BY REPORT OF MISSION TO THE SOUTHERN SUDAN

REPORT OF MISSION TO THE SOUTHERN SUDAN BY

Dr

Nomo rlAounkoilo

WHO| APOC

Chief

Epidemiologist

ond Vector eliminotion Unit

APOC

Heodguorters,

Ouogodougou

lAr

Lozorus Nweke

WHO| APOC

Temporory

odvisor Enugu/A

nombro/Ebonyi CDTI The Carler Center,

Enugu

- Nigerio

21 FEBRUARY-4

MARCH 2OO8

Bahr Al ^Unily

i!t'pJ6t BalY A!Geal

Jorylei'

sd

VWst Bahr El Ghazal Project ,i.., East Bahr El Gazal

East Equatoria WEst Equatoria ' , .' Upper Nile

Sates and delincatlon of CDTI projects, Southern Sudan

East Equatoria

..ry',

TABLE OF CONTENTS

Toble of

Contents

Abbreviotions/

Acronyms ilt

Acknowledgement tv

1.O

Bockground

of the

ltAission 1

1.1

About

the

CDTT Projects ond

Its

Scope in

the

Southern Sudon ...1

t.?

^{Prof ile}

of

Southern Sudan ...2

1.3

Objectives

of

the Mission

?.O Methods of

Tockling Eoch

Objective

3

3.O The

Mission Processes

4

2

3.1. Arrivol In

Noirobi on ZLst Februory

2008

....

3.2.

Meeting

of

the Mission

with the

55OTF Coordinotor

at

WHO Southern Sudon

Office

in

Noirobi

on22"d Februory 2OO8

3.3.

Meettng

of the

Mission

with the

CBM

country

representotive

at the

Oncho

Secretoriot,

Rumbek in Lakes

Stote

on

the 25

February 2008

3.4. Visit

by

the

Mission

to

WHO Of

ficer

in Rumbek on ?6rh Februory

2008 9

3.5.

Field

Visit to

West Eguotorio CDTI Project

sites

on

27

February 2008...

3.6.

Meeting

of the

Mission

with

Mvolo community members ond CDTI on ?7 Februory 2008

...

...12

3.7.

Briefings on

the

f ield

visit

situotion/meeting

of the

Mission

with 55OTF

(Coordinotor _{ond CBM}

country

reptesentotive) on 28th

Februory 2008 ...-....13

.6

10

4

4.O.

Constroints/Chollenges

5.O.

Conclusion

6.O. Woy Forword

ond Recommendotions

7.O.

Development

of

Plon

of

Action

Appendix

1:

Schedule/itinerory

of

^the Mission

from?t

^Februory

^to

^{7 Morch,}

2008

...

Appendix

2:

The Mission Teom ond Persons met during the exercise

15

t6 t6

17

..18 19

APOC CBM CDD

CDTI

c5A

GOSs

JAF

MOH MOU N6DO

oLs

ONCHO PCO REMO

'PLA/

M

5sOTF

TCC

USAID

wHo

ABBREVIATIONS/

ACRONYAIIS

African

Progromme

for

Onchocerciosis Control

Christofell

Blindness Mission

Community Directed

Distributor (of fvermectin)

Community Directed Treotment

with fvermectin

Committee

of

Sponsoring Agencies

Government

Of

Southern Sudon

Joint

Action Forum

Ministry of

Health

Memorondum

Of

Understonding

Non-Governmentol Development Organisotion Operotion Lif eline Sudon

Onchocerciosis

Project

Coordinoting Of

ficer

Ropid Epidemiologicol Mopping

for

Onchocerciasis Sudonese ^{P eople'} s Li berotion A rmylMov ement Southern Sudan Onchocerciosis Tosk Force Techn icql Consu ltotiv e Committ ee

United

Stotes

Agency

for fnternotionol

Development

World

Heolth Orgonisotion

ACKNOWLED6EA,\ENT

The Mission wishes

to

thonk

the

Manogement

of

APOC

for

supporting

the

exercise os well os oll

thosewho contributed to the

successfui occomplishment

of the

tosk especially:

'

^The

^{Director of}

^APOC

^-

^{Dr. Uche} V. Amozigo

for outhorizingthe

Mission.

. The WHO

Representotive

of

Southern Sudon

- Dr.

Abdullohi Ahmed ond his

stoff

in both Nqirobi, Lokichoggio ond Rumbek

for

supporting

the

Mission.

.

The

coordinotor of

Southern Sudon Onchocerciosis Tosk Force(SSOTF)

-

Dr.

Sampson

Bobo for being there with the Mission ond oll his

supports

particulorly on opprovol of ^one

^housing

^oportment for ^the

^WHO/APOC

technicol odvisor ossigned

to

Southern Sudan.

. The

WHO/ APOC odministrotion ond Finonce

Assistont - Mrs

^{Agnes Wonyoike}

for ^excellent

^ond

^guick

coordinotion

of octivities

especiolly

flight

^bookings,

pass permits, vehicle ond hotel orrongments,

. _{The director of} public heolth of ^{Lokes Stote} for ^{offering to}

^include

WHO/ APOC technicol odvisor in his teom

for

integrotion

of octivities.

. _The

CBM

country representotive - Mr Fosil

^Chane

for his kind supports

ond useful deliberotions

with the

Mission.

. _The Bohr el

^Ghazal

CDTI project coordinating officer, the Mvolo

county

supervisor, frontline

health workers, CDDs ond community members f

or

giving

the

Mission useful informotion ond

their

keen porticipotions.

I.O

BACKGROUND OF

THE

'I,IISSION

1.1 About the CDTI projects

ond

its

scope

in the

southern Sudon

The CDTI

projects

in

the

Southern Sudon commenced in 2005 following

the first letter of

agreement between APOC ond

the

Southern Sudon Onchocerciosis Tosk Force

(55OTF)

signed in 2004.

fn the

Southern Sudon,

there

are f ive CDTI

projects

estoblished in f ive out

of the

ten

stotes.

