PROGRAMME AFRICAN

M,,ST EQUATORIA CDTI PROJECT

^III

I I I

COUNTRYAIOTF: Southern Sudan Proiect Name: EEQ CDTI

Approval year: 2003 Launching vearz 2006

REPORTING PERIOD: FROM: JAN TO DEC (MONTH/rEAR)

,2008

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

Date submittedz 27 July 2009 NGDO partner:

Chirstoffel Blinden Mission

ORIGINAL

^{: English}

ANNUAL PROJECT TECHNICAL REPORT .:'t SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

To APOC Management by 31 Julv for September TCC meeting

DEADLINE FOR SUBMISSION: Trclg

To APOC Management by 31 Januarv for March TCC meeting , _VA

COCE\

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AFRICAN PROGRAMME ^FOR

ONCHOCERCTASTS CONTROL (APOC)

WHO/APOC, 15 November 2006

ANNUAL PROJECT TECHNICAL REPORT

1'O

TECHNICAL CONSIILTATIVE COMMITTEE (TCC) ENDORSEMENT

Please confirm you ^{have read this} report by signing in the appropriate ^space.

OFFICERS

to sign the

report:

Country: Soutlrern Sudan

National Coordinator

^Name:

^{Dr. hristo}

^I-uga

Siglaturel

^.

Dater

23rd July 2009 APOC Technical Advisor:

Lazarus Nweke

Signaturc:

Date: ^22"d

July. 2009 NGDO Representative

Name: Fasil

"ffi

Signature:

Date: ^22nd July, 2009

This report has been prepared by

Name :Emmanuel.Ezcma

Designatiott : Project Coorclinating officer Signaturre:

Date: l6d'July.

2009

I

Table of contents

ACRONYMSV

DEFINITIONS VI

FOLLOW

UP

ON TCC RECOMMENDATIONS I

EXECUTIVE SUMMARY

3

SECTION

1:

BACKGROUND INFORMATION4

1.1.

GBNBnal rNFoRMATroN...

1 .1

.1

Description of the

project

(briefly)

1.1.2.

Partnership

I.2.

Popur-erroN...

SECTION 2: IMPLEMENTATION OF CDTI

¹⁰

2.1.

Trvpr.rNe oF ACTrvrrrES ...

5 5 7 9

10 2.2.

2.3.

2.4.

2.5.

3.l.

3.2.

J.J.

3.4.

30

3t 3l

32

Apvocacy

...l2

MostLtzertoN,

SENSITIZATIoN AND HEALTH EDUCATIoN oF AT ^RISK coMMt-nqtrrcs 13

Corrarrau{rry

rNVoLVEMENT...

... 15

Cepncrry BUTLDTNG..

... 15

2.6.

TRperupNrs...

2.6.1.

Treatmentfigures...

2.6.2

^What are the causes of absenteeism?

2.6.3

^{What are the reasons}

_for

refusals?.... ...19

'....'..,..,.19

... 23

...23

2.6.4 ^Briefly

describe

all

lcnown

andverified

serious adverse events (SAEs) that... 23

2.6.5. Trend of treatment achievementfrom CDTI

project

inception to the current year25

2.7. ORoERrNG,sroRAGEANDDELIVERyoFIVERMECTIN...

...27

2.8.

COIT,IITIWITY SELF-MONITORING AND STAKEHOLDERS

MPPUNC

...,...28

2.9. SupeRvrsroN...

...29

2.9.1.

^Provide

aflow

chart of supervision

hierarchy

... 29

2.9.2. Wat

were the main issues identified during supervision? ... 29

2.9.3.

^Was a supervision checklist

used?

... 29

2.9.4.

^What were the outcomes at each level of

CDTI

implementation supervision? 29

2.9.5.

^Was feedback given to ^the person or groups supervised?... 30

2.9.6.

^How was the feedback ^used to improve the overall performance of the project? 30

SECTION 3:

SUPPORT

TO

CDTI3O

EqurrvENr

FNqeNCnL CoNTRIBUTIoNS oF THE PARTNERS AND CoMMUNITIES

Orupn

^FoRMS oF coMMlrNrry suppoRT ... ExpeNorruRE PER ACTIVITY JJ 33

SECTION

4:

SUSTAINABILITY OF CDTI

33

4.1.

