Upper Nile CDTI annual technical report to Technical Consultative Committee(TCC) : January to December 2010

UPPERNILE (TIN) CDTI PROJECT whounproi ect@,gmail.com ORIGINAL: Enelish ANNUAL PROJECT TECHNICAL RBPORT SUBMITTED TO CHNICAL CONSULTATIVE COMMITTEE (TCC) AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) RECU'TE - - J PoF Action fq ! I i RT I i P Aft fuYilt$cnr*on SiR. (^E\ To APOC Management by 3l January for March TCC meeting n To APOC Management by 31 Julv for September TCC meeting li,tfsa Torl > 2 9 JUIL. Z0tt Proiect Name: Upper Nile CDTI projectCOUNTRYAIOTF: Republic of South Sudan Approval vear:2003 Launching vear:2006 From: January 20 I 0........... (Month/Year) To: December 2010 ( Month/Year) Renortins Period APOCfundinevear: (circleone) | 2 3 4 (5) 6 7 8 9 l0 ll 12 13 APOCProiectimplementationvearreport: (circleone) I 2 3 4 (5) 6 7 8 9 10 ll 12 l3 Date submitted: ,e@ort Partners:- Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Christoffel Blinden Mission - 562 communities Apoc /DlR DEADLINE FOR SUBMISSION: WVp* N^L ANN IIAL PITO.IEC]' TIiCHNICAI", ITEI'OI{1' t'o l.llC'llNl(ln l. CONSt.ll. lA'l'lVl: ('OMMI l"l'l:l: ('l'('(') ENDORSEMENT I'lease conlirm vou have read this report b-v" signing in the appropriate space. Courrtri : Southcrn Suclan National ('oordinatot': l)r. [-ucia Williant KLrr S i g.atr-r'c : NA'l!*| I>aLe :J,!{ .lLrlr',i 2o I I /.onal ()nclto ('oorditrator. (llrr"rol Iloth Mal<Lrac S ignaturc llatc:..1 J.l:rJ Lrll'20 I I N(jlX) l(cprcscntativ'c. lrasil (.harre S ignaLu rc t t [)atc I his rcport \\ us l)r'cl)arccl br : ('liLrttl I]oth N4akLrac {fi.tut,'lo I I Srgrlxturc --- .-- . - [)irtc'.11t ''Jril; :ot t I)csigrratton l);o1ce t ( ootrl utittuti, ( )1'l rccr' i-'fuo li {D OI. FICEIIS to sign thc rcport: Table of contents ACRONYMS .............. v DEFINITIONS................... VI FOLLOW UP ON TCC RECOMMENDATIONS .........1 EXECUTIVE SUMMARY..... SECTION 1 : BACKGROUND INFORMATION........ l.l. GsNpRaLINFoRMATIoN..................... 1 .1 .l Description of the project (briefly) 1.1.2. Partnership 1.2. Populerroll SECTION 2: IMPLEMENTATION OF CDTI........ 3 4 4 4 5 6 I 2.1. TIvpLTNIp OF ACTIVITIES 2.2. Aovocecv..... 2.3. Mosrl-zatloN, sENSITTzATToN AND HEALTH EDUCATToN oF AT RISK coMMrrulrrcs l0 2.4. COtvttuUNtrY nIVoLVEMENT............................... .................12 .8 l0 2,5. CapacIry BUILDTNG 2.6. TRparwNTS............... 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 oll known and verified serious adverse events (SAE{ that ....... l7 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year 19 2.7. ORopRnqG, sroRAGE AND DELIVERY oF IVERMECTIN .. 20 2.8. CopTIUNITY SELF-MONITORINGAND STAKEHOLDERSMESUNC 2l 2.9. SuppRvrsroN 22 l3 l5 t5 t7 l7 Provide aflow chart of supervision hierarchy. .......... 22 What were the main issues identified during supervision? ...........22 Was a supervision checklist used? ..........22 Whot were the outcomes ot eoch level of CDTI implementation supervision? 22 Wasfeedback given to the person or groups supervised? .............23 How was the feedback used to improve the overall performance of the project? 23 SECTION 3: SUPPORT TO CDTI.. 23 2.9.1. 2.9.2. 2.9.i. 2.9.4. 2.9.5. 2.9.6. 3.1. 3.2. 3.3. 3.4. EqunueNr FTNeNcIeI CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES.. Ornpn FoRMS oF coMMt NITy suppoRT................ E>cpNonuRE PER ACTIvITY ....23 ....24 ....28 ....28 SECTION 4: SUSTAINABILITY OF CDTI.. 28 4.1. INreRNer-; TNDEpENDENT pARTICIpAToRy MoNrroRrNG; EveLuattoN.................... 28 4.I.l Has the project ever been evaluated/monitored? (tick any of the following which are applicable) 4.1.2. What were the recommendations? ..........28 4.1.3. How have they been implemented? .............. ..............28 4.2. SusraNesILITy oF rRoJECTS: rLAN AND sET TARGETS (MANDAToRv AT...... ..........28 lll Yn 3) ........28 Planning at all relevant levels..... Funds........ Tronsport (replacement and maintenance). . Other resources., To what extent has the plan been implemented 4.3. INrecRartoN 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. 29 29 29 29 29 29 4.3.1. Ivermectin delivery mechanisms................ ..--.........-.-.29 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs..... 4.3.4. Release of funds for project activities 4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health progrommes that are using the CDTI structure and how this was achieved. What have been the achievements?.............. ...........-.......29 4.3.7. Describe others issues considered in the integration of CDTL ..........---..'.......30 4.4. OppnarIONAL RESEARCH ..... 33 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, ....... 33 4.4.2. How were the results applied in the proiect?............. -................... 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES' AI\D OPPORTUNITIES.... ....33 SECTTON 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........33 lv Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with lvermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v Definitions (i) Total population: the total population living in meso/tryper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coverage: number of communities treated in a grven 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 perforrnance of CDTI (or any community-based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session _32 Number of Recommendati on in the Report TCC RECOMMENDATIO NS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Proiect related (i) Efforts should be invested in increasing the proportion of health staff involved in CDTI activities. This is essential given the increasing number of community members due to the changes in the political structures The staff involved in CDTI activities in 2010 did not increase as compared to 2009 and this can be explained by staff turnover. Most of the health facilities are run by NGOs and with annual funding cycles, their staff retention is quite unstable. (i i) Increase the training of CDDs to meet the increasing population and to reduce the ratio of CDD to population Q34a) The total numbers of CDDs trained