Annual NOTF secretariat report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

II I A + SOUTH STIDAN ONCHOCERCIASIS TASK FORCE (SSOTF) whohq pro i ect@gmail. co m ANNUAL NOTF SECRETARIAT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMTSSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) MT ErL. - l'll ..gslrf , Ii* a t ,l W/ OzuGINAL : Enslish COUNTRY/NOTF: Republic of South Sudan Proiect Name: South Sudan Onchocerciasis Task Force Headquarters Approval year:.2003 Reporting Period: From: January 20ll (Month/Year) To: December 2011 ( Month/Year) APOCfundineyear: 1 2 3 4 5 (6) 7 8 9 10 ll 12 13 Date submitted: 9"'August2012 T} Ios t'r')g c'l P r" ,i., -t/,u-u i:: +-' <t 'JJL .. (Y' €- t: TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) trNDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the rcport: Country: I{epublic of, South Sudan J v National Coordinator: Dr Lucia [)ate : .O.1 . ..1 August/20 I 2 I)r Samson Paul []a Signature'. ...{. NGDO ltepresentative : Datc: 01. ... . ./ Augu st 12012 John LJjwok Signaturc: Datc:.. -?"Ll August l2ol2 ; 'l'his report was prepared by: Dr I-ucia William Kur t,, Signaturc: ...f-.. Dale:Q1. . . ...1 August 12012 S-*\t^ 5'JG*r Table of contents ACRONYMS........... ...................... v DEFINITIONS.......... .................... vI FOLLOW UP ON TCC RECOMMENDATIONS ..... VII EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION 1.1. GeNpnRl rNFoRMATroN............. 1.1.1 Description of the project (briefly)..... . l.1.2. Partnership ' 1.2. Popu1nrroN............... , SECTION 2: IMPLEMENTATION OF CDTI 2.1. TruplrNe oF ACTrvrrrES ............ 2.2. ADVocACy 2.3. MoetlIznrtoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMrvruNrrrEs ...2.4. CotraMLnitry INVoLVEMENT............ 2.5. Capacrry BUTLDTNC 2.6. TREarvpNrs.............. 2.6.1. Treatmentfigures.......... 2.6.2 What are the causes of absenteeism?.......... 2.6.3 What are the reasons for refusals?................. 2.6.4 Briefly describe all known andverified serious adverse events (SAE) that........... 2.6.5. Trend of treatment achievement from CDTI project inception to the current year ...2.7. ORorRtNG, sroRAGE AND DELIVERv oF IVERMECTIN 2.8. CorrrvuNrry sELF-MoNrroRrNGnNo SrareHoLDERS MpprrNc 2.9. SupeRvrsroN............... 2.9.1. Provide a/low chart of supervisionhierarchy. 2.9.2. What were the main issues identified during supervisionT ................ 2.9.3. Was a supervision checklist used? 2.9.4. What were the outcomes at each level of CDTI implementation supervision? .... 2.9.5. Was feedback given to the person or groups supervised?................2.9.6. How was the feedback used to improve the overall performance of the project? SECTION 3: SUPPORT TO CDTI 3.1. EqurrueNr 3.2. FINaNcreL coNTRTBUTIoNS oF THE pARTNERS AND coMMUNrrIES............. 3.3. Orupn FoRMS oF coMMUNrry suppoRT............... 3.4. ExpeNorruRE pER AcTrvrry " $ECTION 4: SUSTAINABILITY OF CDTI 4.1. InrenNer-; INDEPENDENT PARTTCTPATORY MONTTORTNC; EValUarroN . 4.l.I Has the project ever been evaluated/monitored? (fick any of the following which are applicable) ........... 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? .............. 4.2. susratNRerI-rry oF eRoJECTS: eLAN AND sET TARGETs (rraaNoeroRy AT Yn 3) 4.2.1. Planning at all relevant levels... 4.2.2. Funds........ 4.2.3 Transport (replacement and maintenqnce) . . lll 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented................ 4.3. INrpcnarroN............ 4.3. I. Ivermectin delivery mechanism,s................ 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs........... 4.3.4. Release offunds for project activities1.3.5. Is CDTI included in the PHC budget? ............ 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OppnerroNAl RESEARCH 1.1.1. Summarize innot more than one half of apage the operational research a undertaken in the project area within the reporting period. 4.1.2. How v,ere the results applied in the project?.... r SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS iv Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBM Christoff Blinden Mission CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin . CSM Community Self-Monitoring LGA Local Govemment Area . MOH Ministry of Health NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force OV Onchocerca Volvulus PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers I-INICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization Definitions (i) Total population: the totalpopulation 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 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached fulI geographic coverage (nonnally the project should be expecied 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) Geographicalcoverage: number of communities treated in a given year over the total number of r-neso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Inteqration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Communitv self-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. vl FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 33 Number of Recommenda tion in the Report TCC RECOMMENDATION ACTIONS TAKEN BY THE SSOTF SECRETARIAT FOR TCC/APOC MGT USE ONLY Report related (i) Update glossary of terms to include (OV, CBM, etc). This has been done. (i i) Cross check the Mectizan data especially for WBEG. This has been cross checked. Project related (i) Take necessary action to improve training coverage for health workers and CDDs, and or set realistic targets. Working with the different projects to implement this recommendation. (ii) Develop a workable strategy to address the treatment needs of nomads. Working with projects on this. CDDs have been trained among the nomad communities and plans are in place to deliver stocks of mectizan to them before their seasonal migration in search for pasture. (iii) Carry out a simple assessment to confirm reasons for refusals for WBEG and improvement of the IEC. Not yet done. This is an important activity that the SSOTF is highly considering to implement. (iv) APOC HQ and SSOTF to establish whether it is feasible to undertake CSM and SHM, if so plan strategically to initiate and consolidate foundation activities. It is generally feasible to have this done. A plan will be drawn and shared with APOC HQ. (v) Take urgent steps to improve the male/female CDD ratio, and female overall participation in CDTI activities. This is work in progress. (vi) Need for continued advocacy for govemment to provide financial support for other CDTI activities to ensure sustainability. This has been done both at state and national level; and efforts continue. In addition, APOC Director & Chief SDD visited South Sudan inMay 2012 to conduct high level advocacy. vll (vii) APOC and SSOTF to examine whether conducting independent monitoring is feasible. If so, provide APOC the necessary guidance and support to implement what is feasible. This is not yet systematically done. (viii) Use available funding to repair faulty photocopier, rather than rely on counterpart funding which may not be forth coming in the near future. This was done; and in addition a new photocopier was also received. (i*) Ensure anticipated support from government accountants is carried through, to facilitate timely release of funds. Then 'uvork rvith communities to reach consensus for a shift of treatment timelines to the dry season. so as to improve coverage. Efforts to have this recommendation implemented are being made in collaboration with respective state health authorities. vlll Executive Summary The total population in the areas covered by the 5 CDTI projects was 5,707,037; with an Ultimate Treatment Goal (UTG) of 4,825,222 andan Annual Treatment Objective (ATO) of 4,360,075 people across a total of 6,728 beneficiary communities in South Sudan. The West Bahr El Ghazal CDTI still remained the biggest of all the CDTI projects, accounting 52%o of the total population at risk. This remained a huge management challenge since this project cannot be managed effectively as one CDTI project because of its size and the logistic and infrastructure challenges being faced. It also covered three states (Local Government Authorities) and harmonizing work under three different independent authorities had a number of challenges for the project coordinating officer. 