Annual NOTF secretariat technical report to Technical Consultative Committee(TCC) : January to December 2010

tSOUTH SUDAN ONCHOCERCIASIS TASK FORCE (SSOTF) whoh nroiect@gmail.com COLINTRYAIOTF: Republic of South Sudan Proi Name: South Sudan Onchocerciasis Task Force Headquarters Approval vearz 2003 Reportin s Period: From: January 2010 To: (Month/Year) December 2010 ( Month/Year) APOCfundinevear: I 2 3 4 (5) 6 7 8 9 10 ll 12 13 Date submitted z 29'n July 2011 ORIGINAL: Enslish ANNUAL NOTF SECRETARIAT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I I A\INUAL NOTF SECRETARIAT TECHMCAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I Country: Republic of South Sudan National Coordinator: Dr Lucia William Kur Signature Date .llulyl20ll SSOTF Chair: Dr Lul Riek Signature Date llulyl20ll NGDO Representative: Fasil Chane Signature: Date: ..lJulyl20ll This report was prepared by: Dr. Benjamin Atwine Designation: Technical Advisor, APOC Signature Date: ../Jul ll vl20tr Table of contents DEFINITIONS.......... FOLLOW UP ON TCC RECOMMENDATIONS.. VII EXECUTIVE SUMMARY......... SECTION 1: BACKGROUND INFORMATION l.l . GpNeRar- INFoRMATIoN 1.1 .1 Description of the project (brieJly). 1.1.2. Partnership 1.2. PopuLlrroN SECTION 2: IMPLEMENTATION OF CDTI........ 2.1 Ttuer-rup oF ACTIvITIES ...... 2.2. Aovocacv 2.3. Mosrl-rzetroN, SENSTTTZATION AND HEALTH EDUCATION OF AT RISK COMMLTNITIES ... 2.4. Couut-rurY INVoLVEMENT................... 2.5. Cepaclrv BUILDING 2.6. TnsnrupNTs............... 2.6.1. Treatmentfigures............. 2.6.2 What are the causes of absenteeism? 2.6.3 ll'hat are the reasons for refusals?.... 2.6.4 Briefly describe all lcnown and verified serious adverse events (SAE| that ........... 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year... 2.7. ORopRiNG, sroRAGE AND DELIvERY oF IVERMECTIN 2.8. COUVTINITYSELF-MONITORINGAND STAKEHOLDERS MPPUNC 2.9. SuppRvrsrou v VI Provide aflow chart of supervision hierarchy. Whot were the main issues identified during supervision? ................ lV'as a supervision checklist used? What were the outcomes at each level of CDTI implementation supervision? .... Was feedback given to the person or groups supervised? How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI... 3.1. EeurpupNr 3.2. FwaNcteL coNTRIBUTIoNS oF THE PARTNERS AND coMMLTNITIES 3.3. OttpRroRvs oF coMMtTNITY suPPoRT................ 3.4. ExppNorruRpPERACTIvITY SECTION 4: SUSTAINABILITY OF CDTI. 4.1. INrEnNer-; INDEPENDENT PARTICIPAToRY MoNIToRINc; EveluartoN 4.1 .l Has the project ever been evoluated/monitored? (Tick any of the following which are applicable) ........... 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? .............. 4.2. SUSTaTNIae1LITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT...... Yn 3) 4.2.1. Planning at all relevant levels..... 4.2.2. Funds........ 4.2.3 Transport (replacement and maintenance) .... 2.9.1 . 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. lll OPPORTUNITIES.... 4.2.4. Other resources 4.2.5. To what extent hos the plan been implemented.......... 4.3. INrpcRauoN............... 4.3.1. Ivermectin delivery mechanisms................ 4.3.2. Training.... 4.i.3. Joint supervision and monitoring with other programs..... 4.3.4. Release of funds for project activities4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes thot are using the CDTI structure and how this was achieved. What have been the achievements?.............. 4.3.7. Describe others issues considered in the integration of CDTI. ............. 4.4. OppnaTIONAL RESEARCH 4.4.1. Summarize in not more than one half of a page the operational research undertoken in the project area within the reporting period. 4.4.2. How were the results applied in the project? .............. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS 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-B ased Organization Community-D irected D istributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Deve I opment 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 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatrnent 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'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-monitorine (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl FOLLOW UP ON 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 Recommenda tion in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY (i) Put mechanisms in place so that projects send financial returns to APOC on time. This will facilitate the release of funds early enough to allow drug distribution to take place during the dry season. The SSOTF is working with the State Ministries of Health (SMoH) in the project areas to have the available SMoH Accountants to work with the Oncho program; in addition to their regular work. These are qualified and will cope well to meet the needs of the program. The APOC Finance/Admin Officer will orient these Accountants on the APOC financial procedure. Executive Summary The total population in the areas covered by the 5 CDTI projects was 5,707,127;withan Ultimate Treatment Goal (UTG) of 4,793,987 and an Annual Treatment Objective (ATO) of 4,203,193 people across a total of 6,511 beneficiary communities in South Sudan. The West Bahr El Ghazal CDTI still remained the biggest of all the CDTI projects, accounting 5 1% of the total population at risk. This remained a huge management challenge since this project cannot be managed effectively as one CDTI project because of its size and the logistic and infrastructure challenges being faced. It also covered three states (Local Government Authorities) and harmonizing work under three different independent authorities had a number of challenges for the project coordinating officer. A total of 3,010,375 persons received treatment in 2010, achieving overall geographic and therapeutic coverage of 860/o and 53o/o respectively. The UTG and ATO coverage was 62.7 andTL6o% respectively. East Equatoria had the highest therapeutic coverage of 75Yo in this reporting period. A total of 12,204 were trained in 2010; of these 6,959 were newly trained while 5,245 received refresher training. There were also a total of 2,432 old CDDs that were not trained; but were available to do CDTI work. The total number of CDDs that were actively available in 2010 was 14,636 bringing the overall CDD/population ratio across the 5 CDTI projects to l:390 as compared to the 2009 ratio of l:605. Advocacy work on the integration of CDTI into the routine primary health care services continued across the country in 2010. Almost all the County OV Supervisors have been absorbed into the government system and there is commitment exhibited from the State Ministries of Health (SMoH) that all the remaining Project Coordinating Officers will be government employees. This will go a long way in strengthening the supervisory oversight that the SMoH staff have over this cadre of staff and hence improve project management at this level. The SSOTF continued to function throughout the reporting period in close collaboration with the APOC technical Advisor based in Juba and also with support