South Sudorn Upper Nile CDTI project

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South Sudorn Upper Nile CDTI project

COUNTRY/NOTF: South Sudan Proiect Name: Upper Nile Approval ^year: 2003 Launchins vearz 2006

REPORTING PERIOD:FRoM: JANUARY TO DECEMBER 2007

(MONTH/rEAR)

⁽

MONTTI/rEAR)

Proiectvearofthisreport: (circleone) I ⁽²⁾ 3 4 5 6 7 8 9 ¹⁰

Date submitted: 6''' August 2008

₊

NGDO oartner:

Chirstoffel Blinden Mission

ORIGINAL

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WHO/APOC, 15 November 2006

ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVB COMMITTEE ^(TCC)

To APOC Management by 31 Januarv ^for March TCC meeting To APOC Management by 31 .Iulv for September TCC ^meeting DEADLINE FOR SUBMISSION:

AFRICAN PROGRAMME ^FOR

ONCHOCERCIASIS CONTROL ^(APOC)

I I I I I I

ll ^{WHO/APOC, 15} November 2006

ANNUAL PROJECT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT

Please confirm you have read this report by signing in the appropriate

space.

OFFICERS to sign the report:

Country: South Sudan

National Coordinator ^Name: Dr Samson

Signature

_a,

Date

Zonal Oncho Coordinator Name: Chuol Both Signa

Date

NGDO Representative Name: Fasil Chane Si

pllps

lkr. ^V

A',r+*t

"'u " "' trqrr

Date: ...0.6.

This report has been prepared by Name :Baba/FaslllLazarus/Chuol Designation

:

Nat CooAIGDO

:tiltfwadl

Date .a/r.al4N..

Table of contents

ACRONYMS VI DEFINITIONS VII

FOLLOW

UP

ON TCC RECOMMENDATIONS

¹

EXECUTIVE SI.JMMARY

^ERROR!

^BOOKMARK

^NOT

^DEFINED.

SECTION

1:

BACKGROLIND INFORMATION

²

1.1.

GruenarINFoRMATIoN...

1.1.1

Description of the

projeu

(brieJly)....

1.1.2 Partnership..,.

1.2

PopureuoN...

2.t

SECTION 2: IMPLEMENTATION OF CDTI

⁷

. ^TIwu.re

^oF ACTTvITIES ... .,.,,.,7 ...9 2.2.

Apvocecv

2,3.

MOBLZETION, SENSITZATION AND TIEALTH EDUCATION OF AT RISK COMMUNITreS ^. 9

2.4.

CotvnvruNlrYDn/oLVEMENT

2.5.

CepecrrvBUILDING..

l1

2 2 3 5

2.6. TnrarwNTS...

2.6.1 Treatment ftgures

2.6.2 What are the causes of absenteeism? ^,.

2.9.1.

^Provide

^aJlow

^chart of supervision hierarchy

EeupwNr...

FnqRNCTAL CONTRIBUTIONS OF Trrp PARTNERS AND COMMUNITIES

Orrren FoRMS oF coMMUNTTY SLIPPoRT

E>cBuolruRp PER ACTryITY ...

4.2.1 Planning at

all

relevant levels...

.... ¹³ .... 15 .... 15 .... 18

2.6.i

What are the ^reasons

for

^refusals? ...18

2.6.4

BrieJty describe

all

known and verified serious adverse events (SAEs) that ... 18 2.6.5. Trend of treatment achievement

from

^CDTI

^project

^inception to the curuent

year2}

2.7

.

OnogRwc, sroRAGE AND DELTvERY oF ryERMECTIN

.22

2.8.

Corvnnnqny sELF-MoMToRINc

axo

SrexnHoLDERS

MrrrNc

.23

2.9 SupsRvrsroN... ...,,.,... 23

.'.,...,...'.,, 23

2.9.2. ^Wat

^{were the main issues} identified during supe'rvision? 24

2.9.3.

