West Bahr El Ghazal CDTI annual technical report to Technical Consultative Committee(TCC) : January to December 2009

It_ UPPER NILE (UN) CDTI PROJECT w h o u np r oiect@gmail. co m I I I I I I I I _l a ORIGINAL : Enslish DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC rneeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) RECU LE Rgporting Period: Frorn: January 2009 To: December 2009 (N{onth/\'ear Month/Ycar APOCfundinsvcar: (circleone) I 2 3 (4) 5 6 7 8 9 10 11 12 13 APOC Proiect inrplernentation t'car report: (circlc one) I l3 Date submitted: Partners: N4inistrv o1'I Iealtlr Afl'ican Prograrnrnc lbr Onchocerciasis Control 1r\l'OC'; ' N'lectizan Donation l)rograrn (N,tDP) Christo fl-el Blinden N{ission 525 conrurunities ANNUAL PROJtrCT TECHNTCAL RBPORT SUBMTTTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) 2 3 (.r) 5 6 7 8 e r0 l1 t2 Snd-tdr@M$rs F.:r .fi"e**rr fcrl ftklr nr i",:r l${'irm.;;tho'rt Tor .LrR F g"hr,i U v COUNTRY|NOTF: Southern Sudan Proiect Name: Upper Nile CDTI project Approval year: 2003 Launching year: 2006 0 ? rgY. 2611 APCC/1.,t,< WHO/APOC, l4 Septernber 2009 ANNIJAI, I'[T().I F,CT'I'E,C }I NICN I- RIiI'()R'I' ,r'( ) l'I.:CllNIC]n I- CONSI. rl.T,\'l lVIr COMMI'l"l'liU t't ( C) ENDORSE,MtrNT Pleasc confirm )'ou havc reird this report b),rigning in thc a l)pro1l riirte sl)ace. Ol''FIC I',ltS to sigrr thc rcJlort: L'orrn( r'r': Soul ircltr S rrrlatn National (lourdirratr)r' Nirnrc: Dr. Vlorinir' ('h:-isttr [-ugga /.t>nlrl ()rrcho Coordirlrtrlr N:rnrc: L'Jrol []tlth - \iiSigrrltin'e: . l. ll,\--',$ft l)lrl.c: i l'' .t,,,',,,,,,i.-11, i', .8..'-- .,-J:3'- g-sr--Si-ertatLrrc A1* [)atc. i l'' .lili]r,rrr \ 20I I N( i tX) IlcpLesr:ntul ivc Nirntc: l'irsil ('lr.trrc i*: SigrraLLrru; . W{"t- l)aLc: 3l'' Januarr' 20I I -l his rcpot-t hns bccn prcpiu'ed b1, - Nrrrrrc: C'hol Ilotiifi. l)csiqnutron P c,t) +g- S rgrrat Lrr-e 3ls] Tl:*:y ,)-0 \ I \,\ l l() ,\PO(. l-.i \r'trlcll)bcr )()i)!) [ );rtc Table of contents ACRONYMS. DEFINITIONS. FOLLOW UP ON TCC RECOMMENDATIONS. EXECUTIVE SUMMARY SECTION I: BACKGROUND TNFORMATION V VI ...2 ...........3 1.1. CjgNeReltNFoRNL\t'toN................... I I I Dc.sc'riptiott o/-tha projac't (briafl1,) 1l) Purlner.sltilt. I .2 Popt rt-ATIoN....... SEC'TION 2: IN'IPLENIEN'I'ATION OF CD'l'l 2.1. 'l-lNlt,r.rNt.- oF.\('Tlvt't'il:s .. ......... ... I 2.2 ,,\Dvo(',\('\ ..i0 2.3. NIogtt-lz,rTIoN. sENSIlrzA'noN .tNDr gn,-rr.TII L,DLrc.\TION ot- ,\T RISK coNINIt rNt I IIrs I 0 l.l CoirtirttrNtrylNvot.\,trl\tENl.. ...12)5. C,rPaclryuutLDINC... li 2.6. TReet'lrLrN'rs.............. . .... 15 2 6 I Treutnrcttt.figuras ... 15 2 6 2 l[''hot ura thc cuu.scs of uh,suttcci.snt? . l- 2 6 3 l['ltul ure tlta rau.sorts'.for rc.fil.ruls'?... .17 2.6 1 Bricflt'dcsc'ribc all knotrrt atrclvarifietl serious utlversc ct'ent.\'(St1li.r) thut . l- 2 6 5 T'rend of'treatntenl achieternent fi'ont CDTI projacl ittcaptrort to llrc currcnt .t'aar l92.7. ORnsRrNc. s'roR,\GE AND DELIVERI oF TvERNIECI-rN ........ ...........20 2.8. Colrtrtunrr'\'sELrr-NToNIToRING AND STAKEHoLDERS MeerrNc ........... ..21 2.9 SupERvrsroN........ ...........22 2 9 I Proyide a flov'clrurt of-superyis'ion hicru'chy 22 2 9 2 l['hul v'cre lhc ntaini,s.siles identi.t'ied cluting.s'ultcrvi,tionl . . 22 2 9 3 I'l/us tr supe rrisiort chacklist used? 22 2.9 I I['httt werc lha otttcontes ul auclt lcrel o.[CDTI intplentcntutirttt.supcrri.ston) 22 2 9.5 lt"as /bedbac'k grve n to thc parson or grottps supervised? 23 2 9 6 Hotr v'us thc./icrlback used to improve the ovcrull pcrfornruncc of the prof cct'? 23 SECTION 3: SITPPORT TO CDTI 3.1. EqurrlreNr 3.2 F INeNcrar- ('oNTRIBUTToNS oF THE pARTNERS r\ND coN,tNIUNn-rrrs 3.3. Orunn Fonr\rs oF coN,tNruNn-\' suppoR't............... 3.-{. ErpENot't r rRE PnR Acrtvtry SECTION 4: SUSTAINABILITY OF CDTI.... :1. I. INTERNeL: INDEPI]NDEN.I PAR.fICIPAloRv NloNI.foI{INc: EvaLuaI.IoN 1.1 I [Jo,s tlte projcc't t'vcr becn evaluatcd,,ntonirored'? (T'ic'k um' of tha lbllov'ittg whic'lt urc apltlic'ublc) Erreur ! Signct non difini. 1 I 2 ll'hul y'ere tha recornntendatrons'? 28 1 I 3 llotr hayc tlrcy hecn intplemcntetl2 28 1.2. Susr'.qtNrrsrLITv oF I,RoJEC'ts: pLAN AND sET TARGE'fs (NIANDAToRv At'.... ..... . . 28 _) J I 6 tt lll WHO/APOC, l4 September 2009 ...23 23 21 28 28 28 Yn 3) 4.2.1. Planning qt all relevant levels... 4.2.2. Funds. 4.2.3 Transport (replacentent and maintenance) 4.2.4. Other resources 1.2 5. To v,hat exlenl has the plan been implemented 4.3. lNrecRerroN............... 4.3. 1. Ivermectirt delivery mechanisntt........ .1. 3. 2. Training. 4.3.3 Joint supervisiort and monitoring with other progrctnts ddfini. 1 3.1 Releuse o.f.funds./br project actit'itias... . ... Erreur ! Signet non ddfitri. J i 5 Is CD7-l rnclucletl in the PHC budget'/ . ..Erretrr ! Signet non ddfini. 1 3 6 Dc.scribe other ltealth trtrogranrnrcs lhat ore using the CDTI .\tructttre and hotr llti.s trtt.s uc'ltiavad trl''hut hut'e be cn lhc uchicvamutt.s'? 29 J 3 - I)a.tc'ribe othcrs i^s.racs crtrt.siclercd itt llte irttetlrelion rtl ('D7'l -10 J.-l Ot,lrtr..r I'toN.\t- I{I-sUARCIJ . . . 3i 1 I 1 ,\'tttrtrtttu-tza ut tlol tttrtre lhun one hul.l'ol u l)ugc llta oltarultortttl ra.sattrclt utttlcrlLtkart ttt tltt' projct't urau v'ithirt tlrc raportitw pariocl jj 1 I : I {ott trarc tlta rt.strlt.s appliad itt the pt'o jcc't'/ J-, SECTION 5: STIlliN(;'tllS, WIIAKNESSES, CHALLENGIiS,-ANl) OPPORTUNITIES SECTION 6: tTNIOUE FE..