Upper Nile CDTI annual project technical report submitted to technical consultative committee (TCC): Jan/2006 to Dec/2006

South Sudorn Upper NiIe CDTI proiect a I I ! I I I I I COLINTRY/NOTF: South Sudan Proiect Name: Upper Nile Approval year: 2003 Launching year:2006 FROM: JAN/2006 TO DEC|2006 ( MONTH/rEAR) REPORTING PERIOD: (MONTH/YEAR) Proiectyearofthisreport: (circleone) (1) 2 3 4 5 6 7 I 9 10 Date submitted z s}'h t 0l t2007 NGDO partner: Chirstoffel Blinden Mission ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLII\-E FOR STJBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting ORIGINAL : English For Tor cL5 for To,\iR AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) if rQ, I I ! I I I I I J Birt cs.b CfrP AHE Bfu Fo 0 3 Avli ?i10/ WHO/APOC, 15 November 2006 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSE,MENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: South Sudan National Coordinator Name: Dr Signature 'w Baba Date Zonal Oncho Coordinator Name: Chuol Both Signature: Dare: 2}thrc3/2007 NGDO Representative b/or /4,oal: This report has been prepared by Name : Dr. Baba/FasiVOjara I National/DeputyAlGDO Cord./PCO Signature /?.Date lt WHO/APOC, l5 November 2006 Table of contents ACRONYMS V DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS 1 EXECUTIVE SUMMARY 1 SECTION 1: BACKGROUND INFORMATION 3 GgNnReI- INFoRMATIoN........................ Description of the project (brieJly) Partnership PopulerroN SECTION 2: IMPLEMENTATION OF CDTI 8 2.1. TrusLtNe oF ACTrvrrrES 2.2. Aovocecv 2.3. MoarLrzRrroN, sENSrrrzATroN AND HEALTH EDUCATToN oF AT RrsK couuurutuns l1 2.4. Corrauururry INVoLVEMENT...,.....,.. 2.5. Cnpecrry BUTLDTNG 2.6. TnrerupNrs................ 2.6.1. Treatmentfigures......... 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasonsfor refusals? ... 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that.... I9 2.6.5. Trend of treatment achievement from CDTI project inception to the current year2l 2.7. ORDERING, sroRAcE AND DELTvERy oF IVERMECTINEnnon! BoorM,c,nx Nor DEFINED. 2.8. CouH,ruNny sELF-MoNrroRrNG nNp SrexrHoLDERS MBerrNc ...........24 2.9. SupeRvrsroN 25 1 .1. 1.1.1 1.1.2 1.2. 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3 3 5 7 .8 10 .12 .t2 .16 .16 .19 .19 Provide aflow chart of supervision hierarchy. ..........25 What were the main issues identified during supervision? .............................26 Was a supervision checklist used?......... ....................26 What were the outcomes at each level of CDTI implementation supervision? 26 Was feedback given to the person or groups supervised? .............26 How was the feedback used to improve the overall performance of the project? 26 SECTION 3: SUPPORT TO CDTI 26 3.1. EeurprrapNr .................26 3.2. FtNRNcrnl coNTRTBUTToNS oF Tm pARTNERS AND coMMUNITrES.............. ...........,27 3.3. Ornen FoRMS oF coMMUNrry suppoRT ...........283.4. ExpnruorruRE PER ACTrvrrY ..........28 SECTION 4: SUSTAINABILITY OF CDTI 29 4.1. INrenNnL; INDEpENDENT pARTrcrpAToRy MoNrroRrNG; Ever_uRttoN..,...............,,29 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)............ ........294.1.2. What were the recommendations? ...........29 4.1.3. How have they been implemented?.............. ..............294.2. SusrRrNesrLrry oF pRoJECTS: pLAN AND sET TARGETs (MANDAToRy AT ...............29 iii WHO/APOC, l5 November 2006 Yn 3)......... 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport (replacement and maintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. INrecRnrroN ............... 4.3.1. Ivermectindelivery mechanisms 4.3.2. Training 29 29 29 29 29 29 30 30 30 30 30 30 4.3.3, 4.3.4, 4.3.s, Joint supervision and monitoring with other programs Release of funds for project activities 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. What have been the achievements? ............. ..................30 4.3.7. Describe others issues considered in the integration of CDTL.......................30 4.4. OpBnnuoNAL RESEARCH.. ..................30 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..... .....................30 4.4.2. How were the results applied in the project? ............. ..................30 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 31 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 32 lv WHO/APOC, l5 November 2006 Acronyms/Abbreviations African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Communily-Based Organization Chirstoffel Blinden Mission Community-Directed Distributor Community-Directed Treatment with Ivermectin County Health Department Community Health Workers Counfy OV Supervisor Comprehensive Peace Agreement Communi ty Self-Monitoring Civil Society Organisations Democratic Republic of Congo Govemment of South Sudan Information, Education and Communication Internally Displaced People Local Government Authority Ministry of Health Non-Govemmental Development Organization Non-Govemmental Organiza tion National Onchocerciasis Task Force Project Coordination Officer Primary Health Care Primary Health Care Center Primary Health Care Unit Payam OV Supervisor Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Sudan Relief and Rehabilitation Commission Technical Consultative Committee(APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ul limate Treatment Goal World Health Organization APOC ATO ATrO CBO CBM CDD CDTI CHD CHWs COS CPA CSM CSOs DRC GoSS IECs IDPs LGA MoH NGDO NGO NOTF PCO PHC PHCC PHCU POS REMO SAE SHM SRRC TCC TOT UNICEF UTG WHO WHO/APOC, 15 November 2006 Definitions (i) Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverase: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geograohical coverase: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (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. VI WHO/APOC, 15 November 2006 FOLLOW UP ON TGC 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 _ (Please add more rows if necessary) Executive Summary Prepare an Executive summary of the report in not more than Wpage, l. Background on treatment and population data - Total communities, comtnunities treated, total population, UTG, ATO and persons treated. 