from the CBM NGDO Coordinator. There has been greatly improved communication within the South Sudan Onchocerciasis Task Force (SSOTF) thereby improving performance of its responsibilities. Key activities undertaken by the SSOTF during this reporting period included facilitating the monitoring of treatment coverage, procurement of ivermectin from Mectizan Donation program and MERCK, provision of support for meetings and training activities in the CDTI projects, printing and distribution of IEC materials and ensuring distribution of mectizan and work support items to all the projects. However, a number of challenges were faced that included the lack of adequate capacity to properly manage CDTI projects by some of the project coordinating officers, inadequate staffing and knowledgeable manpower in the CDTI project areas, non integration of CDTI activities into the routine primary health care system, inaccurate and untimely data reporting, and the repeated incidences of intertribal clashes leading to population displacements in some parts of the country. vlll SECTION 1: Background information 1.1. General information 1.1.1. Description of the country program - CDTI and vector elimination The Republic of South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The climate of South Sudan is tropical with average annual temperature of about 29"C (about 85F). The rainy season months are between April and October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from rainforest in the southern part to Savannah in the northem part. There is a vast swampy/marshy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile CDTI project. The main occupations of the rural communities are subsistence farming and nomadic livestock production. Exposure to infection in South Sudan is by way of village proximity to breeding sites and occupational activities. The major ethnic groups are the Azande, Bari speaking groups, Dinka, Shilluk, Taposa, Lutuho and Nuer people. The Southern Sudan Onchocerciasis control programme consists of five CDTI projects namely; East Bahr El Ghazal, West Bahr El Ghazal, Western Equatoria, Eastem Equatoria and Upper Nile. East Bahr el Ghazal and Western Equatoria were in their 6'n year of implementation while Eastern Equatoria, West Bahr el Ghazal and Upper Nile were in their 5'h year during this reporting period. South Sudan as a country has ten states and project composition based on states are as follows East Bahr el Ghazal CDTI project comprises of Lakes state; Upper Nile CDTI project covers both Upper Nile and Jonglei states; Western Equatoria CDTI project covers Western Equatoria state; Eastern Equatoria CDTI project covers Eastern Equatoria and Central Equatoria states while West Bahr el Ghazal CDTI project, the largest of all is comprised of West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap states. Vector elimination Presently, there is no vector elimination component in the South Sudan Onchocerciasis control programme. Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. The National Plan is implemented by South Sudan Onchocerciasis Task Force that is comprised of Health Staff of the central Ministry of Health, Republic of South Sudan, WHO/APOC staff in Juba as well as Non - Government developmental Organization (NGDO) staff which has a CBM staff as the NGDO Coordinator. The National plan also extends to and is also being implemented through various State Ministries of health at the Local Government Authorities; and at the CDTI project level, County, Payam, Boma and Community levels. The total population at risk of being infected with onchocerciasis in South Sudan in 2010 was 5,707,127 people. There are a total of 5 CDTI projects and I Headquarter project (SSOTF) that is located in the Ministry of Health premises in Juba, the capital city of the Republic of South Sudan. There were a total of 942 health facilities across the five CDTI project areas in South Sudan and these comprised of 2ll primary health care centres (PHCC), 693 primary health care units (PHCU) and 38 rural hospitals. 931(13.5%) of the 6,902health workers available in the project areas were involved in CDTI activities in the period under review. 1 The decentralized administrative structure in South Sudan is comprised of four tiers namely: The State, the County, the Payam and the Boma the lowest community level of administration, The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered by Governors; Counties by County Commissioners, the Payams by Payam Administrators, and the Bomas by Boma councils. Boma consists of several villages and mectizan distribution is based on villages in South Sudan. A village in the South Sudan context is defined as a given geographic area that is under the jurisdiction of a given local Executive Chief. The boundaries of every 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, have similar cultural/social traditions like marriage, funeral rituals and usually make communal decisions about their general welfare. The number of communities cited in this reports are synonymous with villages as per the described society norrns. The five CDTI projects covered 6,51 I communities in a total of a total of 44 counties during the period under review. Health system & health care delivery (state any problems related to health system that impede program implementation). Primary Health Care (PHC) remains the cornerstone of the health service delivery system and needs to receive more political commitment and support for it to meet the needs of the populace. The health system and health care delivery in South Sudan is focused on five levels of facilities/services and these are community based health activities, primary health care unit, primary health care centres, county hospital and state hospitals. The prolonged civil strife in South Sudan had its toll on the health care delivery systems and infrastructure and hence delivery of quality health care to the general population remains an enorrnous task. The health system is fragmented, few functional health facilities but in poor condition, lack of basic facility equipment, limited trained manpower, stock outs of medical drugs and supplies and meager, irregularly paid salaries and general lack of motivation to attract the few qualified staff plagues the public government institutions in general. This also has a direct impact on the CDTI program since the frontline health facility staffs that are predominantly government employees. Inadequate budgetary allocation for Primary Health Care (PHC) services has also directly affected CDTI work since there is no counterpart funding to augment the funds provided by the APOC Trust Fund for direct funding of CDTI at community level. 2 Map of Southern Sudan showing the states in which the CDTI projects are located. tE€END [f State SOI-ITHERN SUDAN (100r) r 3 5(x)0@ Gbqinbhrc FAo/hKFS Juil 2m3 Ihl. itag do.. noi rFrglt oliairl Utf ando.