WEQ CDTI project annual project technical report submitted to Technical Cosultative Committee (TCC): January to December 2007

FOR PROJECT LOGO/HEADING ORIGINAL: English n - 4 -Uu-.l. rcr i+: )-g t& ::tion To, AiR AO Xqlu,la6 n,_&o*o% COUNTRY/NOTF : SOUTHERN SUDAN Proiect Name: WEQ CDTI PROJECT Apprqyalfear: 2003 Launchins Year z 2004 Reportine Period(MoNTFI/YEAR): From: January To December 2007 Date submitted: 6th August 2008 NGDO partner: Christoffel Blinden Mission eoP- *t+a htu CJA BFO Fo I 5 sil, 2tlrlt WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3L Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC)I I I I I il WHO/APOC, 24 November 2OO4 -"-"-"- -'l ANNUAL PROJECT TECHNICAL RBPORT 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 ba. Signature: .. Zonal Oncho Coordinator Name: David Jacob Signature: ...Jll}c-.l.. Date lflllst> NGDO Representative Name: Fasil Chane Signature Date 'flris report has been prepared by Name :Baba/FaslllLazarus/David Designation : Nat CooAIGDO Date: . .o.efslf9e*' :t"iltf?W6)*)J Date .0ti lll WHO/APOC, 24 November 2004 1. l. Gsxenar TNFoRMATIoN.. ...3 1.1.1 Description of the project (briefly) Error! Bookmark not defined. ...6 SECTION 2: IMPLEMENTATION OF CDTI....... .......8 1.1.2. Pannership........ 1.2. Popur-RrtoN............... 2.1. Tnmlnre oF ACTTvITIES 2.2. Apvocecv 2.3, MonnzeuoN, SENSITZATIoN AND I{EALTH EDUCATION OF AT RISK COMMUNITIES Ennon! BooxtulnK Nor DEFINED. 2.4. CorvnvruNlry II{voLvEMENT........ ...... Ennon! BooxuaRK Nor DEFINED. 2.5. CapecrrvBUILDING.... 2.6. Tnrenmxrs............... 2.6.1. Treatmentftgures ....8 .. 10 Ennon! BooxtulnK Nor DEFINED. ..... Ennon! Booxrvtl.RK Nor DEFINED. Enor! Bookrnark not defined. 19 192.6.3 What are the reasons for refusals?..... 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that ... 19 2.6.5. Trend of treatment achievement from CDTI project inception to the current year2l 2.7 . OnDsRnrG, sroRAGE AND DELTvERY oF vERMECTIN ............... ..............22 2.8. Comvrulrny sELF-MoNIToRING nuo StexmroLDERS Mrnrnlc ............23 2.6.2 What are the causes of absenteeism? . 2.9. SuprRvrsroN............... 2.9.1. Provide aflow chart of supervisionhierarchy. 2.9.2. What were the main tssues identified during supervision? ........ 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3.1. 3.2. 3.3. 3.4. EqunwNr FmRNcIer coNTRIBUTIoNS oF TI{E pARTNERS AND coMMUNITIES.. Ormn FoRMS oFCoMMUNITY suPPoRT.. E>ceNoruRn PER ACTrvrrY .. Was a supervision checklist used? .............24 What were the outcomes at each level of CDTI implementation supervision? 24 Was feedback given to the person or groups supervised?................................24 How was the feedback used to improve the overall performance of the project? 24 What were the recommendations? . How have they been implemented? 24 24 24 ...25 ...26 ...26 ...27 27 28 28 SECTION 3: SLIPPORT TO CDTI ..............25 SECTION 4: SUSTAINABILITY OF CDTI....... ..........27 4.1. INTeRNAL; TNDEpENDENT pARTICIpAToRy MoNIToRINc; EvarunrloN.......... .....,....27 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) 4.1.2. 4.1.3. lv WHO/APOC, 24 November 2004 Planning at all relevant levels.. 4.3 INrecRerroN ...... Iv ermectin deliv e ry me chanisms 4.3.2 Training.. 4.3.4. Release of funds for project activities4.3.5. Is CDTI included in the PHC budget? 4.4. OprnnTIoNAL RESEARCH 4.2. SUSTRNanILITY OFPROJECTS: PLAN AND SET TARGETS (lrlmOerORY AT................28 Yn 3) ...28 ...284.2.1 28 4.2.3 Transp ort ( replacement and maintenance ) ....... ,,.,.,.',28 ...,,....28 .........28 .,.,,..'.28 ...,,..,.28 ,','...'.28 4.2.4. Other resources...... 4.2.s To what extent has the plan been implemented. 4.3.1 4.3.3. Joint supervision and monitoring with other programs.... .............28 Enor! Bookmark not deft.ned. 29 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?... 29 4.3,7. Describe others issues considered in the integration of CDTL ..,... .....29 .....29 .29 .29 4.4,1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project?.... SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND oPpoRTLrNrrrEs...... .................29 SECTION 6: LINIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........30 WHO/APOC, 24 November 2OO4 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-B ased Organization Community-Directed 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 v1 WHO/APOC, 24 November 2OO4 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Vo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment 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 full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/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 communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make 