West Bahr El Ghazal CDTI annual technical report submitted to technical consultative committee (TCC): January-December 2007

RESERVED FOR PROJECT LOGO/HEADING COUNTRY/I'{OTF: SOUTHERN SI.JDAN Proiect Name: WEST BAHR EL GHAZAL CDTI Approval year z 2004 Launchins year: 2005 Reporting Period (Month/Year): JANUARY - DECEMBER, 2007 Proiectvearofthisreport: (circleone) I 2 (O 4 5 6 7 8 9 10 Date submitted: 6'n August 2008 NGDO partner: Christoffel Blinden Mission ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) .--.J w 'cr Tcl/ DEADLINE FOR SUBMISSION: To APOC Management by 3L January for March TCC meeting iion To APOC Management by 31 Julv for September TCC meeting To, t 5 sEI', 200f R I AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) I I I I I I I I ZBN u? h*€ btu tu IM WHO/APOC, 24 November 2004I 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 H Date: ....0.61, o.K....... Zonal Oncho Coordinator Name: Daniel Anthony Omido Signa Date: 4rt/rq NGDO Representative Name: Fasil Char Signature,W Date: ..rrf.{/rrr. 'flris report has been prepared by Name :Baba/FaslllLazarus/Daniel Designation : Nat CooAtrGDO CooiTAiPCO Signature Date I I I Table of contents FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY ........... SECTION I : BACKGROII\D INFORMATION....... I 2 3 1.1. Gnxenar rNFoRMATroN............. 1.Ll Desuiption of the project (brielly)..... 1.1.2. Partnership 1.2. Popur-erroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......8 2.I. Tnmr-rNe oF ACTrvrrrES 8 2.2. 2.3. 2.4. Aovocecv ..................... l0 MogLzeuoN, SENSITzATIoN AND TIEALTH EDUCATIoN oF AT RISK CoMMUxTTmS IO Coluvrulrrry rNVoLVEMENT......... .....12 2.5. CepecnyBUrLDrNG.. 14 2.6.2 What are the causes of absenteeism? .......... 2.6.3 Wat are the reasons for refusa\s7..............2.6.4 BrieJly describe all lcnown and verified serious adverse events (SAEs) that ... 2.6.5. Trend of treatment achievement from CDTI project inception to the current year 2.7 . OnoeRnvc, SToRAGE AND DELTVERY oF IVERMECTIN .......... 2.8. CorwruNrry sELF-MoNTToRTNG euo SrernnoLDERS Mnrrnqc 2 9. SupBRvrsroN............... 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? 2.9.3. Was a supervision checklist used? J 3 4 6 20 20 20 22 23 24 25 25 25 25 What were the outcomes at each level of CDTI implementation supervision? 25 Was feedback given to the person or groups supervised?................ ................ 25 How was the feedback used to improve the overall performance of the project? 25 SECTION 3: SUPPORT TO CDTI 26 2.9.4. 2.9.5. 2.9.6. 3.1. 3.2. 3.3. 3.4. EeupwNr FuveNcmr coNTRrBUTroNs oF TrrE pARTNERS AND coMMUNrrrES Ortmn FoRMS oF coMMUNrry srrppoRT ............. E>cBNom-nr PER ACTryITY 26 27 .,.,27 ....27 SECTION 4: SUSTAINABILITY OF CDTI....... ..........28 4.1. INTpnNaUTNDEpENDENTpARTICIpAToRyMoMToRTNc;EvaruerroN....................28 4.1.1 Was Monitoring/evaluation carried out during the reporttng period? (tick any of the following which are applicable)..............4.1.2. What were the recommendations? .... 4.1.3. How have they been implemented? ............. 4.2. SusrenqasrI-rry oFrRoJECTS: rLAN AND sET Ti\RGETS (ueuoeroRy AT Yn 3) 4.2.1. Planning at all relevant levels.. 28 28 29 29 29 29 294.2.2. Funds lll WHO/APOC, 24 November 2004 4.2. 3 Transport ( replacement and maintenance ) .............. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented............... 4.3. INrscnerroN ............ 4.3.1. Ivermectin delivery mechanisms 29 29 29 29 29 29 29 29 29 4.3.2. 4.3.3. Training.... Joint supervision and monitoring with other programs 4.3.4. Release of funds for project activities 4.3.s 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?............. .................... 30 4.3.7. Describe others issues considered in the integration of CDTI. 30 4.4. OpBnaTIoNALRESEARCH .....30 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. ........ 30 4.4.2. How were the results applied in the project?.... SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTLrNrTrES...... .................30 SECTION 6: UIIIIQLJE FEATLJRES OF THE PROJECT/OTHER MATTERS...........31 30 lv WHO/APOC, 24 November 2OO4 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT TINICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Communi ty-Di rected Di stributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non -Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization V WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 847o 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 mesoftiyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) GeoCraphical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower 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 prograrnme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make pppropriate modifications when necessary. vi WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) 1 Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY NOT APPROPRIATE WHO/APOC, 24 November 2OO4 Executive Summary This is the report of CDTI activities implemented by West Bahr El Ghazal CDTI project, Southern Sudan from January to December 2007. The project is in its third year of APOC funding phase. The prqect 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 