL ()() c) q) L U) cq() trd q) L anq) I c) c) F ml orl -ol cdl FI o .g +, 5 o G Its o o .E o E F J c,i F o o rl o tr .9 +,(E +, tr o EIq E IIN z o Il-(J lrl o 2.2, Advocacy Number of Policy/decision makers mobilized The Project Coordinating Officer mobilized five top State officials and these included the Deputy Governor of the State, the Director for Social Development, the State Surveillance Officer, Director of Community and Public Health and the Director of Curative Medicine of Western Equatoria State. At the county level, Ten County Medical Officers, eight County Administrators and five executive Chiefs were mobilized. At Payam level, 502 stakeholders and Community Leaders attended a session on community mobilization and sensitization. The reason to undertake advocacy The reasons for undertaking the advocacy included to: o To get the State authorities to be involved in the CDTI activities . To get support of stakeholders and other community leaders in CDTI activity implementation. . To discuss the sustainability and ownership of the CDTI program. Outcome of the advocacy The state health authorities have now included the OV program under the directorate of community and public health and have promised to integrate CDTI activities into the primary health care plans. The constraint experienced o No counterpart funding, and so there were un-implemented activities due to lack of sufficient resources. o Insecurity in the counties that boarder with the Democratic Republic of Congo. Suggestion on how to improve advocacy Some of the suggestions to include advocacy include: . Intensi$ community mobilization and sensitization at all levels. . Provide adequate IEC materials for HSAM. . Involve the key influential community leaders in the process of advocacy and mobilization during campaigns. o Organize meetings with community leaders to share previous mass distribution exercise, evaluate the process and note areas that need improvement. . Conduct more talk shows on FM radio stations o Work with mobile phone companies to send short text messages about OV and the mass distribution exercise. . Lobby for more funding for advocacy and mobilization of the community. o Conduct health education sessions on OV at primary and secondary schools in the project area. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information There are three FM radio stations in the project area, but they could not be maximally utilized to disseminate information to the community across the project area since availability of funds was a huge hindrance. Mobile phones were also used where available. Announcements were also made to the community at community gatherings and at places of worship. 10 Mobilization and health education of communities in including women and minorities Mobilization and health education of the community was done at the community meetings. The health education sessions at the health facilities tended to target the women since they are usually the majority of care takers at these facilities. Response of target communities/villages There were generally positive responses from the community: o Community members that had physical signs of the OV disease were very willing to volunteer to distribute mectizan. o Communities positively acknowledged the additional health effects like expulsion of intestinal worns and this increased the willingness to take the drug. . Communities understood their roles and responsibilities in CDTI Accomplishment Some accomplishments were realized that could be attributed to this sensitization: . Improved therapeutic coverage. . . Generally the CDTI strategy is accepted in the community. o Communities have spoke out on the changes that they are beginning to see in regards to the physical OV manifestations that they had ll LGA - CounW Num ber of com m unities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B. Number with community members as su pervisors B5 Percentage Bo= BJ B, *1OO Male CDDs B7 Female CDDs B, Total Bq= BrtBr Number of communities with female CDDs Br Percentage Brr= B,,,/Bn*100 Ezo 95 60 63.2 168 22 190 64 67.4 Maridi 63 51 81.0 212 64 276 22 34.9 Ibba 45 32 71.t 118 39 157 39 86.7 Mundri West 95 75 78.9 r54 2t t75 21 Mundri East 90 65 72.2 239 44 283 44 Mvolo 220 100 45.5 235 30 265 30 t3.6 Tambura 45 30 66.1 184 37 221 31 82.2 Nagero 29 20 69.0 t01 3l t44 28 96.6 Yambio t32 93 70.5 313 38 35r 38 28.8 Nzara 90 65 72.2 142 28 170 37 4t.t Total 904 591 65.4 1,872 360 2,232 360 39.8 2.4. Gommunity involvement Table 4: Communities participation in the CDTI Comment on: Attendance of female members of the communify at health education meetings The attendance of female members in health education meetings is still low but is gradually growing in good number. During the scheduling of health education in communities, at the PHCCru and at community gatherings female CDDs actively participate. