EBEG CDTI annual project technical report submitted to technical consultative committee (TCC): January to December 2007

South Sudorn Es,st Bahr El Ghozal CDTI project ORIGINAL: English COUNTRY/NOTF: South Sudan Proiect Name: EBEG CDTI Approval vear:2003 Launchins yearz 2004 Reporting Period(Month/Year) : From: January To: December, 2007 ^Proiectyearofthisreport: (circleone)M 4 5 6 7 8 9 10 Date submitted: 6tn August 2008 NGDO partner: Christoffel Blinden Mission *,2"-__ i.. I ,^,-a.-,. 'i',3: g,g fcr, For i,,l:.; r.,..:iion TO, -DiA BM(sA fuP *tE sfttro 1 ) SrP. 2008 I WHO/APOC, 24 Novemb er 2004 I I I Ao h* rli - ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3L January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ll WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: South Sudan National Coordinator Name: Dr Samson Paul Baba Signature: .9 2q:g Date: ... rt Zonal Oncho Coordinator Name: Chol Manyiel Signature, @;,1 Date: Oe /o{( l*d NGDO Representative Name: Fasil Chane Signature: Date: . Od rhis reporl has been prepared bv Name;:tXX1ffIi'k"YrHYffii, :t"ilf,:?woilx Date.ad,/ahna I Table of contents ACRONYMSVI DEFINITIONS VII FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SI.JMMARY 2 SECTION 1 : BACKGROL]ND INFORMATION 1.I. Gexener INFORMATION 1.1.1 Description of the project (briefly).. 1.1.2. Partnership t.2 Popur-enoN SECTION 2: IMPLEMENTATION OF CDTI 8 2.1. Tnmlu.re oF ACTryITIES 2.2 Apvocecv Treatment fi gures ........... Wat are the causes of absenteeism? ................ Wat are the reasons for refusa\s7.................... EquntvmNr. Fnlaxclat- CoNTRIBUTIoNS oF THE PARTNERS AND COMMUNITIES.. Orrmn FoRMS oF CoMMUNITY SUPPoRT ............. I 3 J 3 4 6 ......8 ....10 2,3. Mosn-zRuoN, SENSITzATIoN AND HEALTH EDUCATION OF AT RISK COMMUTTITMS IO 2.4. CorwrrrNrry Iln/oLvEMENT......... .....12 2.5 Cepecrrv BUrLDrNG... t3 2.6 TnrammNTS...................... .... 15 2.6.4 Briefly describe all known and verifted serious adverse events (SAEs) that... 19 2.6.5. Trend of treatment achievement from CDTI project inception to the current year2l 2.7 , Onpgnnlc, SToRAGE AND DELryERY OF WERMECTIN 22 2.8. Corwrulrrry sELF-MoNrroRING euo SrexruoLDERS Mrrrwc ')) ....232.9. SweRvrsroN..... 2.6.1 2.6.2 2.6.3 2.9.I. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 15 t9 19 24 26 26 26 Provide a flow chart of supervision hierarchy................... ............ 23 What were the main issues identified during supervision? ..............................24 Was a supervision checklist used? .............24 What were the outcomes at each level of CDTI implementation supervision? 24 Was feedback given to the person or groups supervised?................................ 24 How was the feedback used to improve the overall performance of the project? 24 SECTION 3: SIIPPORT TO CDTI 24 3.1 3.2 3.3 3.4. E><prxoruRs pER AcTrvrry ............. SECTION 4: SUSTAINABILITY OF CDTI 27 4.L INreRNeU TNDEpENDENT pARTrcrpAToRy MoNrroRrNc; EvaruerroN.......... 27 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)........... ............ 274.1.2. What were the recommendations? 27 IV WHO/APOC, 24 November 2004 4.2.1. Planning at all relevant levels.. 4.2.2. Funds .........28 4.2.3 4.2.4, Transp o rt ( repl ac ement and maint enanc e ) .............. Other resources ..'.'...,.,28 .'.,.,.,..,28 28 284.2.5. To what extent has the plan been implemented 4.3. Ix-recnRrroN ............ 4.3.1. Ivermectin delivery mechanisms........................ Eruor! Bookmark not defined. 4.3.2. Training... ..... Enor! Bookmark not defined. 4.3.3. Joint supervision and monitoring with other programs....Eruor! Bookmark not defined. 4.3.4. Release of funds for project activities Error! Bookmark not defined.4.3.5. Is CDTI included in the PHC budget? ............... Etor! Bookmark not deft,ned. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?..... Error! Bookmark not defined. 4.3.7. Describe others issues considered in the integration of CDTI. Error! Bookmark not defined. 4.4. OpBnerroNAL RESEARCH ..... 29 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. ........ 29 4.4.2. How were the results applied in the project?.... ...........29 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTI.JNITIES 29 SECTION 6: LINIQIIE FEATURES OF THE PROJECT/OTHER MATTERS 30 ,,.'.,,28 WHO/APOC, 24 November 2OO4 Acronyms/Abbreviations African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Chirstoffel Blinden Mission Community-Directed Distributor Community-Directed Treatment with Ivermectin County Health Department Community Health Workers County OV Supervisor Comprehensive Peace Agreement Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Proj ect Coordination Offi cer Primary health care Payam OV Supervisor Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Secretariat of Health South Sudan Oncho Task Force Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization APOC ATO ATrO CBO CBM CDD CDTI CI{D CIIWs COS CPA CSM LGA MoH NGDO NGO NOTF PCO PHC POS REMO SAE SHM SOH SSOTF TCC TOT UNICEF UTG wHo v1 WHO/APOC, 24 Novembet 2OO4 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 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Obiective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to feat 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 coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/ttyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).. (vii) Inteeration: 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 corlmunities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the 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. vll WHO/APOC, 24 Novemb er 2OO4 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 (Please add more rows if necessary) I Number of Recommendation in the Repon TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC4APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary