Southern Sector Onchocerciasis Task Force (SSOTF) secretariat project proposal for Community Directed Treatment with Ivermectin, East Equatoria

t 1.. { .t!{ I SOUTH ERN SECTOR ONCHOCERCIASIS TASK FORCE (SSOTF) SECRETARIAT PROJECT PROPOSAL FOR COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN EAST EQUATORIA SUBMITTED TO AFRICAN PROGRAM FOR oNcHocERCrASrS CONTROL (APOC) E I q t tu08/03 (-/ )..r)RE IAP Ti CTOR ONCHOCERCIASIS TASK FORCE(SSOTF) SECRETARIAT Date: o3ft:g( Z-.o3 Signature, place and date NOTF Rep, of NGDOs PO. Box 10114 - 00100 G.p.O Nairobi' Kenya' Tel: 254-020'562840,562256,Mobi|e: 07223649g2, Email: samson_baba@yahoo.co.uk SOUTHERN SE Signature, place and date NOTF Rep. of Gov. Dr. Bellario Ahoy Ngong Chief Health Officer SpLM 0ur Ref: Your Ref: National Onchocerciasis Task Force (NOTF) of SpLM Th e Arri c a n r,. n f;,,11'j;:'..Ufl ;Ji#:: :i. c o n tro r (Ap oc ) ln accordance with the memorandum of agreement for the African programme for onchocerciasis conkol:1' The NoTF on behalf of the Government of lPlm (3 partnership of government, the NGDos and otherpartners) hereby expresses its wish to enter into collaboritrn *:tn tn. Apoc and the MEC with a viewto conducting an onchocerciasis contror project in rnsf eoUni6nn neotolt. 2' onchocerciasis in EAST EQUAToRIA Tlclol'l.is considered by the heatth authorities as a probtem ofsufficient importance to warrant the impJementation or a-coniroiproject in the endemic areas with theaim of eliminating the disease as a pubtic health and so.ioe.onorric problem throughout the country.3 lt is estimated that out of.a total population of 442,261in EAST EQUATORIA REGION, there are(number of infected people) people'iniected with the prrrrit. 6r-.n ocerca vorvurus, causing brindness,serious visual impairment and debilitating skin disease. 4 nt-:;i::i:it.control project will relv on community-directed ivermecrin treatment as its main 5 The NoTF has scrutinized the criteria and condrtions for application to the Apoc and is satisfied thatthe proposed project(s) meets all the criteria and futfits tn. .;lliturc estabtished by the Apoc. 6' Details of the project proposal for control of onchocerciasis in EAST.EeuAToRIA REGIoN including l?:rtX'#'requested from APOC to successfullv impremeniinl pro;ect ,r. p*io.o ii'r-ne encroseo 7 ' il:J?JffjjPLM pledses its full collaboration with APOC in rhe expectarion of acceptance of rhe t t,, ).1 l:t r t- ,,1 r- l.t. .j .i :t Name and title of signatory FNEW SUDAN a SUDAN PEOPLE'S LIBERATION MOVEMENT SOCIAL SERVICES COMMISSION SECRETARIAT OF HEALTH OFFICE OF THE CHIEF'HEALTH OFFICER Offlce: 254-2-562840 lfome. 254-2-604804 Mobile: 0733-734590 Our Ref: Your Ref: . .. PO. Box 73699 Nairobi. Ken1,a , s lrg/.7 [ff:i"t'* with the memorandum of agreement for the African programme for onchocerciasis Letter of endorsement from the Government ol S1LM Dot",To the African programme for Onchocerciasis Lontrof npOCiio,Support of the proposed onchocerciasis contioipiol'eci' The Health Secretariat on behalf of the sPLM hereby endorses the attached project proposalto be submitted to ApOC for financial support. This proposal reflects the collaboration between the members of the National onchocerciasisTask Force and APOC with a view to conouctini an onchocerciasis control pCIect in EASTEQUATORIA REGION The ssoTF Onchocerciasis Task Force is a partnership of the Government, Non_Governmental Deveropment organisations and other participrting"prftLr, which wiil beresponsible for the implementation of this project. The SPLM shall assure free entry of ivermectin into the country for delivery to the applicantwithout imposing duty, tax, or othei costs. 2 3 4. E The SPLM of pledges the present proposal. its full collaboration with the Apoc in the expectation of acceptance of $t EVr/ S lt '-.. gignature, ptace. and dad: ' '-. j -'.' Dr.,BqltariqAhgy Ngonil Chief Heatth Officer SPLM Name and title of signatory \o l LIB itr t'.,J ut.0nAI_ 20fit ,tr .1u11,23. 2003 Dr. S. P. Baba SSOTF Coordinator SPLM Health Secretariat P.O. Box 10t l4 - 00100 Nairobi, Kenya Dr. Baba: GIobal 2000 of The carter Center is pleasecl to support of the onchocerciasis co,trol(Ri'er Bli,d,ess) progmm (ov) in ar-eas of southeur Suda,. fhe onchocerciasis control Program began in 1995 when president carter brokered acease-fire in sudan to allow for hunanitirian interventions such as Guinea worm filtercloth distribution and health education. mass distribution of Me ctizanrM,and also thedistribution of vitamin A tablets. Since then. The carter center has provided somesupport to the Cou-nty lgaltli Departments of Mundri and Maridi as well as to severalNGos (AAH, IMC, MRD A, anizoARefugee care) including tech,i.ur .uppo.t ro theov Program in various ways, particularly seconding con*ttrri, u, n""".*,jio ueatthNet International and more reclntly the SSOTF. The carter Center is committed to continuing our support for onchocerciasis efforts i,Sudati Fiscal Year 2004 (September 2003 to-Auglrst 2b0r;. n e carter ceuter anticipatesconti,uing to fund rhe NGos and flre clDf supforted this past year (2003). Theorganizations to receive assistance this Fy incluies: AAH - Maridi cHD; AAH _ yeiCHD; AAH - CHD Mu,dri; IMC::MRDA: and ZOA Retugee Care. IIt this Irext Fiscal Year (FY04) we can also off-er sonre techrical assistance to the oVControl Program in whatever frrms appear necessary. The amount of the assista,ce willrrot be known urtil the proposals are subrnitted in micl-August and discussion takenanron-est the partners (The carter center, HNI, and ttre ss6tF) pertaining ro oiir",sotlrces of funding available to support such assistarce. The carter Center,camot HII C/\Rl'DR CUN'H..R C/(, l.ON(;()N0.t.pLACri . .{t}lRl.]\IEN.r.NO. I .(). Ii()\ Slett N.\tRolil, KtaNlA. L LI: I'l I ( )Nf . : l{-c69(}/l-i0(}-s-< . !-.{ X: 2JS6lt7 1'lIE CAR'|'HR Ct.tN,t'!;R. rNC. . ONl.. (.()pliNIIIt,r. A'l'l.AN lh. (;li()t((;tA _'l(,t07 . .t.trt,U[,tl()Nt1 (J0.1) ,{]0 .-r8.r0 'l'lrl F\ J96lt()71 .Ir1\ /_l0Jr 87-1 . i<t< a a fl af ct)l]lll]it to a sreatel'role at this tinre other than continuing the support alread' establishecli, wester, Eq,atoria and offeri,g tecrurical assista,ce ,u.Ir., n""ir;;--- .-.-' - Tliank 1'ou attcl ztll ol1'ottr staff for their declication anci conrmitnrent to the light againstOnchocerciasis. Peace Kelly T Advisor The Carter Center - Atlanta, Georgia I lealth Net Intemational - Nairobi, Kenya 'fhe Carter Center - Khartoum. Sudan Prof'essor Homeida - Khartoum. Sudan "l Cc :sil s[I[#ffi 5q Dpi N m i-H [t"rr'[fr] ffi 550q1ffi ]r[o N Our Ref: Drte Your Ref:........... 2l't July 2OO3 Dr. Samson P. Baba Coordinator SSOTF SPLM Health Secretariat Nairobi REF: glJIfAiq.I.ryTEREsT TO CONT rEs rN KAJoKEfi ANDJUBA COUNTIES _ Dear Sir, StItIA has been for the Iast 3 years carrying out mectizan distribution in 3 Payams of Kajokeji Counry and2 Payams of Juba County. tn these 3 years SUHA had confibuted to the progru.*" in the following ways:- l. Used its only vehicle to support ttre program in transport of materials and referrals if any. 2. Used its motor cycles (3) in support of the program - supervision 3. The PHC supervisor was assigned to allocate part of his time to overseeing O.V. activities and 4. The supervisor was also involved in CDDs, communities and senior administrators haining / workshops. In this regard, SIJHA is here expressing its interest in continuing with the O.V. activities in the stated areas and a new one Korok Payam ofJuba County. Above is for your attention and possible action. Thank you, Sincerely |--Dr. Pius Su (lo PO- Box 727tt. Tcl: 251-2-728560. Fex: 2jt-l-72r562. Naitohi - Kcsva 1SECTION 1: COUNTRY PROF|LE 1. INFORMATION ON THE PROJECT AREA 'O* ".'.'.,.* 1.1 Gagraphical and administrative area(s) P/ease describe th.e grea(s) of the country in which the proposed cDTt witt be carriedout. (List the administrative units or parts therqf e.g.,'Locat Government Areas,Districts, Arrondi*sements, Health areas etc. that witt be covered and provide a mapshowing their lay-out) For -\ctr-,, To: East Equatoria region is the south-eastern region of the southem sector of Sudan. lthas boundaries to the south with Democratic Republic of congo (DRc), uganoi anoKenya; to the south east with Ethiopia; to the north with Uppei ruiie ano eist eanr etGhazal, and to the west.with West Equatoria. East Equaioria is comprised of eignt counties Juba, Tere[e[a, ye!, KajoKeji, Magwi, Torit, Budi ano kaloet . rn. counties are sub divided. intg_39 payams. Five (5) counties yei, Kajo(eji, Magwi,Budi and Kapoeta are in the SPI-A controlled areas along with parts of juba and T-orit counties. ln these five counties there are 33 eayams. A payam is similar inpopulation to a district. Prolonged civil war compounded by chronic insecurity in neighbouring countries especially the Lord's Resistant Army Rebel Group of Uglnda ano the acCompa4ying cross-border traffic of refugees, has destabilised the region and destroi"J'iirEinfrastructure. ln 1995, the Government of_sudan (Gos) ani tne sudanese euppi",Liberation Army (SPLA) declared a ceasefire in orderto allow humanitarian aid'into the country. Most of the East Equatoria CDTI endemic areas currenfly falls under thejurisdiction of the SPLM/A and by eXension its humanitarian wing of tne SpLM/A, theSudan Relief and Rehabilitation Commission (SRRC). The administrative levels are standard in the SPLM/A areas. The regions form the first level of administration followed by the counties, payams and Bomas. Regions are administered bygovernors, counties-by commissioners (spLM secretaries) and payams by payam administrators, and Bomas by Boma liberation councils. pl6ase see-appenitix 4 fn East Equatoria, sudan Heatth Association (suHA), Action Africa Hilfe (AAH) ,zoARefugee care (ZoA), American Refugee committee (ARc) and Many nanos orYour Heart (MHOYH) are NGos already invotvect in bori programs in the fiveCounties of Juba, KajoKeji, Yei, Magwi and Terekeka. CDTI aciivities have not been initiated in the two Counties of Torit and Budi. tc{_l+ / ('o:'eu' cLv c3A COP -Brrr5-it For lnforrnotlon To'5t& AO 1.2 1.2.1 Please see appendix 4 To pog raphy, cl i m ate, access please describe the type of country or bio-climatic zones that wilt be avered by the CDT.(e.9., rain-foresf, foresf-savannah mosaic, Guinea savannah, Sudan savannah, mountainous 'fi ',.=: C # I i AoiiT ?fi*j APCC/DIR * Additional sheets may be used to provide information in this form where necessary 2or flat), providtng maps, if appropnate This area is composed of three ecological zones, Guinea savannah, Sudansavannah on clay and sand, and woodland recenfly olriveo from rainforest. Thereare also mountains in^thg Eq.uatoria region. The land form is iron stone plateau withcomplex basement. Rainfail varies rrom ooo -2000;; p"i-v"r. This project area covers. 26-34 degrees.east rongitude and 4-6 degrees northlatitude. rt transects_ two. hydro-topolraphicar. zonei ueing "rong the Nire_congowatershed and characterized by fdst-irowil,g ly;r; ;.'g. i;i: yate, Bahr-Naam, Era,Maridi, Lesi, Sue, yubu, Lingaii, lbba, Biki Mbungu"anJ'brrr. All rivers drainnortheast to the Jur and east to BahrelJebel, wnicnionnr"*" to become the WhiteNile' lt is precisely because of the climatic ano tlpograpnic conoitions that thedisease prevalence rates are very high, as the oracr tiv t"nriJes in such environment. Please see appendix 5 give the approximate times of the rainy and dry seasons and the months coverd bythe farming s@son. The East Equatoria wet season begins in April with light rains and continues untiloctober. The area has an annual rainfall or doo -2ooo n,iirir"tr"., which makes thesoil.extremely fertile. The commencement or rarminj;;i;idr corresponds with thebeginning of the light rains...T.h." ow season covers November to March. During thedry season, subsistence activities ituster around hunting ancl fishing in the centralpart. Provide information on the state of the roads and the effect of this on the movementsof cDTt personner rn the area at different times of tie-viii.-ii^rp may be usefur) Accessibility to the region.is through the North westem part of Uganda via Arua, as'the road infrastructure still exists inougn worn out. lt's also accessible by air fromLokichokio in northem Kenya and frorir Entebbe in uganoa Accessibility by roadfrom Lokichokio is via Narus, road to Torit, Budi ,no'xapreta counties. lt,s alsoaccessible by road through the Northem part of Uganda via ruimure afthough-re|elactivity in Uganda affeds the region. Withinlhe region there are intemalflights between the counties. There is also a roadnetwork to all counties covering liuo of the counties. naoit or the roads in thecounties have land mines. Some of the bridges are broken, hence somecommunities in the counties are inaccessible. Most roads are passable all year round with the exception of some feeder roads.Ground transportation is.also. ielatively insecure and river crossings remain unsafe atthe moment. The security situation remains pr".rrtori anJ potentialty affects themobility of personnel. 1.2.2 ' 7.2,3, IWFP and other private companies provide flights to this project area. Flight regutarityis dependent on the security situation. FurthJrmore, the government of Sudan (Gos)retains the right to ban flights and this can also hinder air access into the region. 1.3 Onchocerciasisendqnicitytevels The levels of onchocerciasis endemtcity tn communities in the CDTt area must be assessed by simple methods before treatment starts. For the purposes of this proposat, the level of endemicity in a community or a group of simitarcpmmunities is defined on the basis of the prevalence if nodule carriers. (See tabte 1) TABLE 1. classification criteria for endemicity levets in rural communities ENDEMICITY LEVEL and recommended Upe of treatment Percent of nodule carriers in REA sample (Minimum sample S0 adult Esti mated prevalence of O. volvulus in the Whole community H YP E R-EN D E M tC Comm u n ity Treatment (URGENT) Greater than 3g% Greater than 5g%o M ES O-EN D EM|C Co mm u nity Treatment 20 - 39% 40 - 59% HYPO-ENDEMIC (NON-URcENT) Less than 20% L*s than 40?G 1.3.1 1.3.2 1.3.3 1.3.4 D.lrected on the system in Table I and using the format in Appendix 1, please indicatethe estimatd numbers of communities at each endemic ievet and the numbers ofpersons in them. complete Appendix 1 for each area covering the nut s years of the projxt. lf methods of assessing endemicity thresholds other than nodule prevalence wereused when your endemicity data were cotlected, please indicate the method used. for areas still to be covered, where endemicity levels are not yet known, p/easedescibe the method you wiltuse fo collect the netessa ry "ia*riaty data. Rapid-Epidemiological Mapping of onchocerciasis (REMo) was recenly canied out(fro.m M1ryh to July 2003) to asiess the levels of endemicity of onchocerciasis in the region. of the 76 communities selected for assessment onty 54 could be reached. 