WEQ CDTI annual project technical report submitted to Technical Consultative Committee (TCC) : July 2004 to June 2005.

South SudornWest Equatoriq CDTI project ORIGINAL: English I COUNTRYAIOTF: South Sudan Proiect Name: WEQ CDTI Approval year: 2003 Launching year: 2004 Reporting Period: From: Julyl2004......To: Junei2005......(Month/Year) ( Month/Year) Proiect_year of this report: (circleone) (1) 2 3 4 5 6 7 8 9 10 Date submitted : 22/07 12005 NGDO partner: Chirstoffel Blinden Mission ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting I I I I I I I I I I ! I I I I I JlEs-- !. c i I ,I ri\ : I I ,ti -Ii[,I I I Q (0 For I To, r,ro tio' ft \AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ! I I I 2 7 iuiL zn't:l WHO/APOC. 24 November 2004 I I I TI OFFICERS to sign the report: ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. Country: South Sudan National Coordinator Name: Dr. Samson I Baba Signature: Date: 2210712005 Zonal Oncho Coordinator Name: David Bido. Signature: dffi Date: 2210712005 NGDO Representative Name: Fasil Chane Signature: Date: 2210712005 This report has been prepared by Name : Dr. Baba/Salah/Fasil/Bido Date 2210712005 ll WHO/APOC, 24 November 2004 Table of contents ACRONYMS............ DEFINITIONS ......... V VI ..1FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY 2.6. TR1arusNrs................ 2.6.1. Treatmentfigures........... 2.6.2 What are the causes of absenteeism? 2.6.3 What are the reasonsfor refusals? ... t SECTION 1: BACKGROUND INFORMATION........ ...................3 I .1. GeNpnal TNFoRMATToN 1 .1.I Description of the project (brieJly) 1.1.2. Partnership 1.2. PopularroN SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. TrvpLtNg oF ACTrvrrrES .............. J 3 5 8 9 ...,....9 ......1I2.2 AovocRcv 2.3. MosILIzetIoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT zusK coMMUNITIES I I 2.4. CovuuNrry rNVoLVEMENT............ .................14 2.5. Capacrry BUTLDTNG ...................... 15 l8 t8 2I 2t 2 7. 8. 9. 2 2 2 2 2.6.4 Briefly describe all known andverified serious adverse events (SAEO that....2l 6.5. Trend of treatment achievementfrom CDTI project inception to the current year23 OnDERING, sroRAGE AND DELTvERy oF rvERMECTIN......... ...................24 Couvuxrry sELF-MoNIToRING aNo SterpHoLDERS MprrrNc ...........25 SupsRvrsroN 26 9.1. Provide aJlow chart ofsupervision hierarchy. 26 What were the main issues identified during supervision? ... ... ...26 Was a supervision checklist used? ......... ....................26 What were the outcomes at each level of CDTI implementation supervision? 27 Was feedback given to the person or groups supervised? .............27 How was the feedback used to improve the overall performance of the project? 27 SECTION 3: SUPPORT TO CDTI 27 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3.1. 3.2. 3.3. 3.4. 27 28 28 29 EquterrarNr FINaNCTaL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES OrupR FoRMS oF coMMUNrrY suPPoRT Expr,NottuRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI.. .............30 4.1. INrenNal; TNDEIENDENT pARTrcrpAToRy MoNrroRrNG; Ever-uauoN....................30 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) ............ ........ 304.1.2. ll/hat were the recommendations? ...........30 4.1.3. How have they been implemented?.............. ..............30 lll WHO/APOC, 24 November 2004 4.2. SusrRNasrr-rry oF rRoJECTS: nLAN AND sET TARGETs (uauoaroRy AT ...............31 Yn 3) ......... ...........31 4.2.I. Planning at all relevant levels .................31 4.2.2. Funds ................._11 4.2.3 Transport (replacement and maintenance) ................31 4.2.4. Other resources... ..................31 4.2.5. To what extent has the plan been implemented......... . ................31 4.3. INrpcnauoN ..,............ .................31 4.3.1. Ivermectindeliverymechanisms ..............31 4.3.2. Training.... ........31 4.3.3. Joint supervision and monitoringwith other programs..... ...........31 1.3.4. Release offundsfor project activities ......31 4.3.5. Is CDTI included in the PHC budget? .....32 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What hove beenthe achieyements? ............. ..................32 1.3.7. Describe others issues considered in the integration of CDTI. .....32 4.4. OpsnauoNAl RESEARCH.. ..................32 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period........ ..................32 4.4.2. How were the results applied in the project? ............. ..................32 SECTION 5: STRENGTHS, WEAKNESSBS, CHALLENGES, ANID OPPORTTAIITIES....... 32 SECTION 6: UNIQUE FEATURES oF THE PROJECT/OrHER MATTERS...........33 lv WHO/APOC, 24 November 2004 Acronyms/Abb revi ati o ns Action Africa Hilfe African Medical Research & Education Foundation African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Central African Republic Community-Based Organization Chirstoffel Blinden Mission Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Health Workers County OV Supervisor Comprehensive Peace Agreement Community Self-Monitoring Democratic Republic of Congo Government of Sudan Government of South Sudan German Technical Assistance Internally Displaced People International Medical Corps. Local Government Authority Ministry of Health Mundri Relief and Development Association Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Project Coordination Officer Primary Health Care Primary Health Care Center Primary Health Care Unit Payam OV Supervisor Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Secretariat of Health Sudan Relief and Rehabilitation Commission Technical Consultative Committee(APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization AAH AMREF APOC ATO ATrO CAR CBO CBM CDD CDTI CHWs COS CPA CSM DRC GoS GoSS GTZ IDPs IMC LGA MoH MRDA NGDO NGO NOTF PCO PHC PHCC PHCU POS REMO SAE SHM SoH SRRC TCC TOT UNICEF UTG WHO WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesoftryper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage(normally the project should be expected to reach the UTG at the end of the 3'd year 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 coverase: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplemenrs, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Community 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 WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session _ (Please odd more rows if necessary) Executive Summary Prepare an Executive summary of the report in not more than one page. l. Background on treatment and populatton data - Total communilrcs, commurulrcs treated, total populauon, UTG, ATO and persons lreated.2. Background on populatron movements 3 Trarrung data - CDDS, health workers, Tolal populatnn (communfiy) per CDD tramed. 