in 2010 were 2,538 as compared to 1,420 in 2009 making the total available CDDs to 2,787 . This reduced the CCD to population ration to 1 :184. (iii) Suggestions made in this report on improving sensitization (e.9. use of churches and training of county-level supervisors) should be Dut in practice .This has been done in churches and other places of worship. On- job coaching and supportive supervision ofcounty level staffis an on-going process. (iv) Plan for OR and take advantage ofthe financing possibilities at APOC This is still work in progress in collaboration with the SSOTF and probably a proposal will be submitted for the next TCC review for South Sudan. (v) Continue advocacy activities with the government to ensure This is an ongoing activity and we are yet to report positive I the recognition of CDTI and its eventual inclusion in the PHC results. Recommendation to APOC Management (i) Plan for and implement sustainability assessment (this was supposed to be done at the end ofyear 3 of implementation) 2 Executive Summary This is a report of the CDTI activities implemented in the Upper Nile CDTI project from January 2010 to December 2010. This was the project's fifth year of APOC funding. The project is also being supported by CBM, an Intemational NGDO that is part of the South Sudan Onchocerciasis Task Force (SSOTF). The total population served by this project in 2010 was 512,573 and had a UTG of 430,561 and an ATO of 356,1 84. The states of Upper Nile and Jonglei were covered by the project; comprising of a total of counties. A total of 562 communities were targeted for mass treatment with mectizan in this reporting period. 562 communities were treated in this reporting period, giving a geographic coverage of 100%. A total of 337 ,241persons received mectizan treatment during this reporting period. This treatment figure represents an increase in therapeutic coverage to 66%o compared to 56.1%o in 2009. The UTG and ATO coverage achieved were 78o/o and 95olo respectively. Tribal/clan conflicts were quite common in the project area during this year under review; and led to mass movement of communities in the fear of reprisal attacks. There also stillexisted some population movements in other parts of the CDTI project area that were due to due to return of people that had been in concentrated in internal displacement settlements in the past. The total numbers of CDDs trained in 2010 were 2,538 making the totalavailable CDDs to 2,787 . This reduced the CCD to population ration to l:184 in 2010 as compared to I 1344 in 2009. In addition, a total of 188 health workers were trained in 2010. A number of challenges were faced and major ones included: . The integration of CDTI project activities into the routine primary health programming is taking longer than was anticipated. This includes having all OV program staff being included on the government payroll. There is positive indication from the health authorities covered by this project that this will soon be a reality. . There were lesser staff involved in CDTI activities in 2010 as compared to 2009 and his affected the supervisory capacity at the community levels. This was due to the fact that most of the health facilities in the project area are being supported by NGOs and with annual funding cycles, their staff retention is quite unstable. o Data management is still an issue. Maintaining good record of CDTI activities by the CDDs is still a challenge. All County and Payam were constantly reminded of the importance of supporting the CDDs in the record keeping endeavour. . There is always a logistic problem in Upper Nile, and 2010 was no exception. Getting project supplies delivered was an enorrnous challenge - the mectizan and other program supplies still had to be airlifted to the project sites with highly unpredictable flight schedules and minimally permitting weather conditions. 3 SECTION l: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate The Upper Nile CDTI project is located between latitude 5"N and ll"N and between longitude of 29"8 and 35"E. It is situated in the Northern section of Southern Sudan and borders with Ethiopia to the east. The project covers the two States of Jonglei and Upper Nile; out of which six of the counties of Akobo, Pochalla, Boma/Pibor, Longichuk, Maiwut and Maaban are onchocerciasis endemic. The Upper Nile CDTI project lies in 3 ecological zones. The western part is a flood prone zone; the southern part is mainly savannah with clay soils and the eastern part along Ethiopian border is relatively hilly. 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 Pochalla, Akobo and Rahad rivers drain this Upper Nile region. The rainy season in this area begins in May and ends in October; with the dry season lasting from November to April. The area receives annual rainfall that ranges from 800 - l000mm. Flooding is common in the flood prone areas due to the rivers flowing in from the Ethiopian highlands. Population: activities, cultures, language The Upper Nile CDTI project area is home to Nuer, Murle, Anyuak and Dinka. Nuer population forms the majority of the inhabitants in the project area. The activities of majority of the people in Upper Nile include cattle keeping and subsistence farming. Fishing along the rivers, their tributaries and the marshy areas becomes a major activity for these communities during the dry seasons. Communication systems (roads...) This CDTI project is situated in an area that has the most challenging terrain in Southern Sudan. The road infrastructure ranges from very poor'to non-existent in most areas. In rainy season the majority of the project sites can't be accessed. Only county headquarters and surrounding villages may be reached by boats or dugout canoes. Some minimal travel by road is only possible during the dry season that lasts from November to May; efforts are made to target mectizan distribution during this period. Upper Nile CDTI project area can also be accessed by air transport via Juba and Rumbek. UNWFP operates humanitarian flights in the region and facilitate movement of humanitarian workers in different parts of the