19communities weFe insecure, 2 were inaccessible and one is yet to be accessed. ofthe.54 villages accessed,.g were hyperendemic, 19 were mJso and 2l were hypo_endemic' lt is estimated that over 5years, the number or communities to be treatect will increasefrom 300to..439.(i.e.300 in year 1;330 in year z:;szoin year3,400 inyear 4 and 438 communities in year 5. 4s/No Name county of Total no. of communities No of Communities to be treated Total Population of treatment area UTG 1 Yei N/A 227 312,341 209,893 2 Magwi N/A 36 300,738 101 ,048 3 KajoKeji N/A 112 Parts of Magwi 4 Juba N/A 19 157,737 74,199 6 Terekeka 240 44 170,000 57J20 TOTAL 5 240 438 94,0916 442,260 1.4 CommunityStructure Provide background information on the social organizations of communities in the C.B.I.T. areas. This may include information on: I Settlement pattern of the community (e.9. hamlets, seasonal farmsteads, dispersed populations, etc.) Prior to conflict, the majority of the East Equatoria inhabitants were setiled agricultural communities, practicing subsistence farming and cattle rearing. Current settlement patterns have been impacted by prolonged conflict; however, less people have been able to carry out their previous trade. Due to both intemal and external conflicts, East Equatoria also accommodates intemally displaced people (lDPs) and refugees from Upper Nile, Juba and East Bahr el Ghazal regions. I the ethnic group(s) in the community East Equatoria is home to the Bari speaking groups e.g. Kakwa, Kuku, Mudari, Nyaangwara, Pojulu, Acholi, Mardi, Lotuho, Didinyga Boya Toposa, Lungwaro, Lulubo and Lukoye. The Bari and Toposa are the dominant ethnic groups. I Please provide information about the area covered by CDTI indicating whether they are migrants, nomads, refugees or internally displaced populations. The indigenous groups are the main agricultural communities. There are internally,lisplaced people (lDPs) from Juba, Upper Nile and Eastem Bahr el Ghazal settled in KajoKeji, Magwi, Kapoeta, and Torit Counties. These lDPs had OV treatment in SPLM/A areas through SUHA, ZOA, ARC AAH, MOUH, MSF Swiss for the last five years. The Diocese of Rejaf and NPA undertake clinic based treatment in Juba. 5I Community leadership structure Traditionally, a headman whose area is defined geographically heads a group of families. The village headsmen represent the families to the sub-chiefs. The sub-chiefs report to the chief of the village and the chief reports to the Paramount chief in-charge of several villages. ln the SPLM system, a group of communities make up a Boma headed by a Boma councillor. The Boma councillors are answerable to the payim administrator. The payam administrators report to the county secretary who are heads of the county civil administrative structure. a Main occupation of ammunity and periods of major communal activities The main occupation of the majority of the population is farming, sunday church seryices, hunting and/or fishing. lndividuals convene in th; marketplace to exchange information, on either a daily or weekly basis, depending on urgency. This informal forum for information exchange is positive in itself. Hunting is practiced in the dry season as well as dancing after harvest. a Preferred channels of communication in the community lmportant messages are channelled through the paramount chiefs to chiefs. From the chiefs messages are passed on to sub-chiefs and to the headsmen. From the headmen information is passed to the elders and their farnilies. Schools and churches are also effective information channels. ln addition, some villages still use the drum to disseminate messages which is quite fast and effective. t Existing active community associations/groups in the area (e.g. social, religious, etc.) . village health committees and farmer's/women's groups are often the most functional groups in East Equatoria. lndigenous community-based organizations also exist e.g. enterprise mill markets services. The lmplementing agencies in the project area shall build partnership with them as a means of building local capacity. Establishd distribution sysfems in the community The sudanese Relief and Rehabilitation commission is the humanitarian wing of the sPLM. As such, it is primarily responsible for coordinating relief supply delivery with intemational NGOs and overseeing community- level distribution. community structures are used to dislribute relief materials. ltems to be distributed are passed to the paramount chief of the village. within the village the sub-chief, village headsman and households heads work out the distribution according to the families. I a o'l a I social communar activities and months during which the activities take ptace As stated above, impromptu meetings at viilage and town markets represent the major communal activity. Many Ealtem Equatorian, ,rualso observant christians and splnd every sunoay in church.lnterestingly, funerals are also mal6r social adtiriti"r in which entire villages wiil participate. and herp to dig the grrr", and express condolences to the family. Any previous expel,,iutce of the community with devetopmentlheatth projxts communities in the region have had severar experiences withdevetopmenuheatth.oro]9cts. The region h_as been entiiely ieriant on tre infuiof intemationar NGos. The approaches of the various ttoos vary from croseinteraction with the community to a comprete rack or input trom the side of thecommunity. community-based health care projects a're oeing supported bythe NGos. The socio-economic circumstance is a ,"loi.onrtraint as thecommunities do not often have the "free time" to ptan rortheir own future, asfood security is so unstable. lnternational NGos stay for unpredictable periods operating with emergencyfunds. This high turn over does not aflow rohg term oevJopi.,"nt funding andhence .lhere are gaps. in the deveropment agenda. The importrnj" oipreventive health care in generar is widely unaplreciated. communities arestill overwhelmed tryrng to meet daily subiistenii requirem"nts, which makethe proper prioritization of preventive hearth care ,ery diffidrt. This probrem iscompounded by the profound lack of infrastructure ihat hampers community availability and access to these services. De-scription of other anthropological characteristics of the communities. Th.e peop-le are predominantly Christians with smatt minority traditionalbelievers from the sudanic Bantu and Nilohamites groups. in"v normally livein clusters. 2.1 2. PASTAND CURRENTSTATUS OF CDTI IN PROJECTAREA 2.2 P/ease indicate if the CDTI is an expansion of an existing CDT\. The proposal is an expansion of an existing CDTI program. lmplementing partners of the East Equatoria Onchocerciasis Control Program have been conducting OV control activities for the last five years in the East region except Torit County. HealthNet lnternational co-ordinates the disbursement of APOC Trust Funds to NGOs- SUHA ARC, AAH, ZOA, MHOYH, MSF Swiss, NPA and Diocese of Rejaf for OV implementation. Program activities to date have included mass treatment with Mectizan to villages, implemented by cDTl approach. MSF swiss have also helped strengthen the refenal system for patients suffering from (sAEs)/ MEc/Tcc guidelines for treatment in Loaloa endemic areas, (training and management skills upgrading) for KajoKeji MSF hospital staff. Other countiegrefenals centres woutd need training in the management of SAEs. Sfafe fhe number of years the programme has b*n operating, and if possible enclose previous statistical, financial and annual reports. As stated above, NGo implementing partners have been operating in Eastern Equatoria for periods varying for 5 - 7 years. The proposed program is an expansion of the current OV efforts. Year County No of Communities TotalPopulation Pop. Treated Coverage !998 KajoKeji/ Magwi N/A N/A 1,712 Yei 10 8,000 1,443 18.OYo Juba N/A N/A 0 Terekeka N/A N/A 0 Total 3 1 55 The data is missing in these tables because before 1998 there were no treatment in these Areas as the areas were active frontlines. Towards the end of 1997, the SPLA took over the region and gradually the populations returned from internal and External displacements to reconstruct their lives within the region. This encouraged The NGOs to begln the provlsion of health services. Year County No of Communities TotalPopulation Pop. Treated Coverage !999 KajoKeji/ Magwi 69 80,000 8,884 11.Oo/o Yei 10 8,000 4,131 51 .60/o Juba 2 50,000 2,O20 4.Oo/" Terekeka N/A N/A 0 oYear County No of Communities TotalPopulation Pop. Treated Coverage 2000 I Magwi 69 80,000 12,197 15.7/o Yei 10 8,000 5,121 64% Juba 2 50,000 2,382 4.7% Terekeka N/A N/A 2,906 Total 22,606 Year County No of communities TotalPopulation Pop. Treated Coveraqe 2001 KajoKeji / Magwi 69 80,000 15,126 18.9o/o Yei 10 78,000 46,415 69.7% Juba 2 50,000 21,630 13.8% Terekeka NiA 80,000 6,939 18.1% Total 83,171 Year County No of communities TotalPopulation Pop. Treated Coverage 2002 KajoKeji/ Magwi 69 80,000 40,741 50.9% Yei 10 88,476 78,000 Juba 2 50,000 21,052 20.3o/o Terekeka N/A 80,000 10,177 13.5% Total 150,269 a2.3 State the number of persons treated each year for the rast 5 years COUNTY I 998 1 999 2000 2001 2002 KajoKeji/ Magwi 13,073 22,274 27,966 15,126 40,741 Yei 1,443 0 0 46,415 88,476 Juba 0 2,020 5,288 21,630 21,052 Terekeka 0 0 2,392 6,939 10,177 Total 14,516 24,294 35,636 90,110 1607UG "Terekeka was caryed out of Juba in 2001 * Magwi was caryed out of Torit in 2002. 2.4 NB- NGo's invotved in oV treatment are ARC, AAH, zoA, suHA, MHoyH and MSF_GHNPA and Diocese of Rejaf treats in OV clinic. List the o.rganization(s)_ invotved in the programme, the sources and amount of fundsused each year for the last S years. Year / Amount in US Doilars (g) NGDO* 1 998 1 999 2000 2001 2002 ARC zoA HNI 27,651.70 27 ,651.70 16,376.5 16,376.5 17,016.7 AAH SUHA 3,500 4,000 7,250 11,700 15,600 MHOYH MSF NPA * contributions of other NGos will be communicated to Apoc later SECTION 2: PROJECT EXECUTTON OUTLTNE 3. DESCRIPTION OF PROPOSED COMMUNITY.DIRECTED IVERMECTIN TREATMENT(cDT\ 10 The main strategy of the proixt witt be to develop and establish community-directdivermectin treatment sysiems, which can be susiainei ii th. endemic communitiesthemselves without exGrnar support afte the s-year ir"j.; period. rhis sec(jonshould describe how the NorF-ptans to dgvetoy iri iiii;iirt cDTt in att high-riskcommunities in the qror^e:!.are?: The ptan s'hourd trii iii" account the n*,d todevelop approaches to cDTt, which are appropriate for the iiterent local situations,and the ned to carefully e.valuatethe imp-timentation of trre selecrea approaches andadjust them when rquired. 3.1 Outllne plan and Ttmlng PLA}IIIII{G / REVIEW MEETINGS SSOTF - 2 Days Regional - 2 Days Courty - I Day Stakeholders meetings - Z days PROCUREMENT OF IUATERIALS OVsupplies-2-3months ADVOCACY Regional - 3 months County - 3 months Payams - 3 months TRAITIING :1S9TF / Counry supervisor,s management and other traimngs _ I month* Training of CDDs - 2 months * Training ofPayam supervisors - I month + Training of community leaders - I - 2 months * Trainirry of TOT - 3 days ' * Training of health staffon SAEs - I month ASSESSMENTS * KAP sh.rdies in new areas - I month *Review ofIEC materials - I - 2 months IIEALTH EDUCATION SESSIONS * Community awareness/targets - l-2 months + School health educatior/targets - l-2 months * Churches - l-2 months CENSUS UPDATE * Census / update - l-2 months DRUG DELryERY + Mectizan requests -l- 3 months * Drugs for management of SAEs - l-3 months SETTING UP OF REFERRAL SYSTEMS *Strengthen referral system between communities PHCUs, PHCCs and hospital for patients with SAEs _ Imonth IYERMECTIN D ISTRIBI'TION *Irrcrmectin Distribution- l -2 months + Ivlanagement of SAEs - l-2 months I 11 INTRODUCTION OF COMM-SELF MONITORING / SHMs *SSOTF partners - I month +County Health Departments / Payams - I month r N(iO partners - l-2 month's * Training of Communitres - l -3 months * CSM / SHM in commurities - I -3 months MOP UP TREATMENT * Mop treatment - I month * Management of SAEs - I month SIIPERVISION OX'CDDs, P. St PERVISORS AIID COUNTY SUPERVISORS *SSOTF- 1- 2 mqrths *PCOs - l-2 months + Payam supervisors - l-2 months DATA COLLECTION + SSOTF l- 12 months *PCOs-1-l2months * Payam supervisors - l- 12 months *CDDs-lmonth REPORTING/ DRUG MANAGE ME NT * SSOTF l- 12 months *PCOs-1-l2months * Payam supervisors - l- 12 months *CDDs-lmonth MONTMY FINANCIAL REPORTS *SSOTF - 1-12 months * PCOs / RTF - l-12 months MID TERM/ANNUAL TECHMCAL REPORTS * SSOTF - l-2 months * PCOs / RTF - 1-2 months APPLICATION FOR MECTIZAN@ *SSOTF/PCOs- I month IIIDEPENDENT MONITORING *SSOTF/PCOs/RTF - I month MID TERMREVIEW *SSOTF/RTF-3weeks EVALUATION + SSOTF/RTF- I month 3.2 Health Education and Community lnteraction and Pafticipation 3.2.1 How will you approach and interact with the community 12 The approach and interaction with the communities in the cDTl project area will bethrough the traditional community structure and the spLM/A administrative structuresfrom county, payams and Bomas. rndividuars oetong to L .rrn and a famiry. Ameeting will be held^with the paramount chiefs, vitlag-e -cniers and sub -chiefs tosensitize them on cDTl. following this, anoth"r ,6"tin! wi1 be hetd with theheadsmen of the payams. For each iommunity, informationLitt o" prrieJ on'iv tneheadsmen to the elders and householcls. They witt oecide on a dite tor a me6tingbetween the health staff/NGos and the entire community. During the meetingRo1t9p' pamphlets, brochures and flipcharts wilt oe uieo ior health education andmobilization of the people. The olher important means of interaction is through the churches, which