\]'tll{Es OF ]'llE PIiO.IECT/OTI{ER NIAT'I'El{S 33 IV WI{O/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI C]SIVI LGA IVIOI.I NGDO N(i() NOt'L' I'I I(' RENIO SAII SI INI T'CC t'( )'t' LlNlCBl' TJI'G \fu,I IO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Comrnunity-Directed Treatment rvith Il'ennectin Comnrunity, Self-Monitoring Local Goverrunent Area N'linistn' ol'Health N on-Ciovernrnental Deve Iopment Orqan izi.rtion Non-(iover-nureutal Organization National Onchocerciasis -['ask Force Priuran' hcalth care li.aprd I iprclern io I o gi ca I N'lappi n g of Onchocerc ias i s Severc adverse cvcnt Stakeholders urectiug 'l'cchnical Consultativc C'onrntittee (r\I']()(' scicntitic advisorv groLrp) J-raiucr ol trainers United Nations Cltildren's liund Llltirnate Treatment (ioal World Health Organizatiorr WHO/APOC, l4 Septernber 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities rvithin the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84oh o[ the total population in mesoihyper- endemic communities in the project area (iii) Annual Treatment Objective: (ATO): the estirnated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat rvith ivennectin in a given vear. (ir'; UltiInateMcalculatedastltctrlaxitnumtrutllbcrtll people to be treated annuallv in ureso/hvper endemic areas rvithin the pro.iect area. ultimatelv to bc rcached n,hen the project has rcached tull geograpltic coverage (nornrallv the project shoulcl lre expected to reach thc UTG at thc end of the 3''r r car ol thc prtr.icct) (\') 'lltcrapg4!! ,r!rq sc nurntre r ol- peoplc- trcatcd irt a givert \,car ovct' thc total population (this shoulcl bc erprcssed as a perccntaqc) (r'r) Ceographical coverage : nunrbcr of'clrn.rrnunitrcs trcatc'd in a given rear ovcl thc total nLrrltrer ol nrcso/h\'pcr-cndcuric conrnruuities as idc-ntif rcci bv RElvlO in thc prtr.;cct arca (this shoulcl bc crpresse d as a pcrccntage). (r'ii) [rrtcgration: delivcrrns additional healtlr interventions (i.c. r,itarnin A supplerlrents. albcndazole for I-F. screening ftrr cataract. etc.) through CDTI (Lrsing thc samc svsteurs. trairrinu. supcrvision and persclnnel) in order to rnaxirlise cost- cll-ectiveness and empo\\er courmunities to solve rnore of their health problcms. -l-his does not include activities or interventious carried or.rt bv cornrnunity distribLrtors outsidc oi CDTI. (r'iii) Sustainabilitr': ('l)l-t actrvities in un area lre sustainrrble u,hen thc,r, ct.r,r,;rt',a ,a fuuction cll'cctir,elr for the fbrcsecable fLturc. rvith high trcatrncnt coverage. rntc-gratc'd into the availablc hcalthcare service. u ith strong conrrnunitl' ou'nerslrip. tusing resourccs nrobilised bv the coururunitl'and the governmeut. (ix) eommunitl' self-rnonitorins (CSM): -fhc process b1' which the corlrnunitv is emporvered to oversee and rnonitor the perlormance of CDT I (or any cornnrunity- based health intervention prograrnlne). ri ith a vierv to ensuriug that the progranrnre is being executed in the u,av intcnded. It cncourages the cornrnunitl,to take full responsibilit), of iverurcctin distribution and nrake appropriate urodifications uhcn Iteccssar)/. vl WHO/APOC, l4 September 2009 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 29 CSM and SLIM sliould be included in routinc CD'tl training and collllllellced as soc'ln as the securitv sil.uatiorr rrnrts Numbcr of Recomnrendatio n in the lleport TCC RECOMMENDATION S ACTIONS TAKEN BY TI{E PROJECT FOIT TCC/APOC ]\TGT USE ONL}' (i) 'frain CDDs u,ell to erlsure that thev givc the drug correctl_\' bv height. and on the CDTI philosopht'to reduce the expcctation of incentives or emplor other innovativc u'aYs like using sanrc 1-rcople tbr paf ing and non- pa1,ing cor-nrnuuitv initiatives Ilnsure monitoring checklist is produced in adequate numbers and is used Additional ToTs rvcrc trained ancl the old ones relieshed. CDTI philosophr uas stresscrl as a nra-jor conrll()r'lcnt lirr thc CDD trairring. AdditionaI a\\ a[eltcss creation has bccn givcn to the alrcaclv existing CDDs so that thcr tunderstarrcl thc CDl'l plr ilosophl . 'l-he Ituttttrcr o l- t'DDs has also bc'cn increased so that the rr'orkload becornes relative[r, lessened. (rr) N'lonitoring checklists u'cre pnrdtrccd arrd thc slalTs are using thern. (rir) CSM and SHM has been rncorporated in routine CDTI activities and st'rrne cornrnur.rrties did CSN{ and hetd SHMs. WLIO/APOC, l-1 September 2009 Executive Summary This report is of the CDTI activities implemented in the Upper Nile CDTI project, fronr January to December2009. The project is in its fourth year of APOC funding. The project is also being supported by CBM, an International NGDO that is part of the Southern Sudan Onchocerciasis Task Force. The total population served by this project in 2009 rvas 487,939 and it had a UTG of 409,869 and an ATO of 259,766.11covered the 2 states of UpperNile and Jonglei and 6 counties and it had the responsibility of providing treatnlent ri,ith mectizar-r to 52,5 comrnunities. 520 communities rvere trcated rn this reporting period. giving a geographic cuverage ot'999',r A total of 273.691 persons received mectizan treatment during this reporting period. 1'his treaturent figtrrc represeuts a therapeutic covcrage of -5(r.101,. U'l'G coverage o1-66.89,i, iincl z\TC) coverage of 10,i.-+9; I'optrIatiolt tnolc'tnents in tlie I'eportirtu pcriocl \\'lls arc nrainIr' clrrc to retrrrnecs rnto thc pro.jcct area tiom the peoplc that had bccrr in couccntratecl in lntr-nrirl displacentcnt scttlcnrcnts fb[[oriing I'ears ol'conllict ancl flood c]erastation rn tlie prast. A total of l.-120 CI)Ds \\,clc trained tiut ol'an A'lO of 1.108. hring dol'n thc (ll)l)ipo;rulatiorr ratio to l:34-l as cornpared to the l00tj ration ol'I:1.26-5. In adclition. a total of ]3t) health rvorkers un,ere traiued in 20()9 A number of challenges \\'c're laced and nrajor ones inclr.rdcd: . Still a number of CI)-l'l pro,ject staffs arc still not vet on go\emnrent pavroll. IIor,vcver. discussions are still ongoing u'ith statc MoH authorities and there is anticipation that this will occur rvith tirle. o Data management is still an issue. Maintaining a good record of CD'l-l activitics by'the CDDs and also sonrc ol'Supervisors is still a problern. All County' and Pa.v-am \vere constantly, remindcd of tl-re irnportance of good data management and asked to closelv supen,ise the CDDs on record keeping. o Getting project supplies delii'cred still rernains a big challenge - thc medicincs zind training materials har,'e to be airlilied to the project site bclore the rains begin. If this rs not done belbre the onset o1'rainy'seasou. then it becoures virtualll,in-rpossible to have supplies delivered because of the tc'rrain in this area. 2 WHO/APOC. l4 Scpternber 2009 SECTION 1: Background information 1.1. General information 1.1.1 Description of the projcct (briefl1') Geographical Iocation, topographl', climate The Upper Nile CD'fl project is located betrveen latitude 5'N and 11'N and betrveen longitude of 29"8, and 35"E. It is sitr"rated in the Northern section of Southern