When

the

CDTT

projects

were eloboroted Southern Sudon hod only two odministrotive levels (Regions ond Counties). Since

the

peace agreement, Southern Sudon hos

three

odministrotive levels: regions,stotes ond counties.These CDTI

projects

are Eost Bohr

el

Ghazol,

West

Bohr

el

Ghozal, Eost Eguotorio,

West

Equotorio ond Upper Nile. They were estoblished bosed on

the

onchocerciosis prevolence patterns os obtoined

from the result of

Rapid Epidemiologicol Mopping

of

Onchocerciosis (REMO) conducted in

the

Southern Sudon in Morch 2003. ^The Southern Sudon Onchocerciosis Tosk Force

(55OTF)

wos

formed

ⁱⁿ

October

2O0O

but

become operotionol in

July

²⁰⁰²

Each

of thefive

CDTI

projects

is composed

of

one

or

more

stotes. For

instonce, Eost Equatoria CDTT

project

covers Centrol ond western

port of

East Eguotorio

stotes; West

Eguotorio CDTI covers only

West

Eguotorio

stote;

Eost Bohr el

Ghazal CDTI

project

is mode up

of port of

Western Eguotoria neor Rumbek, Lakes ond Worob stotes; ond

West

Eguotoria CDTI

project

comprises

port of

Worab ond

ports of North

Bohr

el

Ghazal ond

West

Bohr

el

Ghozol (See _Mop).

Monogement

of

APOC hos hod series

of

missions

to the

Southern Sudqn in

the

ef f

orts to

ensure

the

implementotion

of

CDTI

octivities giventhe

conf

lict

situotion

over

there for

yeors. Availoble records show

thot

APOC Monogement hod undertaken more thon

four

Missions

to the

Southern Sudon in

the past.

The conf

lict

in

the

oreos oven

the

years hos stolled

both infrostructurol

developments ond provision

of

heolth intervention progrommes including ivermectin

distribution

ocross

thefive

CDTT

projects within theten stotes.

The

treatment

with

ivermectin hos

therefore

met

with

chollenges in

this

areo.

It

^wos

^the

expectotion

of

APOC

thot

these

projects

become olive

to

implementing

the distribution of

mectizon.

It

becomes most compelling in

the context of

APOC phosing out ond

exit strotegy

ond

the

opprovol

of the

committee

of

sponsoring Agencies

(csA)

endorsed by

the Joint

Action Forum (JAF)

to

provide more support

to

post conf

lict

countries. The Mission hod

briefing

in Ouogodougou on

l6-L9

Februory 2008

with the

APOC

Director.

The Objectives

of the

Missionwere

to

ossess

the

need

of

technicol support

to

55OTF ond

to

conduct ropid evoluotion

of

CDTI implementotion in Southern 5udon.

1.2

Peofile

of Southern

Sudon

Southern Sudon is _{mode up}

of threeregions,

which ore divided into

ten

stotes, counties ond Bomo

of

o lower level. The

three

regions

with their

respective

stotes

ore Eguotorio (Centrol Eguotorio, Eost Eguotorio, ond

West

Equotorio),

Bohr

el Ghozol

(North

_Bohr

ol

Ghazal,

West

Bohr

ol

Ghazal, Lokes, ond Worob), ond Upper

Nile

(Jonglei, Unity, ond Upper Nile).

Southern Sudon borders Ethiopio

to the

eost, Kenyo, Ugondo, ond

the

Democrotic Republic

of ^the

^Congo

^{to the}

^{south, ond}

the

Centrol

African

Republic

to the

west.

Southern Sudon, olso known os New Sudon, hos nearly oll

of its

odministrotive of

fices

ⁱⁿ Juba,

the

capitol, which is olso

the

lorgest

city,

bosed on populotion estimotes.

It

^is estimqted

thqt the

Southern Sudon has o populotion

of

oround 15 million. This

figure

^{will be} updoted by

April

2008 census which will take

of return of

refugees.

This region hos been negatively

aff

ected by wors

for

^{more thon 21 yeors, resulting}

in serious neglect,lock

of infrostructure

development, ond mojor

destruction

ond displocement. More thon 2 million people hove died, ond more thon

4

million qre

internolly

disploced

or

hove become ref ugees os o

result of

the civil wor ond wor-

reloted

impocts.

The Comprehensive Peace Agreement signed on Jonuary 9,2OO5 in Noivosho, Kenyo

with the

SPLA/M,

tentotively

bringing on end

to the

Second Sudonese Civil Wor.

1

.3 Objectives of the

Mission

(1)

To ossess

the

perf ormonce

of

CDTI

projects

in

the

Southern Sudon with emphosis on community involvement ond implementotion

of the

process

of

CDTT.

(?)

To

identify

oreos f

or

strengthening copocity

of

notionols on

eff

ective implementotion ond monagement

of

projects.

(3)

To develop

with the

Southern Sudqn Onchocerciosis Tosk Force

(55OTF)

o plon

of

oction

for

^improving geogrophicol ond

therapeutic

coverage.

(4)

To introduce o Technicol Advisor

to the

Southern Sudon

CDTI projects,

Mr

Lozarus Nweke, selected by

the

SSOTF.

2.O ,IAETHODS OF

TACKIJN6

EACH OBJECTIVE Design opprooches

-

Consultotive meetings ond discussions

with

55OTF coordinotor, WHO of f icers,WHO/ ^APOC odministrotive ond f inonce Assistont, MOH of f iciols ond N6DO (CBM)

to determinethe

situotion

of

support

to

CDTf

ot

eoch level.

-

Meeting

with stotes

CDTI

project

coordinoting

officers,

copturing problem oreos. Ascertoin vehicle ovoilobility ,

office

equipment ond drug availobility ond new APOC

treotment

forms. Stotus

of

Data monogers

ot this

level, number

of stoff

ovailoble ond shoring

of

counties

to stote

teom members.

Reports ovoiloble or otherwise ond why. Number

of

ovoiloble CDDs versus

totol

populotion ond census update.

Obiective t

Undertoke

visits of

selected

treotment sites

^including

the

counties, heolth

focilities

ond communities. Visit

ot

community level will exqmine vorious processes

of

CDTI which

are

selecting

of

CDDs,

troining of

CDDs, drug

distribution

and reporting bock.

fnterviews of

some community members on how they

feel

obout

the distribution

ond support

to

CDDs etc.

Chains

of

drug collection ond odeguocy

of

mectizqn toblets.

Looking

ot both

geographicol ond

theropeutic

coverage in selected

treotment

sites.

