SSOTF/HQ annual NOTF project secretariat technical report to Technical Consultative Committee (TCC): from January 2006 through December 2006

t- I South Sudoin Oncho Torsk Force Coordinstion offi,ce COUNTRY/: South Sudan Approval year: 2003 Reporting Period (MonthrYear): Jan 2006 through Dec 2006 Project year of this report: (circle) L2 L3 L4 3 4 5 6 7 8 I 1011 Date submitted: Dec 30,2006 ORIGINAL : English ssoTFlHQ ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL r-{i , -. r-'0 r tccJs; I rI 3 AVR 20tli ",it4cs.\CD? ^lrE |'J- TL: I,\ '_'l I ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country : South Sudan National Coordinator: Name: Dr. ':#"T."*: Signature Date: 2010312007. NOTF Chair: Name: Dr. Majo Signature Date: 2010312007. This report has been prepared by: Name: Dr. Baba/Fasil Designation: Na GDO Cord. Signature: ... Date. ..2010312007 d-, ! I -.t WHO/APOC, December 15, 2004I TABLE OF CONTENTS FOLLOW UP ON TCC RECOMMENDATIONS.. w .VEXECUTTYE SIJMIVIARY SE CTION 1 : BACKGROUND INFORI\,IATION........... 4.I. FTNENCTEI CONTRIBUTIONS OF THE PARTNERS... 4,2. OTHSN FORMS OF COMMUNITY SUPPORT............. 1. 1. GpNpRel INFoRMATIoN............ 1.2. PopuletloN AND HBRLtn SYSTEM SECTION 2: SUMI\{ARY OF CDTI IMPIJMENTIATION 2.I. DISTRTSUTIONPERIOD .,,.7 2.2. AnvocecveNo SgNsITIzATIoN.. ................7 2.3. INTORUATION, EOUCATION AND COMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT 2.4, COUIT,TUNTTINS, TNVOLVEMENT INDECISION.MAKING 2.5. CnpecITY BUILDING 1 2.6. ORopRINc, sroRAcE AND DELIVERY oF IVERMECTIN.....".....'. .... 13 2.7. TnBarupNTS............. ........""" 16 2.8. SuppRvtstoN 2.9. COttruuxttY SELF'MONITORING eNo SIaTpHOLDERS MpstINc.. SECTION 3: OTHER ACTIVITIES OF TIIE NOTF ............. ...............23 SECTION 4: SUPPORT TO CDTI....... .................28 1 1 6 7 8 9 0 .. 19 ..20 28 oo 4.3, RPSOURCOMOBILIZATIONEFFORTS 29 4.4. ExpBtlottuRE PER ACTIVITY BY THE NOTF SECRETARIAT 30 4.5. EqutrueNt 31 SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MOMTORING AND OTHER REVIEWS ................32 5.1. INoopBNIENT PARTICIPAToRYMoNIToRINo/BvelueuoN .......,,32 5,2. SUSTEINEEILITY OF PROJECTS: PI,AN AND SET TARGETS (VTAUOETORY AT YN S) 33 5.3. INrponatloN........ 33 5.4 OpBnerIoNAL RESEARCH ....""""'34 SECTION 6: STRENGTHS, WEAI{NESSES, CHALLENGES AND oPPORTUNITIES........ .......34 a Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MoH NGDO NGO NOTF PHC REMO SAE SHM SRRC SSOTF TCC TOT UNHCR UNICEF USAID UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community'Directed Distributor Community'Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non'Governmental Development Organization Non'Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sudan Relief and Rehabilitation Commission Southern Sector Onchocerciasis Task Force Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations High Commissioner for Refugees United Nations Children's Fund United States Agency for International Development Ultimate Treatment Goal World Health Organization ll WHO/APOC, December 15, 2004 a Definitions (il Total population: the total population living in meso/hyperendemic communities within the project area (based on REMO and census taking). (iil Elieible population: calculated as 84% of the total population in meso/hyperendemic communities in the project area. (iiil Annual Treatment Obiective: (AT0): the estimated number of persons living in meso/hyperendemic 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 Geosraphical coverase: number of communities treated in a given year over the total number of meso/hyperendemic communities as identifred by REMO in the project area (ttris should be expressed as a percentage). (viil Intesration: The bringing together of two or more health programs, removing barriers between/among them, in order to maximize cost- effectiveness and permit free and equal association. For example delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximize cost'effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTL (viiil Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. lll WHO/APOC, December I 5, 2004 a FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fiIl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session - Number of Recommendation in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY 1 a Focus on training more CDDs and Community supervisors in every community SSOTF has intensified CDDs and Community supervisors training in all CDTI project areas and achieved 65% of the Arurual training obiective. 2 a Continue advocacy and supervision at all levels SSOTF coordination office has carried out advocacy and zupervision visits in Rumbek/?och all a lW au N ei I Yambio project coordination offices. 3 a Continue polishing the population data The overall OV population data has not been polished as yet. We are awaiting the mass measles campaign result, which is being carried out in the whole South Sudan, and the results will be released in early January 2007. However, the annual treahnent objective of the population data has been revised accordingly. 4 Try to attain a good therapeutic and geographical coverage next year The SSOTF has achieved a better therapeutic and geographical coverage in all CDTI projects in the year 2006. 5 a Train health workers and CDDs in the management of SAEs SSOTF has carried out SAEs management training for Health workerg zupervisors and CDDs in co-endemic OV and RAPLOA areas. This was possible after APOC sent expertise. 6 a Add Vit A supplementation to CDTI activities At this stage the SSOTF is of the opinion that introduction of Vit A distribution at this moment will be confusing to the CDDs since they are sendhg signals of payment instead of volunteering. The introduction of Vit A distribution will be considered where CDTI is lv WHO/APOC, December 15, 2004 relatively well established. (Please add more rows if necessary) o Executive Summary Prepare an Executive summary of the report in not more than one page. 1. Suauary of tt@tment aad populatioa data ampariag prujecte, trcade in trcataeat over time i.e.- Total nuabr af coaaunities, aaauaities' treated, total populatioa, UIG, Arc aad pereoas trcated. There is marked increase in project areas populations due to refugees returning back home as well as internally displaced persons. The population movement in South Sudan is so dynamic that the actual population will only be established after general census. The CDTI projects for the South Sudan (SSOTF) were Iaunched successively as follows. In the year 2005 the SSOTF has managed to launch the East Bahr el GhazallHQ and West Equatoria CDTI project. In 2006, East Equatoria, Upper Nile and West Bahr el Ghazal CDTI projects were launched. The SSOTF coordination office oversees the East Bahr El Ghazal, West Equatoria, East Equatoria, West Bahr el Ghazal and Upper Nile CDTI projects that targets 3,625,332 people over a five-year period. In these frve CDTI project areas an estimated 4,138,848 people are at the risk of being infected with OV and therefore the SSOTF has set up its annual treatment objective of L,05O,624 people in 1,623 communities in 2006. The overal OV treatment data in the year 2006 shows 936,375 people have been treated, 89% of the ATO and 260/o of the UTG have been achieved in the five CDTI project areas. In July 2006 the APOC management availed technical expert to help SSOTF carry out SAEs management training in Yei. Participants were from all 5 CDTI project areas and who were specifically selected to be TOTs. In June 2006 APOC/CBM carried out harmonization on principles and CDTI strategy in Rumbek. treatment table N.B. East Equatoria, West Bahr el Ghazal and Upper Nile CDTI projets treatment figures for the year 2005 only reflect clinic based treatment and hence the false high percentage increase. These projects were launched in 2006 using CDTI principles. TREATMENT 2005 TREATMENT 2006 O/.INCBEASE 2005 - 2006 POPULATIONCDTI PBOJECT WEST EQUATORIA 425,751 226,131 247,653 'loa/o EAST EQUATORIA 505,934 92,816 151,475 64o/o EAST BAHR EL GHAZAL 778,920 276,422 4'.t2,021 49o/o WEST BAHR EL GHAZAL 1,508,733 9,894 70,460 713% UPPER NILE 405,994 6,033 54,766 908% TOTAL 3,625,332 611,296 936,375 154"/o WHO/APOC, December 15, 2004 2. Summary ef flaining data of projects (nationally) for: - hnject Officer (training of tuainers and/or other specitic training), total number of CDDI and health workets trained, total population per active CDD trained. Actual CDTI training and refresher courses started in February through September 2006. 