-iliani Additional information to clariff the location of the CDTI projects on the map above o East Bahr el Ghazal CDTI is composed of Lakes state; . Upper Nile CDTI is composed of Upper Nile and Jonglei states; o West Equatoria CDTI is composed of West Equatoria state; r East Equatoria CDTI is composed of East Equatoria and Central Equatoria (marked as Bahr el Jabal above) states; o West Bahr el Ghazal CDTI is composed of West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap states. 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - national, international) At National level, the partners involved are: o The National Ministry of Health. o Chirstoffel Blinden Mission, the lead NGDO . WHO/APOC At the State and County levels: . State Ministries of Health o County Health Departments. o Frontline health facility staff. 8.all Prolacildd PraD.lad bt D.b A xil@aiars J \'_ r--illrdb{ P isl isrg rdrii6i N B.hr W Balrr ol€hilil h.ts E Equetorlr lor*a3 L l.,imc,ltil At community level: o The Payam and Boma Administrative structure . The community leaders o The beneficiary community members r Frontline health facility staff. Describe overall working relationship among partners, clearly indicating specific areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc). The overall working relationship among various partners was good hence the overall improvement in all activities such as advocacy, trainings and mectizan distribution. The stakeholders plan, mobilize, train and supervise CDTI activities as well as preparing reports. Before commencement of this year's distribution, a review meeting of the projects' performances was made and also training of Project Coordinating Officers was organized by the SSOTF, WHO/APOC and NGDO. This training was then also cascaded to the lower levels by the PCOs in their respective areas of operation. WHO/APOC and NGDO jointly participated in conducting meetings with the MoH authorities over soliciting for counterpart contribution from the government for the funding of CDTI activities' State plans if any to solve any issues arising as regards CDTI implementation. The SSOTF has plans to solve any issues that may arise in the course of implementing CDTI activities as follows: a. The first step is to investigate the issues and determine the root cause such as finding out why some people refused treatment with ivermectin or reasons for absenteeism. b. The second step will be to identify appropriate officers to deal with the issues. c. The third step is to empower such officer through providing necessary means to the task. d. The fourth step is to report back after investigation. e. Finally, maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field and the office so that quick timely intervention is applied on any issue pertaining to the CDTI implementation. 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not during the reporting Period Name of CDTI Project Total communities in meso/hyper-endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (urG) East Equatoria 560 978,183 821,674 West Bahr el Ghazal 3,009 2,966,286 2,491,680 East Bahr el Ghazal 1,476 550,325 462,273 West Equatoria 904 699,760 587,798 Upper Nile 562 512,573 430,561 TOTAL 6,511 5,707,127 4,793,987 4 Source: Natienaleenst*t Other source, speciff: population figures that were used in the REMO exercise. Population growth rate of 2.9o/o has been used annually to project the figures to what is used in this report. Year of source: originally 2004 !@ Calculated as the meximum number of people to be treated annually in meso/hyper endemic areas within the project aree, ultimately to be reached when the project hes reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3d year of the project). 5 SECTION 2: Summary of CDTI Implementation 2.1. Distributionperiod Chart the actual distribution period for each CDTI Project in the country in the table below. p[!9.!: Overview of distribution undertaken by project Briefly note any problems/issues. Three major problems affected mectizan distribution in the projects and these were insecurity, heavy rains/flooding and lack of government counterpart funding to complement that received from APOC. There is always insecurity caused by cattle rearing communities annually. This such insecurity hampered smooth distribution of mectizan in East Bahr el Ghazal (in Wulu and Yirol counties of lakes state), West Bahr el Ghazal (in Gogrial East, Gogrial West, Tonj East and Tonj North counties of Warrap state), Eastern Equatoria (Magwi and Terekeka counties) and Western Equatoria (Mundri and Maridi counties). The heavy rains and flooding restricted air travel to Upper Nile for the delivery of project supplies. The airfields in the Upper Nile areas have clay-like soil that gets very sticky on even the slightest rainfall. Road transport to this project area is not an option especially in the rainy season. The topography in West Bahr El Ghazal is expanses of flat plains that are highly prone to flooding and thus hampering movement. With the huge geographical area, the challenging logistical situation, the seasonal roads and the extremely high cost of operations in South Sudan, the funds provided by the APOC fund cannot be translated into the required outputs as required by APOC management. Lack of counterpart government funding to augment what APOC provides led to failure to implement some activities and thus the current project performance. 2.2. Advocacy and Sensitization a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the sensitization and outcome. At the national level, 3 key officials of ministry of Health of Government of the Republic of South Sudan were mobilized and sensitized. These were three Director Generals of the Primary Health Care, the External assistance and coordination, and the Preventive Medicine. At the State level, the ministers of health of Lakes, Western Equatoria, West Bahr el Ghazal 6 Project Name Distribution Period Jan Feb Mar Apr Mav Jun July Aus Sep Oct Nov Dec East Bahr el Ghazal West Equatoria East Equatoria Upper Nile West Bahr elGhazal and Northern Bahr el Ghazal states including their Director Generals and their Directors of Primary Health Care were met and spoken to regarding CDTI projects in their various states The reason for undenaking the advocacy and mobilization exercise anchored on advocating for direct funding of CDTI activities; inclusion of CDTI in the routine primary health care services; absorption and integration of the remaining CDTI staff into the health system of South Sudan. The major outcome was that most of the County OV Supervisors are now government employees and there is assurance that the remaining Project Coordinating Officers will follow suit as government budget and allocation/disbursements to the states improve. The government has understood/appreciated the impact that the OV disease has on the quality of life of the people affected is gradually no longer considering it as a vertical project in the Ministry of health and hopefully counterpart funding will be received in the near future. b) State progress made towards internal resource mobilization. Within the reporting period, continuous efforts were made towards getting the government to appreciate the roles regarding counterpart contribution to onchocerciasis control. Despite not having received funding from the government, the OV program is recognized as one of the key areas in NTD control and hopefully with continued advocacy, funds will be allocated to it soon. c) Describe any policy-related constraints being faced by any particular project and describe what was done to assist the project (outcome). Explain any plans on how to improve advocacy. There were no major policy related constraints faced by the projects during this reporting period. 