Oblective

²

Try to find

out number

of

troined ond knowledgeable

55OTF staff

_,PCOs

qnd

other stoff

_, county supervisors, heolth

focility stoff

ond CDDs ovoiloble,

their

odeguocy or otherwise.

Ability

ond copobility

of

PCOs ond county supervisors in monaging

projects

in both

stote

ond county levels respectively.

Objective

3

fnitiation of the 55OTF

plon

of

oction

to

oddress issue

of

both geographicol ond

theropeutic

coveroge, sustoinobility

of

CDTI.

Completion

of

REMO ond Roploa.

Review

of

2008 plon

of

oction.

Needs

of

each

of the

5 CDTI

projects to

be incorporoted in

the

plon ond woys

to

reinf orce

the

coordinating role

of

55OTF

secretoriat.

3.O

The

lAission Processes

3.1. Arrival in Nairobi

on

21st February 2@8

The Mission, comprising two _Persons, orrived Noirobi , capitol

of

Kenyo

onZl"t

Februory 2OO8

from

Ouogodougou vio Coted'fvoire. The Mission wos met on arrivol by

the WHO/

^APOC odministrotive ond f inonce qssistont

, Mrs

Agnes Wonyoike.

3.2. ^ltleeting of the

tlhission

with the

SSOTF

coordinator at

WHO Soufhern Sudan

office in Ndirobi

on

2?d Februory 2008

At the

meeting,

the 55OTF

coordinotor

Dr

Bobo oddressed

the

following ^issues;

1.

Bockground

of the

Southern Sudon ond

the

CDTI

projects.

The informotion provided by him

ot the

meeting was used

to

build

the

bockground in

this report.

This ronges

from

odministrotive

structures to

displocement os well as CDTI

structure, terroin

^{problem ond vostness}

of

lond in

the

Southern 5udan.

2.

Problems facing/needs

of the projects

include

a)

Humon resources: He exploined

thot the projects

ore continuolly losing

stoff to other

N6Os ond UN ogencies due

to

poor payment.

For ^instonce, UN agencies poy o

driver $800

^plus

other

benef

its

but

the

CDTI

project driver

collects $150. The

situotion

in

the

Southern Sudon hos given rise

to

open competition which nobody con control.

b)

APOC Manogement

not

releosing funds on

time:

The top-ups

the

stoff orereceivingarevery

irregulor ond when

they

ore not

released

for

^up

^to

^{3 months, they}

^get

^{ogitated. As}

^of

^{dote solaries}

is

not

being poid by government. Second instollment

of

^2OO7

opproved budget by APOC is

yet to

be releosed.He expressed displeosure over not releosing f und f rom APOC

Trust

Fund.

c)

^{High cost}

of

living and occommodotion:

In

Jubo and Rumbek,

there

is very serious shortoge

of

occommodotion, which

result

in high living ond occommodotion cost. A

tent

costs os much os

U5$200 -

US$250 o

night

in Jubo ond between U5$100 ond U5$150 in Rumbek. A

bottle

^(smoll)

of

woter cost

U5$5

in Jubo ond

U5$4

in Rumbek.

d) Woter: fn

Rumbek ,

there

is woter scorcity.

e)

^CDD

^troining:

^{This is done}

^bit

^by

^{bit. All}

^hove not received training due

to

due

to

budget line drosticolly scole down by APOC

Monogement.

f)

^{APOC generotor not onymore}

^efficient

^{ond lock}

^of

^resource

^to

contribute to fuel

cost stroining.

3.

Construction

of

a new

office for

^{SSOTF ond plon}

for

VSAT instollation:

The

office ot

Rumbek in Lokes

stote

hos been

rebuilt

and

furnished

by USAID. The Eost Bohr

el

Ghozal CDTI

Project

is olso locoted

here.There

is now on orrongement

to

provide VSAT in

the Ministry of

heolth,

the project

ond

the secretoriot.

4. Ministry of

heolth: There is o shortoge

of

expertise, solories

areyet to

be poid.

At the

meeting, APOC delegotion highlighted

the

following points ^by

o)

^Trocing

the history of

formotion

of

notionol Oncho Tosk Force ⁱⁿ

the

Southern Sudan.

b) fndicoting thot

Oncho is public heolth problem in

the

Southern Sudon ond should be oddressed properly.

c) fntroducing Mr

Lozorus Nweke as WHO/ APOC technicol odvisor to

the 55OTF. Dr

Bobo welcomed him ond informed him

of the

situation

in

the

Southern Sudon. And

thot

he is looking

forward to the

technicol Advisor's working

with

them ond ploy his role.

d) Stoting thot

^APOC will phose

out

in 2015 ond theref

ore

urgent actions

ore

needed in Southern Sudan

to

drive ond estoblish

f unctionol CDTT

projects

bef ore APOC closes. Hence the need f or a

technicql odvisor whose role will be

to

support

the 55OTF

under supervision ond guidonce

of the

55OTF coordinator in CDTf

implementotion.

At the

end

of the

meeting,

it

wos ogreed

thot

.

All should meet

ot

Rumbek, Southern Sudon on 25th Februory 2008.

.

The Mission should leove Noirobi

for

Lokichoggio on

the

24th February 2008 ond sleep

ot

Lokichoggio comp Operotion Lif eline Sudon (OLS).

. Mrs.

Agnes should orronge oll plones, comp bookings, f

light

authorizotions, ond Lqzorus's poss

permit to

Southern Sudon.

. _Working

ogendo be drown os contoined in oppendix 1.

3.3. iheeting of the

tlLission

with the

CBtll

country represenfative at

fhe oncho

Secrefariat,

Rumbek in Lokes

sfafe on fhe 25 February

2OO8 The

porticiponts

broinstormed ond generated

the

following information

Dr

Nomo's

briefings dwelt

on

the

following ^points

to

improve on theropeutic ond geogrophicol coveroge

rates.

document

of

o.

^Extension

^of

^APOC

^to

^2015.

b.

^{Support troining}

^of

^CDTf personnel including copocity building.

c.

Financing

other

heolth interventions such os

moloria,Vit

^A,

Polio erodicotion ond lymphotic f iloriosis in

the

f ramework

of

co-implementotion.

support (?Ots APOC will

exit from

countries).

cotch up in CDTf implementotion conseguent

of

^yeors

of

conf licts.