INTERNaI; TNDEIENDENT pARTrcrpAToRy MoNrroRrNc; Ever.uerroN... 33

4.1.1

Was

Monitoring/evaluation carried

out

during

the reporting

period?

(tick _any of ^the

following

^which are opplicable) ... ...

...

^{... ... .. . .. 3 3}

4.1.2.

What were the

recommendations?

... 33

4.1.3.

^How have they been implemented?

...

... 33

4.2.

SusreINesrLITy oF nRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT... 33

Yn 3)

4.2.1.

Planning at

all

^relevant levels

rll

^{WHO/APOC, I 5} November 2006

4.2.2. Funds...

... 33

4.2.3

^Transport (replacement and mqintenonce)

. .

^.

.

... 33

4.2.4.

Other

resources..

^{.... 34}

4.2.5.

^{To whot} extent has the

plan

been

implemented...

... 34

4.3. INrecReuoN ...

... 34

4.3.1.

Ivermectin delivery

mechanism,s...

... 34

4.3.2. Training.... Erreur !

Signet non ddJini.

4.3.3.

^Joint supervision and monitoring with other

programsErreur ! Signet

non ddJinL

4.3.4.

Release offunds

for ^project activities

^.,..

Erreur !

Signet non ddJinl

4.3.5.

^Is

^CDTI

included in the PHC budget? ...Erreur

!

Signet non ddJini.

4.3.6.

Describe other health programmes that are using the CDTI structure and how this was

achieved.

What have been the achievements? ...

Erreur !

Signet non ddJini.

4.3.7.

Describe others issues considered in the integration of CDTI.Erueur

!

^Signet

non ddfini.

4.4. OpenerroNAl

RESEARCH

^{... 35}

4.4.1.

^Summarize

in not more than one half of a page the operational

research undertoken in the

project

area

within

the reporting

period.

... -rJ

4.4.2.

^How were the results applied in the

project?...

... -r.5

SECTION

5:

STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES

35

SECTION 6: UNIQUE FEATURES

OF

THE PROJECT/OTHER MATTERS

36

Ac ronym s/Ab brevi ati o ns

APOC African Programme for Onchocerciasis Control ATO Annual Treatment Obiective

ATrO Annual Training Oblective CBO

Community-Based Organization CBM Chirstoffel Blinden Mission CDD Community-Directed Distributor

CDTI Community-Directed Treatment with Ivermectin CHWs Community Health Workers

COS County OV Supervisor

CPA Comprehensive Peace Agreement CSM Community Self-Monitoring

CSOs Civil Society Organisations DRC Democratic Republic of Congo GoSS Government of South Sudan IDPs Internally Displaced People LGA Local Government Authority MoH Ministry of Health

NGDO Non-Governmental Development Organization NGO Non-Governmental Organization

NOTF National Onchocerciasis Task Force PCO Proiect Coordination Officer PHC Primary Health Care PHCC Primary Health Care Center PHCU Primary Health Care Unit

POS Payam OV Supervisor

REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event

SHM Stakeholders meeting

SSOTF Southern Sudan Onchocerciasis Task Force

TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers

UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization

V WHO/APOC, I 5 November 2006

Definitions

Total population: the total population

living

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

(i i)

Elisible

population: calculated

as

84%o

of the total

population

in

meso/hyper- endemic communities in the project ^area.

(iii)

Annual Treatment Objective:

(ATO):

the estimated number

of

persons

living

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

with

ivermectin in a

given year.

(iv)

^Ultimate Treatment Goal (UTG): calculated as the maximum number of people to

be treated annually in

meso/hyper endemic areas

within the project

area,

ultimately to

be reached when the project has reached

full

geographic coverage (normally the project should be expected

to

reach the

UTG

at the end

of

the 3'd

year

ofthe

project).

(v)

Therapeutic coverage: number

of

people treated

in a

given year over the total population (this should be expressed as a percentage).

(vi)

Geographical coverage: number

of

communities treated

in

a given year over the total number

of

meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).