Sudan and borders u,ith Ethiopia.'fhe project co\rers the tr.vo States of Jonglei and Upper Nile: the counties of Akobo. Pochalla. Boma. LongichLrk. Nlairvut ancl N4aaban. fhe Uppcr Nile CDTI pro.iect Iies in 3 ecologiczrl zones.'l'[tc uestern part is a l'lood prone zone: the southern part is mainlv snvannah ri'ith clal soils and the castern part along Ethiopian border being rclativelv a hilli'arca.'fhe elstcrn l)irrt is a corrtinuation olthe Ethiopian plateau rvitlr lhst llouing rivcrs and strcanrs and hcnce sLritablc sites firr ,\irttrliunt vcctor [rrcccling 'l-he []onra plate-au to the south is nrountainous aud volcanic in origin.'l'hc Pochalla..,\kobo and I(ahad rivcls clrain this LIppcr Nrlc rcsion 'l'hc raiul scason in thrs area begins rn N,lav aud cnds in October: rrith thc dr1'season lasting liorn Novernber to April. The fhrnrrrrg activities start \\ith the onsct ol'thc rains 'l'he arca has an annual rainlirll ol'8()() - 100() nrillimctres or ur()rc iu the savannah areas and thc Boma plateau. Floodiug is conrmon in tlic llood prone areas clue to the thst llosiug rircrs ll'onr thc lithiopian higlilands.-l'he Bonta highlands arc charactcrizcd bv mcdiurn \\'et scasons that are cooI ancl rainlall varics liour 600 - 1000 rnillirnetres. During the dn,scason. the main subsistcncc- activitf is fishing along the rivers. their tributaries and the nrarshr areas. l'opulation: activities, culturcs, language Tlie total population at risk of Onchocerciasis inf'ection in thc Upper Nile region is -187.9i9. With the returnees coming in fi'orn Keuva. llthiopia, Uganda and North Sudan and other population lnover-nents rvithin Upper Nile. the at risk population keeps fluctuating. 'fhe Upper Nile CD'l'l pro-ject area is hotne to Nuer, Mr-rrle , Anl,uak and Dinka. Nuer poulation fbrrls the rnajoritv of the inhabitants in thc project area. -lhe activities of nia.ioritl'o1'thc people in tJpper Nile include cattle keeping. subsistence larrning. hunting and fishing. Communication systcms (roads...) Accessing the Upper Nile region is through Juba and Rumbek in Southern Sudan or through Ethiopia by'air. -l'lie road inlrastructure ranges from verl'poor to non-existent. trar.'el by road is only possible during the dry season. In rainy'season the majority of the project sites can't be accessed. only'the county headquarters and surrounding villages can bc rcached. N,lovement is much easier during the dry season. u'hich lasts from Nr-rvember to Nlay', hcnce the need to target nrectizan distribution during this period. WFP flights operate in the rcgion and ['acilitate lnovernent of health rvorkers in difficrent parts of the regiou. N4otor boats aud/or calloes can also be used to access the communities along the rivcr banks.'l'his pro-ject is situated in an area that has the rnost cliallcnging terrain in Southern Sudan. Administration structu rc The adrninistrative structure in Upper Nile like in anv othcr part o1'Southern Sudan is dividcd into state. count\'. Payam and Bonra. The Borla is the lou,est level ol sor''ernment administration. The state is administered bt' Governor. count\ L-rv u 6r.,r',,-,ry Comruissioner. J WLIO,/APOC, l4 Septernber 2009 Payams by Payam Administrators and Bomas by Boma Councils. The project covered 6 counties of Longichuk, Mair,rut, 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) The Government Primary Health Care system is the rnain health service delivery system in 1he project area. There are also some NGOs running sorne olthe health facilities in the area. However, drug stock outs and lack of medical equiprnent and supplies chronically affects most of the health facilities. There are a total of l12 health facilities in the project area 82 Primary Health Care Units (PHCUs), 23 Primarl, Health Care Centres (PHCCs) and 7 rural I{ospitals. Numbcr of henlth staff in projcct arca and nurnbcr of health staff involvcd in CI)'tl activities. A total ot297 (3-5.3oztr) out ol'842 health statf in thc prqect arca \\crc involvecl in ('l)l'l activities. 'l-he break don'n is shou,n belorr'. Tahle l: Number of hcaltlr staff involverl in CD'l'l Count\'- LGA Nuntbcr ol hcalth staff involvcd rrr (-l)'[ I activitrcs. 'l'otal Nunrbcr of health stal'l'in tlrc entire llrojcct:rre:r Nunrber oI hc:rlth -staf[ involvcrl in('I)'t'l I)crcentirgc B tl Br=Brl I], ' 100 Akobo 200 .18 21 Pochalla 58 5(r 96.6 Bonra 160 46 28.8 Longichuk t -18 .10 27.0 Maaban li0 146 6_S 50 2 8.8 Maiu,ut ,1) Total 842 297 35.3 1.1.2. Partnership Indicatc the partners involved in projcct implementation at all levels The partners involved in CDTI activities in the Upper Nile CDTI are the 525 cornmunities, health facility service delivery staff. though still weak and requires signilicant improveurenl. the NGDO - CBM and WHOiAPOCI A number of NGOs like Nile Hope Development Forum (NHDF) in Akobo, International Medical Corp (lMC) in Akobo. Christian Mission Aids (CMA) in Dajor and Relief lnternational (RI) in Maaban provide their health statT to assists in training of CDDs and also in supervision of distribution as well as dissemination of infbrniation. Describe overall rvorking relationship among partners, clcarh, indicating spccific areas of project activitics Despite the huge challenges I'aced q,orking in this project area. all the partners are rvorked tor.r,ards meeting the CDTI objectives. Partners.yointlv carried out cornnlunity mobilization. 1 WHO/APOC, l4 September 2009 health education, training and mectizan distribution. The project staff conducted planning meetings and advocacy sessions in conjunction with SSOTF and NGDO. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The CDTI project planned and implernented the conductiou of advocacv rneetings. The meetings were held rvith State, County and decision rnakers and NGOs to assist in the implementation of CDTI actil'ities. The states Ministries of Healtl-r rvere also contacted through the Director Generals on the need to have the CDTI progranl and staff integrated into the Ministries of Health services of Upper Nile and Jonglei states. 5 \ /HO/APOC, l-1 September 2009 o al L ci -o E C) o-o <f U o o. o :E () o. o() ()Q. :! 0) Q.jp ocd Q'o 0)! o-o:/. 9,frl F (Jv ^O -a ar) a' ,= C- 7r t ., '-)3L.= - t ---,,L_ aD= -C) i a'Z -.