UPPER NILE (UN) CDTI PROJECT whou n proiect@qm ai l.com ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUB SSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR oNcHocERclASls coNTRoL (APOC) COUNTRY/NOTF: Republic of South Sudan Proieqtllanoe: Upper Nile CDTI project Apprqvalrcar: 2003 Launchinq vear: 2006 Reportin q Period: From: January 2013... (rvlq!t!!nrgerl To: December 2013 ( Monthl/ear) APOCfundinsvear: (circleone) 1 2 3 4 5 6 7 (8) I 10 11 12 13 APOC Proiect implementation vear: (circle one) 12345 6 7(8) e 10 11 12 13 Date submitted:N Juty 2u4 Partners: - Ministry of Health - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Christoffel Blinden Mission - 259 communities I t I UPPER NILE 2013 ANNUAL PROJECT TECHNICAL REPORT TO TECHNTCAL CONSULTATTVE COMTMTTTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Republic of South Sudan National Coordinato Dr. Tong Chor Malek Signatu Date:.4' IJ ly12014 Proiect Coordinator: Chol Omak '-F Bc,.F ^Pt6$J \ NGDO Rep Signature: .. . ... .. Date:. .......t July tZOlq resentative: John Alal Ujwok Signature: ... ... .. Date. ........tJulyizoi q This report was prepared by: Dr. Tong Chor Malek Designation ational Coordinator Signature Date:.il 12014
Table of contents ACRONYMS.................. DEFrNlflONS ....... FOLLOW UP ON TCC RECOMMENDATIONS. EXECUTIVE SUMMARY............ SECTION 1 : BACKGROUND INFORMATION .. 1.1. GEueRRl lNFoRMATIoN....... 1.1.1 Description of the proiect (briefly) 1.1.2 Parlnership 1.2. PopuurtoN.......... SECTION 2: IMPLEMENTATION OF CDTI...... 2.1 . Ttriltrltrur oF ACTIvlrlES ....... 2.2. AovocncY 2.3. MOAIIIZRTION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COTUI\iIUNITIES 14 2.4. CovruurutrY INVoLVEMENT....... ' "'15 2.5. CRpRctrvBUlLDlNG "'""""""16 2.6. TReRrrrlEttrs............. """""""18 2.6.1. Treatment figures """'18 2.6.2 What are the cLuses of absenteeism?....... " """"'20 2.6.3 What are the reasons for refusals?............... """"'20 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that 20 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear......... """21 2.i. oRoeRtruG, sroRAGE AND DELIvERY oF IvERMECTIN """23 2.8. COtvttuurutrY SELF-MONIT6RING Rruo STnTSHOLDERS MeErtruC... ......25 2.g. SupeRvtstoN.............. """""""25 2.g.1. Provide a flow chart of supervision hierarchy. "" ' "" """"'25 2.g.2. What were the main issues identified during supervision? .............. ....26 2.g.3. Was a supervision checktist used? """' ' """""26 2.g.4. What were the outcomes at each level of CDTI implementation supervision? ............ """26 Z.b.S. Was feedback given to the person or groups superuised?...................26 2.9.6. How was the feedback used to improve the overall pefformance of the project? 26 SECTTON 3: SUPPORT TO CDTI EoutptueNr FIunTCINT CONTRIBUTIONS OF THE PARTNERS AND COMMUNITIES OrHeR FoRMS oF coMMUNlrY suPPoRT .............. ExprruotruRE PER ACTlvlrY.... SECTION 4: SUSTAINABILITY OF CDTI.. """"""31 4.1 . lrureRrunl; INDEPENDENT PARTICIPATORY MONITORING; EVnlUnrtOu .......'... " " "31 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) 3.1 3.2 3.3 3.4 26 26 27 31 31 3 7 9 0 0 0 1 2 3 4.1.2. What were the recommendations?... 4.1.3. How have they been implemented? ...... 4.2. SusrntNRatltw oF eRoJECTS: eLAN AND sET TARGETS (trlnruonroRY AT........... Yn 3)........ 4.2.1. Planning at all relevant levels.... 4.2.2. Funds 4.2.3 Transport (replacement and maintenance).... 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented...... 4.3. 1rurecRnrtoN.......,...... 4.3.1. lvermectin delivery mechanisms............. 4.3.2. Training 4.3.3. Joint superuision and monitoring with other programs 4.3.4. Re/ease of funds for project activities.. 4.3.5. ls CDTI included in the PHC budget?...... 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?. 4.3.7. Describe othersissues considered in the integration of CDTI. 4.4. OprnnroNAL RESEARCH 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporling period. 4.4.2. How were the results applied in the proiect?.. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES ..34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 31 31 31 31 31 31 31 31 32 32 32 32 32 34 34 34 4 Acronyms APOC ATO ATrO CBIVI CBO CDD CDTI CMA CSM LGA MOH NGDO NGO NOTF OV PHC REMO SAE SHM SSOTF TCC TOT UNICEF UNWFP UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Christoff Blinden M ission Commu nity-Based Organ ization Commu nity-Directed Distributor Commu nity-Directed Treatment with lvermecti n Christian Medical Aid Community Self-Mon itoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Onchocerca Volvulus Primary health care Rapid Epidemiologlcal Mapping of Onchocerciasis Severe adverse event Stakeholders meeting South Sudan Onchocerciasis Task Force Technical Consultative Committee Trainer of trainers United Nations Children's Fund United Nations World Food Programme Ultimate Treatment Goal World Health Organization 5 Definitions (i) Total ulatio the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (i i) Eliqible population calculated as 84o/o of the total population in ( iii) meso/hyper-endemic communities in the project area. : (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 of the project). (v) Therapeutic coveraoe: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geooraphical coveraoe: 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) lnteqration: 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-monitorinq (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. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 6 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 _ 37 The recommendations cited below are those that were given to Upper Nile project that was comprised of two states i.e. upper Nile and Jonglei. Please note that the same responses are going to be provided for Jonglei CDTI project that was art of U r Nile ectfrom 2006to2012 Number of Recommendati on in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Recommendations to improve report (i) Correct table 7. lt is reported that all the communities in Longichuk, Maaban and Maiwut achieved over 80% coverage yet there was no treatment. The column is about communities that had less than (<) 80% therapeutic coverage and not more than 80% therapeutic coverage rate. Since there was zero treatment; that was the reason that all the communities in the project area were included under the communities had treatment coverage of less than 80%. ( ii) Assess and include the existing opportu nities for the project (e.9. the re- launch of CDTI provides an opportunity for the project to refine its implementation process. Recommendation well received; and when activity implementation resumes in the project area, all efforts will be made to have it implemented. Recommendations to improve project (i) It is imperative that efforts are made to conduct a census in the project sites. The current figures are based on estimates that may be outdated. This has still not been done due to the numerous challenges faced by the project. The figures in this report are those got from subjecting the 2008 national census figures to progressive annual successive population projections based on an annual population growth rate of 3%. 7 (ii) lncrease the proportion of the health staff involved in CDTI activities from the current 15.2%. This would require setting training targets (there were no targets set for the reporting period). Recommendation well received; and when activity implementation resumes in the project area, all efforts will be made to have it implemented. (iii) Training for CSM and SHM should be undertaken because this would be a critical measure of the community sensitization and mobilization. Recommendation well received; and when activity implementation resumes in the project area, allefforls will be made to have it implemented. Recommendations to APOC (i) Access remains a key challenge for this project. The vehicle and 4 motorcycles supplied by APOC are non- functional. There is need to find mechanisms to support the implementation team to ensure that the drug supplies are transferred to the communities in good time. This would also facilitate supervision. 