region. Administration structu re The administrative structure in Upper Nile like in any other part of Southern Sudan is divided into state, county, Payam and Boma. The Boma is the lowest level of govemment administration. The state is administered by Governor, county by a County Commissioner, Payams by Payam Administrators and Bomas by Boma Councils. The project covered 6 counties of Longichuk, Maiwut, Maaban, Pochalla, Akobo and Boma. Health system & health care delivery (provide the number of health posts/centres in the project area if the information is available) 4 The Govemment Primary Health Care system is the main health service delivery system in the project area. There are also some NGOs running some of the health facilities in the area. However, drug stock outs and lack of medical equipment and supplies chronically affects most of the health facilities. There are a total of ll2 health facilities in the project area;82 Primary Health Care Units (PHCUs),23 Primary Health Care Centres (PHCCs) and 7 rural Hospitals. Number of health staff in project area and number of health staff involved in CDTI activities. A total of 188 (22.5%) out of 834 health staff in the project area were involved in CDTI activities. The break down is shown below. Table 1: Number of health staff involved in CDTI County - LGA Numbcr of hcrlth stall involved in CDTI ectivities. Totel Number of health staff in thc entire projcct arce Bl Number of heelth staffinvolvcd in CDTI B2 Pcrccntagc B.=B,/ B' rl00 Akobo 200 3l l5 Pochalla 58 39 67 Pibor/Boma 160 35 21 Longichuk 148 31 2l Maaban 122 28 22 Maiwut 146 24 l6 Total 834 188 22.5 1.1.2. Partnership Indicate the partners involved in project implementation at all levels The partners that were involved in the implementation of CDTI activities in the Upper Nile CDTI were the 562,the frontline health facility staff, the NGDO - CBM, Christian Mission Aid (CMA) ind WHO/APOC. Describe overall working relationship among partners, clearly indicating specific areas of project activities The different partners worked well despite the huge challenges faced working in this CDTI project area. Partners jointly carried out community mobilization, health education, training and mectizan distribution. The project staff conducted planning meetings and advocacy sessions at various levels with close collaboration with the SSOTF. State plans, if any, to mobilize the state/region/districttLGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Upper Nile CDTI project conducted advocacy meetings with decision makers at State, County and Payam levels. NGOs working in the area and CBOs were also urged to assist in supporting the implementation of CDTI activities. Both the state ministries of health were also contacted through the respective Director Generals on the need to have the CDTI program and staffintegrated into the primary health care system of the health ministries in Upper Nile and Jonglei states. 5 1.2. Poputation EuIEl: Communitics and population at risk in thc entirc projcct rrca whcthcr thcy arc trcated or not during thc rcporting pcriod UTG = ulqlotcd u thc murmum lo n mcso/hypcr crulcm,c ate* wthtn,he pro|ecl qrca, lo reochcd when lhc prolect has reoched full gcographrc coverage (nomally prolect should be expected to rcoch lhc UTG ot the cnd of thc J year of thc proyct) Was a ccnsus for thc project donc during thc rcporting pcriod? No- If No, what is the source of the data in the table above? * Source: Annual projection ofpopulation of2.9Yohas been projected over the years to a baseline population figures derived from harmonised figures used/derived during thc REMO exercise and WIIO nceds assessment done in 2004. Other source, speciry: _Yea..2004-d-"ua@2.9%hlsbeensubjectedtothisbasefigureovertheyears. 6 Popuhtion ofNumbcr of communitics/villages in Hypcr- cndcmic zonc in thc projcct rrce Ar Ar= Ay' Ar Totil in mcso/hypcr- cndcmic zonc (UTG) Ultimetc trcrtmcnt Gorl Hypcr-cndcmic zonc in thc projcct Ar lrct Ar = Ar+ Ar Totrl in mcso/hypcr- cndcmic zonc Aa Mcsocndcmic zonc in ttc projcct rrcr County - LGAs Tot.l populetion in thc cntirc proicct rrce A1 Mcso-cndcmic zonc in thc projcct rrce 74.130 74, I 30 62,269Akobo 74.130 155 155 76.4|67 90,966 90,966Pochalla 90.966 67 100.127 100,127 84,107t00.127 8l 8lPibor/Boma t77.020 148.69795 95 t77,020Longrchuk t77,020 39.23366 46,705 46,705Maaban 46.705 66 23.625 23.62s l9,E4s23-625 9E 98Marwut 165,096 s12573 430561340 ,)) 362 347,411TOTAL 512,573 If you are using thc term community or villegc, dclinc whet constitutcs the community or villagc. A vrllage in the South Sudan context is defured as a given geographic area that is under thejurisdiction ofa given local executivc chief. The boundaries of cvery such community are defined by the chief system of local authorities, In this such community, it is common to find that the people speak a common language, havc similar culrural/social raditions like maniage, funeral rinrals and usually make communal decisions about the general welfare of their community. Thc number of communities cited in this reports are as per these society norms. Isthcrernyothcrinformationofintcrcstaboutthepopulationinthcprojcctercr? Ifso,includeitherc.None 7 SECTION 2: Implementation of CDTI 2.1. Tlmeline of activities }!!q!: Timclinc of ectivitics for thc rrces trcrtcd in thc currcnt ycar Commcnts - None DistricULGA Mobilizetion of communitics Trainins Ccnsus/Updetc Drug distribution Supcrvision Strrting monlh Complction month Strrting month Complction month Stlrting moDth Complction month SrlrtiDg month Complction month Strrtitrg month Complction month Akobo Junc July July August August Septcmbcr August December Junc Deccmber Pochalla June July July August August Septembcr August December Junc Deccmber Boma Junc July July August August September August December June Deccmbcr Longichuk June July July August August Septcmber August December June Dcccmber Maaban July August July August Septembcr October September December July Dccember Marwut July August July August Septembcr Octobcr September December July December 8 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year At the