33 project staff, 592 health staff, 137 TOTs and 3,281 CDDs have been trained and refreshed in this reporting period. The CDDs available in the project areas are 4,176. The ratio of one CDD to the population being 1:868 3. Ertefi of integration of CDTI prcjects into the health system. Integration of CDTI into PHC is being implemented. However, the administrative Ievels of South Sudan are undergoing major restructuring of the health systems. The restructuring also involves adjustment of borders and appointment of senior management staff. This is still ongoing and is likely to spill over to next year. 4. Strcnglhs and weaknesses of the national onchoeniasis contrrl prugrami challenges and how they werc overcoaei and opportunities that will strcngihen the prcgram. Strengths o The SSOTF has a newly well'constructed modern office for all SSOTF coordination unit staff and East Bahr el Ghazal CDTI project coordination staff. This is a good step forward. . All the CDTI projects in South Sudan have now been launched and the project coordination office is consolidated. o The Government of South Sudan has now officially recognized OV as one of the major forgotten and neglected diseases as it appeared in the "Presidential 200 Day Action PIan" which mentions OV as a problem to be addressed. Both therapeutic and geographical coverage has shown increase in the year 2006. The SSOTF has a strong partnership with other stakeholders, especially with the local administrative authorities and endemic communities. Challenges The SSOTF coordination office has witnessed considerable turnover of staff in the SSOTF/HQ and various CDTI project offices, which draws back the projects in general. This is being addressed by inclusion of the SSOTF staff and CDTI project staff in the Government of South Sudan budget for 2007 and onwards. The budget has already been submitted to the council of Ministers for approval and thereof to the parliament for final endorsement. The attrition rate of CDDs is increasing as paid practices/salaries replace volunteerism. This is due to high expectations in terms of remuneration and less volunteering. As more Government offices are set up, UN agencies bilateral offices and NGOs spring up which offer higher pay, there is vi WHO/APOC, December 15,2004 a o a a oo o a always a drift to greener pastures. This is partially addressed by training more CDDs to offset the attrition. The Upper Nile CDTI project of6ce has a major problem due to lack of office space. Therefore, the SSOTF office is an able to supply fragile and delicate office equipments e.g. Computers, printer, photocopier machine etc. This matters has been raised with the State Authorities of Upper Nile. The SSOTF coordination office seriously exploring and considering the relocation of the PCO office from Pochalla to Akobo where office facilities are available in 2007 Communication is a challenge but there is an improvement in some Iocations. South Sudan as it is still emerging from war and modern communication facilities are not yet available. To address the issue of communication SSOTF has allocated VHFs long'range radio, a satellite phone to the CDTI project offices for regular communication. Transport is another challenging issue. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Air transport, which is the available means at the moment, is very expensive. It is hoped that the road infrastructures shall be maintained as soon as possible and in fact work has started in some sections. Transportation in general in South Sudan is not adequate. The vehicle in West Equatoria CDTI project is grounded for the last two years and cannot be maintained. Women's participation in the program is still very low due to some cultural barriers and influences. Relatively a good number of female CDDs trained and participated in the current year. Weaknesses . The capacity of the project Coordination Officers and subordinate staff is Iow and hence are unable to produce required reports leave alone the APOC Technical Reports, which is quite demanding. This has resulted in aII technical reports being produced by the National coordinator and NGDO coordinator. o Computer illiteracy is a weakness in all projects, which hinders efficiency and speedy data entry and reporting. To overcome this problem, the SSOTF had trained project staff on computer training in the coordination and project areas. However, a few of them have already deserted. Opportunities . - With the Comprehensive Peace Agreement (CPA) being in its second year, a considerable stability in peace has been achieved. Internally displaced and refugees are being rehabilitated and resettled. With time as this process continues the population figures become stable. However, it also introduces the element of population increase, which needs to be captured and planned for. The Government of South Sudan has already considerably contributed towards providing a modern newly constructed office for SSOTF/HQ. The West Equatoria CDTI project offrce in Yambio has been offered office space in the newly constructed State Ministry of Health headquarter premises. vii WHO/APOC, December 15,2004 a a Oo The contribution of the Government of South Sudan towards the CDTI project is to be realized probably in fiscal year 2007. o o a Key actiuities uadertaLea by the SSOIiF during this ,aporting perid. The SSOTF coordination office launched the East Equatoria, Upper Nile and West Bahr el Ghazal CDTI projects. With support from APOC management the SSOTF is able to conduct SAEs management training in Yei which, involved participants from all CDTI projects in South Sudan. The SSOTF coordination office in collaboration with APOCAMHO and CBM organized a 3'day workshop in June 2006 at AFEX compound in Rumbek. The main theme of the workshop wasr "THE PIIYLOSOPHY AND HARMONISATION OF CDTI". The SSOTF in collaboration with Chirstoffel Blinden Mission processed the annual Mectizan application to the Mectizan Donation program in November 2005. In early January 2006, 2.704,000 Mectizan tablets were received and distributed to all CDTI project areas through the Project Office, County Health departments and NGDOs (National and International). Different types of CDTI trainings organized and facilitated by SSOTF for different groups of trainees such as: Trainers of Trainees (TOT), County supervisors, Payam supervisors, health staff, CDDs and Community leaders. a a . In this reporting period, the SSOTF coordination office procured and distributed work support items to the CDTI project areas through the project coordination offices. hogress on vector elimination actiuities (where applicable) The SSOTF is now planning to request APOC management to assist in the assessment of vector foci with an intention of ultimately developing a proposal for vector elimination. vllt WHO/APOC, December 15, 2004 a SECTION 1: Background information 1.1. Generalinformation 1.1.1. Description of the country pnogram -CDTI and vector elimination(txeny) The South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The climate of South Sudan is tropical with average annual temperature of about 29"C (about 85F). The rainy season months are April' October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from typical rainforest in the southern part to Guinea or derived Savannah in the northern area. There is a vast swampy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile. Human settlement seriously affected by 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 second phase of the Onchocerciasis control programme which requires the implementation of CDTI strategy was earmarked for five (S) COtt projects in East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile have all been launched. Vector elimination At the moment we do not have vector elimination component. We are considering vector elimination options that are cheap and sustainable through appropriate surveys of breeding sites. The situation has not changed much after the CPA - Status of National plan implementation, population at isk, number of pmjects being implemented, other relevant actiuities, and infrastructurc (e.g. Adequatc health facidties, is system decentualized or not, etc), Iogistice, administrative stntcture. The National Plan is being implemented through the involvement of national staff (lay people and health workers) appointed by Ministry of Health government of South Sudan, and the State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National and International NGOs and Community based organizations have also been supporting the implementation of the national plan by providing technical assistance/guidance through their freld medical coordinators. They also facilitated the logistical needs for the smooth running of the planned activities. The total estimated population at risk of being infected with OV in South Sudan is 4,138,848 people. 