2,670,680 persons, UTG of 2,243,368 persons and an ATO of 271,572 persons during the reporting period. It is made up of three states namely West Bahr el Ghazal, Warrap and Northern Bahr el Ghazal with a total of ten counties and 3219 communities but this community figure was net comprehensive. Data on the number of health staff involved in CDTI shows that only 138(33.3Vo) persons were involved in CDTI activities out of 414 avallable health staff in the project areas. On treatment, only 120 communities were treated and thus giving a geographic coverage of 3.77o. A total of 203,784 persons received mectizan treatment during the period under review. This treatment figure represents a therapeutic coverage, UTG coverage and ATO coverage of 7 .67o, 9 .l%o and 7 5 .07o respectivel y in 2007 . Population movements are very common in the project area potentially due to the fact that they are nomads and farmers. This accounted for high level of absenteeism recorded in this report. On training, 522(65.37o) CDDs were trained out of annual training objective of 800. The population/CDD trained was in a ratio of 1CDD to 5116 population. The number of payam supervisors/health staff was 26(13.07o) out of 200 targeted persons. The project had series of challenges that drastically affected its output. These include poor record keeping by CDDs and payam supervisors that resulted to non availability of data in some cases, coping with poor community census registration which was sequel to influx of returnees to already censused areas, inadequate availability of knowledgeable manpower at all levels in the project area, non absorption and non salary payment of CDTI staff which was addressed by carrying out advocacy visits to relevant health authorities but not much was yielded as situation was not yet stabilized, non availability of project vehicle as well as inadequate number of motorbikes to county supervisors and problem of repeating mobilization and sensitization of new returnees. Finally, population / CDD ratio was still very high in the project. Efforts were made to put more CDDs on the task of CDTI activities but it would really take the project some time to strike a balance in population/CDD ratio. 2 WHO/APOC, 24 November 2OO4 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geo graphical location, topo graphy, climate Populatio n : activitie s, culture s, lnnguage Communication sy stems (roa^ds, . . ) Administration structure Health system & health care delivery @rovide the number of health postslcenters 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. Geographical location, topography, climate The West Bahr El Ghazal CDTI project is located on the latitude of 7 .69727 o and longitude of 27 .99882". The elevation of the prqect is 442m above Sea level. The project is made up of three states and ten counties. The states are West Bahr el Ghazal with two counties, Northern Bahr el Ghazal with five counties and Warrap with three counties. The topography of the project has two marked characteristics, namely mountainous and rocky soil zone in the West Bahr el Ghazal state, and flat and muddy soil zone in both Warrap and Northern Bahr el Ghazal. The climate of the project is cold during the rainy season between May and September but with the heaviest rain in July through September. It is hot during the dry season but a maximum temperature of about 40 degree centigrade. Population: activities, cultures, language The population in the project area is estimated to be 6 million people in the three states. Only 2,670,680 people are estimated total population in the project area. The activities of the people in this project area are mainly cattle rearing (nomadic farming) , farming and hunting. There are cultural differences in the three states. In the West Bahr elGhazal state, the two spoken languages are Arabic and English with about 30 other local languages. In the other two states, Northern Bahr el Ghazal and Warrap, the three major languages'used are Dinka, Arabic and English. Communication systems (roads...) Communication Systems are by road and air. There are network of roads within the project and these interconnect with county areas. The roads are however very bad and movement is really difficult during the rainy season particularly in Northern Bahr el Ghazal and Warrap where roads in county areas are muddy and prevent free vehicular movements. For instance, there is a river which does not allow vehicles to Aweil North during May and January, Aweil South County due to very muddy nature of road as well as rough and muddy road to Aweil Centre, all from Aweil town. The prciject can be accessed through air by planes and helicopters. It has modern mobile telephone communication system networks and internet services are available. Administration structure The Administrative structure consists of four distinct levels, namely (i) State, administratively in charge by Governor; (ii) County by Commissioners; (iii) Payam by Administrators and (iv) Boma by Councils. Boma is the least administrative unit with many villages. The project has a total of ten counties and more than 3219 communities (Bomas). 