are wellorganised in East Equatoria. community-directed distributors (cDDs) will also be trained in communitymobilization and act as a direct link between NGos and the communities. They willbe responsible for community sensitization and enco*rgi.t community members toseek treatment. Community shall be used for disseiririation of irirJrmation tomembers. Health staff wiil atso. work through viilage hearth committees, headsmen andcommunity hearth workers as a means o1 targeting the community in the mostculturally accessible and amenable way. 3.2.2 Health education Health education and community mobitization witt be an integral part of all approaches tocDTl' Health education activities shoutd ensure a two-wZy fLeoback with regards toknowledge, awareness, perception and obseruabte attitudinat "hrng"" about onchocercrasisand.its treatment. Appropriate heatth education messages in thefirm ofposferg paip16ts and verbal presentations will need to be devetopea alna fested. Healt'h educaiion ihouruaddress the following lssues (Tabte 2): J 1? \ Table 2: critical issues in the development of Health Education for cDTl a) Have any KAP surveys been done in the project area and if so, what were the results?Yes Ll9 .ov- KAP surveys were conducted in Tali Payam of Terekeka and Juba counties byHNI in 2002 and 2003 respectively. A questionnaire of twenty questions was used. The findings in the two counties are asfollows: Objectives: 1 To know the progress of the programme activities carried out in the past.2. Access awareness, health education and Mectizan distribution in tne community and3. Know the overall perception of the community on the programme andhow it benefited them ever since inception. METHODOLOGY A questionnaire of 20 questions was used in eight villages selected randomly.Fifteen households per village were interviewed. ISSUES Health Education Knowledge of the dlsease lLocal name of the disease ISymptoms usation/transmission Knowledge of treatment lPrevious experiences with Carbamazine (DEC) llntroduce MectizanT (lvermectin) lDosage lExclusions lReactions Dr-Ethyl side effects Attitude to treatment lAdvantages of treatment Free Yearly treatment Self-treatment at commu nity level. m of maximal Attitude to disease lThe drsease can be controlled IOnchocerciasis blindneqs and skin changes can be Attitude to good record keeping lMinimum requirements for record keeping lRecords are confidential and stricfly of h6atth issues lRecords required are for suOsequent irug supply 14 What is OV (Oncho the tocat name of the disease?) out of 115 people interviewed, g60/o were able to give the local name of thedisease. How did you get OV? What causes OV? o,rl ol1l" 90 people interviewed , tso/o were able to identify fly bite as a cause,while 5% did not know. ls there a treatment for OV? out of the 120 peopre interviewed , looo/o gave the correct response. How do you feetaftertreatment? out of 71 people interviewed, 59% said they feel better and 4go/odid not know. What should you do aftertaking Mectizan? Out of 109 people interviewed? 91said no drinks 9% don't know ltr.at-sfrguld you do if you have side effects of Mectizan?Out of 1 10 people interviewed? 92o/o se.a CDD/CHW 8% did not know the correct answer. The detailed findings of .the KAP reports for the two counties are documentecl andavailable in HealthNet database. b) What methods wilt be us€,, to devetop health education materiat for the communitiesand for the agents who wilt be responsibre for ivermecfin treatn ent? 'Health education messages and tools for cDTl have been developed. These will betranslated into the rajol ranguages of Bari ,no -ropt.r. some of the Heartheducation materials developed oy tne sudanese nati;nals and HNI in lggg wereposters, flipcharts, manuals and comic books are already in use. They will bereviewed for cu.ltural. acceptability to the varieo enoemic communities of EastEquatoria based on their cultural backgrounds ano mooes of livings. communityinvolve.ment approach will be the strate-gy in oevetopin! anolor revrYsing ali neamreducation materials. The following steps wiil be used in deveroping the materiars: 1' KAP questionnaires (both qualitative and quantitative) will be used to collectnecessary data 2' Focus group discussion (FGD) discussion with community members and groups willbe canied out. 3' Participants observation instruments that are geared to generate retevantinformation: these shatl be translated into the rel6vini ma;or-tanlua!"rlr tn"endemic communities and tested. Posters,.biltooaroJ ano f ampit"ts *Ii# pioouceofor the dissemination of the messages and tne campaijn.' I 15 c) llVhat methods will be used to provide health education to the endemic communities and to the agents responsible for treatment? Two methods will be used to provide health education to the communities. a) Workshops, seminars using- flip charts, brochures and reading materials for advocacy, education and mobilization of the paramount chiefs, chiefs, and sub- chiefs. b) Meetings wilt be held with the headsmen using- flipcharts, posters and pamphlets. c) Mobilization of endemic communities- using posters, brochures, pamphlets. d) 'OV Daf will be celebrated with local music, church sermons, dramas in market places and the local authorities will address the community members. 3.2.3 Community Participation It must be reminded that in community-directd ivermectin delivery sysfems, members ofthe endemic communities themselves do the ex*ution of iverm*tin treatment. Treatment may be providd by tnind personnel, Rnown as Community-Directd Distributors (CDD's), se/ected from various organizational structures at the community level ranging from women cooperativx to traditional organizational structures. ttVhatever the treatment approach usd, it should be fully supported by the community itself and the community should De rcsponsible for its organization and q*ution with minimum but effective medical supervision once it has r*eived the nxessary information and training. a) Exptain the organization of the intend& community-directd ivermectin treatment in the project. The CDTI manualwill be used as a guide. Advocacy visits to policy-makers and traditional leaders will be held to sensitise and educate communities on CDTI and the roles and responsibilities of each partner. Advocacy workshops on CDTI will be held for health staff. Regional County and payam health staff will be trained on CDTI implementation using APOC training manual video by the SSOTF and county health staff respectively. Stakeholders meetings will be held to further explain each partner's roles and responsibilities. Meetings will be held with headmen and elders and dates for sensitization of communities on CDTI will be agreed with community leaders. The key to a successful OV control programme is community participation, therefore, the project will invest on activities to improve the participation of communities. Meetings will be held with the communities and posters, flipcharts and brochures will be used to educate them on CDTI, and on individuals and communities benefits of long-term treatment. Also, their roles and responsi.bilities of communities and those of other partners will be emphasised. Theywill be encouraged to partake in all steps of the planning and distribution process. Each village will select its own CDDs for training and decide on the mode and period of distribution. Community members and the CDDs will decide on when and where distribution willtake place. Methocls of improving coverage rates, Community self-Monitoring (CSM) and achievement will also be discussed on a community level. a a a a a t a a b) How will ivermectin distributors be selected? 1) The communities from among their own ranks in community meetings/gatherings wiil serect ivermectin distributors 2) The Projgct will empower communities village health committees and respective community group.s (chiefs, suL chiefs, erders, religious readers and grass route rocar authority) to serect th; ebb;. '-"' 3) Voting on suggested peopte by the community 16 some possiote 0uioerin;;;; *,,:?[TIrn, c) How will non-etigibles be identifid and defautters be foilowed-up? old registration in collaboration with sed on household registrations, the local headplay a central role in identifying ail defaulters 2) Adequate training of cDDs on identification criteria for non-eligible persons willenable the non-eligible such as under fives, lactating mothers 6r onty one week,severely ill persons to be identified. When they are etiliote they will oe lreateo. 3) The defaulters will be able to be traced through the household registration booksand be followed up for mop up treatment. 33 Ldcat OperationatResearch Are there any plans to conduct localoperational research? yes {No lf yes please give details operational Research is highly desirable under current situation. The project is inconflict area and war has negative effects on the sociat fabrics. ' ) operational Research will further enhance our knowledge on things that have beenoverlooked and probably needs to be modified to achieie adequaie teograpnic anotherapeutic coverage and especiaily recording keeping by non-riterate cDD's. The 2002 assessment by WHo reveale.d a high prevatence of 'nodding disease" and/or seizure disorder in some oncho hyper 6nO'emic .ornti"r in East Equatoria region. As part of a rapid assessment research, implementing agencies shal iompilea register of all nodding disease cases in the aifeAed co-unties to determine thepossible link (if any) between OV and seizure disorders. A pilot study on integration of treatment of seizure disorders into CDTI will be canied out. A study on the potentialfor income-generating activities for cDDs. 1) CDDs will undertake househ County/Payam/Boma authorities. Ba man, the sub chiefs and CDDs will under their jurisdiction. a a a a 17 ' lntegration of cDTl into existing hearth systems in a war situation 3.4 Training Training and re-traininq.of community-directed distributors to operate the cDTt is a vitalfirst step in organizing the programmZ and remains a continuing commitment thereafter. a) \!.-training wilt be provided to ensure the development and sustainment of theCDTI? New cDDs will be trained f or 2-3 days and old ones retrained tor 1_2 daysBasic training will include: . Background on OV/CDTI program (Tasks of CDDs) . Communitymobilization . Health education . Distribution and data collection/accuracy of reporting . Record -keeping o Health networks for referrals and management of SAEs . Basic management, supervisory and leadership skills Payam supervisors will be trained on . Background on OV/CDTI program (expectations of CDDs) . Communitymobilization . Health education . Distribution and data collection/accuracy of reporting . Health networks for referrals and management of SAEs . Basic management, supervisory and leadership skills . lnventory management . CSIM/SHMs . Use of checklist for supervision . Planning of CDTI implementalion t . Background on OV/CDTI program (expectations of CDDs) . Communitymobilization . Health education . Distribution and data collection/accuracy of reporting . Health networks for referats and management of SAgso Basic management, supervisory and leidership skills . lnventory management . CSf\rUSHMs . Use of checklist for supervision . Planning of CDTI implementation County Supervisors Project Co-ordinators . Background on OV/CDTI program (expectations of CDDs) . Communitymobilization 18 . Health education . Distribution and data collectioniaccuracy of reporting . Health networks for referrals and management of SAEs . Basic management, supervisory and leidership skills . lnventory management . CSWSHMs o Use of checklist for supervision . Planning of CDTI implementation . Monitoring of CDTI ln addition, County supervisors and the projed coordinators will be trained in finance,administration and wlitils-skillsJmplementing agenciei *irr-arso train hospitat andprimary health care staffsfor sAEs riranagement ind refenal system and Tcc / MEcguidelines in management of Loa Loa. b) lndicate criteia for distributors) sel*ting trainees (superuisors and community_directd Trainees will be serected..according to the foilowing criteria:Commu nity-directed distributors . Those selected by the communities to be their CDDs . Must be a village resident - trusted by community "adult' young and old notnecessarily literate and willing to atten-d training. ' Good understanding of Engrish is an advantagi out optionar ' Highry motivated and wiiling to work without ,Jmuneraiion Payam Supervisors lvork in the oV program for at reast 6 months is an advantageGo.od understanding of English (writing and reporting) Willingness to work Highly motivated and good rapport with communities under his/herjurisdiction Fair mathematical skills Good interpersonal and leadersh ip skills County Supervisors ' work in the oV program for aileast 6 months is an advantage . Good understanding of English (writing and reporting) . Willingness to work ' Highly motivated and good rapport with communities under his/herjurisdiction . Fair mathematical skills . Good interpersonal and leadership skills t 40 e) lndicate number, type and duration of training courses intended 4, SUPPLY, IMPORTATION, STORAGE, INVENTORY AND DELIVERY OF MECTIZAN TABLETS This setion is only a reminder and concems the supply, importation, storage, inventory and delivery of ivermectin tablets, donated by Merck & Co, who will atso pay handling charges for iverm*tin to their accredited agents. PLEASE NOTE THAT REQUEST FOR IVERMECTIN AS WELL AS REPORTING OF ITS SUBSEOUENT USE MUST BE MADE DIRECTLY AND SEPARATELY TO THE MECTIZAN EXPERT COMMITTEE, USING THE FORMS PROVIDED BY THE MECTIZAN DONATION PROGRAM AND A COPY SENT TO APOC The Current Mectizan flow chart is shown on the diagram below; HealthNet lnternational has expressed its intention to continue to apply for Mectizan for the control programme from MEC. ln future it is anticipated that the SSOTF and WHO/south Sudan will take over this responsibility. t Type of Training Yrl Yr2 Yr3 Yr4 Yr5 Duration CDDs 2,000 3,000 4,000 5,000 6,625 2 -3 days Payam Supervisory Health staff 39 39 40 40 40 2-3 days ToT (PcO+ RTF) 20 22 24 24 24 2 days County Supervisory Health staff 6 6 6 6 6 2-3 days Community leaders Training 750 750 800 800 