=- Ud OCa eo_2eE o tro}jaaa -Oi.d'Jta > u.= CJ '=. .r.t QlatP -'-_o boy-o = ot- \ a'aO'- cr c,t o1 L))e -a 6 qr6: e)=Ei^a, bo", >trqc-, aE! L o-r .Yc! bJi : *.tI I I I I I l I i I '5 0) o.a (.)(.) ! o a !q) o I I I I I I I ^l -u1 UI !a)d_tq: -.o x o.9 -a or) E 6-1 P! -c, L-i s(J (H ol ulOI :l)l 61 ul ,^u .- <) li: :-() >QDr'. z(H .. 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(d EA O bo J -o a z. -] 3 F O CI L o _o o o o a =Q o o- o I 0) 0,) bo 0) o -o (f) (n O OJ -o = =q)r --0(),7 Ll) g =c);tne .t (J Y C) =,e ()<) -(JL -C U =Ua"?(- L! -Lc! C, ::L-vU cqd .- ').. p O,)OTJ uJ -^ !(u! .FL6Fo =6cJ - u &C!9 tr)oE -v=.- t.4 !o! 6 eY -o 'J c. I] =ro.).JiE ?ieQ=!cnP- id - H V !^lllxd +(H9 -^6 -pLto6lcJ6 C! '6r o !-r9 tr -)- o6- t'! -tv.?t dJP)-oo'F i d) )-qCI)E tr - ^ ._U ao= * o!!tr'6 0 -!-, -P =,.E R c)9 q)tey/L deI or;1 ! l-I > a)a- tr- o\OO c1 Lo tr U o-o CN -t l, o o- 3 o -r a P q) O o q)e po o U L() -o oO 0) o a) -o E() o() c o -o (_) o 0) o ,o E(.) (_) 0_) a (.) -o E(J o C) IJ 0) -o E 0.-) o() c b0 () o 0) () t a oo U) a c)(, so EE U 0) -o E OJ o 0) ! L(.) _o E uo 0) qJ _.o d O c) o L(-) -o (.) o o o L() -o: o(J a o ! o _o =(-)() a) o o.! - V,- !rt ra at) ta at) q) =al) a) .c CJ o oa rJ .J 4)a -o (, -o C) 0)a .o () () a ! a) -o 0) () ca : u -o =a) 4)a L o -oa oC L -oc .) Y= (h- q bo q bo q bIl a =OTJ (.) -o T 0) () i/) ! a) -o (.) (-) U) bx d F oe U br) q bll a o/J bl.) q brl q bo b0 a- Qo a-E z q)e (-) a oo q br.) dD a- 0) () () 0.) J I aa o ,o oJ Oo o- o J -qo bI) J -o(! d 2. i Z oo () o z I O q) U 4.,) oL () c) L a o o U) O c) F cil orl -ol6l FI o .9 .: J o G ta- o o tr o E i: - c,i 3 U () () crl z 3U t.la 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year At the project level, trvo state officials - the Minister of Health and the Director General rvere 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 328 community leaders/supervisors were rnobilized for their involvement in CDTI rvork. The reason(s) for undcrtaking the :rdvocac5,and the outcomc The advocac_\' \\'as undertaken in order to: . Attract rnore support through govenln)ent cor:nterpart coutribution and a\vareness about C'DTI strategr and activities . Cor-ttrrtue to drau their attention on inclusion of CDTI into prinrary hcalth carc systcnr and contiuuing . Create ou'ncrship ol'tlic progranlnre bv various cornnrr-rnities. Thc outcornc(s) 'fhe outconres real ised inclr-rdcd: . 'l'he health authoritics acknou'lcdgccl the need to have the CDTI actir itics inclLrded in I']HC activities and all CDTI statf onto thc pavroll. . -l'hc comurunities urct also expressed their commitment to the cause of thc OV prograrli. Dcscribe difficulties/constraints being faced The constraints included that: . 'l'he health authorities could not nrake a flrm cornrnitrnent to the suggestions that rnadc about taking on CDTI staff onto the goverrunent pal,roll due to budget constraints. . l'here \vere sonle aspects of inadequacy clf advocacl,skills/approaches since sonre pL-rsons aurd comrnunities need to be approachcd rvith caution. . Therc was a logistical challcnge olir-raccessibilitl'o('some of the arcas due to flooding and swaurpv nature of the project area. Suggestions on hou' to improve advocact' . Continued and persistence rvith the hc health ar-rthorities so that CDTI issues are kept on the agenda o1'the ministries of health. . Training of CDTI staff on advocacv skills arrd urethods. . Conduct advocacv during thc drier seasons of thc month or consider purchase or hiring boats for transportation itt sonre parts ol-the pro-iect area. 2.3. Mobilization, sensitization and health education of at risk communities The usc of media and/or other local s1'stems to disseminate information . In 2009. the use of mass rnedia fbr infbrrnation dissenrirration rvas t.tot a possibilitl, because o1'the non-existe nce ol'FNI radio statrons in the project area. . The ntobile phone companies had also not extended their netrvork co\/erage over the project area. l0 wHo/APoC, 14 Septenrber2oog Information is mainly passed by word of mouth through traditional systems of village chiefs. sub chiefs, and headmen or at the community, meetings. Announcements in churches; women's groups and village health committees meetings rvere used to disseminate information. Mobilization and health education of communities including rvomen and minorities Cornmunitl,rnobilization and health education of communities rvere done at various locations especially through home visits; group discussions in the community, health centres and in places of u'orship. The key issues discussed w,ere selection of CDDs and involvement of Wotnen in CDTI actil'ities. More rvomen were noticed to have begun participating in CDT'I activities. llcsponse of ta rgct comm unities/r'illages . Getreral inrpror enrent in coururrrnitv involve rncnt antl ou'ucrship of'thc pr()graur. Cunrurr.rnitv have takeu mclre responsibilitv in collc'ction ancl clistribution rll'nrcctizan . -fhe nunrbcr ol'CI)Ds sclectc'cl by the conrutunitr increasccl . 'flicrc \\as r)lore particillLltion olw'onren notecl. .\ cco nr p lis h nr cn ts . 'l-here \\.ere no rc'lirsals rcptlrtc'c1. the peoplc absent \\'erc a\\iu grazing thcir lrr cstock. . -['he nunrbcr o1-CDDs increased to 1.420 as cornparcd to 3 8 I in 200ti . Conrutut-tity me mbers understood tlieir role-s and c'lenrand ol'n-rcctizan great[1' rncreasecl leading to increased geograpliic and therapeutic tionr 51.\oti, ancl 38.-5uzi, in 200[t to 93.90,,r and 56.1%r respectivelv in 2009. Suggest x'ay,s to improve mobilization and sensitization of the target comnrunities. . Because of the diflicultl,there is in moving liom one county to another and also ri,ithin oue count\/. the Countl, Supervisors and their respective Countv Health Department stalf should be full1, take charge of the mobilisation and sensitization of communitics es opposed to have to rvait for the PCO to take lead on tliis. . I{aving a rn1'ririd of comrnunity, leaders, church leaders. r'arious local N(iOs involi'ed irr speaking to their audiences about OV so that opportunitl' of havc an1' comrnunitr gathering is not lost. . Having continuous involl'ement of rnore \\'olneu in the CDTI g'ork. since they are the primary care takers o1'the family unit. then more of their larnilv member ri'ill access the treatment. a ll WI-IO/APOC. 1.1 Septernber 2009 a Countr'- LGA Number of communities/villages with communitl' members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. comnrunities in the entire project area Number with community rnelnbers as supcrvisors Br B5 Percentage I]6- B(/ B{ * 100 Male CDDs Fcmale CDDs Total B, IJr Bq= IJ"+88 Number of com m unities ryith female CDDs Percentagc Brr= I],r/Br" 100 ,,\kobo ti6 le ll 6l ll t6l ril ii: 09 ill ll6 i8 0t lt I liu ll llrr 196 l0-1 300 -15 23 ) -\.