(vii)

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

A

supplements, albendazole

for LF,

screening

for

cataract, etc.) through

CDTI

(using the same

systems,

training,

supervision

and

personnel)

in order to ^maximise

^cost-

effectiveness and empower communities

to

solve more

of

their health problems.

This

does

not include activities or

interventions

carried out by

community distributors outside of CDTI.

(viii)

Sustainability:

CDTI

activities

in

an area are sustainable when they continue to

function effectively for the

foreseeable

future, with high

treatment coverage, integrated into the available healthcare service,

with

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

(i*)

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.

(i)

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

28

I

Number

of

Recommendation in the Report

TCC

RECOMMENDATIONS

ACTIONS

TAKEN BY THE PROJECT

FOR TCC/APOC MGT

USE ONLY

Report related:

I

Include comments

from TCC

and respond

to all

questions

This is noted

^as

shown below

) Redefine "community"

- ^the

^current

^definition

is insufficient

(as noted

for the Upper ^Nile

report)

Community

refers

to part of

^payam

where a

^people

with the

^same

cultural

^and

homogenous

background

^are

living

together.

3

Fully complete

the

table on

^financial

expenditure

to

facilitate a calculation of the cost per treatment

It is difficult to fill this

^{because some}

funds are spent in

Nairobi and

^by

SSOTF which the

project has

^no

record of.

4

Provide details on

^in-

kind

support

from

other NGDOs

- ^it

^{is not clear}

how they

contribute to the project activities

NGDO

^provides

some

work support items while

^others

provide facilitate staff

transportation

Project related:

I Sustain ^{advocacy in} order to ^benefit

^the

project

^including

absorption of ^CDTI

staff in the

government system

Work

^towards

integration of CDTI in

This has

^been

noted and effort would be made to address the

issue

of integration

and

absorption ^of

CDTI project

and

its staff.

Though

effort has ^started

WHO/APOC, 15 November 2006

the health system

in

²⁰⁰⁸

with letter

written

^to

Undersecretary

^by

Technical Advisor

for aII staff ^of

CDTI in Southern

Sudan but

^more

efforts will

^be

made

in

2009.

.|

Increase

^geographic

and

therapeutic

coverage building

on high level advocacy

This ^{project is} already ^working

towards this

^and

there is

increase

in

both therapeutic

and

^geographic

coverage in

²⁰⁰⁸

as contained

in the

present

report.

3 Increase

the

number

of

communities ^with

supervisors

The project

^is

mindful

^of

this but was limited due

to

fund. In the

2008,

this was ^partly

addressed and

this

will continue in

2009

4 Increase

the

number

of

CDDs to ^reduce

^the

high ratio

^per

population

In ^2008, this

^was

addressed a ^bit

with more trained

CDDs

^and

population/CDD ratio was

reduced

to

789 persons

per CDD. This project

has ^planned

^to

further improve

on

this in

2009.

5 Increase

the

proportion

of

female CDDs

More ^villages selected

^more

female CDDs ⁱⁿ

2008

by

21.8%

and

in 20009;

^the

project will ^still

improve

on

it.

6

Initiate training

on

CSM and

^start

implementing CSM

This ^will

commence

in

2009

as it ^{was carried}

out in

²⁰⁰⁸

^{due to}

no fund.

7

Conduct

operational

research on

^social

structures

that

could be

utilised for CDTI in

^a

post-conflict context

The ^{project will} try to ^develop

^a

proposal

on this in

2009. This

^has

been

^discussed

with the

Technical Advisor.

(Please add more rows

if

necessary)

J WHO/APOC, 15 November 2006

Executive Summary

This is the report

of CDTI

activities implemented by East Equatoria

CDTI

^project, Southern Sudan from January to December 2008. The project is in its

third

year

of

APOC funding phase. The project has four main partners and they are communities, health services,

NGDO

and WHO/APOC.

The project has a total population of 602,302 persons,

UTG of

505,934 persons and an

ATO

of 379,451 persons during the reporting period.

It

is made up

of

seven counties and 532 communities. Data on the number of health staff involved in

CDTI

shows that

only

l20l(49.0%)

^persons were involved

in CDTI

activities out

of

2451 available health staff

in

the project areas.