Sudon ond what eoch

portner

should do.

implementotion

of CDTI

in post conf

lict

countries.

Southern Sudan. He is

to

work in colloborotion

with the

SSOTF

secretariot

under

the

f

ist

supervision

of

Notionol coordinotor ⁱⁿ

troining

personnel ond implementing CDTI

strotegy to

moke ^o

difference

in

the

neor

future.

project

oreqs, ond os regords

office,

whot con we do by woy

of

improving

the

communicotion

with

APOC.

The

CBlrt

country representotive, Mr

Fosil welcomed

the

Mission ond

afterword

responded

by

roising

the

following issues.

Portners: CBM is ploying o major role, followed by ^{APOC qnd} MOH lost

with

no budget ond no releose.

Humon resources: There ore o

lot of

positions in

the 55OTF letter of

ogreement

but

pockoge is low hence occounting

for

loss

of stoff

to others thereby

resulting

to

9op in humon resources ond thus provided.

The Toble below shows

stoff ot

SSOTF level ond

their

stotus

Copacity

of stoff

:

Stqff

ore not ovoilqble ond those avoiloble hove low guolif icotions ond educotion. All

stotes' project

coordinating

off

icers ore not oll

that

guolified

to

be in those positions.

No solory

from the

ministry

of

heolth

to stoff

. This hos

remoined _o problem getting

to three

yeors now. There is not

yet

o notionol budget.

Top-up

from

APOC: The top-up

from

^APOC connot sustqin the

stoff

os no solary comes

from the

ministry. Even

the

Top-up hos not been poid

to stoff for

^{6 months now.}

Turn over

or ottrition: stoff

desert

the project

?

or

3 months

ofter

troining due

to

poor solory.

fn

Southern Sudan,

there

are o

lot of

^UN ogencies

thot

poy very well.

No.

of

supervisory

centers:

There is plon

to

increqse

the

I

I

S/N

Position

of Stoff ot

SSOTF

No. of stoff

I

Notionol coordinotor 1

2 Deputy Notionol coordinotor ¹

3 Administrotion ond f inonce off

icer

0

4 Driver

I

5 Assistont

driver

¹

6 Rodial operotor 1

7

security

¹

8 bookkeeper 0

9

secretary

0

10 Doto monoger 0

Period

of

mectizon

distribution:

^{This varies}

from project to project

occording

to the dry

seoson , e.g. Upper Nile f rom Sept

to

Dec.

Review meeting ond troining: ^The

project

normolly holds review meeting ⁱⁿ Jonuory eoch yeor

with

oll

projects before

conducting troining

loter

in Jonuory

-

Februory. ^Up

till

now

thesetwo octivities

^{have not been performed due}

to

no release

of fund from

^APOC.

Rebuilding

of

Oncho

office

by

USAID.

The

55OTF office situoted

in

the

ministry

of

heolth premises

at

Rumbek in Lokes

stote

hos been

rebuilt

^ond

furnished

^by

USAID

under

the

leodership

of

5SOTF coordinotor.

New ^APOC doto collection

forms:

^These

forms

^ore

yet to

be introduced

to

most CDDs qnd heolth workers.

Lozorus commented on

the

some issues roised

-

^{Clorif ication on}

^the

^line

^of

^reporting

^of

^CDTT

octivities

f rom

the stote to

community level in

the

Southern Sudon: This wos provided

beginning

from stote,

^County, Heolth focility/Poyom, ^{ond Boma}

-

Community. Sometimes Bomo is skipped.

-

^Need

to line-list

oll communities occording

to

heolth

focilities,

counties ond stotes

for ^better

^dato monogement.

-

More informotion on

the projects

os provided below

s/N CDTI

projectlyeor of

commencement

Locotion No

of

stoff

No. of

supervisory centres

No. of

counties

1 Eost Bohr el Ghozol/2OO4

Rumbek 7 4 4

2

West

Bohr el Ghozal/2006

Wou 7 ^{10 10}

3 Eost

Eguotorio/2006

Yei 7 7 7

4

West

Equotorio/2OO4

Yombo 7 5 5

5 Upper

Nile/2006

^{Akobo 7 6 6}

6 Notionol

ssorF/2000

Rumbek 7 32 32

HTGHIJGHT OF

ISSUES

DISCUSSED

*

^New

direction of

APOC

betore exiting

in 2Ol5 os contoined in

the strotegic orientotion

document.

*

Deployment ond copocity building

of

WHO/ APOC Technicol Advisor

to the

Southern Sudon CDTI

project.

*

NGDO concerns over providing

the

need

of the

technicol odvisor in terms

of trovels to project

locotions os well os APOC's opplying

the

OLS rules

of

gronting

stqff

leave

after

six weeks

to

him and general living conditions ⁱⁿ Rumbek.

*

Humon resources:

profile of stoff

ond capocity

ot

both notionol 55OTF

secretoriot

ond

five stotes

CDTI projects.

*

Review

of

packoge

of certain

categorres

of stoff

on

full

time within

the

notionol

secretoriot

f

or

APOC support.

*

Review

of

opproved 2008 plan

of

oction porticulorly os

it

concerns vehicle/eguipment where no money wos opprovedby APOC

to

cover mointenon ce, f ueling ond runnin

g

cost , training/ educotion ond

trovel

cost where

little

wos opproved

for

^SSOTF

secretoriot.

*

Deloy in releosing the remoining top-ups f

or

^2OO7 which omounts

to

$78 ,784 , representi ng 23%

of

the

totol

opproved budget

*

Eguipment: Photocopier ond

oir

conditioner

to

be provided.

+

^Remo ond Roploo

to

be completed

/ref

ined in

October

2008

*

^Period

of

mectizan

distribution:

This depends on

diff erent project but within

two periods

of

Jon

-

Jun ond Sept

-

Dec.

*

Dote

for

submission

of

TCC

report: In

July ogoinst TCC meeting in September.

* coverage:2oo7

Theropeutic coverage was 35.75% while

the

Geographic coverage wos indeterminote os

the

number

of totol

CDTI villoges wos not ovoiloble due

to the

prevailing situotion in

the

Southern Sudon.