4ppropriate modifications when necessary. vll WHO/APOC, 24 November 2OO4 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session - (Please add more rows if necessary) 1 Number of Recommendation in the Repon TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC.APOC MGT USE ONLY No recommendation WHO/APOC, 24 November 2004 Executive Summary This is the report of CDTI activities implemented by West Equatoria CDTI project, Southern Sudan from January to December 2007. The project is in its third year of APOC funding phase. The project is also being supported by CBM, an International NGDO coordinating CDTI in collaboration with Southern Sudan Onchocerciasis Task Force. The project has a total population of 506,848 persons, UTG of 425,752 persons and an ATO of 3271,986 persons during the reporting period. It is made up of 5 counties and 697 communities. Data on the number of health staff involved in CDTI shows that only 60 persons were involved in CDTI activities but available health staff in the project areas is indeterminate. On treatment, only 487 communities were treated and thus giving a geographic coverage of 69.9Vo. A total of 280,725 persons received mectizan treatment during the period under review. This treatment figure represents a therapeutic coverage, UTG coverage and ATO coverage of 5 5.4Vo, 65.9%o and 85.6Vo respectivel y in 2007 . Population movements are mainly attributed to those still returning from internal displacement following years of conflicts. Informationldata on absenteeism was not available in the project. On training, 480(100Vo) CDDs were trained out of annual training objective of 480. The population/CDD trained was in a ratio of 1CDD to 1056 population. The number of payam supervisors/health staff was 122(85.1%o) out of l24targeted persons. In implementing CDTI activities, the project was met a lot of challenges and which are summarized below: a. Inclusion of CDTI in the nominal role of the MOH: The project coordinating officer met with authorities of the ministry on this matter and there was assurance that they would be included in staff nominal role in no distance future. b. Attrition of trained staff in the project: This is a problem in the project but the project made every effort to encourage some to remain with hope that one day they would become part of ministry of health staff and they agreed and remained in the project. c. lnadequate number of CDDs: This was addressed through training more CDDs but still these were not enough given the population of the communities each CDD has to cover. o Lack of proper household census registration: The project has not been to grapple with this due to situation in the project area. o Lack of the project vehicle: This was included in 2008 work plan sent to APOC and it is hoped this would be approved. o Maintaining a good record of CDTI activities is a problem. All county and payam supervisorsftrealth were reminded of the importance of this and the project anticipate improvement in the future as they have noted their mistakes and need to keep good records. o Community self monitoring is yet to carried out in communities: The project identified this as a problem in all communities. Efforts would be made to address this in 2008. o Lack of data on the number of available of health workers in various health centers/post in the project area: The project has already taken note ofthis and has mandated all health staffto provide this in 2008. o More improvement in Health education and community participation especially women: The project experienced low women participation and efforts would be made to address this more in 2008. 2 WHO/APOC, 24 November 2OO4 SECTION L: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate The West Equatoria CDTI project is located between latitude 4.0 - 6.5 degrees and longitude 26-31 degrees in the south-westem region of south Sudan. The project office is situated in Yambio town in West Equatoria state. The state is bounded on the North by Lakes, Warrap and Unity states, on the East by Central and East Equatoria states. South and West parts share international boundaries with Central African Republic (CAR) and Democratic Republic of Congo (DRC) respectively. The project consists of five counties namely; Tambura, Ezo, Yambio, Maridi and Mundri. The Nile River traverses the Equatoria region dividing it into Eastern and Western Equatoria. The topography of the state is ironstone plateau with complex basement. The project area transects two hydro-topographical zones of the Nile and Congo watershed, which is characterized by fast-flowing rivers e.g. Yei, Yale, Bahr-Naam, Era, Maridi, Lesi, Sue, Yubu/Ringasil Ibba, Biki, Mbungu and Duma. All rivers drain northeast to