^Was a supervision checklist used? 24

2.9.4.

What were the outcomes at each level of CDTI implementation supervision? 24

2.9.5.

^Was feedback given to ^the person or Sroups supervised?....'...'...'.. 24

2.9.6.

^{How was the} feedback used to improve the overall performance of the proiect?

25

SECTION

3: SLIPPORT

TO CDTI

²⁵

3.1.

3.2.

3.3.

3.4.

25 26 26 26

SECTION

4:

SUSTAINABILITY OF CDTI

²⁷

4.1. INrrnNaU

INDEpENDENT PARTICIPAToRY MoNIToRINc;

EvaruerloN...

...27

4.1.1

^Was

Monitoring/evaluation carried

out

during

the reporting

period? (tick

any

of the

following

^{which are} applicable)

..27

4.1.2 What were the recommendations? ...

..27

4.1.3, How have they been implemented? 27

4.2.

SusrRrNeuLITy oFrRoJECTS: PLAN AND sET TARGETS

(uexoeroRY

AT... ...27

Yn 3) ...27

...28 ...28

4.2.2 Funds.

iv

^{WHO/APOC, 15} November 2006

4.2.

3

^{Transport (} replacement and maintenance ₎ ...

4.2.4.

Other resources

4.2.5.

To what extent has the

plan

been implemented...

4.3.

INrecRnrroN ...

4.3.1.

Ivermectin delivery mechanisms...

28 28 28 28 28 28 28 28 28 4.3.2

4.3.3 4.3.4 4.3.5

Training...

Joint supervision and monitoring with other programs....

Release of funds

for

project activities

Is

CDTI included in rhe PHC budget? ...

4.3.6.

Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the

achievements?...

... 28

4.3.7.

Describe others issues considered in the integration of

CDTI.

^{... 28}

4.4.

OpTnITToNALRESEARCH

^...29

4.4.1.

Summarize

in not more than one half of a page the operational

research undertaken in the project _area

within

the reporting

period.

...29

4.4.2.

^How were the results applied in the

project?....

...29

SECTION 5: STRENGTHS, WEAKNESSES,

OPPORTI.]NITIES

29

CHALLENGES, AND SECTION 6:

LJNIQLIE

FEATURES OF THE PROJECT/OTHER MATTERS30

V WHO/APOC, 15 November 20O6

Acronyms/Abbreviations

African Programme for Onchocerciasis Control Annual Treatment Objective

Annual Training Objective Community-B ased Organi zation Chirstoffel B linden Mission Community-Directed Distributor

Community-Directed Treatment with Ivermectin County Health Department

Community Health Workers County OV ^Supervisor

Comprehensive Peace Agreement Community Self-Monitoring Civil Society Organisations Democratic Republic of Congo Government of South Sudan

Information, Education and Communication Internally Displaced People

Local Government Authority Ministry of Health

Non-Governmental Development Organization Non-Governmental Organization

National Onchocerciasis Task Force Project Coordination Officer Primary Health Care

Primary Health Care Center Primary Health Care Unit Payam OV Supervisor

Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event

Stakeholders meeting

Sudan Relief ^and Rehabilitation Commission

Technical Consultative Committee(APOc scientific advisory goup) Trainer of trainers

United Nations Children's Fund Ultimate Treatment Goal World Health Organization APOC

ATO ATrO CBO CBM CDD CDTI CHD CHWs COS CPA CSM CSOs DRC GoSS IECs IDPs LGA MoH NGDO NGO NOTF PCO PHC PHCC PHCU POS REMO SAE SHM SRRC TCC TOT UNICEF UTG

wHo

VI WHO/APOC, 15 November 2006

Definitions

(i) Total population: the total population

living in

meso/tryper-endemic communities within the project area (based on REMO and census taking).

(ii)

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

(iii)

Annual Treatment Objective:

(ATO): the

estimated number

of

persons

living

in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a

given year.