8 Executive Summary This is a report of the CDTI activities that were supposed to be implemented in the Upper Nile CDTI project from January 2013 to December 2013. This was the project's eighth year of APOC funding. The total population that resided in the CDTI project area in 2013 was 217,788 and had an ATO of 174,230. A total of 259 communities were targeted for mass treatment with mectizan in this reporting period; howeverthere was no CDTI implemented in 2013 because of the outbreak of a conflict situation at the time that the planned activities were going to be commenced. The main challenge that affected the project, and is still affecting it to date is the current conflict in this part of the country. The upper Nile project area is one of the states in the country that has a strong presence of anti-government forces and thus is not in direct communication with Juba. The other challenges were faced in the past still linger on and they include . Tribal/clan conflicts the fear of reprisal attacks. . Lack of integration of CDTI into the routine primary health care . Poor data management . Logisticalchallenges THIS REPORT WAS PREPARED AT THE NATIONAL LEVEL AND NOT AT THE PROJECT LEVEL BECAUSE THE PROJECT IS NOT OPERATIONAL AT THE MOMENT DUE TO THE ON-GOING POLITICAL CRISIS. 9 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate The Upper Nile CDTI project is located between latitude 5'N and 8'N and between longitude of 29"E and 35"E; situated in the Northern section of South Sudan, lt now covers Upper Nile state that has three of the counties of Longichuk, Maiwut and Maaban that are onchocerciasis endemic. The topography of the project is mainly composed of vast expanse plains of savannah grasslands with clay soils. The rainy season in the project area begins in May and ends in October; with the dry season lasting from November to April. The area receives annual rainfall that ranges from 800 - 1 000mm. Flooding is common in the flood prone areas due to the rivers flowing in from the Ethiopian highlands. Population: activities, cultures, language The Upper Nile CDTI project area is home to the Nuer, Anyuak and Dinka people. The activities of majority of the people in Upper Nile include cattle keeping and subsistence farming. Fishing along the rivers, their tributaries and the marshy areas becomes a major activity for these communities during the dry seasons. Communication systems (roads...) This CDTI project is situated in an area that has quite challenging terrain in South Sudan. The road infrastructure ranges from very poor to non-existent in most areas ln rainy season the majority of the project sites can't be accessed. Only county headquarters and surrounding villages may be reached by boats or dugout canoes. Some minimaltravel by road is only possible during the dry season that lasts from November to May. Upper Nile CDTI project area can also be accessed by air transport via Juba and Rumbek. UNWFP operates humanitarian flights in the region and facilitate movement of humanitarian workers in different parts of the region. Admi nistration structure The administrative structure in Upper Nile like in any other part of South Sudan is divided into state, county, Payam and Boma. The Boma is the lowest level of government administration. The state is administered by Governor, coun$ by a County Commissioner, Payams by Payam Administrators and Bomas by Boma Councils. 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 main health service delivery system in the project area. There are also some NGOs running some of the health facilities in the area. However, drug stock outs and lack of medical equipment and supplies chronically affects most of the health facilities. There are a total of 56 health facilities in the project area',41 Primary Health Care Units (PHCUs), 12 Primary Health Care Centres (PHCCs) and 3 rural Hospitals. t0 Number of health staff in project area and number of health staff involved in CDTI activities. A total of 425 health staffs are recorded to be existent in the project area. However since there was no data reported from the project area, the participation in CDTI activities for 2013 is not known. Table 1: Number of health staff involved in CDTI County Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Br Percentage BfBzl 81 *100 Longichuk 137 0.Oo/o lVlaaban 156 0.jYo Maiwut 132 0.0% Total 425 0.0% No data available on the involvement of health staff 1.1.2. Partnership The partners that were involved with the project include cbm that went out to the project for a field visit; WHO/APOC who coordinated the delivery of the year's mectizan supply and funds disbursal in collaboration with the National Coordinating office at the national Ministry of Health. Describe overall working relationship among partners, clearly indicating specafac areas of project activities The different partners that were able to have some work done as mentioned above coordinated quite well. State plans, if any, to mobilize the state/region/districULGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The SSOTF, WHO/APOC, and CBM had a meeting with the State health authorities and the key reason was to have a project Coordinator appointed to run the activities of the project. A new Project Coordinator was assigned to the project in 2013, and participated in the Oncho trainings and meetings that were held in Juba in 2013. ll c.l s .E an o) (o .C a,q) (5 3rg!otu z- cootroE-c .8 .