5 CDTI project and 1 Headquarter project in total 6 projects are being implemented in South Sudan. r\ccolding to UNlChll. rnapping dzrtabase of 20011 in the three main regions of the sotrthern s€'ctol and the SPLM controlled portions of the three contested areas of -'\b)'ei, Nuba lVlountains and Bltre Nile: there are a total of 788 PHC {acilities. 783 aro said to bc cun'cntly functional. Of thcse facrlities 99 or about 13% are PHC ccntcls and G;16 (gl9zu) are PHC units or mobile outreach clinics. The remaining WHO/APOC, December I 5, 2004 18 ot'60/o arc rural hospitals or specialized treatmcnt facilities. The distribution of services is not equai throughout the regionsi Equatoria rvith 260/o of the population accounts for 48o/o (gSt) of the facilities, Bahr cl Ghazal wtth 49o/o of thc populatiori has 21% 06I) of the facilities while Upper Nile with 19% of the populirtion has 23o/o (17t]) of the fncilities. The health systern is fragrnented nnd disjointed. The Iederal Ministry of Health of Government of South Sudan is currently embnrking on restructuring process. The SSOTF headquarters is situated in Rurnbek town. Rumbek airstrip remains thc largcst und the busiest airstrip, capablc of rccciving diffcrer-rt types of aircrafts. This airstrip is currently being upgraded to an all-weather airstrip and is a rnajor airstrip fcrr OLS opcrations in southern Sudan. Rumbck is stratcgically linkcd rryith Westcrn Equatolia, East Equatoria and other parts of Rahr el Ghazal thmgh road netrvork. 'l'he adrninistrative structure levels are undergoing chilnges rlfter the Comprehensive Peace Agreement. There are lbur administrative levels in South Sudan as fbllor.vs: The State. the County, the Payam and Boma at the grassroot lcvel. T}rc Statcs fornr the first level of administration follorvcd by the Counties, Payzrnrs and ,Bomas. Stntes are administered by governors (Administrative supcrvisclrs as of July 2005); cotrnty'by-cotrnty sccrctary (formcrly commissioncr) bcing the adrninistrativc and political head of thc county. The payam by pa-v-arn irclministrator and Bomi,i by Boma liberation council. Currently, l4o/o of women hold scats in the SPLN{ National Liberation Council whicli is the parliament. Health system & health care delivery (state any prpblems related to health system that impede program implementatioil. The PHC system has been badly disrupted by the wari its coordination is poor and lacks trained manpower. Until the Ministry of Health GOSs and State Ministries develop a budget to run the Primary Health Care (PHC) these obstacles will continue to impede CDTI implementation activities to a considerable degree. 2 WHO/APOC, December 15, 2004 Prouide map locating all projects @DTI and Vector Control, if any) within country. Pro ect 1: Bahr El Ghazal West 2: Bahr El Ghazal EastP .t , etc 3: West atoria uatoriaect 4: East E Southern Sudan Il{4r 5 : CDTI errces anil fr rccasbil CDTI pnjects with thcir rcqrcctiw coor{iletion end sr4rcn'ision ofEccs/ccnt'cs of Congc KM lgtnda 0 100 200 Legend E.rqty or unirhabitebil zoncs RrfirD CDTI Priority arces NO CDTI erces RE|IO b be perfirrncil Etltiopia lfury.r WIOlAFm'l lJu[2001 r INortlr*,tft Sudan C*, n t r.t I Aft ica n F$p u b I ic Q ,tort HQ, Proiect Coordination ofiice (PCoJ, Prolect Surpervision Centre[PSC] ;f eto;"d coordinnt.on ofiice (PCO) & Proiect superuisionoc:g:lfrlHs|rr* ff t.o1.* Supervision cer*re (PSc)only B rrt B D.ruatorrry U Dl@bA rrE rlrE rldly tu SS OIFgDri b Cd$)tut dfi pOC M - Indicate the partners involved in prcject implementation at all levels (MoH, NGDOI'national, internationaD Secretariat of Hea|th (MoH) o SSOTF Secretariat o East Bahr el Ghazal CDTI Project Secretariat o West Equatoria CDTI project Secretariat o East Bahr el Ghazal County/Payam health staff o West Equatoria County/Payam health staff o East Equatoria CDTI Project Secretariat o The affected communities 3 WHO/APOC, December | 5, 2004 J t l_!_ I I fu*_ I t* i l- ""'- . lr a:- The lead NGDO group o Chirstoffel Blinden Mission: Members of the SSOTF: . SPLM Health Secretariat o Chirstoffel Blinden Mission (NCO Coalition Chair) . Carter Center o WHO, Southern Sudan o International Medical Corps (West Equatoria CDTI lead NGO) o International Rescue Committee . Sudan Health Association* . Sudan Inland Development Association*(East Bahr el Ghazal CDTI lead NGO o Mundri Relief and Development Association* . Sudan Medical Care* o County Health Department " County OV Supervisors" (2), Equatoria o County Health Department "County OV Supervisors" (Z) gafrr el Ghazal o County Health Department "County OV Supervisor" (1) Bahr el Ghazal NGD partners and regions/counties, 2006: Name AAH Equatoria (West) Maridi, Mundri, Yei ARC Equatoria (East) Kajokeji, Nimuli DOR East Bahr el Ghazal Tonj, Yirol, GOAL West Bahr el Ghazal Twic ICRC consortium East Bahr el Ghazal Yirol IMC West Equatoria Tambura, Ezo, Yambio IRC Bahr el Ghazal (Esat & West) Rumbek, Aweil World Retief Upper Nile (Jonelei) Bor (South) World Outreach Foundation Ministries East Equatoria Yei (Morobo payam) MRDA West Equatoria Mundri NCA West Balu el Ghazal Gogrial Samaritans Purse West Equatoria Mundri (Lui only) SIDF Ease Bahr el Ghazal Mvolo SUHA East Equatoria Kajokeji, Juba ZOA East Equatoria Juba, Terekeka - Describe overall working relationship among partnerc, cleaily indicating specif,ic areas of pruject actiuities whete aII partners ate involved (planning supemision, advocacy, resoulres mobilization, endemicity mapping / assessment, development of IEC materials, etudies or suweys etc), The stakeholders plan, monitor, supervise, mobilize and apprise CDTI activities of the previous year through the below indicated meetings and workshopsi o Annual SSOTF Meeting o Ministry of Health monthly Coordination Meeting o Quarterly operational plans o Regional and County Mini SSOTF Meeting o County specific planning with NGOs. . Village health committee meetings 4 WHO/APOC, December 15, 2004 Rsgton(S) -: k "ri .i,ir'i'.C"S* ffi ,Gg[iiilY;rr';,f *;,ir:; .th:s_E tE xEEl' Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activity plans. Ministry of Health monthly Coordination Meeting: The coordination meetings take place in Juba in which SSOTF HQ is represented by the National coordinator. There is a representation of health NGOs in South Sudan, including UNICEF, WHO, UNFPA and the Multi Donor Trust Fund (MDTF). The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. Quarterly operational planning :( RegionaUCounty SSOTF meetings) are normally done jointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the County Health Department while at the Payam Ievel is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. The PCOs, COSs, CHWs, and POS carry out advocacy, mobilization and sensitization. For the management of SAEs cases the CDDs will refer the cases to the nearest level of health facility. County specific planning meeting with NGOe: The CDTI project office works closely with these groups to promote CDTI in the communities. Each endemic county has a designated county onchocerciasis (OV) supervisor. Each Payam (local district) within the county have a Payam onchocerciasis supervisor who is also known as (Community supervisor). Most of these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of the communities within their locality. Village Health Committee meetings All plans for implementation and monitoring are developed in close consultation with the Bomas Liberation Councils (communities), these being the grassroots arms of the administrative system of South Sudan. All health and developmental programs in the communities must receive the formal approval of the Boma Liberation Councils. Community health workers and Traditional birth attendants are the lowest cadre of health service providers who are supervised by Village health Committees. The communities elect these groups. - State plans if any to solve any issues arising as regards CDTI implementation. The SSOTF has a strategy to mitigate issues arising. a. The first step is to determine the level of the issues arising in the hierarchal set up of the management. b. Determine the nature of the issue i.e. is it managerial, organizational, or participatory etc c. The principle approach to problem solving is by giving a chance to all parties to the dispute to air out their views and grievances in a relaxed atmosphere. d. Solution to problems is not by pointing fi.ngers and blames but by an accepted consensus agreement 5 WHO/APOC, December 15, 2004 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not during the reporting period. (Please add more mws if NB-Because of the prolonged conflict in South Sudan reliable figures on the number of communities/villages is not available. \Atrhichever figures are given are always estimates. Source: From Oncho Project reports Other source, specifr REMO National census! Yearofsource: 2003 UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year of the project). 