1. Challenges and how they were overcome I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY There were no recommendations made for West Equatoria CDTI project. The CDTI project is in its frrst year of implementation The West Equatoria CDTI project launched and the project office consolidated. WHO/APOC, 24 November 2004 Executive Summary The project is an expansion of an existing semi CDTI program that was implemented by NGDOs and CBOs as part of their Primary Health Care activities. It was mostly clinic based treatment. From the REMO exercise conducted in South Sudan from March - Iuly 2003, 39 villages were selected in West Equatoria. REMO was successfully conducted in 38 villages;1,2were hyper-endemic, 16 were meso-endemic and L0 were hypo-endemic. It is estimated that 410 communities will be treated in the region over 5 years. From January 2005 - June 2005 the preliminary treatment data shows that 125,498 people have been treated and 8,953 persons developed minor side effects after Mectizan treatments which were all managed by the drug distributors. 62"/" of the ATO and 30% of UTG have been achieved in the project area. The total CDTI population is estimated at 425,751people in the region. Prior to the war, the inhabitants of West Equatoria were settled agriculturists in the communities practicing subsistence farming. People were not able to carry out other occupational activities as a result of internal and external conflicts. The population was dispersed deeper into the bushes. The indigenous groups are the main population in the area although there are refugees from the DRC and CAR. There are also internally displaced people (IDPs) from Raja who are settled at Mabia in Tambura County. These IDPs had OV treatment in the GoS area and after displacement they received the follow-up treatment in SPLM/A areas. There are also internally displaced persons in Maridi, Ezo and Mundri counties. CDTI training started late December 2004 but there were a number of trainings carried out from January - April 2005. A total of 954 CDDs, 60 Payam OV Supervisors, 5 County OV Supervisors,129 health workers and 80 different groups of community leaders/LGAs were trained in the Five Counties in the project area. Supervision and monitoring were not very effective due to the vast geographical area/inaccessibility due to natural barriers and inadequate OV supervisors at all levels. To meet the above challenges more supervisors were trained and logistic support for supervision/monitoring such as motorbikes and bicycles were availed for the CountylPayam supervisors to have access to the remote areas and more training activities for supervisors were planned. Inadequate human resources and technical manpower in some counties is an issue since implementation of CDTI requires personnel with good understanding of the strategy. To address the issue SSOTF secretariat carried out frequent visits to the Countiesfayams to coach and uplift the standards of the project staff and stakeholders on the round. 2 SEGTION {: Background information t1.1. General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate - Population: activities, cultures, language - Communtcationsystems (roads...) - Administrationstructure - Health system & health care delivery @rovide the number of health posts/centers in the project area if the idormation is availab le). - Number of health staJf in project area and number of health staff involved in CDTI activities. - Geographical location, topography, climate West Equatoria is the south-western region of South Sudan that is comprised of five counties: Tambura, Ezo, Yambio, Maridi and Mundri. The five counties consist of 29 Payams. Tambura has five payams and one centre for Internally Displaced Persons, Ezo County has five, Yambio has nine, Maridi six and Mundri four. Boma, the smallest administrative unit in the SPLM is made up of a collection of communities. The west Equatoria CDTI project office is situated in Yambio town. The Nile River traverses the Equatoria region dividing it into two, Eastern and Western Equatoria. The West Equatoria CDTI project borders Tonj and Cuibet Counties of Bahr El Ghazal and Juba and Yei counties in East Equatoria. It also borders two oncho- endemic countries, the Democratic Republic of Congo (DRC) and the Central African Republic (CAR). This project area covers 26-34 degrees east longitude and 4-6 degrees north latitude. The land formation is iron-stone plateau with complex basement. The proiect area transects two hydro-topographical zones of the Nile and Congo water-shed which is characterizedby fast-flowing rivers e.g. Yei, Yale, Bahr-Naam,Era, Maridi, Lesi, Sue, Yubu, Lingasi, Ibba, Biki, Mbungu and Duma. All rivers drain towards northeast to the ]ur River and east to the Nile River to form a confluence with the Blue Nile to form the White Nile. It is precisely because of the climatic and topographic conditions that the disease prevalence is so high, as the black fly thrives well in such environment. The vegetation of the area is mainly guinea savannah with woodland derived from rain forests to the south. - Population:actiuitiesrcultutes, There are an estimated total of 506,847 people at risk of being infected with onchocerciasis in West Equatoria and with the signing of the comprehensive peace agreement (CPA) the population is expected to