5,526 of the 6,728 at risk communities received treatment thereby achieving a geographic coverage of 82oh. 3,477,340 persons of the total5,707,037 in the project received treatment in 201 1 , achieving a therapeutic coverage of 6l%o. A total of 16,467 CDDs were trained in 2011; of these 9,864 were newly trained while 6,603 received refresher training. The overall CDD/population ratio across the 5 CDTI projects to was 1:347 in 201I as compared to 1:390 and 1:605 in 2010 and2009 respectively. Advocacy work on the integration of CDTI into the routine primary health care services continued across the project implementation areas 2011. All the County OV Supervisors and Project Coordinators (except for one) are Government employees. With such continued human resource support, the projects will work towards continuous improvement in of the supervisory oversight that the State Ministry of Health staff have over the CDTI project activities. The SSOTF continued to function throughout the reporting period in close collaboration with the APOC staff (Technical Advisor & Finance/Admin Officer) based in Juba and also with support from the CBM NGDO Coordinator. Key activities undertaken by the SSOTF during this reporting period included facilitating the monitoring of treatment coverage, procurement of ivermectin from Mectizan Donation program and MERCK, provision of support for meetings and training activities in the CDTI projects, printing and distribution of some IEC materials and work support items. However, a number of challenges were faced that included the lack of adequate capacity to properly manage CDTI projects by some of the project coordinating officers, inadequate staffing and knowledgeable manpower in the CDTI project areas, non integration of CDTI activities into the routine primary health care system, inaccurate and untimely data reporting, and the repeated incidences of intertribal clashes leading to population displacements in some parts of the country. 1X SECTION 1: Background information 1.1. Generalinformation 1.1.1. Description of the country program - CDTI and vector elimination The Republic of South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The climate of South Sudan is tropical with average annual temperature of about 29'C (about 85F). The rainy season months are between April and October with annual rainfall of more than 1000 mm (40 inches). The vegetation varies from rainforest in the southern part to Savannah in the northern part. There is a vast swampy/marshy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile CDTI project. The main occupations of the rural communities are subsistence farming and nomadic livestock production. Exposure to infection in South Sudan is by way of village proximity to breeding sites and occupational activities. The South Sudan Onchocerciasis control programme consists of five CDTI projects East Bahr el Ghazal and Western Equatoria CDTI projects completed their 7th year of implementation while Eastern Equatoria, West Bahr et Ctraiat and Upper Nile completed their 6th implementation during this reporting period. Vector elimination Presently, there is no vector elimination component in the South Sudan Onchocerciasis control prograrnme. Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, and infrastructure (e.g. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure. The National Plan is implemented by South Sudan Onchocerciasis Task Force that is comprised of Health Staff of the Ministry of Health, Republic of South Sudan, WHO/APOC staff in Juba as well as Non - Government developmental Organization O{GDO) staff which has a CBM staff as the NGDO Coordinator. The National plan also extends to and is also being implemented through various State Ministries of health at the State Government Authorities; and at the CDTI project level, County, Payam, Boma and Community levels. The total population at risk of being infected with onchocerciasis in South Sudan in2011 was 5,707,127 people. There are a total of 5 CDTI projects and 1 Headquarter project (SSOTF) that is located in the Ministry of Health premises in Juba, the capital city of the Republic of South Sudan. The decentrulized administrative structure in South Sudan is comprised of four tiers namely: The State, the County, the Payam and the Boma the lowest community level of administration, The States form the first level of administration followed by the Counties, Payams and Bomas. States are administered by Governors; Counties by County Commissioners, the Payams by Payam Administrators, and the Bomas by Boma councils. Boma consists of several villages and mectizan distribution is based on villages in South Sudan. A village in the South Sudan context is defined as a given geographic area that is under the jurisdiction of a given local Executive Chief. The boundaries of every such community are defined by the chief system of local authorities. The number of communities cited in this report is synonymous with villages as per the described society norms. The five CDTI projects covered 6,728 communities in a total of 44 counties in 2011. l0 Health system & health care delivery (state any problems related to health system that impede program implementation). Primary Health Care (PHC) remains the cornerstone of the health service delivery sysrem in South Sudan. The health system and health care delivery is focused on five levels of facilities/services. These are community based health activities, primary health care units (PHCUs), primary health care centres (PHCCs), county hospital and state hospitals. The prolonged civil strife in South Sudan had its toll on the health care delivery systems and infrastructure; and this also has a direct impact on the CDTI program since the frontline health facility staffs that are predominantly government employees. Inadequate budgetary allocation for Primary Health Care (PHC) services also directly affected CDTI work since there is no counterpart funding to augment the funds provided by the APOC Trust Fund for direct lunding of CDTI activities at community level. 11 Map of South Sudan showing the states in lvhich the CDTI projects are located. Additional information to clariff the location of the CDTI projects on the map above . East Bahr el Ghazal CDTI is composed of Lakes state; . Upper Nile CDTI is composed of Upper Nile and Jonglei states; o West Equatoria CDTI is composed of West Equatoria state; o East Equatoria CDTI is composed of East Equatoria and Central Equatoria (marked as Bahr el Jabal above) states; o West Bahr el Ghazal CDTI is composed of West Bahr el Ghazal, Northem Bahr el Ghazal and Warrap states. 