6 Name of CDTI Project Total communities in meso/h1per- endemic zone Total population in meso/hyper' endemic zone Ultimate Treatment Goal (UTG) by 2010 East BEG CDTI Project 1,001 778,920 778,920 West Equatoria CDTI Project 4t0 425,751 425,75L West BEG 3,219 1,508,733 1,508,733 East Equatoria 438 505,934 505,934 Upper Nile 332 405,994 257,294 TOTAL 5,400 3.625.332 3,625,332 WHO/APOC, December 15, 2004 o SECTION 2: Summary of CDTI Implementation 2.t. Distributionperiod Chart the actual distuibution peiod for each CDTI Project in the country in the table below. Overview of distribution undertaken rows as n Brielly note any problems/issues (one paragraph). There was a delay in the transfer of projects funds, which kept the projects stalled for six (6) months. The scheduled planned activities could not take place. In addition to this, the third quarterly operational plan and budget (April through June 2006) for CDTI activities, which were submitted to WHO for subsequent release of funds, were only received on 28th December 2006. 2.2. Advocacy and Sensitization d Sarc the number and tsrye of policy / decision makere mobilized at the national and lower (state and district leveD during the cunent yeari the reaeons for the sensi tization and outcome, At the national level 3 policy/decision makers were made and sensitized on OV magnitude in South Sudan. The frrst visit was with the officials of the presidency, which resulted in OV being mentioned as a priority in the Presidential 200 days plan of action. Advocacy meeting with the Minister of Health Government of Southern Sudan was held. At the State level the NationaVNGDO coordinators met the Governor of West Bahr el Ghazal and his Minister of Health on matters pertaining to OV. In East Equatoria and East Bahr eI Ghzal States the Ministers of Health and their Director Generals were visited and discussions on OV were held. The entire visits were fruitful and the offrcials met have committed themselves to work closely with the SSOTF and the Ministries of Health towards control and eradication of OV. 7 Distribution PeriodProject Name Jan Feb Mar Apr Mav Jun July Aug Sep Oct Nov Dec East BEG x x x West Equatorir x x x East Eouatorit x x Upper NiIe x x x x x Wegt Bahr el Ghszal x x WHO/APOC, December 15, 2004 b) State prugress made towards internal rcsourue mobilization. The SSOTF has already submitted a budget to the Government for activities related to OV control in southern Sudan. Results are being awaited. d Describe any policy-rcIated constraints being faced by any particular pruject and describe what was done to assist the prcject (outcome). Explain any plans on how to imprcve advocacy. The SSOTF has so far not experienced any policy related issues. On the contrary the government of Southern Sudan is coming out strongly in support of activities that will reduce the prevalence of tropical neglected diseases. 2.3. Information, Education and communication stratery and materials development Brielly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. A minor review of IECs materials were conducted during CDTI harmonization workshop in June 2006 in Rumbek. The following also reproduced by SSOTF coordination offrce for the South Sudan Oncho Control Program in 2006. The materials were distributed through the SSOTF coordination offi.ce in Rumbek to Project offices for onward distribution to nine (tS) supervision centres, payams and communities. . "Procedure Manual for Ivermectin Distribution Programs" (WHO) . Manual for CHW's and PHC for the control of onchocerciasis with Mectizan'" o Manual for CDTI provided by WHO/APOC and distributed to partners o Illustrated OV training flip charts (OV Oncho in Sudan) o OV poster sets (3 posters per seti "What is OV', "How do you get OV', and "How to treat O\f'). These posters are laminated in plastic for longer life under field conditions. o Illustrated educational booklets "What is OV Oncho" for primary school age children. . Simplified CDTI instruction manuals for community distributors. How were the IEC materials developed? o These materials were already developed by HealthNet International and partially reviewed and reproduced by SSOTF coordination office. Are the materials reviewed to address upcoming issues (ti*e decreasing refusals, sustainability, maintaining compliance to long-term treatmen t, SAE)? o The CDTI activities in Southern Sudan are on the first and second year of implementation. With current dynamic population movement due to rehabilitation and resettlement of displaced persons and refugees the SSOTF feels that currently the activities requested are premature. Report ifany KAP surveys have been done and how their results were used? o KAP surveys have not been conducted in the whole project areas. Su mmari ze information on : - The use of appropriate and innovative media and/or other strateg"ies to disseminate information among the projectsi 8 WHO/APOC, December | 5, 2004 a Modern media such as television, Iocal radio stations are not available in most of the project areas. In some counties in East Equatoria project, information is being disseminated through FM radios. In most cases, information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, women's groups, village health committees (if exists and functional) are used to disseminate information. Mobilization and health education of women and minorities - method and response o The method used to sensitize the women and minorities is through home visits to the communities and focus group discussions in villages, health centers, worship places, and market gathering. Special attention is paid to the men in order to sensitize them so as to understand the role that women and minorities can play in the control and eventual eradication of OV. . Communities now know that onchocerciasis is a disease of public health concern and have accepted full participation and contribution in all onchocerciasis treatment activities in the project areas. They know Ivermectin is the only drug that can reduce and eventually eliminate the burden of onchocerciasis from their communities. . Communities do appreciate the fact that Mectizan is safe and has other health benefits. Major accomplish men ts i o The Therapeutic coverage increased from L8% to 26% tn 2006. o The number of drug distributors trained has increased. (The ratio of one CDD to the population being reduced from 1:1,000 - 1: 868 o The negative attitude towards the usage of Ivermectin reduced o Relatively a good number of Female CDDs trained and participated in drug distribution in 2006. Wea k n e s s e s/C on s tra i n t s i . High attrition rate for CDDs due to non'support and also due to attractive incentives paid by NGO's and UN agencies for special campaigns o The number of female CDDs still low o There is frequent turn over of project field staffand at SSOTF coordination offrce. Suggest ways to improve mobilization of the target communities among projects. o Integration of CDTI activities into Primary Health Care network. o Full participation by local authorities and support from the Government organs. . Involvement of women groups, youth and religious groups in campaigns. . Increased health education sessions in the communities o Increased training and refresher courses for CDDs, CHWs and OV supervisors. 2.4. Communities' involvement in decision'making Comment on community participation making comparisons among projects - Participation of female and youth members of the community at health education meetingsi - fn general, how do you rate the participation of minority groups and female members in community meetings, decision'making, (attendance, participation in the discussion etc) other issues. 