800 1 day Hospital/PHCC staff 100 100 100 120 120 2-3 days 20 MECTIZAN FLOW CHART MSD USA MSD (France) SSOTF Nairobi Schenker agent Loki HNI Store Counties SSTOF Store CDDs (community directed distributor) ltIt lt II II Mectizan flow Reporting flow PHC Facility / Payam store a Key ! !5. SUPERVISION/MONITORINGANDEVALUATTON 5.1 Supervision during CDTt Proiects require be superuising and m-onitoring. However, Apoc fundd projxts willne€d to be designed to functioi with effective iut minimum supervision compatibte withits objxtives. a) Please describe the.superuisory arrangements you consider will be reguired for thecDTt you propose. How wiil thii continle at theies "aion ot Apoc support? Below is a flow chart of.the proposed- supervisory structure. lt has been suggested tohave one project coordination office in [ei) ano a iupervisory centre in eaii county.supervision with be integrated and run as a routine activity of the county and payamhealth services. The SSoTF yill supervise. the project coordinator supervisors. The pco wi1supervise the county supervisors. The county supervisors will supervise the payamsupervisors. The payam supervisors and the communities throuin "orrrnity selfmonitoring wilr supervise the cDDs and cDTl implementation. a1 SSOTF I Project Coordinator I I Co NGDOs/CBOs/CHD/D|OCESE OF REJAF(ARC/AAH/SU HA/M HOYHZOA) ftv Sunervisors Payam Supervisors I CDD'S I Endemic Communities 22 NB. This structure is be integrated into the pHC system. b) Describe how you would ensure that supenrision wiil: llall within the reguirement accounting for ivermectin usellbe sustaind when the programme eids in S years llensure maximum invotvement of the commuiities in theprocess The retraining for supervisors is to enable..ffrem to supervise the oV program in theirdesignated are1]1{lendenily. rn . addition, tne -iupporting agencies that aremembers of the ssorF will coniinue to provide tecnnicilassisianclio in" progrrr,monitoring both supervisors and cDD; gh"f .g"n.i", supporting cDTr (cBos,National NGos and tNGos) will liaise with the ssoiF and wiil be invotvect intabletvusage and inven-tory'of Mectizan will be undertaken during supervision andmonitoring' csM and sHM will be introduceo inJ us.o to improve communityinvotvement and participation as weil as sustain tnJ prog;mme. 5.2 Monitoring ot CDT| It ls impodant to atlect information to monitor fhe progress of the cDTl. what indicatorswill be used to monitor: I iverm*ti n distibution? I health education and community participation?f management systems? The lollowing ltems may be considered lve[mectl n Dl stri butl o n numbers of communities and persons treated wfth ivermectin treatment coverage regulaity of treatment exercise{ ampliance to annual treatment1l repofting and management of adverse reactions . lndep-endent p-articipatory monitoring involving nationals and external experts will beconducted after the first year oi ivermectin mass ai-striuution. Thereafter, the ssorF willorganise internal annual monitoring using the foilowinj inoi..torglvermectin distribution . Number of trained CDDs/Supervisors ' Number of communities treated/number of persons per community treated ' Number of Mectizan tabrets used/barance of Mectizan . Annualtreatment . Number of persons with reactions/ management Health Education and Communitu Mobilization 1f numbers of communities being mobilized by the projectI evidence of impact of health iducation . KAP survey results . Number of persons with sAEs coming for earty treatment . Number of attendants during community awariness sessions . Number of CDD training requests aaa J 23 . Number of health workers trained . Referrals and management of SAEs Manaqement I are activities being carned out according to plan and on schedule? I inventory antrol, 1f are record forms accurate and completed on time?I numbers of persons trained I balance of genders in sta/f of the programme Manaqement . Frequency and accuracy of reporting . Supervisory reports . ln-seryice skills assessment o Accountability of supplies/ tablets . Number of supplies requisitions . Safety of supplies . Planning/ meetings reviews . Data management 5.3 Evaluation of CDTI Annual extemal review incorporating field visits will be undertaken to ensure that projects are meeting target indications outlined in this proposal. Such reviews will provide,{Q,Q with the assurance that each project is moving towards its long tqm statd goat and if appropiate make recommendations about any deficiencles or modifications to fhisproiect. Such reviews will draw on the indicators developd by TCC as a guide (sx Appendix 3) for such evaluation. The SSOTF and partners will review the project annually. There will be a midterm evaluation in the 3'd year to assess to what extent the irolect is making progress towards sustainability and a. final evaluation of the sustainability in the Sth yearof the project. Both the 3d and 5th year evaluations will be organised with sufport from APOC using the APOC guidelines and tools for assessing the sustainability of CDTI projects. The indicators for the SSOTF annual review will include: Program Manaqement . Financialmanagement . Communication effectiveness - prompt referral and treatment of SAEs . Training session effectiveness . Geographic and therapeutic coverage Prooram lnteoration . EXent of collaboration with other primary health care activities/lntegration of OV program into the PHC system . lnvolvement of health workers . Extent of involvement of CBOs an 6. SUSTAINMENT OF THE CDTI AFTER THE WTHDRAWAL OF EXTERNAL FUNDING lh9 concept of sustainabitity refers to the abitity of countries and aff*ted communitiesfollowing inttial ertqnal investment to mainiain the viabitity and continiity of tn.iverm*tin treatment process without extemal support. For apoC fundd projects, suchsupport will normally /ast 5 Wars, as the APO? donors dqnand that there shalt be avisible and achlevable end point for the extemal donatton aspecf of the programme, andthat the ammunity directd dlstrlbution sysferns staottsnea snah ihereafter besustalnable by the govemments of the endemlc auntrles ancqned. Ltlgryt and plans towards sustainment, including the phasing out of qtqn4 and ,vcDo's suPPort, must be reported annually and satiJactory progress in this dirxtion wittbe a condition for each succding yeifs fundlng initalmqt. please address thefollowing areas that retate to sustainabttity: "integraiion into primary heatth care*, ,,cost- recovery", and "other sustalnment issues". ln the absence of a "Peace Agreement" between the SPLM and the GoS, the project willface stiff challenges in its efforts towards sustainability. These efforts will bi targeting sustainability at the community level and by the health services. The establishment of a regional MOH is already a positive step towards sustainability. And efforts will be madeto integrate CDTI right from the onset of project-design into the pHC system by usinghealth personnel involved in other health projecti of the pHC to perform CDTI.Therefore, from the first year of CDTI implementaiion, the partners will aiir at integrating training, supervision, monitoring as routine activities of heiftn personnel. The integrationinto the PHC will enhance the likelihood of the PHC sustaining the project after the , qessation of NGO and ApOC support Should Peace Agreement be signed soon as expected, Funds will be available forprogrammes, donors funding should reduce and will be reported. lntegration into pHC yll i" strengthened as well as capacity building of project, heatth staf, and communityempowerment. These efforts will gradually led to of sustainability Progress towards sustainability. APoC indicators will be used. Recommendation from the review and evaluation will be used to improve on the implementation. 6.1 lntegration of the CDTI into other Community-directd or Primary Heatth Care (pHC)Sysfems The principal goal of the APOC is to establish cost-effective iverm*tin4irwted controlfor onchoceraasiq whidt can be sustained by the qtdemic ammunities and countries.One way fo ensure sustainment is to intqrate the CDTI into the pHC system of the countryL which means more than just using the system for ivqm*tin distrtbittion. 6.1.1 ls there an officlal PHC policy and structure tn the country? yes { No lf y*, plea* give a brief outtine of what it is. Although the southern sector of Sudan does not have its own Minisiry of Health, the SPLM Health Secretariat has a PHC policy and the Operation Lifelinb Sudan (OLS) assists the Health Secretariat in establishing a relatively functional primary lieann care system. M-ost County Health Departments (CHDs) are supported by NGOs (see Plan of Action for areas fhe NGos are working and aunties with pHC iacilities) and are unable at this point to function autonomously. The Health Secretariat is gradually being transformed into the future Ministry of Health. 25 a) How functional is the primary health care system? - Fully functional - Partlv functional - Non Functional (Please specify) (Please specify) (Please specify) The primaly h"lll care system is partly functional. An extensive survey carried outby UNICEF in 2003 estimited the total number of heattr facitities in Equatoria (Eastand west) to be 391. of these, 309 are pHC Units, sz pnc centres and 19 arehospitals. only one is non-functional. The survey oy utrttcer mentioned above didnot however specify the number of the facilities in eitner the East or. w"rt-f.rt, orEquatoria. The functioning facilities still neeo strenginening in terms of facilities,refenal and drug supplies. .ln order for any.cDTI program to be successful, there must be a certain degree ofintegration into the PHC_system. Recognizing tlris ract, implementinfitencies wirrco-ordinate with the cHDs at differeni leveli to hetp'ensure the sistiinabitity orprog:am initiatives._Bgcalrse drugs will be stored localiy, health staff will oe traineo inthe management of Mectizan and data collection. Thisiiaining will aim io rffi1 tn.development of a health information system (Hls) at eacn cor-nty ano attne Flgionallevels. Furthermore, selected health staff will be trained in the management of serioaAdverse Events (sAEs) as a means of strengthening not onry in"r1. ,.rponse toMeclizan post treatment but also other dilear"r] Mor" will be traineu onmanagement of SAEs in Counties co-endemic for onchocerciasis and loaisis.Similarly, agencies will conduct basic refresher training on a pHC level as an hddedbonus to the cDTl prog-ram. Lastly, there will be contiiued emphasis on communityparticipation. These efforts will encourage community members to take an activeinterest in their health and well being, which will undoubtedly stimulate better heatthseeking behaviours..lt will also help re-activate the dormant vittage health committees and boost integrated community trealth initiatives. b) Does it cover the whote country? yes No { lf no, in what part(s) of the country is there a fuily functionat pHC structure? East Equatoria has a.less developed PHC structure than West Equatoria. Even thisonly.is partiallyfunclional in parts of Juba, KajoKeji, yei, Magwi dnd Torit counties.Terekeka has very litfle pHC infrastructure. q Vl! .percentage of ammunities where onchocerciasis is endemic, and which aredigible for community4irected treatment, have an existing ana'runctiiiai pnc structure? About 65% of the pr-op-osed project area is endemic for onchocerciasis and eligiblefor CDTI (REMO, 2003). Although some levels of PHC "tr"tri"t-"-riri, ii.i.i ,r.many factors that are hindering their proper functioning. . War . High tum over of international and national NGo's and their staff. . No revolving drug funds . Funding by NGO is donor driven (emergency oriented) ' The vastness of the CDT|project areas road infrastructure are inaccessiblility during the rainy seasons d) what organizations are supporting the devetopment of pHC in your country? y.ryP.Ef has for years provided enormous support towards the devetopment of thePHC infrastructures, EPI and other activities.iri in! errt equatoria ano itner i"!ion,in the southem sector of sudan. The operarion Life 1i.", IrJ";;;;p-6x;'trlining,capacity building, EPI activities, community developmlht activitibs, waier anosanitation and development of health informa[ion system in collaboration with spLMhealth secretariat. The NGos working in oV contror-in East Equat"ri; hil; p;;gr.r,supporting the development of the pHC. The process of developing the PHC has not been easy parily due to the conflictsituation/ war and also the mandate of some of the rueos that conflicts with theSPLM Heatth poticy. WHo/ south sudan in collaboration with NGos and spLM health secretariat hasbeen building an early waming system on disease outbreaks and surveillance. WHois also.the lead Age.ncy in strengihening TB control actirities, Leprosy treatmeni anocase detection, Polio eradication, Hlv/ AIDS control, prophylaxis mitaria ireaimentfor pregnant women with Fansidar, integrateo manigerunt or childhood illness(lMcl' and of late management and control of yellJw i"r", out break in EastEquatoria. other organisations are NGos e.g. zoA, surn, ARC and AAH. e) l.s- there.any Past experience in the country of a programme intqrating with the pHC? . lf so, what programme was it and how succes sfi wis the intqitioni Tl'9 ?Ic program was first started in the southern sector of Sudan after the signingof Addis Ababa Accord in 1972 and the Ministry of r-{eatih iil;ilih;rn'l"l.ior. orSudan introduced it in 1973. Support from WHo was received after the Alma AttaDeclaration in 1978. The region, therefore, rras consioerable experience in pncsince by then. 26 The control of dianhoeal diseases was one of the most successful implementedthrough PHC programq in East Equatoria. MSF-Swiss "rGolitn"o a successfutsleeping sickness control in East Equatoria using the pHC structure. 0 Are there any plans to intqrate other rurat.heat-th programmes, such as the ExpanddProgramme of lmmunization, Matemal and Chitd'Hea-lth programmes or progrirmmesfor the control of oth* pamsific diseas.