(iv)

(v) Therapeutic coverage: number

of

people treated

in a

given year over

the

total population (this should be expressed as a percentage).

(vi)

Geographical coverage: number of communities treated in a given year over the total number

of

meso/hyper-endemic communities as identified by REMO

in

the project area (this should be expressed as a percentage),

(vii)

lnteeration: delivering additional health interventions (i.e. vitamin

A

supplements, albendazole

for LF,

screening

for

cataract, etc.) through

CDTI

^(using

the

same systems, training, supervision and personnel) in order to maximise cost-effectiveness and empower communities

to

solve more

of

their health problems. This does not include activities

or

interventions carried out

by

community distributors outside

of

CDTI.

(viii)

Sustainability:

CDTI

activities

in

an area are sustainable when they continue to

function effectively for the

foreseeable

future, with high

treatment ^coverage, integrated into the available healthcare service,

with

strong community ownership, using resources mobilised by the community and the government.

(ix) Community self-monitoring

(CSM): _The

process

by which the

community is empowered

to

oversee and monitor the performance

of

CDTI

(or

any community- based health intervention programme), with a view to ensuring that the programme is

being executed

in the way

intended.

It

encourages

the

community

to

take full responsibility

of

Ivermectin distribution and make appropriate modifications ^when necessary.

Ultimate Treatment Goal (UTG): calculated as the maximum number of people to ^be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached

full

geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year of the project).

vll

^{WHO/APOC, 15} November 2006

FOLLOW

UP ON TCC RECOMMENDATIONS

Using the table below,

fill in

the recommendations of the last TCC on the project and describe how they have been addressed.

TCC session

-

(Please add more rows if necessary) Executive Summary

This is the report of CDTI activities implemented by Upper Nile CDTI project, Southern Sudan from January to December 2007. The project is in its second year of APOC funding ^phase. The project is also being supported by CBM, ^an International NGDO coordinating CDTI in collaboration with Southern Sudan Onchocerciasis Task Force.

The project has a CDTI total population of 614,994 persons, UTG of 516,594 persons and an ATO

of

119,868 persons during the reporting period. It is made up of 6 counties and 1238 communities. Data on the number of health staff involved in CDTI ^shows that 115(17.47o) persons were involved in CDTI activities out of 662 available health staff in the project areas.

On treatment, only 597 communities were treated and thus giving a geographic coverage of 48.22Vo.

A total

of

l36,49lpersons received mectizan treatment during the period under review. This treatment figure represents a therapeutic coverage, UTG coverage and ATO coverage of 22.19Vo,26.42Vo and

II3.9Vo respectively in2007 ^.

Population movements are mainly attributed to those still returning from internal displacement following ^years of conflicts. Information/data on absenteeism was not available in the project.

On

training,

605(88.3Vo) CDDs were trained out of annual training objective of 685. The

population/CDD trained ^was in a ratio of 1CDD to 1017 population. The number of ^health staff was 79(88.l%o) out of ⁸⁹ targeted persons. The project had a lot of challenges as stated below:

o

lnclusion of CDTI staff in the nominal role of the MOH: This ^was not well ^discussed with the authority but there is hope of their absorption over time.

.

Getting the drugs and other training materials before the ^onset of rainy season: This is still a

problem and the project would want airlifting of materials before setting in of rains.

o

Inadequate number of CDDs: This was addressed through training more CDDs but still this was not enough given the population/CDD ratio of 1017:1.

o

Lack of proper household census registration: The project has not been able to deal with this but as things change later, this activity

will

be performed.

o

Lack of the project vehicle: The approved vehicle in2007 has not been released.

All

effort to get it failed.

o

Maintaining a good record of CDTI activities is a problem.

All

county and payam supervisors/trealth were reminded of the importance of this and the project anticipate improvement in the future as they have noted their mistakes and need to keep good records.