the Jur and east to Bahr el Jebel, which form a confluence at the White Nile. It is precisely because of climatic and topographic conditions that the disease prevalence rates are so high, as the black fly thrives in such environment. The vegetation of the areas is mainly guinea savannah with woodland derived from rain forests to the south. P op ulatio n : activ itie s, Cuhure s, language The estimated total population at risk of being infected of onchocerciasis is 506,848 people. The people who emigrated or internally displaced persons are returning homes and this exerts increase in the overall population of the state. Prior to the war, the majority of the inhabitants of West Equatoria were settled agriculturalists in the communities practicing subsistence farming. Current settlement patterns have been impacted by prolonged conflict. People have been unable to carry out their farming and other occupation as a result of both internal and external conflicts. The population is dispersed with seasonal farmsteads. West Equatoria also accommodates Internally Displaced Persons [IDP] and refugees from DRC and CAR. The languages spoken by the people of West Equatoria are Balanda, Zande, Moru, Baka, and Morukodo. TheZande is the dominant ethnic group. Communication system (road, Accessibility to the region is via North West Uganda although the road infrastructure is worn out. It is also accessible by air from Lokichokio in northern Kenya and from Entebbe. Within the region there are internal flights between the counties. There is also a road network to all counties. These roads are in a poor state, they are relatively good compared to those found in most southern Sudan location and are passable throughout the year mainly because of the free draining laterite soil. There is a road connection to Uganda through Maridi, Yei and Kaya. This road is responsible for the improvement of trading activities in the area. The roads are not tarred seasonal and prone to flooding during the rainy seasonal. A dm inist raliv e st ru cture There are three tiers of administrative levels, the State, the county and the payam. The state forms the first level of administration followed by the counties, payam and Bomas. The project has five counties and about 697 communities. Health systems &health care delivery (provide the number of heakh pots / centers in the project area if the informalion is available). 3 WHO/APOC, 24 November 2004 West Equatoria state has 156 PHCUs, 36 PHCCs and 5 rural hospitals namely Yambio, Lui, Tambura, Nzara and Maridi hospitals. The specialized treatment center for sleeping sickness is situated in Yambio hospital which is supported by Medicine Sans Frontiers (MSF), B0lgium Number of health staff in project area and number of health staff involved in CDTI activities The total number of health facility staff available in the project area has not been determined. However, the available figure of health staff who are involved in CDTI was 60 as indicated in the table below. 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 B1 Number of health staff involved in CDTI Bz Percentage BrBz/ Br *100 Tambura NA 10 NA Ezo NA l0 NA Yambio NA 10 NA Maridi NA 15 NA Mundri NA 15 NA Total NA 60 NA 1.1.2. Partnership Indicate the partners involved in project implementation at all levels IMoH, NGDOs (national/international), communilies, local organizalions, etc.l Describe overall working relationship among partners, clearly indicating speciftc areas of project activities (planning, supervision, advocacy, plnnning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the statelregion/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaUinternational), communities, local organizations, etc.l In West Equatoria CDTI project, the parthers involved 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 four other NGOs supporting the state and these are International Medical Corps (nvIC), Action Afrika Hilfe (AAH), Mundri Rehabilitation Development Association (MRDA) and Samaritans Purse. Describe overall working relntionship among partners, clearly indicating specific areas of project activities (plnnning, supervisi.on, advocacy, mobtlkation, etc) where all partners are involved. 