9 WHO/APOC, December 15, 2004 o Youth attendance is fairly commendable in public gatherings in all CDTI projects. They actually form the most influential entity in terms of mobilization and implementation. . The youth tend to pick up messages faster than the rest of the community and this is obviously due to their age learning capacity. o The youth disseminates information much faster and effectively to their parents and siblings o Women attend public information sharing meetings in fair numbers in all CDTI projects. o Members of the village health committees are predominantly men o Women's participation at decision'making meetings is very low as men dominate decision-making process in all CDTI projects 2.5. Capacity building Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) Briefly describe any training done by the SSOTF/NOTF for specifrc CDTI or Vector Control hojects (Obj ectives, participants, ou tcomes, any follow'up needed). Though there is high attrition of all types of staff from the various project locations SSOTF has continue to train a staff at all levels in CDTI strategy and general management and computer skills in 5 CDTI project areas. The main objective of the above mentioned trainings are to build capacity at the national, county, payam levels. The other objective is to inculcate into the staff the importance of the principles of CDTI, the required managerial capacity for implementation including participation and ownership. This has resulted in marked improvement in terms of participation and commitment. Table 3: Type of train:ng undertaken at national level by the GTNOAIOTF (Tick the boxes where was carried out the Briefly describe any technical assistaace pmuided to the CDTIprujects. The SSOTF coordination units assisted the CDTI projects, on program management skills, data collection and analysis, drawing joint operational plans, plan of action and preparation of Mectizan@ distribution plans were some of the technical assistance given to the projects. Time management was also 10 WHO/APOC, December 15,2004 Type of training Project staff MOH staff Opinion Leaders Others (specify) Program management How to conduct Health education ofManagement SAEs CSM SHM { NGDo partners) Data collection Data analysis Report writing Others (specify) Computer training emphasized. During supervisory visit on the job training has been carried out in all projects. 1t WHO/APOC, December I 5, 2004 \f 8N ,ri 3 o(.) o o UIur o B N $ tr5I *s € oq .R $ s I! a q) ^!{E s.t' Ts B o)\ * E $ $ .sl *t 'r. o{ $s N ! trsi * *)q .S P o) $ \ * \ p I c! ho .x .E sB s \ v) ^c!Dp\{ q) s c! 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H o, -E h oQ.E h.9?i f 5 *i 8- EE iiH O.o tr o d 0) Cd! o) F ho c! li a) o() F a @ il-\oOtsI AA o 3 E5E9H zz t 9 " H.i :TE = o'= <Fo o6t od ts-t- rO ts- 'rtci$ .+ 6rl O) \ato l() cn cvl F- od .o- $ O) 'rt 6-q(r, gr: rO 6-q(o 6ril + @ ts, tr- r{l o\ F- s @j N ro s o)N ro$ c\ ro rO oo lO co CT: ro tr- o ca o ro cO 6{(o. H .! e)b !H5 '= tr= cEE =>0)JH\L)- = @JZE 8.9 o B>3 3 o- L I -E:qx s E+e*^ N a e E'EIHts; g3<Fo :s, 9!6 fol v 59 ootli- a[.>AQ $ N $ O) Nd c\ clo CD 3 c{$ d * 6) 'a h Pi a\ ritr o(! frl (! o!a!Bio rd cU ! o; cd(d fr] -c?CdN cag E6B6 I z k 0) o.p. D FI u oH lt oo {l6 a a If the projects are not achieuing 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. The project area has not achieved the above'mentioned figures for the following reasonsl . Three projects out of the five CDTI projects in Southern Sudan are in the first year of implementation. o The East Equatoria CDTI project drug distribution activities were delayed until the SAEs management training conducted and referral health facilities identifred for any possible SAE cases after mectizan treatment. o The West Bahr el Ghazal CDTI project was launched in August 2006. The delays occurred due to the outbreak of meningitis in the project area o Population figures are changing by the week as the result of internally displaced persons and refugees returning to their homes. o Despite the conditions above, the five CDTI project has made tremendous achievement in both geographical and therapeutic coverage. There is no fluctuation rate in the project areas, instead the therapeutic and geographical coverage's increased. The OV treatment data for the year 2006 indicates 89% ATO, 26o/oUTG and 24.60/o Geographical coverage. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the o Since the CDTI project has not conducted a household registration census, it is quite difficult to have the numbers of people who have refused treatment and those who were absent during the campaign. However, in areas where the household registration is being conducted the SSOTF has not experienced refusals but in agro-pastoralist and pastoralist communities seeking pastures make it diffrcult to locate them during distribution. 2.7.3. Briefly describe all known and verified serious adverse events (SAEg) and provide in table 7 the required information when available. o The CDTI project has not reported SAEs during the period 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the orti eriod add more rows * SAEs should be verifred by project coordinator Sequelea is defined as those cases that have not recovered fuIIy from the SAE and are left with lasting neurological or other debilitating elfects. x Name of project Number of verified* SAE cases reported Action taken sequelea Number of cases with ofNumber deaths t7 WHO/APOC, December 15, 2004 \t N ,.i oD o(.) 0) o O q o oo -i! c)ood tr d o <d dq) cd (.) o 'a q) o oo () d E o (.) E{) F d o oxo z IJ.]& o C) a! o !6 G (! otr 0)Eo R,(, 'd o ad oo 0) st: .s q E a s .E !'rSt B Ns E .E st a) € s I Q si * B s as x q I q)t .H st\ P St R ot .! 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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 neede0 Table 9: Supervision undertaken by the NOTF (Please add more rows if Project Name Supervisor Date Objective of supervrslon Outcome/follow' up needed Dr.Baba/FasiUAgnes 0215106 *To assess progress of CDTI implementation *To assess the overall performance of the CDTI project. *Follow up financial management *The concept of CDTI picked by the project implementers e.g. The ICRC consortium, SIDF, did a commendable job. *Demand for more treatment created *Emphasis was made on prompt compilation of imprest vouchers by all concerned. East BEG Dr.Baba/Fasil 2519106 *To follow up CDTI trainings and drug distribution *The different type of CDTI trainings conducted as planned. *The East Bahr el Ghazal CDTI project has distributed Ivermectin in all endemic counties. *High attrition rate of CDDs was noted East Equatoria Dr. Baba/Fasil 13/10/06 *To monitor possible SAEg cases *To follow up CDTI trainings and drug distribution * No SAEs cases reported in the endemic counties and payams. * Different type of CDTI trainings conducted as planned. *The East Equatoria CDTI project has distributed Ivermectin in the endemic counties. I9 WHO/APOC, December 15,2004 West Equatoria Dr. Baba/Fasil 2014106 *To review the first quarter CDTI implementation activities. *To review disbursement of funds * To assess prog*"r. of CDTI implementation *Most of the activities were executed as drawn in the fust quarter "Due to delay in releasing funds, some training activities had to be rescheduled & followed up. *Funds were disbursed to the endemic counties and accounted for. * There is good progress towards CDTI strategy implementation 2.8.1. What were the main issues identifred dwing superuision? o Accessing County OV supervisors due to lack of roads and transportation. o Difficult train to operate in and poor communications. . Poor recording, wrong addition and poor failing was noticed at all levels o Most of the planned CDTI activities were carried out in an appropriate manner o Poor reconciliation of accounting 2.8,2. a 2.8.3. a o o Was a standard supervision chuklist used? Yes. What were the outcomes at each level of CDTIimplementation supervised? The concerned individuals were coached on the job. Improved performance noticed at the supervision centers. There is demand and need for refresher courses at aII levels. 