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TIPPER NILE (UN) CDTI PROJECT i

whou nproi ect@ gmail. com

ORIGINAL: Enslish

COUNTRY|NOTF: Southern Sudan Proiect Name: Upper Nile CDTI project

Approval year:2003 Launching year:2006

Reporting Period: Frorn: January 2009 To: December 2009(Nlonth/\'ear) ( MonthA'car)

IAPC)Cfundinqycar: (circleonc) I 2I (1) 5 6 7 8 9 l0 1l 12 t3l-I

lAtqcProjectinrplenrcnt:rtionyearrcport: (circlconc) I 2 3 (4) 5 6 7 8 9 10 ll 12ln-I nrt. rrr-itl*-,rr -Tts4-r",.'l- i Minisrnot'lleelthI I - All'ican Progranrnre tbr Onchocerciasis Control 1AI'O(')I | - ' Vt".rizan Donarion Progranr INIDP)

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ANNUAL PROJtrCT TECHNICAL REPORTSUBMITTtrD TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

DEADLINE FOR SUBMISSION:

To APOC Managernent by 3l January for March TCC meeting

To APOC Management by 3l July for September TCC rneeting

AFRICAN PROGRAMME FORONCHOCERCTASTS CONTROL (APOC)

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APCC /WHO/APOC, l4 Septenrber 2009

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GENEReI Ir .w For{rr L\TIoNDa.scription of the proicct (brie/11,)

. Portner.sltiltPoptrr.ettoN........

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SIICTION 2: MPLEI\{ENTATION OF

2.1. 'l'tlu.l.rNg oF:\c'TI\,'trtES .. ....... ... .. ti22. ..\ovoc.rc\ . .. .. . .... l01.3. N4ogtl-lz.rttoN.sENSIt'tzA'noN'ANcrHe.^rt.tuhDrr(-,\rroN()F,.\TRISKcoNIi\lLiNI't'tES I02 1. CoirtirtuNtty INy9L.\/EN1EN I-........... . .... 12

l -). C,u,ACI'fy BUII-DING... .. ll2.6. l-RserlrgNt's.............. ... .. 15

2 6 l. T'realment /igurc.s ..

2.6.2 ll:hat urc lhc ccruse.s of ab.senteei.snt.)2.6.3 l['lrut ere lhe reason.s .for refusal.s'?

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2 6 4 Brie.fl1'describe all knotvn and wrified seriou,s uclt,erse et,ents (SAEs) thut . . l-2.6.5.7.rend o/.treatntenl uchievemenlfrom CDTI project incclttion to tlrc currant )tcctr l9

2.7. ORopnrNc, sroRAGE AND DELIVERy oF TvERN,IECT'rN ...............202.8. CoH,rrrruNtty sELF-NToNIToRING AND S't'AKEuoLDERS MpErtNc ............212.9. SupeRvrsroN............... .............. 22

2 9. I . Provide a.flov' chart of supervisiort hierorchl2.9.2. l'['hat wcre lhe main issues identified during s'upert'ision')2.9.3 l'l/asasupervisionchecklistttEed? .. .....222.9.4 ll'hal v.'erc the otficornes al cach level o.f CD7-l implcnrcntutiott supervi.ston'? 222.9.5. Itr'as /bedback given to the person or groups supcrvised? . . l32 9.6. Hov'v,cts the/bedbackused to irttprove the ovarall parfornrurtce of the prrlec't'?

23

SECTION 3: SUPPORT TO CDTI ..............2-1

, 3.1. EqurelreNr . .. ..233.2. FINnNctel coNTRIBUTIoNS oF THE pARTNERS AND coN4N,luNt'rrEri............. . ...........24

. 3.3. Oruen FoRN,ts oF cotvltvtuNt'ry suppoRl............. ..283.+. ExpeNnrruRE, pEIl Acrrvrr\' ...........28

SECTION 4: SUSTAINABILITY OF

4.1. [Nrrnual; TNDEpENDENT pARTICIpi\ToRv NIoNlTot{tNc; Ever-u,rnoN.......... ..........281 I I Ha.s the proiect ever bccn cvaluatcd,irnonitored'? (Tit'k an;' o/'thc followittg whicltara apltlicuble) .. Erreur ! Signet non ddfini.1 I 2 trlrhat we re the recontntendation.s? 284.1 3 l{ov, ltat'e they bean intplemertted? . . . .. .28

4.2. SusrrrtNaetLITy oF eRoJECTS: eLAN AND sET TARCI rs (N,IANDA roRv At'..... ..28

iii WHO/APOC, 14 September 2009

Yn 3) .......284.2.1. Planningatallrelevantlevels... .294.2.2. Funds. 294.2.3 Transport (replaceruent and maintenance) .. ... 294.2.1. Other resources .291.2 5. To v,hat exlent has the plan been implemented . . . . . 29

4.3. INrecRnrroN ............... .....................294 3. 1 . Iverntectin delivery rnechanisms ,.... .. . 294.3.2. Training .. . ... Erreur ! Signet non ddfini.4.3.3 .Ioint supervision and ntonitoring u,ith other progrotns. .... Erreur ! Signet nondifirti.1 3 1 Releusc o./.fitnd.s.for project actit,itier' . .

1.3.5 Is CDT-l includecl in the PHC bttdger'? .

......Erreur !Signet non ddfini.

. ... Erre ut' ! Signet nort ddfini.4 3 6 Descrtbc other health progrumrnes thal ure usiug the C'DTI strttctut'c ttntl hottthi.s tru,r ucltieved ll4rut hove been thc achieyeme nts'/. .... .