4 WHO/APOC, 24 November 2OO4 The working relationship among partners can be described to be cordial and strong. Prior to training, planning was done together with all partners especially NGDO/SSOTF and the outcomes later were translated to other levels and the communities where mobilization and distribution of mectizan are carried out by communities through their CDDs. The project in conjunction with NGDO/SSOTF carried out advocacy for soliciting of government and community supports. Supervision was not jointly carried out due to difficulty in organizing this activity. Furthermore, the project has maintained a strong partnership with the affected communities. CDTI programs are based on the principle of community participation and encourage community members to take an active involvement in both the planning and distribution of Ivermectin. State plans if any to mobilize the state/regionldistrict/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The plans the project has are to mobilize various decision makers in the state ministry of health and county commissioners as well as various payam administrators and boma councils. Also the international NGDOs and NGOs will further be mobilized for their continued supports to the project. The policy of the Ministry of Health is that all NGOs involved in PHC program are expected to include OV as part of the control of 10 most important public health diseases in the region. 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current yearl the reason(s) for undertaking the advocacy and the outcome, Describe difficulties/constraints being faced and suggestions on how to improve advocacy The project co-coordinating officer paid courtesy visits to two top key policy/ decision makers in the state. These were the acting director general in the state ministry of health and the state Sudan Relief and Rehabilitation Commission (SRRC) administrator. Also 275 community leaders were mobilized by conducting a workshop in their respective counties. The reasons included advocate for support to CDTI activities at the state and county levels as well as general sensitization on CDTI activities. The outcome was smooth implementation of CDTI activities at all levels in the project area. They accepted to support the CDTI activities and also recognized and acknowledged the county supervisors Efforts to support CDDs by some communities proved abortive. The only constraint is lack of enough social mobilization tools to distinguish the work from other programs campaigns. Suggestions on how to improve advocacy L In the next treatment circle, all the necessary materials should be provided for smooth running of CDTI activities. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: The use of media and/or other local systems to disserninate informuion There was no radio - FM station in the project Area. The only means of disseminating information is through the local leaders, and announcements in the churches and public gatherings. Mobilizaion and health education of communities including v,omen and minorities The method to mobilize women and the minorities is through community Health education. As women were given the right of 25Vo in government, most of them are mobilized in offices, trainings and workshops and in different associations and groups. Re s p o ns e of target c ommunitie s /village s Communities understood that Onchocerciasis is a public health and socio-economic problem. They agreed to support and encourage the distributors to show confidence in their work and continue giving them mectizan annually. Accomplishments o Communities are coming by themselves asking for treatment, o Side effects rate is very low and complain are reduced. o Treatment coverage achieved is fair. o Most people with skin problem are relieved. l0 WHO/APOC, 24 Novemb er 2OO4 Suggest ways to improve mobilization and sensitizstion of the target communilies o All stakeholders should carry out their role and responsibilities in CDTI activities. o SSOTF is to provide adequate T-shirts, OV posters, Comic books for improving mobilization and sensitization in the forthcoming mass treatment. o Payam supervisors should be given sufficient work-support items to motivate them to improve their work. o Community members who are participating in CDTI activities should be motivated. o Training for more CDDS, Health workers, Payam and Boma supervisors is very essential o Funds must be provided for mobilization and community awareness. o Public announcement can be done for public awareness. ll WHO/APOC, 24 November 2004 c.) ol Ho -o o o z$cl (J alJr o B N B o o bo ^Vd o an o C) € o(J (! ! O d E (! o da (J L a q) F q)(, 6E c) 6 o €)t)th Ith E a0 q) €)k c! raq) tt)tt, 3 U q) t) E! q) c) I q) t, !rq)E () q) CE e o e 9 !rGla oq) E8 ' )a) a0 -q) E.:E= '6t E EE' [otstrE o0 q) q) =.E 8qp o5 EO -6) aE#Q) ut ghO cs .E .:6 E= xo o--' qrioH thE ,rX6lv o-tr96)E ctYl>bH ltr C)o() o)E GthEiitrEI o.r -_E<F o q) oQ h v1 v1\)(J ? :! p \)4 \) q. F t-.1U 0) o g o t- a o o oU rl orl -ol(!l FI c) q) Q t N Q()5-9 '= c6 EEEsx .e BQE EUloD ;< z ilF raE re o a0 C! q)(.) c)il (a N 9(\t oqco q t-- q t-- \o rr c re E.E * EEfE \o c.l rrN (n (-)ro 0,) €re9E=Ti t/5 qJE tro =9z € le +Fe ila EE c! oF OO oo oo O o\ Oo\ a = la 9oEQ €) r\ aN c.l t'-ol !n roa r la -,0 ..:! Ac!