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses The attendance and participation of female members in CDTI issues is still low. However the few that attend usually take lead in decision making at the CDTI meetings. Incentives provided by communities for the CDDs No provision of incentives by the community to CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Yes attrition is big problem for the project. The project tries as much as possible to convey the message on the CDTI philosophy to the community members so that the CDDs begin their work knowing that it is purely on voluntary basis. Other issues None. 22.1 48.9 t2 2.5. Gapacity building Describe the adequacy of available knowledgeable manpower at all levels. There is generally inadequate manpower to manage the project at all levels. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. The project did not experience frequent transfers of trained staff during the course of this reporting period. l3 q) ah U o o! z : --d s.:qv ir *u O o\ nr- ral \o t,-N N \o h r-(n \o r- o\ tr) t-r tr)\o co oo N cn N r ca\o N oo o\ h\o Nc\ oo s $$ rn ca o\ r) ca \o o\ r- r- mN N o\ o\ ra sio l q) o e) e) s?:FU Or-rr) oor-ca lr)cn+ F-tr) r)ca (\ca |.a)N(\ (nooca No\r- F-tr-$ ra ra ra an q) .=G6l t-,'{ ! f-r 6)' yahoo ,-9 oL z 6 ll rr, o .= +F e.: S .i-qv s r'lzv o O O O O e) 0) q) (.) \o UF O q) g5 !s 3E tr-s zY= C)I Eir+F-d L) U .l z tr) tn o\ o\ O o\ o\ r- r- cn c.) \o \o oo oo \o \o t)F- t) F* s nr- : c) q) q) o sOLF r= r- o\ O $ r-- \oN N r !f, ra U) 0 J 9e(.)0) 6! o z E.:+ U, 6 ( O s ra q) c) g) I \e QF C\ N N N c.l N c\ N C\ N N Ji Q Nsl L C, <{z d .o -o rh o L 'o z ah(!i! L <rz o o z dL -o F oL(l) bo cd z o -o dL(! N z Fl t-r oF $ bo o o o p B o o 60 oq I L o -< o\ € B\ o B * ,* z; d 4) c) FAU U) q) o q) L() c) EO 6lLF ral arl bl cll t-,.1 Table 6: Type of training undertaken Any other comments - None 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100"/. geographical coverage and a minimum of 65oh therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The reasons for not reaching the 100Yo geographic coverage include: o Poor motivation of CDDs and Supervisors. . Insecurity in some parts of the project area . High CDD attrition . Poor community involvement. Plans to remedy this are: . Considering lobbying for funding from other sources like NGOs. o Continued sensitization of the community members about the CDTI philosophy. o Ensuring that adequate community mobilisation for involvement in CDTI activities Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staffor Other Political Leaders Others (specifu) Program management How to conduct Health education Management ofSAEs CSM SHM Data collection Data analysis Report writing Others (specifu) l5 \o (d o! oo 'a o. o o rl.]d h otri oP d 0) .E o o 8l E -l oxl 9 rl o ol -l;il 6iil o-!t > ol tol odlodlo >l L >l o .el b .=l ! 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I I c- \ \ o s- U h0 B\o oIJ B .g\ P b0 o bO =\\ U $\ q s =s o' ..iF f \3 egJ .\'tds-OU:L>: d '!\ - ooiI s-s o' .td o}:a) -c Y\P:^, .E l6 >s .-t *sSo .tt6:NI :s(! Bt o 9\ oi: 9aLEHNe iiisUo :.sI .\o\ ^..L € :ta. 9\So o'-sa\s E qs .E tSr !:Ug U;F-3 sPi-L : i ^-; -! B< ^iEo' -s$\o \\ $ot ; u s Pol - u s,\ ;l 3. s b;" _t a -x \ ",Ho i-i< EI b Y:{ ol! \ ; Q'!l c ! qj> ,l 5 *E iElc S's $ I_ A'T U ut q ;\sol_o E s :AI F t q G:l sSp ut €l Y35 =l >^o2l ::s -:>-s$ s.Hdpi\.