On treatment, only 428 communities were treated and thus

giving

a geographic coverage

of

80.5%.

A

total

of

376,045 persons received mectizantreatment during the period under

review.

This treatment figure represented ^a therapeutic coverage,

UTG

coverage and

ATO

coverage of 62.4Yo,74.3% and 99.1%o respectively

in

2008.

Population movements are very common in the project area as they are potentially farmers and agriculturalists. This accounted for the number of absentees and refusals recorded ^as those who have not received health education do not know why they should take the medicine.

On

training,763(101.7%)

CDDs (638 males and ¹²⁵ females) were trained out

of

annual training objective

of

750. The populatiorVCDD trained was

in

^a ratio

of

1CDD to 789 in 2008 as against ICDD:1581 population

in

2007. The number of payam supervisors/health staff was

40(87.0%) out of 46 targeted persons.

Major challenges in the project during the reporting period include the

following.

(a)

Conduct

of

census update: The project has continued to improve on this as reflected

in

decreased population in this report.

(b) Ratio of Population/CDD is still high: With the current population/CDD ratio of

789:1, the project intends to train more CDDs

in

2009.

(c)

Absorption

of CDTI

staff and

CDTI

integration into health service system: TA/SSOTF made

effort in

2008 but

in

2009,there is hope this

will

be materialized.

(d)

Inadequacy

of

available knowledgeable manpower:

Many health workers

and other

CDTI staff will

be trained and

effort on staff

absorption

into

health services

will

^be

maintained to encourage

CDTI

staff to remain in the project.

(e) Low level of

education

among CDTI

personnel

especially at county, payam

and community

levels:

Continuous

training

and capacity

building of

these categories

of

staff have been noted to be

critical

to the project and

it

has planned to pursue

it

during the2009 distribution.

(f)

Problem

of

maintaining good record keeping

of CDTI

activities at

lower

levels: This has been emphasis

to the county and

payam supervisors,

and

change

is

expected

during the 2009

treatment year

with provision of

registers

to all village CDDs

and relevant reporting forms.

(g)

Solving vehicle and motorbikes problem: The project vehicle is getting old resulting in frequent breakdown and the project may need

to

approach

APOC for

a

possibility of

replacing

it with

^a new one plus 4 motorbikes.

(h)

Handling the issue

of

community

CDTI

ownership: The project has started addressing the

community CDTI

ownership through increased health education and community mobilization and this

will

be given greater momentum

in

2009.

SECTION 1: Background information

1.1 . ^General information

1.1.1 Description of the proiect ^(briefly)

Geograpbical

location, topograpby, climate

thebait

Equatoria

CDTI project is

located between the longitude

of

26.0-34.0 degrees and between

the latitude of

4.0-6.0 degrees. The project situated

in Yei in

East Equatoria state.

The

two

states that made up the project are East Equatoria and Central Equatoria' The East

Equatoria

state,

where the project actually

situated,

is the south-

eastern

region of

the Southern Sudan.

It

has boundaries

to the

South

with the Democratic Republic of

Congo

(DRC) and

Uganda,

which are known

Oncho-endemic areas.

It is also

bordered

to

the southeast

with

Ethiopia, to the

North with

East Bahr-el-Ghazal, Jonglei and Upper

Nile

states and to the west

with

west Equatoria ^state.

There are three

ecological

zones; guinea savannah, south savannah

on clay

and sand, and woodland recently derived

from

rainforest. There are numerous mountains and fast

flowing

rivers that compose the

relief of

^the

area.

The landform

is iron

stone plateau

with

complex basement;

Rainfall

varies

from

600-200mm per year,

which

makes the

soil

extremely fertile.

The wet

^season

begins in April with light rains and continues until October.

^The commencement

of farming activities

corresponds

with

the beginning

of the light

rains. The dry season covers November to March.

It

^transects

^two

hydro-geographical zones,

being a long the Nile-Congo

watershed and characterized

by

fast

flowing

rivers e.g.

Yei,

Yale, Lesi, Swe, Lingasi, Ibba,

Biki,

Bunqu and Duma.