= 2a) @ @00 c.)t-- o\F- (n F- ra o\Q tr, '8E.Fa0xGt: >.o]>oEi cs .E ,a tr61a9 Eq) otr -9 >r -aE 50ze il te=P .'B Fo o0 6t q) I q) \(o(o u? otr) n$(t) q @N g? e) q o,(f) ta EaHr?'i e .i + Er ! E?)37 \n @s t-r\o $ \o (nr-c.l EE q?a)d etE g -=er:,|g Ei 3q)'r E rnt'- rno\ rno\ s o] rro\\o J (J o E -o cgF NEI o c! ! r A t cB otr $o c.l ts(.) -o C) oz t et Q o l- 'JrB ca d5O-C 'E on >-c ;'i bo c.! trcd(d0) ooo 9,= orqt5; o9,q) tio= Eb(!< >(,abo oo.= E90)trU9 !ooc)>11 OE>otrbo .H(! 1,o)=c)Li= = cs !'l .EEElE*o)^0) l>t<(,rr o ,li oLro! E 0) ,; U 0)L z Fi o bo 0. 0 o c) 'F c) F 9 0) t-d+.P 0)v r,L(,6) O-C eL{tiEE9o)EEE .:'6 U 0+ I >90 I6)H ,iE 100) =.=>H tr ooo +.tr1(Jt( Eoxo e-= e EgErPpdEg troQe)Eq)8,6 E.E6 "fr E €{irE !t E: >N oPE -;do ...- =Ea" A I-l 0.) u f-'l { O!= >a .H.= tr iJEE << u 0) E cg 0)H o U)(! E bo E OIQoOvt vx 0) l-{EU .c) QY .9-JO) E-o e9 >-,Y!>E9OQ >.9 a= th t; >E troE=tr,9 2.5. Capacity building Describe the adequacy of available knowledgeable manpower at all levels. There is no adequate knowledgeable manpower at all level. The project is intending to train and include the community base organization than to rely on teachers and health workers. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staffs are frequently transferred during the course of the camp The issue of transfer of staff is not applicable at the moment in the project area. However, where a staff moved out due to better job or going to school, arrangement would be made so that project does not suffer. I4 WHO/APOC, 24 November 2OO3 co 8 c.l H 0) C) z$N opr i! > ln ,/, o an o.(! (! o o c.) U)tro .! E Ero .to Oe €) e, LU) oxa ia();-O cs toe)'=LFc:hi -EBt(, EN tr9 r'5o(nHU)o)o SE(l,)d .= /-\ eAi 0)trA(l)x}U 6U%!q)e q)FCE trY (HE .t) CliCq)- dLJL LOP} e 6-)oo:9 OO Q s o 4 p \) B p U) \) "Y h OO q-\)l. UU v \) p \) $ b \$' n< 1$ e h !q U2p v\) :? S $ ! q)q \) o.. o c! O o a F oU(H o 0 a) o oL .o E 0) 6d 60 (! liF ,rit d)l -ol(dt FI E €) CEL th (J Lq)E z ccll +h +a€!r Eccc-' $ \ \ v n< > $z o\ o\ o\ o6$ €tf, Be o 0) c) q) 9 s (.)LF o\ o\ 6:t o ,rq) .a'q-FF r- Fro: 'ri (,oo ,,(9 Lc! olL z ?rr + €dOF € riCq'' *,=du is *d : @ : oo \ot \ot s O q) q) q) I N()L!o @ oo \ot oL ou* | dGt0)6i9a tle 7EH;L<C,oL>E9?6 = !?Ez'2 GIL SNd' u F() +IQ U GrrE.TE-- \) = \o \o : \o $ cn $N co co co co co co co co N6l o NN Nv € o\ E() q) q) I sQ L I\J (o (o $ c\ cf)co ro !rNr{ !H th th (,J\ "3c9qJ EcE Lq) z c{ ilv E t",3 $\$' : > * N N : \o s\in6 q) q) q) I s QtrF i t- Fl I tr o (! H -o (!F oN rI] o -o (€ 'o dga Lr 2 Fl Er F Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments No 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving l00%o geographical coverage and a minimum of 65Vo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The reasons are: o Insecurity in some parts of the region caused displacement of the population. o With the signing of the CPA the drug distributors refused to work on volunrary basis o Inadequate availability of knowledgeable manpower. Plans to remedy this are: o CDDs have to be properly educated on their roles and what the CDTI stands for. o Communities to be sensitized on their roles and responsibilities especially in area of CDD support o Provision of work support items such as T-shirt Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management { How to conduct Health education { Management of SAEs { CSM SHM Data collection { Data analysis Report writing Others (specify) t6 WHO/APOC, 24 November 2003 x ct C) -o E o z$N O oA o > r- oF C)k o 0) 'a Lra c) B 0(! 0)lr o C)E o IH C)a o(A 0) !o 6)L 6) .o o o o 0)a o lr 0) ,o (! oF (! C)l-r € o C) 'd La 0) : Sz r!d -oE C) oE od o 0) oo o C) YgvtviDOl Ol-lrr 'lOq xl > xF -t '5 .a u8 E z glx p() 5I \J EE a.rl = o -lL+r 016) OO OItr O ri ol .E c)0) OIcd O -O ol 0) LE 31fi ea Hr E tr Hl r tr71 5t E =izl<z x E C)(! otr o obl(! o o oo lt o tr C) -o z (! 6)Ld o 0) 'a t-.a C) B t) C) o o o! 0) I 0)a Et I *l g xl H al col '- :l boUl tr!l:i o)t -oltrbto ol '5ol (! LI;'ol 6.!l o8e.trlE =l oZlt- C) C) o(! tJ s 0) 0) boF^ oFs U oF o dtr C)bodLo oo d -q 9-(! libo oo o dL c) bo(€ Lo oo O, 'i xO C)a cg C) F al c)l boftllLI()l >t ol :ldlol EI oldlkl btr ol ol b4 €l EI ctl crl =lol otftllLI 6)l -cl bd cl 'El ol EI ol :l €l dl =l EI ol tJil il ^!qrE'= H E AE E 5-;9< tr-c< (g E 6 s?* e EEeor 0 oF oo !* o lr 0) -o z ,o €H =v)zz -0E8 z€ b E^H E '!qo=6aF E" L; E' E o o o r,!^ \io ac)6)ho a cd-a8.9 b Ea0)->vFOF(.) o\ c,- 9 o\ t-- cj r-\o ,Q totn rr \o co rC inta F o =E -oxo EbHE Z Q! @!n @\n NN@ oi co in r* \o\o \nq$\n f-\o oo\o raNr- €N € :o)E 6.2 -tr:.1 ==0)tEe \n\n(n( @ rnN co N\o \o\o oo\o" F- ta) C\.l\o o\ \o6 o\ r-N ?a tsi s€e$S uF j ;-da6)o ULA! +\o \o- N@ \o mc\ .