=$o €(g-Y f =),X o>6 c rao^xaE etr(Ef o c.E=" Eou Goo,ea E +t v'.J Oo<5b : A e '7 EE'=-6 oE cr- -cE;c(Eirr'; I c,e.- I8gp .Eg^LgPU3 (EE*oq ae3t sEB: PE E.9 Eg8E E(Uzr (/) .Cl = o-l'E (E 'tE i fr =ou oL'E.I. L>;: sr ='- o ecvE =05 bEEg E6 Eo EF! E EEd p € ".s 6 Cv€!- .C f = Lf oE oE(, So -s .E oE 5 J -() -E:B Eo$* Ef (Ei: oo= = -c>>= +r =< d L ah =ac oO (o C o .F (o z 6OoN Eo Eo q) 5I sq (f) o o) (u -c =oL o) C o (g f o- o o_ G =1-C 9EoE -o(!(Eroi .Clcg.e P8 +, O'erA .= oo L *E a * ci= Lh9oE'Ec c sOCots (5 o!Pog r.o 3 EK -.vo) .e gg E geiie;68ZyR =tr6 I oz (\. E o o o. o)tr E o CL o o E')tr ,E oq oE o o 'd CL o -c o o o o o G o G B q) S q) i a) o$ e A) Q-.- oo!0)\'-ox Gnr ss i(B Us. oE ts c')oa, !uu-O 0.: > .sP '=*s* oo(U(n oXb5 Qq) 8: oii 8-s\> ^s.0 3E :6 .\ q)\a osl co N(/) !::e6(!'hOY 8s s+ O(U a.h8b4.5bE bE' EqIe ^o tr$ ilR, E!, ta-{eOc) =(UtE .!l o(Boo<IE PS L5 E. o) E oo() L o o) .T J1' o o E o (E o oL(! o o o -c =G o (E o o 'd o o o o .E .Y o (E o (E o o o. 1' (g o o '= E tsE(E trO 5 Or-& ot.(LNI ol qEl F l-l o o (E =o o(L (, Ff oEEg"E.boE a!O5E N @ ,r)- @lr) \t rr) O)- s s O)(o- (o r.* o(9 ol t ,q)Lc . t-9 6 !.-xb Eioo, OE'trc r-N c\l CY) f.* C9$ .t- N r.c) @ N o) @ @i-- N o . os- b'EE I q *3; p'H < -trco-(l)o N OvEOO-o O..Y(!o.y cLo) * Ee Ht,eCtro.- I I I t-NN col'- cf)ss- N rr) @ N O) @ c,\ N .= oo c,g '5 o o .E E E o o o o .cl E z N + I tHc cLi; F.u Ei E, oE'EC ro o) (o(o @o) o) lO ot N o S: EE-(E 9;8 o=o *x a.I I I I (Dvco aO, 6 x'p'.o.Y o- o S Ee Et!ECo.- ro O) (o @ @ O) o) ro(\ ocltr.= O AgL .=ts(EIov -i or !l €sEsF CL.= O t-N o{ (f)t- (9 .ts N ro @ r N o) o €\ $l ; =&,oOC)J .Y J .o o)coJ C([ -o(!([ = f .=(5 J l- oF I a-) () o '6- L o_ o .C o C oa o(E =C(! .N o o E io c(o c f ooo(! o o 'o' L o_ oE o Eoa L) -o .aE>r gLc=(U(J -oE2E'- 'So o- a9 U'A(E- =dU'C :cg .>b oo_t.E F- ,-.| O OE _co :=O.h5o o)'E .=>E= -L, =(glJ- :-rEgo (1,o)E> :q)ts3oo()I (E o o =o o .= E o G o o G o (U o -tr o oo 't o(E o o =o E tr c"it ol Itl(Ul FI tro o la- o o +,(E ;o6.s F.= OE CLE ooiE z9o.E FoltJ -O e.i tr .9 .9 e oo o o o= cLo EE o o or- E9 I I I tr o J -o L .9.E ol o .9- E= cLo EEo-o- I I I or- ;q au I I I o (E E o.f, o oc oo o_EI cLo EEo-o- Et- E9 o' I I I ol .E c '6 o o= -ob EE o o I I I Er - he(rt - I I I oo -oo.= (E=NE Ittroo =e c o ot v- cLo EE oo I I I 9-c he I I I tr oo .Yf -c .o(,) C oJ c o -oo G = .=(E 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year There is no record that this activity was done. The reason(s) for undertaking the advocacy and the outcome N/A The outcome(s) N/A Describe difficulties/constraints being faced N/A Suggestions on how to improve advocacy N/A 2.3. Mobilization, sensitization and health education of at risk communities The use of media and/or other loca! systems to disseminate information N/A. However it is known that FM radio stations exist in the project area and can be used in the future. Mobilization and health education of communities including women and minorities N/A Response of ta rget communities/vi llages N/A Accomplishments N/A Suggest ways to improve mobilization and sensitization of the target communities. N/A t4 2.4- Communityinvolvement Table 4: Communities participation in the CDTI Comments: No reporting from the counties from Upper Nile CDTI project Attendance of female members of the community at health education meetings No reports. ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses No reports. lncentives provided by communities for the CDDs No reports. Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? No reports. Other issues - None County Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Ba Number with community members as supervisors Bs Percentag e Be= Bs/ 84 -100 Male CDDs Br Female CDDs Br Total Be= fl7+Bt Number of communities with female CDDs Bro Percentage Btt= Bro/Bn*100 Longichuk 95 I Maaban 66 [Maiwut 9B TOTAL 259 l5 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels The project area has a number of health workers that can be trained in CDTI activity implementation n future. As of now their availability and knowledge on CDTI is not known and cannot be reported on. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. Not reported on, however the insecurity caused a number of health staff to flee the project area for their safety. l6 !, o C '6 o o o o o L oll E z :E tr t-> Ed*=o t&d i,gd O o O o @s o O o o o O o o o sq o C o E o, .9 o s8sFc) Olr) cf) s (o C{ ro s- o o .=ooF .:o o-Eooo -9o.= r(Eg.: Eo z =Eu<) EJ*=(.) =" *d o o o O o o O O o o o o sq o o E 6) .9E o sooF o o o o T' o -c =ooE(Ug *o oo ^88aCLE- Z3= o o EuciFd*- -o o o \il)q iil) e o o o o o o o o o o o o so c o E o .9 o sooF o o o o (E o c =t,oo o.E tr (Eots oll E z E,, dFd+-ro o o + rt)q =oe o o O o o o o o o o o o so c(, E o .9 -co s o o F o o o o cf oo -Y = -c. .9 o)c oJ c(! -oo(u f = o F oF a- o o) oo o oE oo oL oz a q o E E o o o, oo o a o! o q e() G{ Q o r< o =5co o o O) b oa I) oo ru{ ob S Q o_ d aGEIo oq c o G c o Eg o. .E F-o o o .9, o g c o oE E o t! cD '= '6 riit o,l -cll(Ul FI Trainees Type of training CDDs Community members e.g Community supervisors Health Workers (FLHFS) MOH staff or Other Politic a! Leader S Others (specify ) Program management How to conduct Health education Ittlanagement of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Table 6: Type of training undertaken Any other comments - No training conducted Treatments 2.6.1 . Treatment figures 2.6 tf the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons No treatment occurred. Plans to remedy this are: The hope is that the conflict in the area end and probably CDTI activities may resume in 2015. a l8 o\ ! f o € o .o. a. o c\ !- E o s o Bl G o o .g{ a.G E, o o Et t o € G o ac o '6. tq3: ccoo ';] CE -o .:o 9o Eaao EI >G G=tEorl J2h:-E!\o Ea.oo '6'S \.s F8 o'so; cti C\CC q'= T5ix .9 !,'d.Et o E e.$ 5€ e .. oo . qc;o! as 0tcr0'r o ot !r EtP 'tlo .3r I .>oo\'E Q.Q.Ooooo oc e. e.€bEt b bpaa\ ==oc c= E EAo=o EE5EE \BisO GE oo-alfEEflrg oo r,tSr oFf o o o o a o oE Ec = 'o o o .9 E oE c o oo E o o E a o oo oP3; .g -9od ol6 ol oot: ot oFIE rl o olEolYplt el Ect o 6t+ot.L ot F5tr !t =ol6 0lL E E;lE sli slEbl blbl bl ol 6lEI EIrl rl zl zl oI o o o o E =o Ut ! E o =c op 6 q =cl E E o o 9 8tI rl c xl g Elscl>olE -lo olootE6l- >t 6 ol! =l Eclrflc ct :to EIF otF bl LI ol!l EI 2l oI G o6' o oE c E = oE cf E E o 9 E o!c o J. oo E o o E E ootcol t *l c ul 9 .916 3laEloql o olE 3tF bl blol EI 2l ol oi $l ol ol -t6lol ol dl ol ol 3 cldl EI ol el ol -leql 3l ."1 olol bl ol6l rl EI ol Ll o o 'a CL o,E E o oE o CL o oz o c o E E o o .Y o L (! o(! o G (E .; c J oo .cl o UI o !,c G tr o E (E o F f'- f o,I ltl6IFI IOEi ='9oo\ od-=9H8!eo5ks o E oo E o oo- 3e)Eo o o o o o o o oo o o 3S a oo E ocF b.^r.^^9€* EE65#EEE ;38 6eteE o O o o !+ U)tr o t.lJ 2a6 o o o o sd)(JO.= ., .= o) -Fv f o,o.t ir* o N € EEB E s46. ,P8 o o O o -o* -C 5;* H o O O o *qEEi* b 9 3 0., E i"os;E=E o O o o c o g =o o o- oll -oo'df, o 0,oD cL6 G()L-bE I "5EO FO o o o so o b r- E;g 5hrz- o o o o o tsoE 6.2 =EEE .E "86 t- C\I c\l (f) t- (a$$- Nlr) @ N o) o @\ (\t o ,EtE-gs t-N c\l (f) F- (f)tt s- Nlr) @ N o) @@\ (\l oo E,g 5 @o .E E E oo oo rrf o'd o .99 -oI 9.9 s H',8 -OE o O o o o bE E-L: (rN € E+E JOo-z,oot o o o o o .!E Efts-o E g..3'<E 5 ro o) (o(o @o) o) lON rE s E., * c o)o >F U, * = 6E-c = (E -IE=:ETEO: c >.= c, tr.!E E; E 9 lo O) (o(o @o, o, lO(\t tr oo -Yf, -c .o o)c oJ c o -ooo = .= o J F oF 2.6.2 What are the causes of absenteeism? Not applicable 2.6.3 What are the reasons for refusals? Not applicable 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. Not applicable Parasitologist trained? N/A Existence of microscope? No Has the project reported all SAEs to Mectizan Donation Program (MDP)? Please tick one. Not applicable because there no treatment conducted. Eruo !Yes ln case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report x 20 so o, 9E:->JO o N u? cf) \ca co o)\ ros oq(o(o q @ F.- q cr) rr) tr o (U Jo o(L oorrr ui Lri uJ o EDn (E^tr bs o o Nq lr) r- q (a r c?(o t- nloO \$ o) q CO @ oo il:- uJ l.r, LIJ s E6,iE'(EooEBFo O) -q cr) O) ni N q @ co (o rr) oq 1r)(o q rf)s TU E r_ E;*5[rz (o(o r.