+ _Quontity of

mectizan

toblets

required

for

²⁰⁰⁸ is 7,140,000

3.4. Visit fo

WHO

office n Punbek

on 26th

February

ZOOa

The Mission poid o courtesy

visit to WHo office

where

they

met

with

Dr Joyoprokosh Voliokorleri.

After

o

formql

introduction,

the

Mission informed him

thot

they ore in Rumbek plonning ond discussing

with

MOH

off

iciols on

Advisor who would ossist

the 55OTF

in

troining

people

ot

eoch level ond implementing

other

CDTI

octivities.

He wos

told thot the

^{technicol qdvisor}

would

from to time brief

him on whot is going on.

fn

his response,he thonked

the

Mission

for

^{coming ond expressed}

^the

^hope

^to

hove o good working relotionship

with the

technicol odvisor when would f inolly come

to

be

port of efforts to

deol

with the

heolth situotions in

the

Southern Sudon.

3.5. Field visif to

l0/est Equotoria CDTT

project sites

on

27 February

^2OO8 The Mission wos occomponied by

the project

coordinotor

of

Eqst Bohr El

Ghazal who orrong ed the f ield

visit to

Mvolo County in

the Western

Eguotorio.

At

Mvolo heolth

centre :

On orrivol,

the

heolth plonning

officer

ⁱⁿ

the

heolth center,

Mr

Williom Dolli received the team ond

after

o

formol

introduction,

the

Mission exploined

the

objectives

of the visit,

^which

wereto

ossess

the

performonce

of

CDTI

project

ond whot is on ground

for

^oncho

^control

^{os well}

os woys

to

strengthen

the

copocity on oncho

control throughout

Southern Sudon

in

general including introducing Lozorus selected by

the 55OTF

Headguorter ^qs

the

_Person

to

work

with

them

for ^{the next}

two yeors by Dr.

Nomo. The Mission

further

^expressed

^its

^reodiness

^to

^{work on}

^other

^heolth

progrommes such os molorio, schistosomiosis, ^guineo worm ond

other

neglected

tropicol

diseoses.

Mr

Dolli quickly replied

thot April -

^{November used}

^to

^{be o}

diff icult time for the

people

of

Mvolo os

biting

black f lies ond mosguitoes ore in obundonce resulting

to

high prevolence

of

malorio ond elephontiosis in

the

community. Mvolo community is sotisf ied

with

oncho

control

ond people skin conditions

are

being improved, however

they

complained obout molorio ond elephontiosis which connot

betreoted.

The Mission exploined

thot

elephantiasis is now possible

to treot with

combinotion

of

olbendozole ond mectizan.

Mectizon

movement:

Mr

Williom Dolly

correctly

described

the

process

of

mectizon

distribution to

community members.He ^exploined

thot

he hos been ⁱⁿ OV

activities

especiolly in

porticipoting

in

the troining of

CDDs

for

^{yeors now.}

He exploined

thot the heolth

center

distributes the

mectizon every yeor to CDDs who in

turn treot

community members

with it.

On how

they collect

drug he soid

thot the

county supervisor collects

from the stote

^{qnd then}

distributes

them

to oll

heolth

centers

in

the

county.

Mectizon

storoge: fu\ectizon

toblets

ore

stored ot the

heolth centers

from there they

ore collected by CDDs or occosionolly

by

^Boma supervisors

for ^their

CDDs.

l/tobilizotion:

On

the

system

of

mobilizotion,

it

wos

leornt thot

^key community leoders ore olwoys mobilized. These ore

chiefs,

Poyom

odministrotors,

church leoders ond

the

schools.

Troining, troining moteriols

ond

tronsport: Mr

Dolli soid

thot

troining

of

CDDs is

corried out before

eoch

distribution ot the heolth

^{center. Troining} moteriols ^included monuol

for

^{CDD troining plus} incentives in

form of

mosguito nets, blankets, smoll bogs

for

corrying mectizon ond

tolly sheets(treotment forms)

^{by CDD ond roincoqt. He described}

tronsport

as o problem in

the

oreo and

thot

motorcycle

for

^the county supervisor has been

off-rood

since 2005.

Number

of stoff lhealth centers:

^A

totol of

ten health

focilities

^ore ovoilable in Mvolo County. These ore Mvolo

,Yeri,

^Bogori , Bohr el Gigirididi, Kulu, Lomu, Combi, Lali, Domeri, Lesi ond

Dori.

Mvolo

health

center hqs 16

staff.

At

Domeri

the

Mission met

with the

Countv suoervisor: The coun

ty

supervisor,

Mr

Wisley Bcourt hos been in Oncho progromme

for

^{o long time. He is}

^troined

ond knowledgeable obout

the

diseose ond mectizan

distribution

mechonism. He is olso

the

progromme coordinator

of

a locol NGDO,

SIDF.

He is doubling

for

oncho ond

SIDF

works. He recounted

his

experiences ond post works on Oncho ond below ore

the

issues he provided informotion on during

the

meeting with

the

Mission.

Number of

Poyom

in

Mvolo County: Seven Poyoms ore in Mvolo County nomely, Mvolo,

Yeri,Lesi,

Dori, Boggori, Borigrindiond Kokori. This hos o relotionship

with

heolth

focility

os one Payom cqn hqve one

or

heolth

focilities.

Oncho Endemicity

in

ltAvolo County: This County is highly endemic

for

^oncho.

The

result of

REMO exercise shows

thot the

prevolence

rate

wos 93%.

Number of

ovoiloble CDDs,

troining

ond storoge: Mvolo County os o whole hos 203 CDDs out

of

which 50

fresh

CDDs ond onother 50 old CDDs were

trained

ond

retroined

respectively in yeor 2007. Troining took ploce

at

county heolth

office

under

thetrees.2-3

doys ore used in troining

the

CDDs depending on

whether

they are new or old. The mectizon

tablets

which qre

stored

in

the

heolth county of

fice

ore

distributed to

CDDs immediotely

after the

troining

octivity.

Solories

ond Top-ups: Salories hove not been paid by

the ministry of

heolth

to

heqlth workers in

the

ten counties in West Eguotorio since

the

peace

ogreement wos signed in 2005. On

the

issue

of

top-up,

the

County supervisor is

the

only one receiving top-up

of

_$120 in Mvolo county ond

the

lost he wos poid wos Moy 2007. The county supervisor requested

for

upword review

of the

Top- up given

the

prevoiling situotion ond

the

cost

of

lif ^e.