increase with the returnees. Prior to the war, the majority of the inhabitants of West Equatoria were settled agriculturalists practicing subsistence farming. Current settlement patterns have been affected by the prolonged war. People have been unable to carry out their farming and other occupation as a result of both internal and external conflicts. West Equatoria also accommodates internally displaced people and refugees from DRC and CAR. West Equatoria is home to the Balanda, Azande, Moro, Baka, Avokaya, and Morokodo ethnic groups. The Azande is the dominant ethnic group. j - Communication system (toad..,) Accessibility to the region is via North West Uganda through extremely poor road infrastructure. It is also accessible by air from Lokichokio in northern Kenya and from Entebbe. Within the region there are internal flights between the counties. There is also a road network to all counties covering 60% of the counties. Although the roads are in a poor state, they are relatively good compared to those found in most southern Sudan locations and are passable throughout the year mainly because of the free draining laterite soil. There is a road corurection to Uganda through Maridi, Yei and Kaya. This road is responsible for the improved trading activities in the area. The roads in Yambio, Maridi, Mundri and Ezo are better than in Tambura. The roads are not tarred, seasonal and prone to flooding during the rainy season. - Administationstuctute The Government of South Sudan is currently making changes in the administrative set up. Western Equatoria CDTI project area is designated as one of the three states of Equatoria Region (Headquarters in Yambio). The administrative levels are standard in the SPLM/A areas. The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered by governors, Counties by commissioners (SPLM secretaries) and Payams by Payam administrators, and Bomas by Boma liberation councils. The Bomas are still being worked out by the County Authorities. The project has 5 counties which are used as supervision centers - Health system & health care delivery (prouide the number of health posts/centerc in the project area if the information is available). The primary Health care principle is the official system of health care delivery. Though it is well developed it lacks the necessary drugs, equipment and instruments. The staffs are all volunteers for over twenty years and hence are becoming de- motivated. West Equatoria has 102 PHCUs, 19 PHCCs and 2 rural hospitals namely Lui and Maridi; the third rural hospital is situated at Tambura but not fully functional yet. Ibba is the specialized treatment centre for sleeping sickness. + Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area B Number of health staff involved in CDTI B, Percentage B.=Brl B' *100 Tambura NA 24 NA Ezo NA 16 NA Yambio NA 34 NA Maridi NA 11 NA Mundri NA 44 NA Total NA 129 NA 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communilies, local organizations, etc.l - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, f any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. SSOTF Secretariat (Federal Ministry of Health) GoSS: Dr. Bellario Ahoy Ngong, SSOTF Chairman Dr. Samson Paul Baba, SSOTF Coordinator Mr. Salah Emmanuel, Deputy Coordinator Mr. Ceaser Longa, Data Manager Mrs. Rukia Juma, Finance Officer Mr. Jacob Madut Tong, Secretary Chirstoffel Blinden Mission:( Lead NGDO partner) Mr. Fasil Chane, NGDO Coordinator West Equatoria CDTI Proiect secretariat (Ministry of health): Mr. David Bido, Project coordinating officer Mrs. Mary Francis, Finance Assistant Mr. Joseph Ndukayo Marko, secretary Mr. Jackson Abisai, Yambio supervisor Mr. Mathew Gwaso, Tambura supervisor Mr. Benet Kazimillo, Ezo supervisor Mr. Fraser Juma, Maridi supervisor Mr. Michael K. Baya Mundri supervisor NGDOs partners in the proiect areas: International Medical Corps (IMC) Action Afrika Hilfe (AAH) Mundri Rehabilitation Development Association (MRDA) Samaritans Purse Members of the Mini SSOTF at project level: o WEQ Health Secretariat (2),PCO, Finance Assistant o International Medical Corps (NGO Coalition Chair) o County Health Department (1), Yambio o County OV Supervisors (2) Yambio,Maridi 5 Members of the Mini SSOTF at County level: o County OV Supervisor o County Medical Officer o Partner NGO (1) International/National/Community based organization o Payam Representatives (2), -Describe overall working relationship among partnets, cleaily indicating specilic areas of project actiuities (planning, superuision, advocacy, mobilization, etc) where all partners are involved. The WEQ CDTI proiect has strong partnership with the affected communities. CDTI Programs are based on the principle of community participation and encourage community members to take an active involvement in both the planning and distribution of Ivermectin. The positive results of the CDTI program are widely acknowledged. The WEQ CDTI project office is situated within the County Health Department office in Yambio; there is a strong partnership between the SSOTF headquarters, National and international NGDOs totaling 4. The County Health Department (CHD) at the county level is also involved in the OV treatment activities. All the stakeholders coordinate the CDTI activities through the following meetings and workshops: o Quarterly operational plans . Project area and County Mini SSOTF Meetings o County specific with NGOs . Village Health Committees Quarterly operational planning is normally done jointly with NGDOs partners, the PCO and the COS. Supervision at the county level is done by the COS, NGDOs partners and the county health department. At the Payam level it is done by Payam OV Supervisor and at the community level by CHWs, CDDs and the community leaders. Advocacy, mobilization and sensitization is carried out by the PCO, CHD, CHWs, COS and POS. Project area and County Mini SSOTF meetings are conducted to coordinate and plan CDTI activities within the project area. These are useful meetings because all NGOs, CBO, CMO, COS, are involved and