1.1.2. Partnership At National level, the partners involved are: . The National Ministry of Health. o Chirstoffel Blinden Mission, the only NGDO . WHO/APOC At the State and County levels: . State Ministries of Health . CounU Health Departments. o Frontline health facility staff. At community level: . The Payam and Boma Administrative structure . The community leaders o The beneficiary community members . Frontline health facility staff. t2 Describe overall working relationship among partners The overall working relati,onship among various partners was cordial. State plans if any to solve any issues arising as regards CDTI implementation' fne SSOfp has ilans to solve any issues thaimay arise in the course of implementing CDTI activities as follows: a. Investigate the issues and determine the root cause such as finding out why some peopleiefused treatment with ivermectin or reasons for absenteeism' b. Identify appropriate officers to deal with the issues' c. Empower such officer through providing necessary means to facilitate accomplishment of the task. d. Actualinvestigation. e. Reporting back after investigation' f. Maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field and the office so that quick timely intervention is applied on any issue pertaining to the CDTI implementation' L.2. Population and Health sYstem Table 1: Projects and population at risk in the entire country whether they are treated or not during the rePorting Period Source: ationaltrN census: Other source' sPeciff: Year ofsource: 2006 UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimatety to be reached when the project hras reached full geographic coverage (normally the project ,norta U. expected to reach the UTG at the end of the 3'd year of the project)' Name of CDTI Project Total communities in meso/hyper-endemic zone Total population in meso/hyper-endemic zone Ultimate Treatment Goal (urG) East Equatoria 560 978,1 83 821,674 3,226 2,966,286 2,491,680West Bahr el Ghazal 550,325 462,273East Bahr el Ghazal 1,476 West Equatoria 904 699,760 587,798 Upper Nile 562 512,573 430,561 TOTAL 6,728 5,707,127 4,825,222 13 SECTION 2: Summary of CDTI Implementation 2.1. Distributionperiod Table 2: Overview of distribution undertaken by project Briefly note any problems/issues. Three major problems affected mectizan distribution in the projects and these were insecurity, heavy rains/flooding and lack of government counterpart funding to complement that received from APOC There is always insecurity caused by cattle rearing communities annually. This insecurity hampered smooth distribution of mectizan in parts of East Bahr el Ghazal and West Bahr el Ghazal CDTI Projects. The heavy rains and flooding mainly restricted travel Upper Nile and West Bahr El Ghazal CDTI projects due to flooding. The other CDTI project areas were accessible, though with difficulty. With the huge geographical area, the challenging logistical situation, the seasonal roads and the extremely high cost of operations in South Sudan, the funds provided by APOC cannot be translated into the required outputs. Lack of counterpart govemment funding to augment what APOC provides led to failure to implement some activities and thus the current project performance. 2.2. Advocacy and Sensitization At the national level, continued advocacy took place with Ministry of Health Officials like Director General for Community and Public Health. At the State level, the ministers of health of Lakes, Western Equatoria, West Bahr el Ghazal and Northern Bahr el Ghazal states including their Director Generals and their Directors of Primary Health Care were met and spoken to regarding CDTI projects in their various states. The reason for undertaking the advocacy and mobilization exercise anchored on advocating for direct funding of CDTI activities; inclusion of CDTI in the routine primary health care services; absorption and integration of the remaining CDTI staff into the health system of South Sudan. The major outcome was that most of the County OV Supervisors are now government employees. All Project Coordinating Officers except for one are also government employees. Project Name Distribution Period Jan Feb Mar Apr May Jun Julv Aus Sep Oct Nov Dec East Bahr el Ghazal West Equatoria East Equatoria Upper Nile West Bahr el Ghazal l4 States have pledged to budget, allocation and disburse funds from their Primary Health Care funding to support CDTI activities in their respective states. a) State progress made towards internal resource mobilization. Within the reporting period, continuous efforts were made towards getting the government to appreciate the roles regarding counterpart contribution to onchocerciasis control. Despite not having received funding from the government, the OV program is recognized as one of the key areas in NTD control and hopefully with continued advocacy, funds from primary health care budgets will soon be allocated to it. b) Describe any policy-related constraints being faced by any particular project and describe rvhat was done to assist the project (outcome). Explain any plans on how to improve advocacy. There were no major policy related constraints faced by the projects during this reporting period. ' 2.3. Information, Education and communication strategy and materials development Briefly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. The SSOTF coordination office located at the MoH office in Juba did not do much in 2011 in regards to reproduction of IEC materials. The main reason for this was the limited funding that was available to the program. However, the under listed were produced in limited quantities. . OV poster sets (3 posters per set; "What is OV", "How do you get OV", and "How to treat OV"). These posters are laminated in plastic for durability under field conditions. o f- shirts for health workers and other partners with inscription 'OV control in South Sudan' How were the IEC materials developed? Most of the IEC materials were developed during the time of Health Net International and later reviewed and reproduced by SSOTF coordination office and while one originated from field situation and APOC manual. Are the materials reviewed to address upcoming issues (like decreasing refusals, sustainability, maintaining compliance to long-term treatment, SAEs)? No review was done in this reporting period. r Report if any KAP surveys have been done and how their results were used? There was no KAP survey in all the projects in201l. Summarize information on: The use of appropriate and innovative media and/or other strategies to disseminate information among the projects; . Modern media such as local radio stations are available in most project areas; however these were not maximally utilized due to the high costs associated with their use. 15 . At community level, information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, and women's groups were used to disseminate information. Mobilization and health education of communities including women and minorities The five projects carried out this activity before mectizan distribution to create awareness about the mectizan, its availability, and