2.8.4. Was feed'back gzven to the supervised, and how was the feedback used in impruuing the overall performance of the pruject? o On the spot discussions were done and later on feedback communicated. Follow up supervisory visits not take place due to delays of APOC fund. 2.9. Community self'monitoring and Stakeholdere Meeting Table 10: Community self'monitoring and Stakeholders Meeting (Please add more rows if Project Name Total # of LGAs or districts in the entire project area No. and % of LGAs or districts that carried out self monitoring (CSNI) No. and % of LGAs or districts that conducted stakeholders meeting (SIIM) 20 WHO/APOC, December 15, 2004 East BEG_ West Equatoria Flqrst Equatqria _ Upper Nile West Bahr el Ghazal 4 _5 5 3 6 Not done 4 Not done Not done 5 3 Not done Not done 3 TOTAL 23 16 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. From the SHM, the following resolutions were made: The decision the stakeholders meeting could not be implemented due to lack of funds. Funds were delayed by APOC for half a year and the amended budget has not been received fully. a a o a In most of the CDTI project areas the stakeholders addressed the need to train more CDDs to help the few trained CDDs and CHWs. As soon as the budget is availed more CDDs will be trained in the next reporting period Possibly. In few CDTI project areas the period of drug distribution was not aPProPriate. The community will decide on the period/method of distribution on the coming treatment campaign. Sufficient Mectizan is being requested. In most CDTI project areas the stakeholders meeting as not yet effective. During community sensitization and community leaders meetings, effort will be made to impress the significance of CSM/SHM and encourage community participation 2.10 Compliance to long'term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with long'term mass treatment with ivermectin? (For projects 4 and above years old) Table 11: Activities of that promote compliance to long-term treatment with ivermectin Objective Specific Activities Proiect targeted 1. Promote Integration of CDTI with other health care services 2. Maintain high therapeutic (>65x) and geographic (toox) coverage 3. Promote strong community ownership 4. Promote high 2l WHO/APOC, December 15, 2004 government commitment 5. Support partnership strong 6. Put in place a strong IEC strategy that encourages continued treatment Other NB. This is not applicable since the project is still in year one 22 WHO/APOC, December 15, 2004 a SECTION 3: Other activities of the SSOTF S.lDescribe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, I(AP studies, vector elimination where applicable, etc). The SSOTF with the support of APOC expert organized SAEs management training in Yei. Participants from all 5 CDTI Project areas were selected and trained as TOTs. The remaining three CDTI projects were launched in Yei, Wau and Pochalla. The Upper Nile and East Equatoria CDTI Project offrces have been consolidated. However, the consolidation of the West Bahr eI Ghazal project is in the process. 3.2 What was done to coordinate CDTI Project activities? The SSOTF coordination office operational plans are drawn in consultaion with the 5 CDTI projects. There is close consultation, which enables each project to follow what the other is doing. The below mention meetings also act as consultative meetings for coordination o Annual SSOTF Meeting o Ministry of Health monthly coordination Meeting o Quarterly operational plans Annual SSOTF Meeting: members of the SSOTF, consists of the Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair meet annually. The SSOTF appraise the previous year activities of CDTI and review and approve the next coming year CDTI activities. Ministry of Health Monthly Health Coordination MeetinB: The Ministry of Health coordinates the quarterly health coordination meeting in Juba in which SSOTF HQ is represented by the National coordinator. UNICEF, WHO, other UN agencies, and both National and International health organizations attend. The SSOTF secretariat has always an opportunity to introduce discussions on OV matters. In this forum the SSOTF/HQ introduces topics of CDTI strategy of implementation, updates CDTI activities and gives an opportunity for stakeholders to address issues. Quarterly operational planning :( RegionaUCounty SSOTF meetings) are normally done jointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the County Health Department while at the Payam level is done by Payam OV Supervisor and at the community level is done by CHWs, CDDs and the community leaders. The PCOs, COSs, CHWs, and POS carry out advocacy, mobilization and sensitization. For the management of SAEs cases the CDDs will refer the cases to the nearest higher level of health facility. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up needeO There was two meetings were held in Rumbek in June 14 and August 23 2006. The participants were drown from the Government of South Sudan Ministry of 23 WHO/APOC, December 15,2004 o o Health, State Ministry of Health, Local authorities, contractors and SSOTF coordination unit staff. The objective was to review the progress of the construction of the offices of SSOTF headquarters in Rumbek. In August 8, 2006 a meeting was held in the Ministry of Health Government of South Sudan premises. The participants were Director General PHC and medical Services, Director General for Preventive Medicine, Director general for Finance and Administration, the Undersecretary and the NGDO coordinator. The objective of the meeting was to explore the possibility of the Government taking over the payment of salaries and inclusion of budget for CDTI activities. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. The NationaVNGDO coordinators attended meetings in West Equatoria, East Bahr el Ghazal and East Equatoria project offices to provide a technical input on data collection and management. So far no meeting attended with other countries. 3.5 Briefly state any administrative duties undertaken ' Number and type of reports reviewed hechnical, financiaD, - Eeports forwarded to APOC management, - Administrative assistance or trouble shooting for projects. The first and the second financial quarterly reports were submitted to APOC management in 2006. Due to delay of funds project CDTI activities and SSOTF coordination office activities have not been executed as planned. Due to this delay the submission of the 5 annual TCC report could not take place in 2006 as expected. However, the SSOTF and CDTI project offices are now forwarding the 5 TCC reports.. 3.6 Insert the Plan of Action for the NOTF activitiee for the current year activities which were im mented. a Proiect Neme - SSOTF YEAR (2). 2006 MAINACTIVITIES Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct Nov Dec *p[nnlnsAcyl6g r[C6ttdE! 'i'; r' . itl ' . _.T# .r,ffd]jltl :$1,1, !r'; i :. i -.;;-].*, +'!fr\..ll l.'.'+;; aitr" - li'l:t5,r'-'I,x :siEq, ,'1.t'''r *SSOTF coordrnatron o(Ece x *Regronal (Defined prorect area) x *Cou n ty x x *Stakeholdere meetings/com munrtv x x Procuemcatof mrtcrieL 1: : ii$\iit is:5F * OV suoohes x x rAdvocran '! ij.:rlt , irFsi 1rrffi; s#t$ i'lErj f i-,: ? *SSOTF' coordrnatron olfice x x *Reeronal (Defined ororect area) x x *Cou n ty x x x x *Payams x x x x TRAINING *-r."1 I!i: "--ri{ ' rl+t*,.r El'. {t3!+i:.-.-i! -\"r. t?i+ '!l .. t{-.1 llt r,' .i' *SSOTF coordrnatron offi ce x x * Trarnrng o[CDDs x x x x x x x * Trarnrne of suoemeors x x x x x x x x x x x x x x* Trarnrng of communrty leaders 24 WHO/APOC, December 15, 2004 '}j- ' ,ltri * Trarnrng ofhealth staf? ASSESSMENTS I -,,:r$,^i' r;,]:rl! lr,Wu' ft.^''lf Ilxi. 1- :i, -'i '' - r XAP studres rn new areas *Revrew of IEC materrals x x HEALTII EDUC,Afl ON EDSTIIONS rl . . ,:.!i i,,',i;,-f' * Communrtv awareness/tarset€ x x x x x x x x x x * School bealth educatron/tersete x x x x x x x x x x * Churches x x x x x x x x x x Ccneur .,:Irr{E i#r-B :v.,ffi :".s: ;ffiI.; i{S^. r;i Census Update x x x x Drur Delivervr8uoolbr ) . ill, ffi::,' 11 rrtr ):E,,::.iiil&' *wf S"P.j$ ",.:,,,,:.rl, ..;] - ltl x x *Druee for SA-Ee x x x rVEE},TECTIN DISTBIBIIIION .:"' ,'r *lvermectrn DBtrrbutlon x x x x x x x x x x *Dntrrbutron of mrnor erde effect drues x x x x x x Iaboduction of CSIfl SAnr a.".i:t rk [ilU 'tffis'. i[tmdiL ,..8';- '..isl i:.: . <i]]i, , ' rrh"E ' rnq,.., l *County Health DeDartments * NGO partnershrp * Trarnrne of CDDs and others x x x x x x x * Local Health syeteme -CSM/SHM rn community x x x x x x x MoD uD trcrtnant r,rt:.i{fl SS*B' 4H,)": i"Sj li;llti,l ' "l' !1' ";ff: :{, MoD uD treatment x x x x x x x x x x x x x rSuperviriot of CDDr, F. ruo.