there is wide sharing of opinion and consensus building. County specific with lead NGO: The CDTI project office works closely with all partners to promote CDTI in the communities. Each endemic county has a designate county onchocerciasis (OV) supervisor. Each Payam (local district) within the county have a Payam onchocerciasis supervisor (Payam supervisor), most of these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of communities. Village Health committee meetings All plans for implementation and monitoring were developed in close consultation with the Boma Liberation Councils representing the communities. All health and development programs in the area must receive the formal approval of the Boma Liberation Councils. Communiti, health workers (CHW's) and Traditional birth attendants (TBA's) are the lowest cadre of health service providers who are supervised by Village health Committees. The communities elect these groups. 6 - State plans if any to mobilize the state/region/disttict/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Campaigns are always staged before any implementation of the CDTI. The Sudan Relief and Rehabilitation Commission is the official organ of the SPLA/SPLM that oversees all activities and is always involved along with the County, Payam and traditional authorities. The policy of the SoH is that all NGOs involved in PHC program are expected to include OV as part of the control of 10 most important public health diseases in the region. This is now being implemented. 7 I N C) -o () o z$N (J Or o I o 0) 'o .d q') (6 o B(,,)9(EQ rr.TF xz o tJ. :t Fit.oo Cr')EU) O' l+i qr- bO :\ ti i c,tB0) rHq)\E ,s\-{x'n ^9(s -:!'- q)pxs\tiq) H\tu ttrS %tl .ea) .js F ilbN u \S-c . ftt t.=P^ i: qs a)&'V s!t 6 .s=i; EE6 .g Ex e. bo \; ': - 9As.=S I :: Qrc. s .i .F s'3S:s sk v'iI 0) h S'o -s = e i.'C);E S E?{ oJ.a =o.S t i S-E; ca-g lSeS tr S,- s.Eg 3 s 3 s" -H$.iOT h S F EE s{ F$ s - Eg!ia S:.4 B.S;sEErsEiE s; t$stss S flt [* Stcs'=.SF!;S- S E $*g i BE *Cs-.Ss'i'-itS$sEsE .:9 S X,s**X S E ! f s + $ ii|:1ScnBjghc)Eqr:""E EF E Z ss o.l\(]\)\ =z frld € o Cg (! trl& .:H q) * $\ 4 Lq) o a aU I I -l{ k p B o =R ;uI oq IX ol = I I I _ls t o b a- so ti .:> \9\.s $*pt FS'is\s xr *q) sh RI{E .bs qq n:U} sis\ oo 4 L Iq) L\q) s) : q) I q) q) o q) t! 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(Jj CB 6qF Nri o G €Etsr2 E 2 ,l F otr tt @ SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for arees treated in current year, indicoting when the key activities were implemented by the month they began and the month they ended. 9 WHO/APOC, 24 November 2004 .+ C.l H 0) -o C) o z tN o Or{ x t<6 a) ot .9 ts{ L{(6 U tr OJ 0)p 6(t o FJ P.43d,H .-oh.d .'1= 0.)u 0,) fi"urlae'd0J >\ o(!Utr UO 'O€ato 0,)qH (J 6l;Fo;i i(! 0J Ir €u (,)\JOO-0.< L< !i= .r, Efits69'6l)- .'9E)oE egH8 o= .98 ,e .)O) 9u)LIti -l ooGEgo,(6-q UP o(6Li^i Lo -o0t\ .qx#(E EZ * s q) oU I -\ uq 4q) Qq) U't > o\ \ t g q)q q) e1 lr Cg 0) >. trOL{L o (.) P q) (s q) *i cr) cO C)L (.) lr € (h 0) o(d (H o o (.) E F ..il ol -ol(dt FI th tq) a o o.= EE I o z z a0 .E?tr a- ok a or cl o! a >' o E L ah al L a5EE Q E(.) -o 0.) z C) -o C) o z EO eS .tE cg: a- ko -o () o() n L() .o q) oq) n ! C) -o () oq) o 0) o q) cl U) an oQ o EE U aoEE 1-tr c= o o o z c) ! z (.) z a)tro! o z C) o o z bx GIL F-( o.= EE Q o. L o. L o. (l) C) b!tE cr= t 3L -o0)t! L C! L -oC) (€ ! -o 0.) Er hd -oC)tu h e -o0) frr -6) '5E(= Ni- ooEr9a o *oEE Q k(E L -oC) tl. !d L -o0) E. e.d -o0) Il. k L a. a0eE liE Lo .o oo() a () -o q) oo o Lo -o (.) o C) H tr(B -o(.) tJ. h(B L -oot! () Fl I L U) G! E Fr o NH 6l E L cltsta L =Z Fl F F 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the curuent year; the reason(s) for undertaking the odvocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. In December 2004; soon after launching the West Equatoria CDTI project in Yambio. Courtesy calls were paid by SSOTF secretariat senior staff and Project staff to several SPLM offices in Yambio. In particular the office of the commissioner, the executive director and the SRRC county secretary were among the offices visited for advocacy purposes. The official launching of the CDTI project was carried out by the executive director who on be half of Yambio commissioner called upon all commissioners and executive directors in the project area to take the implementation of CDTI seriously and own it. Six (6) policy/decision makers were sensitized as part of an advocacy to the CDTI strategy. These policy/decision makers have accepted to participate in the implementation of the program and to sensitize their communities. They are no difficulties faced since the communities have understood the menace of OV its social implication and the benefit of treatment by Ivermectin. Improvement on advocacy at all levels may be achieved through constant involvement of the policy/decision makers in all activities pertaining to CDTI implementation. Constant visits to their respective offices and asking them to include budget for OV control in all county development activities planning. 2.3. Mobilization, sensltization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Mobilization and health education of communities including women and minorities Re s p ons e of tar ge t c ommun it ie s/v i I I a ges Accomplishments Suggest wqys to improve mobilization qnd sensitization of the target communities. o Modern media such as television or local radio stations are not available. 