On whether

ony

treotment

ond Number

of treoted

communities

in ?@7:

^A

lot of

people were

treated

ocross oll 7 Poyams in over 200 communities

with

on

estimoted

totol

populotion

of

111,000 persons.

Response

to treotment by

community members. The county supervisor

reported thot there

is rush

for

^mectizon

treotment

in Mvolo county. People are willing

to

tqke

the

drugs qnd some ore now hoving 'good'skin and 'good' sight.

Supervision ond motorcycle/bicycles: Supervision hos been hompered due

to

non functionol motorcycle.

ft

^wos understood

thot

one motorbike was provided since

the

inception ond o

lot of

money hod been spent in

the efforts to get it

bock on

the

road

but to

no avoil. The motorbike is porked in

the

55OTF

secretoriot of

Rumbek. The two bicycles ollocoted

to the

county were looted during

tribe

conf licts.

Additionol

public

heolth

chollenge: Nodding diseose is o concern

to the

county os well as lymphatic f iloriosis ond molorio ond con be found ^{in mony}

ports of the

county especiolly Mvolo, Domeri, Yeri etc.

Reguests: The progromme county

officer

requested side

effect

^drugs,

Motorcycle

,bicycles,increase

^{in top-up, payment}

of

heolth workers solories os well os

the

outstonding top-ups

The

Mission's Comments

The Mission proised

the efforts of the

county supervisor ond assured him

thot the

issues he raised would be oddressed.The Mission olso informed him

of the

plon

to

^secute

the

speciol country

initiotive to

support

troining

more CDDs ond heolth workers

for

improvement

of

geographic ond

theropeutic

coverage.

3.6.

tl,leeting

of the

rltlission

wifh l|volo

community members and CDDs on

27 February

?OOa

A group

of

community members numbering

l?

were met in

the

village squore.

One

of

them o teacher nomed

Mr

Gobriel

Sebit

wos

interviewed.

He provided bosic information concerning

the

menoce

of biting

block _f lies ond mosguitoes in

the

community. He said

thot bite of

block _f lies is very painful ond more intense during

the

roiny seoson. The

octivities

such os hunting, f ishing ond forming by Mvolo people exposed them

to the bite of

both block

flies

ond mosguitoes Mectizon intoke hos helped in reducing

the

problem ossocioted

with

OV. The Mission

told

them

thot

mosguito control would be embarked on

with the

help

of

PCO ond

the

technical odvisor APOC is deploying

to

them.

Treatment

with mectizon is very populor in

this

community os oll

thot

were asked whether token mectizon,

the

response wos tO}% positive

evento the

point

of

indicoting

the

number

of toblets

token

with their

f ingers

without

being osked. The community hqs

three

CDDs nomely Froncis Dolo, Jocob Hobbos ond Jocob Camis. However,

it

wos only Jocob Comis

thot

wos present. He soid he is willing

to

continue

distributing the

mectizon

to

help his people. He soid

thot

his problem is _monoging side

eff ect

ond

tronsport

when

trying to

cover more locotions. On

the

number

of

persons

treoted

in 2OO7, he quoted 700 persons

but

could not produce his

treotment

notebook which he cloimed wos in his house. But whot is

very interesting

ond encouroging is high level

of

^qwqreness, enthusiosm ond response

to treotment with

ivermectin in

this

community.

According

to the

CDD,

it

tokes

7

days

to

complete

distribution

ond

the

time

of

distribution

is

both

morning ond evening

but

vorying _f rom household to

household. Regording incentives, he expressed

the

need

of

books, roincoots ond bednets.

3.7. Briefings on fhe field visit situation/meefing of

^{The l4ission}

^{with SSOTF}

(coordinator

dnd CBtl,l

country representafive)

^on

28h Februory

2OO8 All met

ot the

SSOTF

secretoriat

f

or briefing

ond discussions. The Mission expressed pleosure over

the

level

of

work in Mvolo county especiolly community members' enthusiasm ond respond

to treotment

ond thus commended

the

coordinotors ond

their

teom

for their efforts.

The coordinotors ond

the state

CDTI

project

coordinoting

officer for

^Eost Bohr

el

Ghazal however

retorted thot

the

situotion

in Mvolo County is o speciol cose ond mony

other

oreqs ore guite

contrary.

The PCO recounted how some communify members were

ref

using mectizon

treotment

in some oreos in

the

stote.

Other motters

discussed centered on

1. Census, which

Dr

Bobo soid would hold in

April

2008 ond

this

would give informotion on updoting the populotion

ot

high risk.

2. REMO and RAPLOA. This would be completed in

Oct-

Dec 2008 due

to

census slated

for ^April

^plus

the foct thot

on integrated diseose workshop would toke ploce during

this

period in Southern Sudon. Dr Nomo soid

that

no technicol

ossistont would be sent ond

thot Dr

Babo, Fosil ond Lozorus

wete

enough

to

hondle

the

exercises including

other

olreody

troined

people on

thqt.

3. Additionol qdministrotive

structure.

Administrotive levels

weretwo before

such os region ond county

but

now

three

nomely region,

stote

ond county. Forecosting whot would hoppen

to

oll oreas

thot

were not occessible during

the

REMO

exercise,the

present ten

stotes

hove

to

be covered

within

the

five CDTI projects

ond

foilure to get ot

oll

the

ten

stotes

meons hoving

f

oci

of

infection.

4.

Building

of

Oncho of f ice. Need

for

solor energy os on

olternotive

powe? supply,

internet

service

to

moke communicotion eosy and procuring eguipment such os

oir-

conditioners, fons

etc.

However

there

is plon occording

to Dr

Boba

to

hove VSAT in

the

building.

5. Plon

of

^Action. Lazorus needs

to

develop o work plan

for

providing ossistonce

to the

5

CDTI projects

ond

the

55OTF

secretoriot.

5. Humon resources development in

order to

secure ond

troin

more people in

the

7. Logistic ond mointenonce. More motorcycles ond bicycles areneeded including mointenonce

of

existing

project

vehicle.

8.

fntegration.

Additionol fund could be provided

for

co-implementotion

of

oncho

with other

diseoses using

the

CDTI

structure.