I 3 - Describe other,y i.t'slrcs cottsidcred irt lhe rntagralion rt"/ ('D7-l-l 4 Opgn.r'ftoN,\i. RusEARCtl

14 L\untrttut'r:a in rrct ntore tltun one hul.f'of o poga the opcrutirtntrl rasaurclttrrtdarlukcn irt tlta pr<tject arcu withitt llte raporting trtariocl Jj1 1 2 [Jott' trara lha ra.sttlt,y uppliecl in lhe pro.ject') . -i-i

SIICTION 5: STREN(;'fHS, WIiAKNESSBS, CHALLENGES, ANI)OPPORTUNITIES .....33

SECTION 6: tlNlQtlE FIIATIIIIBS OF THE PRO.IE,CT/OTI{IIlt NIAI"I'EI{S...........33

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iv WI{OiAPOC, l4 Septcmber 2009

Acronyms

APOC African Programme for Onchocerciasis Control

ATO Annual Treatment Objective

ATrO Annual Training Objective

CBO Community-Based Organization

CDD Cornrnunity-Directed Distributor

CDTI Conununity-DirectedTreatmentwithlvennectinClSIvl Cornmunitl, Self-Monitoring

LGA Local Government Area

NIOII lvlinistrl,' of Llcalth

NCIDO Non-(ioventntental DevelopmentOrganization

NGO Non-Goverrunental Organization

NO I'l' National Onchocerciasis Task Forcc

PII(' Plruran' lrealth care

IiLNIO Rapid Epidenriological N,lapping ofOnchocerciasis

S.\li Severe adversc cvent

SIIN,I Stakcholdcrs urecting

fCC l-cchnical (-onsultatirc ('omurittee (r\l'OC scicntiflc advison' grotrp)

l'( )1- I'rainer o1' trainels

tjNlCEF United Nations Clhildren's I.-und

tJ I'G Ultimate'l'reatnrent Goal

WHO World Health Organization

WHO/APOC, l4 Septernber 2009

Definitions

(i)

(ii)

(iii)

Total population: the total population living in meso/hyper-endemic communitiesrvithin the project area (based on REMO and census taking).

Eligible population: calculated as 84o/o of the total population in rneso/hyper-endemic communities in the project area.

Annual 'freatment Objective: (ATO): the estirnated number of persons living innreso/hyper-endemic areas that a CDTI project intends to treat rvith ivermectin in agiven year.

(i*) Ultirnate-l'reatnrent Goal (UTG): calculatcd as thc maxirnum nunrber of people tobe treated annualll, in meso/hl'per endemic areas u,ithin the pro.iect area.

ultirnatell'to be reached w'heu the project has reached full geographic coverage(norrnallv the pro.lcct shoirld be expected to reach thc IJTG at the encl ,rf the i'dr ear of'thc pltiject).

(r )'l'hcrape utic cor erau.c: r.rurnbcr ,rl people treated in a gir,'cn vear r)\'cr the total

1-ropulatiou (this should be erl;r'essed as a percentase).

(ieoqraphical coveraqe : r'runibcr o1'cor.r-rr.r.rur.ritics trcatcd in a given ,'"rt ..rrcr thc-

[otal nunrber ol- r-nesoihl,per-e ndenric comr.r.rr-tnities as identifled b1' RElr4O in thcprrr-iect area (this should be erpre sscd as a perccntagc).

(vii) Inteqration: deliverinq additional health interl'entions (i.e. r,itamin A suppleurerrts.albendazole for I-F. scrcening fbr cataract. etc.) througl-r CDTI (using the same

systerns. trainirrg. supervisiorr and personnel) in order to maxirnise cost-cll'ectiveness and empo\\er communities to solve urore of their health problerns.-l-his does not irrclude activities or intelventions carried out bv commurritrclistribLrtors outside of CDTI.

(viii) Sustainabilit-r': CDl-l acLivities in an area are sustainable u,hen thel,continue tcr

lunction cl'f'ectively' tbr the fbrcseeablc flture. with high treatment coverage,integrated into the available hcalthcare sen,ice, u,ith strong comrnunitl' orvnership.using resources mobilised by the conrnrur.ritv and the governrnent.

(ix) Cornrnunit), self'-nronitoring (CSM): I-he process b1, which the comrnunitv is

ernpowered to oversee and monitor the perfrrrlnance of CDTI (or any comrnunity'-based health intervcntion prograrnrne), rtith a vierv to ensuring that the programmeis being executed in the rvay' intended. It encourages the cornmunity to take fullresponsibilitl, of iverrnectin distribution and make appropriate rnodifications rvherr

Ireccssar)'.

(r'i)

t,i WHO/APOC, l4 September 2009

FOLLOW UP ON TCC RECOMMENDATIONS

Using the table belorv, fill in the recommendations of the last TCC on the profect and describehorv they have been addressed.

TCC session 29

Number ofRecommendation in the Rcport

TCCRECOMMENDATION

S

ACTIONS TAKEN BYTHE PROJECT

FOR TCC/APOCMGT USB ONLY

(r) 'l-rain CDDs u,ell toensure that tlie1,' givethe drug correctll' brheight. and on 1he

CD'fl philosophy toreduce the expectationol incentives or ernplorc'rthcr innovative u at's

like using samc people'

tbr paf ing and uon-paf ing comr-nunitvinitiatives

Additrorral ToTs rveretrained and the old ouesrelieshcd. CDTIphilosophv u,as stressed as

a nrajor component lbr theCDD traininq Additionala\\ areness creation ltasbeen givcn to the alreadr,,

cxisting CDDs so that ther'Lrnderstaud thc CDTIplrilosophr 'l-lre nurtrbcr ol'CDDs [ras also beenrrrcreased so that t[reu,orkload beconresrelativelv lessened.

(tt) Ensure monitoringcliecklist is produced inadequate nurnbers andis used

N,lonitoring checkl ists rvereprodrrced and the stalTs arcusing thenr.