selection of CDDs. Community leaders were responsible for contacting and arranging for the meeting with community members which involved the participation of men and women including the blind people and other minorities. Key messages included cause of onchocerciasis, health/social/economic implications, symptoms, who should not take mectizan as well as the dosages and possible r side effects after taking the drugs by individuals with heary infection. Community members were encouraged not to be absenting themselves during the distribution or refusing the drug outright. Also benefits of mectizan were addressed during such mobilization. Response of target communities/villages There was high response of community members during the mectizan distribution as the people who previously refused treatment were noted to have turned up this time round Major accomplishments . More communities received mass treatment in 2011 as compared to 2010. . More persons received treatment with mectizan in 2011 as opposed to 2010. Weaknesses/C onstraints o There still needs to be a lot of improvement in the Community support to CDD. . There is also need to have more women getting involved in CDTI work as CDDs and also in participating in community meetings. . The CDTI philosophy has not yet been fully embraced by the community members and thus their mentality on CDTI ownership is not yet to the levels expected. . The counterpart funding and available budget allocation for the production of health education posters is not sufficient for them to be produced in numbers would have a visible impact in the communities for which they are intended. . The number of health staff and CDDs required for providing information to community members is still inadequate. Suggest ways to improve mobilization of the target communities among projects. . Availability and use of more posters during mobilization and also their placement in each village and strategic places to attract community members is highly suggested. . Continued advocacy for counterpart funding from the government of the Republic of South Sudan . Engaging more health workers by integrating them into the health systems is ideal. . There is need to recruit more CDDs and community supervisors in order to facilitate r health education and mobilization activity in the communities. . Women groups, youth and religious groups should be involved in the campaign. . Health education messages should be intensihed in all communities o More funds should be allocated for this activity. r Mounting of billboard in strategic positions in each state urging people to take mectrzan once a year for l5 years. o Regular radio programme on disease situation and on treatment with mectizan 16 2.4. Communities' involvementin decision-making Comment on community participation making comparisons among projects. Participation of female and youth members of the community at health education meetings; In general, how do you rate the participation of minority groups and female members in community meetings, decision-making? Community participation in 2011 was not significantly different from what it was in 2010. Social - cultural norms and beliefs still hinder the expected level participation of females in active CDTI implementation work. However, with the insight that these beliefs can gradually be overcome, continued and persistent sensitization on the need to have more women actively involved in CDTI work will continue at all levels of project implementation. 2.5. Capacity building Training of national, district level staff in CDTI and gcneral management skills in computer applications, project planning, etc Briefly describe any training done by the SSOTF/NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow-up needed). Continuous on the job training and mentoring was done for the PCOs and County OV Supervisors and this was targeted to improve their performance project management, to provide them with capacity to apply basic CDTI strategies, CDTI philosophy, to provide them with skills that will foster smooth partnership between the communities and the health services, and to maintain community information data base. There was an improvement in the understanding the basic CDTI strategies but there is still more work to be done in regards to data management. Table 3: Type of training undertaken at national level by the NOTF Tvne of traininp Proiect staff MOH staff Oninion Leaders Others Proqram management Conductins health education Manasement of SAEs CSM SHM Data collection Data analysis Report writine Others (specifu) Briefly describe any technical assistance provided to the CDTI projects. The key technical aspects of onchocerciasis control and CDTI implementation were provided to the project staff. These including things like understanding the transmission cycle of onchocerciasis, methods of avoiding being infected, basic management of side effects to mectizan ingestion, determining population/CDD ratio, maintaining community information data base, data calculation and analysis, monthly report writing, annual technical report writing, field supervision using checklist and accurate and complete filling of all field forms. 17 Table 4: Summary of training done by nt""""' , ,t , ^r.Ttns trained -ffi Num Nurrffi cu ia,, ia,.*ra:,i@n N UmDcl ur r^----- , . ^+^ff tvqined trarnerl+#i'Tfi-'--\ co=ffi" ATrO C,r Numbe centt Ar.o 1 IC. l ffi ATrO Cr New iy 4 Total , Cr= lC,+Cr _ -*-ffi 5,692 t,sltiSs5i'''oo r ?1e i qtt t. 2,D9me Cr 16 -+ \4 i8 | \ o iroi to 126 7o i'oi ""il n i13i. ll_ 5,503 6f-eunt "t 16 0 oi0 l)J Lr , ' I rsq i+loi ssq r ?A1 i qgz \ 2,629154 ^inio g,7v(Jnaza 20 0fr-est Equatorta : East Equatorta 335 22 \ 52 \t '74 77 "t. 95 \", 172 2+6 t: zzl t' qgz 415i+ZS' ggO niOi0 ll -:)-!--L-j)ler',43 4.967 0 5,150 i :,+zo i t,slo14 ui 66 299 ll,zl9 il-pper Nile 6 35 - i q i 16 g 1,413 A\ e.864 : er606 t, 16A9l -W--"tt Buh' "l Ghazal TOTAI, 13 51 % Actfivement ': lq,l'/oS-rL-L-:-+- 69 \ rr issi a6 A"f,f"""*""t Wt t, 60.4"/o o//o::-=:=:- ,/" Achievent - rent i 66'7Yo [ 7o 'qcrt"'"'"--- 18 al la tt la 6. Ordering, storage and delivery ofivermectin Please describe how Mectizan@ h ordered and how it gets to the communities. When the retums ofmectizan consumption get to the SSOTF Secretariat from the field sites, compilation ofthe consumption and balance of mectizan remainiflg in the field is done. Once this is complete this data is use to make an order for the following year bearing in mind the targets of the new the year. The SSOTF then submits a drug application/order for the mectizan to the Mectizan Donation Programme (MDP). Once the county request is approved, it is then sent over to MERCK. Then MERCK ships the consignment and to the WHO South Sudan office in Juba with collaboration ofthe liaison oJfice in Nairobi. On receiving the mectizan in Juba, the SSOTF notifies the five projects ofthe mectizan availability and then the projects collect it ftom Juba or at times it is setrt depending otr the project (in the case of Upper Nile, it has to be airlifted). The project oflices then supply the coulty health deparftnents, which in tum supply the ftoltline health facilities. Boma supervisors (who are in most instances head CDDs) collect the mectizan fiom the ftontline health facilities at the time when the distribution to the community is due and then at this stage there is