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. The SSOTF coordination office located at the MoH office in Juba reproduced a number of IEC materials for the South Sudan Onchocerciasis Control Program in 2010. The materials were distributed to Project offices for onward distribution to CDTI communities. The following were produced: o Manual for CHW's and PHC for the control of onchocerciasis with Mectizan'" . Manual for CDTI provided by APOC through the technical advisor and distributed to five project coordinating officers. o Illustrated OV training flip charts (OV Oncho in Sudan) o OV poster sets (3 posters per set; "What is OV", "How do you get OV", and "How to treat OV"). These posters are laminated in plastic for durability under field conditions. . Simplified CDTI instruction manuals for community distributors. . On the spot training guide for health workers and CDDs o T- shirts for health workers and other partners with inscription 'OV control in South Sudan' 7 How were the IEC materials developed? Most of the IEC materials were developed during the time of Health Net International and later reviewed and reproduced by SSOTF coordination office and while one originated from field situation and APOC manual. Are the materials reviewed to address upcoming issues (like decreasing refusals, sustainability, maintaining compliance to long-term treatment, SAEs)? Yes, they were reviewed (during the previous reporting period) with emphasis on maintaining compliance to long term treatment and other upcoming issues such as sustainability. Report if any KAP surveys have been done and how their results were used? There was no KAP survey in all the projects in 2010. Summarize information on: The use of appropriate and innovative media and/or other strategies to disseminate information among the projects; . Modem media such as local radio stations are available in most project areas. For instances, East Equatoria project made use of Spirit and Liberty FM radio stations in Yei and Miraya FM station based in Juba, East Bahr el Ghazal project uses FM radio in Rumbek and West Bahr el Ghazal relies on FM and radio station in Wau. Upper Nile makes use of Malakal FM while West Equatoria project had no FM radio station. In both East Equatoria and East Bahr el Ghazal FM radio stations exist that can be used to transmit health messages. o At community level, information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, women's groups, village health committees (if exists and functional) are used to disseminate information. Mobilization and health education of communities including women and minorities The five projects carried out this activity before mectizan distribution to create awareness about the mectizan, its availability, and selection of CDDs. Community leaders were responsible for contacting and arranging for the meeting with community members which involved the participation of men and women including the blind people and other minorities. Key messages included cause of onchocerciasis, health/social/economic implications, symptoms, who should not take mectizan as well as the dosages and possible side effects after taking the drugs by individuals with heavy infection. Community members were encouraged not to be absenting themselves during the distribution or refusing the drug outright. Also benefits of mectizan were addressed during such mobilization. Response of target comm unities/villages There was high response of community members during the mectizan distribution as the people who previously refused treatment were noted to have turned up this time round. Major accomplishments o More communities participated in the mass treatment in 2010 as compared to 2009 o More persons came out for treatment with mectizan in 2010 as opposed to 2009. . There were more active CDDs in 2010 as compared to any other year. Weaknesses/Constraints . There still needs to be a lot of improvement in the Community support to CDD. 8 . There is also need to have more women getting involved in CDTI work as CDDs and also in participating in community meetings. o The CDTI philosophy has not yet been fully embraced by the community members and thus their mentality on CDTI ownership is not yet to the levels expected. . The counterpart funding and available budget allocation for the production of health education posters is not sufficient for them to be produced in numbers would have a visible impact in the communities for which they are intended. . The number of health staff and CDDs required for providing information to community members is still inadequate. . High rate of absenteeism due to involvement and occupation in grazing cattle by adult men and male teenagers resulting in missed mobilization and health education. Suggest ways to improve mobilization of the target communities among projects. . Availability and use of more posters during mobilization and also their placement in each village and strategic places to attract community members is highly suggested. o Continued advocacy for counterpart funding from the government of the Republic of South Sudan . Engaging more health workers by integrating them into the health systems is ideal. . There is need to recruit more CDDs and community supervisors in order to facilitate health education and mobilization activity in the communities. o Women groups, youth and religious groups should be involved in the campaign. . Health education messages should be intensified in all communities o More funds should be allocated for this activity. o Mounting of billboard in strategic positions in each state urging people to take mectizan once a year for l5 years. o Regular radio programme on disease situation and on treatment with mectizan 2.4. Communities' involvementin decision-making Comment on community participation making comparisons among projects. Participation of female and youth members of the community at health education meetings; In general, how do you rate the participation of minority groups and female members in community meetings, decision-making? Community participation in 2010 was not significantly different from what it was in2009 bearing in mind that there were almost a similar number of the total persons treated. The percentage of communities with female CDDs also decreased from 2l.2yo in 2009 to l6.6Yo in this reporting period. This is not a good sign for female involvement and every effort will be made in the next reporting period to ensure that this negative trend is reversed. Strong social, cultural and religious beliefs greatly come into play in affecting female involvement in community work outside their homes. 