(rir) CSM and SLIM shouldbe includcd in routineCDTI training andcornmenced as soonas the security situatiorrpermits.

CSM and SHM lras beenrncorporated in routineCDTI activities and sorneconrmunitres did CSM andheld SHMs.

WHO/APOC, l-i Septernber 2009

Executive Summary

This report is of the CDTI activities implemented in the Upper Nile CDTI project, fromJanuary to December2009. 'fhe project is in its fourth year of APOC funding. The project is

also being supported by CBM, an International NGDO that is part of the Southern SudanOnchocerciasis Task Force.

The total population served by this project in 2009 was 487,939 and it had a UTG of 409,869and an ATO of 259,766.It covered the 2 states of UpperNile and Jonglei and 6 counties and

it had the responsibility of providing treatment rvith mectizan to 525 communities.

5?0 cotnmuuities tvere treated in this reporting period. giving a geographic coverage of 99u/r.

A total of 213,691 persotts reccived mectizan treatment during this reporting lteriod. Thistreaturent figr-rre represents a therapeutic crri'cra-qe ol56 1ol,,. UTG coverage o1'66.8?6 andATO coverage of 105 1" .

I)opulatirtrt nrrtvc't'nerlts in the relrorling pcriod \\,ils itrc urarnlv cluc ttr retLlntecs ir-rto the projcctarea fl-onr the people tlrat hzrd bccn in cclnccutrated iu intema[ disltlaccrncnt scttlcnrcntslbllou'ing 1'cars ol-conllict and llood devastation in the 1tast.

,,\ total of 1.-120 C'l)l)s tverc tnrrned out of an r\-fO o1'1.108: bring doivn thc CDDipoltulationratio to l:34-l as compared to tlie 2001J ration of'l:1.26-5. In additron. a total of lic) healthrvorkers n,ere traiued in 2009.

A nunrber of challenges \\/erc firccd ancl rnajor ones includcd:. Still a number of CDT'I project staffs are still not yet on govcmmerlt pay'roll. Ilor,vcr,'er.

discussions are still ongoing "r'ith

stztte MoH authorities and there is ar-rticipation thattl-ris rvill occur with tirne.

o Data management is stilI arr issue. Mair-rtaining a good record of CDTI activities by theCDDs and also some of Supcrvisors is still a problern. All County and Payam wereconstantly rerninded o1'tl-re importance of good data managernent and asked to closelr'supervise the CDDs on record keeping.

o Getting project supplies delivered still remains a big challenge - the n.redicines and

training materials have to be airlitied to the project site belore the rains begin. If this is

not done befbre the onset of rainy' season, then it becomes virtuall), impossible to havcsupplies delivered because of the terrain in this area.

WHO/APOC. l4 Septenrber 2009

SECTION l: Background information

1.1. General information

1.1.1 Description of thc projcct (briefly')

Gcographical location, topographl', climate1-he Upper Nile CDTI project is located bctrveen latitude 5oN and I l"N and betrveenlongitude of 29'E and 35"E. It is situated in the Northern section of Southem sudan and

borders lvith Ethiopia. Tlie project co\/ers the trvo States of Jonglei and Upper Nilel thecounties of Akobo. Pochalla. Boma. Longichuk. Mairvut and N,laaban

'fhe Upper Nile CDl-l project lies in 3 ccological zones. -fhe rr.'estern part is a flood prone

zonc: the southern part is urainlt' savannah *'ith clav soils and the eastem part along Ethiopianborder being relativelv a hillv area. The eestcrn pf,rt is a cor-rtinuation of the Ethiopian platear.r

rvrtlr thst llosins rivers and streams ar-rd hcncc srritablc sites tbr ,Sittrilitrttt vector brccding '['he

Bonra plateau to the south is nrountainous and volcanrc in origin. ]-hc Pocltaila. Akobo ancl

Rahacl rivers drain this Upper Nile regron.

l-hc raiur, scAsou in this area besins in N,lay arrcl cnds in October: u,rth thc d11' season lastingfl'onr NorenrLrer to April. 'l-hc lirrurins activities start u'ith thc onset ol'thc rains.'l'he arca has

an anttual rarnlirll ol80() - 1000 rttillinretres ()r nrore in tlre sarannah arcas ancl thc [JonrirplateaLr. Floodrng is conrurou iu thc 11ood prone arcas clue to the last llou ing rivers lionr thcEthiopian liighlands. -l-hc llonta highlands are characterized b1'nrediunr \\et seasol)s that arccool and rainlall varics liom 600 - 1000 rnillimetres. During the dn' seasou. the mainsubsistence activity' is fisl-ring along thc rir,'crs. their tributaries and thc marshv areas.

Population: activities, cultures, languagcThe total population at risk of Onchocerciasis int'ection in the Upper Nile region is 487.939.With the returnees coming in from Kenya, Ethiopia. Uganda and Nortli Sudan and otherpopulation r-novernents within Upper Nile. the at risk population keeps tluctuating. ths flpperNile CDTI project area is home to Nuer, Murle. Anyuak and Dinka. Nuer poulation formsthe niajority of the inhabitants in the project area. The activities of rna-iority of the people inUpper Nile include cattle keeping. subsistence tarming. hunting and fishing.

Communication systems (roads...)Accessing the Upper Nile region is through .luba and Rurnbek in Southenr Sudan or tluoughEthiopia by air. The road infrastructure ranges fiom ver)'poor to non-existent; trar.'el by roadis only possible during the dry seasorl. In rainy seasol'l the rnajority of the project sitcs can't be

accessed; only'the county headquarters and surrounding villages can be reached. IVlovement ismuch easier during the dry season, rvhich lasts fi'on-r Nor,'ember to May. hence the need totarget mectizan distribution during lhis period. WFP flights operate in the region and facilitaternovernent of health rvorkers in different parts ol'the region. Motor boats and/or cauoes canalso be used to access the communities along the river banks. fhis proiect is situatcd in an

area that has the nrost challenging terrain in Southern Sudan.