allocation to the respective CDDS according the populations in the areas that they are meant to distribute. Plerse comment on whether IvermectiD delivery has beetr ir egrated into the essential drugs delivery system at the natiodal and lower levels or not. State sctivities under Ivermectin delivery that are integr.ted itrto the national health care system in the country. The situation has not changed much as compared to the previous years. The essential drugs delivery system is not yet well functioning in South Sudan and every agency supporting a health facitity has its own mechanism delivedng medical drugs and supplies. Integation of Ivermectin delivery into the national drug delivery system at the national and lower levels is not yet applicable. Please state where aDy remai ng Mectizan@ is stored after the distribution cycle. Whenever there are balances of ivemectir tablets, the CDDS submil it to the Payam Supervisors/Frontline Health Facility Staff. At the Health facility the remaining balances are quantified and the record comrnunicated to the County OV Supervisors who then submits this information to the Project Coordinating Oflicer. The amounts of stock ofmedicines that rcmain arc communicated to the Project Coordinating Officer that in turn communicates this to the SSOTF secretariat. The remaining mectizan is stored at the ftont line health facility in preparation for the next teatment cYcle. t9 Project Name In stock from previous vear Number of Mectizan@ Tablets Who (MOH, WHO, UNICEF, NGDO) does the following to Mectizan @? Requested Received Used Lost Wasted Expired Remaining Orders Stores Delivers East Bahr el Ghazal 4.762 1,200,000 1,201,304 l,l7 5,119 r.625 0 0 )o 1)1 SSOTF/CBM SSOTF/WHO SSOTF/WHO West Equatoria 9.326 1,607,429 1,607,429 1.604.69',7 i40 0 0 3.163 SSOTF/CBM SSOTF/WHO SSOTF/WHO East Equatoria 0 2.198,000 2.198.000 1,711,581 0 0 0 486.419 SSOTF/CBM SSOTF/WHO SSOTF/WHO Upper Nile 0 1,251,500 1,251,000 692,259 294 0 0 558.447 SSOTF/CBM SSOTF/WHO SSOTF/WHO West Bahr el Ghazal 2.871.7 69 s.221.078 4,921,078 5,428,842 53,095 0 0 2.29s.69s SSOTF/CBM SSOTF/WHO SSOTF/WHO Total 2.885.8s7 11.478,007 11,178,811 10,612,498 55,154 0 0 3,373,046 Table 5: Mectizan@ Inventory Comment The bulk ofthe balance of mectizan in West BahI El Ghazal was as a result of minimal utilization in the Longichuk county in Upper Nile CDTI project, general poor peforrnance of Central Equatoria state in East Equatoria CDTI project and Raja./Jur river and Wau cotmties in West Bahr el Ghazal CDTI project. This poor mectizan utilization was primarily as a result of weak project leadership. This issue is being addressed in collaboration with the respective State Health authorities. The balance in East Bahr el Ghazal CDTI project was more of a result of access issues arising from insecurity and lack offunctional project vehicle. 20 at It 2.7. Treatments 2.7.1. Treatment figures Table 6: Treatment and SAEs by Projects in all areas at risk County - LGA Communities/Villaees Ponulation Number of persons who refused the treatm ent Number of a bsentees Number of communiti es with < 800 therapeuti c coverage Number of SAEsTotal # of com m unities/ villages in the meso/hyper- endemic areas Dr Annual Treatment Objective Dr Number of communiti es/villages treated DJ Geographical coverage (%) Dr= D3/ Dr*100 Total population of the meso/hyper- endemic areas Dr Annual Treatment Objective D5 Number of persons treated Dr Therape utic coverage (%) Ds= Drl Ds* [00 East Bahr el Ghazal 1,476 1,476 1,348 9t% 550.325 420,135 296,309 54% 1,580 4,263 1,227 0 West Equatoria 904 904 827 91.5% 699,670 533,841 473,026 67.6% 0 0 53 0 East Equatoria 560 560 454 8t.t% 978, I 83 782.544 570,527 s8.3% 0 0 0 0 Upper Nile 562 562 381 68% 512.s73 366.342 230,7 52 45% 0 0 396 0 West Bahr el Ghazal 3.226 3.226 2.516 78% 2,966,286 2.257.213 1,.906.726 64% 219 1324 535 0 TOTAL 6,728 6,728 5,526 82"h s.707.037 4.360.07s 3,477,340 61,/, 1,799 5.587 2,211 0 Formula for computrng theraoeutrc and qeoqraphrcal coveraqe's Therapeutlc coverage rate(%) Total populatron hvrng rn meso/h1per-endemlc communrtres wtthrn the proJect area Geographrcal coverage rate = Number ofcommunrties/vrllaees treated x 100(%) Total number of meso,tryper-endemrc communrtres ro rdentrfied by REMO rn the pro1ect area ATO coverage rate = Number ofoeoole treated x 100 (%) % UTG achreved Tool nudh€r .f paple ro b. ea.n m6orwd.6dmrmse hinricplor.cr,H(urC) ATo - 6. eih*d nmh.r orp.Mn, lrv(g ri mdo^yFr<nd.mrc ,as rhar r CDTI prol.cr rd.ld! ro rd Ih. .nd of tI. 3d ylar of the proFd) Annual Treatment Ob.,ectrve 2t If the projects are not achieving 100'h geographical coverage and minimum of 65"h therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this. The reasons for not achieving the above mentioned coverage include: . Weak project leadership. o Insecurity in West Bahr El Ghazal state and East Bahr el Ghazal CDTI projects. . Inadequate available knowledgeable manpower especially CDDs in Raja and Aweil West counties in West Bahr el Ghazal CDTI. . Failure to access some communities since the distribution was conducted in the rainy season. Plans to remedy this: o Strengthen project leadership at state and county levels. Improving and strengthening community participation through mobilization and healtli education as well as motivation of CDDs. Increasing capacity building of new staff and CDDs. Conducting distribution of mectizan in dry season Improving logistics to projects at county and payam levels. 2.7.2 In general, what are the causes of absenteeism and refusals and how is the o The nomadic lifestyle for a big proportion of the population. . Travel outside their communities in search ofjob during the period of distribution. . Fear ofside effects. . In some instances poor coordination between the distributing teams and member of the community 2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and provide in table 7 the required information when available. There was no report of any SAEs in the projects. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to report Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period Not applicable since there were no SAEs reported a a a Name of project Number of verified* SAE cases reported Action taken Number of cases with sequelea Number of deaths N/A N/A N/A N/A N/A * SAEs should be verified by project coordinator 22 E "ta 2.7.5. A summary of the trend of treatment acuievement per project from inception of firs. *-DTI project to the current year What is the ultimate treatment goal for the entire country? 4.793,987 Table 8: Treatments and coverage by calendar vear for the entire project area I Geographic data were not available before the REMO exercise. There remain some villages in the project areas that remain inaccessrble. 