*, wlth the pHC system? ln line with the policy of the SPLM Health secretariat, the pHC program in EastEquatoria has already integrated the following, EPl, Maternal cnilo'Hel1h progr.r, clinjcal management of the 10 most prevarerit diseases, oV, Guinea wffi: oi rrt"and rrachoma through funding by The carter centre. other programmes are, TB,HIV/AIDS, Leprosy, De-worming of school pupils and malaria tieaimeni oi expeaant mothers with Fansidar. other organizations ZoA, suHA, ARC and nAH "rusupporting integration of Epl, MCH, Water and sanitation. 27 il Describe how the CDTI will be intqrated into the PHC systeml; the way the pHC system will be used to achieve integration and the key persons in the PHC system who wil be neded to achieve the integration Refer to appendix The planned expansion of CDTI will be integrated into already existing PHC system in each county using health personnel of the County Health Departments (CnO;, which fall directly under the Secretariat of Health. ln the areas where the County Health Departments are not yet established, the SRRC will take over the coordination of CDTI at that level. The County Medical Officer of Health (CMOH) in charge of all health activities will oversee the staff in the county. The newly introduced post of project Coordination Officer (PCO) will operate under the direction of CMOH. fnis plan will enhance integration of supervision and monitoring of CDTI activities into the iounties' PHC. h) lndicate how early in the CDTI the process of intqration witl be introduced; how it wilt continue thereafter, and after how many years within the extemally-supported lifetime of the CDTI it will be completed. CDTI will be integrated into the PHC from the first year of the approved project. The only challenge is not all counties have fully functional PHC due io the eitects of the war; and lack both human and financial resources. Given the on-going conflict situation it very difficult to predict a time frame the CDTI will be independdnt of external support. The health personnel in the counties will undertaKe CDTiin addition to other activities they perform. And, through active participation of community mgmbers, Village Health committees, and community-based groups, partnership building between communities and the PHC system, like other programs described above, integration of CDTI into the PHC is achievable 6.1 .2 lf there is at pruent no PHC sysfem in operation, or in those areas where these structures are non-functional, descibe how the CDTI may be used to initiate and expand into such a system, giving a tim*frame for intendd progress. It is difficult to give a time frame for intended progress in the current situation of the southem sector of Sudan for the following reasons: 1. lnsecurity 2. Poor accessibility to some communities due to natural and man made obstacles(mines) 3. Lack of resources for implementation e.g. office space, transport and personnel incentives. However, the CDTI implementation process of advocacy, community sensitization, community education and mobilization to empower communities in implementation will be used. The health personnel in the counties will be used in implementation of CDTI. They will train/retrain the CDDs and partake in community mobilization and facilitate CSM and 1. Simply stating that the project will be integrated into PHC b not enough. 28 6.1.3 11 which way(s) can community-dirxted ivermectin treatmqtt tnitiate or strengthenPHC? SHMs. The drug delivery, monitoring and supervision, reporting and management of SAEs willbe undertaken by the health personnel. Logistics srpp-ort available within the existingPHC structure will also be used for implementation of iDTl. IEC materials will be developed in the local languages and used. OV will enabte the communities to initiate PHC and expand health caie delivery for the control of otherdiseases. As stated above, cDTlwill strengthen the pHC system in the following ways: ' flospital'staff training in the management of SAEs will be OeniRciilto other PHC activities . Refresher training for pHO-level personnet on supervisory skills ' The implementation of a population and household registration scheme/MlS . Routine supervisory visits to pHC centres (as a means of monitoring Medizan supplies and storage) will be applied to other pHC programmes. ' Statistics from OV control programs in the Counties will be uJed for other PHC programmes. 6.2 cost-recovery systems d u ri n g com m u n itydi rected lvermecti n Treatment Cost rxovery for Primary Health Care is mandatory in some countries and it may be one means of sustalnlng a CDTI after APOC funding ceases. However, p/ease note wett that , ,?!Fcs. ivermectin ls donatd free, there can be nb cosf recovery in respxt of the value ofthe drug it*lf; cost rwvety can only retate to the cosfs of dislrtOution. N/A 6.2.1 P/ease state whethq there wilt be any system of cosf recovery (such as is r*ommended in the Bamako lnitiative) to hdp cover outtays on the distribution oflvermectin in the presant CDTI. N/A 6.2.2 State exactly low any such system will be organized, including answers to thequestions listed below. fWhat charge wilt be made per person or per family? N/A Which grrrups of persons will be exemptd from payment? N/A lwill payments be in cash or in kind? lf in kind how will this ensure sustainability? N/A lWhat provision will be made to ensure that alt those eligibte to take ivqmectin, but who ate unable to pay, will also receive treatment? How will it be determind whois unable to pay? 29 N/A lwho will collect the payments? How will this person safely transport funds to aplace of safe keeping? N/A lWhere and by whom willany funds collected be safely kept?N/A lwhat systems will be put in ptace to ensure the proper use and management ofcollected funds? N/A fFor .what purpose(s), including defrayment of distribution costs, will the fundscollected be used? N/A lwhat role will Village Health committees play in the management and allocation ofthe funds raised? N/A 6.3 Other issues P/ease provide information on other issues and constraints relating to sustainabitity otcDTl you anticipate and identify how they witt be overcome. Foi exampte: I the mobilization of endemic communitiesI the maintenance of adequate supervision and monitoringI inadequate human resources I logistics and communications I social/cu ttural factors I declining community compliance a a Mobilization of ammunities - Most communities are stiil overuvhermed tryingto meet daily subsistence requirements, for this reason, pieventive health care is hardly considered a priority. The project wiil thereforb place emphasis and resources on such activities as sensitization, intensive community mobilization and health education in the treatment areas during the saf5periods in orderto attain and maintain the desired coverage rates.- Remuneration of cDDs - communities will be sensitised to select as manycDP.r for training as they consider necessary in order to reduce cDD w.orkload and time spent on cDTr activities. Arso, cDTr wi1 be integrated intoother programmes. These initiatives will be introduced with the aim of reducing cDDs demand for incentives. Also, the project will exptore income_generating activities as a means of remuneratinj coos. lf these efforts are not successful because of the conflict situation, it-may oe oimcun to maintainthe necessary degree of commitment and motivation from cDDs in order to 30 a a a ensure successful coverage rates. where the turnover rate of cDDs is highmore will be trained as required. Maintenance of adequate superuision and.mon.itorilg -supervision wiil be byall partners. csM and sHM wiil be introduced in ini riisillar of the projectalong with the use of checklist to improve supervision. tn order forsupervisors to be successfur, it is imperative thdt tney-nave satisfactoryadministrative, leadership, managerial ancr a"counting iriirr. sp".ial trainingswill be undertaken to achieve thii. lnadequate human resources- Localrecruitment and retention of staff willbea challenge. Because of the situation and lack or rocailnirastruc.ture, mosttrained staff have moved on in search of better p;dp;e;:'ihe use of hearthpersonnel involved in other programs to implement the ov program will helpthe proJec't in addressing thii chlilenge. Logisfr'cs and commu.1i9.ati9n - rogistics and communication are probrems.NGo staff wi[ be soricited to assi-st the project with rogistics and improvecommunication. lntegration into other programs and combined use ofresources of programs operating in the cou-nties ano pryrms wilt also beexplored. social / cultural factors - these will be taken into consideration during reviewsof IEC materials and during health education ancl mobiliiation sessions aswell as the use of community structures. Declining community amptiance - Annual csM and stakeholders meetings will be used to improve the community compliance. o a 6'4 How do you intend to monitor and measur-e the progress towards sustainability (sxAppendix 3 for a rist of possibre indicators or "r"t"in"o'iiitgz Progress towards sustainability will be assessed using the Apoc ,s guidelines andinstruments that include the assessment of project on the iottowing indicators: 1') Community involvement.and participation - High tevels of community support andparticipation are imperative to a successfut Cort. Without their commitment toov control, there is litfle chance of program sustainabirity.2') Financial commitment - As stated aoove, West Equatorii resioents would not beable to sustain the oV program without extemal'supd. Because ov conirot requires a 1O-year commitment to achieve lasting suicess, donor commitmeni isimperative. 3.) Community ownership 4.) Community compliance I I 9ly:.f.qes (Iherapeutic and geographic)6.) CSM/SHM J/ 7. CROSS.EORDER COIVS/DERATIONS Where an endemic area extends across the borders of two or more adjacent stafes, special problems of cooperation between the respective country CDT1 may irise. ln the event that there are areas to be coverd by your proposed CDTI where the endemic zone extends across the frontier into one or more neigibouring countries, and wherethere are likely to be transitory or even larg*scale mi-grations 6f onchocerca-infectdpersons etther way across the border. 7.1 Please describe the particutar situation, as if is tikety to aff*t ivermectin treatment, andthe methods you will use to deal with it. The bordering countries of Uganda, DRc, and Ethiopia already have or are setting up onchocerciasis control programmes. Once refugees and returnees re-setfle and/or integrate lnto communities, they will be targetLd and treated like any other community member by CDDs. lmplementing partners do not distinguish between nationalities when administering treatment in communities. 7-2 lnclude pertinent obxrvations on current potiticat and health relations with the n ei g h bo u ri ng state( s). Relations between Sudan and neighbouring nations are unpredictable. EastEquatoria share common boundaries with Uganda, Ethiopia and Democratic Republic of Congo (DRC), there is a substantial amount of cross-border traffic, eiineifor trade or for those seeking free medical treatment in Sudan. Because of frijnpopulation mobility, critical public health issues have diffused across borde-rs although there is no documented supporting data available. Based on the REMO maps of APOC, OV endemicity levels of bordering communities in DRC and CAR are similar to those in the East Equatoria region. AJ soon as the situation improves an inter-country workshop will be held and plans for a joint program developed with the neighbouring countries. 8. SPECIAL R'SK'SSUES ln some areas of some countries there may be special risks which could hinder the smooth running of an CDTI. 8'1 Please describe the situation in any areas coverd by your proposd CDTI where thisfactor may inteiere with the progr€rmme, and assess ruiuTe prospects. lmplementing agencies have worked in East Equatoria for nearly a decade and are well aware of the security risks in the region. On the other hand, civil/cross border conflicts represent a constant source of threat to all NGOs operating in the southem sector of Sudan. Although parts of East Equatoria have. been relatively stable in the past few years, increaJed'fighting in Upper Nile could spread to East Equatoria. There is also conflict in parts ot.tuOa, Magwi and Torit counties as a result of rebel activities in north east Ugancta. Similarly, lig-ht Oans associated with increase fighting could hamper access to endemic communities. ln order to minimize risks, NGOs do follow a strict security protocol. All expatriate fleld J1 staff will undergo security training before entering the field. ln order to maintain a state of alertness certain resources (i.e. HF radios) high frequency are required. Currently the IGAD peace talks are going on in the last stages and there is high probability that peace might be realized. Also the fact that peace is returning to Democratic Republic of Congo increases socio economic activity in the region. Other Filarial lnfections and Trypansomrasis There are two other filarial infections that are potential problems in the southern sector of Sudan, Loiasis and Lymphatic Filariasis. The main concem regarding Loa Loa is patients with very high levels of Loaloa microfilaria in the blood sometimes have SAEs. MEC/TCC guidelines have been put in place as several Payams that are Loa Loa endemic. Mass treatment in such areas combined therapy of Albendazole and Mectlzan given yearly. Similar to the Mectizan donation program supported by Merck, the Albendazole used for LF control is supplied to WHO free of charge by SmlthKline Beecham Company. Typanosomiasis is also co-endemic in Yei, Juba and KajoKeji counties. Care would need to be taken in mass treatment in these counties. Treatment with Mectizan is contraindicated on patients with 2nd stage disease. SECTION 3: ADMINISTRATION/FINANCIAL 9. ADM!NISTRATION lmplementing agencies will work closely with the SSOTF. The project officer and imptementing agencies representative will be responsible for overall program supervision and monitoring and evaluation. He/She will provide progress reports and any pertinent program information to the SSOTF. 