-/o I'ocha lla llorrra I-Lrltgrclluk N'la a ba n N'la irvut I : 94 215 il+ -l00 31.39i, . _l -1,, ,I ri6 t47 ni t9 I08 155 61 150 .18 100 26 t4 t5l [6 I [J.29 o TOTAL 525 73 13.9 885 535 1,120 143 27.3"1, 2.4. Community involvement Table 4: Communities participation in the CDTI Attcndancc of fcnralc members of the conrmunitl' at health education mectings In manv comnlLurities iu the projcct areas. l'emale atteudance increascd at health education meetings. In gcncral, hou'tlo \'ou ratc the participation of fcmale members of the communit,' meetings lvhcn CDTI issucs are being discusses The participatiou of fbrnale mcrllbers \\,as fair; thev are gradual[1, coming out to take part in these discussior.ls. lncentives provided by' communitics for the CDDs No incentivcs are provided to CDDs Attrition of CDDs. [s attrition a problem for the projcct? If 1'es, how'is it addrcsscd? Yes it is a problern and it u,as addressed by continuously preaching the CDTI philosophy,. Other issucs - Nonc l-7 10 - /.J r) a 1 lrl -J- l , I l2 W[{O/APOC, l4 September 2009 2.5. Gapacity building Describe the adequacl, of available knowledgeable manporyer at all levels . Availability of knowledgeable manpower in the project is still quite inadequate at all levels. o The endemic areas are located in such a way that travelling betrveen the 6 counties is a huge challenge especially rvith the predominance of swampy/marshy vegetation and rvith no roads. An additional staff at the levelof a PCO to co',,er the counties in Upper Nile state could benefit the program as regards monitoring and supervision of the project. . The Countl' Supervisors and Pal,am Supervisors are relativelt, knorvledgcable about CDTI . 'fhc C'l)Ds hare bcen trained. but stilI recluire on the job nrentoring. Whcrc frequent transf'crs of trained staff occur, stzrtc rr'hat thc llro.ject is tloing, or intcnds to do, to rcnrcdv thc situation. Stal'l'translcrs ilicl not happen in this reporling pcriod. l3 WHO/APOC, l4 Septernber 2009 ?rt Q o -: + '(, + >v r1 ! 1_ 0) U) U 0) Z O ca \o Os(.l C N co c- -f OO C' .{- \o$ a] (..l : ln l= -1- = O O tr- C' o\ \.) OO c.l $ \o (.lv ra rn cO Ut\o \c al ci al c) o c) o ^\€ -lv r -.i U - l I i L L[-(,, ' .! 9!. Z C C a C a s =,,.,c. t Q ) (-l FU qJ L O a I -o z c- -f cl t-- t \c CJ : -f CI oc cl ..l & * al f -, IC t-- c1 o\ 11 a.l @ € s 6l a.l ?tr Q =., f -\, U U J q LF F O O 'l (J() C L o z O O - C O C f a..l \o C\ o C) () c\ J a L o -oo& oo o- tr o ,) bo oJ -o z 2 C6 z- l F F 6l 6 -o a u c- utl J C o- o :E -t q) o F U A) C) - o b! 3 rnl o,l _oldt FI t-: =a .: e o c c t o c a 04\ o c ! l e at s ! C ct !( = < Table 6: T1,pe of training undertaken Any othe r corrrnrcnts - Nonc 2.6. Treatments 2.6.1.'l'reatment figures If the project is not achio'ing 100"1, gcographical coverage and a minimum of 65'h therapeutic coverage or the coverage rate is fluctuating, state the reasons The project is not achieving the above coverage because: . The tirning of the majority,of the CDTI activitie-s rvas not in svnc u,ith the'"veather and clinratic conditions of the project area. Project funding, rvork support iterns. rnectizarr rvere received in thc rainy season and hence rnaximum outputs could not achieved ilt thc- circumstances olalrnost no r-no\/cnlcnt rvithin the pro-iect. . ('tlmnrunitY orvnership is not universal across the il,hole project area. there arc still sorne comnrr"rnities that have CDDs that still deniand fbr incentives. Plans to remedy'this arc: . -l-r) ing as much as possible to c'nsure that ke1, CI) l-l activities are implemented in the drie-r months of the y,ear. . l-ire Iessly preaching the CD'l'l philosophv to the comrnurtitr'. Trainees l')'p" of training CDDs Other Conrrnunitl' mernbers e.g Communitl' SUpef,',iSOrS IJealth Workers (lrontline health fac i I ities) lvlOH staff or Other Po litica I Leaders Others(specifu) Progranr nranagenlcnt Ho*'to conduct Health ed ucation IVlanaqcrncrrt ol- SAEs (.SNI SIII\I [ )uta co llcctirin L)ata analr sis ILcport u liting Others (specitj ) t5 WIIO/APOC, l4 Septernber 2009 OO al L o -o E o o- oa : (, o o- o 'r \o aa\ a U e\ Ct ! 0O \ ! U !\ : !! .\ - \i- !J .' ri !] ! iai f := --! _? \-:J_! .i i ! -':= r -E r^i -\! =,\!\= = i> .- rJ! ., ='=-<P r:Y;, Y:S . si !o\\\ 7 q.= !Y \'=< : F-=,- L\:C', - :i!.U ! \! * \ U+,2 h'= ., JLX,- u :si' ot 6 .: i\3l o i 5: .,ld*\- .--l qr = -'<Y,la !\* El ; S!.tr Ll -\tV ol i s'rt =l c :'-!q Y* -nlx ! 3s ?l .:r! :11 b.! !5l t-< \ cl '1=ec!t .i\\ =l._tLI *E}:sa y :!^J: a-* ,+!_ a \ _,va'i rlt s !{i s: \.% s\>U:Y I t.:l'- :J Ur!- uiij ? SS T ,! t\F='t'' ,, rr I \ o$ i NF ! .\!! u -o E, C C E -u F E =C, -1. - cL .: - - = Li cl E -! = n a a =tr tr c ,2 - =* c ED = =^, LOOO e') =L -A*o ci - UYl O a c-3 5Ir oO3 CO /. -D D bI : - 9 C E E a a I I =Z ^) . = ; = :1 , ! a =o D ela -1 2 /t _ ala --l =ll- -l o!l o ;I Ld= ul ;i ..-t Lrl' :l t;1 z-l - dl6 D a =! o-d o F D OJ( o a E 9 =c d ood -o d 9 o 6 oE U c; o E o € Od trtr LL 1;9 q! 94 o - -o ,U1 --q0 .-E; O >aPi5 '" il8 '"o zDOOL =o U o o ! E C O O O O 9q-- = -<Zact, O O O O O q3.oo ..LvrOl)6 trc. A- 6 -o='.,o-iF C - t) > =!!OUzd;E'' =-!/ - -=^,1---,- L/-'J- = .1 / - t= \c) : (--\o @ o oo @v) ln c.l rn 6 x, -t cot\ al U) r--\o ar) al cc \- lft o o. ;J --t, t)- r-- c' ,a, ,rl r- -a C_, t\ -t a h- Z r- @ r- -f -t r- @ ,a" -f c..l6 30 (-I -f r\ ta', l aar- ai Ets. lDt -u c-\c ,a? \o -f n: -a O C O .; @ \,\o r- (.l CO "l : \o F- rn a.l e-= d=-/,i, *--)=-Oauo -1 O. r- (-l N\o. o\ @ t-- -1-9 @ tO .t -t t-- \c) oo c-l \o t-- c.l c.l o\ ca rj 0lov rn 0.) bo a() E E oU ll * =2o -dl ;o<- il') o o\OO o\ o\ r- o\OO o\O o\O : s o\ o\ e=ii* o =:'u z3u \o -f\c) r- ca cooo c.lrn c d0-- -d,Y2gts - \-' \o r-\o co o' @ &@ ra c..l m --! '+ u= -, ee--= + c - a.,, - 6 = o-: c!gCilt!! O-d\auLEiQ- O.