This is the report of CDTI activities implemented by East Bahr El Ghazal CDTI project, Southern Sudan from January to December 2007. The project is in its third year of APOC funding phase. The project is also being supported by CBM, an International NGDO coordinating CDTI in collaboration with Southern Sudan Onchocerciasis Task Force. The project has a total population of 972,285 persons, UTG of 778,920 persons and an ATO of 428,406 persons during the reporting period. It is made up of three states namely Lakes, Warrap and West Equatoria with a total of four counties and 1001 communities. Some of these counties are joined together and the community figure was not comprehensive. Data on the number of health staff involved in CDTI shows that only 278(28.37o) persons were involved in CDTI activities out of 983 available health staff in the project areas. On treatment, only 635 communities were treated and thus giving a geographic coverage of 63.4Vo. A total of 469,737 persons received mectizan treatment during the period under review. This treatment figure represented a therapeutic coverage, UTG coverage and ATO coverage of 50.77o, 60.37o and 92.8Vo respectively in 2007 . Population movements are very common in the project area as they are potentially nomads and farmers. This accounted for high level of absenteeism experienced by the project although actual figures were not available in the report. Influx of returnees is continuing in the project and thus creates imbalance in the total population. On training,784(7l.3Vo) CDDs (659 males and 125 females) were trained out of annual training objective of 1100. The population/CDD trained was in a ratio of 1CDD to 1183 population. The number of payam supervisors/health staff was 79(657o) out of 120 targeted persons. Major challenges in the project during the reporting period include the following. (1) low level of available knowledgeable manpower in the project area. The project intensified efforts to get more CDDs, payam supervisors and county supervisors and even health workers and also encouraged them to remain in,the project; (2) high attrition rate of CDDs at community level. This matter was discussed with community members and some of those that resigned have been replaced; (3) non integration of the prqect and non absorption of CDTI staff into the ministry of health. This was one issue confronting the project and the project has tried to discuss with the minister of Lakes state ministJy of health on this. It is hoped that some staff will be absorbed in 2008; (4) intensifying health education and community mobilization. This was used to defuse beliefs on the mectizan and thus reduce the number of refusals and the project has planned to strengthen this activity next year; (5) identifying various cattle camps and treatigg the cattle itinerant workers there with mectizan. The project tried to identify various cattle camp locations but due to rains/floods and fuel problem not much was done but all the county supervisors have been told to include this in their plan next year to reduce missed treatment among these cattle nomadic; (6) non availability of community data base collection. The project was not able to compile this to due the situation in the project areas and is on the top agenda in 2008; (6) ratio of CDD to total population in the project is still high. More CDDs were trained in 2007 than in 2006. The project made effort to train more CDDs but many CDDs needed to be trained and this has been put in 2008 plan; and finally (7) community census registration is a still a problem in the project. Many returnees affected the whole plan as you need to go back several times and the project will intensify on this activity next year. 2 WHO/APOC, 24 November 2OO4 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) G e o g raphic al locat io n, to po g rap hy, climate P opulation : act iv itie s, c ultures, language Communication systems ( roads... ) Administ rat ion st ructure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available ). Number of health staff in project area and number of health staff involved in CDTI activities. Ge o graphical lo c atio n, top o graphy, climale The East Bahr el Ghazal CDTI project is located on the latitude of 6.80961o and longitude of 29.67870". The project has an altitude of 424m above Sea level. The East Bahr el Ghazal CDTI project office is based in the State Ministry of Health and sharing the same block with SSOTF secretariat. The project is made up of three states, namely Lakes, Warrap and West Equatoria. It is bounded on the North by Unity and Warrap states, on the South by West and Central Equatoria states, on the East by Jonglei and on the West by West Bahr el Ghazal state. The topography of the project area is made up of Sudan savanna and Guinea savannah to the west and flood region to the eastern part. In the western part of East Bah El Ghazal, the soil type is a basement complex resting on iron stone plateau. In the western part of East Bahr El Ghazal, the soil type is made up of superficial clay. Rainfall ranges from 750mm - 1200mm. The climate varies from wet monsoon to medium wet monsoon in the west and dry monsoon to long dry monsoon. Population : activitie s, culture s, language The project has an estimated population of 1r729r275 with at- risk total population of 927,28s (53.627o) for onchocerciasis infection. This increase in figure was as a result of the returnees from the neighboring countries. The National census in 2008 will provide a clear picture of the population figure. The dominant ethnic group are the Dinka who are agro- pastoralists whereas the minority Jur Bel are agriculturalists. But through socioeconomic interactions, the communities have gradually begun to exert influences on one another. Languages