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 (where exist and functional) are used to disseminate information. Mobilization and health education of women and minodties -Method and response Response of tatget communities /uillages o The method used to sensitize the women and minorities is through home visits to the communities and focus group discussions in villages, health centers, Prayer places, and market gathering. Special attention is paid to the men to sensitize them so as to understand the role that women and minorities can play in the control and eventual eradication of OV. 11 WHO/APOC, 24 November 2004 o Communities now know that onchocerciasis is a disease of public health concern and have accepted full participation and contribution in all onchocerciasis treatment activities. They know Ivermectin is the only drug that can reduce and eventually eliminate the burden of onchocerciasis from their communities. . Communities do appreciate the fact that Mectizan is safe and has other health benefits. Accomplishments o Negative attitude towards the effects after drug administration is minimised. o The number of drug distributors trained has increased. o Increased annual treatment coverage attained. . Communities have known and accepted Ivermectin as the drug to fight onchocerciasis Suggest ways to improve mobilization of the target communities. o Greater involvement of women and lay groups o Full participation by local authorities and support of the SPLM o Increased educational sessions in the communities o Training more CDDs to offset the high attrition rate. o Reduce the ratio of CDD to the reasonable number of Ivermectin recipients. t2 WHO/APOC, 24 November 2004 co oN !(.) -o q) z$ C.l O o * o P Jd H - .9(a -iUs c.)u-d ot:aoa!Sqr8t -Eg UE -s ;\ -qou BqJ$€ Ltsr B;-1;E5 €fiSEi'6s.E q-.sv2pds .3i sRsp uJ\s qSEhH .i) -8! sogsbb3!'t -.aqtsS;H .{1, 6HrR \ EEres r 8"FE .$S I A;r s$! i;Ei E $+ sE it"Ef,, E aBati E reE": i x"E:iSsi #EE€ E ATE s.$ei .g5HE fiin€€fSNss'E*'ilH 5E'ioqsEP.:*\-$ E - 0J ,u tr - - O= ts sEtt €i;U :=fes:PtE: ;$EF E€&EIiS\Ft ES.5Ai (6EgtrVe si:s $Eg! EgEIEf $iBfl-EE.Et*EIiflf;E s$sss: : : : s:::::iq) oU q) q L a)\ o N q) 4 vq) F aO o i (n o ) o() g E o E o .: o .E T .E =E E o(, 1N E \ o u0 CE o () Cr ili .i co le s @ d sO ae\o oq s .-e@(r? o\ sq \D oA '= \J E6 o{ r!9o tru0 7= E.E Ti =54E E=q;z a'i \o N O N rnN tr + e il le 6t F @ N co \l rON N o\ i rO co sl ro CA tr .9o(!6 E O r\ \o O F\N (o tO o I =EE-Zc9oZ (, oE z OI 6t z rtr tst\ c.) <n$c{ N o\ coro o o\ o ho 6t €) q) Cr o ll * c0E ta z z z z z z Eafte ,'7 r Ib = E't -a E= h 2Eia z z z z z z E,C '3o'= Er6 >OEr tro5E EO oE ,la o= -oE 50 zo le ?o6 EEI H - = oi'l g E+ 5 co co N o\ ro cON @N ot I rl > .9 .2a 6t ! CE Fr N Fl E C! ! a! 2 2 cE oF 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. Training at various levels of CDTI whether for management, advocacy, distribution of drugs and all other aspects of CDTI implementation is very crucial. To that effect training takes a lot of logistics, coordination and time input. In most cases NGO health workers, teachers, county OV supervisors, project coordinating officer, are used as TOTs. Training and re-training is almost an ongoing process especially that the education level of the communities is very Iow. The project coordination office needed strengthening by selective computer packages for general communication, data compilation and analysis. CDTI TRAINING: The below table shows the number of male and female county supervisors, payam supervisors and CDDs trained by the project office and partner NGDOs between February and March 2005. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementalion where not enough knowledgeable manpower was available or if staffs are frequently transferued during the course of the campargn). This is not applicable in our situation because staff transfer does not occur at this moment. However, in cases where a gap has resulted as a result of sudden staff movement members from the nearest CDTI project are asked to cover. Besides this there is acute shortage of knowledgeable manpower in all project areas in South Sudan. COUNTY COUNTY SUPERVISORS PAYAM SUPERVISORS CDDS REFRESHED CDDS Male Female Male Female Male Female Male/Female Tambura 1 0 6 0 100 10 71, Ezo 1 0 6 0 90 0 47 Yambio 1, 0 9 0 140 10 1,04 Maridi 1, 0 1.7 1 1,97 0 0 0Mundri 1, 0 20 1 1.67 18 TOTAL 5 0 58 2 694 38 222 COUNTY NUMBER TRAINED Tambura 18 Ezo 16 Yambio 34 Maridi 12 Mundri NA TOTAL 80 Package Number trained Designation Ms Word & Excel 01 PCO Ms Word & Excel 01 Finance Assistant Ms Word & Excel 01 Project Secretary Ms Word & Excel 01 COS Yambio TOTAL 04 ,rt ^\ WHO/APOC, 24 November 2003 oLlJ: lr *o oo r- F- ao r\v o\ $ c.l $ t F- o\ r- o\ oo rr oo $in o\ CI6lN N(a r- 0) 6lL ah U Lq) z ?!FU otr) c.l o c.l N q) q) (l) (,) \o st+ ra o\ 5.ia<v ]s ?v o $ .+ O o 6 € ahLq) .a'ca'cn-t)- r--o): .oE r- !cOJ|.. z () co a.t $ ct c) q) o I \c s t rL(J 6 .L a< I +. (,) dz c- ooN \o N \o d co F- r- F- \o N c-.1 N ot Nr- Q oL a.l oN e..l sN : q) o () (,) s q) dlro- =s 9kr=tr: zio 0)I s o .t E.'l +F'd .L A< = 00 Fr \o r- t-- $ c.) N N 6 \o = =?o c! o o Fl 3o9q) r)P o q) E z U o la) o co c^l N El o a n L clF o Nri cll E L cl =a L =a Fl Er ol'r o o) q) \c so6 c.t ON 0) -o o o z$ C.l o Or{ TD \ bo oo .a o\ o \ s B G o hO\ o * |. oo o Bt ,a:: .. ro + qq q) uq) S o) > T\ q) r. t q !q) U o (! o tr C) a F Qq< o cn (.) 0) oH _0) !ff o d oo (! L.F :l _ol(Bt FI Trainees Typ. of trainrng CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report wtiting Others (specify) Inuoduction to Computer Table 6: Tvoe of traininE undertaken (lick the boxes where specific trainingwas caried out duingthe reportingpeiod) a 2.6. - AoJ olher commeils There was a delay in the transfer of project funds which kept the project on halt for about four (4) months from the scheduled period that activities were to kick off. During this reporting period activities which have not been carried out so far shall be executed at the next quarter. Treatments 2.6.1. Treatmentfigures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverqge or the coverage rate isJluctuating, state the reasons and the plans being made to remedy this, .i'ii,"i!T}s.fF"Rl-I"Eg-ulTo.Blbi,iii,,r NUMBER TREATED %ATO ACHIEVED %UTG ACHIEVED MARIDI AAH 15,026 Sub Total 75026 50"/" 78.2o/" MUNDRI AAH 1.9,81.5 MRDA )1 A3 WHO/APOC, 24 November 2003 SAMARITANS PURSE Sub Total 19,8L5 90o/" 72.70/o TAMBURA IMC 23,786 Sub Total 23,786 52"/" 34.20/o EZO IMC 1.7,948 Sub Total 77,948 69o/" 5L.80/o YAMBIO IMC 49,923 Sub Total 49,923 60.80/" 59.9"/o r :: I l:r.h€,SA'IYBSoI4I,iji #q.;'f' - If the project is not achieving 100% geographical