2. Backgrourtd on population movements. J. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT USE ONLY The Upper Nile CDTI project is still in the frrst year of implementation. WHO/APOC, 15 November 2006 Executive Summaty Upper Nile CDTI project is an expansion of an existing semi CDTI program that was implemented by health agencies as part of their Primary Health Care activities in particular in Pochalla and Blue Nile. It was mostly clinic-based treatment. From the REMO exercise conducted in South Sudan from March - Iuly 2003, 92 villages were selected in Upper Nile. REMO was successfully conducted in 45 villages; 11 were meso-endemic, 10 were hypo- endemic, 24 were sporadic, 47 not surveyed due to insecurity at the time of exercise and 2 were in accessible due to natural barrier (flooding). It is estimated that 332 communities will be treated in the project area, Ratio of CDDs and health staff trained on CDTI to the CDTI population is 7:872 and 7:5,970 respectively. Therapeutic coverage for 2006 is 73oh within 30% geographical coverage of the defined meso/hyper endemic population in the project area. From ]an 2006 - December 2006,54,756 people have been treated with no severe adverse events recorded during the course of treatment. 75"/o of the ATO and 13"/o of UTG have been achieved, The total CDTI population is estimated at 405,994 people in the region. This figure has been significantly exceeded due to the on going voluntary repatriation process. The demographic picture is still obscure. The majority of the inhabitants of the Upper Nile were not able to carry out their occupational activities as a result of intemal and extemal conflicts. The communities are cattle keepers practicing subsistence farming. They always migrate to grassing area in dry season. Returnees from the Ethiopia, Kenya and from North Sudan are receiving Mectizan at the way stations within the region, The region also is home to displaced persons from neighboring country (Ethiopia). CDTI training started in the middle of ]une 2006, but there were a number of training conducted from March through May 2006. Total of 500 CDD, 3 COS, 18 POS, 5 TOTs, 68 heolth staff, and 150 Community leaders I LGA uerc traineil on CDTL Project staffs together with selected health staff were coached on APOC philosophy and its strategy as well as management of APOC funds. This training took place in Rumbek. In ]uly 2006 the Project coordinating officer was trained on the management of severe adverse effects following mectizan treatment. Supervision and monitoring exercise were not very effective due to the vast geographical area, insecurity, inaccessibility due to natural barriers and inadequate logistical facilities. To overcome the above challenges more health workers and community supervisors were trained. Logistical support for supervision/monitoring activities (e.g. motorbikes and bicycles)was availed for County/Payam supervisors. The CDTI office was originally situated in Pochalla, but due to insecurity in the area the office was moved to Akobo until the situation improves. Akobo County Health Department (CHD) and South Sudan Relief and Rehabilitation Commission (SRRC) provided offices. 2 WHO/APOC, l5 November 2006 SEGTION 1: Background lnformatlon 1.1. General information 1.1.1 Description of the project (briefly) Geographic'al ktcation, topography, climate Population: activities, cultures, language Communic ation syste ms ( roads... ) Arlmi n i st rat io n s t r uc tu re Health tystem & health care delivery (provide the number of health posts/centers in the project area d'the inlb rmation is available ). Number of health staff in project area and number of health staff involved in CDTI activities. - Geographical location, topography, climate East Upper Nile CDTI is located in the north eastem part of Southern Sudan along the Ethiopian highlands. It composes of three States (]onglei, North Upper Nile, and Blue Nile ) and six counties namely, Pibor, Pocholla, Akobo, Latjor, Renk and parts of Blue Nile region. The Upper Nile CDTI proiect lies in 3 ecological zones. The western part is flood Prone zones, the Eastern part being Sudan savannah on clay and Guinea savannah, the eastern part along Ethiopian border is hilly area. The eastern part is a continuation of the Ethiopian plateau with fast flowing rivers and streams and hence suitable sites for Similium vector breeding. The Boma plateau to the south is mountainous and volcanic in origin.. The Pochalla, Akobo and Rahad rivers drain the Upper Nile region. The rainy season begins in May and ends in October. The dry season is from November to April. The farming activities start with the onset of the rains. The farming season lasts from May to September. The length of the growing seasons varies fromT -9 months in the highlands. The area has an annual rainfall of 800- 1000 millimetres or more in the Sudan-savannah, guinea -savannah and the Boma plateau. Flooding is common in the flood prone areas. Due to the fast flowing rivers from the Ethiopian highlands. The Boma highlands are characterized by medium wet seasons that are cool and rainfall varies in this section from 1000 -1600 millimetres. During the dry season, the main subsistence activity is fishing. - Population: activities, cultutes, language There are an estimated total of 448,093 people in the Eastem Upper Nile at risk of Onchocerciasis infection. With the on going repatriation exercise, this risk population has increased significantly. The demographic description of the population is yet obscure. East Upper Nile CDTI is home to Nuer (Lou Nuer, Jikany Nuer, Gajak Nuer and Gaguang Nuer), Murle, Anyuak and Dinka. Nuer is the dominat ethinic