9.1 Organogram of the CDTI Project 9.1.1 see apPndix PCO: Project Coordination OfficerPSC: Project Supervision Center Please provide an organogram for the c.DTl showing the organizational structureresponsible for implementing this proposal. .1,) Communities + + West Equatoria Yei (Pco) Cannty Slpervisor Psc 34 9.2 Financial Administration Mechanisms of disbursements and transfer of funds from the World Bank to countries Funds from the World Bank AP0C Trust Fund witl be channetted through WHO and A1OCto the Proixt bank acaunt. Disbursements of funds will rquire-2 signatures from members of the N|TF, one representing the Ministry of Health (Governient) and one representing the NDGO partners. APOC will lssue chegues (advanc*) in accordane with WHO rutes and the previously agred proiect docunrents andlor ptans of operations. When the total payment in cash rciuired for the Project exceeds $ l(n,o(n, the paymurt must be madd ii instattments. The first installmenUadvance autd cover 3 months or 6 months of activity depending on the duration and magnltude of the prcjxt. Management of funds by proJects and wHo/Apoc mechanlsm for monltortng The size of the proiect will determlne which of WHO's contractual syslems rs used, e.g.T*hnlcal Senrlce Agrement, Letter of Agreement, Contnctual Selvfce Agr*ment orAgreanent for the Pertormance of work. A document on Administntive and Financial Proedure witt be made availabte to proJxtsbeing fundd by APOC. Bullt into this document ls an imprest mechanism, whereiy theproiect will report its expenditure on a quarterly basis and receive further advances onthat basis. Each proiect funded by APOC wilt require a periodic erternal audlt at proJecf expense. Each proi*t must have one senior staff member who is accountable for the management anV controt of proJecl. funds. Standard internal financial checfts and balances must be , , incorporatd lnto each proJerlt's financial management plan. 9.2.1 lnput from the Ministry of Halth a) lndicate resourc€s that will be provided by the Ministry of halth and other governmqtt agencies. Due to ongoing conflict, the SPLM Health Secretariat is not fully functional. Although there are a number of county health departments and primary health care programs in the region, most are understaffed and lack essential drugs. lt would be difficult for implementing agencies to ask the Ministry of Health for any financial input. lnstead, the CHDs will provide the human resources (i.e. CDDs supervisors/supplementary health staff for SAEs management) necessary to run the program. They will also help supervise CDTI activities. 35 b) Please provide a list of personnel assigned by the MOH to this project, including their name and proposd time (state percentage of time allocated to the projxt) for theproiect and where appropriate, their experience in onchocerciasis controt through ivermectin treatment. SSOTF SECRETARIAT Name Designation % time Experlence Dr. Bellario Ahoy Samson P. Baba Agum D. lssac John M. Samuel Martin Mande Betty lmoya Kennedy Jaden Robert Ajobe Chairman SSOTF SSOTF Coordinator Deputy coordinator Administrator Data officer Secretary Driver Assrstant driver OV Supervisor VOM Hospital St Bakhita PHCU Arwara PHCU Olikwi PHCU Jale PHCU Pageri PHCU 100 o/o 100 o/o 100% 100 o/o 100% 100% 100 % 100 o/o 5 Years 5 Years 1 year 1 year 1 year 1 year 1 year 1 year OFFICES One in Nairobi and one in Rumbek 2. EASTERN EQUATORIA COUNW STAFF Name Designation Juba Emmanuel Ezama o/o time OV Supervisor 25o/o OV Supervisor 25% OV Supervlsor 25% Experience 8 years 6 years 3 years 3 years 3 years 3 years 3 years 3 years 3 years Yei Michael Lugalla KajoKeji Paul Duku Magwi Julius Kenyi Jacob Agnes Ochaya Richard William Geri Jino Mark Benson Ongwea Santo Longa Torit Terekeka Banza Daniel 25% 25% 25% 25 o/o 25o/o 25% OV Supervisor 25o/o 3 years 36 9.2.2 lnput from the partner NGDO(s) a) Please provide a letter ftom the Executive Director or the Director of onchocerciasisProgrammes of.each participating lvc_Do stating their intentions to participate in andsupport the National Onchocerciasis Control programme. (NGos) Lefter willbe provided from SUHA, the lead NGo in this region) b) Give information of the input from each NGD} participating in this prolect. 1) Most of the implementing NGDO partners have specific personnel assignedto carry out cDTl training, supervision, monitoring, supply of Mectizan and reporting according to the standard reporting formit. ttiey covertne salaries and oflen the travel costs for oV activities oi their personnel. Rs examfle, in2002, SUHA provided financial support in cash of more than US$ t2,Ooo tothe project. 2) They facilitate supplies and medicines to the endemic communities.3) Transportation of patients with SAE to the nearest health facilities for management. Transportation costs in the are expensive and most NGO coverthese cost as their contribution to the onchocerciaisis control program I. !NPUT FROM HEALTHNET INTERNATIONAL LOG!STICS 2 Vehicles 4WD . OFFICE SUPPLIES Nairobi and Lokichoggio offices Utility bills COMPUTERS AND OFFICE EQUIPMENT 1 laptop 2 Desktops Fax machines Video camera, ordinary camera Heavy duty safe Office furniture (Nairobi and Lokichoggio office) COMMUNICATION VHF Radio contacts- Nairobi office Two mobile phones and one land line OFFICES One building with 6 rooms and meeting room in Nairobi One office in Lokichoggio 37 II. INPUT FROM SUHA LOGISTICS 1 vehicle 4 motor bikes 14 bicycles OFFICE SUPPLIES Stationery and utitity bilts COMPUTERS 2 laptops in the freld 3 desKops COMMUNICATION VHF Radio contacts OFFICES KajoKeji County - 5 rooms Kampala - 4 rooms Nairoh-2roomsliaison b) Please provide also a nominal list, gradin_g and post desciption for the personnel to beprovided by partner NGDo(s). naicate cteaay wnat iii oe their functions in theprogramme and their experience in onchoerciasis controt tnroigh -iiiri*ti,distribution. 1. Health net lnternational Name Post Description Function Experience lrene D. Mueller Fasil Chane Agnes Ngina W. Cornelius Ndungu Program Manager Program Coordinator Adminrstrator Logistician/driver Management of programme TyearsCoordination TyearsAdministration 7 years Logistics and driving Z years 2. Sudan Health Association (SUHA) (Lead NGO) Name: Post Description Function Dr. Pius Subek Justus Lugalla Paul Jaden Sebit Ezbon Charles Wani James lrama Alison Duwa Anne Mulama Director Field coordinator PHC Supervisor Administrator Trainer Malaria control Clinical officer Secretary/Admin. Member SSOTF Coordinator Supervisor Administrator Trainer Supervisor Supervisor Administration Experience 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 6 months 1A 9.2.3 lnput from other Agencies. Please list any other agencies or parties that witt be involved in the running or financing ofthe cDTl, and indicate clearly their roles, functions and contributions. olher NGo partners involved in the oV activities in East Equatoria are ARC, ZoA,AAH, MHOYH, MSF swiss and Diocese of Rejaf. They rrive personner such asDoctors, clinical officers, Nurses, Laboratory te6nniciani, orir"is, Radio op"1gt*,Logisticians etc. who will continue to be involved in tnJ p'rogr"rr" Their fundions include. organising and .facilitating CDTI trainings, providingtechnical support, ldmili:trative lupport in the iefiverv of ivermectin fromCounties to payama health facilities. They also provide orugs for side efects, tieiJsupplies and training materials, finance and managerial sipport, communication and transport (Logistics/storage) and reporting or treitment da'ta from tally ,n.rilnto the monthly standard report form. 39 9.3 Timed plan of action Provide a time chart(s) showing how the various activities of the CDT\ wilt proceed overthe course of the proposed programme. Numerical annual targets toi ail ptanned activities should be provided for each time point. The time charts should also indicate how externat support witt be phasd out over the Syear period. Please find attached the s-year timed plan of action as Excel file ho rol H tri, frl X X x I 6 o ga o FT 6 rd o X X x I x x x X x x x X X x X X x I /, $ il ofr il^ fr] E x X x X 6l o ql (t FI C' Fl o clo o x x x x x x x x X x x x x x X x x x x l?a H r{il rtF & ri !to X X X x ,l 'El o a q trl 6lt{I o c{o x x x x X X x x X X x x X x x x, x X X I 6l o BF & rd {o x x x x oot c{o o X x X x X X x x x x x x x X x X x x x $ x x x x 6 o € q FI 6 F{ a frlzo & rq o No C' x X x X x x x x X x x X X X x x x x X E az E a ttc t< I tJ z 3a I tr t'{ oaa * GIq c bt o)& * al cll c) Gi E o E o,) E 0) (.) otr F{ o * I (, a a &tr 6 oao o b0tr tr d F * 0l o u, e G) o. v, o o0 a c l'EIFl* o * A Ia o * I aHz frlEa U)a trlt)a I od o) G, B o) tr o(, .E, vo O. V * () lH o B G., 0.) -lzl ol aa fr1a z o tt I a ln IEIti IrIr{ IE a C)@ c! ah C)tr0)kd B(lt b E oo + 61 G) oo!d o .JJ(! o t() Gt C) -4 l8IElota l* (n !.) ob o * O t2 EIo() (,) (g ED @ tDtr Q) C) ut oo cr d) a clN I * UI EI U) L. € 6 o0 EA + O Eq) OIJ cttrt- e G)t- o c ur EI n) v) E5E() tEH .^aCEH9'E4i?5'A uttr=EiD E'X # EE B9 .O .d s8E9 H.t zo H FE ilHa e z4 N It {(Jlri IE o .E -o o !o c! .N t) rt) * oltl a o aC' E C) o( GIc(tt 2 * EI a1 Ea Ea(J o Eo q, !to E 6 o, a6o t\Foaa 6 trI ts ts(!o G) a d C) * Ec oO * $ No 6 c 6t q frl O 6 rd 4t x X X x X x x x X X x X X x X x X x X X X x x x X X X x x X x X x x X x x x x x x X x X X x x X X X x x X x x x x x x X x X X X x x x x x x x x X x x x x x x x x x x X X X x x X x X X x X X X x x x x x x x x X x x x X X x X X x X x X X X x x x X x x X X X X X x x x x X x x X x X x X x X x X X X x x x X X x x x x X X X X x x x X x d N tJo a € o() z * * 0!() € o ! (! o CI a(J +io ctH doo -l * 2 +rU) = aO a,trq) E GI c)tr o !tr GI Eo C') U) o (J o o c) c, c! nt tr( Fr o(a U) t\H& 0 o(Jr lzl Fr oaU) fr F<& oQ or { E6) !) Eq) 2 I Itrto (l d rd * ll l# Tlt r"l"l tf ti-t Ill tdl=IEIE lad I\ E t]EI =rlol EEJE"lli ot xEl $El 1O BUDGET 10.1 Budget estimate Budgets must indicate total funds to underTake the project. The amount of funding requested from Apoc, and the amount provided oy {ne MoH, NGDolsj, -and otherpartners. Allestimates must be made in US dollars. AL Each budget must include at least the following major categories (see Appendix 2) indicating the contribution of the partners to reflect sustainabitity of CDTt:- I persr.nnd (senrices)I capital equipmentI suppliesI tniningI travelI ammunlcationsI consultantsI operating expensesI extemal audit 10.2 Budget Justification P/ease provide a narrative description of the reasons for each proposed line items of thebudget. 10.3 Current resources available in CDTIs E*tsting CDTIs (for contlnuatlon or expanslon) witl haveresources atready availabte. Please provide a detailed tist of all existing personnel, equipment and suppties (including u-ehicles, etc) belongtgg to the progrrmmZ,'indicating thetr'ownership M:dH, NGD2, otherAgency, etc.) and thelr level of functionality. a D zl-l t-tZp or-2 o oo61 oo oo @_(o or o t o o, -+_N(9 (0 cc o_ N oor: @(\I o(o\lot o ro .,)-(9 G' oo +- 0 o(\t(9- (o or \oN .+ \o o o o- N(f, (o(o oo o)-(o @ o(, @- oo(o- (o @ @ c!(o rf) oo o) o(o(r) (9(o o ro(r, (f, c! oo$ o ooo- tr) 6 ra o\ \o tat oo(9 z I 8 o) o) ra @ t-r o\ c.t o ce O tat ra-) c.l@ o\ r- o\ 66 o = @ @o$ I @- Io o olo c,(r) ol oI s ot oo$- |\r It- o, I rO rr)N € o\ =!(r) llra F]F 14z El F,(ri() np FE .l r{z z,o V)& 14 tr< Fz E1 p< Dq rq .l = or () a rrl JA tr{D(A zIF O o rI] o 4() z z dF Fa oO zo F.D cq ilF(A o JEl &F zo F N F v) z rl.lU) z - F N J too a zo F 9zD o() (A trlU) z rI.] o<X rI] *l zo t- & rrl tr{o J FoF FA () o rrl Er (, E g ,a A3 r-l (n Fr oilt{ F U trlh oil Fr FI t-r aU rqtr t'r fr o & lr] I ra f-l Fril otr t< t-l() eiJ rq il zt-a a rr) 4h O LO -_l + . . ";r l: l Fo . IIJ\qa o M, o. tr o tJ. ocez dz3tt lL o ,\l tr IIJ OONOcoO\f,OCOOf'-O@Oo)OO -,1 t, )r :ri. . O SCVIN=ICU=Id I "t -,i " rt, :I \ \ ri :f r i i . -"ntl' .:l 12. -1;,,-rir : tlrtl i.l'+' :!I ,,i l: .l ,|..',\ I '-ii -.: .:i 'i , ,i ,': ,"il ii ' il : ,!' 45 (It t, U' o o oo E o E o U' oo 'a o- o() c, o G ET UJ U' trl E, lu E, IU o- u = =f @ UI(, of dl o a)p z Fz o 2 LI I e ed E oF o!t o- oN oo o. o ro -@ oo(o- oN oo G)- @N oo @- ao oo o- @ oo o. aa !t @ GO- o) 6 o- o o o o- @ No o o- oo @- 0o <; N oo d o o- ooo .i ooq2 @ da €r oo oz oo o- ooN. 8@ o @ ! i I o = N o @ o 8 E ci E ci EF eo d - n oF o!t c,dN o GIq Eo- !a E ao ao- ot C'lo ot{N ooq o I C'. @ o6ol to G'. c, oo cidd I o oo o o o_N ooo o- @ o- o a- N 8o @_ Io o- E ooo N. Fo a € o d oo oz oo 6_ P oo o @ ! I F -o = 8 ots N. e o I ! d ,4 6 oF oco!to o'N oq oo(o- o ro oq c,N\o oIo ro ol- ta oq @@ -+.t-d oq o ro o)-!t N oq ooc @ oq oto _o- @ ocoo6l ooi(o dr- o oq N{odt- o o 0- o o- oN oo N o @_ oo @ o- @@ o N Io N oo @- @ oood oo o- oo N e?6 €r a o o(, z ooo <t ooo oo @ @- @ @ oo{ r o = Iq 8 o8 Ioq 2 t1F r,1z -T F r-l op aq ,-1t{zzU c *r Fz E2 BDo r{ c?to 2 E2g)o r{ EI() E o q H 0{ 5q slo E v tr (.) o rll 2 o z a E o oD& o dF zo E E E2 a zoF Nt- q z ltlo tr NH!i lao J lrl e v trkI 2.5 oQ q rrroztrl fr 14 czIF at{ o. o ,I tr F ca o a gl f& () rn z Fzp o z I i J F oF o rCodN oo ro{d, C' o,o- q, C'o o.!t N o ao(\!. o C'o rO((; oo dr- N !t@ o- roN !tF F-t o oo @Is oo o_ B N oo o ooo o- o@@ gq B@_ e e cd6 dE €oo oo(, z I @ c{ 8o ooo o oood oo @ N. o =I! dN I o = N(.) o-(o o6t- oo @ oo o 8@ o oot- 8 o- o .i d I a 6 oF o{odN oo ro- o o ro cr- ts oo\1\N ooo-i-N oE o. o oo o! @ oo dt- N t@ o_ o N rd o o 0- (o o- @ o o_ ooF- oo{- o@N @_ 8 oo ci oo o I I\i r cd oo oz 8 o- o 8 N. ooo @_ oo o- @ ooo N. o o- @ ! @- d I o = t nr o_ N g ci g P oo6 @_ 8@ oo @ c{ oI a- at vi z rd F{ Id z ,1 F r'1 o Sla ,.1 E qd !{A k2 H2 Bo E1J , ? O k2 g Bq r! r{o E o o BJ O{ Bo EIO E z o tr oD o rJl e o a Z E qI d a € t- z 4 E E Eo 6 zo tr N Eazlr]h z k sd la JId E z o tr ZJ E o q r{q z s1&x rr] J zo tr d ct o ,I t- o F{ ca o a r{ Ilr oo@ o A{ East Equatoria CDTI project, Southern Sector Sudan Year 1: 2004 l. CapitalEquipment Vehrcle (Land cruiser Hard Top) Motorbikes Bicycles Computer (Desk top + accessories) Printer Photocopier Base Radio (Codan) for vehicle (Codan) Accessories A. Personnel SSOTF Project Coordrnator Officer (pCO) Prolect Supervrsors Clerk (Frnance and Sec) Drtver Asst D(ver Secretary Secu Guard Person 1 Mobil Radio Solar Panel + OTA pital Office Equipment Modem Office table and 2 chairs Chairs Metallic cabinets Computer cover Book Shelves B Metallic Trunks )TAL Office E Office Supplies Diskettes pack of 10 Printer cartridges (colored) Printer catridges (Black and white) Toner (photocopier) Bulk Stat. |TAL Office Training and Education TOT on CDT| Transportation Feeding Accomodation Training of Heatth staff (l2tCounty) Training of CDDs Computer trainrng for project Coord Computer training for Secretary. Computer training for Clerk Refresher courses for staff rAL. and Education bution ater. Drugs CDD treat.reg.