coverage and a minimum of 65% lherapeutic coverage or the coverage rate isfluctuating, stqte the reasons and the plans being made to remedy this. The project area has not achieved the above mentioned figures for the following reasons: o This is the first year of the project lifecycle based on CDTI principles. o Population figures are ch€mgi^g by the week as a result of internally displaced persons and refugees returning to their homes. o There are areas that implementation of CDTI is held up pending the outcome of the RAPLOA exercise. o Despite the conditions above the project has made tremendous achievement in both geographical/therapeutic coverage. The preliminary OV treatment data for the year 2005 indicates 62% ATO, 30%UTG and 47%Geographical coverage. It is quite difficult to make a statement to remedy the situation at the moment. When the process of resettlement and rehabilitation is over and the anticipated general census for the whole of South Sudan takes place; then that will be the time for us to talk about remedial measures. Jr/L} WHO/APOC, 24 November 2004 ? 7 .+ N !(.) -o o z$ ol U ^ so B ^O H6qc 0lOJUbooEA 0., EU) HU s) .! oiH6v U.:Erha-XAO,U zirI]:AU -: cJE9 bD o-Co) tb o0)E}co(,).0J(! -aJ e .91 (,)O- 90,5.!bo!rEb 9or OE -o- 0Jo -C o)F! >JIE -:ZXc;5U 9E= trU9:6L:Yxoll0J -o .treCqoboAl! okt! +.i -s xU psQo.rX6"8 y 0J0)V) 'E69 PC*tsre orE.H EQ)veoA EIN EEE 'E .= \< '=Y1 =r oEoc,tr-.Y u-r5q 59o o'i Ht o tr i.i q)7 3€ *ao.) E5X!ovs 8EOJ U- H.g.: ao6 \)$\a 8\B 'rt$\$ OO \ q)tB$\ 5Q .li Al S'!s\ xsSr:,U 'asool E! " 9.s S! ?E Eoou-.i d saF ( Els: -s Pit( s E'EE\ E ;E€s s Esi s I tsl!s { BiEs .g Es}!k E oSU E S EtR$s e F.*s'P! i E.risS i EFEsi s E:ssS=rS ! S ii\\l E !! a'l !t|i - iE*ii,Els E 3ii= qS giE qt*s a$ S! tls Elitl srlE I EE tl $El S sl{ sl 5 s"s s tlt" Elt ti tl€ E E s $u€ls$*$':tttl sl sl tl S3.H € t € ::ssEl il il il EBi ,ls $ , r,, , itt SEE ^ s iisSPs : ="I; & sssp $ n Ei'P$ 6 S \ €q\Sstsil*-t S S*:-S-S-t EEsR+6rirrrB S S { 5 qsS -o! dj€ (; q 9< a-c d E fi{?EE#Z gqY o6g a. o o O rrl *?2A AO O O o Q bE co =-ozd z z z z z z : e- b F oI E -o;E d tr;['€c z z z z z z ll * aa o eO =oood EsooEOF .-eq .+i cr) "-Sq Fi ro "-eq o, ro .-S\N .-S o.l @ ri s\q\ N r HE EEE = Q.!z \o @N cON co .+ o\ ba cO c.l o\ o\v \o o.lO lr) tf ro @ o\ @ ch$ \0N :o? b.z e .d ,:- < E*'F !,/ o\ \o ro <1 <i o\ o\ ro c.l NOO N@ N cO o\ o\ c\t OOO c..t c...t N <li 1r) rr)oN (! q o Pr .9 .,8:xo *, EH5-€ lo -9OF @ eO .$ o\\o @ co \F cO @N cO co@ No$t N@ \o <i o\ rO ro N roN tr)N =I ll r ^-A cd .9or0O ^G!wo o0a 6() ;s\ @N aSq N "-SN N\o "-S\ cO be\o$ sq \D <{ E.9 - o C ooi.1! = d-ttr tr= ii =E>!AO o \o c.l c\tf <1 rOro o\ro N C'\ :o d o.= itri) t.u PFV cr) ror< ro.$ o@ rON 1') =nN U) 0) b0d (A o oO =BE r $ sEcEE^5ttrE cO cO N o\ rO coN @c! ri o =n .9<;v o{ c, ! E GIt{ Nrrl o ! E c, E r! 2 E tr FJ F. oF 4q q) Uq) k- q o\ t \) U1 U ea v(n H (! rh CB 0)Lrd (t -l o l-r th >. -o cn rrl a E (t C) CB(.) LrF r-f o.r I _ol(dl FI 2.6.2 What are the causes of absenteeism? Since the CDTI project has not conducted a household registration census, it is quite difficult to have the numbers of people who have refused treatment and those who were absent during the campaign. 2.6.3 What are the reasons for refusals? The CDTI project has not experienced refusals 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. The CDTI project has not reported SAEs during the period In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. I No SAE case to report X z0 l\s WHO/APOC, 24 November 2004 .+ N C) -o q,) z$oi (J o Or o * B R ,{ o EOe -EE 5<.E E sHg aj (! .:l(Eot^ == E6 = j ,EE5 l* ().9 CAOEgts \J O. o Oa(*Y a9 ^ =?i da .= q)a).C tr *va (Ei;o- o.9 -q 6o tr c= d40()O € 8,,9 ,. .9E3=t' L.l (B -c Gi (BE-9ep'EE E,9.= !?#sEt: o o. a _E ! L 0)!+c) A>. O.l-lo@atr =o .Ntofi- -^62o> x o 0.)boc d.l =60ao xo U) 0) oo * v) a) \.r Lq) \ a)q tt U't U'1 q) S q oL \ o ts s) rriuq) s o lr(,)a o0 L oq 0)H o b0 Lr q) LrL Oo o Cd cr) r! a (/) o C) C) V) Lr(.) €d U) o Lr C) cnqr o th oth(€ O #r()I -ol(dl FI $ oN q) -o q) o z$ a.l O \J Or IJ =l .Y \ q) bo E Eo*r ></ -o(-) z z z z z z z .o o\ + a.) s r- o\ al o cd g o ll r ri () _b0P ecl- Oo\4',>r o -o o\ v] $ \oo\ c.i$ \o o9 o\o .o o\ co t-$ \oo\ e 00 o\ cl oo yQ 6\ v.) o\ F- sr- F- s u) \o ll * rd rd rd \o oEo =h0od ::io q)o soF \oo\vl € o.l o\q coN .o o\ c.l co qO o\q .+ c{ \oo\q \oA\t.-F- \oo\9 c.lF- .o o\ + ao s\ o\N ri ,o odL9 oi9-- =oZ* 'o o. o$ r{$ N\nN N$ c.\ N c-lN @ \o ro cON o\\o tr) @ cO cONts o\ cO <n cO\o $ rO{r @ CA!n \oN f.l =od o-a =tro =:(.)t,e FFV rON rO tr) c't CO O\o @ \o co @@ c.l .+ Oor+ cOoN N$ rO a N N <f rO tr) N N sft ro rO a.l a@ ^.rd- :1 0cxE HGE.E or )o . .os€='Er. ' a 39 o. "6 rO\o OO tr)\o O rONN rONN o rONN O roNN rON rONsf roN rO c!$ rON LnNsf 0) oo cB a 0) oO ll * rilI] ti 0) ^ oI)U !E- tl Oa\ -o o z z z z z z z s cJ cO co .-e c,? @N a.oo=!q-!q-[i' E'3 95o; rt O r,iv z z z z z z z .-eY co cO .-e og \o stt ri q<o o'E v) o =:Yo €E=E = Ei !z8' cON cOc.l (O N cONts co c.l cO c{ COc.l :tlrO No\ td :od o.a < 94'FU z z z z z z z ro co F rO slt\l oo =q!}.. b ij * [i€ Hl i: tr'- o Eo=ql aaF tr q 9E EO o (O N cO(\ ro rO Fro rO ro o <{ o <1 N o\ o\ co o\ o\ o\ o\o\ O6l N NO c\l a oN :l o e.t rO N -ah L I .l +. t - -o -(,() a06Ebs; \oqJ .\v rlVD .\= =qrGtPStr -.r-trrr dgN Et\tr =9'=()3E .Es3 : Lf- 0) o\)E;rq-gv9 .