\ \\->a OO'! sll L\ s3 sisy =ie-tsls 16B tiE = -io:5=d H F€ '=4! SS t '' F\N u \Jilll o'!,,L5 Qp \F"f- P \vq ol to)al > El 3dl -sl5 "l;oI ool trol 5 tsl,s -l -3lE tl c =l trzt< o(! obo-E"\uv o oF 2.6.2 What are the causes of absenteeism Not applicable 2.6.3 What are the reasons for refusals? Not applicable 2.6 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. Not applicable Parasitologist trained? None has been trained Existence of microscope? None is available Has the project reported all SAEs to Mectizan Donation Program (MDPX Please tick one. Not applicable since SAEs have not been reported. XNo In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. None was reported No SAE case to report x l8 oOO EE 9lJ>- <.E E z - MoqP tr'9 60h iFC!au5 z o o-2 E^OEgbo (J O- z (€ o v,6O< q9 d.9()-d&.L z AGq;o- o.2E 6 o c c=(toooo€,he z >\ ro od e 6E6J'= .! :-6 oI-.] d-c z abo diz _ oi: dEarNe tr'5E€ 3: o<L3Z z E o. a z o =o Ho6 z s*e8;d> x z odDc = oI) .-.->5 z xo U) z o oo z * a o\ o L c) b0 L o)L a bo L c)Ltr I() :o ^Po .9) ?trg< OA c)*>()obC)>tlD '?be>c) 28 iri G)07 aFdOoU)-4)qu2 0- cE is'U5 €l'4 c)l -olclt-l c) boI Ea - ox -1 ></JO (-) s cd c.t \oo\a c.i .t .o o\q \o sq o\tr) s oq F-\o s c1 F- oo sq ca oo o d o H a tr i ,-i rJ !d o o F0.=F 6N <. >v -o 1Oo\9 oo s rr) ol s .') s + co s ar; o\ \oo\ c.l o\ o\ q oo oo ll r t{ li tll o\ o !o =oood As) oo ,<oF \o n c.l \oo\ t- \o o\q lr)\o sq o\ r 6\ oo t-\o s c') cor- \o o\\o t-\o l.l ,o o6 r9 oE4-tsE -9zfr o. co\o ca(\ c'l ca .o- r-$ C.l lr.) N t-- 00 c.l o\N 00 ca a.l $\oC\ c-\o$ $ o\ N \oN ca a-$ li :oE 5.> < 9*'FL,) c.l <. (n c.l c-l$tn r N co oo ,d r-(\ o\ oo oo \o ca ca c.t oo- o\$ cao 00 \o r o\ r,- co L66 *3 -: o-E .:i': o a'o e O. o-Ji o. F* (\$ o\\o^$ aa$ (\ \(\$ r-$ € \o h o\ .t- o\ €\o \o r- o\ o\\o \or- o\ o\\o () bo(! ao oO ll * t: ti E] o ^ aI)I Sc' i Oo:<B- o \oo\ oq ca \oo\ n oo \o 6\ 09 .o o\ .I o\ \o6\\q $ \oo\ n c.l o\ \oo\ v? o\ o.bo= d- €^il -F3 qEld Oorrl \o oo \o$ o\ F- Or- o\ cl o\r- o\ t-- ^\ ,r1 t-- o\ \oo\$ c.i o\ ,a? o\ li LOo'5 n - = Y,-o o =:Jo LL;-O; E.a !z3' c'.1 o\ Oo\N Naa $ €co \o ca 00 r- c.l oo Q tso d o.a < 94' FLJ oo $ al aa O\o $00 $ o\ $ o\ bo =@:i.rdq->..6 Iv a: o:i + o= t:: i: c'- o Eoa?aaF tr - 9E EO oo s $ $ co 00\o aoo o\ $ o\ $ o\ o N \oO c.l r- O C.1 oo N o\ c.l o c.l a cn N L c(q) 0)trLCEag)or ocll -o)o'= .-! c) 3Etrc) 6: ?9/aa '.-Ll\J dt ool ,i cslel tr>lo -oltro)obo oL '=9EI o)LicE ct=ox ijtr o6 =-L6F F a\l -olv) =l\o 6lc.i Fl 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by n,n* E *"n F *,,.r, n NGDO Other (please speciff) Mectizan@ delivered by - (please tick the appropriate answer) *""--! WHO tr ,*.r. E *nnn Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities . After the annual treatment cycle, the Project Coordinating Officer receives information from the community about mectizan usage, wastage and remaining stock. . This information is then sent over to the SSOTF. o The SSOTF compiles this information and uses it to prepare an order for submission to MDP. . MDP reviews application, approves and forwards the recommendation to MERCK. o MERCK then ships the mectizan to South Sudan and it is received by WHO country office. . In conformity with the data that had earlier been received from the Project Coordinating Officer, corresponding amounts of mectizan is supplied from the SSOTF to the project. o At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for collection. . The Payam Supervisors on collection notiff and invite Boma Supervisors to collect supplies for their corresponding communities. . The Boma Supervisors, some of who are CDDS share this information with other CDDs and the communities. . The community members then decide on the time for the mectizan distribution to the rest of the community members. Table l0: Mectizan@ Inventory County /LGA Number of Mectizano tablets In stock from previous year Requested Received Used Lost Wasted Expired Remai ning Ezo 0 96,500 96,500 96,407 J 0 0 90 Maridi 0 147,500 147,500 147,034 t6 0 0 450 Ibba 0 82,500 82,500 82,321 34 0 0 145 Mundri West 0 229,000 229,000 229,954 6 0 0 40 Mundri East 0 206,000 206,000 205,097 J 0 0 900 Mvolo 9,326 420,000 420,000 419,684 8 0 0 308 Tambura 0 152,000 152,000 151,596 4 0 0 400 Nagero 0 42,000 42,000 41,675 25 0 0 300 2l tr Yambio 0 181,509 181,509 181,509 4t 0 0 450 Nzara 0 50,420 50,420 50,420 0 0 0 80 TOTAL 9,326 1,607,429 1,607,429 1,604,697 140 0 0 3,163 How are the remaining ivermectin tablets collected and where are they kept? Whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the health facility staff so that they are stored in preparation for the next treatment cycle. The amounts of stock of