23 YEAR Com m unitiesA/illases I Population Total # of com m u nities/vi llages in the meso/hyper- endemic areas (H,) Annual Treatment Objective (Hz) Number of communities/vi llages treated (H3) Geographica I coverage (%) H3/ Hr*100 ATO coverage (%) Hy' H2*I00 Total population of the meso/hyper- endemic areas ffi.) Annual Treatment Objective (H' Number of persons treated (Hr) Therapeutic coverage (%) Hs/ H6* 100 ATO coverage (%') Hs/ H7*100 1997 180 NA NA NA NA 415,500 208,885 84,992 20% 4t% r 998 180 NA NA NA NA 415,500 208,885 121,963 29% 5\Yo 1999 222 NA NA NA NA 687.500 268.1 08 170.520 25% 64% 2000 230 NA NA NA NA 718,500 284,508 176,707 2s% 62% 200t 238 NA NA NA NA 868.s00 344.508 249.186 29% 72% 2002 2,299 1,102 620 27% 56% 1.253.000 502.800 437,666 3s% 87% 2003 2,289 1,102 70 3% 6% 1,285,000 600.000 386,7s5 30% 64% 2004 4,777 655 485 r0.r% 74% 3,476,632 825,076 327,271 9.4vo 69% 2005 5.1 18 845 572 tt.t% 67.6% 3,476,632 825,076 611,296 t8% 74% 2006 5,424 1,623 r,335 24.6% 82.2% 3.625.332 r.0s0.624 936.375 26% 89% 2007 7.103 6.124 1.965 27.6% 32.1% 3,625,332 1,545,909 1,370,246 38.0% 89.0% 2008 9,426 7.327 6.576 69.8% 89.8 5.t89.269 2,17',7.344 2.029.828 39.1% 93.2% 2009 6.473 5,438 5,701 87.7% 104.8 5,605,726 3.019.7 66 3,0 1 2,05 g 53.1% 99.7% 2010 6,51 1 6.51 l 5,615 86% 86% 5.707.127 4.203.t93 3,010,375 s3% 7t.6% 20t1 6,728 6.728 5.526 82% 82% 5.707.037 4,360.j',l5 3,417.340 6t% 72.5% 2.8. Supervision 2.8.1 Note the supervision that was undertaken by the SSOTF (Project supervised, date, by whom, objective of supervision mission, outcome, follow-up needed) Table 9: Supervision undertaken by the TA/SSOTF Project Name Supervisor Date Objectives of supervision Outcome/follow-up needed West Bahr El Ghazal CDTI National Coordinator and NGDO Coordinator February 20tl Improve data compilation and reports. Planning for the next mass treatment cycle. Data collected and the mectizan needs for 201 I was prepared and ordered. East Bahr el Ghazal CDTI APOC TA June 201 I Monitor training activities and assessing preparedness for annual mectizan distribution. Trainings found to be fairly well on course. Some of the CDDs had begun distribution using the remaining balances from previous year. APOC Finance/Admin Officer August 20ll To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of returns of vouchers was stressed, and on job coachins took place Western Equatoria CDTI APOC TA September 201r Meeting of State Health Authorities on integration of CDTI activities into the routine the PHC system. Monitor distribution exercise and retrieve available treatment and training data. CDTI to be included into the planning and budgeting process for the next financial year. Preliminary data received APOC Finance/Admin Officer September 20tr To follow up on fund disbursement to the project and monitor for proper use Prompt compilation and timely submission of retums of vouchers was stressed, and on job coaching took place Eastern Equatoria CDTI NGDO Coordinator, Technical Advisor October 20t1 Follow up of mectizan distribution and treatment coverage and provision of technical support to the project staff. Visited communities where distribution was taking place and provided support to the staff. Received preliminary data on the distribution exercise. UpperNile CDTI No supervision visits to Upper Nile CDTI project areas Cue to security concerns 24 2.8.1. What were the main issues identified during supervision? In addition to the objectives that the supervision teams went out with, a number of additional issues were identif,red: . Insecurity and flooding were delaying mectizan distribution in some places. . Poor communications within counties and distances are very far apart from one village to another. . Some communities were without CDDs and therefore not receiving treatment. . Inadequate number of CDDs hence long time in completing distribution since each CDD has to cover more people. . Poor data management and inaccurate population figures and irregularities in treatment data in most records and registers. . Community treatment registers not available in all villages 2.8.2. Was a standard supervision checklist used? Yes it was. 2.8.3. What were the outcomes at each level of CDTI implementation super"vised? . The concerned individuals were coached on what to do. . Improved performance noticed during follow up visits. o Information sharing on CDTI activities (reports) took place. 2.8.4. Was feed-back given to the supervised, and how was the feedback used in improving the overall performance of the project? o Yes, on the spot discussions were done and the findings were shared with them at the time of the support supervision. 2.9. Community self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting It was not possible to conduct CSM and SHM because of logistical challenges experienced in facilitating this process across the projects. Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. Not applicable in this reporting period Project Name Total # of LGAs/Counties in the entire project area No. and % of LGA/Counties that carried out self monitorins (CSM) No. and %o of LGAs/Counties that conducted stakeholders meetins (SHM) East Bahr el Ghazal 8 0 0 Weslern Eqqqtqfq l0 0 0 Ea$q{!tqqqlqia 7 0 0 Upper Nile 6 0 0 West Bahr el Ghazal 13 0 0 TOTAL 44 0 0 25 2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table ll that the NOTF has done to ensure that CDTI projects comply rvith long-term mass treatment with ivermectin? Table 11: Activities that promote compliance to long-term treatment with ivermectin Obiective Specific Activities Proiect targeted 1. Promote Integration of CDTI with other primary health care services Meeting with policy/decision makers on absorption of CDTI activities into health system and provision of counterpart funding to supplement what is currently available. AII projects. 2. Maintain high therapeutic (>65%) and geographic (100%) coverage Increase in the number of CDDs and community mobilization and health education so that the CDD/population is reduced and thereby increase coverage. All projects. 3. Promote strong community ownership Involvement of more community members in CDTI activities especially women. All projects. 5. Support strong partnership Addressing the issue of partnership between endemic communities and health system. All projects. SECTION 3: Other activities of the SSOTF 3.1 Describe any additional activities undertaken by the SSOTF (NOTF) (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc). None of the above mentioned activities were conducted in the reporting period. 3.2 What was done to coordinate CDTI Project activities? Coordination of CDTI project activities was done mainly through conducting performance review and planning meetings and also though information sharing. 3.3 Note meetings convened for the NOTF. (Objective of meeting, issues addressed, date, participants, outcome, and constraints faced follow-up needed) o The annual program review and planning meeting took place at the beginning of the yeat. o Meetings with project coordinators and the county supervisors to review the performance of the CDTI projects and aim at improving coverage. 3.4 Note meetings attended to provide technical input to other projects, other countries, or other sectors. Not applicable Other country: None. 3.5 Briefly state any administrative duties undertaken Financial reports submitted, technical updates and briefs also submitted as and when requested for. 26 3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented. ,fC Project Name - SSOTF YEAR (6), 201 I MAIN ACTIVITIES *Pla + SSOTF coordination offi ce lders meeti muni Procurement of materials *ov les *At * SSOTF coordination offi ce *Regional (Defined proiect area *Pavams Tl {ING * SSOTF coordination offi ce + Trainins of CDDs * Trainine of supervisors * Training of communi leaders * Trainins of health staff/ ASSESSMENTS * KAP sfudies in new areas *Revi uction of IEC materials HEALTH EDUCATION SESSIONS * Community awareness/tar * School health educati * Churches Census Census U for SAEs IVERMECTIN DISTRIBUTION *lvermectin Dishibution +Distribution of minor side effect Introduction of CSIW SIIMS *Gounty Health * NGO inine of CDDs and others * Local Health *CSN4/SHM in commun treatment. treatment. Manasement SAEs/Minor side effect *Supervision of CDDs, P. sup.