-_ tf ro o) s_(o co N(o n ro @ O) @- cof-N s ryt- CO co Nlr) |t.-- o cf) N uJ ?o(! o.a =EoE E.q "86 oo o_(o F- @(o @- o) (oo o_ cf)$N (o(o F-_ o)loN $ @ (o lf) co Ns co^(o(o cf) s:* fe e.e E" $ o) O)- lr)os $ O) O)_ $ (o rr) rr) N @$ O) cf) Or_ F- @$ (f)t\ rO- N r lr) (f) F- ro- N lo U'o cD s5 o .9 .=tr5 E E oo o c, rr I-tTti UJ o cDr't .!^tr bs o o @ ri$ @q @ cf) c.l oo r oi O) oo r @ F-(o *g r $i i8** Nr cj cf) N c! @s @o $ ro r oi O) oo oqr-(o tll .= o-I 5PE EbEEgz 3.8 " oo No,lo oNr- r oN rO N(o lr) @CO UJ ?oE 6.= =€E"86 o ro - o o (o rr- r loN rO N(o ro N(o rO iEEEE, N(f) C) @ cf,N. o @ r c) * * roN|r) N(olo N(o rO t UJ @ooN r-ooN @ooN o)ooN o roN roN c.l (I, o c ot- (E5EO(E9E =oo'd tro.oo cL:.8bco o .o6 o- o.G o 5sl Etrlbol ,ts 3l o -olEoocn .eb(roGO =T,PEi=o(E2Eb oH E' !I) o F orl "i *lqGl N l-l E o L o o. o) E o o. o o cnc L !, E o EEoo €=(E-o eC vO Ovltl c<9@t -(uoo oo>coo E9 e6 EEq; .03 b'aoa sEoG u, .oG,=o*35 ..o colz. ol -ololFI o9- ooX ->-8g b <.= E z 3r$c=c =6!o19()(, catr .9Edxo-LJJoo z a.o -O5P!-) 6, rO(Joo_ z Io 0)!D =ou .9EcE-:< ooo0)oE trtr =6 z oE(noQ -c>d\ - alZ E€EEE z cOr = ur=e(,(tr> o'= o= dE.sE z C o €ogor.N(5i o.= ofgEtg z o E o o_ E a z r-e H o: !] o) E ie ItJ U' E (UE z C oNqE - b 8g si z o oo)co6):'->o z x o)a z o){o z z U) o o.l ol q 0) 0) a) U) q) q) o o a- ,eb G (D o o (/) o O) ooq) 'o o o B5 o t, oi o,ooN c4 o) oo o oa o o o o o E ocF- -q r-$ so af-s so q Cf) Cf) so t-t- lo_ COt- o Ns co-(o(o (f) @ @ r-- F- N (f) r- ro- N r rr) @ @\f- N q o,$ o q O)s o o,t-N o N(0 ro O)toN N(o ro o) roN N oN (f) roN 21. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for bY: n NGDO f, Other (please specify) Mectizan@ delivered by *.*-E WHO N Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities . Community level information is received through the payam and county supervisors to the project coordinating officer on the total population residing in the project area and also data on the usage, wastage and remaining stock of mectizan available after the cycle of treatment. . The Project Coordinating Officer then compiles all this information from all the counties under their jurisdiction and sends this to the SSOTF secretariat. . The SSOTF compiles all the data on consumption and balances available, and prepares a drug request for submission to MDP. . MDP reviews application, approves and forwards the application to MERCK. . MERCK then ships the mectizan shipped to South Sudan and it is received by WHO Office in South Sudan. . ln conformity with the data that had earlier been received from the Project Coordinating Officer, corresponding amounts of mectizan is supplied from the SSOTF/NGDO to the Project. . At project level, each county supervisor collects the mectizan from the project office and then notifies all Payam Supervisors of the mectizan availability for collection. . The Payam Supervisors on collection notify and invite Boma Supervisors to collect supplies for their corresponding communities. . The Boma Supervisors, some of whom are CDDS share this information with other CDDs and the communities. . The community members then decide on the time for the mectizan distribution to the rest of the community members. 23 County tturnUer of Mectizan@ tablets ln stock from previous year Requeste d Received Used Lost Wasted Expired Remainin s Longichuk 0 219,681 219,681 0 446,667 0 0 219681 Maaban 0 157,329 157,329 0 102,943 0 0 157329 Maiwut 0 276354 276,354 0 54,068 0 0 276354 TOTAL 0 653,364 653,364 0 672,866 0 0 653364 Table 10: Mectizan@ lnventory The 2012 mectizan that was not used could not be traced when a field mission was conducted to the project area early 2013. !t is thus recorded as lost in the mectizan inventory table. How are the remaining ivermectin tablets collected and where are they kept? ln the previous years, whenever there are balances of ivermectin tablets, the CDDs are charged with the responsibility of submitting them to the frontline health facility staff so that they are stored in preparation for the next treatment cycle. The amounts of stock of medicines that remain are communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities that are carried out by the health care personnel include: . Training for both new and old CDDs within the communities before the mectizan distribution. . lssuing the CDDs with mectizan tablets and collecting/receiving the remaining