2.5. Capacity building Training of national, district level staff in CDTI and general management skills in computer applications, project planning, etc Briefly describe any training done by the SSOTF/NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow-up needed). Continuous on the job training and mentoring was done for the PCOs and County OV Supervisors and this was targeted to improve their performance project management, to 9 provide them with capacity to apply basic CDTI strategies, CDTI philosophy, to provide them with skills that will foster smooth partnership between the communities and the health services, and to maintain community information data base. There was an improvement in the understanding the basic CDTI strategies but there is still more work to be done in regards to data management. @-1,: Type of training undertaken at national level by the NOTF Type of training Proiect staff MOH staff Opinion Leaders Others Program management Conducting health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specifu) Briefly describe any technical assistance provided to the CDTI projects. The key technical aspects of onchocerciasis controland CDTI implementation were provided to the project staff. 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Oo\o a-t o\ N ?.) o\ ra 6l s a :, -E L.=-iEE<E g -E u E* la) C-l c'r O ra) \or- o, o\\o ao € odr- o\ r- v) c.l rn \o € c\l \o\o o\ a..l r-N r-- t-- ia U)ob! u)o Q ll * 4io H c! .9o -E bo F bs de o\\or- o\ c.l o\ o\ \o o\$ co s\o € I'E 3ne o=clg4t E= dEtr>; =:D-zio a.) ol \ocn 00 \o c.l\o aorn N ia \o ra ? E.z =EE5 El- \o(.-s *o, \o OI\o ra) o\ o c-) [n \o )9.,3 5,:: *i ==oE.=A E E.E'AE ' o= E =e>-6 \orr$ +o\ o\o c.l\o o a.) ro Ib<E rr oFl U TEN 6 EI 6 L U)= a) >d 6 .E o e!l6) cgqEl El L() o. c) >z tr ESII CB Ba t] F F If the projects are not achieving 100"h geographical coverage and minimum of 65"h therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. The reasons for not achieving the above mentioned coverage include: o Insecurity in West Bahr El Ghazal state and East Bahr el Ghazal CDTI projects. o Inadequate available knowledgeable manpower especially CDDs in Raja and Aweil West counties in West Bahr el Ghazal CDTI. . Failure to access some communities since the distribution was conducted in the rainy season. Plans to remedy this: . Improving and strengthening community participation through mobilization and health education as well as motivation of CDDs. . Increasing capacity building of new staff and CDDs. . Conducting distribution of mectizan in dry season . Improving logistics to projects at county and payam levels. 2.7.2 a a a a In general, what are the causes of absenteeism and refusals and how is the The nomadic lifestyle for a big proportion of the population. Travel outside their communities in search ofjob during the period of distribution. Fear ofside effects. In some instances poor coordination between the distributing teams and member of the community 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. There was no report of any SAEs in the projects. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report x l5 Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period Not applicable since there were no SAEs reported * SAEs should be verified by project coordinator Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea Number of deaths N/A N/A N/A N/A N/A t6 C) s ooo(! c) = 6 C) C! o c) 'a o o @xoo' a) c! o o o F d oLo x() L., z E]d() c)E ,o c) .o c) !(d (q (! o C) c) (!(! ! o o(qE oo o() L CBq) oLL I e Io L F U oL 6)c, cgE9 oc)& et.9 €-loC.)Qlfr .gd qo-ol 9LtsIL a $1Eb64.. o - ).Eit:o=rr E =di98: .9orU €.E 36ltrcl r eElEotrl Ef*l8e;lr.-El! cl -,' o Eop EleL869l-tro () Gtr -L= oou) >6r E E.E Etr=ijtr=F 5q)li rlE2( 7;:, .- srlia G=l iEflI o G otr * o o ina 4 >! rO o\ yOo\ara rOo\$\o s e.l\o rA o\(\lt\ sF- € s$\o .o o\ o\\o 1Oo\$r\ s o\@ o\ o\ oo \oo\cl ca o\ -oo\\ o\ o\ \o 9 c- *=UO c^aL-O6 9c\ ooE9 F- so c{ so\ c{ s rr)(\I s(r) c{ s o\(\I s( ca so cn s n o\ s6 s\oN s od cn s o\ an o\r- ca s c.t .() Ooa :e EE 23 (\t o\q sf o0 ca\o o\ N oNrn ot\ (\ t\ \ot\ \o € o\sf(\I \o\o\o t\ ca+ (( c\ \o oo cq r- c\ r-6l co \o o\ol \o |r) r- co ld ca o\ \o$ C-t r- c.t € c.l € o\ e.l c.l 00 ol ca c- c.) co " 5.a =EE!Eaq rn € €- €o c.l rn €a €o(\t €o €\o c.l 00oid €(\l €ora $$ ca oo6(\lo rr) ooo. oo\o \ot- rn 6l6 \o c- la) o.l6 $c\\o o\ o\ tr)s\n st ao t-- r-- 6i \o\orr o\ c'i c.| o, c.)(\ $ { .9 .'3E TC if -?.gE:> E " - E€ o rat r $ oo ,.I \n $ oo r r\a\o oo\n € t\ o r €\0 € ooo t?)ra(\I ooo rrr oo c.l N ca ,o" \or- n^ cO N c-)\o" \or- n co c..l c.) c"I ra) ol\o- cO C! ca crl ra)N\o^ co o\\o o.l o\ € tr) \o c.l t-- \o- t-- c.l tr- e- U)o H o U * o oa c! I6se!- F z z z z z s\o rr) s\o ssr- \o 6\\? r-\o scl o.la s c.i co oq o\@ 09 s s\o oo I is $is3: z z z z z sF-N scn \vo\ : ^\ s9 =fN s9r-N \o o\ € O.\o s\ F- oo \oo\\o 6 !;E:.e;!.E ta EEaszEe z z z z z o c.l\o ot\ \n oo$ Nr- ra) \n co co rn\o o\ \or- rn\li c- \o ? 6.:i EE iEe* z z z z z No No rrlra)\o rrl .+ 6 c.t o.l\o * o.l \o F- c..l c.t r- € co$ \o :E: ll^ - I '- !'.9 -?: = g€- EeF ES EE uo 00 o € N6lN o ca6l € caN g\ €oI 6l o\ €C\l(\I t'-r-\$ oo rn sN n^(a) ca c- \o oin o\ c.t c-q \o \o t\ o\ o\ € o\ o\ o\ o\ o\ oooGI ooN (\t(>(>6l caooGI sl N \n N \o N r- c.l € c-.1 o\ N N 2.8. Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) Table 9: Supervision undertaken by the TA/SSOTF Project Name Supervisor Date Objectives of supervrsron Outcome/follow-up needed West Bahr El Ghazal CDTI National Coordinator and NGDO Coordinator March 2010 Improve data compilation and reports. Planning for the next mass treatment cycle Data collected and the mectizan needs for 2010 was prepared and ordered. Finance/Admin Officer June 2010 To follow up on accountability of funds disbursed to the projects and monitor compliance to finance regulations. Improved compilation and submission of returns ofvouchers. Conducted some on job training. East Bahr el Ghazal CDTI National Coordinator and NGDO Coordinator July 2010 Monitor training activities and assessing preparedness for annual mectizan distribution. Trainings found to be fairly well on course. Some of the CDDs had begun distribution using the remaining balances from previous year. Project was generally well prepared for the mass treatment cycle. Finance/Admin Officer August 2010 To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers was stressed, and onjob coaching took place Western Equatoria CDTI National Coordinator, Technical Advisor November 20r0 Meeting of State Health Authorities on integration of CDTI activities into the routine the PHC system. Monitor distribution exercise and retrieve available treatment and training data. CDTI to be included into the planning and budgeting process for the next financial year Preliminary data received Finance/Admin officer November 2010 To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers was stressed, and on job coaching took place 18 Eastern Equatoria CDTI NGDO Coordinator, Technical Advisor October 20t0 Follow up of mectizan distribution and treatment coverage and provision of technical support to the project staff. Visited