group Majority of the people in East Upper Nile are subsistence farmers, Cattle keepers, and hunting and fishing are also important. Due to intemal/extemal conflicts the communities are not much practicing the above-mentioned activities. However, the GOSS initiated disarming in some of the counties such as area of Akobo, Sobat, Maiwut and Renk counties and the other counties in the process of disarmament. J WHO/APOC, l5 November 2006 Recovery from civil conflict, the population is now highly armed with guns; a source of insecurity until demobilization and disarmament is completed. Communication system (road,..) Accessibility to Upper Nile region is through Lokichoggio in Kenya by land or air. It is also accessible through Ethiopia. UNICEF and WFP flights operate in the region and facilitate movement of health workers in different parts of the region. The road infrastructure is very poor and some villages are not accessible during the rainy season that is usually in May, June, July, August and September/octobre. Movement and accessibility are much easier during the dry season, which lasts from November to May. Supervision of CDTI communities requires the use of 4WD vehicles, motorcycles and bicycles and canoes. Adminis tra tion s truc tute East Upper Nile comprise of three federal states; Jonglei and upper Nile and Unity state. These states are subdivided in to counties, counties into Payam and Payams into Boma. The Boma is the lowest level of government administration. The states are administered by Governors, counties by commissioners, Payams by Payam administrators and Bomas by Boma liberation council. The project covers 6 counties, which are used as supervision centers. - Health system & health cate delivery (prouide the number of health posts/centers in the profect area if the information is available). The Primary Health Care system is the principle for health care delivery. Though it is well developed it lacks the necessary drugs, equipment and instruments. The staffs are all volunteers for over twenty years. The CHW and the Village Health Council provide and direct the delivery of health service at the community level. Both local and international organizations are partners in the delivery. The Govemment skill will introduce in the near future. The East Upper Nile CDTI has 28 PHCUs, 4PHCCs and2 rural Hospitals (in Boma and Kurmok) Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health stalT involved in CDTI activities. Total Number of health staff in the entire project area B1 Number of health stalT involved in CDTI Bu Percentage Br=B/Br *100 AKOBO NA 29 NA POCHALLA NA 18 NA PIBOR/BOMA NA 2L NA Total NA 68 NA 4 WHO/APOC, I5 November 2006 1.1.2. Partnership - lndicate the partners involved in project implementation at all levels IMoH, NGDOs (nationaUinternational), communities, local organizalions, etc, l - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plan,r, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementatbn. SSOTF Secretariat (Federal Ministry of Health) GoSS: Dr. Majok Yak, SSOTF Chairman Dr. Samson Paul Baba, SSOTF Coordinator Chirstoffel Blinden Mission :( Lead NGDO partner) Mr. Fasil Chane, NGDO Coordinator Upper Nile CDTI Project secretariat (Ministry of health): Mr. Chuol Both, Project coordinating officer Mr. Omot Ogul, secretary Mr. Yien Chuol, Akobo supervisor Mr. Jacob Logocho, Pibor supervisor Mr. Nyinginga Okhan Pochalla supervisor NGDOs partners in the project areas: World Relief (WR) Members of the Mini SSOTF at project level: o PCO, Finance Assistant o World Relief (WR) o County Health Department (1), Akobo o County OV Supervisors (2) Akobo, Pibor Members of the Mini SSOTF at County level: o County OV Supervisor o County Medical Officer o Partner NGO (1) International/National/Community based organization o Payam Representatives (2), -Descdbe overall working relationship among partners, cleatly indicating specific areas of profect actiuities (planning, superwision, advocacy, mobilization, etc) where all parmers ate involved. The Upper Nile CDTI project has good partnership with affected communities. CDTI Programs are based on the principle of community participation and encourage community members to take an active involvement in both the planning and distribution of mectizan. Community leaders participate during mobilization, planning and distribution of mectizan. The Project Coordination Office is currently situated within the County Health Department building in Akobo. Partnership between the CDTI proiect office and the County Medical Office, National and intemational NGDOs and SSOTF headquarters is strong. CDTI is not fully integrated in to the PHC systems and the project office will emPhasize to include CDTI trainings into CHW training curriculum. 5 WHO/APOC, 15 November 2006 Stakeholders participate in Operational planning and review meetings together with the mini OV task forces at the regional and county level. Village Health Committee members and Community Health Workers have been responsible for the supervision and mobilization at the community level. Quarterly operational planning is normally done jointly with NGDOs partners, the PCO and the COS. Supervision at the county level is done by the COS, NGDOs partners and the County Health Department. This strucfure extends even to the Payam and Boma level where CHWs and other Health Centre facility staff are more involved in CDTI activities. Advocacy, mobilization and sensitization are carried out by the PCO and CHD. Project area and County Mini SSOTF meetings are conducted to coordinate and plan and review of CDTI activities. During such meetings, support NGOs, CBq CMO, COS, is involved and there is wide sharing of opinion and consensus building. County specific with lead NGO: The CDTI project office works closely with all partners to promote CDTI in the communities. Each endemic county has a designate county Onchocerciasis (OV) supervisor. Each Payam (local district) within the county have a Payam Onchocerciasis supervisor (Payam supervisor/Community supervisor), most of these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of communities. - State plans if any to mobilize the state,/reg'ion/district,/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The CDTI project plans before the rainy seasons to advocate and mobilize State, County and decision makers, NGOs, CBO to assist in the implementation of CDTI activities. This is intended to increase awareness of responsibilities of all the partners and revitalize commitment to CDTL Campaigns are always staged before any implementation of the CDTI. Consultation is on going with the Ministry of Health through the Director General to have the CDTI program included in the Ministry of Health budget. 