+ N o\ o\ @ o\ oo o\ (n \o(n @ €t € \o in 6o o! o C) U o ll * oo '= bo !iha[iYBaauovuo cl cor- e.l cO\o q \ol-- co +\o € @ o\ o\\o ts:E r u E bO!6)=(!!2 J F- cdtr ='l 6) =E;Ezon) \nin rn o\ Nco r-6$ d E0) <FEH-U .79 F F\J r-- INoo F- oo\o ra o\ ra ,,rali:.: o 92 (JI =E',g5s n. E E't.= 9E F-i 8B E ? \nt- \no\ rno\ $ No\ r-o\\o .9<;v (! li ! dF NIJ] o .o E(! .d L(! =a L A Fl 3 F h 4q \J U AJ 4 v p \ !o U2 !q) a.. v(A lr o !)H(! c! oJ () L a € oH U) o do liF r-.t a->l -ol(!ll FI a ll t ts ol Eo -o o o z$N U o0. B 00 E{ a A) a' .Lb3x*Ss =e *+i s$E NSS s*LVl Ss : S,NEEi :l .S s)N ts\\a ri' s'\ p\ \i Bi SEs "E s\$ XbF SSN is\,) ," s: SN s!\SE Tt$$(Jb EB. .S TH{EsP s=Is 3s\ s%A\S ;s r$H S\i N* ba$>,s 'sN':: SSt sIE$S * F*"! 3eE S;\v\!t\ s=s =$s E$3 Sbof f$P PE 2.6.2 What are the causes of absenteeism? No proper report on absenteeism. 2.6.3 What are the reasons for refusals? No information on refusal 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that o occurred during the reporting period and provide (in table 8) the required information when available. No case of SAEs occurred during this reporting period. 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 { 19 WHO/APOC, 24 November 2OO4 $o N Ho -o o o z .+ N tu o I]r B ol \) \\) \ q) L$q h 4q \JU\) .S 4 S \) ! N!B s)4 s) a.. ! c) o0 L oqI o bo t- €oF aoo d U)I! a q O O o0 c) E(! q o lioO o o C)o(d U cbr ol _oldlFI o()tr -.Elpo7 0ll>= <.= b A6 - ooo)9Ptr'9 .;i=d Cg (J i, 6 ==NFHE] U'6 U) o o bo otra (t o E oo o q aO+ex 'li 6 93 <- ;.9 Uo-q tr&9d Eq6o.2 -c 5UHEJ- dEE_8d , .9{ = 4= >rv4Gle6)'= o= O H.EE (! € - E qp.Et = O.! ogEETg 3 H UJ 0i F z 6 o o >' v) i^C) JYL =dC)!#c) !H d h'E S= rg:€ o oqotr N.- -hD ao X C)U) obo )E z U) tO c.t o -o E(.) z tN o0. o B N -t) A o5 I -9 6I q) 60 CELq) seBV\t rl\32 lr-) i S. ctp osxxsv !JSGIa- 9N'=L'SEL\X =$2cJv2L3s€'t\9 AVI5i - ; t1EIY6 -o) .4Hq, .!= G LL+€=Y,9EOE .9. lE 'r O- u) -LEi€ '=Pc) L.r=aE-? c)uxyNtu:p.lE€KIo:$lAU;--tr:l uqJ -=t !iEEI Gt9el Eo flt .3rE3lg :8"9ou-troL9---t,d!r- o I rhL-vajY? -E!EdD -90)v)E .\EEq)ETHE . 6i ()ra_tr5tdFE oi oir 'forl A _tHsFl t- o boO EaF 9B\ -oU N + co \ o\N cl 6!n q TN\o o d o 0r ll -Oo &-[rf - 'st! o o $ooF 6EYd >v o oq oN q (o u? O)o q ro @ lfEti [> rd'rc =Ooboo. ss-9.9 6 \Ro >v -coFo ol$(f) \ o)(\I c.l @ rO n ro rO €riE er+l!rdHbg .= Q.!z \ot rn$ @ o\a\oN co\n F-$N ta)N\ ooN c E o.r cd O.= =EUi strFIJ N$(n rn N N .+ vI l,n c.l co(n @\or-N \o @q t-- cn ca EE€EE*"' \n\\n c.lt (n\ rn oi$ \n\ ra)N$ @$@ \o rn o C) b0 U) 0) oU Itdti'$A o o &ooF 6E\< e- cj cA € c.l @r- c.) o\ ,a; € $c E E,!+BF.5- g rd € cO oo \o$ r- F- o\ oi\o ri b E _t't EtE=Ez E.E r t\n No\ o\N t'-@$ N rd :a)d o.=5tr1r.. < g4'FU \n @ \n$N co ca o\(n >o<- 6).1 d ts 3€ E s +r,: tr x:: r.r-u t-6\!E .:=6)oEo tr 600 6)ti tr d 92E -H-p- o- H:i $ t $ t-. o\\o & rI] $ N rn N \o c.t r- 8 ol 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriqte answer) MOH N{ WHOE UNICEFf] Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH tr WHOtr{ UNICEFf] NGDO fh/ NGDO E Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities West Equatoria CDTI project orders and collects from the SSOTF office in Rumbek, Lakes state. When the drugs get to the project office in Yambio, they are shared according by county sizes. 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. Alternatively, the county supervisors used his motorbikes to send to health workers/payam supervisors. 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 10: Mectizan@ Inventory (Please add more rows if necessary) How are the remaining ivermectin tablets collected and where are they kept? There were no remainingmectizan tablets in the field. List and briefly describe the activities under ivermectin delivery that are being carried out by heahh care personnel in the project area. Training for CDDs: This is carried out before mectizan distribution for new and old CDDs. The training is done at different convenient venues within the communities. Issuing mectizan drug: They issue CDDs with mectizan tablets and collect from them any remaining tablets at the end of distribution. Health education and community mobilization: Mobilize members of communities and educate them on mectizan and inform them on the availability of drugs, selection or sending their CDDs for collection and training. Management of persons with adverse reactions after taking mectizan: Health care personal carry out further referral or management of SAEs and also treat persons with minor side effects including keeping records of the patients. Data collection: They collect mectizan summaries from CDDs and forward to county supervisors. Remaining 0 0 0 0 0 0 Person treated Lost Wasted Expire dState/District/LGA Number in stock Requested Received Used 251 0 0Tambura 201,@0 201,@0 201,389 58,580 Ezo t10,7'74 tto,774 I 10616 32,822 158 0 0 Yambio 234,586 234,586 234586 66,705 0 0 54,451 0 0Maridi 173,800 173,800 173800 0Mundri 238,000 238,000 237883 68,167 tt7 0 TOTAL 958,800 95E,800 9s8274 280,725 526 0 0 22 WHO/APOC, 24 November 2004 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 If so, When? NA Table l1: 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 carried out self monitorins (CSIO No of Communities that conducted stakeholders meeting (SHM) Tambura Ezo 75 NA NA NA95 NA Yambio 195 NA NA Maridi 140 NA NA Mundri r92 NA NA TOTAL 697 NA NA 23 WHO/APOC, 24 November 2004 2.9. 