project level, two state officials - the Minister of Health and the Director General were met and talked to about the CDTI activities and their support was sought. At the different county levels, six County Commissioners and six County Medical Officers were met to discuss the CDTI activities and they all pledged their support for the CDTI work. At the community level, a total of 182 community leaders/supervisors were mobilized for their involvement in CDTI work. The reason(s) for undertaking the advocacy and the outcome The advocacy was undertaken in order to: o Attract more support through government counterpart contribution and awareness about CDTI strategy and activities, o Continue to draw their attention on inclusion of CDTI into primary health care system, o Create ownership of the programme by various communities. The outcome(s) The outcomes realised included: . The health authorities acknowledged the need to have the CDTI activities included in PHC activities and all CDTI staff onto the payroll. . The communities met also expressed their commitment to the cause of the OV program. Describe difficulties/constraints being faced The constraints included that: o The health authorities could not make a firm commitment to the suggestions that made about taking on CDTI staff onto the government payroll due to budget constraints. o There were some aspects of inadequacy of advocacy skills/approaches since some persons and communities need to be approached with caution. o There was a logistical challenge of inaccessibility of some of the areas due to flooding and swampy nature of the project area. Suggestions on how to improve advocacy o Continued and persistence with the health authorities so that CDTI issues are kept on the agenda of the ministries of health in the states covered by the project. . Training of CDTI staff on advocacy skills and methods. . Conduct advocacy during the drier seasons of the month or consider purchase or hiring boats for transportation in some parts of the project area. 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other local systems to disseminate information . In 2010, the use of mass media for information dissemination was not a possibility because of the non-existence of FM radio stations in the project area. o Two mobile phone companies have now extended their services to some parts of the project area; so project staffcan occasionally be reached using mobile phones. l0 Information is also still being passed on from person to person by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen or at the community meetings. Announcements in churches and other places of worship; community gatherings; women's groups and village health committees meetings were used to disseminate information. Mobilization and health education of communities including women and minorities Community mobilization and health education of communities were conducted at different locations especially through home visits; group discussions in the community, health centres and in places of worship. The key issues discussed were selection of CDDs and involvement of Women in CDTI activities. Response of target communities/villages . General improvement in community involvement and ownership of the program. Community has taken more responsibility in collection and distribution of mectizan . The number of CDDs selected by the community increased. Accomplishments . There were no refusals reported, the people absent were away grazingtheir livestock. . The number of available CDDs to do CDTI woik increased to 2,787 as compared to 1,420 in 2009. . Community members understood their roles and demand of mectizan greatly increased leading to increased geographic and therapeutic from 93.9% and 56.1%o in 2009, to 100% and 66Yo respectively in 201 0. Suggestways to improve mobitization and sensitization of the target communities. . Because of the difficulty there is in moving from one county to another and also within one county, the County Supervisors and their respective County Health Department staff should be fully take charge of the mobilisation and sensitization of communities as opposed to have to wait for the Project Coordinating Officer to take lead on this. . The project covers two states state focal persons have been assigned to each state; this hopefully will ease communication with state health authorities in regards to the needs of CDTI work coordination. . Having a myriad of community leaders, church leaders, various local NGOs involved in speaking to their audiences about OV so that opportunity of have any community gathering is not lost. o Having continuous involvement of more women in the CDTI work, since they are the primary care takers of the family unit, then more of their family member will access the treatment. a a b ll 2.4. Gommunityr involvement Table 4: Communities participation in the CDTI Attendance of female members of the community at health education meetings In many communities in the project areas, female generally remained the same as last year and there were incidences of reduction in attendance at health education meetings as compared to last year. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses The participation of female members was relatively low; they are gradually coming out to take part in these discussions. There was a fall in the level as compared to last year. Incentives provided by communities for the CDDs No incentives are provided to CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Yes it is a big problem and it was addressed by continuously preaching the CDTI philosophy Other issues - None County - LGA Number of communitics/villeges with community mcmbcrs es supcrvisors Number of CDDs end thc communities involvcd Numbcr of communitics /villegcs with fcmelc CDDs Total no. communities in thc cntirc projcct area B1 Numbcr with community membcrs as supcnisors B5 Perccntegc Bo= BJ B. *100 Malc CDDs B1 Femrlc CDIh Bs Total Bo= B:tBr Numbcr of communitics with fcmalc CDDs Brn Perccntege Brr= Bro/8.