Administration structureThe administrative structure in Upper Nile Iike in any other part o1'Southern Sudan is dividedinto state. county. Payam and Boma. '['he Boma is the lou,est level of governmentadrninistration. The state is administered by Governor. county by a Countv Comnrissioner,

WHO/APOC, l4 Septernber 2009

Payams by Payam Administrators and Bomas by Boma Councils. The project covered 6counties of Longichuk, Maiwut, Maaban, Pochalla. Akobo and Boma.

Health system & health care delivcry (provide the number of health posts/centres in thcproject area if the information is available)The Government Prirnary Health Care system is the main health service delivery system in thcproject area. There are also some NGOs running sorne of the health facilities in the area.

However, drug stock outs and lack of medical equiprnent and supplies cluonically affectsmost of the health facilities. There are a total of I 12 health facilities in the project area 82Primary Health Care Units (PHCUs). 23 Primarl, Health Care Centres (PFICCs) and 7 ruralHospitals.

Number of health staff in pro.ject area and numbcr of hcalth staff involvcd in CD-I'Iactivities.r\ total of 297 (35.3%) out ol8-12 health staff in the pro.ject area \\'ere involvccl in CDTIactivities. The break dou,n is shorvn belou.

Table l: Number of health staff involvetl in CDTI

Countl'- LGA

Nunrber of hcul

'l-olul Nunrller ofhcalth stafl'in thecntirc llrojcct arc:r

th stat'l involr cd rrr CD'l'l ac(ivitics.

stlff rnvolvctl irrcD'rr f

B, llr:Br, U, * r,r,,

Akobo 200 ,48?,1

Pochalla 58 5696.6

Borna 160 4628.8

Longichuk r-18 ,1021.0

Maaban 130 6s50

Mairvut t,16 4228.8

Total842 297

35.3

1.1.2. Partnership

Indicate the partners invoh'ed in projcct implementation at all levelsThe partners involved in CDTI activities in the Upper Nile CDTI are the 525 communitics,health facility service delivery' stafl-, though still r,veak and recluires sigrrilicant improl'enrcnt.the NGDO - CBM and WHO/APOC.A number of NGOs like Nile Hope Development Irorurn (NHDI') in z\kobo, lnternationalMedical Corp (lMC) in Akobo. Christian Mission Aids (CMA) in Dajor and Relieflnternational (RI) in Maaban provide their health staff to assists in training of CDDs and alsoin supervision of distribution as well as dissemination of infbrnration.

Describe overall rvorking relationship among partners, clearly indicating specific areasof project activitiesDespite the huge challenges faced u,orking in this project area. all the partners are rvorkedtorvards meeting the CDTI objectives. Partners jointly' carried out communitl' rnobilization.

WHOiAPOC, l4 September 2009

health education, training and mectizan distribution. The project staff conducted planningmeetings and advocacy sessions in conjunction with SSOTF and NGDO.

State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs,NGOs, CBOs, to assist in CDTI implementation.The CDTI project planned and irnplernented the conduction of advocacy rneetings. Themeetings were held with State, County and decision makers and NGOs to assist in theimplementation of CDTI activities. The states Ministries of Health rvere also contactedthrough the Director Generals on the need to have the CDTI program and staff integrated intothe Ministries of Health services of Upper Nile and Jonglei states.

WIIO/APOC, l4 September 2009

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2.2. Advocacy

State the number of policy/decision makers mobilized at each relevant level during thecurrent yearAt the project level, trvo state officials - the Minister of Health and the Director General rveremet and talked to about the CDTI activities and their support was sought. At the differentcounty levels, six County Commissioners and six County Medical Officers were met todiscuss the CDTI activities and they all pledged their support for the CDTI work. At thecommunity level, a total of 328 communitl, leaders/supervisors were mobilized for theirinvolvement in CDTI rvork.

The reason(s) for undertaking thc advocacv and the outcomeThe adr,,ocac\' \\,as trndertaken in order to:

o Attract lnore support through govenlmcrlt counterpart contribLrtion and ar\\,areucssabout CDTI strategv and activities

. Cotrtit-tt-te to drarv their attentiol-t or-l inclusion olCD'l-t into prinrarv heaIth carc svstclt.land continuine

. C'rcate owncrshil-l ol'the progralnrre bt' rarious comnruuities.

The outcornc(s)l'he outconrcs realised incltrded:

. -l'he hczrlth authorities acknouledged tl're need to have the C'D]-l activitrcs inclLrdcd in

PHC activities and all CI)TI staflonto thc pavroll.. The cot-trmuuities tnet also expressed their comrnitment to the cause o1'the OV

progranl.

Describe difficulties/constraints bcing facedThe constraints included that:. The health authorities could not make a f-rrm cornmitment to the suggestions that rnade

about laking on CDTI staff onto the goverrunent payroll due to budget constraints.. There were sotre zrspects of inadequacl'of advocacy skills/approaches since sonre pcrsous

and comrnunities need to be approacl-red rvith caution.. There \vas a logistical cl-rallenge of inaccessibilitv of some of the areas due to flooding and

swampv nature of the project area.

Suggestions on horv to improve advocacyo Continued and persistence rvith the he health authorities so that CDTI issues are kept on

the agenda of the ministries of health.. Training of CDTI staff on advocacy skills and methods.. Conduct adr,'ocacy during the drier seasorls of the month or consider purchase or hiring

boats for transportation in sorne pafts o1'the project area.

2.3. Mobilization, sensitization and health education of at riskcommunities

Thc use of media and/or other local systems to disseminate information. In 2009, the use of mass r-nedia for infbmration dissenrination was not a possibilitl

because of the non-existence of FN4 radio stations in the project area.