-, \o : t-- oo oo @oo rn(\I rn ;Y o\ o -oo .v (n (-) o r (! E o m () bo oJ -o (! z. 'l F F a a q) '] a) 0 ): A) E] a o 0) F r-l oJl -ol6l FI 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. It could also be seen as poor coordination betrveen the CDDs and the pastoralist communities. . There were also areas that rvere inundated with floods and treatment could not be there as well. 2.6.3 What are the reasons for refusals? 'l'here \\/ere no reported refusals o1'treatment 2.6.1 Briefl1' describe all knou'n and verificd serious adverse events (SAEs) that ttccurrcd during thc reporting periorl and proviclc (in tablc 8) the required infornration u'lrcn avnilablc. -l-hcre \\cre no le ltortccl S,\lrs during this re portrng period I'arasitologist traincd'l Nonc uas trainecl Ilristcncc of microscopc'.' No Has thc llrojcct rcltortcd all SAIis to N'lcctizan I)onation l)rogranr (N'f DP)'l Plcase tick orre. Not applicahlc bccur.rse thcle ltarc beeu no Si\[rs reltorted. fl N,, I t'cs In case the projcct tlid not havc ant'cascs of serious adversc events (SAE) during this reporting pcriod, pleasc tick in the box. No SAII casc to report x t1 WIIO/APOC. 1.1 Septernber 2009 o\OON Lo -o E 0_) o-oa s U o o- o J oc t L(, bo L c)L q) bir L l- a) E9 ^i= 2.a < Irla-t -a oJ- >9)qril Q> 6)! o-r d* -9, !0,oV(HCoOc) O-0, o-00- u6 6lF orl -ol cEl FI o -c2LO; Lo;o ac= z z .J4 cC ^o a3^ --l= ,-;u 6600 C ^av -u u -=-):-o u X - al -.N ,h Y '-tl : --* v ui: u--<a-OEZ. o=b A66d E o E a >1_o a 0_) bo * 4 CN o oo 0) xI! o o o = boo <)q F(J5.:oo .2 o b.,) o L o- .J .Y d a € o o o oOe -b, >5 N :6d> I l I l I I l Z. Z z z 1 I Z Z z I z z 1 l Z Z, N L 0) -o E o o.o cn v U o o. o B A a lJ ! lJ ! - ! at, 50 iJi) iJ ;\ a a 1) aU a,) -a lJ o' iJ XJ > x * q) bo L o -I fA\JF) a LA ! d '= t^ c) J .J ::F 2tr,!q)a)LL:-- =b!'J t- qJ ::aU_ !do) ia) 9!tc-olQLI ^l4 .=trv' L9:'-o'dE.\ Lv(! - -.e - L9 -LcoVnO, ;UV ),ot tl -l! vt !vtrtr| qJ 6J OJI L -I CEtr qlt 9vl <)a>le9^l IIA YACJL a) hn 6 ! k:.! AL!L (r') '99q !v99ct ecil-(HqD P !e)Esd Y/!(,)L- --i .22lft F !5 ^F.- :Ar.je .l :.1 cr Sjl a= -ol li e -to-lltFI o.U o oo F U^\.- _>--Jo U (\ vl I \aa i$ 09 \o \c) 5I .-t EI =ld-t o o. ,-i El l! ^oO F 4r^\I >:' -o c\q tr- q ca c1 \o r-. n O ilr ,i..i a fdlo -^ Ju. F,J - a -J I at cl oo '; - a- .)=2- ==/_- - .cr: -f -t\, c.l\, -1, = t\ el =o -t1 z ?i t a,\c r = 1 al \o T- al a L -: J A' -f t o' o. =t al @ -t o\ tr- @ -f o o, * a .9 E E a(, ll * !l E- 3.,1 ! ^ al) 1>- a co -t al C @ € cl c.l @ -t c.l C o',A coO -t ,j] c='i_ .) = \:tu ; == u 7- 3 ''' OI t--o Ocl: O(.I =o c-!/aE t-- c tat O O \o : ...t d) - = =a^,i? + != >. - a- L-=u^J; -=, =a .l ca @ l O @ * c.l t! \cOO(.I t--OO a.l @OO a.l O c.l : ON 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for b1,: tr --- - tJNleEF NCDO Otlier (please specifl') Mectizan@ delivered b1': n*.n_E wHo tr n'(I)O Other (please specif'v): Pleasc describc hon' Nlectizan@ is ordcred and horr' it gcts to the conrmunitics . 'l'he Pro.ject ('oordin:rting Offlcer provides data on the total population ararlablc in thc pro.ject area attcl also clata ()n the usage. \\'astagc ancl rcnurining stock ol'rncctiz.un available itlicr the crcle ot'treatntcnt to the SSO'|F . The NGDO partrlcr tltcti tlikes leacl in corrrprlinu lhis cla(lr ancl Prcpurinq thc olclel firr. sutrurissiou to NII)l' . N4[)I'}revicu's application. al]llr()\'es ancl lirruurds the applrcation to N,ll-l{C'F. . a The mectiz.an shrpped to thc couutrv and rs rcccived br \\'lIO. . Iu confbrrnitr uith thc data that hltd earlicr becn rcccivcd liorn tlic [)roject Coordiuatinc ()l'llcer. correspouding antt'rturts ol'mectizan is sLrppliccl ll'onr the SSOTF/N(}DO to the proicct. o At project levcl. eaclt coLttttv supen'isor collects the nrectizan lion-r thc pro.;cct ol-llcc and then notillcs all Pavam Supen'isurs o1'the mectizan availabilitr' lbr collcction . The Pa1,21, Supervisors on collection notif,r' aud invite Boura Supe rvisors to collect supplies lor thcir corrcsponding contnrunities. . The Boma Supen,isors, somc olrvho are CDDS share this information n'ith othcr CDDs and tlre cornrnunities . The cornmunity metubers tlien decide on the time lor the nrectizan distribLrtion to the rest of the cornrnunitv mernbers. Tablc 10: Mectizan@ Inycntorr' Hou'are the remaining ivcrmectin tablets collected and rvhere are they kept? Whenever there are balances of ivermectin tablets, the CDDs arc chargcd rvith the responsibility of subnritting them to the health facilitl,stalf so that thel,are storcd in preparation for the next treatment cycle. The amounts of stock of rnedicines that rernain arc State /District ILGA Number of Mectizano tablets In stock frorn prel'ious year Ilcquested Rcccived Used Lost Waste d Ex pired Rernai n ing Akobo 140.000 140.000 li9,90l 99 0 0 0 Pochalla r 3 0.000 r30.000 129.8e9 l0l 0 0 0 Boma r 50.000 r_s0.000 149.94,1 56 0 li I 0 0 Longichuk 256.500 25 6.500 256.299 201 0 0 0 0 Maaban 65.29 8 65.298 65.220 78 0 0 Maiwut I7.500 I7.500 )li') 77 0 0 0 TOTAL 779,298 779,298 779,696 612 0 0 0 20 WHO/APOC, l4 Septenrber 2009 tr communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. List and briefl5' describc the activities undcr ivermectin delivery, that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: . Training for both nerv and old CDDs rvithin the communities before the mectizan distribution. . lssuing tlie CDDs rvith rnectizan tablets and collecting the remaining balance tiont them for inventorv and storage at the health centre at the end of distribution c1'cle. . Couducting conrmuuitt, urobilization and health educertion on OV prograur. . Facilitating the process o{'selection ot'CDDs b1' the cornnrunity. o it'lanagenreut ol'a11\'pers()r'l u'ith advcrse siclc eltects reactions and keep rec()rrls. AnY otltcr cornnrents Nonc 2.4. Community self-monitoring and Stakeholders Meeting I'[as anv training (of traincrs) for conrnrurritl self-nronitoring bccn done in the projcct a rcl'l A total ot'328 conttnlutitv leade'rs reccircd trarning in cournrunitv scll'ntonitoring. If so, When? 2"d Quarter of 2009 Tablc I I: Communih,self-nronitoring and Stakcholders Nleeting Describe horv the results of the community self- monitoring