=L:- :Gf, oi2q)(.)OL d- )vEogtrt()ortrq) .t) O.L.E l9ftrc) i c) t)L6r=X.EYi-:'tavxF .vtr$ita .P H$ :h;itrHl s)ql Fil -"1Exl 6lE.qEadt 6) .9 0l '=E>1 tro-ol ^GI:b-gE B: 9Aqp;e g ; E -stroijgtrq) Lls -tdGl (D9Ui-E\otr ci o\l ';()l .t) =l Gt*l q)(utFl Fr SSOTF/CBM Nairobi WHO Sudan I VY LOKI/WHO store \ Rumbek/SSOTF store NGDO NGDO tr 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ied for by - (please tick the appropriate answer) WHO tr UNICEF tr speciff): Mectizan@ delivered by - (please tick the appropriate answer) MOH Other MOH tr Other (please specifr) wHo x UNICEF tr Please describe how Mectizan@ is ordered and how it gets to the communities MECTIZAN FLOW CHART +f t x MSD USA MSD (France) County mini SSOTF store PHC Facility Payam store CDDs 7)x WHO/APOC, 24 November 2004 J, Mectizan@ add more rows - How are the remaining iyermectin tablets collected and where are they kept? The project is still distributing Mectizan to the communities. Once the distributiorr cycle is over remaining drugs if any will be collected by supervisors who will forward them to the next level of supervision and an appropriate report is given. All drugs shall be stored at the county level. - List and brieJly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. Health care personnel in the project area are involved in advocacy and sensitization. Currently they are involved in monitoring drug distribution, management of minor side effects; reporting. Some health personnel were trained as TOTs and now in turn they train new CDDs, supervisors with the project staff prior to Ivermectin distribution. - Any other comments The Secretariat of Health is being transformed into the Federal Ministry of Health of the Government of South Sudan. It is imperative that the system of drug distribution and delivery in general shall be overhauled. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Due to delays of fund by APOC management all operational plans are running behind schedule. This has disrupted our plan and hence community self monitoring training will have to be reprogrammed as soon as possible. Table l1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Mectizano Number of Mectizano tablets State/District/LGA Forwarded Requested Received Used Lost Waste Expired Tambura 0 140,000 150,000 96,120 NR NR NR Ezo 0 105,000 85,500 81,730 NR NR NR Yambio 0 280,000 289,500 1 19,004 NR NR NR Maridi 245,000 175,000 55, I 84 NR NR NR Mundri 150,000 66,000 2605 NR NR NR TOTAL 25,924 920,000 766,000 353,643 0 0 0 District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meetins (SHM) TOTAL ;r29 WHO/APOC, 24 November 2004 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. 2.9. Supervision 2.9.1. Provide atlow charl of supenision hierarchy. SSOTF HQ Su 2.9.2. llhal b'ere lhe main issues identiJied during supervision? . CDDs and some community leaders are not motivated due to delay or non receipt of work support items. o There are also cases where recording are not properly done resulting in inaccurate reports. o In the rainy season, roads become inaccessible due to flooding and therefore limiting supervisory visits. This is also compounded by more communities being busy in their farms. o The pastoral communities during the dry season desert their homesteads in search of water leaving behind the very elderly. It is not easy to track them since they are constantly on the move. 2.9.3, lYas a supemision checklisl used? In most cases the supervision checklist is not used by the county lpayam supervisors since they have not mastered it. In the coming training cycles the use of supervision checklist will be highly emphasized. -'-l ;if,'q'1qi. " rir, at'fi;.1i{.)ii iiirlf4;:lr,Lct, o ,"s\ WHO/APOC, 24 November 2004 ao 2.9.4. llhatwere lhe outcomes at each level of CDTI implementation supervision? Areas supervised showed some improvement in treatment coverage, good record keeping and some improvement as well in filling reporting formats. 2.9.5. llas feedback given to the person or gruups supervised? Yes! Feedback was sent to the supervised persons and person to person discussions were conducted to improve performance. 2,9.6, How was the feedback used to improve the overall performance of the project? o Those found to be weak during supervisiory on site coaching were conducted immediately to uplift their standards. Further supervisory visits were arranged for follow up. SEGTION 3: Support to GDTI 3.{. Equipment Table 1,2: Status of equipment (Please add more rows if necessary) *Condition of the equipnent (Functiorul, Cunnt! nonfinctional bat npairable, l%itten ofr). Hou dou the pmject intend to maintain and nplace exitting equipnent and other mateiah? o As per statements of the Commissioner of Health of the Federal Ministry of Health, budgets shall be included in the Ministry for strengthening the OV control program; so all project staff shall be budgeted for by the Government and NGDOs cover the gap areas. Source Type of equipment APOC MOH DISTRICT/LG A NGDO Others Condition of the equipment * Please state Functional Currently Non Functional but repairable \Yritten off l. Vehicle 0l 0 01 0 2.Motor cycle 02 0 0 0 0 02 0 0 3. Computers 0l 0 0 0 0 0l 0 0 4. Printers 0l 0 0 0 0 0l 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others a) Photocopier 0l 0 0 0 0 0l 0 0 b) Safe 0 0 0 0l 0 0l 0 0 c) rfi WHO/APOC, 24 November 2004 Contributor Year | ('provide the period') Year2 ('provide the period') Year3 ('provide the Period') TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) In kind MOH (District/LGA) In kind Local NGDO(s) ( if any) N/A NGDO partner(s) 9,377.00 Others a) b) Communities APOC Trust Fund 116,265.00 TOTAL 125,642.00 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years If there are problems with release of counterport funds, how were they addressed? Additional comments Up to date SoH can not meet its obligations due to lack of National budget. This might change in 2006 since budgets are being prepared for the respective ministries of the Government of South Sudan. A budget component for OV control shall be included. NGDO partner CBM has been very punctual in releasing its obligated funds and SSOTF commends them for that. Unfortunately APOC management has not been punctual in releasing funds which have been approved on time to the SSOTF coordination office. It is worth noting that the flow of funds for CDTI activities was delayed by virtually 4 months as the result some planned activities could not be executed due to lack of funds. Right at the moment the funds which was requested for the third quarter of the year have not been received despite the fact that plan of action, budget, and financial report were submitted at the close of March 2005. The contribution of Carter Center has been direct to the NGOs and hence we do not have the necessary financial information to include. a a o o 3.3. Other forms of communlty support - Describe (indicateforms of in-kind contributions of communities tf any) o Provision of venues/shelters for community leaders meetings and CDDs training ,,26 WHO/APOC, 24 November 2004 o Some communities do the mobilization and sensitization of their own people. . Communities collect firewood, water and also cook for training participants. . Some communities store drugs and provide good security awaiting mass treatment. o Selection of the CDDs is a major community contribution in the CDTI strategy. o Some communities do their own census; this is also a community contribution. 