3 WHO/APOC, 24 November 2OO4 Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). For each state in the project, there is ministry of health which formulates and directs all health policies. The system is composed of state hospitals, county hospitals, primary health care centers (PHCC) and Primary Health Care Units (PHCU) as well as dispensaries. From the available statistics in the five counties, there are 30 PHCC and 50 PHCU, totaling 80 primary health care facilities. This figure is expected to increase when data form the remaining five counties are provided. Number of health staff in project area and number of health staff involved in CDTI activities The project has not been able to determine the total number of health facility staff and those involved in CDTI. From the available record, only 138 health staff were involved in CDTI out of 414 health staff in the project area in 2007. Table 1: 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 Bz Percenfage Br=BzlBr *lfi) Aweil North NA NA NA Aweil South 4t NA NA Aweil East 86 NA NA Aweil West NA NA NA Aweil Centre 47 36 76.6 Wau 197 74 37.6 Raja 43 28 65. l Gogrial West NA NA NA Gogrial East NA NA NA Twic NA NA NA Total 414 138 JJ.J 1,1.2, Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaUinternational), communities, local organizations, etc.l The partners involved in CDTI in the project are the health services (the state ministry of health, county health department and primary health care centers/units); Communities which include the payams, Bomas and villages; CBM and APOC/VVHO. There are no local NGOs supporting the state or the counties. 4 WHO/APOC, 24 November 2004 Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. The working relationship among partners is very cordial. Planning is done together with all partners especially NGDO/SSOTF and the outcomes later are translated to communities where mobilization and distribution of mectizan are carried out by communities through their CDDs. The project in conjunction with NGDOiSSOTF carried out advocacy for government and community supports. Supervision is not jointly carried out in most cases unless where the officers at the lower level accompanied the one at the upper level. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The project's plans include mobilizing various decision makers in the state and counties as well as UNDP and other local organizations to assist in the implementation of CDTI. Aweil East county has perfected plan to approach LINDP to assist her in rebuilding the county office in 2008. 5 WHO/APOC, 24 November 2004 t E et Ho -o C) z vN o. o B o B o oE L<(.) C) B o <A d B cn 4) q) o o F U\) F \) \) \) p \) q) B 'Il -{. s8 rJ o'US5n -$ d,h '6. b\E$9 .s -, .S :.) -Su >\ qr O' p: s\) oru'FS tBsr\9N $\,$q) \: ta()ss\l SrstsE!S*v\J!s)X-os\\x 3E !.L3\\s s'ii r.3 ^s:i :L\s =66 dx sp u -s.: d$ sry :ooi= ).1 \ Id vUt\q\U q \JU q p q) t ! o !o O. oo li o C)H o oo L lr o(! q)tr C)lr(n >.q) Hq) C) B c! c)L CB 9(l) A' L x q) , c) C) v U) .F o (! a a (! C,) 0) cgtr trr_o ^oU 6tl ol o! 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O-)ie!() z o; a (h o B cdgl o , q) B o B o C)U C) B dB c, 'a o B d hI) o d rr.l d bo oo o ,F Fl 3 F $ c.l ! c) -o C) z$ c.l U +r F ,hq) 9p -o) o 0)e(h= :e -- .s aO o e+' Gt ,. q) dc6 yc) =q)9E =9rtr(l) cie!tr otr oC! o= Eath o) -a cd 00) -u)q) Oti -c(l) o1rt EE(AE =Lep€ o -OL q)HE0)o o=. =G .29(!(l) n!:fi PZ q) f- o L €) c! 0L 0) a q) 7 Q , o 00 tr o I q) thq) th I CE o o c) o0 c! , oI Lq) q) o0 =cE-q)0)LLGl rC) =q):1'= *! r- (t o 0.)o(h C)() tr o tro o aU e.o c) cq q) cg G q) +r q)Itr o(h o cn c€ F z (h IA q)() (! c!4.. oPr- o .c)(/) / SECTION 2: Implementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 24 November 2004 ! o c.l o o z tcl Ut-\ o. B o oe(Li 0) 0)(! 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E c) o.o(n o o oq)(n o -o E c) o()(/) q) -o o o C)(r) 0) cgE ah (n c)() o)e o.= EEI 0)D Eo o.o U) Eo! E o o 4)(n () -o Eo ao cn H()E Eo Ao(n q) -o o oo(/) r c) -o Eo a 0) U) oDo o o E() o (.) o ko ,.o o oo o .o o 0 o H.= .Ptr 6t= c) -o q) o U) o -o o o. 4)(h ! c) -o Eo o U) c)p E c) o c) U) o E C) o.o U) oo (J Eo oo(h 0)3 E c) oo(n o -o o oo u') o! o o()(/) AI CELF o e:o.= EE L) a >l bo ooJ bo bo H. iiE 6t= >\ oo bo = bo a ho fr VUD rC) !E=Nar oo =9a o 9: EE ! c)e oo os o o ()4 oo Ho! () op o -o o a 0)(r) c) -oo() o (.)3 oo c) o o (.) -oo H.L.tr bo bo abo ao rh FI 9 , ta z o = o V) o > E1 o () B c) B o (J Q 0) ' cn B CN & o B € bo d rI] d bo(, () EF Fl Er Fr 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 difficuhies/constraints being faced and suggestions on how to improve advocacy. State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy The project mobilized four state policy decision officers namely the minister, Director- General, directors of public health and finance to solicit for support to CDTI activities and absorbing the CDTI staff in the ministry of health. Commissioners at the county level and medical director at the primary health care centres were met on the issue of absorbing the county supervisors in the health care system. A few Payam administrators were mobilized at this level to provide support to CDDs. Two advocacy visits were made to manager of radio FM in the state to support in airing the activities of CDTI. The outcomes There were promises by both state and county policy makers to absorb the CDTI staff in the ministry of health and county health department. Perhaps in 2008 the CDTI staff will be absorbed. No incentives were provided to CDDs despite all efforts. Describe difliculties/constraints being faced The major constraints were inadequacy of funds for.fuel and enough motorbikes to cover the areas of operational activities. Suggestions on how to improve advocacy l. Sufficient funds should be provided for fueling of both motorcycles and project vehicle. 