communities where distribution was taking place and provided support to the staff. Received preliminary data on the distribution exercise. UpperNile CDTI NGDO Coordinator May 2010 Delivery of mectizan and work support items to the project Follow up of training and conducting advocacy with health authorities. Enabling environment for project implementation created. Have CDTI integrated as part of the routine PHC delivery system. Finance/Admin Officer May 2010 To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers was stressed, and onjob coaching took place 2.8.1, What were the main issues identified during supervision? In addition to the objectives that the supervision teams went out with, a number of additional issues were identified: o Insecurity and flooding were delaying mectizan distribution in some places. o Poor communications within counties and distances are very far apart from one village to another. . Some communities were without CDDs and therefore not receiving treatment. . Inadequate number of CDDs hence long time in completing distribution since each CDD has to cover more people. o Poor data management and inaccurate population figures and irregularities in treatment data in most records and registers. o Community treatment registers not available in all villages 2.8.2. Was a standard supervision checklist used? Yes it was. 2.8.3. What were the outcomes at each level of CDTI implementation supervised? o The concemed individuals were coached on what to do. o Improved performance noticed during follow up visits. o Information sharing on CDTI activities (reports) took place. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? o Yes, on the spot discussions were done and the findings were shared with them at the time of the support supervision. 2.9. Community self-monitoring and Stakeholders Meeting t9 Project Name Total # of LGAs/Counties in the entire project area No. and %o of LGA/Counties that carried out self monitorins (CSM) No. and % of LGAs/Counties that conducted stakeholders meeting (SHM) East Bahr el Ghazal Western Equatoria Upper Nile West Bahr el Ghazal 8 r0 7 6 l3 0 0 0 0 0 0 0 0 0 0 TOTAL 44 0 0 Table 10: Community self-monitoring and Stakeholders Meeting It was not possible to conduct CSM and SHM because of logistical challenges experienced in facilitating this process across the projects. 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. It is expected that the communities will: . Gradually take full charge of the delivery of the CDTI activities in their community like have new CDDs selected without necessarily having the Health staff facilitating. o Demand for mectizan when there are delays or if some communities are inadvertently left out during the distribution of mectizan. o At a later stage begin conducting advocacy campaigns for the CDTI program. 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with long-term mass treatment with ivermectin? gp!g-Ll: Activities that promote compliance to long-term treatment with ivermectin Obiective Specific Activities Proiect targeted 1. Promote Integration of CDTI with other primary health care services Meeting with policy/decision makers on absorption of CDTI activities into health system and provision of counterpart funding to supplement what is currently available. East Bahr El Ghazal, West Bahr El Ghazal, UpperNile, Eastern Equatoria and Western Equatoria 2. Maintain high therapeutic (>65%) and geographic (100%) coverage Increase in the number of CDDs and community mobilization and health education so that the CDD/population is reduced and thereby increase coverage. East Bahr El Ghazal, West Bahr El Ghazal, Upper Nile, Eastern Equatoria and Western Equatoria 3. Promote strong Involvement of more East Bahr El Ghazal, West 20 Eastern Equatoria community ownership community members in CDTI activities especially women. Bahr El Ghazal, Upper Nile, Eastern Equatoria and Western Equatoria 5. Support strong partnership Addressing the issue of partnership between endemic communities and health system and their roles in CDTI. Approach a number of available NGDOs for support to OV control work. East Bahr El Ghazal, West Bahr El Ghazal, UpperNile, Eastern Equatoria and Western Equatoria 6. Put in place a strong IEC strategy that encourages continued treatment Not yet done extensively due to limited resources. East Bahr El Ghazal, West Bahr El Ghazal, UpperNile, Eastern Equatoria and Western Equatoria SECTION 3: Other activities of the SSOTF 3.1 Describe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). There was completion of the REMO and RAPLOA exercise that was begun in 2008 in all the five project areas. A total of 126 villages were targeted during the exercise. 3.2 What was done to coordinate CDTI Project activities? These were mainly through joint budget development plan, holding planning meetings before distribution, exchanging information as appropriate, requiring projects to submit monthly reports to SSOTF of their monthly activities under the guidance of the TA. The SSOTF also shares with other partners CDTI activities during meetings or conferences. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up needed) . The annual program review and plan meeting took place at the beginning of the year. o Meetings with project coordinators and the county supervisors to review the performance of the CDTI projects and aim at improving coverage. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. The meetings that were attended by SSOTF officials include: o An eye care meeting that took place in May 2010 in Juba. o NTD stakeholders meeting convened by Ministry of Health - Republic of South Sudan that also took place in Juba. Other country: None. NOTF meeting in Ouagadougou and JAF meeting that took place in Abuja were not attended because of unavoidable circumstances. 2t 3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, financial), - Reports forwarded to APOC management, - Administrative assistance or trouble shooting for projects. All the financial reports were submitted to APOC management in 20109. SSOTF and TechnicalAdvisor assisted the various projects in preparing and forwarding 2009 TCC reports to APOC Management. 22 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. Project Name - SSOTF YEAR (6), 2010 Nov Dec Jan Feb Mar Apr May JuneMAIN ACTIVITIES Jul Aug sep Oct Nov Dec ',ilihtiillfrcnijiihiar,": ::i ..: I *SSOTF coordination offi ce x *Regional (Defined project area) x *County x x * Stakeholders meetings/community x x x Frb.illEdt'rrfiiltt$l'd4 r'F* ^,- "'.1'"i " * OV supplies x x x *ddv;;;,' r i,. r['i -.. , I *SSOTF coordination office x x *Regional (Defined proiect area) x x *CounW x x x x *Payams x x x x rsarxi*e rf'l. "'*: J *SSOTF coordination office x x * Trainins of CDDs x x x x x * Training of supervisors x x x x * Training of community leaders x x x X * Training of health staffl x x x x ASSESSIf,ENTS: * KAP studies in new areas *Review/reproduction of IEC materials x x EEALTE 3IX'C^$iGhI LtsSCiMb ..,. -l * Community awareness/targets x x x x x x x x x x * School health education/targets x x x x x x x x x x * Churches x x x x x x x x x x Ccmr -- l Census Update x x x x un&*ihri:r*smridi 'r."ir j'I ''r "7i', l'r.' (: x x *Druss for SAEs x x x rvnhrrrbeiw'Dr$Itiiliur#iitv' l; i: ,, I I *Ivermectin Distribution x x x x x x *Distribution of minor side effect drugs x x x X x x C6rhfrI6"jiiecsdA&*# i :-: :i::i''";. -., i *County Health Departments x x x * NGO partnership x x x * Trainins of CDDs and others x x x * Local Health systems x x x *CSIWSHM in community x x x Modrru,criient I Mop up treatment. x x x x x x x *Sqrrrisqd@F;*F{8, " CelrtVSID) . 