spoken are Dinka Agar (the majority), Jur Bel, Bongo, Juba Arabic (written in English alphabets). English is spoken as the official language. Kiswahili is now also spoken mainly my returnees, refugees and the traders. Communication system (road...) Roads in the project area have been graded and this has resulted to considerable improvement in accessibility to hitherto difficult- to- reach places. There is also now accessible road from the project to northwestern Uganda and West Equatoria. Air movement is available in the project area. There are WFP and other private flights available in the project area which connects Nairobi, Lokichogio in Kenya and Juba. aJ WHO/APOC, 24 November 2004 Administratio n structure The administrative structure of the East Bahr El Ghazal State follows the Government of South Sudan structures. The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered through Governors, Counties by County Commissioners, and payams by Payam administrators, and Bomas by Boma councils. The project has 4 counties, which are used as supervision centers but there is a plan to increase the number to five in very near future for better coverage. Health system & health care delivery @rovide the number of health posts/centers in the project area if the information is available). The project has a total of 115 health facilities which composed of 77 PHCUs, 32 PHCCs, and 5 rural hospitals and one state hospital. The five rural hospitals are situated in Billing, Adior, Mapourdit, Yirol and Bungagok while the state hospital is based in Rumbek, the capital of Lakes state. The rural and state hospitals are referral centers for PHCCs. The Primary Health care system is gradually developing but still experiencing shortage of qualified manpower. Number of health staff in project area and number of health staff involved in CDTI activities. In the project area, there are a total of 983 health staff, of which 278(28.37o) were involved in CDTI as shown in the Table below. 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 Br Number of health staff involved in CDTI Br Percentage B.=Brl B, *100 YIROL/AWERIAL 219 86 24.6Vo RUMBEIgCUEIBET 448 100 22.3Vo TONJ 276 56 20.3Vo MVOLO 40 36 9l.0Vo TOTAL 983 278 28.3 There was an increase in the number of health facilities, number of health staff as well as number of health staff involved in CDTI in East Bahr el Ghazal project in 2007 when compared to 2006 figures. 1.1.2. Partnership Indicate lhe partners involved in project implementation at all levels IMoH, NGDOs (nationnUinternational), communities, local o rganizations, 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, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Indicate the partners involved in project implementation al all levels (MoH, NGDOs - n atio nal, int e rnatio nal) 4 WHO/APOC, 24 November 2004 The partners involved in CDTI activities in the project area are the communities (1,001 villages for now in 5 counties), health services especially at the county and health facility levels though partially, NGDO - CBM and APOC/WHO. The NGO - Norwegian Red Cross (NRC) which is assisting Yirol County in training of CDTI staff including CDDs as well as supervision and distribution. Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, mobilization, etc) where all partners are involved. The overall working relationship among partners is very cordial as all work towards ensuring that ivermectin gets to communities and that the affected communities select their own drug distributors. Before the commencement of mectizan distribution, partners engaged in planning, advocacy and mobilization. And while distribution of mectizan is underway, supervisory visits are carried out by partners to ensure success of the entire project activities. At the end, a review meeting is organized to assess activities and then identify areas that need improvement. State plans if any to mobilize the state/region/district/LGA decision-rnakers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project intends to visit the three ministries of health officials such as ministers of health, Director-Generals and public health directors in lakes, Warrap and [est Equatoria states for inclusion of CDTI staff in the various ministries of health and also begin talks on full CDTI integration into the health services. This integration and absorption will provide an enabling environment for effective CDTI implementation. The commissioners of health in the five counties will be approached and mobilizedfor support to QDTI activities in various counties, payams and bomas especially directing their communities to provide any kind of motivations to CDDs. The supporting NGDO - CBM will still be requested to continue its assistance to the project. More Local NGOs will be contacted to assist especially the Norwegian Red Cross that is known to be assisting Yirol County may be asked to expand her support to other counties in the project area. Also, the Sudan Relief and Rehabilitation Commission will be contacted and involved in assisting CDTI implementation. 5 WHO/APOC, 24 November 2OO4 x N o -o 6) o z$ c.l(, p. o *r B .g .Eh v2't L\ -A)r {rOYe 'i:(rr q-oo. ALq)\rol:p=.ii .z;seOEEEE HSEP.E S A €vd .3fStr. 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U)o U c-l C) (nF o c! a 0r N \)U u, S' P\) S\ F$ll .spi rr dr: .s t\BbP oF3 EF ::Ed = f,9 N@dl c.l@ \Nv} o\t'-N t'- t N \o o\@ c.[ N o\ €r-r- + il \o .0) -oo .= EN E E.: ,9 AE \o o\q N$N 00\oF. c.i ca ca N t'- N 8 n .+ co ro6N r-N o\ -,d . eE EL'= e di *Eiii . E F.g \o o\q N$N oo -t: $ c-) \o o\ m F-r-(t) o 6l I E:a) *E h F'i sO E'Fgsr @\o t-- e.i cO co N t'* N o\ €6 o\! ra I q) >t: >F0 tt trE cI,c) F + il \ coN lr)\o co O\nN |r) -.9 .