2.Iltgh powered team should assist the project in advocating for support from state top officials. 3. There is need for additional motorbikes to the remaining five counties for effective mobilization and advocacy to commissioners. 4. Calendars and T-shirts could be given to top policy makers as a means of winning their hearts to towards supporting the project. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disseminate information Types of IEC materials used Mobilization and health education of communities including women and minoritics Re sp o ns e of targ et c o mmunitie s /villag e s Accomplishments Suggest ways to improve mobilization and sensitization of the target communities, The use of media and./or other local systems to disseminate information The project relied on the FM and Wau Radio to disseminate information. l0 WHO/APOC, 24 Novemb er 2004 Types of IEC materials used These are laminated posters, flip charts and manuals. Mobilization and health education of communities including women and minorities Mobilization and health education were carried out effectively in five counties of the project area. The county supervisors contacted the trained community leaders and they assisted in grassroots mobilization and education of community members. Both women and minorities were included in the mobilization. Response of target communities/villages Actually, some Bomas that found their CDDs unwilling to continue distribution replaced them with new ones. Also in Bomas where CDDs were not existing had to select them and distribution took place. Overall, response was on average as people are still emerging from displaced places and not too sure of the possible reactions and benefits of the drug. Accomplishments There was a slight improvement in mectizan treatment compared to previous year. The therapeutic coverage increased to7.6Vo in2007 from3.97o in 2006. Suggest ways to improve mobilization and sensitization of the target communities. - Provision of adequate logistics and fueling for covering vast areas. - Provision and use of megaphones for effective information dissemination at community level. - Production of more posters and handbills to cover all bomas and strategic areas. - involving schools for faster information dissemination. 11 WHO/APOC, 24 November 2OO4 co 8 N Ho -o o o z t+ N Q 0. ,l > c{ Ei C) bo Cd!tr(g c.)Lr 0) B a, bo C)o 0<)o0=loqb o< -o5f 8ro =trUB 85 Eg >r! .Eo Ed =()oo9Eq)- =q)r-, E v tl)ch? tr6 rc)0)tr E a.r LGIEE €r -O -v.H o ''li c=o tr9trEb5lr.C o<< q AQ e* =!r!(u.^!UtrE0 ZF ll *' OJ a0 .'l 0) q) z z z z z z z z z z z Eg* i EEEz a'i z z z z z z z z z z z o (J q,) E z q et le I le F z z z z \oo\ r- o\6 F-o\ rooo d00 NN ra tr 9oEA () ri z z z z r- cal c.l c.l o\ cA t\o Fle q U o) 6 a z z z z o\@ @\o o\ $c- t,.- € rr') = >a 8'F ED !.I >o)roucl 'Eq tr6) iq) otr ,!r o= ze - ll * letr tr q) oo c! q) Lo z z z z z z z z z z t- rr') la f -z'A e i Eg fltrtrEX EeET z z z z o o o o N e.E.E Etr'E E c! - - (u:t g EE 5Fi<L g'r * z z z z z z z z z z o\ EI(.) Fl tr o z o B U) (J > d rI] o B c) B o B o oO C) , (, B (! 'a & C) B (! bo oo d El bo oo o ,F 6l Er h q c'tp\)\J (+.- V2l p t vq \) o. F U o rO ts8. o)o o(t tru) 'i 0.) ri= 6?+t o-ll RFINFI $O N (.) -otr o z$N (J o nr B ca Lr -v .I ch(! o 'x o .=q) trF o <! ;u)onoOUQ9 o€ 3'E EEo .' =:?u s3E.E '6d[i!'l coLtroEE A 'E 'aE O d - - a ^Lg.vX.:s d.Xrn o H;^ .- l<E =3 etotr EEE b a sS*€ g Eiit JdH H+. O V =9-UIrCJ*5.9.9 E(.)9-tr tr u Z.Z aA-,H>r -9CLR€ 5 9 e€E ;i5E- !.1 Ef; = F'(,OFOL= C.) .r^VlI *L .i,E cg.= EEEq #Li.--6JUg 6 'E)'.cEE t -Q(aQ(e -HEA.A3x a E >; (!' \J ^-dV 7\ F -L\J - :,: O a*i .w (Lt LE2.e ;"8 >\.r0F .r U'Fe.-.E . =i.i.a)LO L .i-C = ..9E[JHE-E ,j=<>50H >t q) 0)Hbo ah(!q)(hX =,ZiiE6 a0= L1 .E E3 -_L{ €r td ,'3ec! tBE H.A -.:l<d ia .2 tq -otjFoc A !.; ) dL/ -o5E cA'i00) E= IV! , 3E$ =i=J E:?e(! :( oN 1!9 EP() =0)>..=e9li 'E 9c tlr- !- = 'E6 ILts8 89(l) e= -E'-9i)54lr.YtrO .o;H ilF € E\J t EC)6 qE -L-tr 6trE ;E cE o q_- .(l,).o) -..>>L^-6)o'o' O =9-- E ! r'E .lEa\- crt.= . OAL/]=-e -r^9.n = 0)EvJ!r\ E.EUEEE =# -O c j5 .E €.9 EgrEO e.! &eF =:o e -.= ts ':;rrai = X = ct X.= x.+ 5.e €#EE icE!?uaavA{ oE &E E F.=l.6;-tr9EEF oi'll-oojS'6 E E Efi H 2.5. Capacity building Describe the adequacy of available knowledgeable tnanpower at all levels. The project has not enough knowledgeable manpower but they are just being managed because there is nothing the project could do during the period. At the state level, the staff strength is still weak, leaving the PCO with most of the works. At the County level, virtually all the county supervisors are new and not well knowledgeable on CDTI activities. At payam primary health care center level, very few of them were health staff but complemented by payam supervisors who are still not adequate and knowledgeable. CDDs are deficient in many communities due to lack of support by their communities. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff are frequently transfened during the course of the campaign). Transfer of workers in the ministry of health at this stage of coming out of conflict is not a factor and not applicable as the project has not experienced it but where it occurs, the transfer of trained staff has to be within the project and thus has no positive effect on the outcome of project activities. What would be required is orientation of the staff to the new location. Some CDDs and payam supervisors were deployed to cover other communities that have no CDTI personnel. Even PCO had to participate in the training of CDDs and payam supervisors to ensure improved coverage. I4 WHO/APOC, 24 November 2003 co c.l o -o C) oz .+ N U L,,A B \n C! >t a € <! an aU(H o a0 (!tr o o o (h o CA do() o o trq) o ! CA o0 H !o cn t<o a. cn ho ,nHq) ! o tr ILt- o U) C,) o (g oU C) odLLoo>(/) o- aii -o Er aQ ahq) L L q) E CE q)L c! (l) o B c\l Xq) e)o fit 0) q) d ,a OLo B 0q)(l) c!L(r Ql)L c) cllL Lq) OO o(.) q) "s o V2 U q) 4 U .v >t o 0O \ q-p oQ \) \) o ^:v .s ! B \)\b lr v ts > F h q aa\)Q v q S L \ \)q ! \.) (! o o o. F aU(t o ln o (.) OL 0) 0) d bo liF ,iir ol -oldlFI Eq) CEL o n aQ Lq) z \)' a< U ?u+-99iF € d<ju i.t$,:z \, a O O O O a O \oo\ \o o\ (o t-- (fl c- O o\ € o\6 F- o\ c- o\ (.) € co oo {@ t@ o alN aal C.l s (f) ia 0) o o I s FO @ o@ o@ @ o@ € a@ O € @ O€ € oLq) .= 't r'dFrLh rr Fio: Eooq) ,. qJ o)L z 'Etr+ 9dcE € riricl t- 5 \)z S a< a O O a O O O O c.l \o \o $ v O c-) co co c.) O o\ o\ s U? r\rt o o o 9 s!o d $ t $ tt $ s s $ t -f t E .q .E dL H!H rg E3tr> zE q) 9 !q ll !t, Fds \) a s a< NQ .E a a O O a O O O O $ $ o\ o\ o F- F- O $ $ O \oN \oN s (.) c) 0) q) I sto d O c.l ct Ocil ol N Oc.l oN N aoi ol N IH c! l,h th JEo9oJ E'e L c) z eq ll !/ E r=$ :h,adv q) z U O O O O O O \o \o s \o c) 9 q) I s F Q J 9 .A oz 0) a o(/) o B G, rrl c) 3 0) =o B o oQ o B CEB c, 'a & o B ? 60 cd EI d bn(, tF Fl Er Er N O O O O Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments No 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving I00Vo geographical coverage and a minimum of 657o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The reasons for not achieving the coverage are l. Many years of conflicts and this resulted in many community members being refugees outside the project areas. 2. Structures not conducive or available in some counties. 3. Very poor road and connection between project and endemic communities becomes difficult. 4. Difficulty in getting mectizan and materials from Rumbek and also reaching some counties as movement by air is very expensive and irregular 5. Not able to get census and number of bomas in the affected communities. 6. Attrition of CDDs and other health workers due to poor or no remunerations. 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 { ./ ^i ./ { Management ofSAEs { ^/ CSM .i ^/ { \iSHM { { { { Data collection { { { { Data analysis { { { ./ Report writing \i ./ Others Census registration (specify) { { ./ { t6 WHO/APOC, 24 November 2OO3 7 . Mobilization and sensitization of community members has not yet gone project wide as people are still emerging from war. 8. The project is vast connecting three states is major challenge Plans being made to remedy the situations . Ensuring that CDDs are selected by all communities and trained. . Community members to be well mobilized to ensure their participation and support to their CDDs. . Ensuring that all counties have supervisors and are covered. . Health workers at primary health care center level to be involved more in CDTI activities. r Recommending to APOC to have a new project in Northern Bahr el Ghazal state for effective coverage. t7 WHO/APOC, 24 November 2OO4 $ a cl o -oA (.) o z$N U o o. :\\J > 00 d(.)L Cd (.) 0) 'a lia q) o E]& >. -o C) l+= o € .r7(! .A o ot tr "l 3Hl t-r =l'=91 6el EolEol a)aot sl b =l o,>t x Bl* PIA '=l o) =t cEtict o 8t b ,Nl #ot tr LI J6)l c .ot _trl d =l oZl t- c!3 oL(€ () a) 'a l<p. o B (A C) o (,) oE o Ilroa at6Ol o) tcxl ; !|.i9l oo(!t c9t'; 6)l -olE PI H r*l 3ol o, rl Ool o- €t-I-l cll =t 6Zll- o cg! 0) bo(€ o oo f,^ FO\ L ho o C)o c)(!E 0) bo(ntr c) o(.) o-. oa(! Lr 0) F <hlol a0 cdlLrl o:rl >t ol "ldl(-)I -cl$lil bJl ol olbll EItrl 3 al ol(dl Lrl a)l -cl od EI 5lol EI ol :l €l (€l 5l EI ol lJrl lt il Eg E i?i E ggqY o69 0. o C) o o -o E z z z z z O a o o 3 rrlc<. =qzz z z z z O a O O vob9 -otrEg zd z z z z \or- Nt'- €o\ o\\o co c.) \o € t co( ^=e Q 5 9s E!oIO!ct>a=2d E s z z z z Nol tc.l l-' o\@ $ \n$ o\ c- tr o (c a o0i ll *AA () !o =boO cd,^o-trad gJa- ootoF z z z z ('l oo ,r;$ q \o c.i cl n C.lN 9 t-- o -- Aiiia)46EHb9 = o.!z z z z z r-\o .o- \o ot co co co s! $ co @- o\ @\or- c.) co c.l c.l 00N co\oq c.l co t@\ cnON =o? 6.2 EE.g< 94F9 *\o@\o N ooN c-t o\ o\ co o .+ c.l co\o $ $\o N c.) €t .+ t-- .+ o\ c-l c- co 00 c.l { oo cninN c.)O o\$ o]t--tr} l-- c..l e .=-'dE Eg = o P-cn1€ -?.g6,: O tr ? 