'tF;': {'r'r. i': I l * SSOTF coordination offi ce x x x x x x x x x x x x x x Mectizan uests SAEs/lvlinor side effect 23 ',-i ,. x *PCOs/RTF * *SSOTF/PCOs/RTF x X X x X x X x X x x x x x x x xX x x x x x x xx X x x xx x x x x*SSOTF coordination office xX X x X x x*PCOs xX x x x x x* Payam supervisors xX x x x x X* CDDs x x x x x x x*PCOs x x x x X x x* Payam supervisors x x x x X xx* CDDs Monthly finrncid rcporting GTDGtrditUTG X xx x X x x X Xx x x*SSOTF coordination office xx x X x x x Xx x x xPCOs / RTF Prcpareti,on of mid tcm/ rnnurl tcchnicel rcoort x x*SSOTF coordination office x xPCO / RTF for Mcc{izrn1} x X*SSOTF / PCOs 24 3.7 Plan of Action for 2011. Proiect Name SSOTF HQ Years Year 7 20tt MAIN ACTIVITIES QI Q2 Q3 Q4 *Planning/Review meetings +SSOTF x *Regional x *County x x * Stakeholders meetings/community x x x X Procurement of materials * OV supplies x X *Advocacy *Regional x x *County X X *Payams x x TRAINING * Training of CDDs x X t Training of supervisors x x * Training of community leaders X x * Training of health staff/ X x Management / SAEs x x ASSESSMENTS * KAP studies in new areas x *Reviewof IEC materials X HEALTH EDUCATION SESSIONS * Commun ity awareness/targets x x x x + School heatlh education/targets x x x x + Churches x x x X Census Census Update x x x Drue Deliverry/Supplies Mectizan requests X *Drugs for SAEs x x Setting up of referral systems *Strengthen up referral systems b/w communities, PHCUs, PHCCs and hospitals for SAEs x x TVERMECTIN DISTRIBUTION t Ivermectin Distribution x x *Management of SAEs x x lntroduction of CSIW SHMs *SSOTF partners x x tCounW Health Departments x x * NGO partnership x x * Training of CDDs and others x x * Local Health systems x x *CSIU/SHM in community x x 25 treatment.rYru 1, u J x xMop up treatment. x xManagement of SAEs *Supervision of CDDs, P. supervisors and County Supervisors) xX x xSSOTF x x x xPCOs/RTF xx x x* Payam supervisors X x xx*Data collection x x x x* SSOTF X xx x*PCOs x X x x* Payam supervisors x xx x* CDDs *ReDorting/ drug management x x x x* SSOTF x x xx*PCOs x x x x* Payam supervisors x x xx* CDDs x x x XMonthly financial reporting expenditure x Xx xSSOTF x x x xPCOs / RTF xxPreparation of mid term/ annual technical report x xSSOTF XXPCO / RTF x*Application for Mectizan x*SSOTF / PCOs x xINDEPENDENT MONITORING x x*SSOTF/PCOs/RTF *Mid term review x* SSOTF / RTF *Evaluation * SSOTF / RTF 26 r- c.l c; C) z C) I)L C6 :;g' !rNE 'i v) <0(H (69 o9 .nE(o= 5v)o =-co9 ro(! c0) u) >\ O -v) !() OL O() =FE) E= 9(6 ?,c)aSC)l-tr =-boEtE c) (.) E ZQ oo .l *L vA otr tr 0) - U - tr 6lo q) J tr .v -th -Iq) vtrA - , Aht U 6l I: 1ntiq) I !ti cl 6l A rn2!-Ioo i9 - !L'i -t9E .-F+.5 Ho?L/2'6 A;t v -tl -- :ra,=L-:-x'iE a-trh rOLrA:E -lr'5E zEAAEY ii oir - t-rl \J =lEl trr crlV)+FI Eq) 1n 6lq) q)lr E t, q) L o) tr U Ehtre () fr lh t, o (.) te U Go F] (a L() L Fr a z co\o \o q o\ sf, o\ q .+N co rn oo\o o\ oo $ o\ co o\ f- ctl c! co =(a (a6 a D 6lq)Hrl L v) taa \o r- \o N ca rn r- n rn\or- oo cl ca ca oo c- 9 ooF- c..l \o c\ € tl\o oo 'a La F HO(t o o C! z N c6 C) Lr CB m (r) CB CB Lo sl li c) chq) (g Lro(! r! L C) (h (B trl (.) z L C) D N o Lr CEo (, o ts tuF oaa 6! F If there are problems with release of counterpart funds, how were they addressed? Comments: Yes there are problems with budgeting and appropriation of counterpart funding for direct activity implementation in the OV program. Continued tireless advocacy is being done with the government of the Republic of South Sudan to have funding provided for OV work as opposed to relying on APOC and the NGDO partner only. State the number of projects that had no funding from APOC Trust Fund? o None. All the five CDTI projects plus the SSOTF received funding from the APOC Trust Fund. State the number of projects that had no funding from any outside source? . None. All have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? None, financial reporting has significantly improved; and for the very first time, the second installments of APOC funding were disbursed to all projects' 4.2. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) . Provision of venues/shelters for community leaders meetings and CDDs training. . Some communities do the mobilization and sensitization of their own people. o Communities collect firewood, water and also cook for CDDs during the training. . Some communities store drugs and provide good security awaiting mass treatment. 4.3. Resourcemobilizationefforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. Submission of work plans to the Ministry of Health, which included activities to be implemented by the CDTI activities. The outcome has not yet become positive; but continued efforts will be continued to advocate for release by the government funds to CDTI. 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency - 2.8 Sudanese Pounds to the US Dollar 28 @1!: Indicate how much the NOTF secretariat project spent for each activity listed below during the reporting period Activity of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc 0.00 8,908.33 0.00 0.00 0.00 6,036.00 0 0 Monitoring and supervision of CDTI Proiects Training of Project officers, TOT, NOTF staff, etc. 6,724.16 0.00 0.00 0 Advocacy visits to health and political authorities at national level 3,760.42 4,458.33 0.00 2,632.00 0.00 0.00 0 IEC KAP studies, materials development, Annual review workshops 0.00 0.00 0.00 1,499.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 I 3,060.00 12,000 0.00 0 0 0 0 Bi annual NOTF meetings/conferences Fuel and maintenance of Vehicles, Maintenance of office equipment Stationery Others/Salary by MoH-RoSS 6,219.43 1,000.00 1,000.00 0 025,600.00 TOTAL 57,670.69 12,000 l, 13,227.00 0 Total number of persons treated 3,010,375 Comments - None 29 Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currently Non Functional but repairable Written off l. Vehicle 0l 0 0 0 0 0l 0 0 2. Motor cycle 0 0 0 0l 0 01 0 0 3. Computers 0l 01 0 0 0 02 0 0 4. Printers 02 01 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others a) Photocopier 01 0 0 0 0 0l 0l 0 b) Cash safe 0l 0 0 0 0 0 0 0 c)Lap top 0l 0 0 0l 0 02 0 0 4.5. Equipment @-14,: Status of equipment of NOTF Secretariat Project *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). How does the project intend to maintain and replace existing equipment and other materials? This will come from government counterpart funds which is hoped would be available in very near future. Describe the adequacy of available knowledgeable manpower at all levels. The SSOTF headquarter office: Apart from National coordinator, Deputy