(h. cover)/Tally sheets Summary forms Drugs & Kits for pHC Units (Loa) Mobi Rucksack for CDDs) Non Medrcal m boots Distribution M itization SSOTF/project review meeting Mobilization/Sensitizatron of Comm T-Shirt for CDDs 'AL Mobilization/Sensitization Item Descnctton # ltem Unit cost I'ot. Cost MOH NGDO APOC ToTAL (us$ 1 6 1 1 1 1 1 1 12 12 1) 12 12 12 3s0 1 '150 150 100 150 50 4,200 8,640 1,800 1,800 1,200 1,8oOl 0 0 0 0 0 0 0 0 0 0 0 0 4.200 8,64 ,200 ,800 1.8001 6ool 4,200 8,640 1,800 1,800] 1,2oOl 0 20, L 2or4o 1 6 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 25,000 3,000 'l50 1,000 6,000 3,500 25 1 1,000 6,000 3,500 18,000 1,800 0 0 0 0 0 0 0 0 900 0 0 25 ,| 900 1 1 6,000 1,000 8,000 2 25 1 1 1 59,300 0 6,900 s2,400 59,300 1 10 18 1 o 8 30 50 ,| 1 120 25 1 50 240 400 100 1200 450 1200 450 0 0 0 0 0 0 1 2401 4ool 100 1200 450 1280 s0l 3,720 1,890 0 1,830 3,720 4 6 12 5 10 60 70 6oo 120 3s0 600 280 3,600 ] 0 0 0 0 300 0 0l ol 3l't 00 120 350 6ool 2801 3,6001 4,950 300 1,000 3,650 4,950 1 12 000 1 1 1 I 1 1 1 12 1 'I 1 1 400 400 300 70 45 87.5 5 400 400 48 360 12,600 0 0 0 0 0 't,000 2,000 0 0 0 ,ooo] 0 0 0 4 2,O00 7 6, 48 400 1 48 400 2 1 10, 27,469 3,000 6,800 17,668 27,469 1 500 I 1000 0.5 2500 13 2,200 250 2,500 13,000 7,000 0 0 0 0 0 0 0 0 0 o 2,200 250 2,500 13,0001 7,0001 2,200 250 2,500] 13,OOOl 7,0001 24,950 24,950 24,950 16 1 1 2 2 1 87.5 1 000 4) 2,800 2,000 4,000 0 0 ol 0 0 0 2,800 2,O00 4,000 2,800 2,000 4,000 0 0 8,800 8,800 fravel 1 I 1 I 0 U 100 0 0 ,2SOl 501 .Jl 1 1 1 1 1 120 350 600 280 2,300 1 1 8,800 [- t7 East Equatoria CDTI Project, Southern Sector Sudan Year 1; 2004 Communicatlon J. Operational Expenses Equipment maintenance Utilities Vehicle maintenance Vehicle fueling Motorcycles fueling Soaps for hand washing (CDDs) Bulk TOTAL GRAND TOTAL A.J Percentage of Total lltem Description # ltem TIME/Mth! Unit cost tot. Cost UJ} MOH NGDO APOC TOTAL US$SSOTF/Secretariat Travels PCO + drivers Trav/Superv, & Monit PSCs Travels/Superv & Monitoring NGDOs Travels/Superv & Monit. _Flights to Loki, Yei & Nairobi Flat amount 1l Flat amount Flat amount 1 1,200 2,000 1,600 1,250 1,200 2,000 1,600 1,250 1,200 2,000 1,600 1,250 1,200 2,000 1,600 0 1,250 TOTAL Travel 6,050 0 0 6,050 6,050 l. Communicatlon Courier Telephone/FarlModem lnternet services Flat amount Flat amount I 500 1,000 400 500 1,000 400 0 0 0 0 0 0 1 500 ,000 400 500 1,000 400 1,900 0 0 1,900 1,900.0 Flat amount Flat amount Flat amount Flat amount Flat amount616 Flat amount 500 2,000 1,500 4,000 1,500 24 3,000 500 2,000 't,500 4,000 1,s001 8641 3,000 | 0 0 0 0 0 o1 ol 0 0 0 0 0 864 0 500 2,000 1,500 4,000 1,500 0 3,OOO 500 2,000 1,500 4,0001 1,s001 864 I 3,oool 0 864 12,500 13,364 USD us$ US$ us$ us$ 170,542 5,190 15,564 149,799 170,542 100o/c * 3.04o/o 9.13o/o 87.930/0 100% 13,364 t8 BUDGET JUSTIFICATION (East Equatoria CDTI project) The East Equatoria Project has requested the sum of us $660,426 for implementingCDTI in the region over 5 years. In the period 442,261persons will be treated. of thisamount, us $436,958 is requested from Apoc representing 66.16.,A, us $gg,970(13.47%) is expected from NGo parrners and us $ t i+,+gs (20.37%) from MoH. In the first year of rreatment, us$ is requested from Apoc which is g7.g3% of the loo-l flt, yearbudget. This represents u unit cost of us $1.67 in the first year uJ us$0.33 in the fifth year. PERSONNEL The sihration in southern sector is unique and different from other countries in conflict. Thispart of the country has been under siege for more than 20 y"., *d so the basic in&astructurefound even in the remotest parts of other countries is non-existence in many countiesThis is a first year budget in which the sudan Peoples Liberation Movement (SpLM) doesnot have a formal Ministry of Health. In place of a formal rrai"lrtry of Health southem sectorAuthority established a health secretariit to develop una -*"g" the health services incollaboration with international and local NGos. The southem sector health secretariat doesnot a formal budget pr^esently. When the peace agreement is signed the health secretariat willbe transformed into a formal Ministry of Health. It is against fris iackground that we wouldl]!t^'9 submit the justification notes of this proposal foi consideration. ssorF is aware thatAPOC under normal circumstances does not pay salaries. our staff *1ir",-*qri;;';J;",but will need top-ups for start-up CDTI activities. . AP-OC is being requested to provide top-ups to seven (7) essential personnel who at differentlevels will liaise with the NGo partners uni .or-rniues in East Equatona to implement theCDTI. Given the vast expanse of southem Sudan, on-availability of reliable transport and the Heoffice in Rumbek will not be effective in supervising the SsoTn decided that the position ofProject coordination offrcer (PCos) is eisential for effective launching of the CDTI,monitoring and supervision of activities of the health staff and community-directeddishibutors' The PCo will ensure full integration of CDTI into the health care services. Thesum of US$ 4,200 For the same reason as above, APOC is also requested to cover the cost of technical assistance to be provided__by.Project supervision ofh."r, (in East Equatoria. They wiil beattached to the County Health Departments. There ur" .i* p.o:""t supervision officers(PSOs) in the six counties in East Equatoria. A total of US$8,640 is"requested from the ApOCTrust Funds' A total of uS$20,040 is being requested for year oo, or tr,. project as technical assisiance to personnel CAPITAL EQUIPMENT To facilitate the first year activities, SSOTF is requesting for one l-and Cruiser (1) atus$25'000. Four motorbikes are requested from APoc uiuisri, 000.00. These will beused to facilitate collection of reports from dispersed communities. CDD supervisors i, *itrneed bicycles. Twelve (12) bicycles is being requested from the Trust Funds. Other itemsrequested are; Desktop-computer (l), Printer, Base radio, funds to repair the Mobile radio. A3 2 sets ofSolar Panels and accessories have been requested because there is no power supply.The solar panels wrll be required to operate the computer, Printer, photocopiei una *re 'gaseRadio. Buying two solar panels will cost less than one and is also more efficient. A total ofUS$52,400 is being requested for Capital equipment. OFFICE EQUIPMENT One thousand six hundred and trventy (US$ 1,830) is being requested for a modem (l) to be attached to Base Radio to facilitate E-mail services; 8 piecei of metallic cabinet foirt#g" "fimportant documents, for security and to protect these iocuments from been eating "p at?..Also, for storage of Mectizan, T big metallic tnrnks are been requested. The USI f ,Sf'O *iff cover the cost of the above mentioned office equipment. OF'FICE SUPPLIES The remaining items (stationary, Diskettes, Toners etc) for a total of US$3,650 are being requested form the APOC. NGOs will provide some of the office supplies as ieflected in the budget. TRAINING AND EDUCATION To meet the Ultimate Treatment Goal (442,621 people) by year five of the project and avoiddemand for incentives by cDDs, the project willieniitize tommunities to a".ial and select as many of their members as possible to be trained as CDDs. Based on the experience from otherAfgC countries the project, if necessary will advice communities to selecf one CDD to treat a mziximum of 100 people in the CDDs village. A total of 1,000 CDDs will be required todistribute ivermectin within a period not exceeding four days to M2,621persons in theiegion at US$6,000. Twelve (12) county health stafffrom the counties and aboui 1000 CDDs wiit Uehained for 2 days for each group in Year l. SSOTF is requesting APOC for US$ 7,600 for these tainings. Thr-ee persons - Project coordinator, Secretary to POC and the data manager/ finance oflicer will require additional training to be able to effectively carry out their functions. The total cost is US$l,200. The total of US$|7,668 is being requestid from Apoc rrust Funds. DISTRIBUTION MATERIA,LS/ DRUGS A total of 1100 treatment registers or Tally sheets will be used for recording /reporting on ivermectin distributions. Treafrnent registers will be used in villages with literate iOOr. fi," sum of US$2'450 is being requested. This will enable each CDDIo have either a Tally sheet or a treatrnent register. To support PHC centers in the management of SAEs, drug kits will be supplied. The amount requested is US$2r500. Because of the social unpredictable situation, iOOr require some work support items _e.g. US$13,000 Rag sacks for carrying Mectizan and usg7,000Gumboots to protect CDDs from snake bites. For this line item the sum of US$ Ze,eSO is being requested from APOC. Please note that some of these items will be provided by NGOs and are not included in the APOC column. 2 5a MOBILIZATION AND SENSITIZATION OF COMMUNITIES 16 members of the sSoTF including Pocs from the counties will attend one arulual Review and one ssorF meeting at a cost of uS$2,800. Two mobilization visits to communities willcost US$ 2,000' Each CDD will receive one T-shirt for dishibution and advocacy- Theamount requested is uS$4,000. The totar surn of US$g,g00 is requested from Apoc TRAVEL To cover the travel costs of PCos and enable his/her to participate in meetings in other areassuch as Rumbek and Nairobi, and the travels of PSC *t p", di"-" for driveis, usS +,soo isbeing requested from the Apoc. The project needs to kelp an ,,Emergency Flight Fund,, toenable the staff to be evacuated in casi oi "-ergeo.y. rhe sum or usltzso o [-uag"t"J fo.this activity. A total of uS$6,050 is being requested from Apoc for this line item. COMMUNICATION A total of US$1,900 fo_r courier services, purchase of a modem and Intemet services is beingrequested for the PoC offrce in Yambio to facilitate communications befween tn. "o,rnryoffice, SSOTF office in Rumbek and the NGOs. OPERATIONAL EXPENSES A total sum of US$I2,500 is being requested for the following (i) maintenance and fuelling ofvehicles, motor cycles; (ii) _maintenanie of equipment; (iii) utiiiie, ura (ir) uurt pur"r,ur" inatransportation of fuel from western Kenya to the CDTI project office in yei, eu.inqurto.,r., 3 10.9 5t SSOTF SECRETARIAT Name Dr. Bellarro Ahoy Samson P. Baba Agum D lssac John M. Samuel Martin Mande Betty lmoya Kennedy Jaden Robert Ajobe Yei MichaelLugalla KajoKeji Paul Duku Magwi Julius Kenyr Jacob Agnes Ochaya Richard William Geri Jino Mark Benson Ongwea Santo Longa Torit Terekeka Banza Daniel Designation Charrman SSOTF SSOTF Coordrnator Deputy coordrnator Administrator Data offrcer Secretary Drrver Assistant driver OV Supervrsor VOM Hospftal St Bakhrta PHCU Anzara PHCU Olil$/iPHCU Jale PHCU Pageri PHCU % time Experience 100 % 100 % 1O0o/o 100 % 100 o/o 100% 100 o/o 100 % 5 Years 5 Years 1 year 1 year 1 year 1 year 1 year 1 year OFFICES One in Nairobi and one in Rumbek 2. EASTERN EOUATORIA COUNW STAFF Name Designation Juba Emmanuel Ezama % time Experience 8 years 6 years 3 years OV Supervisor 25% OV Supervlsor 25% OV Supervrsor 25o/o 25o/o 25o/o 25o/o 25 o/o 25% 25% 3 years 3 years 3 years 3 years 3 years 3 years 3 yearsOV Supervisor 25o/o I. INPUT FROM HEALTHNET INTERNATIONAL LOGISTICS 2 Vehicles 4WD OFFICE SUPPLIES Nairobi and Lokichoggio offices Utility bills COMPUTERS AND OFFICE EQUIPMENT 1 laptop lo.3 E^9 2 Desl(ops Fax machines Video camera, ordinary camera Heavy duty safe Office furniture (Narrobi and Lokichoggto office) COMMUNICATION VHF Radio contacts- Nairobi office Two mobile phones and one land line OFFICES One building with 6 rooms and meetng room in Nairobi One otfice in Lokichoggio 1. Health net lnternational Name: Post Description lrene D. Mueller Program Manager Fasil Chane Program Coordinator Agnes Ngina W. Administrator Cornelius Ndungu Logisticiar/driver Function Experience Management of programme TyearsCoordination TyearsAdmrnistration 7 years Logistics and driving 7 years II. INPUT FROM SUHA LOGISTICS 1 vehicle 4 motor bikes 14 bicycles OFFICE SUPPLIES Stationery and utility bills COMPUTERS 2 laptops in the field 3 desktops COMMUNICATION VHF Radio contacts OFFICES KajoKeji County - 5 rooms Kampala - 4 rooms Nairobi - 2 rooms liaison r o.3 53 2. Sudan Health Association (SUHA) (Lead NGO) Post Description FunctionName: Dr. Pius Subek Justus Lugalla Paul Jaden Sebit Ezbon Charles Wani James lrama Alison Duwa Anne Mulama Experience Drrector Freld coordinator PHC Supervrsor Administrator Trainer Malaria control Clinical officer Secretary/Admin Member SSOTF Coordrnator Supervisor Admrnrstrator Trarner Supervrsor Supervrsor Admrnrstratron 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 6 months PART V: APPENDICES 11 55 APPENDIX 1:ESTIMATED NUMBERS oF COMMUNITIES AND PERS ONS TO BE TREATED EACH YEAR, BYENDEMICITY LEVEL AREA COVERED. ease see note below YEAR 1 YEAR 2 YEAR 3*' YEAR 4** ** YEAR 5 onchocerciasis is not considered an important Pubtic Health problem in hypo-endemic communities and Apoc will not normallyfund communitydirectcd treatment in such communities. The inclusion of such communities in the proposal will require a specialjustification for consideration by the TCC. It is understood that the figures for years 2-6 are likely to be estimates which may change as the projectprogresses. COMMUNITY ENDEMIC LEVEL HYPER-ENDEMIC MESO-ENDEMIC HYPO- ENDEMIC TYPE OF TREATMENT Communitydirected Community-directed Community- directed No. of communities to be treated 12 16 10 Total population in above communities 27,141 74,724 119,703 No. of communities to be treated 12 16 10 699 Total population in above communities 38,773 106,749 171,N4 be treated 370 No. of communities to 12 16 10 Total population in above communities 55,390 152,499 244,292 be treated 400 No. of communities to 12 16 10 571 Total population in above communities 79,129 217,855 348,989 No. of communities to be treated (438) 12 16 10 Total population in above communities (940,816) 113,040 311,221 499,535 N s's "* The number of communities within 10 KtVl of each endemic community assessed by REMO is not completely known. However, during implementation, the project will include all communities surrounding those assessed, as they implement CDTI. ,:' APPENDIX 3: INDICATORS FOR EVA[.1'ATION, SIJSTAINABILIW/INTEGRATION OF CDTI Pro.