9i oF ttf,N$\o(\l lr) 8 o\ cfl o\\o c.) o\ co (n c.l( o\ o\ co 00I N c.) c.l co @ c.) $ r.1 ol o\ @ N \n co * €t'-ol { o\\o o\$ ol N \o\o$ O@ \O- t-- \O- C\l ln o b0(! (n q) E oO I ll * ^.4 d .9 qrrho ^ G^ tv ob\Eoi- ovo z z z z z z z z z z \ c.) ':o O E MU €esE =c>!z6 o z z z z z z z z z z O oi =o? 6.2 =E: =:oi.(D.o' Fl) z z z z z z z z z z o\ N co \@qo-.,6 :.o= E !)v!aAE E F.- > -3os.9/ig E sE E -9:- E trvaO z z z z z z z z z z o\ N c-) HA z o , o V) C) ' 6 sl o B () . o = c) q) O o B d B CI o B d ho o 6I! bo o L) o 'F Fl F o Er - caq\)U ! 4 L P a v \)q \) & )l ah .F (€ U)(! 0)L(d (! (,J (_) .F (n >. -o C,) IJ] a q) (g(.)trF r-f ol -oldl FI sa N E 0) o z$ c{ o tu B c) EA PI s{ s.I' bO Oo \Sq) * B B g s \ q)s q)si q)sq sI q) 'ao 5$ E s $$ B gs P'E\,Y$o's\ Rq) -ES ':r q. -r3l EXBl sit.:.Eo'?rsh r..i: s'sOrhBfrrsvET \SsS*B'sts$srs\ ss$\i =$+E B.R\C cs EES't :u .S 'E d\ sPoE :Ii rH='IsOEhls\s o\ B$I e) hO q) Tp { t E$ $ $ '+ \ a\) B { $\s g $\ q){q) E3\ c) Eo $\ $\ q) 6 \!$ B c) s ll s F (! 0)H cg o 0) t<a o 3 o otrd o C)E 0) I li oa >\ oo 0) € C): ^r !)9tL ol !tl o "lf!t Y9l c.r Ul rEl I9l a 5loOl p :t8ol ELl =8l tr Hl d .=l oZll- OIOI Jl toxl > EI E EIP sl Eol 0)ot tr BIE Elt 3lE Et d zt< o o o t- s C) dFr o bo(!^ .o B\ (J oF il I2.6.2 What are the causes of absenteeism? 1. Travel due to nomadic life, hunting and farming during the period of distribution 2. Transfer from one location to another 2.6.3 What are the reasons for refusals? 1. There is belief mectizan causes problem 2. People do not understand the benefit of it 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. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ 20 WHO/APOC, 24 November 2004 $ o c-.1 Ho .o tr C) z t cn U o o. o > c.l q) \) H L \,) .a .F \)|9') ,F h !qqp\)\) L % > S SJrt t \J U1 a. o t< C)a bI) t< oaotr (.) bo 'tr !oLrLr oo o (! U) sl C,) U) tro o q) IAHq) cd (n o .F otn l: (/)(.) (n(! U #r 6)l -oldlFI =Eeez Hiz>v <.EE L - aoq) dF O € cE .::(qoa) Od4!E9XAE lJ.,l o (J o o.9E2OE s? bo a .\)o6. O+ q-Y qA ^ 6.= Q)O.E tr *vO 'i6 trr;o-o.2E oo i tr= clo-()NEE.E ; ob'E-a AEsE € - g 9p.E =3aHa)SEEIS q o. U) rI]J m I .J 5&z< tr! ii !: c)=c) A- >r O.l)aad =c) .N*gT; o>; oboE d,: =b0 ao *,o U) o bo * z(n oboI EaF 9N rO U c.) tr o o O.r - * ri ri il ti c) o &ooF 6E\< e-o q rn c{ rnF- t ,$ft tl o 'EoJboO cdaSbs ooEOF q co 9 F- ri ,o odx9E- 30 ab a O\o -i: o c- $@\ c-)ON rI1 =oE 6.25trlii c (!.9 < 94'Fl, N F-lr) t-- ol NF-!n rr C\l aqo *3 _ E EHtsEo)o.o.!E<'=El ' 4 A.B \o o\t-- O@\odrr\o. N q obo (.) o(J t ll * r-I ti t{ o o EooF 6B\< a- I U? cO \ cO -cO- $= g.e r'IOoli n(o \c.) ri qOo"E-3_ E 5 HE =Etb>Oo $ o c.l ri =o?dz =F?E (g.= < 9€'FU o\ c.l co o\ N c.) bo Cg =q .r6tsi q, E I +.q€ 5I _! .= 7_r Oa!1 aaF tr U 91J EO oo o\ o.l cO ol co il r! r- o\ @o\ o\ o\ o\ o\ O c.l oo c{ NaoN co N $o ol lr) 8 c.l \o 8N Fr 8N @ N o\ ON O (.l s a c{ k C) -o o zsci U 0, o B NN -o L o .-tas - -! c!I q) 00 CEL o) b vte\(,PH's) Sr=Pcg rr:EAYE:5:.sEPR.EL{gUKE odq,) -E :3ev!:.€EgH5c!q)BE = eo00 .= 'e rEEE..= .Sl o i5o' .! c)Llic,)atr=HoY -()co'^ -C \Ol-l € (nUxdtEdxEHc'iL()t €iGttrEl 9tsEI Ee*l E .9 el '?E5E.LY (.)i.oI)=E H: 1iorHg:e +jtrl =cq); e=.ECor.gtro L-9F-( tE cgP.9rnaE v5 '-. tr oi otl '; o)l u)EI .EFl 0r 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please tick the appropriate answer)MOH{ tr WHO tr I.JNICEF tr NGDO { Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer)MOH N WHO ./ tr I.TNICEF tr NGDO Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The project collects from the SSOTF office in Rumbek and later in the project office in Wau shares the drug according to the size of the counties. Due to poor means of transportation, the project sends to the county supervisors in their various counties from where the health staff/payam supervisors come to collect drugs or alternatively the county supervisors used his motorbikes to send to them. At the health centres or from the house of payam supervisors, the boma supervisors who are also CDDs will come and collect the community's drugs to share with other CDDs for distribution to community members. Table l0: Mectizan@ Inventory (Please add more rows if necessary) Number of tablets How are the remaining ivermectin tablets collected and where are they kept? Payam supervisors collect the remaining drugs from the CDDs and send them to county supervisors. The PCO receives from the respective county supervisors and then keeps them in the project office store in the ministry of health. Remainin NA NA NA NA 160,000 0 0 0 0 0 Requested Received Used Person treated Lost Wasted Expired State/District/LGA Numberin stock NA NA NA NA NA NA NAAweil North NA NA NA NA NA NAAweil South NA NA NAAweil East NA NA NA NA NA Aweil West NA NA NA NA NA NA NA Aweil Centre 240,000, 240,000 80,000 26,667 0 0 0 205,000 204,999 62333 1 0 0Wau 205,000 Raja 60,000 60,000 59,800 t9,834 200 0 0 Gogrial West 105,000 105,000 105,000 33,768 0 0 0 Gogrial East 90,000 90,000 90,000 28,231 0 0 0 Twic 100,000 100,000 r00,000 32,963 0 0 0 TOTAL 800,000 800,000 639,799 203,784 201 0 0 23 WHO/APOC, 24 November 2OO4 List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The activities of primary health care personnel are not well pronounced as payam supervisors do most of the works. They are mainly concerned with handling any adverse reactions from the treated persons. For payam supervisors who mostly not health staff, they train the CDDs on the conduct of health education and community mobilization, Census registration of community members, Dosage determination and drug distribution. They supervise the distribution of mectizan by CDDs, and collect reports bnd forward to county supervisors. Any other comments No. 