& Couty $uo) i!, lJ11 *Ttir: }}_fl" :1*d'rm .t i,;t'*-.: ,'lsii tr +4.t:lf. *SSOTF coordrnatron office x x x x x *PCOs/RTF personnel x x x x x x x x x x x x x x x 'D.tr collcctioD .{r"& t(1i,* i.Ei-qt ww ,41!,iCI4,,i3\ , '!t- Prr j, rt *SSOTF mordrnatron office x x x x x x x *PCOs x x x x x x x 'Payam supemeors x x x x x x x x * CDDg x x x x x x rleporting/ rlrg ElltgEDrDt ,' l'. i' ,' iri,f) ".t4,1 i, '1 "PCOs x x x x x x * Payam supervrsors x x x x x x x * CDDs x x x x x x x Mouthlvfinrneid raoctiumndihi''' 1 i--L-' - ft1., ddntl [:i,r #firy ,lilr.iE +:*..:1./ti ,-q 'SS0TF coordinetion ofice x x x x PCOI /RTF x x x x x x x x x x x x x x Puprrr6ou of -ld bru/ ronuel tccf,alcrl nmrt )-" :i,:, !i'rl3tuil ;.$t+ *r['i ,]LIr TSSCIIF coordination oficc x PCO / RTF x rAoolicrtion br Mactiru -.!r ' '!r',id*, .,1 I1r;1 11 Y. ri i-,,'. ir - *SSOTF / PCOs x x Iudcpeurhut Monitorirr rt' "t- _, i,.l 4lr" . i.,' ' ,:.+rr'rir srde effect 25 WHO/APOC, December I 5, 2004 s*ris x x x x x 3.7 Insert the PIan of Action for next SSOTF HOPrqiect Name Year Three (2007)Years o4QI Q2 Q3MAINACTIVITIES *PIannine/Review meetings x*SSOTF x*Regronal x x*County x x x*Stakeholders meetingVcommunity x Procurement of materials t OV suoohes x x *Advocacy x x*Regronal *County x x *Pavams x x TRAIMNG * Trarnrng of CDDs x x x x* Tranrng of supervison x x* Trarnrng of commuruty leaders * Trarnrng of health staff/ x X Management / SAES x X ASSESSMENTS * KAP studies in new areas x +Revrewof IEC matenals x IIALTH EDUCATION SESSIONS * Communrtv awareness/tarsets x x x x x x x x* School heatlh education/targets * Churches x x x x Census Census Update x x x Drue Deliverv/Suoolies Mectrzan requests x *Drugs for SAEs x x Settine up of referral svstcms +Strengthen up refenal systerns b/w communities, PHCUs, PHCCs and hospitals for SAEs x x IVERMECTIN DISTRIBUTION *lvermectln Dstribution x x *Management ofSAEs x x Introduction of CSM/ SHMs +SSOTF panners x x +County Health Depa(ments x x t NGO oartnershro x x t Trarnrnq of CDDs and others x x * Local Health systems x x *CSM/SHM in commuruty x x Mop uD treatnent. MoD uD treatment. x x Manasement of SAES x x *Superyision of CDDs, P. supervisors and CounB Supervisors) SSOTF x x x x PCOVRTF x x x x * Payam supervrsors x x x x *Data collection x x x x 26 WHO/APOC, December 15, 2004 x x x x*PCOs x xx xI Payam supervrsors x x X xr CDDs *Reoortine/ drus management x x xxi SSOTF x x x x+PCOs x x x x* Payam supervisors x x x x* CDDs xx x xMonthly financial reporting expenditure x x x xSSOTF x x x xPCOs / RTF x xPreparation of mid term/ annual technical report xxSSOTF x xPCO / RTF x*Application for Mectizan x*SSOTF / PCOs INDEPENDENT MONITORING x x*SSOTF/PCOs/RTF *Mid term review * SSOTF / RTF x *Evaluation * SSOTF / RTF x x x x 27 WHO/APOC, December 15, 2004 ! N ,/i Eo ooo o Uo o > @N .:\ a No a s -a'\ 0Bq t) td *i 3 tat!t (r)\ a .s t/) tr .x -a E xv!t t .E\ o -c(a s q\ a)st ho 4H!H +)t{ IA c, Fi !q) dv kI) tr(! a) C) * +) ti -oH <n +)() 6) 'a frAH F -\ O d v +) ati 0) L +)ti lu * (t a a2Ltraiotr5t7q-nLr{ sF9E vIJ {J C)()tsi e a ':'i;EE5.E EA.trH0.6l-):rH(i!3 a$o= ZHO.EE()-iF:H,h 7-\ gA E SI I ot ..=l n?l!, Fl a 0)a C! 0) 0)ti E H J( H a E 0) +) tro q) Ho E o +) p Fr +)d oO oti 0) +) +> l{s o a g g H g ! trg a o EArf (,vo) +) =tsCJ >{ YOFIO E g g li 0) +) ,i c! Fr o a z N ro F- od ro @ t ct 4 O) F- i od @ tr- co co @ tr- ro tr- oi6t @ ts-(o 6i ro e9 IJ d 0) +r o t-r +)a g E .d g g .{J 0) 'a Fr P. +r o C) tr z o rr Aa *{ d UH cdStIU c! tro +)(! Erl +)a 0) ts E{ o{J Cd rI1 +)o cgH q) z I 6)aa d N CU -( q) ti .c c! FA +)(n 0) B cd +)oF Ifthere are problems with release ofcounterpart funds, how were they addressed? - Comments . Up to date the Ministry of Health of the government of South Sudan has not been met. However, approval is expected since a budget was developed and submitted to Ministry of Finance. o CBM as the NGDO partner has always been punctual in releasing its obligated funds. o The APOC has been very irregular in release of funds to such an extent that most planned activities had disrupted. This has resulted in the 5 projects including the headquarter loosing the few trained staff to other agences. This year alone the delay amounted to six month and unfortunately along with it a considerable reduction in the ammended budget with out consultation with the SSOTF. State the number of projects that had no funding from APOC Trust Fund? . The Five CDTI project plus the Headquarter project funded by APOC. State the number ofprojects that had no funding from any outside source? . All have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? o None 4.2. Other forms of community support - Describe (indicate forms of in'kind contributions of communities if any) o Provision of venues/shelters for community leaders meetings and CDDs training. o Some communities do the mobilization and sensitization of their own people. . Communities collect firewood, water and also cook for participants. o Some communities store drugs and provide good security awaiting mass treatment. o Selection of the CDDs is a major community contribution in the CDTI strategy. 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. o The NationaVNGDO coordinators have already submitted a budget to the Ministry of Health, which includes salaries to the project offices and headquarter and other support of CDTI activities. The results have been awaited. The SSOTF coordination office has succeeded in mobilizing resources from other donors, which has resulted in construction of a modern office facility to house the headquarters of the SSOTF and East Bahr el Ghazal project office. Efforts are being made to solicit funds for furnishing the offrces. a 29 WHO/APOC, 24 November 2003 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 much the NOTF secretariat project spent for each activity Iisted below d the Comments Activitv of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER I I I I r' I ! I I Dnrg dcliverv HQk'ntry point clistricts, etc N{onitoling and supervision of CI)'l'l Projccts 'l'raining of Project officers. TOT, NOTF'staff. etc. Advoczrcy visits tti henlth and politrcal atrthorities at nzrtional ler,cl lFlC KAP sttrdics, matcrials AnntraI rcvieu' rvorkshops Ili anr.rual NOTF nicctings F uel ancl nrainLcnancc of llq'-ri!eqg "q9!ftf!-q9-gssrpt!9.4t Stati<-,ner;, Others .develop tn€,nt. from NOTF to projects, -\-.qhi,qlqr:,.-. TOTAL Total number of persons treated 30 WHO/APOC, December 15, 2004 Source Type of equipment APOC MOH DISTB,ICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currently Non Functional but repairable Written off 1. Vehicle 01 0 0 0 0 01 0 0 2. Motor cycle 0 0 0 01 0 01 0 0 3. Computers 01 01 0 0 0 02 0 0 4. Printers 02 01 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Othere a) Photocopier 01 0 0 0 0 01 01 0 b) Cash safe 01 0 0 0 0 0 0 0 c)Lab top 01 0 0 01 0 02 0 0 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if necessary) *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). How does the project intend to maintain and replace existing equipment and other materials? 'Describe the adequacy of available knowledgeable manpower at aII levels. t) The SSOTF coordination officel There is deficit in manpower i.e. Deputy National coordinator, Finance officer, Data Manager. This poses a challenge since most of the works are heaped on the NationaUNGDO coordinators. 2.) The CDTI project ofEces: There is general shortage of manpower in the project coordination offices. The project coordinating officers are so week and an able to produce annual technical report. Coaching has been taking place howeveri more and more coaching is to be done. 3.) Project supervision centers: Most of the CDTI project County supervisors(COS) have worked as CDDs in the past and hence promoted to supervisors. However, they don't have a basic education background and therefore, a lot of coaching is required. ' Where frequent transfers of trained staffoccur, state what project is doing or intends to do to remedy the situation (The most important issue is what measunes weie taken to ensune adeguate CDTI implementation where not enough knowledgeable aanpower was available or stuIf often tranefemed during the cou$e of the campaigrl. This is not applicable in our situation because staff transfer does not occur at this moment. However, in cases where a gap has resulted as a result of sudden staff movement, members from the nearest CDTI are asked to cover. Besides this there is acute shortage of knowledgeable manpower in all project areas in South Sudan. 