. 'fhe mobile phone cornpanies liad also not extended their netrvork coverage over thcproject area.

l0 WHOiAPOC, t4 Seprernber200g

. Information is mainly passed by word of mouth through traditional systems of villagechiefs, sub chiefs, and headmen or at the community meetings.

o Announcements in churches; women's groups and village health committees nreetingsrvere used to disseminate informatiou.

Mobilization and health education of communities including rvomen and minoritiesCornmunity mobilization and health education of communities rvere done at various locations

especially through home visits; group discussions in the community, health centres and in

places of worship. The kef issues discussed were sclection of CDDs and involvement ofWomen in CDTI activities. More rvornen were noticed to lrave begun participating in CDTIactivities

' Rcsponse of target communitics/r'illagcs. General irnprovenrent in conrmunity,ini'olveurent ancl ciunc-rship ol'thc prr)gram.

Conrnrunitt' have taken more responsibilitv in coilectiou and clrstribution o['nrectizan. The nuurber o1'CDDs selected b1'the c()lnu.luurtv incrcascd. Therc \\rls nrorL- perticipation olu'onrcn uoted.

Acco nrplishnrcnts. -lhere were l)() relirsals rcported. the people absent \\/crc zr\\':lv grazing thcir livcstock. 'l'he numbel ol-CDDs increased to 1.420 as corrlpared to i81 in 2008. Cou-rurunitt'members r.rnderstood their roles :rnd denrand ol'urectizan greatIf increasccl

leading to iucreased geographic and therapeutic tiom 51.1o./o and 38.591, in 2008 to c)i.9(r'o

and 56.1%o respectivell,in 2009.

Suggest rval's to improve mobilization and sensitization of the tirrgct communitics.. Because of the difficulty there is in rnoving frour one countl, to another and also s,ithin

one county, the Counly Supen,isors and their respective County Health Departr-nent stalfshould be fulll,take charge of the mobilisation and sensitization of cornrnunitics as

opposed to have to wait fbr the PCO to take lead on this.. Having a rnyriad of comrnunitl,leaders, church leaders. r,arious local NGOs involved in

speaking to their audiences about OV so that opportunitl, of harve an1, cornrnunitvgathering is not lost.

. Having continuous involvement of more wornell in the CDTI r,vork, since thev are theprirnary care takers o1-the faniily unit. then more of their larnily member rvill access the

treatment.

1l WHO/APOC, l-1 September 2009

2.4. Gommunity involvement

Table 4: Communities participation in the CDTI

Attcndancc of female members of the communi$' at health education meetingsln many courmunities in thc proiect areas. I'emale attendance increased at health educationrneetlngs.

In general, hon,do I'ou rate the participation of femalc members of the communitymeetings rvhcn CDTI issues are bcing discussesThe participation of fernale members rvas l-air; thev are gradually coming out to take parl inthese discussions.

Incentives provided by communities for the CDDsNo incentirres are provided to CDDs

Attrition of CDDs. Is attrition a problem for the project? If yes, horv is it addressed?Yes it is a problern and it was addressed by continuously preaching the CDTI philosophy.

Other issues - None

ounty - LGA

Number of communities/villages withcommunity members as supcrvisors

Number of CDDs and the communitiesin volved

Number of communities/villages with fcmale CDDs

Total no.conrrnunitiesin the entireproject area

B,

Number withcomm u n it-l'

rnembcrs as

supervisors

B5

Percen tage

Il r:lls/ B! * 100

r\{are cDDsl ffir I rotar

I

Br Bt i Br= Iir+B*

Number ofcom m u nitiesw ith femalc

CDDs

I],^

Perce ntagc

lJrr=llr0/Br* 100

Akobtr r36 l9 ll 196 10"1 300 45 )).Yo

Poc ha lla 67 II t6l llr 9.1 2t5 _1 -)+.)-/o

Bornu 8l ()9il I

r86 lll 300 l9 l_l .10,,;

[-onsichuk 9i ll ll (r1.17 r08 25s 26 )-1 lo'

I\4aaban .l8 0l l: Irii 67 150 ll t1,+ toLt)

N,lairr Lrt ti lt ti tl.l l5l .18 200 l6 t 8.29,,,

1-O'IAL{:, < 73

lJ.9 88s 535 1,420 11327.3"1,

t2 W[IO/APOC, l4 September 2009

2.5. Gapacity building

Describe the adequacl, of available knowledgeable manpower at all levels. Availability of knowledgeable manpower in the project is still quite inadequate at all

levels.. The endemic areas are located in such a way that travelling between the 6 counties is a

huge challenge especially with the predominance of swampy/marshy vegetation andwith no roads. An additional staff at the level of a PCO to cover tire counties in UpperNile state could benefit the progranr as regards monitoring and supervision of thepro.ject.

. 'lhc Countt, Supervisors and Pal,am Supervisors are relatively knorvledgeable abor.rt

CD'fI. The CDDs have been trained, but still reclLrire on the job nrer-rtoring.

\\/here frcquent transf'crs of trained staff occur-, statc u,hat thc project is doing, orintends to tlo, to rcmcdv thc situation.Stall'transl'e rs clicl not happen in this rcporliug period.

13 WHOiAPOC, l4 Septernber2009

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Table 6: Ty,pe of training undertaken

An1' othcr cornments - None

2.6. Treatments

2.6.1.'freatment figures

If the project is not achieving 100" geographical coverage and a minimum of 650/,therapeutic cor/crage or the coverage rate is fluctuating, state the reasonsThe project is not achieving the above coverage because:

. The timing of the majority of the CDTI activities u'as not in sync rvitli the rveather andclirnatic conditions of the project area. Project funding, work support iterns, mectizanrvere received in the rainy season and hence maximum outputs could not achier,'ed inthe circumstances of almost no moverlent rvithin the project.