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No CSM training has been conducted in the project area. If so, When? Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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 District/ LGA Total # of communities/villages in the entire project area No of Communities that canigd out self monitorins (CSM) No of Communities that conducted stakeholders meeting (SHM) Aweil North Not available 0 0 Aweil South Not available 0 0 Aweil East Not available 0 0 Aweil West Not available 0 0 Aweil Centre Not available 0 0 Wau Not available 0 0 Raja Not available 0 0 Gogrial West Gogrial East Twic Not available 0 0 Not available Not available 0 0 0 0 TOTAL 3219 0 0 24 WHO/APOC, 24 November 2004 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Reporting 2.9.2. What were the main issues identified during supervision? There was no clear supervision due to difficulty in transportation and nature of terrain. 2,9.3. Was a supervision checklist used? No, checklist was not used during supervision 2.9.4. What were the outcomes at each level of CDTI implementation supervision? In very few communities visited, they were wrong entries by CDDs and among some payam supervisors. 2.9.5. Was feedback given to the person or groups supervised? Yes, feedback was given to them on the spot verbally. 2.9.6. How was the feedback used to improve the overall performance of the project? The mistakes that were noticed during the supervision were used as main points during the meeting with county supervisors with a view to pass on the message to other areas where supervision was not carried for overall improvement in the prqect performance. SSOTF IVq 25 WHO/APOC, 24 November 2OO4 SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows.if necessary) xCondition 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? This is intended to come from government and NGDO supporting the project. Government will take over the responsibilities when her budget is in place through the project counterpart funds. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 0 0 0 NA 0 NA 0 NA 0 NA 2. Motor cycle(s) 5 4-F 1- CNFR 0 NA 0 NA 0 NA 0 NA 3. Computer(s) 1 F 0 NA 0 NA 0 NA 0 NA 4. Printer(s) 1 F 0 NA 0 NA 0 NA 0 NA 5. Photocopier (s) 1 F 0 NA 0 NA 0 NA 0 NA 6. Fax Machine(s) 0 0 NA 0 NA 0 NA 0 NA 7. Others 0 NA 0 NA 0 NA 0 NA a) metallic cupboard I F 0 NA 0 NA 0 NA 0 NA b) Ceiling fan 0 NA I F 0 NA 0 NA 0 NA 26 WHO/APOC, 24 November 2004 Others 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years NGDO partner(s) If there are problems with release of counterpart funds, how were they addressed? There was no budget at MOH level as government is still grapping with even salaries. However, as things normalized, the project has a plan to approach the ministry of health authority for counterpart funds for CDTL Additional comments No. 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) No community support to CDDs except to assist in cooking food for CDDs during 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 exchange rate to local currency. Indicate exchange rate used here_ Contributor Year I (2005') Year 2 (2006') Year 3 ('2007') TOTAL AMOUNT (cASH) Budgeted (US$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted rus$) TOTAL CASH Released (us$) TOTAL AMOUNT (cASH) Budgeted rus$) TOTAL CASH Released (us$) MOH (Central + Provincial/State) 0 0 0 0 0 0 MOH @istrict/LGA) 0 0 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 0 0 26,620 26,620 27,495 27,695 a) b) Communities 0 0 0 0 0 0 APOC Trust Fund 7t340 5448t 74940 59574 TOTAL 0 0 97960 8l 101 102435 87269 27 WHO/APOC, 24 November 2004 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of 9elqrnq4y Mobilization and health education of communities 5000.00 APOC Trqi,rirg of CDDs Training of health staff at all levels !qp_ervpt Internal moni ties Advocacy visits to health and political authorities 4415.00 APOC APOC IEC materials S forms for treatment Vehiclesi Motorcycles/ bicycles maintenance 5559.00 APOC APOC _O_ffice Others Pqq i p gt",tt__(e. g cplt pglg.r.pn n tgrg etc TOTAL 14974.00 Total number of persons treated 203,784 Table 14: Indicate how much the project spent for each activity listed 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 N Mid Term Sustainability Evaluation 5 year Sustainability Evaluation -N Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? NA 28 WHO/APOC, 24 November 2004 4.f3. How have they been implemented? NA 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the oroiect evaluated durins the reoortins oeriod? No Was 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 (replacement and maintenance) 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. Ivermectin delivery mechanisms: the mectizan is currently distributed Through the PHC structure, the PCO who is a staff of the ministry receives the mectizan and sends it to county health department who in turn to PHCC at payam level. All the county supervisors are staff of health ministry. However some payam supervisors are not health staff but the project is working towards ensuring total integration into the PHC at payam level. 