balance from them for inventory and storage at the health centre at the end of distribution cycle. . Conducting community mobilization and health education on OV program. . Facilitating the process of selection of CDDs by the community. . Management of any person with adverse side effects reactions and keep records of the case treated. Any other comments - None. 24 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No. lf so, When? NiA Table 11: Community self-monitoring and Stakeholders Meeting Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. N/A 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. SSOTF Task Force Project Coordinating Officer / I )ounty OV Supervisors / I Payam Supervisors / 7 CDDs / f eneficiary communities Supervisi Reporting County Total # of comm unities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) Longichuk Maaban Maiwut 95 66 9B 0 0 0 0 0 0 TOTAL 259 0 0 25 2.9.2. What were the main issues identified during supervision? NA 2.9.3. Was a supervision checklist used? N/A 2.9.4. What were the outcomes at each level of CDTI implementation supervision? N/A 2.9.5. Was feedback given to the person or groups supervised? N/A 2.9.6. How was the feedback used to improve the overall performance of the project? N/A SECTION 3: Support to GDTI 3.1. Equipment Table 12: Status of equipment ndition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written off) How does the project intend to maintain and replace existing equipment and other materials? N/A NGDO OthersMOH COUNTYAPOC No. Condition No Condrlro n Condition No. Conditron No Condrtion Source Type of equipment No. NA 0 NA0 NA 0 NA 01. Vehicle 1 CNFR NANA 0 NA 0 NA 04 CNFR 02. Motor cycle(s) 0 NA 0 NACNFR 0 NA 0 NA3. Compute(s) I NA0 NA 0 NA 01 F 0 NA4. Printer(s) NA 0 NA 0 NA1 F 0 NA 05. Photocopier (s) NA 0 NA0 NA 0 NA 06. Fax Machine(s) 0 NA 7. Others NA 0 NA0 NA 0 NA 0a)Bicycle 10 CNFR 0 NANA 0 NA 0 NA4 F 0b)Metallic Cabinet 0 NA 0 NAF 0 NA 0 NAc)Metallic trunk 4 26 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c lf there are problems with release of counterpart funds, how were they addressed? This is not yet applicable since there are not yet funds being received from the government to directly fund the implementation of CDTI activities. Additional comments - None 27 oq t @61 c{t (oq o @ ro- oi@oto o 'c; ,@ , U'. I lo lo loto :o :olo io lo 'Cr iO ,Oi@ t(o lt 'c"l I jd -: i- o lco lco(.) io) t(\l <ci lci irio :(\ :(,otslt c., :o ;ro f..- u? oN @_ N Io io, r :O :(O r.- :ro iro$ :F- itoi(o:t tt , lF. 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O: O,o o o o oo o ooq c9o oo o o ooq, qi q,q o o oo O O:oq q:q O O,O o eo ooqc oo oq o o o-oo oo o oo o eo oo:oq q,q ooo oooolooooo'od o ci oc; oq o oo c; oq o oq o oo o oq o oq o oq o oq o oq o oq o oq o oo o I o, O6 E"OtrF 't -9Oo 9-o ;ol! ttoooc:o).-tt E, .n OtEtr, o =6:o z oq o oo o oo o oo o oq o oq o oq o or CO oq o o ooq qq o, o,o o ooq qq o o,o ()ooqq9(oo,@ o)- oI(9 (t!,oo E'I!, J o o o o ooq q q qq o o o oo o ooq qq o, o,o o(\ E' oE o o. o U)tr o -o t llJ GEtrg oo o o o o CL 9 IE o N o 3F tr o 5 .o tr o(, Fz UJ =ztr lrJ oo an- o an tr 0,q x:ocE,EC- or ;r.=- :El tl #eElelq I<l '.1 n, €sl'l - d J FoF oz t o !rcg.ebc;{ n€ fi3f $9 E,oo: b9q E .LE:C :E E. E9pc;; .e o'E-g='-e :sl F F $ gtl - c.i a o sl -,Ni 3 s c'o(,lc 'o .S; .9 -o: (E;iri= o-!(,(/)' >, tu r, N, ('(f):o:(f) I G o aitn o cr o 0) o- 9ro' Eo o)Eb !o)au)iro .oYE oo)(l) oi>E. (E: \bl6is2l>iO FIN:{l *l=;a o ooos G !s a! Ee 'Eeloa> 'Io EaE5 s>Et(J(! 9oSbo>>o Ib llJz J F IIJ(9 of dt 5 .:(o =E 9E E ilE E a oi= E $ il $ c! (.)l $ -l- 'l 0) c o G ut 0) 14 s(, G(, o E-ab iE .e3 s€so 3SEE G o aI at, 0)fE,a E oo rt cO o L(E o) o)L -c o(tl c) -C L o a ocE(! (! aC .o -o L c oo -Eoc(5 .