. Comn-runity orvnersliip is not universal across the rvhole project area. there are stillsorne cor-nnrunities that have CDDs that still demand fbr incenlives.

Plans to remedy this are:. Trying as much as possible to ensure tliat key CD ll activities are irnplemented in the

drier rnonths of the year.

. -lirelcssly preacliing the CD'l-l philosophy to the community.

l5

Trainees

T)'p"of train ing CDDs

OtherCornrnunity'mernbers e.gCommunitysupervisors

HealthWorkers(frontlinehealthfacilities)

MOHstaff or'

OtherPoliticalLeaders Others(specify)

Prograrnnranagerle ntI{orl,toconductHealtheclucation

N4 anagenrentol'S;\EsCSNI

SIINI

L)utu

collcclionData analvsis

Reportu'ritingOthers(spec i[,)

WIJOiAPOC, l4 Septeurber 2009

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2.6.2 What are the causes of absenteeism?The reported causes of absenteeism were:

. Movement of people with their livestock from one place to another and thusrriissing treatment. It could also be seen as poor coordination betrveen the CDDsand the pastoralist communities.

. There were also areas tliat were inundated with floods and treatment could notbe there as rvell.

2.6.3 What are the reasons for refusals?There \vere no reported relusals of treatmeut.

2.6-1 Bricfly describe all knou'n and vcrificd serious adverse events (SAEs) thatoccurrcd during the reporting periotl and provide (in tablc 8) the requircdintorrnation w'hcn availalllc.

-l-[rere \\L're n() rcltorted S.\l]s dLrring this reltorting period

Parasitologist traincd'l Nt)ne u'a.s trained

No SAE case to report

Ilxistcncc of rnicroscopc? Ntr

Has thc project rcportcd all SAEs to N'lcctizanticl< one. Not applicablc bccaLrsc therc havc been

Ixo I vcs

In case the project did not havc anvthis reporting period, pleasc tick in

I)onation I'rogranr (N'IDP)? I)lcaseno SAEs reportcd.

cascs of serious adverse cvents (SAE) duringthe box.

t7 WHO/APOC, l4 Septernber 2009

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2.7. Ordering, storage and delivery of ivermectin

Mectizan@ ordered/applied for by:

-*--- tr *u,,,, E uNr€'tr- tr NGDO trOther (please specif,v):

Mectizan@ delivered b1,:

N{es tr wHo tr L.N*o rOther (please specifl'):

Please describc horr'Mectiz:rn@ is ordcred and hou it gets to thc conrmunitics. Tlte Pro-iccl ('ottrdinrrtiug Otficer provicles data on tlic total pt-rpulation arailablc in tltc

prttject areit ancl also dirta on the Lrsage. rr.astage ancl rcnrair.ring stock o1'rncctrzanavailablc aftcr thc crcle oltreatntent to the SSO'l-l'-.

. The NCD() paltner tlten takes leacl in con-rprlinu this rlata aucl preparing tllc orrlcr tirr'suburission to NfDI'

. N4DP rcvicus aplrlicetion. up[]r'()\cs ancl fbrulrlds the appIication to I\,1l1.RCK

r The mcctizan shiltpcri to thc couutrv antl is rcccn.ccl b1 \\Il{O.. Iu conlbrniitl w'ith thc data that had earlier bccn rcceivcd lionr thc Prttjcct

Coordinatinu ()fllcer. cclrresl-ronditrg anrounts of'urcctiz.an is sr.rpplred ll'onr thcSSO't F/NGDO to the pro.jec1.

. At project levcl. cach couutY supervisor collects the urectizan 1rom tl-re pro ject otflccand then notifles all Pavam Supervisors of the mectizan availabilitv lbr collection.

. The Pal,arn Supervisors on collection notify aud invite Borna Supervisors to collectsupplies lor their corresponding comnrunities.

. The Botna Supervisors, solre of r.vho are CDDS share this inlbnnation r,vith othcrCDDs and the couununities.

. The cornmunity members tlien decide on the time for the urectizan distribLrtion to the

rest of the communitv members.

Table 10: Mectizan@ lnventory

Hon,arc the remaining ivcrmectin tablets collected and rvhere are they kept?Whenever there are balances of ivermectin tablets. the CDDs are charged rvith theresponsibility of subnrrtting them to the health lacilitl,staff so that thev are stored inpreparation for the next treatment cycle. The amounts of stock of rnedicincs thal remain are

State /District/LGA

Number of Mectizane tabletsIn stock fromprevious year

Requested Received Used Lost Wasted

Ex pired Relnain ins

Akobo r40.000 140.000 139.901 99 0 0 0

Pochalla r30.000 130.000 129.899 l0l 0 0 0

Boma r50.000 r50,000 149.94,1 56 0 0 0

Longichuk 2s6.500 256.500 256,299 201 0 0 0

Maaban 65,298 65.298 65.220 78 0 0 0

Mairvut I7.s00 3 7.500 37.423 l7 0 0 0

TOTAL 779,298 779,298 778,686 6120 0 0

20 WHOiAPOC, l4 Septenrber 2009

communicated to the Project Coordinating Officer that in turn communicates this to theSSOTF secretariat.

List and briefly describe the activities under ivermectin deliverl' that are being carriedout by health care personncl in the project area.The activities that are carried out by the health care persorutel include:

. Training for both nen'and old CDDs rvithin the communities before the mectizan

distribution.. Issuing the CDDs u,ith tnectizan tablets and collecting the rernaining balance frorn

them for inventory and storage at the health centre at the end of distribution cycle. Conducting couuntrnity nrobilization and health education on OV prograln.. Facilitating the process ol'selection of CDDs b1' tlie comnrunitl,.. It,{attageurent clf anv person u'ith adverse side ell'ccts reactions and keep re corcls.