9. Speciol Country

Initiotive.

This would enable

for

increosing

the

number

of

CDDs ond copocity

of

heolth workers so os

to

realize

CDD/total

populotion

rotio of

^1:100

and

this

would

ultimotely

^improve geographic ond theropeutic coveroge

rotes

ⁱⁿ Southern Sudon.

10. Nodding disease epidemiology. Some oreos where

the

disease is prevolent ⁱⁿ

the

Southern Sudon ore

port of

Jubo, Mvolo, Eost Moduru, Rojo ond Mugi counties An operotionol is needed.

3.8.

tl,leeting

with the

WHO Represenfafive

of

Southern Sudan on

4 tl\arch 2008

Dr

Ahmed Abdullohi received

Mr

Lazorus Nweke in

his office.Hetried ^to

f ind out whot

his

experience like

from the visit to the

Southern Sudon ond whether he was in Jubo

before

proceeding

to

Rumbek.

fn

his response,

Mr

^Nweke

told

him

thot the situotion

in Rumbek is too chollenging

giventheperceived

high cost

of

trovel (oir ond high cost

of

vehicle fueling on lond, poor roods ond generol ef f

ect it

would

exert

on mointenonce

of

vehicle including humon heolth implicotions ond olso occommodation problem.

Dr

^{Abdullohi guickly agreed}

with

him by saying

thot

logistics alone

tokes

80%

of the

whole fund. On whether he wos in Jubo, Mr

Nweke

told

him

it

wos on

tronsit to

Rumbek ond not necessarily being

to

ony of f lce in Jubo.

Dr

^{Abdullohi osked} him obout his

controct

^document

with

regards

to the

new

job. Mr

Lozorus showed him APOC invitotion

letter to

undertoke

the foct

f inding mission.

Dr

Abdullohi

told Mr

Nweke

thot

he needs

to

get

the

detoils so

thot

EMRO

office

would be communicoted. He directed

thot

o copy

of theletter of

of f

er be

given

to the Administrotive

of f icer

to

enoble

her

open o f ile f

or Mr

Nweke.

On issue

of

occommodotion

Mr

Nweke exploined

to

him

the

extent

of eff

orts so

for

^{ond how}

Dr

Bobo hos given consent

to

ollocoting an oportment in one

of the

new houses in

the ministry

ond olso

the initiol

thought

of

^APOC

Director to

^reoch him concerning building o

tent within the

WHO ^premises in Rumbek.

Dr

^Abdullohi described

her

ideo os

perfect.

He osked qbout

the internet

system in

the

SSOTF heodguorter ond

it

wos exploined

to

him

thot the ministry

wos

yet to

hove one. He soid

their office

is ovoiloble

for internet system. Dr

^Abdullohi osked

the

Administrotive officer to get

Ouogo

to

send

the controct

document

to

his

office.

On when

Mr

Nweke would be relocoting

to

Rumbek, he wos

told it

would be on 25

April ond he osked

Mr

Nweke

to

be in

their

Jubo

off

ice on his woy

to

Rumbek

for further briefing.

4. O CON5TRAINTS/CHALLENGE5

1.

Deloy in releosing fund

to

pay top-ups

to staff

and general CDTI operotions by APOC.

2. Ministry of

heolth's non poyment

of

solories

to stqff for

mony months now.

3.

Mectizon

tablets areyet to orrive for

commencement

of

2008

distributionbef

ore the onset

of

roin in Moy.

4.

Freguent turnover

or

high

ottrition rote of troined or

ovoiloble

stoff.

5.

^{General scarce}

^of

monpower rn the Southern Sudon CDTT

projects.

6.

Low pockoge f or CDTI

staff

ogoinst high pockoge by

other

UN ogencies in

the

Southern Sudqn.

7.

^{No record}

of

number

of

communities

treoted

ond

theref

ore colculoting

the

geographic coveroge wos most chollenging.

8.

^The

^project

^{is obviously very}

for

f rom reoching

the

minimum

theropeutic

coverage rote

of

65% as mony Poyom/heolth focilities/communities ore

to yet

commence

treotment.

9.

^Report

^of

some people ref using

treotment with

mectizon due

to

reoctions ond generol unwillingness.

10. High cost

of

petroleum product os one drum

of fuel

costs os much os $3,500.

11. Poor communicotion networks in

the

Southern Sudon.

12. Logistics in oreo

of

motorcycles ond bicycles ore inodequote ond some very old motorcycles need replacement.

13. High cost

of

vehicle mointenonce including motorcycles.

14. Complete lock

of

ossistont

project

coordinoting

officer ot stote

level ond ossistont county supervisor

ot

county level.

5.O CONCLUSTON

The

CDTI

in

the

Southern Sudon reguires re-lounching

with greoter

momentum in capocity building ond empowerment

of project

coordinoting

officers to eff

ectively mon

their

respective

projects for future

sustoinobility.

6.0 WAY

FORWARD

AND

RECOAAAAENDATIONS

1.

^APOC should consider os o

motter of

urgency

the

release

of the

outstonding top-ups

for

?0O7 ond olso

to

speed up

the

releose

of

fund opproved

for

²⁰⁰⁸

^to

^{enoble CDTI}

octivities to

commence in

the projects

z.

^The

6055

ond

the Ministry of

heolth

to

f ind o solution

to

chronic non- poyment

of stoff

salories

to

reduce loss

of

troined ond knowledgeoble monpower in

CDTI project to other

ogencies ond thus reduce ^over dependency on top-ups.

3.

APOC is reguested

to

give speciol considerotion ⁱⁿ supporting

certoin

cotegory

of stoff ot the

Notionol Oncho

Secretoriot

^as

tobulated

below

s/N Stoff ot 55OTF to

be supported by APOC

No.

of stoff

Proposed pockoge Being poid by NGDO &

other

UN progrommes

1 Administrotion ond finonce

officer

0 $1200

-

_$1500

2

Logistic officer

0 $1000

-

_$1200

3

Secretory

⁰

$8oo -

^$1200

4 Doto manoger 0 $1200

-

_$1500

4.