6 WHO/APOC, 15 November 2006 \o 8 c.l o -o C) o z OI o B is c) 'otg so F3 U)i(6t rr. :.: F:Autt O'-\.<huFrs sFN h,O :. i (fiE iU) .qJ Xr wlY^ o 3;o HSdz \.=t! \l:1d su € EE -! *r .e s.F H q.!{ !r9s>-o L$=tE.=2'=tro Elrt=otV t\ 1,, E 6 E SE {t+>re. "l :H 3I ioo H:r'id1i; s'E .. .sS F€S i ,--GVvU.rE rUoJl"S-IttsL.- I q(E S EI :*e 3l<cdI ; oS ElsgSe A 8' sSis i!).i.iEssE E'r'I I $;I u;$SsEI x E iSr€I ! u T.s ts E; gE TTEE: s1*!:Es ! E s $EEE i =-P\:::o: .! E streP YSFiSE; ; s iss: EULY€oigt"' .- EL, .s * \.F H \) oQ \ s N. o 'I \ oo 1: SB $$:ts U YS ts xsii sr th S' qr nP s8 ^ s Qi st ! o'\ U t qJ \ !9 UBU\ U q) B !9sEX :.T '=lq xs sQ' !s s! .\ASr q.e tt- }\J *{ !JS u}JS!C\)<\ ^.t* .iP So SrSXsi :$datsq,G-a!\ -so !q qJU '> \J sts'\\\! bss: =\ =\ !oo5l \o $(Js.l riS\xQ00 sqoU- Id t\B t-r p t \,)4 ! \0 ! o tr 0)a oo .E (.) li o bo ti € li o o C)L !) d C) lr 0) 6) B 6, e)L cl Iq) Lo q,)L q) o .v v) .F (d o. a U) o oQ oit o-: I -oldlFI E o a-i.t! -fe oE aN IF % () \o 3.EE" stN @-|o @ @ o) ol- ro { @ @. lo @ (9lo @dN F. ro c)- c)(\J o)o- not + I b q) :N >:9E,E -= tr6Ye -o9E i OJ @- tr) @ @ o, N.|o|o t(o @- ro @ (Y)lo @-|oN Nlo(7' (7' N tool loot -E* crc6 .r '=.i !'l i-E ,.i fr'E H E+ c! a q) E(! oP o ;'l ff c.i' zNa iN @. ro @ (o o,(\,1 rt rJ) t @ @- u)(o (v) rn ao- 'r)F,. Nlo cr- c)N (,)g)- u)o!t e 0o0J N .= .9 clo Fc) +_ il N N t+ AJ E9 &c fl >r -r :Y rfrNC! o o 6, AI 6) q) z 0) ECq €Jq) ?Eo-.q)E E'A>si N N .+ ri tr9 Ec!Eog) J9?= .g :i *o 9' F O.i5 0. o 8.(o O) o(o U)_ @ OJ oolO t- @ @ @. (o(\J N +.(,t F' o)od !l o) }E Et s -q9- - <.= 9Fl a tro ta 0i sj O o 0{ o FAo M troh s Hzritr dH oH SEGTION 2: lmplementation of GDTI 2.1. Timeline of activitles Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were intplemented by the month they began and the month they ended. 8 WHO/APOC, l5 November 2006 \o 86l o -otr o oz \a Q o. B o ta L 6) a o7.E := .YXIJE h k 0) .o h h o0 AE h €a bo (g o L l,h E 0! L a,) Etr -Y:q,E tr 0) E o 0)a 0) h 00 (hE h Cg a o a bo C( a c) an (h q) U o7-E _Y=UE 0) n 5r -o 0) 0) U) o h o0 cqo(htr CU E €a a bo h Cd o! cltrF (,) _v= >) CT a o bD OD cqo(aE trq tr aq N= <roAa) ql7-E e=9E CB A Pa bo h6 A 00 c!o AE Erq lrq .] 9 L (n s Fl a o 0.i o Fq E o FAll P{ o FAo M o\ (n)o oo C)F 9 o9g6 a\Lt-o(n +uro)oo !'-u)o.t\ 'E9H H(!t<E oho . l-t c, 0)\J:!L v9EQo.))c=(! 8.8F.e(.)= E--6d .=9tr ! ^ I ooL '50 'Y goE<g = €()i:C) :9() )HU arroLd=a U i ,\dEFE.:Erro(H oEo o!2aoc) v!t-ou)oES)-tro)5>tiaE.)(!j=>#e v)tr-: o5v '5 (F o) .;9>L.,)O!ua.9Ad:? EFr(r9nO.= f ) () aabEsEE€ .9-4.0.== >aq)L>\=8-S ?A A E - 44q) U \o u1 o o c) % \J A. L(! o C)F o 0) .g 0)L o oLr(! o l-o (r) C) o (H C) o F c'iJ ol 3ldlFI q) I €€€ t2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. Prior to the launching the CDTI project in Pochalla, the NationalNGDO coordinators paid a courtesy call to the local government authorities such as commissioner, the Executive Director and the SRRC County secretary. Two International and one National NGO operating in the locality were visited. Due to lack of flights and the heavy rains the PCO was not able to mobilize policy/decision makers. The Executive Director and SRRC county secretary officiated in launching the Upper Nile CDTI project. At the county level, 26 decision makers were mobilized and sensitized including 1 Commissioner, 3 Executive Directors, and 3 County medical Officers of Health as well as 16 Payam Administrators. The PCO highlighted the urgent need to support CDTI activities in their counties. In the other endemic counties efforts are being made to highlight the importance of Onchocerciasis disease. In April and June 2006, at least 150 community leaders were mobilized and sensitized at the Payam and Boma levels. Due to lack flights and heavy rains IECs materials and others were not delivered which, hindered the efforts of mobilization and sensitization. This will be improved by pre-positioning of required materials once a secure office availed. Improvement on advocacy at all levels may be achieved through constant involvement of the policy/decision makers in all activities pertaining to CDTI implementation. a l0 WHO/APOC, l5 November 2006 2.3. Mobilization, sensitization and health educatlon of at risk communities Provide information on The use of media and./or other local systems to disseminate tdormation Mobilization and health education of communities including women and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. There are no mass media services in the project area to disseminate information. 