= .9.E9 €E_troX9E tri-c!6JE >roFtr -o N N rn c.) e.l \n \oa(.) t)q) OI CE (h o oI L c)E z 'l-..E=q) €: H FIEgsi I rn\o c.) rnN ro \o GItr9 .9ge =EE.EE 3E i'EA-A \o o\ o\ c.ld c.l @\o t-.N c-) ce N t-- c.l o$t c.) la €N Fr c.l c\ o)- € .E.E EL 3'=;trEc! ={ iHFVljArl F 0) B o .o U .Yq) -o & '= oF o A rl E< oF I $ N L C) -o C) o z$ c.l U o Er o 'JrB r- -t B,i$tsSc)$sN.=>(DS!\+\H Bls;er*'s- S+.SC! TE su\o' a!\tl s9 S: EQSEB=}.J -)E3 .$ OrEg $-or.i!$t€Es;9rP SEE R B.t! uotrs .s.9 E.HEis€$ Si.!\SE$ 'i. 0.) * s€ -Bo\\>. <<d 0-,tr "€ U) SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas teated in current year, indicating when the key activities were implemented by lhe month they began and the month they ended. 8 WHO/APOC, 24 November 2004 $O CI op C) oz t c.l U 0r o > o\ bb 5 o o t+.i €dtr EE .-!u! -9J,r'lCDAEF5 E3 o E!lU2Cticlt ^'=I 6ta !3 ^ ct*: 9d -vtL- = 9E E O.HE st ^OoE )ooEo L-!E E:ia P9HlvH 8,=d!o6 t,;JH-J c! Y-ali - c)!t 0) r<3 [ctr ,2 :. .i. cb 5H '- UE(l)=r .--lV.-9v':- 'sgb! .;r0))v E Ei 9LYI--6d - X'O C) -V-dcoE9 €r r:i - .- e+i c)otrE: '!i a OJ .I Sz rE;d > .= 74 stgHHE SUEF E ; ".i ..; h q 4 \) \,) q > p t ! q v[. l-r(!(.) >t 0) H () 0) q) ()lr cn(! oLr(! o t< U)o o +r o o A F e.it ol -oldt FI o cn lre U) o 9:cL= EE(J o -o o oo(n o -o Eo a c)(/) o -o Eo oo U) o -o E 0) o c)(/) Eo -e 9E Gt= x o L t) OI L ti o o,= EEQ o o o C) th o -o C) o C)(/) o o o. C)(A o C) o.o U) l,.e l:Jtr bo bo bo bo o CEE (n (h q) U o o.= EEQ c) -o E c) a c)(/) () o o C) th c) -o E c)q c)(n o -o o a c)(/) En.. 1.E Gt= ho bo oo oo oa G , Er g: EE() uo bo a bo uo .E',s1iE 4t: >, >r x qr EUD rQ) s= SEoo =9a 3:o,= 5EQ C) -o Eo oq)(n o 0) 0)(/) 0) -o o o()(h o o o.o(n .Hs '!r E (n- x rh -I I L 0 F oE c) (,) x €)E & o a 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. N umb e r of p e r s on s mo b ili z.e d/ r e a s o n s fo r adv o c ac:t / o ut c o me s The project conducted advocacy at state, county and community levels. At the state level, minister and DG were updated on the CDTI progress and integration of CDTI as well as motivation of CDDs. They encouraged the project coordinating officer to ensure that good coverage is achieved and promised to integrate CDTI at the appropriate time in future. At County level, 4 commissioners were visited to solicit provision of security during the training of CDDs at different venues of the project areas. They agreed and promised to provide policemen during the training of CDDs. However, all the trainings were later shifted very close to police stations for security. At community level, some payam administrators/community leaders were approached and requested to talk to their people so that they would not refuse mectizan and to provide a sort of incentives to CDDs. Community leaders assure them that would try and convince their people to accept mectizan. This led to reduced number of persons who refused treatment in the project. D iffi cult ie s/c onst raint s b ein g fac e dr Not providing the salary to CDTI staff and non integration of CDTI into CDTIt Large areas to cover in the face of fueling problem of the project vehicle r Repeated visits and this exerts on project vehicle . Security risk visiting some areas r Community members not providing incentives for CDDs on on how to r Adequate fund for vehicle fueling as project covers three states and they are far apart. ' Providing a kind of T-shirts or face caps or calendars to policy makers during advocacy visit. . Displaying the current CDTI report of the project to policy makers for them to see the gaps. 2.3. Mobilization, sensitization and health education of at risk communities P rov ide info rmation on: - The use of media and/or other local systems to disseminate idormation - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilimtion and sensitization of the target communities. The use of media and/or other local systems to disseminate infonnation The project used its based radio in Rumbek to communicate to county and payam supervisors for collection of their mectizan allocation in Rumbek and in different counties respectively as well as other information pertaining to training. Also the project made use of Radio FM in lakes state to invite county supervisors in one of their meetings. The methods used were home visits to the communities and focus group discussions in villages, health centers, prayer places, and market gathering. Types of IEC materials used l0 WHO/APOC, 24 Novemb er 2004 The only IEC materials used during the reporting period by the project were laminated posters, flipcharts and T-shirts. Mobilization and health education of communitics including women and minorifies This was carried out in the project before mectizan distribution to create awareness about the mectizan. Community leaders were contacted to arrange for the meeting with community members which comprised men and women including the blind people. Key messages were the cause of onchocerciasis, symptoms, who should not take mectizan as well as the dosages and possible side effects after taking the drugs by individuals with heavy infection. Such meetings were organized in all the counties in the project area. In some areas women attendance surpassed that of men especially at Mvolo and Yirol counties. Re s p o ns e of targ et c ommunifie s /village s A lot of people participated in receiving the mectizan tablets to the extent that the entire drugs allocated were all used and no unused drug was returned. Even those who refused in the previous year received treatment. Accomplishments . There was higher therapeutic coverage than in 2006. . Reduced number of refusals than in previous years. . More communities selected CDDs than before. . There were more female CDDs than in the previous year. Suggest ways to improve mobilkation of the target communitics. o More women should be encouraged to involve in mectizan distribution as CDDs. o Communities should be made to own the project to ensure their full participation. o There is need for more health education sessions in the communities particularly for the returnees. o More Information, Education and communication (IEC) materials be made available to the target communities. These materials include T-shirts, face caps, posters and handbills. 