medicines that remain are communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: . Training: Health workers assist in training of CDDs, planning and implementation of CDTI activities within the communities. o Distribution: They facilitate the issuing of drugs, supervise and monitor the CDDs and also keep mectizan inventory. . Community awareness: Participate in community mobilization and sensitization sessions. o Management and referral of SAEs: Health workers manage drug reactions and in the event of an SAE, they referral the person to a higher level health facility. o Data collection: Health workers collect CDTI data, submit and also keep a record for future reference. Any other comments None 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so, When? N/A Table 11: Community self-monitoring and Stakeholders Meeting Ezo 95 0 Maridi Ibba Mundri West Mundri East 63 0 45 0 95 0 No of Communities that conducted stakeholders County - LGA Total # of communities/villages in the entire project area mon No of Communities that carried out self 0 0 0 0 090 22 0 Mvolo Tambura Nagero 220 45 29 132 90 0 0 0 0 0 0 0 Yambio Nzara 0 0 Total 904 0 0 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. N/A 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. SSOTF Secretariat staff Project Coordinating Officer at State level / 7 County OV Supervisors / / Payam Supervisors / 7 CDDs / 7 Communities Supervis Reporting 2.9.2. What were the main issues identified during supervision? The main issues found during supervision were that: . CDDs are reluctant to work. . Some CDDs refuse/fail to record treatment given in the household register book. . Level 4 forms are not filled correctly. 23 0 a Poor record keeping 2.9.3. Was a supervision checklist used? Yes, Supervision check-list was used. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? On-job coaching and mentoring was given to the County OV Supervisors that were found to have not been doing supervision of their counties. They were also shown how the data collection sheets should have been filled and it was emphasized that this needs to be cascaded to the Payam and Boma Supervisors. 2.9.5. Was feedback given to the person or groups supervised? Yes feedback was given 2.9.6. How was the feedback used to improve the overall performance of the project? o On the job training was given to the staff supervised on how to update the household information, fill the summary forms and tally sheets. SEGTION 3: Support to GDTI 3.{. Equipment Table 12: Status of equipment *Condition of the equipment (F:Functional, CNFR=currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? If integration of the CDTI activities into the goverrment PHC was to take place as desired, the state MoH would ideally maintain and replace the existing equipment through the counterpart contribution to the project. Source Type of equipment APOC MOH DISTRICT/LG A NGDO Others No. Condrtion No. Conditron No. Condition No. Condition No Conditron l. Vehicle 1 F 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 5 F 0 NA 0 NA 0 NA 0 NA 3. Computer(s) 2 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) I F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) I F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a) Laptop 1 F 0 NA 0 NA 0 NA 0 NA b) c) 24 3.2. Financial contributions of the partners and communities If there are problems with release of counterpart funds, how were they addressed? The project is not receiving any government counterpart funding for direct implementation of CDTI activities. Additional comments - None 25 \oN N (l) L q) L b! q)E il ri L 6l tr c) U tr o E o oL)tt ,2 ! 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Community members assist CDDs with bicycles to collect the drugs. o Communities contribute ideas to planning and management of the CDTI activities . Communities provide training venues in secure areas. o Some communities provide food for CDDs during training and distribution. 3.4. Expenditure per activity Indicate in table 13, 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. Indicate exchange rate used here_3.2 SSPs_ Any comments or explanations? None SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation x 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? CDTI needs to be re-launched in this project area since the project was not found to be moving towards sustainability. 