1

Number

of

Recommendatio n in the Reoort

TCC

RECOMMENDATIONS

ACTIONS

TAKEN BY THE PROIECT

FOR TCC(APOC

MGT USE ONLY

NOT APPROPRIATE.

WHO/APOC, 15 November 2006

Lack of Community self monitoring activity: ^The project has not introduced this but this

will

be accommodated in 2008.

More improvement in Health education and community participation especially women:

Women participation was poor before but the project's effort improved this ^and it was fair ^as earlier reported.

SECTION 1: Background information

1.1.

General information

1.1.1

Description of the project (briefly)

-

Geographical location, topography, climate

-

Population: activities, cultures, language

-

Communication systems (roads...)

-

Admtnistrationstructure

-

Health system

&

health care

delivery

@rovide the number of health posts/centers

in

the project area if the information is available).

-

Number

of

health

staff in

project area and number

of

health staff involved

in

CDTI activities.

-

Geographical location, topography, climate

Upper

Nile

CDTI is located between latitude 5oand 1loand between longitude

of

29" and

35'. It

is situated on the North

of

Southern Sudan and bordering Ethiopia.

Lying

across its base

or

South is Jonglei state and stretching towards the West is North Sudan.

The project is made up of two States (Jonglei and Upper Nile) and six counties. The Project has its Office at the County Health Department building in Akobo.

The Upper Nile CDTI project lies

in

3 ecological zones. The western part is flood prone zones, the Eastern part being Sudan savannah on clay and Guinea savannah, the eastern part along Ethiopian border is

hilly

area. The eastern part is a continuation of the Ethiopian plateau with fast flowing rivers and streams and hence suitable sites for Similium vector breeding. The Boma ^plateau to the south is mountainous and volcanic

in origin..

The Pochalla, Akobo and Rahad rivers drain the Upper Nile region.

The rainy season begins in May and ends in October. The dry season is from November to April. The farming activities start with the onset of the rains. The farming ^season lasts irom May to September.

The length of the growing seasons varies from 7

-9

^{months in} the highlands. The area has an annual rainfall

of

800- 1000 millimeters or more

in

the Sudan-savannah, guinea -savannah and the Boma plateau. Flooding is common in the flood prone areas due to the fast flowing rivers from ^the Ethiopian highlands. The Boma highlands are characteized by medium wet ^seasons that are cool and rainfall varies from 1000 to 600 millimeters. During the dry season, the main subsistence activity is fishing.

Population : activities, cultures, language

The estimated total population at

- risk of

Onchocerciasis infection

is

614,944.

With

the ongoing repatriation exercise,

this led to the risk

population increase

in this

^report.

The

demographic description of the population is yet obscure. The Upper Nile CDTI project area is home to Nuer (Lou Nuer, Jikany Nuer, Gajak Nuer and Gaguang Nuer), Murle, Anyuak and

Dinka.

^{Nuer is the} dominat ethinic group

The activities of majority of the people in Upper Nile are subsistence farming, Cattle keeping, hunting and fishing. Due to internaUexternal conflicts, the communities are not much settled to engage in ^those activities.

Communicalion system (road...)

Accessibility to Upper Nile region is initially mainly through Lokichoggio in Kenya by land or air.

It

can now be accessed through Ethiopia, Juba and Rumbek in Southern Sudan only by air. UNICEF and WFP flights operate in the region and facilitate movement of health workers in different parts of the region.

a

a

2 WHO/APOC, 15 November 2006

The road infrastructure is very poor and some villages are not aicessible during the rainy season that is usually in May, June, July, August and September/October. This accounted to non implementation of

CDTI

activities

in

Kurmok

in 2007.

Movement and accessibility are much easier during the dry season, which lasts from November

to

May, hence the need

for

mectizan distribution during this period. CDTI activities in the project areas require the use of 4WD vehicles, motorcycles and bicycles and canoes.