National coordinator, and administration and finance officer and one driver, other staff such as Data Manager, Secretary, logistician etc are lacking. The CDTI project offices: There is general shortage of manpower in the project coordination offices. Only PCOs are involved in technical matters as they have no assistants at state project level. Most project coordinating officers are not yet good in producing the annual technical reports due to their low educational level. This is considered a serious matter for good CDTI management at project level. Project supervision centers: Most of the CDTI project County OV Supervisors have worked as CDDs in the past and hence promoted to supervisors. However, they don't have a basic education background and therefore, a lot ofcoaching is required and the number per county should be at least 3 persons for good supervision. Community level: The overall CDD/population ratio across the 5 CDTI projects was l:390 in 2010 as compared to the 2009 ratio of 1:605. Gradual reduction in this ratio is being realized although it is still quite high as compared to APOC recommendation of lCDD per 100 persons. . a a a a 30 Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). This is not the situation in South Sudan during the period under review because staff transfer does not occur. 3l cn c.) o -o .9 6 ot _oo3z a.Eo-q) ZE o) 'o1 A 'E O) og x6) o >oEEZ o!+.LQ)U)o>= 'E6EEE ,t I !Y !Y C) o o=IEAoo- aD bD >. ET< 6t?o= ra [a ia >. -o o .(E6_)6=trJi6! IJo)Q. oo (t o.- .s bbE EZ !l .9 -,..., e (d >2 .L 6)tr= q)o-o () (0 ((H :v -a Cg ,a=99.1 r, >r () o :iJ 6a6o..= ootr>. t-=E trsf E ca tr5 5 ocE ] CO:C .YiZcucc ==>()Z,6o)>1 - )'eHXFon ,r Y U F > 8E.E H '5 8_.E ,!'E () c -LrA<'6:= .\- ^ - F C) (d z o 0) 'a tr €) c! Lq) 6) 6t bD L 6) 6) tro rnl -l0)t -ol ctlFI +. Lq) EO L q) tr 0) b! o a ! 6l <) el a tr 6t o! L h 6l I L cl q) 0) o 6l O: >A ra rt) o) ()L Lq) cg b0 L o o) o 6) - -3 ii ov5 +r 6l >'S .- 6) llE .i; OO u)a ;.= trE .=e Gl !- ;r 9r >tr rd€fi6z?AEVE 3 QtijAa D 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) There was no plan yet. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. No plans yet. <', ) 5.2.3. s.2.4. 5.2.5. 5.2.6. Funds No plans yet. Transport and equipment (replacement and maintenance) No plans yet. Human resources No plans yet. Which projects have submitted sustainability plan? No plans yet. To what extent have the plans been implemented? No plans yet. 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms Ivermectin delivery system is separate from other drugs in the PHC system as a result of non integration. The Ministry of Health of The Republic of South Sudan is yet to have an integrated drug delivery system involving all drugs. 5.3.2. Training There was no integrated training yet with other programmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff is not ministry of health staff and the CDTI has not been taken fully over by all state ministries of health. There is a sign that integrated training of programmes such guinea worrn eradication and onchocerciasis control and other NTDs would be a reality in the not very distant future. 5.3.3. Joint supervision and monitoring with other programs Joint supervision and monitoring with other programmes is not yet occurring. The more likely integration to happen soon will be that of neglected tropical diseases. 5.3.4. Release of funds There are no funds available or released to any programmes but with stabilization of health system, there is chances that common budget and release would be possible in South Sudan over time especially through joint NTDs fund release. 5.3.5. Is CDTI included in the PHC budget? No, direct funding for CDTI activities is not included in the PHC budget JJ i 5.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? There are no other health programmes in the Ministry of Health are using the CDTI structure 5.3.7. Describe other issues considered in the integration of CDTI The CDTI strategy could be used in management and control of lymphatic filariasis through albendazole drug distribution alongside ivermectin. 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) No integration yet 5.4 Operational research No operational research was carried out 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. Not applicable 5.4.2. How were the results applied in the project? Not applicable 5.4.3 Note the issues that have been identified by the NOTF for future operational research. KAPs in the new CDTI areas . There are no identified new CDTI areas 34 aSECTION 6: Strengths, weaknesses, challenges, and opportunities Strengths The presence of the WHO/APOC Technical Advisor to support the SSOTF and the CDTI projects. Good working relationship with CBM in regards to drug procurement and delivery WHO/APOC office in very useful in hastening fund disbursement to SSOTF and projects. a a a Weakness o Available manpower and staff commitment is still inadequate. . Unreliable population figures in virtually all CDTI projects. o Poor state of roads with resultant high wear and tear of the vehicle. . Frequent insecurity in project locations disrupts treatment and thereby leads to low coverage. o Distribution during rainy season renders many areas inaccessible o Frequent break down of motorbikes and project vehicles due to poor maintenance. Challenses and how thev were addressed . Inadequate staffing and knowledgeable manpower in the project area. There is deficient staff strength across all levels and SSOTF has planned to continue working with the state ministries of health on recruitment of the missing staff. o Non availability of CDDs in some communities. This matter was discussed at a meeting with community members as discovered during SSOTF supervision and new people were later recruited and trained. o Non integration of all projects and non absorption of some CDTI staff into the ministry of health. Effort has been towards this through meetings with and letters to govemment top policy/decision makers in Government of Southern Sudan o Intensifying health education and community mobilization. This was used to diffuse beliefs on the mectizan and those who previously refused now accepted treatments. o Population/CDD ratio in the entire country is still high. Although this has been reduced but communities without CDDs are being encouraged to get CDDs and those with less number of CDDs to get more CDDs. . High cost of Transport system in the whole South Sudan. The road condition is still very poor with consequence huge cost of vehicular maintenance due to frequent break down. 35 IIndicate how rtunities can be utilized to imorove CDTI a The continued peace and stability in South Sudan has offered platform for community penetration and further improvement in both geographic and therapeutic coverage. NTDs control offers an opportunity for utilization of CDTI structure and thus leading to popularity of mectizan distribution List the strengths, weaknesses, opportunities and threats of the vector elimination project (where applicable). This is not applicable since there was no vector elimination component in South Sudan. a a 36