4.1.3. How have they been implemented? The re-launch has not yet happened. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _N o Was a sustainability plan written?_No When was the sustainability plan submitted? _No What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - No plans made yet 4.2.2. Funds - No plans made yet 4.2.3 Transport (replacement and maintenance) - No plans made yet 29 4.2.4. 4.2.5. Other resources - No plans made yet To what extent has the plan been implemented - Not yet applicable 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The Ivermectin delivery mechanism used now is that: o WHO delivers the mectizan to the state ministry of health o The state ministry of health is then responsible for releasing the mectizan to the County Health Department stores in the Counties . It from the County Health Departments that they will later be dispatched to frontline health facilities in the Payams. o Most Payams in the project area have health facilities, so there were no instances of having the mectizan kept outside the health facility. 4.3.2. Training: In regards to training there is willingness of other programs to cooperate. These include EPI (Expanded program on Immunization) and GW (Guinea Worm Eradication program). The final implementation needs to be finally planned and executed. 4.3.3. Joint supervision and monitoring with other programs Not much progress has been noticed here. 4.3.4. Release of funds for project activities There were no funds released from the PHC system 4.3.5. Is CDTI included in the PHC budgetr Not yet. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? There is no Health programme using CDTI structure. Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc...)? Explain what are the combinations of interventions co-implemented? There is no clear set out arrangement for co-implementation yet. How were the interventions implemented? (at the same time?) The interventions are not implemented at the same time. The different programs utilise the same persons in the community to implement the programs. a a 30 4.3.7. Describe others issues considered in the integration of CDTI This is not yet applicable in this project. 3l N ca 4q) H\) q o.)L. S a) -a ! q) \q) q q q) \q) a) co o I G,o q oo q) o q) z CE F o 0) Gt q) h qq) 6l z 0) q) bD ct q 0 o o q) z cl F qq) () tu q) c! z O a nUar*9 r9 .aE z G F q o 6t q,) tu qq) CI 2 ,-3O.- E= =trz6q) q) () GIq)il 0) c) b0 cttr oq -oL E.2 =Ez q) () c) q) bo €Btr =.s\J\ >,R o-S 6i*cg o i'l >:Lfr q) a a a a a a a a a oo H.: _ra OFc) o € G+. Io liIq) a )iI Il.\ OO \J .E .. R:f,E F{(c()- (D .Qxc\l:?z co c.} q q) s_ xq) .a) q a) I\ a) "aB q) q) .E: 4 o q) \ q) a = u) o) *. lr oI lH o q) (l) o l-l 0oq) o0 o) o o 0 o c) 6t6 a0 () EO ozEA Ee 2 o 6l q) o 0 c)a q a Lo (l)oAOF oF E.9 0t) l:'lr ! aI " E.9ES =a) :c) '5Ea()c)q)= qE 2 a bD 6t o o o q) 0o (B () q) o q) F a a a a a a a a o I o c) F c)L I L C') U oo (t) a)o cgL bo ofi L(l) bI) !'=oI tae- -Eo6 6b?z a 4.4. Operationa! research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None has been done 4.4.2. How were the results applied in the project? Not applicable. SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: o Communities appreciate the importance of the mass distribution exercise and are committed to the OV control activities. . The State government acknowledges and appreciates the work being done in the OV program and is working at integrating it into the directorate of community and public health o There are fewer reported clinical cases at the health facilities. Weaknesses: . Timeline of planned activities are not followed as planned. . CDTI activities are still being considered as vertical by some state health authorities. . Inadequate funding to cover the whole state for the CDTI work. Challenge: . The extremely high cost of program implementation in South Sudan. o Poor relationship between CDDs and FLHF workers in coordination of CDTI activities. o Continuous pockets of insecurity in the project area. . Lack ofcounterpart funding. Opportunities: . Other community based programs in the project area want to implement their activities using the CDTI approach. SEGTION 6: Unique features of the proiect/other matters None. 34 t