3.4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchangeratetolocalcurrency.Indictateexchangerateusedhe'e- 2s 2,+ WHO/APOC, 24 November 2004 Activitv Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Iryt_q,_,lg_qf CDDs r.eube o_f !ea!!! s_t4llslelllevelq _ s and distribution Internal monitoring of CDTI activities NGO contribution +sio.ga 3,668.44 APOC + CBM APOC 10,427.15 Adv__o_cqqy visits to health and authorities IEC materials APOC + CBM Summa-ry (rgp_ortilg) folms !o1 lrg{mqnt Vehicles/ Motorcycles/ bicycles mqlnt_enapgg Office etc Others 1,520.00 APOC TOTAL 20,266.55 Total number of persons treated 126,498 Table l4: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monltoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4,1.2. What were the recommendations? 4.1.3, How have they been implemented? 2q x8 WHO/APOC, 24 November 2004 e. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportingperiod? Was a sustainability plan vwitten?_ When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4,2.4. Other resources 4.2.5, To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4,3.1, Ivermectindeliverymechanisms The Ivermectin delivery mechanism will be inbuilt into the PHC structure system of drug delivery. The Federal Ministry of Health of the Government of South Sudan has already embarked on major overhaul of PHC drug delivery system. Communities will be able to benefit from receiving their Ivermectin in the nearest health facility. a o o 4.3.2. Training PHC health workers are an essential source of trainers after having being trained. They are normally well versed with the locality and act as a source of trainers. 4.3.3. Joint supervision and monitoring with other programs Integration of CDTI into the PHC system has a lot of advantages since other shared resources could benefit CDTI project. CDTI becomes an integral part of the PHC and hence joint supervision can be very effective through joint plans of action in supervision etc. 4.3.4. Release of funds for project activities Handling of resources at PHC level has not been implemented in South Sudan. We do not have the experience since we still do not have budgets. cq ?frD wHo/APoC,24 Novemb er2004 o 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . The Federal Ministry of Health is considering using the structure of CDTI to implement IMCI which is now modified to Integrated Essential Child Health Care. It is still in the early stage of planning. o SSOTF is seriously considering the distribution of vitamin A through the CDTI channel. A pilot project is anticipated in West Equatoria since the CDTI concept is understood. 4,3.7. Describe others issues considered in the integration of CDTI. . The CDTI strategy could be used in management and control of malaria which is a major cause of mortality in South Sudan. 4.4. Operationa! research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research activities have so far been conducted in the CDTI project area. a a 4.3.5. Is CDTI included in the PHC budget? The budget for Federal Ministry of Health of the Government of South Sudan is still being developed. It is anticipated that the state budgets will include PHC budgets with OV control line items featuring prominently. 4,4.2, How were the results applied in the project? Not applicable SEGTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. Strengths o West Equatoria is the only zone in South Sudan that has a well organized PHC system. This stems from the fact that the PHC system was originally developed as pilot projects by German Technical Assistance (GTZ). It was consolidated by AMREF/GTZ and the Regional Ministry of Health before the SPLA/M war broke out. The system is effectively being used to implement CDTI through integrated approach West Equatoria has reasonable manpower that is involved in all aspect of CDTI implementation. a 7r 3D WHO/APOC, 24 November 2004 D I o West Equatoria is the least Equatoria zone affected by the war. Displacement is not as massive as in other areas. The traditional social fabric is almost intact and traditional authorities are very much respected. This is being made use of in campaigns and CDTI implementation. Weakness o Vast areas to be covered o Ratio of CDD's to recipients is not yet defined. . Inadequate manpower for CDTI implementation due to lack of National support budget. o All CDDs are volunteers, and volunteering has a limit as far as personal needs are concerned. Strategy to address challenges o To cover the vast area there is already a strategy to train more CDDs to bring the ratio to 1:150 o The Federal Ministry of Health of the Government of South Sudan is in the process of developing budgets for the health sector. OV is a major Public health problem which is being considered for budget allocation from 2006. SEGTION 6: Unique features of the projecUother matters . The West Equatoria CDTI project borders two endemic countries namely DRC, CAR. . The border persons are of the same ethnic group e.g. the Azande which has cross border implications. o The area is a suspect of co-endemicity of Loa loa and OV. o Hemorrhagic fevers have been reported this area several times. o It is also an area of high HIV aids prevalence in South Sudan o It is also an area heavily infested with sleeping sickness. . The West Equatoria CDTI project borders DRC and CAR which OV endemic. ,y 3L WHO/APOC, 24 November 2004