*100 Akobo 155 l9 12.2 495 t4 509 l3 8.3% Pochalla 67 ll 16.4 504 l0 514 09 13.4% Pibor/Boma 8l 09 ll.l 492 l5 507 15 18.5% Longichuk 95 t2 12.6 524 07 531 07 73% Maaban 66 07 10.6 366 05 371 05 7.6Yo Maiwut 98 l5 15.3 347 08 35s 08 8.1% TOTAL 562 73 12.9 2,728 59 2,787 57 l0.loh t2 2.5. GapaciQl building Describe the adequacy of available knowledgeable manpower at all levels o Availability of knowledgeable manpower in the project is still quite inadequate at all levels. . The endemic areas are located in such a way that travelling between the 6 counties is a huge challenge especially with the predominance of swampy/marshy vegetation and with no roads. An additional project staff member at the level close to that of a PCO (that has been called a state focal person) has been assigned to cover the counties in Upper Nile state. This person will bring hopefully bring monitoring and supervision support closer to the communiry level project staff. . The County Supervisors and Payam Supervisors are relatively knowledgeable about CDTI activity implementation. . The CDDs have been trained, but still require continuous on-the-job mentoring. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. There were staff turnover especially in the frontline health facilities that are supported by NGOs. The project plans to remedy this by training the new health facility staff so that there is a critical mass of supervisors to oversee the implementation of CDTI work at the community level. l3 !!!C-5: Treining et the diffcrcnt lcvels of CDTI implementetion DiStIiCULGA Nurnbcr of Districts/LcAs strff trelncd Number of Heelth ccntGr/Dost st.If tmincd Numbcr of othcr treincrs of treinces ( TOTs) Numbcr of CDDs trlincd ATrO c, : ToEl icr . c+c,c, ATrO c. Nil iRcti c.'.c,: Toul CF c.+ G ATrO c, C,. Totrl CrF c..+ c,, ATrO c,, c. i R"f' ,. c,, ' Totd ; Cr- : Cr+CB Akobo I 0llil 6l t4 i, t7 i, 3t 3 3 74t 300 i156i 4s6 Pochalla I I I 5l l5 l,z+i 39 3 zio 2 910 300 il52i 4s2 Boma/Pibor I I 63 14 t2li 35 3 2i0r2 I,001 300 il6si 465 Longichuk I 0 I I 46 12i19i 3l 3 3 | 0 3 1,770 350 i136i 486 Maaban I I ioil 4l 20 i 18 38 3 2i 0; 2 309 260iSri3sl Maimt I 0 lil 37 09:15: 24 3 2i0 2 236 2s0i7Ei!28 TOTAL 6 2 4i6 301 74 iil4!l8E rE 14i0!14 4,967 1.760 177Ei2,538 7. Achlcvcmcnt i 100Y. 7. Achicvcmcnt i 62.40/0 7. Achicvcment i 77.7'/. 7. AchieYcmcnt : St,lY. hol thaQ h no doubl. counling t4 1 Table 6: Type of training undertaken Any other comments - None 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l00oh geographical coverage and a minimum of 65oh therapeutic coverage or the coverage rate is fluctuating, state the reasons This year, the project reached 100% geographical coverage and660/o therapeutic coverage. Plans to remedy this are: Not applicable. Trainees Type of training CDDs Community members e.g Community supervisors Health Workers (FLHFS) MOH staffor Other Political Leaders Others (specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speciff) l5 [!!S_Z: Trcatmcnt end SAEs by districUlcA in all rrcas rt risk Fomulrc forcompu[ne thcneuuc md sEo(rphrcd @ycrtec Tlsrpcutc @vcralc nE (%\ G@gnphrcd @vcrit. r.E (%\ Nuhb€r of mlc ErEd x lU) TMI poputruon Lvrn8 rh mcso/h)?cr{ndlmrc comurucs wrlhh thc proj.ct Et Numbcr of colMurlcs/vlll..cs hrrcd x 100 Tool numb.r of ms/hypcr<n&mlc conmurucs s rdcnulicd by REMO u llrc prc1cct mr ATO covcra8c rrE = Numbcr of ffilc rrkd x 100(%\ AMu.l TE.ftnt Objcc0vc % UTG rhrclcd = Numbcr of 't@lc ErEd x 100Tobl numbcr of p@plc b bc hrEi rn mcsrrypcr+n&mc Es wrlhr thc projcct mr (UTG) ATO - Thc atimcl nunba of pcopb hviag h nadhypalcair tcot tid, a CDTI ptojd idrd.k b ncc, pti Ddrutu it a giva ycor. q.dal b r.dch rhc IJTC d th. cnl olrh. ,r !.o, of rt. projd), l6 Drsmct /LGA CommunitiesA/illases Population Numbcr ofpcEons who rcfucd thc trcatmcnt Nmbc of abscntc Numbcr of comultics with < 80% thmapcutic covcragc Nmb cr of SAEs Numbcr of scnoN rdvcrc cvcns (SAEs) rcfwcd to thc hcdth post/hosprtal Totd # of commsrfucV nllegc rn tlrc mesMypcr- cndcmrc tc DI Annul Trcalmcnt Ob.;cctrvc DI Numbcr of communlte s/ulhges trcdcd Dr Gognphrcd covcragc (%\ D.= Dy' D,.l0o Total popuhnon of thc mcr'hypcr- cndcmrc sc6 D. Amuel Trc.lmcnt Oblcctrvc D. Numbcr of PCEOB trc.tcd D, Thcnpcut tc covcrtS€ (%) D.= D,/ D3'lm Akobo 155 155 155 100% 74. I 30 54,825 57,237 0 133 t07 0 0 Pochalla 67 67 67 t00% 90.966 67,173 67.958 7 5o/o 0 98 6l 0 0 Boma/ Pibor 8l 8l 8l IOOYI t00.127 70,609 71,13 '71% 0 t63 69 0 0 Longrchuk 95 95 95 lO0Yo t77.020 |7,4s3 95. I 58 54Yo 0 238 89 0 0 Maaban 66 66 66 100% 46.705 27,240 26,759 57% 0 89 58 0 0 Matwut 98 9t 98 t00% 23.625 1 9,1 85 19,016 80Yo 0 E6 39 0 0 TOTAL 562 562 562 100V. 512,573 3s6,lt4 337,241 660/0 0 807 423 0 0 2.6.2 What are the causes of absenteeism? The reported causes of absenteeism were: . Movement of people with their livestock from one place to another and thus missing treatment. o Ineffective communication between the CDDs and the pastoralist communities; treatment should still be availed to pastoral communities- . There were also areas that were inundated with floods and treatment could not be there as well. 2.6.3 What are the reasons for refusals? There were no reported refusals of treatment. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. There were no reported SAEs during this reporting period Parasitologist trained? None was trained Existence of microscope? No Has the project reported all SAEs to Mectizan Donation Program (MDPX Please tick one. Not applicable because there have been no SAEs reported. ENo lYes In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report x t7 IaD!g-E: Cescs ofscrious edvcrsc cvcnts (SAEs) thet occurrcd during thc rcporting pcriod Not applicable since there were no SAEs reported l8 SN{ Age Scx Vrllagc of orign Datc Mcctizan was taken Datc l" symptom s appearcd Symptoms Hcalth starus bcfore taking Mctian Datc of admission in hcalth facihty Datc of dismissal from hcalth facility Rcsults oftcsts (thick blood smeu) Outcomc of prognosis Exenuating or complicaring circmstanccs Alcohol rnvolvcmc nt or not 0 NA NA NA NA NA NA NA NA NA NA NA NA NA 2.6,5. Trend of trcatmcnt achicvcmcnt from CDTI proicct inccption to thc currcnt ycrr La,!!g!: Treatmcnts rnd covcragc @!g1!4.Lycer for the cntirc projcct rree UTG for the projcct rrce: 430,561 (for 2010) r+The fluctualrcn of the number of communilies rc mamly due lo decongeston oJ internal displacement setllemenls l9 YEAR CommunitieVVrllagcs Population Total # of communrncs/vtllry cs rn thc mcsdhypcr- cndcmrc uru E, Annual Trcatmcnt Oblccuvc E'. Numbcr of communltlc s/ulhgo trcatcd EI Geognphr cal covcraSc (%) E.