[ect Evaluation IVlanagennent 4$ Frnancral management 1S Effectrveness of communrcatrons fi Trarning and capacrty burldrngfi lnstrtutional commitment tr$ Fulfrlment of other relevant sectorsfi Problem solvrng capacrtyft lntegration of operational research Project effectiveness ft Result of KAp studres{ Treatment coverageI Follow-up of non-elrgrble and absenteesfi Management of adverse reactronsft Retiabitity of reportrng S u sta i nabi I ityll nteg ratio n Politicial will of host government 1f, polttical will as shown in policy statements and apparent commitment of hrgh-level offrcrals1$ offrcral actron asslgntng personnel, funds, vehrcles to programme [-ong-terrn planning fi ts there a long-term plan for sustatntng the frnancrng and the management of the programr.e-2 Prog ress toward financial sustainabil ity dtr lf programme sponsors cannot conttnue tnelr current level of commrtment for at least anotherftve year, what percentage of runnrn!l costs rs rro\,,/ pard for host governments or fees? Frogress toward integration ' to what extent has ivermectin distribs.{ttlr.rn heem integrated with other health serviceprogrammes? r evidence of community empowerrnent and ov;nershiplJ change in KAp over time l_l extent of involvement of both genders and ncn_literatest' extent of invorvement of rocar cornrnunity-directed organizations 5'' East Equatoria cDTr project, southern Sector sudan Year 2: 20Os A. Personnel SSOTF Project Coordrnator Offrcer (pCO) ProJect Supervisors Cierk (Finance and Sec) Dnver Asst Driver Secretary Guard rOTAL rsonnel 3. Capital Equipment OTAL ), Office OTAL Office t. Office Supplies Drskettes pack of 10pnnter cartrldges (colored Printer catridges (Black and white) Tone Bulk )TAL Office S Training and Education Refresher for TOT on CDT| Transportation Feedrng Accomodatlon Refresher for Tratn of Heallh staff Trarnrng of CDDs Compute r trarntng for project Coord Compu ter t.aintng for Secreta ryComputer tralning for Clerk Refresher courses for s taFf TAL Train ing and Education Distribution Mater and Drugs CDD treat reg (h cover)/Tally sheets Summary forms Drugs & Krts for pHC Unrts (Loa) Non Medrcal Su Rucksack (Bags for CDDs rpphes ) m boots)T )istri cost M - -..izati ens on SSOTF/project review meeting nsitization of CommMobilization/Se T-Shirt for CDDs AL Mobilizati, on/Sensitization 'ravel S SSOTF/Secretariat Travels PCO + drivers Trav/Superv. & Monit r-uus- I ravels/Superv & Monitoring NGDOs Travels/Superv & Monrt Fti to Yei & Nairobi '\L Travel rmmunication Courier Telephone/Fax/Modem lnternet services rL Communication Item SC ron m I IME/Mths Unit cost l'ot. Cost (US MOH TOTAL (US$) 1 6 1 1 1 1 1 12 2 tz 12 12 1 350 120 .150 100 1s0 50 4,200 8,640 1,800 1,800 1.200 1,800 600 0 0 0 ol 0 0 0 0 0 0 0 0 0 0 ,800 ,800 4 8 1 ,l 1 1 4,200 8 6401 1.800t 1,8001 ;,:::l 10 1 150 1,5001 0 0 1,500 0 1,500 0 0 0 0 1 4 6 1 12 5 70 600 10 70 3,600 950 120 3s0 600 280 I 0 0 0 0 0 0 0 1 1 600 0 120) 3s0l :3sl 3.6ooJ 1 1 1 9 1 o aa 70 6 45 isl 0 0 1 1,612,750 300 3,6 560 4 zUU 1 1,000 0 0 0 750 2,ooo ] 0 0 0 2,500 2,000l 1 1 1 6 2 1 1 1 1l 1 900 2,150 6,00 5,300 200 200 200 3oo 560 48 360 5400 10,000 200 200 2,700 0 0 0 800 19,668 4,950 5,400 1 560 48 36 2 700 200 1 100 500 1 10001 loool 131 7l 2 0.5 2500 2.200 250 2,5001 13 oool 7,0001 0 0 0 0 0 0 0 0l 1 7 2,200 2,500 2 7 2,200 13,000 24,9s0 50 16 1 1,000 2 2 1 a1 a 1 000 4 2,800 2,000 4,0001 0 0 0 0 0 0 2,800 2,000 4,000 4 2,800 8,800 0 0 8,800 8,8 Flat amount 'tl Flat amount Flat amount 1 1 1 2,o00 1,600 1,200 2,0001 1,6001 1 ,2so I 1,2s0 1,200 2,000 1,6001 1 2 ,| ,600 16,050 0 0 6,050 6 50 Flat amount Flat amount I 500 1,000 4001 500 1,000 400 0l sl 0 0 ol 500 1,000 4ool 50 1 1,900 0 0 1,900 .0 >erational Expenses 1 1 1 1 1 2 | 24,e50 East Equatoria CDTI project, Southern Sector Sudan Year 2: 20Os qurpment maintenance Utrlrtles Vehrcle maintenance Vehrcle fuellng Motorcycles fueltng Soaps for hand was hrng (CDDs) Bulk RAND TOTAL A.-.J rcentage of Total E )TAL Item )Uon # ltem TIME/Mtht Unit cost Tot. Cost usr MOH NGDO APOC TOTAL us$Flat amount Flat amount Flat amount Flat amount Flat amount616 Flat amount s00 2,000 1,500 4,000 1,500 241 3,OOOl 500 2,000 1,500 4.000 1,500 864 0 0 0 0 0 0 0 0 0 ol 864 0 500 2,000 1,500 4,000 1,500 0l 3,OO0l 500 2,000 1 ,500 4,000 '1 ,500 864 3,ooo] 13, 0 864 12,500 13 us$ us$ US$ US$101,222 3,050 8,664 89,509 101,222USD 100% 3.01% * 8.56% 88 43% 100yc I East Equatoria CDTI project, Southern Sector Sudan Year 3: 2006 Motorcycles fueling Bulk Tra Soaps for hand washing (CDDs) tron 'OTAL tional ses }RAND TOTAL A.-J ercentage of Total Desc # ltem TIME/Mths Unit cost ot MOH- NGDO APOC rorAL (usgFlat amount616 Flat amount 3,000 24 5,000 3,000 864 5,000 1,000 0 2,000 1,000 864 1,000 'l ,000 0 2,000 864 000 3,000 19,864 7,000 4,364 8,500 19,864 US$ US$ us$ US$113,954 19,512 16,414 78,929 113,954USD 100% 16 26% * 14.42% 69 32% 100% US$ 5: East Equatorla CDTI project, Southern Secton Sudan Year 3: 2006 4". Fersonnel ;SOTF OT'.1L Personnel IGDO l. Ca ital ut OTAL Office Equipment Metallic cabinels Metallic Trunks fTAL Office Office Supplies Drskettes pack of 10 Prolect Coordrnator Officer (pCO) Pro,ect Supervrsors Clerk (Frnance and Sec) Drrver Asst Drrver Secretary Secu Guard Printer cartndges (colored) Pnnter catfldges ( Black and white) Toner (photocoprer) Bulk Stat P Training and Education Trarnrng of CDDs Computer trarning for pro1ect Coord Computer trainrng for Secretary Computer training for Clerk )TAL Office Refresher courses for staff 'AL Training and Education Distri ution Mater. an Drugs CDD treat.reg (h cover)/Talty sheets Summary forms Drugs & Kits for pHC Units (Loa) Rucksack (Bags for CDDs Non Medrcal Su pphes um TAL Distributi on Material Mobilization/Sen sitization T SSOTF/project revrew meeting Mobilrzatlon/Sensltizatton of Comm T-Shirt for CDDs l-ravel SSOTF/Secretarrat Travels PCO + drivers Trav/Superv & Monit. PSCs Travels/Superv & Monitoring NGDOs Travets/Superv & Monit -AL Mobilization/Sens itization to Loki Yei & Nairobr AL Travel ommunication Couner TelephoneiFax/Modem lnternet services AL Communication perational Expenses Equrpment matntenance Utrlrtres Vehrcle marntenance Vehrcle fuelrng Flat amount FIat amount FIat amount Flat amount 2,000 2,000 2,000 5,000 2,000 2,000 't,000 0 1,000 2,000 ] 500 2. 2, 2 0 0 1 2 2,000 5.000 Itenr )tron # ltem M Unit cost fot. Cost ;$l MOH- APOC us$) 1 6 1 1 1 1 1 1 12 12 12 12 12 1a 350 120 150 150 100 '150 50l 4,200 8,640 1,800 1,800 1,200 1,800 600 180 1,260 2,592 540 540 360 l 0 0 0 0 0 0 oi 2 1 1,26 1,260 420 6,048 1.260 4,200 8,640 1,8001 1.8001 rfnl 0 0 0 0 0 1 1 160 50 800 800 250 0 800 2501,0s0 0 1,0s0 0 1,050 4 6 1 12 E .10 70 60 701 8oo I 120 3s0 600 280 I 4,S00 | 0 0 0 1 000 0 0 0 0 1 200 1 a a0 350 600 60ol 280l 4,S00I 120 350 6,150 1,000 1,200 3,950 150 2000 1 I I 9l 2 J 300 300 300 300 20,000 3o0l sssl 2,7ool I 000 0 0 ol 000 0 0 0 800 9,000 300 1,900 2 20,00n 300 300 23,600 2,000 9,800 I 1,800 23, 1 1 500 1 1 000 05 3000 13 7 3,000 300 3,000 1 3,000 7,000 i 0 0 0 0l ol 0 0 0 0 0l 3,000 300 3,000 13,0001 7,0001 3 3,000 13 7 26,300 26,300 26,3 16 1 1,000 I 2 1l 875 1 000 4 2,800 2,000 4,000 0 0 0 0 0 U 2,800 2,000 4,000 2,000 8,800 0 0 8,800 0 1 Flat amount Flat amount 1l Flat amount 1,250 1,200 2,000 1,600 1 1 1,200 2,000 1 400 600 500 750 1 800 1,000 1 2 1 0 1 6,050 2500 0 3,550 6,050 Flat amount Flat amount 500 1,ooo] 5001 500 1,000 500 0 0 0l n 0 0 500 1,000 500 500 1,0001 4001 0 0 2,000 2,000.0 t a 5,000 1,000 500 |--NGT6- EOTAI 1 1 1 1 ,600 .2s01 2,000[- East Equatoria CDTI project, Southern Sector Sudan Year 4: 2007 A. Personnel SSOTF Prolect Coordrnator Offrcer (pCO) Pro]ecl Supervtsors Clerk (Frnance and Sec) Drtver Asst Drrver Secretary Guard -OTAL Personnel i. Capital Equipment OTAL ). Office ut OTAL Office Bulk Stat )TAL Office Supplies Training and Education Trarnrng of CDDs Refresher courses for staff )TAL Trainin and Education Distributi on Mater. andD rugs Summary forms Drugs & Krts for pHC tJnrts (Loa) Rucksack (Bags for C t. Office Supplies Diskeftes pack of 10 Printer cartndges (colored) pflnter catndges (Black and white) Toner (photocoprer) Non Medrcal Su )TAL istribution Materials Mobilizati on/Sensi tization TAL Mobilization/Sensi tization Travel SSOTF/Secretarrat Travels IAL Travel ior;rmunication Couner . Telephone/Fax/Modem Internet serytces AL Communication SSOTF/pro;ect revrew meeting Mobrlizahon/Sensttrzatron of Comm T-Shirt for CDDs DDs) (Gum boots) PCO + drivers Travlsuperv & Monit. PSCs Travels/Superv & Monitoring NGDOs Travels/S uperv & Monit to Loki, Yer & Natrobt Item # ltem Unit cost I'ot. Cost MOH NGDO APOC -rorAl (us$ 1 6 1 1 1 1l 1l 1) 11 12 12 12 12 50 1 350 120 150 150 1001 1 1,200 1,800 600 4,200 8,640 1,800 1 2,520 5,1 84 1,080 720 1,080 1, 0 0 0 0 0l 0 0 0 8,01 1,680 3,4 56 720 480 4,200 1,800 1,800 1.800 600 10 1 150 1,500 0 1,500 0 1,500 1,500 0 1,500 0 1,500 0 0 0 0 0 12 '10 4 6 10 70 60 70 1oo0l 0 0 0 2000 0 0 0 2000 120 350 600 280 2,OOOl 120 3sol 60ol 280l| 6,000 |7,350 2,000 2,000 3,350 7,350 2500 9 2 1 300 25,000 2,700 10,000 0 5,000 1,000 10,000 1,700 25,000 2,700 27,700 1 0,000 6,000 1 1,700 27,700 800 1 1200 1200) 1 1 1 1 05 3500 13 7 400 3,500 15,600 8,400 0 1,500 5,000 2,000 0 1,000 5,000 2,000 400 1,000 5,600 4,400 400 3,500 15,600 8,400 27,900 8,500 8,000 11,400 27,900 16 1 1,200 2 1 90 12oO 4l 2,880 2,400 4,800 0 800 1,000 0 'l ,000 1,000 2,880 600 2,800 2,880 2,400) 4,8001 10,080 1,800 2,000 6,280 10,080 Flat amount 1l Flat amount Flat amount 1 1 1,400 2,200 1,800 1,5oOl 1,400 2,200 '1,800 500 500 1000 800 0 0 1,000 900 1 1, 1,400 2,200) 1.8001 , udl 6,900 2800 0 4,'t 00 6,900 Flat amount Flat amount I 5001 oool 8oo I 1 500 1,000 800 OI 3i 0 0 0 500 1,000 8001 500 1,000 400 2,300 0 0 2,300 2,300.0 escnptlon 20, 1 1 I 1 1 120 350 600 280) 6.000I East Equatoria CDTI project, Southern Sector Sudan Year 4: 2007 Operational Expenses Equipment maintenance Utllrttes Vehtcle maintenance Vehicle fueling Motorcycles fueling Soaps for hand washing (CDDS) Bulk Tra )TAL Operational ,RAND TOTAL A.J ,rcentage of Total Item # ltem r ilYtE/MInS Unit cost rot. Cost (US$ MOH NGDO APOC TOTAL (US$ Flat amount Flat amount Flat amount Flat amount Flat amount616 Flat amount 2,500 2,500 s,500 3,500 24 3 864 2,500 2,500 3,000 5,500 1,000 2 1 0 2,000 1,500 'l ,000 1,000 0 1,500 864 1,000 500 z ? 2,000 1,000 23 5,500 2,500 2,50 23,964 8,000 6,364 9,500 us$ us$ us$ US$ 127,634 45,124 25,964 56,646 127,634USD 100% * 35.35% 20.26% 44.38o/o 100% a I 3.500 864 6.oool A. Personnel SSOTF ProJect Coordrnator Offrcer (pCO) Prolect Supervrsors Clerk (Frnance and Sec) Drrver Asst Drrver Secretary CDD treat reg (h co,.,lr)/Tallv Summary forms Drugs & Kits for pHC Units (Loa) Rucksack (Bags for CDDS) Non Medrcal L Dist tion rials Mob izatio sitization ,. ^4ice Supplies Drskettes pack of 10 Prrnter cartridges (colored) Prrnter catridges (Black and whrte) Toner (photocopier) East Equatoria CDTI project, Southern Sector Sudan Yean 5: 2008 boots Guard I'OTAL onnel i. Capital Equipment Vehicte Lap Top computer OTAL ;. Office E OTAL Office Bulk Stat c )TAL Office Supplies Training and Education Trarning of CDDs Refresher cou rses for staff )TAL Train and Education Distrib ution M ater. and Drugs SSOTF/project review meetrng Mobrlrzatron/Sensitrzahon of Comm T-Shrrt for CDDs T, rb Travel SSOTF/Secretanat Travels PCO + drivers Trav/Superv & Monit. PSCs Travels/Srpe*. & tu,t onrtoring NGDOs Travels/Su perv & Monit ts to Yei & Nairobi 'AL Travel ornmunication Courier . Telephone/Fax/Modem lnternet services Item on # ltem Unit cost Iot. Cost (US$ MOH NGDO APOC roTAL (Us$)- 1 6 1 1 1 1 1 12 12 12 12 12 12 PI 350 120 150 150 100 150 501 4,200 8,6,10 1,800 1,800 1,200 .1,800 600 3,360 6,912 1,440 1,440 1.440 480 0 0 0 0 0 0l 1 240 36 840 1,728 .8001 ;ff1 4,200 8,6-1u 1,8001 20 1 0 4,008 20,040 1 1 2 3 25,000 2,500 7 25,000 2,500 0 0 0 tt 25,000 7,000 25,000 iffil 34,500 0 34,500 34,500 0 0 0 0 1 7 '15( b .10 70 601 701 12ool 150 490 900 I 3s0 I 7,2oll 150 490 900 2600 0 0 0 0l 0 0 0 2 150 490 900 3s0l 7,2oll 9,090 4,490 2,600 2,000 9,090 '1000 o 2 1 A 400 '10,000 3,600 5,000 1 ,100 3,000 1,000 2,000 't,500 10,000 3,600 13,600 6,100 4,000 3,500 13,600 500 1 000 1 1000] loool z 05 3500 13 7 1,000 500 3,500 13,000 7,000 U 0 3,500 8,000 4,000 0 0 3,000 2,000 2.0001 1,0001 1,000 500 0 1,000 500 3,500 I 3 oool 7,oo0 |24,000 1 5,500 5,000 3,500 24,000 Itl 1 'l ,000 2 2 1 90 1200 4 2,880 2,400 4,000 1,200 1,400 3,000 1,000 1,000 1,000 680 0 l 0l 2,880 2,400 4,000 9,280 5,600 3,000 680 9,280 Flat amount 1l Flat amount FIat amount 1 1,500 2,500 2,500 2 '1,500 2,500 1500 1 600 1,300 0 0 500 50ol 900 1.200 1,0001 2.5001 ,,oJl 1,500 2,500 8,500 4,400 500 3,600 8,500 Flat amount Flat amount I 500 000 800 1 500 ,000 800 1 0 0 0 0l si 500 ,oool sool 1 500 1,000 4002,300 0 0 2,300 2,300.0 AL Communication 1 1 1 1 1 1 l 1 1 1 1 1 2.000 East Equatoria CDTI project, Southern Sector Sudan Year 5: 200g Operational Expenses Equrpment matntenance Uttltttes Vehrcle marntenance Vehrcle fueling Motorcycle s fueltng Soaps for hand washing (CDDs) Bulk Tran TAL Operational IAND TOTAL A.-.J centage of Totat SC ton # ltem I tME/Mths Unit colT Tot. Cost US MOH NG-DO- APOC Flat amount Flat amount Flat amount Flat amount Flat amount616 Flat amount 3,000 3,000 3,500 4,000 24 5, 864 3,000 3.500 s,500 ,000 000 1 1, 2,500 2,000 2,000 7.364 864 1,000 1,000 1,000 't,500 1 1 1,000 '1,000 5o0l :*tl 3,000 3,000 3,5001 s,sool '33:l 6,0ool25,964 10,500 us$ US$ US$ US$147,174 62,622 22,464 62,099 14fi74USD 42.55% * 15.26o/o 42.19o/o 100c/o a , i TOTAIJUSS i'r ) a ll.l-lolol> N e\l cr) 1r) I cr)lo N N +v llolslolol> N o)() N q N N n @(o I rI G' o o) rO + 1r)o co tr) cr) NN (\ (E o r @ c) $o N q (U o c/)q cf) vq cv) $ oq c! @ o E o o o a- u UJzFu o- .L o UJ lJ. o z o F- =o Et-z o o o L t!& (J G'o o o J cl tr oo o \o o ! oF a ** The number of communities within 10 KM of each endemic communityassessed by REMO is not completely known. However, during implementation, the project will include all communities surrounding those assessed, as they implement CDTI. I a f,liri a ) N <) -t -o 3 ("0 d.{.(? -l @ --t o c o :) 6 a 4 o ) ! 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