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 are used to disseminate information. a Mobilization and health education of women and minorities -Method and response Re sp on s e of targe t co mm uni tie s /uill age s o The method used to sensitize and mobilize the women and minorities is through home visits to the community and focus group discussion in village. Health education is a continuous process organized in schools, churches, and market places and during clinics in the health facilities. Special attention is paid to the men to sensitize them so as to understand the role that women and minorities can play in the control and eventual eradication of OV. o Communities appreciate the fact that mectizan is safe and has other health benefits. o Communities know that Onchocerciasis is a disease of public health concem and have accepted full participation and contribution in all Onchocerciasis treatment activities Accomplishments o Females make 36Vo of the CDDs, which, is acceptable in the first year of CDTI implementation. o Communities have known and accepted the drug to control Onchocerciasis. o The East Upper Nile CDTI Project launched and coordination office consolidated o Health staff and CDDs trained on CDTI trainings and health Education and data collection. Suggest ways to improve mobilization of the target communities. o Increased educational sessions in the communities where by the project didn't reach in 2006 o Train more TOTs and County project staff in CDTI. o Provision of IECs materials at all levels. o Encourage the involvement of women in CDTI o Reduce the ratio of CDD to the reasonable number of Ivermectin recipients. 11 WHO/APOC, l5 November 2006 2.4. Gommunity lnvolvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: - Attendance ol Jbmale members of the community at health education meetings - ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - lncentiyes provided by communities for the CDDs - Attntnn o.f CDDs. Is attritnn a problemfor the project? If yes, how is it addressed? - Olher ts:;ues . The attendance of females in the health education meetings is low. The participation of female members when CDTI issues discussed are not encouraging since female prefer to listen instead of participating in a discussion. o Majority of the Community Health Workers are men. Women have more family responsibilities and fully engaged in the domestic issues. o The project has not yet reported attrition since it's in the first year of CDTI implementation. - Other issues High rate of school drop out by girls The level of education and awareness among women very low Low enrollment of girl child in schools Young girls are often married off through arranged marriages. Girls are seen as source of wealth through marriage (Bride price) Some communities look at women as personal property 2.5. Gapacity building - Describe the adequacy ol available knowledgeable nanpower at all levels. Knowledgeable manpower is very in adequate to cover the entire project area. Training at various levels of CDTI whether for management, mobilization, distribution of drugs and data collection is very crucial. To that effect CDTI training takes a lot of logistics, coordination and time input. In most cases NGO health workers, teachers, county OV supervisors, project-coordinating officer, are used as TOTs. Training and re-training is almost an ongoing process especially that the education level of the communities is very low. The project-coordinating officer a a a a o a Number of communitieVvillages 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 supervisors Bi Percentage Br= BJ B, ,i1OO Male CDDs B7 Female CDDs Bg Total Bs= BzfBn Number of communities with female CDDs Bro Percentage Btt= Blry'Br*100 Pochalla 60 5 \oo/o 734 66 200 20 33% Pibor/Boma 48 5 l0o/o 90 60 150 16 33o/o Akobo 224 7 3"/o 97 53 150 32 74lo Total 332 18 5.4Vo 327 179 500 58 20"/" L2 WHO/APOC, 24 November 2003 needed strengthening by selective package for data management, compilation and analysis. This has already been planned will conducted soon. CDTI TRAINING: The below table shows the number of male and female county supervisors, Payam supervisors and CDDs trained by the project office and partner NGDOs between February and March 2005. COUNTY COUNTY SUPERVISORS PAYAM SUPERVISORS TOT Health Staff Male Female Male Female Pochalla 1 0 134 66 1, 18 Boma/?ibor 1 0 90 60 1 20 Akobo 7 0 97 53 J 30 TOTAL 321 179 5 68 Community leaders trained COUNTY TARGET ACHIEVED Pochalla 50 20 Boma/?ibor 59 75 Akobo 100 55 TOTAL 209 1s0 Where.frequent lranskrs of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The ntosl importanl issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable nnnpower was available or iJ staff.s arefrequently transferredduring the course of the campaign). Since its launching in March2006, the project has lost an Assistant Finance Officer. A significant number of lower cadres of already trained staff like POS and CDDs are either being attracted to other organizations or the armed force at a high rate. New finance assistant to be appointed and more Community supervisors and CDDs to be trained. The greatest challenge is the disjointed salary scales provided by different NGOs operating in the project area, which are much higher than the APOC top up. Up to now the Government salary are not realized. There is no concrete action plan at the project Ievel to overcome this attrition but training is underway for the new ones. 13 WHO/APOC, l5 November 2006 co c.l o .o o oz d c.l .i o B \t OO 8 € a i SJ tr o S o 0o\ !I 8 :{Y \ q; s B ! a s\S t ..i =* h 4 v)\)q) \) q > S p N vq o (! C) E 0) a F U o C) C) oL ,c) -d C) bo riF ,rir o.r I -l FI 3 z I o -i +L\J: {r tv ], zw 8N Oo b O rJ oln o6 * Iq) Eo o a "\?= nN 66 ro 8 0 .