__ EJ E,'IOO ATO covcragc (%) E- Fr,/ F,,.t00 Total populetron of thc mesdhypcr- cndcmrc ru E. Amul Trcatmcnt Oblcctrvc Er Numbcr of pcEons trcatcd E. Thcrrpcutrc coveragc (%) E,= EJ E.rl00 ATO covcrage (%) Er.= EJ F-TT|)o UTG Covaagc (%) 2006 332 150 100 30 t2 45.1 8 405,994 73,000 s4,766 13.49 75.02 I 3.52 2007 1,238 l0l0 597 48 22 8l 58 614,994 I I 9,868 136,491 22.19 l13 9 33.7 t 2008 3,t 80 t7 t6 1720 54.08 100.23 4E2,ts5 243,006 185,462 38.5 763 45.79 2009 525.. 525 520 99 I 99 I 487.939 2s9.766 273,691 56. I 105.4 66.8 2010 562 562 562 100 100 5t2,573 356. l 84 337.241 658 947 7E.3 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by: ,n*' E *n D *,"r. tr Other (please speciff): NGDO tr futrMectizan@ delivered by:*.*-E Other (please specifo) wHo tr Please describe how Mectizan@ is ordered and how it gets to the communities . Community level information is received through the payam and county supervisors to the project coordinating officer on the total population residing in the project area and also data on the usage, wastage and remaining stock of mectizan available after the cycle of treatment. . The Project Coordinating Officer then compiles all this information from all the counties under their jurisdiction and sends this to the SSOTF secretariat. . The SSOTF compiles all the data on consumption and balances available, and prepares a drug request for submission to MDP. . MDP reviews application, approves and forwards the application to MERCK. . MERCK then ships the mectizan shipped to South Sudan and it is received by WHO Office in South Sudan. . In conformity with the data that had earlier been received from the Project Coordinating Officer, corresponding amounts of mectizan is supplied from the SSOTFNGDO to the project. o At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for collection. . The Payam Supervisors on collection notify and invite Boma Supervisors to collect supplies for their corresponding communities. . The Boma Supervisors, some of whom are CDDS share this information with other CDDs and the communities. o The community members then decide on the time for the mectizan distribution to the rest of the community members. Table 10: Mectizan@ Inventory State /District /LGA Number of Mectizano tablets In stock from Drevious year Requested Received Used Lost Waste d Expired Remai ning Akobo 500 163,974 163,974 164,311 163 0 0 0 Pochalla 300 201,218 201,218 201,423 95 0 0 0 Boma/Pibor 1,560 210,266 210,266 211,690 136 0 0 0 Longichuk 400 351,060 351,060 351,340 120 0 0 0 Maaban 0 81,720 81,720 81,674 46 0 0 0 Maiwut 0 57,554 57,554 57,531 23 0 0 0 TOTAL 2,760 1,065,792 1,065,792 1,067,969 583 0 0 0 20 How are the remaining ivermectin tablets collected and where are they kept? Whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the frontline health facility staff so that they are stored in preparation for the next treatment cycle. The amounts of stock of medicines that remain are communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: o Training for both new and old CDDs within the communities before the mectizan distribution. . Issuing the CDDs with mectizan tablets and collecting/receiving the remaining balance from them for inventory and storage at the health centre atthe end ofdistribution cycle. . Conducting community mobilization and health education on OV program. . Facilitating the process of selection of CDDs by the community. o Management of any person with adverse side effects reactions and keep records of the case treated. Any other comments - None 2.A, Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. If so, When? NiA Table 11: Community self-monitoring and Stakeholders Meeting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. N/A District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN[) No of Communities that conducted stakeholders meeting (SHIvD Akobo Pochalla Boma/Pibor - Longichuk Maaban Maiwut I 55 8t 95 66 98 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL s62 0 0 2t 67 2.9. Supervision 2.9,1, Provide a flow chart of supervision hierarchy. SSOTF Task Force Project Coordinating Officer I 7 County OV Supervisors / 7 Payam Supervisors / 7 CDDs / 7 Beneficiary communities Reporting 2.9.2. What were the main issues identified during supervision? The main issues found during supervision were that: o Transportation was a crucial factor in limiting the supervision process. . Supervision checklists are still not being used across the project areas; this applied mainly to the County OV Supervisors . There are still huge challenges with having the CDDs filling in the treatment registers and summary forms correctly. . Some household censuses were not updated by CDDs. 2.9.3. Was a supervision checklist used? Not really, no evidence of use could be found at county level. 2.9.4. What were the outcomes at each level of CDTI implementation supervision? On-job coaching and supportive supervision was conducted. Data sheets and treatment registers that were not filled properly were filled in during this exercise. Communities that were discovered not to have received mectizan had an opportunity to be identified and treatnent provided as required. CDDs that were not filling out the registers correctly were helped to improve their performance. a a a 22 2.9.5. Was feedback given to the person or groups supervised? Yes feedback was given 2.9.6. How was the feedback used to improve the overall performance of the project? o On the job training was given to the staff supervised on how to update the household information, fill the summary forms and tally sheets. o Practical sessions were given to poorly performing individuals and those performing relatively better were also encouraged to coach their colleagues. o Positive peer criticism was also encouraged. SECTION 3: Support to CDTI 3.