11 WHO/APOC, 24 November 2004 cooO c.l C) -o o z$oi Q 0. + B N 6..t\lUI4l4l\JILI NI BI :l :l ol\l qD %14 fl8 il E .Xl e xl E Uoo rl'E QI.EiLrsl PSl s) "sl cs Sli sl >' SIE 'tl o sl ;Bl -c url F 6lE 8l-E \|o -l a .Sl.= \t (,El o <t> tal ol 8l rl \l 3\.=ql ir :sl tr =l () El:' -l a €18 NI:)l €Sl a\l s ,al 's9l tr €t I qJl'- sl, obo(!lro -JdSl c :l ?itN ';tY? 3l -PI IJ 8t .9rl E srl . sl 6 '-l '5 sl 8. hto BI 'E .F{ H .:t a trl o.>BIFalF \ q 4 \oq 4 Q4 ! \ \ q qJ q F,t c L \ \\ ? (.) \0 !a \) \) \ .\ q $ ( t S \ *\ \ >\ 0 q ql 14 SI$lqil :t\taol o Bl trUI 5 €l 8\rl _ "sl 9 sl> -sl E EI E >l o .t]7 sls Sl s 8t ; slE .hl =\l.e -l Eljl d$l o. *l oosl tr Nt s ^.1 L rJl osl () Nl 6 !\l h6 el 9 NTI FS ll qa S $lF Oa L \ t- O C) .A o oU l- q) c) oO $ N e 00 (u q) [* H: ta sq € s c_.t s9 t-- s9$ s e € q nA 29H6 =6) ==r.E3stra0 zE Eg* ;Eie 0 ra c.l r+ o\ t-- 6 € tr +ts ra I6 ta EF @o c{ $\o ci (n oo F- c.l t@ F- \n[r1 aco O toN .9q EA O r\ O c.) 6 0,) tr q)E_ -c) c!; Q o () E z q (J q) G 2 r @F- o\O ot rn h F- c\l,a\o s oq \o q) u0 o (u [* lQle la s N s cl sn!+ s c.t (--$ $ \oca $$ €\o E -s pv'Ee8i EE EEtrEX Eeal la '8r-', ao :.,1filX >a)oucl '50 tr q,)AA E9 ,!a Etr ze la c) ;E:EEg .B E;6 e* (n Cf) ct rn\o c.) t_) N \n ,l q CE (u =\ q) () O {) & oF o 2 l! F ) d 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels, The project still lacks adequate available knowledgeable manpower at all levels. Most cogent reason being non payment of salary by the government as the current top ups could not sustain them. At the state level, the project lacks secretary and assistance finance officer. At the county level, there was no supervisor for Yirol County. At health facility level, very few health facility staff were available except community health workers and payam supervisors. At community level, the number of available Knowledgeable CDDs was very poor due incessant attrition occasioned by zero motivation and high illiteracy rate. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most impofiant issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the campaign). No transfer of staff rather they resigned and joined UN agencies and NGOs for greener pastures. The measures taken to overcome the situation were that PCO conducted training of payam supervisors in Yirol County and supervised the training of CDDs by payam supervisors at payam level. More new CDDs selected by communities were trained but high level illiteracy among them was a major. It will take the project a long time to have sustainable CDDs. t3 WHO/APOC, 24 November 2003 co o c.l o -o o z$N (, oA B $ (*qr o CA oO. U)lio oo Cgo U'tr oth troa (t) d (ga cnl-ro JUk B (! q) E oo .i a a o(JHHo=E- -cd(tIoo -cl >r C) ,.h :V)bo 'trE L<o rrx ?6 ch) l- >\o-o,tr u)e OEoiDi{= bOl=(!eE -(c(!Eol: E.?oElE< -cn tro Oc) o ,li excq-qU -E(dt-! HI U)q) S\\ a)s \ B S)L B os osi s B e) e) U, Bq) \ 'r,t a) P Pq) = U2q) e) T a' rq) I q) .s a loo oU \) .a o\ o v2 A) \) \) 4 $ .v B s o B oE 0O ! \ qJ oU \) q)\ \ \) s v \) q- .L v F U R h qqp\)\) q > v u i \J U) !\) a. q) o a F oUqr o .h (.) o troL .o o (€ oo tr LrF riir 6)l -oldl FI q,) L o Q o Lq) z Y O +:(J U ir zv I OF .\. A< 't\o$ coF-N !nN N co h C.i O!n \n(-- r,r o co Os i € Fr (.) €N ra s(?) F- 0) €) q) I s U o F aO\o aa c.l a N a,L c) ,=G cEFrLh, ,--c): tt ahoq)rrr 9 tr CE orL z o.i + *':qv is z\J (n c.l co rn O rn \n $ rn $ N $ \o s ia q,) q) o) I s QF O O O = Eo GiL TEts 3Etr: zE q) I s Jr3 U U a< t O co N co o\ co \o \n N cn rn oo r- o\t- inN stn sta\o q,) o q) I s(JoF cal cA co co N lH GI th (a F]E.9q) ZG L() z EJ3 $ U q z c.) N |r) N c.) co c.l co c.l $ \o € s os 6fa q) o) () I s Q?F \o \ct.) o d .9 ta a C! 0) ' o q)E 6) (J x 0,) il H o o a F] 3 o Er Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments: Training was delayed till late November due to flood in the entire project area. 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving l00%o geographical coverage and a minimum of 657o therapeutic coverage or the covera7e rate isJluctuating, state the reasons and the plans being made to remedy this. If the project is not achicving l00%o geographical coverage and a minimum of 65Vo therapeutic coverage or the coverage rate is Jluctuating, stote the reasons o Flood/heavy rains have made movements very difficult. o The commitment of the CDDs has retarded due to lack of motivation by community members. o People are still emerging from war and population figures are very unstable. . Late release of funds and this affected period of distribution. o Breakdown of Mvolo and Yirol motorbikes and this made distribution in these counties really difficult. o Non availability of bicycles for some payam supervisors for effective drug distribution at community level. o Drugs allocated not adequate. Trainees Type of training 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 writing { { Others (specify) Census update ^/ ^/ ^/ ,v 15 WHO/APOC, 24 November 2OO3 The plans beine made to remedy this. . Increasing mobilization of community members on,the need to motivate CDDs. . Repairing of two motorbikes belonging to the project . APOC to be contacted for early release of fund particularly in January - February . Training more CDDs and providing them with work support items. t6 WHO/APOC, 24 November 2OO4 $ N E 0) .o c) o z .+ N U o oE B r- oF (! c)lr oo 'F !(IJr B o}. es .Jioo ,ts83.s 7)S: oo LS ,. L ,:P H't €.8trt9E1.. $esr+ lb O$O:i Hr{ F .= .\ 9Sc)\ d;\ =t g EXl o e xl! : *l o Byt e .E Hl e ;gI B E -l 0) BolO. oBrSC)l L tlolo sul 3 I ol E slrl = O-Ql tr 54t - \ Ht s I =l^ q) zli E bo il: a- \L.\t)s Io\!