= LL i:i(, g -oGF ioiioio, tl 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) N/A 3.4. Expenditure per activity lndicate in table 13, the amountexpended during the reporting period foreach activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndicate exchange rate used here- 3.8 SPP -Any comments or explanations? None SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/ monitored? (Tick any of the following which are applicable) Year 1 Participatory lndependent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation lnternal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Not applicable 4.1.3. How have they been implemented? Not applicable 4.2. Sustainability of projects: plan and set targets (mandatory at year 3) Was the project evaluated during the reporting period? _No- Was a sustainability plan written? _No When was the sustainability plan submitted? _No 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. Planning at all relevant levels - No plans made yet Funds - No plans made yet Transport (replacement and maintenance) - No plans made yet Other resources - No plans made yet 3l 4.2.5. To what extent has the plan been implemented - Not yet applicable 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms The lvermectin delivery mechanism used now is that: . WHO/APOC in collaboration with SSOTF delivers the mectizan to the state ministries of health, . The Project Coordinating Officers in collaboration with the state ministries of health are then responsible for releasing the mectizan to the County Health Department stores. . From the County Health Department stores the mectizan is then dispatched to frontline health facilities in the Payams. . Most Payams in the project area have health facilities, so there were no instances of having the mectizan kept outside the health facility. 4.3.2. Training: ln regards to training, integration is not yet happening 4.3.3. Joint supervision and monitoring with other programs This is not yet happening. 4.3.4. Release of funds for project activities There were no funds released from the PHC system 4.3.5. ls CDTI included in the PHC budget? Not yet. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Not yet applicable for this project. Explain what are the combinations of interventions co-implemented? There is no clear arrangement for co-implementation yet. t 4.3.7 How were the interventions implemented? (At the same time) The interventions are not implemented at the same time. The different programs utilise the same persons in the community to implement the programs. Describe others issues considered in the integration of CDTI. This is not yet applicable in this project. 3Z .; o .E E E o o o +Jtr o E o -zo ?a6s oJ EB o-- o Gt(E ECE -t E')c E o CL on c LoE =a@bo = o (! c o, Eg CL -E 'E. d,^O.= aO o J3c .too', € g.Ec -,,8 .9!Ht E Et'E=(ro bs ho 'EEe dr; otrU,.= E'I .E= do E ot, o E E' o (, CL oo .= oG c o c ot o .s o o o- F a a a a a a a a 6 C o o o o CL F c-t c.) U) o a- E Gxq) =.o) q S) (E q) a(U o bo (r) q G o q) q) a) a e oL () L oE OEOE oS .6@ =FoROlJEO)L-E EP orQ?eCLtr -EO<l,FO 53 .r croo rF r:oI €el-F q o o_ E Gxq) B .P U) eo o) a(U q) Eq) U) q co C)tq) e o c0 = oc o 9,o!o-o oo .(!69 -o- E Jz E oF o g(! E o lJ- o o(! = oc o oLOE o- 6)b3 LL 6)(! E z G oF o o G E o TL o o G = ooo 9EE>uOo> -otrE'- Jz E oF Fo60)trG o g G = @ E.g .t=FE 5Fz6 o oE o(E oE.E o o cn GFE O.n o, .ol:t Lho iE o o(! otE E o o E') (E F B'i a $$B !8s&g' tr ,- .9oE t9 >rLl-o a a a a a oo oE cLc>oFo a E -OL.E 88oP+, .= 5EEI9.eO.! E.E .-C o8-os .. -csf5 -Co=iz(E'=Ftr 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operationa! research undertaken in the project area within the reporting period. None has been done. 4.4.2. How were the results applied in the project? Not applicable SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths: There ate a number of government health facilities in the project area and if they remain undamaged during this war/conflict duration they could be the bases for the commencement of reestablishment of the frontline health facility supervision work. Weakness: . CDTI integration into PHC has not begun. . Lack of staff especially at the community level to implement the CDTI work. . The available number of CDDs is still inadequate. . Poor record keeping at the community level Challenges: . The war/conflict situation. The project area is now under the opposition forces and thus out of reach from Juba. . The literacy level of the community members especially the women is quite low leading to poor quality work at the community level. . Record keeping is a challenge. lt's as a result of low literacy levels and lack of appreciation of the need to keep records. Challenges: The plan to re-launch CDTI was an opportunity that would have seen an improvement in the implementation of CDTI activities. However it is now put on halt until later. SECTTON 6: Unique features of the projecuother matters No additional information to report on. ! 34