Ant' othcr cornntents - Nrlr.tc.

2.8. Gommunity self-monitoring and Stakeholders Meeting

Ilas anv training (of tr:rincr.s) for conrrnunitl'sclf-nronitoring llccn done in the pro.iectarea?A totaI ol-328 conturunitv learlers received trainir-rg ir.r conrnrrrr.ritr scll-r-noniloring

lf so, When?2"d Quarter of 2009

Table 1l: Comnrunity sclf-monitoring and Stakeholders Meeting

Describe how the results of thc conrmunitl,self- monitoring and stakeholders meetingshave affected project implementation or hon' thel,w,ould bc utilized during the ncxttreatment cycle.It is expected that the cornrnunities will:

. Gradually take full charge of the delivery of the CDTI activities in their comnrunitylike have neu,CDDs selected rvithout necessarily har,'ing the Health stalf facilitating.

. Demand fbr mectizan rt,herl there are delays or il'sorne cclnrniunities are inadvertentlyleft out during the distribution of'rnectizan.

o At a later stage begin conducting advocacl'campaigns for the CD'I'l prograrn.

Distrrct/ LGA Total # of conrnrunities/r,i llagesin the entire project arc'a

No of Cornnrunities thatcarried out sell-

nronitoring (CSM)

No of Cornnrunities thatconducted stakeholders

rneeting (SHI\OAkobo

Pochalla

Bonra

I-ongichuk

Maaban

Mair."ut

r36

61

8l

95

58

88

23

08

ilt7

09

12

10

05

\)/

09

03

07

TOTAL 525 80 1t

2l WHO/APOC, 1.1 September 2009

2.9. Superwision

2.9.1. Providc a flow chart of supervision hierarchl,.

2.9.2. What rvere the main issues identified during supervision?The main issues found during supervision were that:

. There was no evidence that the Countl,Supervisors were using the superr,isiouchecklists since done could produce one that they had used in the past.

. The rnajority of the CDDs are not lilling in the treatment registers andsull1r-nary forms correctly.

. Some of the population updates r",ere uot done.

. Some areas were discovered to har,'e not got Lreatrnent during the year and amop up exercise rvas then dor-rc.

2.9.3. Was a supervision checklist used?Yes. Supervision check-list ,uvas used.

2.9.4. What w'ere the outcomes at each lcvel of CDTI implementatiorrsupervision?

o County Supervisors were found to have not been doing supen,ision of theircounties Data collection slteets that thcy would have shor.vn the Payant orBoma Supervisors how to fill rvere not lllled correctl1,.

o Some communities had not received mectizan.

SSOTF Headquarters

Project CoordinationOflicers at Pro.ject levcls

Countv Supcrvisors

I)ay,1lr, Supcrvisors

CHWs/CDDs

Endernic conrmunities

po-vis lleporting

22 WHO/APOC, I4 September 2009

I,T

l, 1

Su

. CDDs were not filling out the registers correctly.

2.9.5. Was feedback given to thc person or groups superwised?Yes feedback rvas giver-r

2.9.6. Horv rvas the feedback used to improve the or.erall performance of the

:t'5;t;r" job traini.g \vas gi'en to tlie staff supervised on ho*,, to update rhehousehold inlbrmation. fill the suntmar),fbrms and talll,sheets.

o Practical sessions \\,erL' gi\/en to poorll' perlbrrning indrr,,iduals ancl thosepertbrnrinu relativell' better u,cle also encoLrraqed to coaclt their coileagues.I)osrtivc peer criticisr.n \\'as also encour agec1.

SECTION 3: Supl)ort to CDTI

3.{. Equipment

- 'l':rble l2: Status of cc;uipnrcnt

xCondition of the equipment (F:Functional. CNFR=Currently non-functronal but repairabt". WO=Urritrc,*ff)

How does thc project intend to maintain and replace existing equipment and othermaterials?If integratiotr o1'the CD-fl activities into the go\/enrnent PHC uas to take place as clesirecl. thestate Mol{ would ideally rnaintain and replace the existing equipment through the counterpartcorttribution to the pro.iect. Since this is not vet a realitv. then additional support ma1,requested liom thc NGDO paftner or APOC.

Sour ce

1-r'pe o l'

cqu ipnrent

,\POC NlOI I DISI'ITIC-I[-G,\

NGDO Othcls

l\() ('trrtti t I ron No Corrd rtron Nrr ( oltlrltrrrt r\() ( ondrtrorr No ('ortLltlt0rt

1. Veliicle I F (.) NA 0 NA 0 NA 0 NA2. Motor cycle(s) 4 F 0 NA 0 NA 0 NA 0 NA3. Cornputer(s) I F 0 NA 0 NA (, NA 0 NA4. Printer(s) 1 F 0 NA 0 NA 0 NA 0 NA5. Photocopier (s) I Ir 0 NA n N,.\ 0 NA 0 NA6. Fax Machine(s) 0 NA 0 NA 0 NA 0 NA 0 NA7. Othersa)Bicycle 10 F' 0 NA 0 N;\ 0 NA 0 NAb)Metallic Cabinet 4 F' 0 NA 0 Nr\ 0 NA 0 NAc)Metallic trunk 4 F 0 NA 0 NA 0 NA 0 NA

Z) WI{O/APOC, l4 Septernber 2009

3.2. Financial contributions of the partners and communities

- Fill tables 13a, l3b and 13c

If there are problems with release of counterpart funds, how' w'ere the1, addressed? Thisis not yet applicable since there are uot yet funds being received tiorn the government todirectly fund the implementation of CDTI activities.

Additional comnrcnts - None.