^{Troining ond copocity building}

^of

^{oll CDTI}

^{stoff at oll}

^{levels such os PCOs,}

county supervisors, heolth

focility staff

ond CDDs

(with

a

greater

focus ^on

the

new APOC doto collection

forms)

^should be given top

priority for stobilizotion

and

eff

ective

functionolity of CDTI

ⁱⁿ

the

Southern Sudon.

5.

Troining

of

doto monogers on hondling, hqrmonizotion, storoge ond monqgement

of

doto using oppropriote computer

soft

wores ond Apoc dotobose.

6.

Providing appropriote

troining for

f inonciol monogement

officer

f or ef f

ect:e

hondling

of

f inonciol tronsactions

ot the

^notional

secretoriot.

7. All projects ot the stqte

ond

the

county levels should hove? ossistonts each f

or better

monogement ond implementotion

of

CDTI.

8.

^Need

^to

^{review ond omend} trovels, troining ond operotron/expenses budget lines in 2008 plon

of

oction os

it

concerns 55OTF f

or better

coordinotion

of

CDTf

octivities

implementotion

ot the

5

stotes project

level.

9.

^The

55OTF project

should increose

the

number

of

CDD

/totol

^populotion

rotio to

1:100 in

the

5

stotes

CDTI

projects

by opplying

to

APOC f

or the

Speciol Country

Initiotive to

tockle

the

issue

of

low

theropeutic

ond geogroph ic

ol

^cov eroge rotes.

10. APOC is reguested

to

consider providing a new generotor

of

high copocity

to

55OTF

secretoriot to

oct os bockup

to the

smoll one presently ovoiloble os

there

is no

other olternotive

power source in Rumbek.

11. APOC

to

support census

registrotion

updote ocross

oll

5 CDTf

projects to

determine

the totol

populotion ovailable in these oreos.

12.

fntensive

community mobilizotion ond heolth educotion should be

strengthened f

or

proper institutionalizotion

of

CDTT

strotegy

ocross oll

projects

ond communities in

the

woke

of the

returning

of

refugees.

13.

APOC

to

ensure ovoilobility

of

^one functionol motorcycle

to

eoch county ⁱⁿ

the

5

projects

ond bicycles

to

some heolth

focility stoff

f

or

ef f ective supervision

of

CDTI

octivities.

14.

Community

self

monitoring ond stokeholders meeting should be exponded

to

include oll CDTT communities ocross

the

5

projects to

accelerote complete community ownership

of

the progromme.

15. More funds should be ollocoted

for ^project

^vehicles ond motorcycles mqintenonce.

7.O

Development

of

Plon

of

Action

Efforts

were made

to

give

direction to

development

of the

plon

of

oction f

or the

speciol

country initiotive

which would enable

for

high number

of

CDDs

to

o

populotion

rotion of

^1:100

to

improve geographic ond

theropeutic

coveroge.

fnitial

cqll

to

develop

it didn't

go down well os 5

projects

needed

to

get

their

plons

to

enoble

55OTF office

come up

with

o

holistic

plan

of

oction. Funds opproved in

2008

APOC

letter of

ogreement hos not

yet

been received.

Appendix

1: Schedule/itinerory of the

^Mission

from 21 Februory to 7

Morch, 2008

Doy/Dote

^Ploce

to visit Activity

^Remork

Day

l/21Feb

Noirobi

-Arrivol

ond

settling

^down by

the

mission

-

Sorting out immigrotion possport issue

with

AA Doy ?/22Feb. Noirobi ^-Meeting

with

^SSOTF

coordinotor ond Agnes

Doy3/23

Feb Noirobi ^Plonning

Day4/?4

Feb Lokichogio

Tronsit to

^Rumbek

Doy

5/25

Feb Rumbek

/

55OTF

office

Meeting with

the

CBM country representotive Day

6/?6

Feb

55OTF office

Meeting contd

Doy

7/27

Feb Mvolo county Field

visit for

CDTf performonce

Day

8/28

Feb

55OTF office

lAeeting

with

Dr. Bobo, Fosilond MOU

presentotion

for

signing Day

9/29

Feb Rumbek

Nairobi

Plon

of

oction development

Doy 10-13/1-4 Morch

Nairobi Report writing

Doy

t4/

5 Monch

Ouogo Submission

of

MOU

Days 15

-

22

/6-14

Morch

Ouogo

Further

Briefings, Finolizing ond submission

of

mission

report

^ond collection

of letter ol controct

Day

?3/

^L4 Morch

Logos Deporture

Day

24/t5

Morch

Enugu Home

Appendix 2z

The

Mission Teom ond Persons

met during the

exercise

s/N

Nome Designotion

Off

iciol locotion

Emoil oddress/Phone No

1 Dr Nomo

Mounkoila

w\o/

^APOC

cEv

Ouogodougou, Burkino Foso

nomom@oncho.of ro.who.

int

?

Mr

Lozorus Nweke

wHo/

^APOC

Temporol Advisor

Rumbek, Southern Sudon

nnabuike ^.com

O7tlt397}8 -

Nairobi +23480474710

-

Nigerio

3

Dr

Sompson Bobo

SSOTF Coordinator

Jubo MOH, Southern Sudan

Somson-bobo@yohoo.com

+256477t25799 -

Jubo

0722364982 -

Noirobi 4

Mrs

Agnes

Wonyoike

wHo/

^APOC administrotive ond

occounting

officer

Nqirobi,

Kenyo

wonyoikeo@ nbo.emro.who. int O7228t6975

-

Nairobi

5 Fosil Chone N6DO

Coordinotor (cBM ₎

Rumbek, Southern Sudqn

f bchone@yohoo.com +8821643335349

-

Sudon +25t911792415

-

Addis

6 Chuol Project

coordinating

officer,

Eost Bohr el Ghozol CDTT

Rumbek, Southern Sudon

7 Dr.Joyoprokosh Voliokolleri T.

WHO Medicol

officer,

Polio Erodicotion Progrom

Rumbek, Southern Sudon

Vtdrlp56@yohoo.com

8 Wilsey Bcourt Mvolo County supervisor

Sudon Inlond Development

(srD),

Domeri, Mvolo

wis leybcourt@yahoo.com

9 Williom Dolli Mvolo county heolth

plonning

officer

Mvolo heolth centre

10 Jqcob Comis Mvolo CDD ond Bomo

Mvolo viilage, neor heolth