4.3.2. Training: There is no joint training of CDTI staff with other staff due to difficulty in organizing it considering the situation in which the project found itself all these years. In future, the project hopes to do integrated training. 4.3.3. place. Joint supervision and monitoring with other programs: This is also not in 4.3.4, Release of funds for project activities: No fund was released to the project with other projects in the ministry of health. Government has no budget for now. 4.3.5. Is CDTI included in the PHC budgett There is no budget in the entire ministry and whenever PHC starts having budget for sure CDTI will be included. 29 WHO/APOC, 24 November 2OO4 4.3.6. 4.3.7. Describe others issues considered in the integration of CDTI. Nil 4.4. Operational research 4.4.1. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? No health programme is currently using the CDTI structure as prevailing situation does not call for it. There is possibility of its use for other health programmes since it is community driven. Summarize in not more than one half of a page the operational research undertaken in the project area within the'reporting period. No operational research was undertaken by the project during the reporting period 4.4.2. How were the results applied in the project? Not applicable (NA) SECTION 5: Strengths, weaknesses, challenges, and opportunities Ust the strengths and weaknesses of CDTI implementation process Strengths of CDTI l. Most trained CDTI Staff are being been considered for absorption into the ministry of health and hence remained with the project for now. Weakness 1. Delay in transporting mectizan to some county locations 2. Inadequate supply of fund for fueling of project vehicle for CDT activities. 3. Poor road connecting to Aweil south, Aweil North and Centre in North Bahr el Ghazal 4. Number of motorbikes available to the project is inadequate and affects mectizan and important CDTI activities in the project area. 5. The number of trained CDDs is low compared to the population 6. The knowledge of actual population of community members is not available 7. Poor record keeping by CDDs and payam supervisors 8. Some data pertaining to the project are not complete. List the challenges and indi.cate how they were addressed. r Poor record keeping by CDDs and payam supervisors: The project had to direct the county supervisors to step up training of payam supervisors and also supervise all trainings at the lower levels. This still a problem but the project is planning to guide communities in CDDs in future. . Coping with poor community census registration: Effort was made to tackle this but it remains a bit hard due influx of returnees to already censused areas. . Inadequate availability of knowledgeable manpower in the project area: The project tried to shift CDDs to cover other communities as well as involving payam supervisors in other payams to ensure distribution in those areas. This issue would be address in 2008. . Non absorption and non salary payment of CDTi staff: Advocacy visits were paid to relevant health authorities on this but it did not bear fruit in all the areas. They promised of their absorption when situation is stabilized. 30 WHO/APOC, 24 November 2OO4 Difficulty in covering three states in the project area: The project has been coping with covering the three states but it would be better to create a new project for effective coverage in Northern Bahr el Ghazal. Non availability of prgject vehicle and inadequate number of motorbikes to county supervisors: This really affected the project but we utilized the available resources to ensure that CDTI activities are on course. Difficulty in connecting flights to Rumbek by County supervisors: This presented a big challenge to the project as four counties did not distribute mectizan. The project has devised means to avoid the repeat of the same situation in 2008. Problem of repeating mobilization and sensitization of new returnees: Payam and Boma supervisors made efforts to repeat or remobilize the community returnees but this was not too significant. Population / CDD ratio is still very high in the project: The project was still grapping with the low CDD number. Efforts were made to put more CDDs on the task of CDTI activities but it would really take the project some time to strike a balance in population/CDD ratio. More CDDs have been planned to be recruited and trained in 2008 especially in those four Counties that missed distribution during the reporting period. SECTION 6: Unique features of the project/other matters This is a big project with a large land mass and composed of three states. There are no visible CDTI activities in the other two ministries of health except at the affected county areas and this has effect on the overall CDTI implementation in the two states. Separating them by approving one more CDTI project will improve CDTI implementation. I 31 WHO/APOC, 24 Novemb er 2004 n