= a;dL o z o -= + .U \: i. =v -----t s6l A o Eo o Ao s IF ro ! o 6 q 9? o z E.q? U U q t 00 6l N m xo6 A 0) Eo o a x Q? 6l c6 o ,l L L z - .ac! il9E,'i + da< z aI Eo Eo o o >e U? J t 6 at t 0r 6 E €o -o E 3oJI N Trainees Tlp. of trainrng CDDs Other Community members e.g Commuruty supefvlsors Health Workers (frontline health facilities) MOH staff or Other Politrcal Leaders Others(specify) Program management How conduct Health education to Management of SAEs CSM SHM Data collecuon Data analysis Report wfltlng Others (specifl) Table 6: Tvoe of trainrnp undertaken (lick the boxet where tpecfic training was caried oat during the reportingpeiod) - Ary other conmenls Community Self Monitoring and stakeholders meeting will be emphasized in the next treatment cycle. The number of people trained in the different categories above is still small. More training have already been planned on data collection and data analysis a a 15 WHO/APOC, 15 November 2006 2.6. Treatments 2.6.1. Treatmentligures UPPER NILE If the project is not achieving l00Vo geographical coverage and a minimum of 65Vo therapeutic coverage or the coverage rate is lluctuating, state the reasons and the plans being made to remedy this - therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project area has not achieved the above-mentioned figures for the following reasons: The project has initiated treatment only in three counties of Pochalla, Pibor and Akobo. The CDTI project is planning to expand in the remaining counties in the year 2007. a O a Accessibility towards the project area was very difficult. Some of the area was not treated due to floods. The area is very vast. This is confounded by insecurity and limited logistical facilities. The Population characteristic of the CDTI area is being updated and correct mectizan request will be made for sufficient therapeutic coverage. The CDTI project is in the first year treatment cycle based on CDTI principle. a o PERSONS TREATED %ATO ACHIEVED %UTG ACHIEVED Pochalla 15,065 75% 27% Akobo 21,848 87% 33o/o Pibor/Boma 16,153 65% 1,90h Blue Nile 1,700 57o/o SW-TOTAL 54,766 75% ' t3% t6 WHO/APOC, l5 November 2006 \o 8N (.) o z|r) o > t-- oU)caa ogkOJ OD .BUU.)! 9u 'r1 'di9xXou Et/E o .91 bo o-r9 !b 'd>o0J;3co 'ElJ<(,,OG v(J s .glcY(/)O- 90, bo:rib 0J ^.>yo :iJ -o-(! ri 0ot o.)F5 >J oEEtJE*; >.U F(JvtrqbE or.o E €C!O !qtr)o .r-(E !(g0,) t1 6>, ,=!il k:tso.ir g .ggs 5.EE oJoC -c o'-!aE d!6 .=-N .gau .:E< =r=tro- Ur'5 hst5.9iiET;5 !q-c _(,QJ'ci5ts :9€tb9 o 9- *=-6' cOiEEz.z H \' oo ! q Ea $L hao & _s\\t B$L 4{ s $ n\ $s TEB$$ehi !rXU .[o t;ESvt\P 5.iss eEoE HP: '= - F{lbpo=$N \ g.:E; : Ft€ --iIAs s Essn $ :t5i s Hii s F Fti-E ! 'Iir< !'fi : g$itd .i *\.E uu = :'\ t S S E HFF\'i s ElsH .i .! ;E.S-i *8rs 9s sLX-l ! il =t u-xl il !:E€ iEI [ : IFIB;v€ u -E: *E ^,.S rl I^,S^,+Ss qig€ sig:slEE i! t|:El:tlEil: i :i S|EilESl*Sl=Sts sti EIE EIi Ec i E SS*g*E=E- ssE *l tl tl i| :$:Ssl sl sl sl E:iher er =r ?r E$$\bFEriil r il il -\'6s .s S ,:lE:! * ot i:dI i \lt V ! r = .EEtpsislsi S i*:-.!-s-t ERs\ $ e o ttllSq :- ! L ^ rr S e S E ! ISs hl FI al -t EI st od ot od\l rl slft "J $ rl .|:l tt\t qt h q ?v Q a,) v1 > -s \)4 \) U) (! U)(n oH(! (ri rl J o 'tr q) ! -o a IJ.] U) o (d otrF :t 5l(!l FI ax q!6 <o .=d\s9,3^E-A tr O o e I'i:>; si Hf I H. O O O o #?CA zz O O O o LOoo EO zH z z z z !o Er ;EE?"ZE :E.5Eg o o c! * il- aa .9 !? ho9dOLb9oF oBRF OJ o\F-N o\ .'e co(O s s(o t< o 6 g- =oo2eE ro\oO rO ro cO \o co <i @ N N \o\oN ro eo o> G b:5!X iE5 O N roN OO roN O O co oQo rON o troOE add + 8.ex >.9 -oq I EFOtro N rJ: rO '+6n co- rO @ v(o ,rt Io @ To tr- f.- rO N .s O)q) rio$ a ob0d 5\O 6) =ltsl EI otUI * lt- o *o 6!9 Y >- -o rO(o s rO6l rO -o o(O o tl- . E Y.,Y E E 6= i o= 9Jzaa>E N N 6\o oo cO o>EE; =oF<FO O <'i N ONts olf) b>-g H o- L !) *' E.E &Er.- >o = oc- c - E bOA !g Es r€# 8= E Ed O(o @ '+ $NN N rO ro o 'tr< .9V Uo o la opa o v (! i( a 0)I q,) z OJ a la Fl F oF $ 8 C.l 3 o o z s e.l U oq B @ 2.6.2 What are the causes of absenteeism? Even though, the actual number of absenteeism is not known, the project has experienced in some communities where cattle keeping is an important activity, men are absent mainly due to seeking grassing areas. 2.6.3 What are the reasons for refusals? Since the project has not done proper house hold registration (census) it is difficult to know the reasons of refusals. However during distribution of mectizan the project has not experienced refusals. 2.6.4 Briefly describe all known and veriflred serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. No case of SAE reported during the period In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report x t9 WHO/APOC, 24 November 2004 .+I c.l C) q) z t c.l Uoq o B N \) \ \) L\) Uq * - qq \o Q \,) ! 4: p p o \)4 ! \J o- o L C) 00 o o li o bo .F rc C)F oo (n ! oa o U) C) (.) q) o 0) E G o o C)o o o U)(! U #t o-.r I -ol FI q) C - qli -89E9E xil>"JE= m()9Ptr-9 eoo 9Ed XALq.tu6 o qr .9E2 !.1 bo =9oa !x oO ! 6.= O &34 -E6()gE >\ ci4OOOE.EE >\E, :YO o !(, o(! IJ (! E - E, oo'!E =.6.= q # sEtg o x(/) =- -E!^U ..o-F g ,)qa<6 =oN= ,9!2- o>; bocG.; =oo ,2O x 0)(n obo * z(h N Eo o z Uo o. o ts N -q2 I5 G)I 9 0) a0FE Dg !^\USeSFSr f-)$L- =$clt9Gtr -a-.r:.i!EE E =P.=;s5\- -!iqJovEe;cJ IYEgi "".:Hq)90J(JqrL H- .; E ,109liq)6 -,iLivLii9 ELO) Fq)2l-0.)- +U bqtr-l.l =LN .EU$ elG!EEI 9EEI H0el E . 6Jt O) .9 0l 'FE 3l E() -OO= !e!96riE>69l.r€i f, - 7h :v \JL9!EF !dD;2.9trorr YFE) L-€FrEc! ()9Ui iE\otr c..i o\l ';q)l tt) =l 6P-l ql Fl 0. C)60 ri (D l- OxaDUg ^\ Fl clol !l(!t il 3o'l ilFo\t Hrird o bo I _b^ k 85 o\ ro F- ll -*66€ E1 rd ri 8_F cdi:E 9a!ANVI. ():A- \o Fi € f-l La q- :oo) =huz ab \oN stt lJ) Fri tr9or7 c!EH =HU o'Ft-5 co D\ Or -LEE 8- .= >rocE <traa oi0 F 3* PE E-=F O.O tr () (€lrl \ti o\ o\ roO\tt 0q) bo \a .9 EI atUI ll-l( H ri r.l o s a b^ k 85 .-9N\o a0) =oou(!= LV H)''i>,I.il-*OE UP)Hkt'r-I dQO co rd b E3'E ^d-67 tr'- dF12L =E\!2E 8 V, T ri H cc)O>c E'i =c)F<Fo O rO rf b;3 .ft()t:C) +t.