()s;s vq(! t)!rsll)S *o t\ (! C) L I o C) 'a dho ,o 99Oso.= 'A^ LV I rrlE& '= -o9 ,9 -rF a.Jo: !lL .= c) HV5 da H!U E.A;i c) OaJ .e 'Et)HAI- o ol E 'd *l EE "l B * El.go, cdl trh sl 6E! !l tBE $l F 8r 3E tl* :lnflr g? ElfrEl= =l E ;l;EI E EIlr EI b ot .Y trt : ot trPIH PIb 9IE t*l i r*l * ql !)ol o. ol E ol- rl O pl !] llrol o- ol tr ol=El= EI= EI= .=l o =l o =lqZl? Zlt- Zl< C) L oboF^ C)AY oo F o(! C)bo l-io oo d to- (glr oo o C) o C) cn 0) bo(!tro oo(J,^ 't FQ C) o.(! o F u)lol a0(!l trl ol >t ol ol (€l ol -clOI(dl !l hrl ol ol s trl(€l .rl 5l ol OIdtLrl ol -ql!l bd EI .ftul =lo EI ol :l €l .sl 3l EI ol rLl il "= B€E E ;i?i l gz Ht e O o a €?2U) zZ O a vobg E9 =-azd z z z z z ^=eva+E .E E,er EEE>O=ja qg z z z z z (! a o0i [*f.x\ o 'Eo =boO ClaO-Lra i! 9o- ooEOF c.)\ c.l t-- la)q(n co @ n c.) co 09 00 F- o!n ai:o 'lf4dHE9 = o!z N(-- \or- € *\o .d N o\ c?l \o\o \o t-- o\ O t-- c.)\ o\\o$ :4)? 6.23tr: c cr.= < 94F!' q. ca o\ N o\ c.f o\ ot-v) o\ C{ co co @- N \o{ €Nt .9 .,p -i. EH .d 9E oF \o o\q o]t ol 00\o\N cal co c] t'- oi t$ co rn 6 o{ t-- o] o\ (n o o0(! ar) o ol OI ll * ^-A ? .9 o.ric)A G^F iBetoi- o\ n o\ a9 o.l rn o oc oo co rn\\o@ sn co\o :o U C M!.? E d-:3 =E>!za o ( ol N o\ tr- c-) lnco\o Eo? 6.22EE!:o < gP'FIJ \n ca o.l o.l cl ON (ncO Nt- \Oq64.t6!.o= d Iv!-AE +;.-> - Z q.c'.9 AE E YoD E -Jl ES 3*9;. E trv2O tr) c.) c.l \n @ ca o rn C.l !n .9<;q Lq! >-99tro &t) oF o z .1 F E< h vqq \J \)(- q > p \) ! 9 \Jq \J\ Ji an tr (t Q(!(.) Cd OJ () L U) >t ,o IA sl U) (c o 63 ohF n't orl -ol(!l FI $ 8N ko -o C) oz$ c-t 0. orn B oo s!oIq) a s s\ E oos e) bo \q) s$ Bs !. T\ c) i $ E$ q) 's 5U B .s I B B !a $: '+u\'xq,Ess- E* .E t' %lls9 :ir s,s $! \qrssdE Et\ sb s*s{ C'P .a^ sS r.sS$&* S'$\s s ,lss! SE 8: s.s s5 rr SOELAbs a2,6.2 What are the causes of absenteeism? Most absentees that occurred during the distribution are traceable to cattle migrants who follow their cattle and had to stay many days in the cattle camps mainly from May to November. People that traveled outside their communities during the period of distribution.a 2.6.3 What are the reasons for refusals? . They have not received good health education messages about the drug as they have been outside their homes for many years. o People still feel shy to take the drugs due to poor knowledge of mectizan distribution. o Due to side effects of the drugs. 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. a No case of SAEs was recorded during the reporting period In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report X t9 WHO/APOC, 24 Novemb er 2004 +oo ol I o oz !f, oi ri o l-\ 'JrB -8,99E EE A <.E E 7-i"gg ed: cg(Jo E 3;PE9XAEsr U'6 o.?E7, ^=gq0 a9oE O* .*Q qE ^ 6 .= 0.)o-c trd3d (Hi;o- o.9t5' o tr tr= d@a(JOEE.E o ^6>vaEi' vta- A 9 y.d dN oo €-99P 6 =.V 'lo i!xl(E;5S a. tr U) rI]tl m Q J 0r Pr H z Fr;=(.) -.Y !a-:9 U ^ PAaad ;i* 9Q-Ag T oboc O.F =t0?o x O v) (.) oo z U) C-l \) S a. v \,) \)4 h qqp\)\) L 4 > o \) ! t \)q v\) 0- ! o 'F 0)p, bo li oooL o o0 tr .F oF (_) oo (! ./) sl U) tt) o 0) o(t) o (g cn a o lio .h qr o ar) 0.) v) U #r o)l -ol <!l FI sOON E(.) -o E c) oz$ c.l O o E l- *{ c.l -U1 -I .9J' s - -! cgI q,) 00ACns'b €B\e$ rh .\E Etr)9-L- LGI tv9is.=;.s E E N,Ei$5vut bi5N9 vv '!3o lul :9e 5cEftO.e.'UU! J .= o' b0H E.2v '=trE :r- aFg Fv= ,-G)vnfR\r.6qtr-€ =Er\EUr- slGttEl IHEI Ee*l Eq) ()l .r- €3+ eoo= -:'t i: e :orr --LE:9ijcfi =rvrJva !9,ocE tr0)!.gtr0,) LH€ -Ec! 9.9UtIEe.i o\l ';G)l u)El I19tFl 0r o60g EaF .)B< -oQ ca O. c-'t \n c.l t) ta) (tl O\o o (g o. o 0r ll -OO 6Fi trl H "Fri o o BooF 6E\< a-o s cl \o rn Ncl cn t-- s\o o\ @ c.i ll * ti tI] o!o =boO 6-O-Exaat 90- ooEOF c.) o\ s n rn ot s ca rn t'-A rn a ! ,o o(! rPOEEo roz?oo rn r.) ca O rn @ ratO \o N € N .+ t'- c.)\ o\\o$ H =o?6> =EE=:o< 94F9 O c- a-\oN Ot-- c-\o c.l \oaa@ ol$ oo o\ C.l \o rn GqA.16 _F &H3Ee€:,; f EEo ol o\ oor-F- O olq oor- F- O c..lq @r-t-. (n oocl c- c.l o\ o o0(! C) U lL *^ E] o o soF 6BR< B-() s @ o 00 s c.ir- s c-- \o oo (n o\ -<9^Eqcg-!s-Ii F3 9Uao OOFI s € \c, rn s c-.1 co$ s @ \o n cO\o trT q(l)o'E. q ts c ux!i i d; E H;J O =tr>L '7Ad O@ c-) co c.tt o\ \o rn ca\o rd :o? 6.2 ,!)-O' Fq, aF-$ \o NOt'- N t'- bod .r6Ei " E I +.9 = b;; -I .= 7_r O)QoaF tr U 9! tro o o\\o\o 8. a 4 ql toO o.l rn c.l \o ON c- c.l 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/ ied for by - (please tick the appropriate answer) wHotr UI\ICEF N specify): MOH Other NGDO x Mectizan@ delivered by - Qtlease tick the appropriate answer) MOH N wHo IJNICEF T NGDO f] Other (please specify): Please describe how Mectizan@ is ordered and how it gets to the communities The project coordinating officer ordered the mectizan from the SSOTFA.{GDO which supplied to the prqect. The county supervisors collect from the project office in Rumbek and send for various payam supervisors for collection. Payam supervisors on collection notify and invite Boma supervisors to come and collect theirs. And on returning, the boma supervisors who are also CDDs share the mectizan with other CDDs in the communities for distribution to community members. Table l0: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? The drugs allocated by the SSOTF office to the project were all distributed and no tablet was remaining. However if drugs happened to remain, CDDs collect and send them to their Supervisors and who in turn submit to Payam supervisors who later send to county supervisors who store them in the county health department. List and bnefly 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 community mobilization, health education and sensitization. ' They are also involved in monitoring drug distribution, management of minor side effects. ' They are also trained as TOTs to train new CDDs and payams Supervisors together with county supervisor. Any other comntents No x State/DistricUlGA Number in stock Requested Received Used Persons treatcd Lost Wasted Expired Remaining Yirol/Awerial 560,000 560,000 559,935 176,721 45 20 0 0 Rumbek/Cueibet 379,700 379,700 379,650 t16,648 0 50 0 0 Tonj 210,000 210,000 209,975 66,392 0 25 0 0 Mvolo 357,000 357,000 357,000 t09,976 0 0 0 0 TOTAL 1,506,700 1,506,700 1,506,560 469,737 45 95 0 0 22 WHO/APOC, 24 November 2004 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No If so, When? Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the communily self- monitoring and stakeholders meetings have affected project implementati.on or how they would be utilized during the next treatment cycle. NA 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Reporting District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSM) No of Communities that conducted stakeholders meetins (SHM) Rumbek/Cuiebet YiroUAwerial 365 235 0 0 0 0 Tonj 250 0 0 Mvolo 151 0 0 TOTAL 1,001 0 0 SSOTF IVq WHO/APOC, 24 November 2OO4 2.9.2. What were the main issues identified during supervision? The treatment registers and summary forms were not correctly filled by some CDDs Census was found not to be completed in most areas. Discovered areas that have not been treated reached. Some trained CDDs were absent for distribution. 2.9.3. Was a supervision checklist used? o The supervision check-list was not available and not used. 2.9.4, What were the outcomes at each level of CDTI implementation supervision? o At county level, some payam supervisors were co-opted to oversee the activities of Yirol county supervisor who was not on ground. In Mvolo County where the supervisor's motorbike was found not functioning, the supervisor was directed to bring up the bike for repair at the state level whenever fund was available. o At payam level, some payam supervisors who have not collected drugs were provided with mectizan. o At community level, CDDs were corrected on how to fill both the registers and summary forms. CDDs that were not performing well were replaced by their communities and new ones were given on the spot training. 2,9.5, Was feedback given to the person or groups supervised? All Feedbacks were on the spot through oral method as it would have been very difficult going back given the road conditions in the project area and cost of fueling. o 2.9.6. How was the feedback used to improve the overall performance of the project? Those found to be weak during supervision, on site trainings were conducted immediately to uplift their standards. Further supervisory visits were arranged for follow up. SECTION 3: Support to CDTI 3.1. Equipment Status of u1 add more rows neces, APOC MOH DISTRICT/ LGA NGDO Others Type of equipment Source No. CondiIon No. Condition No. Condition No. Condition No. Cotrditiotr 1. Vehicle 0 0 0 NA 0 NE 0 NA 0 NA 2. Motor cycle(s) 5 3-F 1 CNFR 0 NA 0 NA 0 NA 0 NA 24 WHO/APOC, 24 Novemb er 2004 o 3. Computer(s) 1 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 1 CNFR 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 0 NA 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA 7. Others 0 NA 0 NA 0 NA 0 NA a) metallic cupboard 1 F 0 NA 0 NA 0 NA 0 NA *Condition 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? It is hoped that the project would be integrated into the ministry of health. The counterpart funds resulting from this integration will be used to maintain the project as well as replacing the equipment. Also, the project is expected supports from the NGDO including equipment. 25 WHO/APOC, 24 November 2OO4 Contributor Year I ('2005') Year 2 ('2006') Year 3 ('2007') 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) 0 0 0 0 0 0 MOH (District/LGA) 0 0 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 0 0 1 8,1 50 18,150 18,750 20,091 Others 0 0 0 0 0 0 a) 0 0 0 0 0 0 b) 0 0 0 0 0 0 Communities 0 0 0 0 0 0 APOC Trust Fund 139787 t36217 t25940 66623 100885 78609 TOTAL t39787 136217 144090 84773 I 19635 98700 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? There were problems due to the fact that the project was yet to be integrated and also the ministry was yet to have a budget. The project is hoping to be integrated by 2008 and it is during that time that the project will begin the process of counterpart fund and its release. Additional comments No additional comments 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) o Providing venues/shelters and security during training of CDDs. o Communities collect firewood, water and also cook for CDDs during their training. 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 exchanse rate to local currencv. Indictate exchanse rate used here 26 WHO/APOC, 24 November 2004 Activity Expenditure ($ us; Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Trainin !e1uqe of health staff at all levels Supervising CDDs and distribution 5395.74 5534.17 APOC APOC Internal monitoring of CDTI activities visits to health and litical authorities IEC materials Summary (reporling) forms for treatment Vehicles/ Motocycles/ bicycles maintenance Office Equipment (e.g. etc Others 1000 APOC APOC401t.52 2500 APOC APOC60,167.57 TOTAL 78,109.00 Total number of persons treated 469,737 Table 14: Indicate how much the project spent for each activity listdd below during the reporting period Any comments or explanations? No SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) N Year 1 Participatory Independent monitoring NA- Mid Term Sustainability Evaluation NA 5 vear Sustainabilitv Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? Not applicable(NA) 4.1.3. How have they been implemented? NA N N 27 WHO/APOC, 24 November 2004 CDDsof 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? -NoWas a sustainabilitv olan written? NA When was the sustainability plan submitted? -N 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. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectindeliverymechanisms o The Ivermectin delivery mechanism has not been fully built into the drug delivery of PHC system due to non integration. However, the State Ministry of Health is planning a major overhaul of PHC drug delivery system and ivermectin will not be left out after CDTI full integration. It is during this time that communities can collect their drugs from the nearest health facility. It is hoped that this will begin in 2008. 4.3.2. Training o There was no integrated training yet with other programmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff are not ministry of health staff and the CDTI has not been taken over by the health services. When that happens, they become an integral part of the normal PHC training systems. 4.3.3. Joint supervision and monitoring with other programs o This has not happened yet because ofno integration. 4.3.4. Release of funds o Handling of funds at PHC level has not been implemented in the project as the ministry has no budget and therefore no release to any projects. 4.3.5. Is CDTI included in the PHC budget? o PHC has no budget and that also affected CDTI. 28 WHO/APOC, 24 November 2OO4 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o No other programmes are using the CDTI structure due to the fact that PHC is not fully operational. However, the State Ministry of Health is considering using the CDTI structure to implement IMCI when it begins to function and operational. The achievement cannot be measured now until future time when other programmes start using it. 4.3.7. Describe others issues considered in the integration of CDTI. o In future, CDTI strategy could be a potential tool'to drive other neglected tropical diseases in the project areas. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area wilhin the reporting period. No operational research activities were carried out in the project. 4.4.2. How were the results applied in the project? oNA SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths qnd weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Streneths o Support of Norwegian Red Cross in Yirol County. This has resulted in better performance. o Strong support from SSOTF as both share the same block in the ministry of health. o Dedicated county supervisors to distribution. Weakness . High attrition rate of project staff at all levels. o Available manpower is not well knowledgeable in CDTI. o Non integration of CDTI into the ministry of health o Non payment of salary by the government to add to top-ups by APOC o Non available of motorbikes by some counties due to breakdown. o Late distribution of mectizan o Census update not completed in virtually all communities o Total list of villages in the project areas not yet available o Poor nature of roads with resultant high wear and tear of the vehicle Challenees o Low level of available knowledgeable manpower in the project area. The project intensified efforts to get more CDDs, payam supervisors and county supervisors and even health workers and also encouraged them to remain in the project. . High attrition rate of CDDs at community level. This matter was discussed with community members and some of those that resigned have been replaced. o Non integration of the prqect and non absorption of CDTI staff into the ministry of health. This was one issue confronting the project and the project has tried to discuss a 29 WHO/APOC, 24 November 2004 with the minister of Lakes state ministry of health on this. It is hoped that some staff will be absorbed in 2008. Vast area to cover and coping with effect of wet season. Efforts were made to commence all CDTI activities in dry season preferably January - May but funds were not available. The project covers three states in Southern Sudan. Coping with late release of Funds by APOC. The project has planned to request APOC through the SSOTF for early release of CDTI activity funds in January so that difficult- to- reach places in rainy season could be overcome. Intensifying health education and community mobilization. This was used to defuse beliefs on the mectizan and thus reduce the number of refusals and the project has planned to strengthen this activity next year. Identifying various cattle camps and treating the cattle itinerant workers there with mectizan. The project tried to identify various cattle camp locations but due to rains/floods and fuel problem not much was done but all the county supervisors have been told to include this in their plan next year to reduce missed treatment among these cattle nomadic. Non availability of community data base collection. The project was not able to compile this to due the situation in the project areas and is on the top agenda in 2008. Ratio of CDD to total population in the project is still high. More CDDs were trained in 2007 than in 2006. The project made effort to train more CDDs but many CDDs needed to be trained and this has been put in 2008 plan. Community census registration is a still a problem in the project. Many returnees affected the whole plan as you need to go back several times and the project will intensify on this activity next year. SBCTION 6: Unique features of the project/other matters The East Bahr el Ghazal CDTI project is one of the two CDTI projects in Southern Sudan that covers three states and this has great toll on field operation funds and equipment. With the way things are, there are no CDTI personnel in the ministry of health in Warrap state. The ministry of health seems not to recognize the project because it has no focal person. This is one issue APOC has to address for full sustainability in the project areas. The project shares Warrap state with West Bahr El Ghazal CDTI project. Warrap state has four CDTI counties, and one county is covered by the project while the remaining three are under West Bahr El Ghazal CDTI project. a o a a a O 30 WHO/APOC, 24 November 2OO4 a