3l WHO/APOC, December I 5, 2004 cos N o -o o oz *6l O E ts N co o CJ +) ad tr o tJ Cd C! o) o) +) o c) oI +) o F .dO c\ cd =a tr cda il a o .d Cd 0) tr C! o +) o cd€ioJ c6= Q)o =bla ah XFoodad c,2 7.r 0)6-q >+r g.Y o.6r{ o) -oF!{ L)C(naQtr otr Fc) C\. x E g\. e $$8t s$ ES ss sEr i.E E rI s HHIsst !4a v p N t c! q) .V(! +) Sr 0) o +) cd c! 0) cg q) B(+r o Bq) tr o) o 6.rd o h o)a ho tr lioAof{ o +) h0 h rd a o 't, 0) tif{ cdI o cd d q) f.{ o rd c! h0 tr !o +) o tr >rf{ o{J c!a o tr cd tu +) q) .d Eq) a oE E dO A.zd;< B .j rri a B c) o)! li 0)E *) (! b! t{ fJ +) 0) C) c) FiF.. IJO <.. C! hd .ts> -i O)5bc!tr c.d(da a'a LO;E €3 troo+i .i c5:a 5A 'j .lJ :v li .< CEIE1 Q ioE >z 0) OEFOk-ar) o)x€ o. ,ri \sJ\ SSrcj aEhTE E# I :>h(J o-O bo -'iFF..:Od'e z E E.} ! ct-r fr> I E ie'fi E XEi ,/ vt)tt!A -:Y.ilu (,4 e6 Ae t +) r.idaEh hoo) tr !{o oa 0) r'1 li E p#itrcg h +) E€.Ea !dQdo.= cd:\f(rX a.^-a .i v/ lV Yi=i 5 >;ha a a:.: li-+)E .E 6E SL rr '3' qS a\ ,t X.i r: li oC}^ E T 2\> '-r q >.= H 0) c! z +)() 6) 'a tr Pr 5.2. Sustainability of projssfs: plan and set targets (mandatory at Yr 3) o This not applicable for SSOTF since we are in the l't year and 2nd year CDTI implementation What arrangements have been made to sustain CDTI after APOC funding ceases in terms oll 6.2.L. plsnning at all relevant levele. 6.2.2. Funde 5.2.3. Transport and equipment (replacement and maintenance) 6.2.4. Human reaourceg 6.2.6. Which projecte have eubnitted euetainability plan? 6.2.6. To what extent have the plane been implenented? 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for compl e te in tegta tion. 5.3.1. fvermectin delivery mechanisms The Ministry of Health Government of South Sudan has already commissioned a consultant to develop the pharmaceutical logistical supply. This is already in advance stage is being funded through the Multi Donor Trust Fund. Of course the Ivermectin delivery mechanism will be inbuilt in to the PHC structure system of drug delivery. 5.3.2. IYaining . There are various curricula being developed for various cadres in PHC activities OV as a disease and its economic impact on the endemic communities is being cooperated into the curriculum. 6.3.3. Joint supewision aad uonitoring with other pmgra.as o |oint integration is being tried with UNICEF and WHO and Ministry of Health in the mass measles campaign. It is expected that resources will be pulled together for joint supervision and monitoring with other programs. a 5.3.4. a 5.3.6. a 5.3.6. a Release offunds This is not practical at our early stage of setting up systems Is CDTI included in the PHC budget? A budget for salaries and other CDTI activities has been submitted and the results are being awaited. Describe other health prograames that are using the CDTI structute aad how this was achieved. What have beea the achieveaeats? The Ministry of Health is considering using the structure of CDTI to implement Integrated Essential Child Health Care (IMCI), and distribution of impregnated nets as well as other diseases. 5.3.7. Describe other issues considered in the integration of CDTI o The CDTI strategy could be used in management and control of malaria, which is a major cause of mortality. 5.3.8. Describe the integration of other programs into CDTI in your country and the resulte of thie integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, ie screening for cataract of primary 33 WHO/APOC, 24 November 2003 oeye care interventions integrated in all or some projects, if no integration hae taken place, are there plans to pilot test a stratery, etc?) Integration only effective once the CDTI principles and strategy have been well understood and successfully implemented. At this moment no other project has been integrated into the CDTI. However, Vitamin A supplement is the most likely program along with integrated essential child health care. 5.4 Operational research . 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 - see above 5.4.2. How were the results applied in the project? o Not applicable - see above 5.4.3 Note the issues that have been identified by the NOTF for future operational research. o KAPs in the new CDTI areas o Operational research into the Nodding disease o REMO in formally sampled inaccessible areas due to insecurity, natural barriers and landmines. o SECTION 6: Strengths, weaknesses, challenges and opportunities List the strengths, weaknesses, opportunities and threats of CDTI implementation process. Strengths o A modern office facility has been built and is operational. . The presence of SSOTF coordination offrce in Rumbek along with CBM as a lead agency within South Sudan has led to effective coordination. . A good number of our partners have now set up offices in South Sudan, which makes issues of supervision and monitoring much easier and cheaper. . The SSOTF has a strong coordination with other stakeholders, more especially with the endemic communities. This strength has led to the smooth implementation of the CDTI strategy. Weaknesses Low Top ups (salaries) and delays of payment have resulted in the following positions being vacantl Deputy national coordinator, Finance and Admin and Data Manager. In adequate educational background is a weakness in all projects, which hinders efficiency and speedy data entry and reporting. a o 34 WHO/APOC, December 15, 2004 Opportunities . Peace is being consolidated and movement is becoming much easier. . The SAEs management training was conducted which helps the project to manage possible SAE cases. . The launching of the 3 CDTI project gives an opportunity in South Sudan for sufficient annual therapeutic and geographical coverage in South Sudan . The road network in South Sudan is being improved generally and hence links with the neighboring endemic counties and states. The network to the neighboring countries e.g. Ethiopia, DRC, CAR, Kenya and Uganda is being improved which is advantageous for inter country coordination and collaboration. -List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicabld. o This is not applicable since we do not have vector elimination component. Indicate how challenges were addressed. Challenges . Illiteracy in females in South Sudan is quite high. Husbands normally do not consent to spouses to take jobs. Women's participation in the program is stil very low due to some cultural barriers and influences, which need continuous community sensitization and awareness campaigns to overcome the challenge. There is a high iiliteracy rate in the project areas. Getting skilled personnel is difficult. The accepted practice of advertising, short'listing and then screening short listed candidates is rigorously being followed. However, due to the high demand of literate persons there is always movement of staff from low paid jobs to high paid jobs. This has been a major challenge to SSOTF coordination office with frequent turn over of the project staff, which draws back the projects in general. This situation is becoming more acute for projects that pay low salaries. The cost of living in South Sudan is now among the highest in the world but with the lowest standard of living. a a a Transport is another challenging issue in the whole South Sudan. This is related mainly to the bad roads conditions and broken bridges leave alone the menace of landmines. Vehicle wear and tear plus fuel consumption are quite high. Road infrastructures maintenance is now taking place. Transportation in general in CDTI projects in South Sudan is not adequate Communication is a challenge to the projects in that South Sudan is still emerging from war and modern communication facilities are not yet available. The only equipments currently in use are the long'range VHF radios and Satellite phones which are quite expensive to run. Mobile phone systems are being installed it is hoped that they will be operational in some of the towns 35 WHO/APOC, December 15, 2004 Indicate how opportunities can be utilized to improve CDTL . With the peace in south Sudan the population frgures will be properly defined especially after the forthcoming census. o The launching of the whole approved CDTI projects in South Sudan will lead to increase the Ultimate Treatment Goals (UTG) and geographical coverage o Access to endemic communities will increase and hence more endemic communities will be treated. This is it true in collaboration with neighboring countries. 36 WHO/APOC, December 15, 2004