= tr x (€ E - 5.g - tr o! Hd=o9o: tr ooxiE ,e O cq X tr-lF o= tr 0.)ll N cO cO H \o N !tI c{ o .o o oz dN U q o B NN Mectizan@ delivered by - Qtlease MOH tr appropriate answer) UNICEFN NGDOtrwHo x Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities MECTIZAN FLOW CHART SSOTF/CBM Nairobi WHO Sudan Rumbek/SSOTF store + t I LOKI/WHO store I I County mini SSOTF store t PHC Facility Payam store I t I MSD USA MSD (France) CDDs 23 WHO/APOC, 24 November 2004 Mectizano Number of Mectizano tablets StatelDietrict/LG A Foryarded Requested Received Ueed Inst Waste Expired POCHALI,A 40,000 40,000 39,973 27 PIBOR/BOMA 40,000 40,000 40,000 AKOBO 40,000 40,000 40,000 BLUE MLE 5,616 5,616 5,616 TOTAL 6,616 120,000 126,616 126,689 27 Table 3: Mectizan@ Inven add more rows - How are the remaining ivermectin tablets collected and where are they kept? The project has completed mass treatment. No mectizan has been reserved - List and brieJly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. The County Health Departments in the project area are involved in advocacy and sensitization. The health staffs also involved in distribution of mectizan and monitor any side effect reactions and its management. Any other cotnments 2.8. Gommunlty self-monltorlng and Stakeholders Meetlng Has any Iraining (of trainers) for community self-monitoring been done in the project area? If so, When? Community Self Monitoring training of trainers has not been done in the project area. Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communitieVvillages in the entire proiect area No of Communittes that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) POCHALLA 60 20 PIBOR AKOBO 48 224 T2 2I 332 53 24 WHO/APOC, l5 November 2006 Describe how the results of the community self- monitoring and stakeholders meetings have affected proiect implementation or how they would be utilized during the next treatment cycle. From the SHM, the following resolutions were made: o Need to train more CDDs to help the few trained CDDs and CFM. The work had been too much for CDDs. o The period of mass treatment campaign need to be changed to dry season so that more areas can be accessible. (The community will decide on the period/method of distribution on the coming treatment campaign. Sufficient Mectizan is requested. o There is a need for additional health education tools such as t-shirt, IECs materials for mobilization and health education activities. 2.9. Supewislon 2.9.1. Provi.de a flow chart of supemision hierarchy, SSOTF HQ / / ' ; . .,,1,.[i;''iiit ii+..-.;lr,.t]i.. " "COS : rl...,:,iv,,$,".:,: .t.', . 1..1;'.-;j,:,i1,'.i.- 7 7 CHWg/CDDa / 7 Endemic communltles ,;, 25 WHO/APOC, l5 November 2006 2.9.2. What were the main issues identifred during supemision? Some of CDDs have not been able to administer the drug according to the height guidelines. The supervisors have taken immediate action and on spot trainings were conducted. In some supervision centers recording are not properly done resulting in inaccurate reports. High expectation by CDDs and CHW for incentives, which is being provided by other UN agencies. In the rainy season, roads are very poor limiting supervisory visits. At the same time most communities are busy in their farms. In adequate supply of work support items. 2.9.3. Was a supervision checklist used? Supervision checklist was developed but not used. Much information was generated through face - face discussions. However, in the next reporting period it will be emphasized. 2.9.4. What were the outcomes at each levet of CDTI implementation supervision? Areas supervised showed some improvement in treatment coverage, good record keeping and some improvement as well in filling reporting formats. 2,9.5. Was feedback given to the person or groups supervised? Yes! Feedback was sent to the supervised persons and person-to-person discussions were conducted to improve performance. 2.9.6. How was the feedback used to improve the overall performance of the project? Those found to be weak during supervision, on site coaching were conducted immediately to uplift their standards. Further supervisory visits were arranged for follow up. SEGTION 3: Support to GDTI 3.1. Equipment Table 72: Starus of equioment lP/eay add mlrc rlws if nece.rsan) '' J -'/ o o a o o a Source Type of equipment APOC MOH DISTRICT /LGA NGDO Others Condition of the equipment * Please state Functional Currently Nonpu1gtionnl but repairable Written ofr 1. Vehicle 2.Motor cycle 04 0 0 0 0 04 0 0 3. Computers 01 0 0 0 0 0l 0 0 26 WHO/APOC, 15 November 2006 al u 4. Printers 01 0 0 0 0 01 0 0 0 0 05.Fax Machines 0 0 0 0 0 6. Others 0 0 0 0 01 0 0a) Photocopier 01 10 0 0 0 0 10 0 0b) Bicycles c)Metallic cabinet 04 0 0 0 0 04 0 0 0 o4 0 00Metallic trunk 04 0 0 0 0 00 0 00 0 0b) Safe 0 0 xCondrtnn of tbc cqarynent (Fanrtional Canentl1 How does tbe proyct mtend l0 ,ilatnlditt and rtplace cnshng eqtipment and othr malcnah? o When Onchocerciasis control is included into the MOH budget, there may be funds. This will support maintenance and repair of existing equipments. The NGDOs also compliment this MoH support where ever and when ever necessary. 3.2. Financial contributions of the partners and communlties Table l3: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? AdditionaL comments Up to date MOH cannot meet its obligations due to delay in the release of state funds. This might change in 2007 since budgets are being PrePared for the respective ministries of the Govemment of South Sudan. A budget component for OV control shall be included. o NGDO partner CBM has been very punctual in releasing its obligated funds. Contributor Year I ('provide the period') Year 2 ('provide the neriod') Year 3 ('providc the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) Others a) b) Communities APOC Trust Fund 63,090.00 s1,000.00 TOTAL 63,090.00 51,000.00 O 27 WHO/APOC, l5 November 2006 Unfortunately APOC management has not been punctual in releasing funds, which have been approved on time to the SSOTF coordination office for subsequent release of funds to the project office. 3.3. Other forms of communlty support - Describe (indicate forms of in-kind contributions of communities if any) o Provision of venues/shelters for community leaders meetings and CDDs training. . Some communities do the mobilization and sensitization of their own people. . Communities collect firewood, water and also cook for training participants. o Some communities store drugs and provide good security awaiting mass treatment. o Selection of the CDDs is a major community contribution in the CDTI strategy. o Some communities do their own census; this is also a community contribution. 