& Co *SSOTF coordination office !.tue M Jan Feb Mar Apr May June x X X *PCOs/RTF 27 Defined oroi *Data collection * SSOTF coordination offi ce *PCOs * CDDs *PCOs * CDDs Monthly financial reporting iture *SSOTF coordination office PCOs /RTF Preparation of mid term/ annual technical report *SSOTF coordination offi ce PCO / RTF *A tion for Mectizan *SSOTF / PCOs dent Monito *SSOTF/PCOs/RTF 28 3.7 Plan of Action for 2012. Proiect Name SSOTF HO Years Year 7 20t2 MAIN ACTIVITIES o1 Q2 o3 Q4 *Plannins/Review meetinss *SSOTF X tRegional x tCounty x X s Stakeholders meetinss/community x X x X Procurement of materials e OV supplies X X kAdvocacy kRegional X X *County X X *Payams X X TRAINING * Train ns of CDDs x X * Train ng ofsupervisors X X * Trainins of community leaders X x * Training of health staff/ x x Management / SAEs X X ASSESSMENTS * KAP studies in new areas x +Reviewof IEC materials X IIEALTH EDUCATION SESSIONS e Community awareness/targets X X X x B School heatlh education/targets X x x X * Churches X x x x ensus Census Update X x x Drue Delivery/Supplies Mectizan requests x eDrugs for SAEs X X Settine up of referral systems tStrengthen up referral systems b/w communities, PHCUs, PHCCs and hospitals for SAEs X X IVERMECTIN DISTRIBUTION *Ivermectin Distribution X x *Management of SAEs x x Introduction of CSM/ SHMs *SSOTF partners X X *Countv Health Deoartments X X * NGO nartnershio X X * Training of CDDs and others X X t Local Health systems x X +CSM/SHM in community X X Mon un treatment. Mop up treatment. X x 29 anagement of SAEs X x *Supervision of CDDs, P. supervisors and County Surrervisors) SSOTF X X X X PCOs/RTF x x X X * Payam supervisors X X X x *Data collection X X X X * SSOTF X X X X *PCOs X x X X * Payam supervisors X X X x * CDDs x X X X *Reporting/ drue management * SSOTF X X X x *PCOs x x X X * Payam supervisors X X X X * CDDs X X x X Monthly financial reporting expenditure X X x x SSOTF x X X X PCOs / RTF X X X X Prenaration of mid term/ annual technical reDort x X SSOTF x X PCO / RTF X X *Aprrlication for Mectizan X &SSOTF / PCOs x INDEPENDENT MONITORING x X *SSOTFiPCOs/RTF x X *Mid term review * SSOTF / RTF X *Evaluation * SSOTF / RTF a t 30 t, SECTION 4: Support to CDTI 4.1. Financial contributions of the partners Table 12: Summary of financial contributions by all partners to all CDTI Projects for the year under reporting Note: figures should include contributions in kind such as salaries paid by the MOH, etc. Comment: The amount under the Ministry of Health is that of staff salaries. Name of CDTI project Contribution (money or items in kind released) Ministry of Health (USD) NGDO Partner (USD) Local CBO/ communities District Others East Bahr el Ghazal 10,617.60 6,631.00 0 0 0 Western Equatoria 7,513.20 9,490.00 0 0 0 Eastern Equatoria 8,765.40 15,324.00 0 0 0 Upper Nile 7,833.20 18,968.00 U 0 0 West Bahr el Ghazal 16,279.60 19,394.00 0 0 0 SSOTF 12,000.00 13,227.00 U 0 0 Total 63,008.00 83,034.00 0 0 0 3l If there are problems with release of counterpart funds, how were they addressed? Comments: Yes there are problems with budgeting and appropriation of counterpart funding for direct activity implementation in the OV program. Continued tireless advocacy is being done with the government of the Republic of South Sudan to have funding provided for OV work as opposed to relying on APOC and the NGDO partner only. State the number of projects that had no funding from APOC Trust Fund? o None. All the five CDTI projects plus the SSOTF received funding from the APOC Trust Fund. State the number of projects that had no funding from any outside source? . None. A1l have supplementary funds from CBM. State the number of projects that are late in submission of the financial reports to APOC? None, financial reporting has significantly improved; and for the very first time, the second installments of APOC funding were disbursed to all projects. 4.2. Other forms of community support "':.'0*".:TIffiT,TJfr:J:;:;*|:"J"'*:.;I;1:|I1LTJI',,1;"J jff UJ,straining . Some communities do the mobilization and sensitization of their own people. . Communities collect firewood, water and also cook for CDDs during the training. Some communities store drugs and provide good security awaiting mass treatment. 'i 4.3. Resource mobilization efforts Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources and the outcome of those efforts. Submission of work plans to the Ministry of Health, which included activities to be implemented by the CDTI activities. The outcome has not yet become positive; but continued efforts will be continued to advocate for release by the government funds to CDTI. 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency - 3.2 South Sudanese Pounds (SSP) to the United States Dollar. 32 t Table 13: Indicate how much the NOTF secretariat project spent for each activity listed below during the reporting period Activitv of NOTF secretariat Expenditure ($ US) and Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry po i nt to prqjggls-4r_qqr cts, .q!_c 0.00 0.00 l 0.00 0 Monitoring and supervision of CDTI P_roj99!s 7.784.00 0.00 ; 6,036.00 0 Training of Project officers, TOT, NOTF staff. etc. 6,422.67 0.000.00 0 Advocacy visits to health and political qullfot{qq at national level IEC KAP studies, materials development, Annual 1e_vie w workshops Bj aqqql NOIF meetings/cgn!-ereqc es f u."l_qd maintenanc g o-f Ve!!9-1 es, Vl,ei{etelpe o,f 9 ff1 cq gquip{rteq! Stationery 3,916.67 0.00 0.00 0.00 I ,Otq.at r,ooo.oo b.oo 0.00 " 2,632.00 ;0.00 i 0.00 0.00 ,, t,499.00 0.00 o.oo 0 0 q 00.000.00 I 0.000.00 0 o.oo I to6o.b-o 0 Others/Salary by MoH-RoSS 28,200.00 0.0012,000 J 0 TOTAL s4343.00 12,000 13,227.00 0 Total number of persons treated 3,477,,340 Comments - None JJ Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others Condition of the equipment * Please state Functional Currently Non Functional but repairable Written off 1. Vehicle 0l 0 0 0 0 01 0 0 2. Motor cycle 0 0 0 0l 0 01 0 0 3. Computers 0l 0l 0 0 0 02 0 0 4. Printers 02 01 0 0 0 03 0 0 5.Fax Machines 0 0 0 0 0 0 0 0 6. Others a) Photocooier 01 0 0 0 0 01 0 0 b) Cash safe 01 0 0 0 0 0 0 0 c)Lap top 01 0 0 01 0 02 0 0 4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project *Condition of the equipment (Functional, Cunently non-functional but repairable, Written off). How does the project intend to maintain and replace existing equipment and other materials? This will come from government counterpart funds which is hoped would be available in very near future. Describe the adequacy of available knowledgeable manpower at all levels. . The SSOTF headquarter office: Apart from National Coordinator and the Admin/Finance Officer, other staff such as the Deputy National Coordinator, Data Manager, Secretary and Driver etc are lacking. . The CDTI project offices: There is general shortage of manpower in the project coordination offices. Only PCOs are involved in technical matters as they have no assistants at state project level. Most project coordinating officers are not yet good in producing the annual technical reports due to their low educational level. This is considered a serious matter for good CDTI management at project level. There are no Data officers in any of the projects, a vital prerequisite for quality data compilation and submission. . Project supervision centers: Most of the CDTI project County OV Supervisors have worked as CDDs in the past and hence promoted to supervisors. However, they don't have a basic education background and therefore, a lot ofcoaching is required and the number per county should be at least 3 persons for good supervision. . Community level: The overall CDD/population ratio across the 5 CDTI projects is generally improving. Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign). This is not the situation in South Sudan during the period under review because staff transfer does not occur. 34 t!a ?a SECTION 5: Evaluation for sustainabitity of CDTI, Independent monitoring and other reviews 5.1. Independentparticipatory monitoring/evaluation 5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? Yes^ Table 15: overview of when monitoring and evaluation undertaken Project Name (After Year 1) participatory independent monitorine Mid-term sustainability evaluation (3'o year) Independent monitoring after rth+ year Evaluation For sustainability (5'n year if necessary) internal monitoring by NOTF Other evaluation by partners West Equatoria YesEast Bahr el Ghazal Yes East Equatoria Yes 5,l.2Ingeneral,whatweretherecommendations?Allthethreeprojeciievaluat.a*@towards sustainability and the general recommendation was that CDTI activities should be re-launched in these projects. 5.1.3 In general, how have they been applied/ implemented? Re-launching is yet to be done; in the meantime, projects are working on improving their coverage performances and sustainability. 5.1.4 Any other comments? None 35 5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Done for the three projects that were evaluated. What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 5.2.1. Planning at all relevant levels. No plans yet. 5.2.2. Funds No plans yet. 5.2.3. Transport and equipment (replacement and maintenance) No plans yet. 5.2.4. Human resources Government has taken up almost all the CDTI project staff at State and County level. 5.2.5. Which projects have submitted sustainability plan? The three evaluated projects. 5.2.6. To what extent have the plans been implemented? Minimally. 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms Ivermectin delivery system is separate from other drugs in the PHC system as a result of non integration. The Ministry of Health of The Republic of South Sudan is yet to have an integrated drug delivery system involving all drugs. 5.3.2. Training There was no integrated training yet with other programmes. Nevertheless, PHC health workers are an essential source of trainers after having being trained. All this is the plan after integration of CDTI into ministry of health. Most staff is not ministry of health staff and the CDTI has not been taken fully over by all state ministries of health. There is a sign that integrated training of programmes such guinea woffn eradication and onchocerciasis control and other NTDs would be a reality in the not very distant future. 5.3.3. Joint supervision and monitoring with other programs Joint supervision and monitoring with other programmes is not yet occurring. The more likely integration to happen soon will be that of neglected tropical diseases. 5.3.4. Release of funds There are no funds available or released to any programmes but with stabilization of health system, there is chances that common budget and release would be possible in South Sudan over time especially through joint NTDs fund release. 5.3.5. Is CDTI included in the PHC budget? I a a 36 No, direct funding for CDTI activities is not included in the PHC budget. 5.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? There are no other health programmes in the Ministry of Health are using the CDTI structure. 5.3.7. Describe other issues considered in the integration of CDTI The CDTI strategy could be used in management and control of lymphatic filariasis through albendazole drug distribution alongside ivermectin. 5.3.8. Describe the integration of other programs into CDTI in your country and the results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?) No integration yet. 5.4 Operational research No operational research was carried out 5.4.1. Summarize in half of a page the operational research undertaken in the country area within the reporting period. Not applicable 5.4.2. How were the results applied in the project? Not applicable 5.4.3 Note the issues that have been identified by the NOTF for future operational research. KAPs in the new CDTI areas . There are no identified new CDTI areas. 37 SECTION 6: opportunities Strengths, weaknesses, challenges, and Strengths . The presence of the WHO/APOC Technical Advisor to support the SSOTF and the CDTI projects. . Good working relationship with CBM in regards to drug procurement and delivery of ivermectin. o WHO/APOC office in very useful in hastening fund disbursement to SSOTF and projects. Weakness . Available manpower and staff commitment is still inadequate. . Unreliable population figures in virtually all CDTI projects. o Poor state of roads with resultant high wear and tear of the vehicle. . Frequent insecurity in project locations disrupts treatment and thereby leads to low coverage. o Distribution during rainy season renders many areas inaccessible . Frequent break down of motorbikes and project vehicles due to poor maintenance. Challenges and how they were addressed . Inadequate staffing and knowledgeable manpower in the project area. There is deficient staff strength across all levels and SSOTF has planned to continue working with the state ministries of health on recruitment of the missing staff. . Non availability of CDDs in some communities. This matter was discussed at a meeting with community members as discovered during SSOTF supervision and new people were later recruited and trained. o Non integration of all projects and non absorption of some CDTI staff into the ministry of health. Effort has been towards this through meetings with and letters to government top policy/decision makers in Government of Southern Sudan o Intensi&ing health education and community mobilization. This was used to diffi.rse beliefs on the mectizan and those who previously refused now accepted treatments. o PopulatiorVCDD ratio in the entire country is still high. Although this has been reduced but communities without CDDs are being encouraged to get CDDs and those with less number of CDDs to get more CDDs. . High cost of Transport system in the whole South Sudan. The road condition is still very poor with consequence huge cost of vehicular maintenance due to frequent break down. 38 .J rm for community penetration and further improvement in both geographic and therapeutic coverage. NTDs control offers an opportunity for utilization of CDTI structure and thus leading to popularity of mectizan distribution t List the strengths, weaknesses, opportunities and threats of the vector . .limination project (where applicable). ' . This is not applicable since there was no vector elimination component in South Sudan. 39