2.9.1. Supervision Provide a flow chart of supervision hierarchy. Provide aJlow chart of supervtsion hierarchy. SS()'I'F I IQ Slrlltri isiorr )rl I lt!l 2.9.2. What were the main issues identified during supervision? o There was poor motivation of CDDs by community meribe.s. o CDDs have large Geographical area to cover. o Mectizan registers books were not distributed according to the villages targeted. o There was increase of population due to internal displaced persons coming from the north. 2.9.3. Was a supervision checklist used? No. Supervisors have problem in using the checklist. Thby consider it as an extra work. What were the outcomes at each level of CDTI implementation Supervision? CDDS who were supervised were able to come out with proper report on treatment and data collection. Payam supervisorsflrealth workers corrected the mistake and started to distribute the registers based on the target villages. 2.9.4. Was feedback given to the person or groups supervised Yes, the feed back was given. 2.9.6. How was the feedback used to improve the overall performance of the project? 24 WHO/APOC, 24 November 2004 The feedback addresses problems and improves each $oup to make better performance in the specific area discovered. SECTION 3: Support to CDTI 3.1. Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F=Functional, CNFR=currently non-functional but repairable, WO=Written off How does the project intend to maintain and replace existing equipment and other materials? The project expects the government and NGDO to support their replacements. When MOH absorbs the project, funds for the replacement will come from the government counterpart funding to the project. Source Type of equipment APOC MOH DISTRICT/L GA NGDO Others No. Conditi on No. Conditi on No. Conditi on No. Conditi on No. Conditi on 1. Vehicle 0 NA 2. Motor cycle(s) 5 F 3. Computer(s) 1 CNFR 4. Printer(s) I F 5. Photocopier (s) 1 F 6. Fax Machine(s) 0 NA 7. Others a) Safe 1 F b) Bicycles l6 F c)Base Radio 1 Not fixed d) Solar Panels 2 F 25 WHO/APOC, 24 November 2004 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partners for the last three years 3.3. Other forms of community support If there are problems with release of counterpart funds, how were they addressed? Currently, there is no government budget in the MOH and no salaries. Request for provision of counterpart funding to the project will be submitted when the situation normalized in the state. Additional comments No. Describe (indicate forms of in-kind contributions of communities if any) Provide training venue, water, cooking utensils and firewood during training sessions. Some communities provide food items to the CDDS during mass treatment Some communities provide their transport for collecting Mectizan from central points to distribution centers a a a Contributor Year 1 (2005') Year 2 (2006') Year 3 (2007') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (US$) MOH (Central + ProvinciaUState) 0 0 0 0 0 0 MOH (District/LGA) 0 0 0 0 0 0 Local NGDO(s) ( if any) 0 0 0 0 0 0 NGDO partner(s) 0 0 12,100 12,100 13,368 t3,368 Others 0 0 0 0 0 0 a) 0 0 0 0 0 0 b) 0 0 0 0 0 0 Communities 0 0 0 0 0 0 APOC Trust Fund 96765 96765 65869 25204 45875 36102 TOTAL 96765 96765 77969 37304 59243 49470 26 WHO/APOC, 24 November 2004 3.4. Expenditure per activity Indicate in tabte 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to localcurrency.Indicateexchangerateusedhere- Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? No. SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) 4.1.1 -N Year I Participatory Independent monitoring _ o- Mid Term Sustainability Evaluation _No _No _No 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of go_!ry!u!-i!L - Mobilization and health education of communities -Irqlilg of CDDs Training of health staff at all levels 3159.00 4640.00 APOC APOC Supervising CDDs and distribution lnternal activities Advocacy visits to health and political authorities IEC materials S forms for treatment Vehicles/ Motorcycles/ bicycles maintenance APOC 512.40 APOC _9_f[ge EqUip_t"gt ! (e:g c9r_np9t9rs1p,ri!!e-I9.9!9) __ __ , __ Others 27,791.N APOC APOC TOTAL 36,102.00 Total number of persons treated 280,725 27 WHO/APOC, 24 Novemb er 2OO4 4,1.2, What were the recommendations? NA 4.1.3. How have they been implemented? NA 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?