{. Equipment Table 12: Status of equipment *Condition of the equipment (F:Functional, CNFR:Cunently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? If integration of the CDTI activities into the government PHC was to take place as desired, the state MoH would ideally maintain and replace the existing equipment through the counterpart contribution to the project. Since this is not yet a reality, then additional support may requested from the NGDO partner or APOC. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtion No Condition No Conditron No. Condition No Condrtion l. Vehicle I F 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 4 F 0 NA 0 NA 0 NA 0 NA 3. Computer(s) I F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) I F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) I F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others a)Bicycle l0 F 0 NA 0 NA 0 NA 0 NA b)Metallic Cabinet 4 F 0 NA 0 NA 0 NA 0 NA c)Metallic trunk 4 F 0 NA 0 NA 0 NA 0 NA 23 3.2. Financial contributions of the partners and communities Filltables l3a, l3b and l3c If there are problems with release of counterpart funds, how were they addressed? This is not yet applicable since there are not yet funds being received from the government to directly fund the implementation of CDTI activities. Additional comments - None. 24 Celender YEAR being rcported 2010 covERI{MENT contrlbutlon BUDGEI LINE Budqet.d Amountr dlsburs.d et th! tollowlng l.y.ls Natlonal Rcglonal Oistdct Tot l % dlsbursad NGDOs - CBM Loc.l NGOO3 Communl tl.3 Oth.rr l- Moblllz.Aon, advoc.cy, s.nsiilzruon et he.lth aduc.Uon 1.1..-V_o!llEtiCA 1.2. Sensitrzation____- 1.3 Adyo_cac.y 1.4. HBalth edu€tpn SuEao,ril 0.00 0.q0 0.00 sqq 0.00 0.m 0.00 0.00 -N4N/A d.m -d.oo 0.m 0.00 Cdo {tii.ai -- {tt-tn 0.00 0.00 0.m -0.00 000 .0.0q 0.00 000 g.qq_ 0.00 0.00 0.00 000 .9.0-o 0.00 N/A 0.00 000 0.00 0.00 0.00 0.00 0.00 N/A 000 000 000 0.00 0.00 N/A 0.00 0.00 0.00 0.00 9,EE7.Ot It- fr.lnlno 0.98 0.00 0.q0_ q0q 0.00 0.00 000 - onit 000 000 -- -..o-oit -- i4.66625 - - -o5o2.'t Training/retrarnrng of CDOS 2.2- Trainino/retrainrno of Health mrkors 0.00 0.00 N/A 5,937.00 0.00 0.00 0.00 0.00 N/A 3,000.00 0.00 0.00 Sub-totzt tt 0.00 0.00 N/A 4,937.00 0.00 0.00 '!4,686.25 ttt. Suocruislon, monftorlno, Ey.tu.Aon ._3_a.i4o.nitonng-- 3 3. Evaluaton 0.00 9_0q 0.99 0.00 0.00- 009 0.0q 0.00 0.00 000 0.00 . . _._ 8.0q 000 - - b.to N/A 900 00 0.00 0.00 0.00 0.00 000 0.00 7,610.40 0.00 000 746 00 0.00 0.00 0.00 ---' ' -it.-oo - -t"6iit.ai,0.00 0.00 N/A 0.00 000 0.00 Sub-tot l ttl 0.00 0.00 N/A 1,646.00 0.00 0.00 lV. lvcncctln disaribuUon .nd m.n.gcment of savarc adtterea avanb 0.90 0.00 ar.bb 000 0.00 0.00 000 . - -.-, -0.9-o 0.qg 0.00 - - oo0 -' ' io,ooo oo 0004l.lvemec1in 42 0.00 N/A E,285.00 0.00 0.00 000 0.00 N/A 000 000 0.00 000 0.00 0.00 N/A 8,385.00 0.00 0.00 0.00 7,433.20 900 7,833.20 00 00 0 o 000 1,q3,3.?9 000 7,E33.20 '- - '- 'o,oo "-"'ono ' -'- b.-dii s:l: qqb!l8_s_, Sub-tot l V 0.00 7.833 20 't00% 0.00 000 000 0.00 0,00 N/A 0.00 000 000 0.00 7.E33.20 100% 0.00 0.00 0.00 GRAND TOTAL 7,833.20 0.00 0.00 7.833.20 7.833.20 100'/. 18,968.00 0.00 0.00 0.00 83,423.98 Teble l3a: Financial contributions by all partners for the last three years OTHER APOC Trust Fund 26,640 00 41 25 Teble l3b: Financial contributions by all partners for the last thrcc years (continued) 26 One (l) ycar prcvious to Celcnder YEAR bclns rcportcd 2009 GOVERNiIEIIT cont lbutlon OTHER p.dn.E dltbuE.m.nt BUDGET UNE Budo.l.d Amounb dlrbur.d at lhr tollowlng bvrlr N.tlonrl Rmloml Dhtrlc.t Totrl % dl3buncd NGDO. LocrlNGEO! communl U.3 O'th.r APOCTrurt Fund t. Itobitinfion, adyocacy, s.nsfth.Aon .t h6.lth cduc.Aon 1 3 Advqgacr. 1.4. Health_ eduetion Su6.rotril 000 0.00 0.gq Lqq 0.00 o30 -l'oo o.oo -- -o oo 000 0.00 q00 0.00 ono 000 0.00 0.00 000 N/A - r'i/A -N/A 0.00 0.00 0.00 - 2JiOI)O -- lrnLco - -ir,66b-.oo 0.00 000 0.09 -0.990.00 000 0,00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 N/A 2,480.00 0.00 0_00 0.00 0.00 0.00 N/A 2,/tE0.00 0.00 0.00 0.00 7,062.00 tl. Tnlnlns I 0.9_ . 9.0! 0.00 0.00 0.00 - - b.oa, 0.00 000 ---0.0d - iO,26o-Jo2.1. Trainrnq/ret aininq ot CDOs 0.00 0.00 N/A 6,650.00 000 0.00 0.00 22 fryininghelraining o, H€alth workors Sub-aoaal ll 0.00 000 NiA 3,485.00 0.00 0.00 000 11,4m.50 0.00 0.00 N/A 't0,135.00 0.00 0.00 0.00 30,6E0.50 Itt. SuDcryislon, monftorrnq, Ev.lu.aon 3.1 3.2. Mon(onna 000 000 000 0no 000 000 000 b.bo 0.00 0.00 000 N/A 0.00 0.00 0.00 0.00 4,398.00 0.00 0.00 0.00 0.00 -' ort' N/A 0.00 0.00 - oo- - 'o-oo 000 0.00 1,400,00 3.3. Evaluation 000 0.00 N/A 000 0.00 000 4,500.00 Sub-tot l til 0.00 0.00 N/A 0.00 0.00 0.00 9,29t.00 lV. twrrmcdn dlsdbutlon .nd m.n.gcmcnt avan s 9.00, 0.00 0.oo 0 qg_ 0.00 ri.oo -..._ .09q -_ _ qsg 0.00 - -'6-dt '----'ooo "-oJo 0.00 0.00 N/A 6,854.00 0.00 0.00 24,998.00 4.2. Management ol Severe adverso ovents 000 0.00 N/A 0.00 0.00 0.00 0.00 SuLtotal M 0.00 0.00 N/A 6,E54.00 0.00 0.00 24,99r.00 V. Addiuonal cxp.nscs 5.1. Salarl6. 8266./t0 0.m 0.00 6,266./t0 6,260.t0 100'6 0.00 0.00 0m 0.m 19,7,.0.m 5.2. Eouiomnt o.m 0.00 0.00 0.m 0.00 N/ 0.m 0.00 0.m 0.m 2.870.00 Sub-tot l V 6.266.a0 0.00 0.00 6.266.40 6.266.40 100t/. 0.00 0.00 0.00 0.00 22,610.00 GRAND TOTAL 6,266.40 0.00 0.00 6,266./t0 6,266.40 100,/. 't9,469.00 0.00 0.00 0.00 9a,64E.s0 1 :l Moq!!zeg9!--- 1 2 Scnsitization 200tTwo (2) ycers previous !q arD A D hrlnc GOVER}{HENT contrlbutlon BUDGET LINE Budo.t!d Amount! dlrbun.d .t th. follwlng l.v.ls Nrtional R.qlonel Dlstrlet Tot l % dlsbursad NGDOr LocelNGDO3 Communl Uor Othrr. t. zdvocacyt, sa ns ita$on et hczlth '1.1. Mobihztron 1.2. Sonsitizaton '1.3 I 0.u) 0.00 g@ 0.(x) _q.@- 0.00 0.00 0.00 N!] N/A o.oo -ooo...__,0.m 0.m 3,125.00 0.00 0.000.00 0.00 0.oo s.q.0. 0.00 0.00 0.qq 0.00 0.00 0.00 _ -049. 0.00 N/A 0.00 0.00 0.00 000 000 0.00 0.00 0.00 N/A 1,250.00 0.00 0.00 2.265.00 0.00 0.00 N/A 4,375.00 0.00 0.00 0.00 7,130.00 ll. Tnlnlno 0.00 0.00 o:bo .0 q0. 0.00 d.rto 000 0.00 b-Jo 000 2.1. Trainlnq,/retrarnrno ot CDDs 2.2. Trcininaheuai^inq of Hsalth rcrkors 0.00 0.00 N/A 9,375 00 0.00 0.00 1,035.0o 0.00 0.00 N/A 0.00 0.00 0.00 0.00 0.00 0.00 tt 0.00 0.00 N/A 9,375.00 0.00 0.00 Itl. SugcMlslon, moniloring, Evduaaon 3.1 32 q.99 q.09 .0,_0.9 0.00 q 90, 0qg 0.9q 0.00 0.00 0.00 - __-.