and stakeholders meetings have affected project implementation or hou' thct'u'ould be utilized during thc next treatment cy'cle. It is expected that the communities will: . (iradually take lull chargc of the delive r)'of the CDTI activities in their cornnrunitv like liave neu'CDDs selected rvithout necessari[\,having the Health staff facilitating . Demand lor tnectizan u,hen there are de lays or i1-sonrc conrnrunitics are inadvcrtentlr left out during the distribution of ntectizan. o At a later stage begin conducting advocac)'campargns for the CD'fl progrant. I)istrict/ LGA Total # of conrnrunitics/r'i I lages in tlie entirc prtr.jcct arca No of Coururunities that carried out sell- nronitoring (CSM) No of Comrnunities that conducted stakeholdcr s rneetinq (SHNt) Akob<r Poclralla Boura Longichuk Maaban Maiw'ut l]6 6l 8r 95 58 88 23 08 l1 ll 09 12 l0 0_5 07 09 03 01 TOTAL 525 80 {1 2l WHO/APOC, l4 September 2009 SSOTF Headquartcrs Project Coordination Officcrs at Project lo'cls Clountt'Supcn'isors I'a\':rnr Supcrr isrlrs I CHWs/CDDs Endemic communitics 2.9. Supervision 2.9.L. Provide a flow chart of supervision hierarchy,. Supen,isio Rcporting 2.9.2. What rvere the main issues identified during superlisionl The main issues fbund during supcrvision r.r,ere that: . There \\ras no er,'idence that the Cor-rnty Supervisors \\'erc using the superr,'ision checklists since done could produce one that they had used in the past. . The rnajority of the CDDs are not filling ir.r the treatment registers and summary forms correctly. . Somc of the population updates u,ere not done. o Somc areas were discovered to have not got treatnrcnt during the year and a mop up exercise rvas then done. 2.9.3. Was a supervision checklist used? Yes. Supervision check-list rvas used. What w'ere the outcomes at each lcvcl of CDTI implementation supervision? Countl, Supervisors were lbuud to liave not been doing supervision of their counties. Data collection shcets that thel' rvould har,'e shorvn the Payam or Boma Supervisors liow to flll were not lilled correct[1,. Some communities had not received mectizan. a a 2.9.4 22 WHO/APOC, l4 Septernber 2009 t 1 2.9.5. 2.9.6. CDDs were not filling out the registers correctll, Was fecdback given to the person or groups supen,ised? Yes feedback uas given Hon' rvas the feedback used to improve the overall performance of the project? o on tlie job training was given to the stafr supen,ised on hou, to update the household information. fill the suntmar), fbrms and tally sheets. o Practical scssiorts rvere given to poor[1' perfbnning individuals and thosc perfbnrting relativelt' bctter rrere aIso cl.]coLrras!'d to coaclt tlieir colleaqLres o Positive ltecr criticisnt \\as also encour-agctl. SECTION 3: Support to CDTI 3.1. Equipment ablc l2 Status of cquiJrnte nl *Condition of the equi pnlel)t (F:Ftltrctronal. CNFR:Currentll' non-functronal but reparrable, WO-Wrinen olf) How does the project intend to maintain and rcplacc existing equipment and other materials? If integration of the CD-l'l activities into the go\/enrment I)HC u'as to take place as dcsired. thc state MoH rvould idealll' tnaintain and leplace the existing equipnrent through thc' counterpart contribution to the proiect. Since this is not vet a realitl'. then additional support nray requested fiorn the NGDO pi.lrtner or AI)OC. Source 'h'pe ol' equ ipment AI)OC Ntoti I)ISTtTI('Ti [.Li.\ N(;DO ( )thcr s No ('r rrrd tl tort N,r CrrrtJ r(rott r.lrr ( \)it(ltll()n i\(r ( ()i)dtttor) Nr ( irtttirtri,rr 1. Vehicle I F 0 NA 0 N,,\ 0 NA 0 NA 2 N{otor cy'cle(s) -+ F 0 NA 0 Nr\ 0 NN 0 NA 3. Computer(s) I F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) I F 0 NN 0 N,,\ 0 Nr\ 0 NA 5. Pliotocopier (s) I F 0 NA 0 N;\ 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 N.-\ 0 NA 0 NA 7. Others a)Bicvcle It) t; 0 NA 0 NA 0 NA 0 NA b)lt4etallic Cabinet 4 Ir 0 NA 0 Nz\ 0 NA 0 NA c)Metallic trunk 4 F 0 NA 0 NA 0 NA 0 NA 23 WHO/APOC, I.1 Septenrber 2009 o 3.2. Financial contributions of the partners and communities Fill tables l3a, 13b and l3c If there are problems rvith release of counterpart funds, horv w'ere they addressed? This is not yet applicable since there are not yet lunds being received fionr the government to directly fund the implernentation of CDTI activities. Additional comments - None 24 WHO/APOC, l4 September 2009 o\OON L o OJ o-(.) v) : U o o. o :E c.l E C'5or! +6q.f LF OOOO -OOOOHoe{doi :N@(oec!(oo N-c.)l- OOO otr)to ooc;@Nco N- rif- @_ o)o (f) ooooOOOO @ooq,o)ooo, co- v_ tr)- o1 it.fo, OOoo @!1 @ o) (J ct)O) .-j O) v{N c..l 3Bq FsE o) ^: (\ltv c! olr) dt(o{ O) oL oE o '= CUI :oE€ o o thtoq3 "z c 0, E o oL f -o .9 !, 'o o trt(! o- t IUIF o o oo(9 z oooq55E5oo @@uUUVrf, NN o55c339 .-3 OOOOOOOO oood OOog s-rro:(o couo(o@ OOOOOO OOO oO o;(o t- o) ! 0.) @ 3 -o U'S.o @ 0) O6 o)otrFt o =Oo d)€ -O =o6EOC'oc5.e -o o)loa) !t o c- -6 =c:o z.t q) f:i o) U (r.l () o 'tr o o Fz UJ =zt[! o o UJz =F TU(, of, TD o o GNE lt, q, t4 io GOcoo>;b- - roG\cXo -O6Yl rj.i = * >. -oQs [ ! H : v !N€ ! 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O o o- o :E r-- c.l oflo C) :' olr(L oooqoq lf)XXorr)E;538 c., c.l d oooq oXoO:o oeo t- t- oooooooo oooc; OOogNScv5oE co co 3Bq o.-o$x$((.)- ii o)- ^^ @Nc\t oq f.-(\l t-^ o to o 0) o ,- lco:oEe oo ahEOq3 'z C o) E o o att .9 E' 'o L c,ct(! o- u. tu IF o o oo oz OOooooq ;OOO;NOOON crr) OOOOOO OOC; OOOOOOOO OOOC; OOoe o-o @@(ouo o) o, OOOOOO OOC; o o o rf_ o ! o o @ ;sE N lt 0) 0J- 6srE .LF 3 o =€O.o 9.6 EOtEEg5 fip'E .1 cElf trlo ol E!l +-_ E] (,) U q q) F r- N q) a o -o L c o(,) Fz UJ Ezt trJ o o I E UJz J F uJ(, o f, o 0) o G :! tt) ott io o(lcOo>;P.. E 3 -OoYl sEE!BEN€ E 3 9 I ;\o o o o o i: €-< c! c, tC d<.i iq an o o G l{ Ot \ o .\] ol El a ov o B ,^f rlEOo)OI oo o) o)cg CC co oq) o, o) o===r==\ .=o6(! ;FFE tNa .NN5 =q t4 o a5q cOo)cd;c9 Coto= ^C= =^!vO Ncoa crcoco: q IC o '0) q) ? C) -o o(r:o) q=c)E;U)6FE @.9(,roc\0) OLC>-! Yoo)> 'uF(o\qEEE 6: Na\vsio(4 tro o o, G G ! G o a t4 ! o o o J ta o t4 c o a_x.-OE '^ a)GYlccY:> € * Jsb./)LUo!YqNa Jro.,d J F oF oz u(, -o 0) oo rn L (.)