-N Was a sustainability plan written?_N When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. 4.2.2. 4.2.3 4.2.4. Planning at all relevant levels: NA Funds: NA Transport (replacement and maintenance): NA Other resources: NA Ivermectin delivery mechanisms The Ivermectin delivery mechanism is not integrated into the primary Health Care structure. Currently, Mectizan@ is delivered by CBM/WHO from Nairobi to the SSOTF head quarters in Rumbek. However the Government of South Sudan is working on the central procurement and supply unit through which all drugs will be supplied to all states. This system will be used to deliver drugs to the project area once they reach the country. 4.3.2. Training The CDTI training has been integrated into the CHW training and refresher courses curriculum of the PHC. In the project implementation, health workers at different categories were trained on CDTI concepts. 4.3.3. Joint supervision and monitoring with other program Not applicable for now Release of Funds for project activities No budget and no release for the period to the project in any rnanner by MOH 4.2.5. To what extent has the plan been implemented: NA 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. a 4.3.4. 28 WHO/APOC, 24 November 2004 4.3.5. 4.3.6. Is CDTI included in the PHC budget? CDTI has not been integrated into the PHC budget but it is in the policy. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? No programme in the ministry of health is using CDTI structures for now. 4,3.7. Describe others issues considered in the integration of CDTI. Nil 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period There is no operational research under taken in the Project within the reporting period. 4.4.2. How were the results applied in the project? Not applicable. SECTION 5: Strengths, weaknesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. Streneths o MOH's willingness and expression of intention to absorb CDTI staff in the very near future. . Strong commitment of Staff at state and county levels. Weakness o CDTI is not fully integrated. o Transport to supervisors is inadequate o The project has no vehicle to facilitate implementation oT CDTI activities. o No census update in the project area. o lnadequate number of CDDs. o Record keeping still is not well done in most of the project areas. List the challenses and indicate how thev were addressed. Inclusion of CDTI staff in the nominal role of the MOH: The project coordinating officer met with authorities of the ministry on this matter and there was assurance that they would be included in staff nominal role in no distance future. Attrition of trained staff in the project: This is a problem in the project but the project made every effort to encourage some to remain with hope that one day they would become part of ministry of health staff and they agreed and remained in the project. Inadequate number of CDDs: This was addressed through training more CDDs but still the figure is still low given the population each CDD has to cover. Lack of proper household census registration: The project has not been grappling with this given the situation in the project area. Lack of the project vehicle: This was included in 2008 work plan sent to APOC and it is hoped this would be approved. a a O a a 29 WHO/APOC, 24 November 2004 Maintaining a good record of CDTI activities is a problem. All county and payam supervisors/health were reminded of the importance of this and the project anticipate improvement in the future as they have noted their mistakes and need to keep good records. Community self monitoring is yet to be implemented in communities: The project identified this as a problem in all communities. Efforts would be made to address this in 2008. Lack of data on the number of available of health workers in various health centers/post in the project area: The project has already taken note ofthis and has mandated all health staffto provide this in 2008. More improvement in Health education and community participation especially women: The project experienced low women participation and efforts would be made to address this more in 2008. SECTION 6: Unique features of the projecUother matters The project covers only one state and it is one of the oldest CDTI projects in Southern Sudan It is one of the two states co-endemic of onchocerciasis and loaiasis. Other tropical diseases thrive in the state such as lymphatic filariasis, malaria and human African trypanosomiasis. There are high cases of HIV/AIDS in the state. a a a a 30 WHO/APOC, 24 November 2OO4