A dminist ralio n stru ctur e

The administrative structures

in

the Upper

Nile

CDTI project basically divided

into

state, county, Payam and Boma.

The

Boma

is the

lowest

level of

government administration.

The

state is administered by Governor, county by commissioner, Payams by Payam administrator and Bomas by Boma liberation council. The project covers 6 counties, namely; Pibor, Pochalla, Akobo, Lador, Renk and Kurmok (Blue Nile).

Health ^system

&

health care delivery (provide the number of health posts/centers in the project area if the information is available).

The Primary Health Care system is still evolving to takes its rightful positibn in delivery basic health activities. Necessary drugs, equipment and instruments are being lacked or inadequate. The staff are

all volunteers for over twenty years. The CHW and the Village Health Council provide and direct the

delivery

of

health service

at

the community level. Both local and international organizations are partners in the delivery,

The Upper Nile CDTI project has a total of 34 health facilities comprising 28 Primary Health Care Units (PHCUs),

4

Primary Health Care Centers (PHCCs) and 2 rural Hospitals based

in

Boma and Kurmok.

Number of health staff in project area and number of health staff involved in CDTI activities.

From the available statistics,

ll5

(l7.4Vo) were involved in CDTI activities out of 662 health staff in the project area. No data from Kurmok County due to inaccessibility during the reporting period. The break down is shown below.

Table 1: Number of health staff involved in CDTI (Please add more rows if necessary)

1r

3

DistricULGA

Number of health staffinvolved

ih

CDTI activities.

Total Number of

health staff

in

the

entire

^project

area Br

Number

of

health

staff involved

in CDTI

Bz

Percentage

Bs=Bzl Br *100

Akobo 85 15

17.6

Pochalla 56 10

17.9

Pibor(Boma) 135 25

18.5

Latjor(Sobat) 156 30

t9.2

[z:VU,

^{ban 230 35} 15.2

Kurmak(Blue Nile) 0 0

0

Tqtal_

^{662 115} r7.4

WHO/APOC, 15 November 2O06

partnership

Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaUinternational), communities, local organizations, etc.]

Describe overall working relationship among ^partner3, clearly indicating specific ^areas

of

project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved.

State plans,

if

any,

to

mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation.

Indicate the partners involved in project implementation at all levels [MoH, ^NGDOs (nationaVinternational), communities, local organizations, etc.l

The partners involved in CDTI activities in ^the project area are the communities (1,238 villages and 6 counties), health services though weak, NGDO

- ^CBM

and APOC/IIVHO. The World Relief (WR) assists in information dissemination in some areas.

Describe overall working relationship among pafiners, clearly indicating spectfic areas of proiect activities (planning, supervision, a.dvocacy, mobilization, etc) where all partners are involved.

Within the limited prevailing atmosphere, all the partners are working cordially and trying to ^{meet the} CDTI objectives. Operating

in

the project area is most challenging to ^partners. Health services from the state ministry to ^payam primary health care centers are still weak as CDTI integration is not ^there fully. Partners like communities project office representing health system

jointly

carry out community mobilization, health education, training and rnectizan distribution. The project

in

conjunction with SSOTF and NGDO do planning, meetings and advocacy. The project has the worst terrain in Southern Sudan and this hampers joint activities implementation.

State plnns

if

any to mobilize the state/regionldistrict/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation.

The CDTI project plans to advocate and mobilize State, County and decision makers and NGOs to assist in the implementation of CDTI activities. This

will

help to increase the awareness and support

of all

the panners to CDTI

activities.

Also there is plan to continue consulting

with

the Ministry

of

Health through the Director General on the need

to

have the

CDTI

program integrated

into

the Ministry of Health ^services.

4 ^{WHO/APOC, 15} November 2006

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SECTION

2:

Implementation of

CDTI

2.1.

Timeline of activities

Fill

in table 3, timeline of activities

for

areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended.

7 WHO/APOC, 15 November 2006

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