- ___0.00 -0_Q9 000 -- "'b-50 N/A 000 000 - -o.do - --'bno -- b-.dit 0.00 0.00 0.00 0.00 0.00 N/A 0.00 0.00 0.00 0.00 0,00 0.00 N/A 0.00 0.00 0.00 000 0.00 0.00 N/A 0.00 0.00 0.00 0.00 lV. ty.m.ctln disarlbuuon ,nd m.n.g.m.nt of savua ady.Bc avants 9,99 0.00 b.iio 0. q0. 0.00 o-.oo -- -q-rl 0.00 -- --o.ooof adversc 000 0.00 6,250 00 0.00 - ..- b.dt -----o.oo 0.00 0.00 12.000.00 0.00 0.00 N/A 0.00 0.00 000 0.00 0.00 0.00 N/A 6,250.00 0.00 0.00 v. Addiuon.t cxD'ns.s s,qsi-qs - 09q 5,953.0E 000 ooo 0.00 _,5,9!9_q_8_ 0.00 5,953.0t 0.00000 5.953.08 1000/" 000 0.00 0.00 0.00 0.00 N/A 000 0.00 000 000 32,000.00 0.00 5.953.0E 100./. 0.00 0.00 0.00 0.00 53,5/t0.00 GRANO TOTAL 5.953.08 0.00 0.00 5.953.08 5.9s3.08 100L 20,000.00 0.00 0.00 0.00 73,705.00 Teble l3c: Financial contributions by all partncrs for the last three years (continued) 27 APOC, Trurt Fund ga9 1,035.OO Str,5-ad.zl ltl Suh-tot.l lV 5 1 Salaries 21,540.OO 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) o Training venues . Collection of mectizan from the health facilities . Provision of meals for the CDDs during treatment time 3.4. Expenditure per activity Indicate in table 13, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here_2.8 SDG Any comments or explanations? None SECTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year I 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? Not applicable 4.1.3. How have they been implemented? Not applicable 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? _N Was a sustainabilif plan written? _No When was the sustainability plan submitted? _No a 28 o What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels - No plans made yet 4.2.2. Funds - No plans made yet 4.2.3 Transport (replacement and maintenance) - No plans made yet 4.2.4. Other resources - No plans made yet 4.2.5. To what extent has the plan been implemented - Not yet applicable 4.3. !ntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms The Ivermectin delivery mechanism used now is that: . WHOiAPOC in collaboration with SSOTF deliyers the mectizan to the state ministries of health, . The Project Coordinating Officers in collaboration with the state ministries of health are then responsible for releasing the mectizan to the County Health Department stores. o From the County Health Department stores the mectizan is then dispatched to frontline health facilities in the Payams. o Most Payams in the project area have health facilities, so there were no instances of having the mectizan kept outside the health facility. 4.3.2. Training: In regards to training there is willingness of other programs to cooperate. These include EPI (Expanded program on Immunization) and GW (Guinea Worm Eradication program). The final implementation needs to be finally planned and executed. 4.3.3. Joint supervision and monitoring with other programs This is not yet happening. 4.3.4. Release of funds for project activities There were no funds released from the PHC system 4.3.5. Is CDTI included in the PHC budget? Not yet. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . Fill tables l4 and l5 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc...)? a a 4.3.6. 29 Explain what are the combinations of interventions co-implemented? There is no clear arrangement for co-implementation yet. How were the interventions implemented? (At the same time) The interventions are not implemented at the same time. The different programs utilise the same persons in the community to implement the programs. 4.3.7. Describe others issues considered in the integration of CDTI. This is not yet applicable in this project. 30 Table l4: Co-implementation This did not happen in this reporting penod. Type of control Typc of i ntcrvention Rolcs pleycd by CDDs (cxplain in balll poina) Numbcr of di!tricts Numbcr of communitis Numbcr ofCDDs involvcd Numbcr of pcrsons trrgctcd Trrgctcd Rachcd frrgctcd Rcrchcd Mrlcs Fcmr las Tolrl Mrlcs Fcmrlcs Totrl Mrlcs Fcmrlcs Numbcr rcrchcd NB: lhe nterventions hsted ,n the table are luslJew examples 3l Table l5: Other programmes using CDI structure There are no programs using the CDTI strucnrre yet. Typc of control NB: the mterventtons hsted m lhe lable are Just few examples "\) Typc of intcncntion Involvement of communities in Phoning SHM Implcmcntrtion Moniloring csM Rcporting Provision of relourccs ectivitics pcriod modc sclcction of implcmcntcr s collcction of commodit lcs stongc of commodit ic distribu tion supcrrls ton In kind finrnci rl a a 4.4. Operational research 4.4.1. 4.4.2. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. None has been done. How were the results applied in the project? Not applicable. SECTION 5: Strengths, weaknesses' challenges, and oppofrunities Strengths: . There are a number of international NGOs in the area and community based organisations that are willing to work on CDTI activities. o There has been a number of newer government health facilities opened up in the project area. This will increase the number of FLHF and possibility if staffed will increase staff working in CDTI. Weakness: . CDTI integration into PHC has not begun. . Lack of staff especially at the community level to implement the CDTI work. . The available number of CDDs is still inadequate. . Poor record keeping at the community level Challenges: . This is the most challenging place in Southern Sudan. There is prominence of swampy/marshy terrain and road movement in impossible in the rainy season. Majority of work to be done in the dry season. . The literacy level of the community members especially the women is quite low leading to poor quality work at the community level. Constant on the job training and mentoring to continue. . Record keeping is a challenge. It's as a result of low literacy levels and lack of appreciation of the need to keep records. Continuous mentoring will be done to ensure that this improves SECTION 6: Unique features of the project/other matters No additional information to report on. - JJ