24 WIJO/APOC, l4 September 2009

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3.3. Other forms of community support

Describe (indicate forms of in-kind contributions of communities if any). Training venues. Collection of mectizan from the health facilities. Provision of meals for the CDDs during treatment time

3.4. Expenditure per activity

- Indicate in table 13, the anrourll expended dLrring the reporting preriod firr each actir,itv listeclWrite tltc atnount expc-nded in tJS dollars using the current United Natirrns erchansc rirte t()

Iocal curre'ncr' [nclicate exchange rate used here_2.-lsdg

Anv cornnre rrts ur explanations'l None

SECTION 4: Sustainabilitv of CDTI

4.1. lnternall independent participatory monitoring; Evaluation

{.1.1 Has the project ever been cvaluated/ monitored? (Tick an}.of thc tbllorvingx,hich are applicable)

Year I Parlicipatory Independent nronitorinrl

Mid Terrn Sustainabil ity Evalr.ration

5 year Sustainabilitv Evaluatior-r

Internal Monitoring by NOTF

Other Evaluation by other partners

4.1.2. What x,erc the recontmendations? Not applicable

4.1.3. How' have they been implcmented? Not applicable

4.2. Sustainability of projects: plan and set targets (mandatory atYr 3)

\\/as the project evaluated during the reporting period'? No

\\/as a sustainabilitl' plzrn rvritten'?__No

When rvas the sustainabilitl,plan subnritted'/ No

f

28 WHO/APOC. l4 September 2009

a

a

What arrangements have been made to sustain CDTI after APOC funding ceases in terms of:

4.2.1. Planning at all relevant levels - No plans made yet

4.2.2. Funds - No plans rnade yet

4.2.3 Transport (replacement and maintenance) - No plans rnade vet

4.2.4. Other resources - No plans made yet

4.2.5. To u'hat extent has the plan been implemented - Not yet applicable

4.3. lntegration

Outlinc the cxterrt of intcgration of CDTI into thc I'FIC structurc anrl the pluns for conrplctcintegration:

-1.3.1. [r'crnrectin delivcrl' mcchanismsThe Ivermectin dc'livery rnechanisur used nou, is that:

. \&'llO delivc'rs the mectizan to the state nrirlistn'o1'lic'alth

. 'lhc state miliistry of health is then responsible tbr relcasing the nrectizau 1o 1he

Countv Health Department stores in the Coultties. It lronr the County ['lealth Departments that thev u,ill latcr be dispatched to ti-ontlinc'

health lacilities in thc Payams.. Most Pavams in the project area have health facilities. so there \\ere no iustances ol

having the rnectizan kept outside tlte health facilitl,.

4.3.2. Training:ln regards to training there is rvillingness of other prograrns to cooperatc.'l'hese include EPI(Expanded program on lmmunization) and GW (Guinea Wonn Eradication pro_erarn). Thefinal inrplementation needs to be frnallv plamred and executed.

4.3.3. Joint supervision and monitoring w'ith othcr programsThis is not vet happening.

4.3.4. Relcase of funds for project activitiesThere were no funds released from the PHC system.

4.3.5. Is CDTI included in the PHC budgetra -.Not vet.

. 4.3.6. Describe other health programmes that are using thc CDTI structure and how'this *'as achieved. What have becn the achicvcmcnts?. Fill tables l4and l5andprovidedescribeotherprograrnrnesthatareusingthe

CD-fl structure and horv this was achieved. What have been the achieven-rents?

. For each intervention listed in table 15. explain what rvere the roles played by the

CDDs (census. rnobilization. distribution, data collectiorr. storase. collection ofdrugs, ref-erral of SAEs. etc ...)?

29 WI IO/APOC, l4 September 2009

Explain what are the combinations of interventions co-implemented? There is no

clear arrangement for co-implementation yet.

Horv rvere the interventions implemented? (at the same time?) The interventionsare not implemented at the same time. The different programs utilise the same

persons in the community to implement the programs.

1.3.7. Describe others issues considered in the integration of CDTI.l-his is r.rot l,et applicable in this project.

30 WHO/APOC, l4 September 2009

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4.4. Operational research

4.4.1. Summarize in not more than one half of a page the operational researchundertaken in the project area within the reporting period. None has been done

4.4.2. How rvere the results applied in the project? Not applicable.

SECTION 5: Strengths, weaknesses, challenges, and opportunities

t Strengths:I . Therc are a number of iutenrational NGOs in tlre arear and coninrlruit1, basccl organrsrrtior.rsr fhat are ri,illing tn u,ork on CDTI activities.

. Therc lras been a nurnber ol neu'er governn-]ent healtli facilities opened Lrp in the projectarea. [his rr,ilI increase the nurnber o1'IrLHF and possibilitr if stall'ed uilI incrcase stal'l'uorkinu in CD-l'1.

We:rl<ness:. C'D l'l intcgration into PHC has not begun.. [-ack o1'stal't'esprc'cialli'at the conrmunity level tcl inrplement the CD-l'l nork.. 'l'he avarlable nurnbcr of CDDs is still inadeqLrate.

. Poor record keeping at the community level

Challenges:. -fhis is the ruost challenging placc in Southern Sudan. There is prominencc ol

st,anrpv/urarshy'terrain and road nrovernent in irnpossible in thc rainy season lvlajoritl'o['rvork to be done in the dr1, seasorl.

. The literacy levcl of the cornmunitl,members especially the w,omen is quite lou, leading topoor qualit), w'ork at the cornrnunitl, level. Constant on the job training and mentoring to

continue.. Record keeping is a challenge. [t's as a result of lorv literacl, Ievels and lack of appreciation

of the need to keep records. Contiuuous rnentoring rvill be done to ensure that this improves

SECTION 6: Unique features of the project/other mattersNo additional inlorrnation to repon on.

JJ WHO/APOC, l4 September 2009