() l- a c! OJ li o (B cn o _o ! o(J o LL (., c,) F 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) . Training venues . Collection of mectizan from the health facilities . Provision of meals for the CDDs during treatment time 3.4. Expenditure per activity lndicate in table 13. thc- attroutrl cxpenclecl during the reporting period lirr eeich activitr,Iisted \\rrite thc atnolutt expcncled in LrS dollars Lrsin{-r the current [,lnitecl Nations ercltansc rate t() Iocal currencr Inclicate erchange rate used here'_2."1sdg .'\nr cornrncnts or crpl:rn:rtions? Nouc SECTION 4: Sustainability of CDTI 4.1. lnternall independent participatory monitoring; Evaluation -1. l.l Has thc pro.ject cver been evaluated/ monitored? (Tick any of thc follox,ing rvhich are applicable) Year I Participatorl' Independcnt utorritoring NIid Terrn Sustainabilitv Evaluation _= 5 r'ear Sustainabilitl, Evaluation lnternal Monitoring b1' NOTF Othcr Evaluation by other partners 4.1.2. What t'ere the reconrrnendations? Not applicable 4.1.-1. Hot' have they' bcen implentented'l No[ applicable 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) \\ias the prqect evaluated during the reporting period'? _No \l/as a sustainabilitr' plan u,ritten'l No When u,as the sustainabilitl,plan subrnitted? No a 28 WHO/APOC, l4 September 2009 What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.3.5. Not yet .1.3.6 Planning at all relevant levels - No plans made 1,et Funds - No plans rnade yet Transport (replacement and maintenance) - No plans rnade yet Othcr resources - No plans made 1,et Is CDTI included in the PHC budget? Dcscribe other health programmes that arc using thc CD'tl structurc :rnd hox, this *'as achieved. What have bcen the achievcments? . Fill tables l4 and 15 and provide describe other progran'unes that are using thc CD fl structure and horv this rvas achicved. What ha'",e been the achievements'? . For each intervention listed in table 15. explain rvhat w'ere the roles plaved b), the CI)Ds (census, rnobilization. distribution. data collection. storage. collc-ction ol drugs, rel'enal of SAEs, etc...)'? a 4.2.5. To u,hat cxtent has thc plan been implemented - Not vet applicable 4.3. lntegration Outlinc tlrc cxtcrtt of intcgration of CDl'I into thc I)HC structurc irud the plans for conrpletc irttegration: {.3.1. Ivcrnrectin tlelivcn' mechanisnts l-hc Ir'emrectin deliven'mechanisrn used norv is that: . WIIO delivers the rrectizan to the statc rninistn' o1- Iiealth . 'l'he state uritiistrl'of health is then responsible fbr relcasinq the urcctizrn to thc Countt' lJealth Department stores in the Counties . It tionr the County Ilealth Departments that the1, 11',11 latcr be clisltatched to fiontlinc healtli facilities in the Pa1,arns. o Mosl Pavams in the project area have health lacilities. so therc \\ere no instances of having the rnectizan kept outside the health facilitl'. 4.3.2. Training: In regards to training there is u,illingness of other programs to cooperate. l'lrese include I]PI (Expanded program on Immunization) and G\\/ (Guinea Wonn Eradication prouram). The final inrplementation needs to be finally'planned and cxecuted. 4.3.3. .Ioint supcn'ision and monitoring n'ith other programs -l-lris is rrot vct Irappcning. 4.3.4. Relcase of funds for project activitics There were lto funds released from the PHC system 29 Wl IO/APOC, l4 Septenrber 2009 1.3.7 Explain what are the combinations of interryentions co-implemented? There is no clear arrangement for co-implementation yet. Hot'rvere the inten'entions implemented? (at the same time?) The interventions are not implemented at the same time. The different programs utilise the same persons in the communiry to implement the programs. Dcscribe others issues considered in the integration of CDTI. 'fhis is not vet applicable in this project. a a 30 WHO/APOC, l4 September 2009 o. ol o -o E o o- 0-)a -f O o o () Cq(,) L L Lq) E z F o\ c\ \o\o O v t- g E o l& aa F- ro^ v cl ca ca\t o(! Z. w oovl r- oo t--- c\ \o C' o () oo O L I Z F o\ o.l \c) : $A$. - q) o(& ca tr-9 -i- o c.l ca "lr- : Z, -t cc 2 F- cl\o * x uO o- z F al !t @ t\ t\ t.! 2 sE 7_6 a o a F- cc 'f c- cc -t r- o o bI, L F t t-- cl oq 2.2 Z o ql al clb! F - -a A .-\ \J\ >r: (.)Q :- ?: C( si ! 0) CE Ad -- ^a(J '-() 'q= =d)A E^ x !', >,\ qJ: -), I o .= q) _o* L: a\> a a a a a a a a L oc ?'a ii .e (J t! o(dLF a AJ$ kU + ,q) ! U) U qJ U \ qJ U) a I L) a, sa a d C) 0) I U \f (.) F a aO ..l ! O -o tr o o- o cn $ U o o- o f B cl ra -iJ 1 a, l e,) 4 p t XJ -ot iJ C) a - c ! i) iJ l-! U)q) I q) q) q) <) L oL o L o c! rg bo L a) bo .= oz .= u) o () L I .a_ !^ oI) = '.)(;,Y ;o '?.- 2 - o I !.: eJ 'iEq 90 qE b0 FA cla I L() o o Lq) F a a a a a a a a 4) F q) a l- a6 Qs,UE bo? a"' r+u) a'\ 0., - cg dr o0.= ^2 L Ct3 9&, aY ra- '<! = !,) -uFtr 4.4. Operational research 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'rvere the results applied in the project? Not applicable. 4.4.1. 4.4.2. a , a a SECTION 5: Strengths, rl'eaknesses, challenges, and opportunities Strengths: . -f[rere are a numbcr of iutc-ruaLiouaI NGOs in the arca and cornnrunitY bascd orgaursations that are u,illing to u-ork on C'D-l'l ectivities. . '['hcrc has been rt uuurtrcr o1-neu'er governr]lent health llrcilities openecl Lrp in the project area -[-his urll increase thc- nurnber of IrLHI] arrd possibilitv if stafl-ccl uill incrcasc stal'1 uorkrug in ('D-l-l We:r l<ness: . L'l) l'l intcgratron into l')ll(' has uot bcgun . l-rrcl. ol'stal1'cspe'ciall_r'at the ct'rr-r.rn.runit\ Iere-[ to rurple'urent tlre CD-l-l ritlrk . -l'hc availablc nunrbcr of C'l)Ds rs still inaclecluate. . Poor recclrd kcepinu at the conrntunit\' leveI Challenges: . -l'his is the nrost cl-rallenging placc in Southern Sudan. There is pronrinencc o[- su'zunpr,/rlarshv terrain and road rnovc-menl in irnpossible in the rainl'seascln. N4a-foritt'ol' rvork to be clonc in the d11, scason. . The literercl'IcvcI ol-the cornmunitl'rncrnbers especialll'the rvonren is quite lori, leadins to poor qualit), w'ork zrt the communitr' leve[. Coustant on tlie job training and urcntoring Lo continue. . Record keeping is a challengc. It's as a result ollou'literacl, levels and lack olappreciatiorr of the need to kecp records. Coutinuous nrentoring u,ill be done to ensure that this inrproves SECTION 6: Unique features of the project/other matters No additional inlorrnation to reporl on. -rJ WHO/APOC, l.l Septernber 2009