3.4. Expenditure per activlty Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here- Table 14: Indicate how much the project spent for each activity listed below during the reporting period o Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communlty Mobilization and health education o{ cgmmg1!ties-,- Training of CDDs Training of health staff at all levels S uperv is i n g CpDs qn d {_t1 tn _b_q.ti -q! Internal monit_o1i_ng 9f QPTI activities Advocacy visits to health and p_oli tical authorities IEC materials Summary (reporting) forms for treatmen Vehicles/ Motorcycles/ bicycles maintenance Office Equipment (e.9. gomputers, printers etc) Others TOTAL Total number of persons treated Any comments or explanations? 28 WHO/APOC, l5 November 2006 SEGTION 4: Sustainabllity of GDTI 4.1. lnternal; lndependent participatory monltoring; Evaluatlon 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4,1.3. How have they been implemented? 4.2. Sustainability of profects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?- Was a sustainability plan written?- When was the sustainability plan submitted?- What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2,1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4,2.5. To what extent has the plan been implemented 29 WHO/APOC, 15 November 2006 4.3. lntegration Outline the extent of integration 0f CDTI into the PHC structare and the plans for complete integration: 4.3,1. Ivermectin deliverymechanisms The Ivermectin delivery mechanism is not integrated to primary Health Care structure. Currently, Mectizan@ is delivered by CBMAVHO from Nairobi to the SSOTF head quarters in Rumbek. However the Government of South Sudan is working on the central procurement and supply unit through which all drugs will be supplied to all states. This system will be used to deliver drugs to the project area once they reach the country. 4.3.2. Training The CDTI training activities has not been integrated into the CHW training and refresher courses curriculum of the PHC. The project office will advocate the integration of CDTI trainings with the existing PHC training curriculum 4.3.3. Joint supervision and monitoring with other programs The CDTI supervision and monitoring is done jointly with PHC system has a lot of advantages since other shared resources could benefit CDTI project. In Boma the County Health Department has integrated OV into its supervision guide. 4.3,4. Release of funds for project activities Handling of resources at PHC level has not been implemented in South Sudan. 4.3.5. Is CDTI included in the PHC budget? It is not included in the PHC budget. However, there is great optimism that it will be included in the PHC budget. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? No health programme has adopted the CDTI structure at present. Describe others issues considered in the integration of CDTI. The project has not yet considered integration of CDTI into other disease intervention until the CDTI concept is well understood. 4.3.7. 4.4. Operational 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. No operational research activities have so far been conducted in the CDTI project area. 4.4.2, How were the results applied in the project? Not applicable 30 WHO/APOC, 15 November 2006 SEGTION 5: Strengths, weaknesses, challenges, and opportunlties List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed, Strengths The Church in the project area has shown interest of dissemination of CDTI activities during their church services. East Upper Nile CDTI has a strong cooperation with local authorities, communities and good understanding toward implementation of CDTI in the affected areas. The traditional social fabric is almost intact and traditional authorities are very much respected. This is being made use of in campaigns and CDTI implementation. Main weakneases Despite the achieueruenfi of the project, the folkwing con$rains and weakruss shoald be mentioned. and addressed The County supervisors need a lot of training and coaching in CDTI. The ratio of CDDs to the population is still below from the requirement (1:812) Supervision/monitoring by Project coordination staff and FLHF staff inadequate The number of health facility staff trained on CDTI is low Ghallenges S Poor road structure and landmines are still a problem for a smooth running of CDTI activities. In other counties there are no roads at all. $ The CDDs were volunteers and continue to be so up to date. They now feel that they have to be motivated S Delays of disbursement of funds by APOC. Strategy to address challenges o Additional budget for travel has been submitted to APOC and CBM since the project relay mostly on air transport. o a s s s s 31 WHO/APOC, l5 November 2006 a o To achieve good therapeutic/geographical coverage, there is already a plan to train more CDDs to bring down to the reasonable ratio to the total CDTI population. o The project will continue to lobby commitment from all stakeholders. o The CDTI project office is scheduled to carry out mass treatment activities during dry season to avoid areas not accessible during rainy season . The project request APOC through SSOTF to avail funds on time. Opportunities . The project coordination office will be stationed in Akobo for better coordination, which will be close to Pibor, Latjor, Blue Nile and Pochalla supervision centers. o The CDTI project initiated cross border collaboration with neighboring country Ethiopia. SEGTION 6: Unique features of the profecUother matters o The East Upper Nile CDTI project borders one of endemic countries Ethiopia. o The people at borders are of the same ethnic group e.g. the Nuer, Anyuak and Uduk speakers in the Ethiopia also found in East Upper Nile CDTI project. o The prevalence of Tuberculoses, Trachoma and Kalazar is high in the CDTI project area. 32 WHO/APOC, 15 November 2006