All rivers drain

northeast

to the Jur

and East

to

Bahr-el-Jebel,

which

confluence to become the White

Nile. It

^is precisely because

of

the

climatic

and topographic conditions that the disease prevalence is so high, as the black

fly

thrives

well in

such environment.

Population:

activities, cultures, language

The project has a total population at

risk of

Onchocerciasis infection was 602,302. The entire population

of

Equatoria

project

area

is not

stable

due to

returnees. People

from the

near boundary countries e.g. Uganda, Kenya, DRC, Ethiopia Tanzania,

Eriteria,

and Somalia have swelled business

activities

and also sometimes caused insecurity especially the

LRA (

Tong Tong

)

^from Uganda movement in the project area.. The population in the

CDTI

communities is therefore

still

fluctuating.

East Equatoria is home to the

Bari

speaking groups e.g. Kakwa,

Kuku,

Mundari, Nyaangwara, Pojulu, as

well

as

the Acholi, Madi, Lotuko, Didinga, Boya,

Toposa, Lugbara,

Lulubo

and Lokoya. The Bari and Toposa are the dominant ethnic groups.

Majority of

the people

in

East Equatoria practiced subsistence

farming,

hunting and fishing.

Current

settlement

patterns have been severely affected by and are reminiscent of

^the

prolonged

war.

Recovering

from civil conflict,

the populations are

now

busy reconstructing their lives which begin by resettlement and rehabilitation.

Communication system

(road...)

The project is accessible

from

Juba the capital

of

Southern Sudan

by air. It is

also accessible from northwestern parts

of

Uganda

via

Arua and

Moyo. Accessibility

to the DRC is via Abba

in

the

DRC.

The road structure

still

exists though

worn out.

There are regular

flights

^from Entebbe

in

^Uganda

to major towns of

Juba,

Yei, Torit, and Magwi. Accessibility

from Lokichokio by road is via Narus road to

Torit,

Budi, and Kapoeta counties.

5 WHO/APOC, I 5 November 2006

Four important roads trespass

Yei

connecting

to

Juba,

DRC,

Rumbek and

Yambio

making

this

small

town

a

focal

spot.

Although

these roads are

in

deplorable state, they are relatively good compared

to

those found

in

most southern Sudan locations and are passable throughout

ih. y.ur mainly

because

of the free draining laterite soil. Attacks by the

Ugandan rebels

(LRA)

have escalated insecurity along the road connecting Juba to

Torit

and Nimule.

Internet communication system exists

in

the project location and

this permit

email messages and mobile phones such as Gemtel,

MTN,

Zainand others.

Administration

^{str ucture}

Administrative structure

in

the project area is composed of four levels, namely state; county, Payam and Boma. The Boma is the lowest level of government administration. The project has seven

CDTI

counties and 532 villages.

Health

system

& health care delivery

^(provide

the number of health

posts/centers

in

the project area

if

the

information

is avuilable).

The Primary Health Care

system

is the official health care delivery. Though it is well

developed,

it

lacks proper coordination due to the shortage

of ^qualified

manpower, drugs and equipment. The project has a

total of

275 health

facilities which

composed

of

191 PHCUs, 71

PHCCs, and 13 hospitals including 5 county hospitals, 4 state hospitals and 4

^private

hospitals. The staff were volunteers

for

over twenty years but

now only

those

in

hospitals ^are being paid. 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.

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

uctivities

Of

245lhealth staff

in

the

project area,l20l(49.0%)

are

involved in CDTI.

This was a slight increase

of

health

staff

involvement compared

to

2007. The breakdown based on counties is as shown in the table below.

Table ^1: Number of health staff involved in

CDTI

District/LGA

Number of health staff involved in CDTI

activities.

Total

Number

of ^health

^staff

in the

^entire

project area Br

Number ^of health

^staff

involved

ⁱⁿ

CDTI

Bz

Percentage

BrBzl

Br ^*100

Yei 454 179 39.4

Lainya 352

r46

_4L.5

Juba ²⁷⁵ 732 _48.0

Kajokeji ^{473 371.} _78.4

Magwi

^{291. 1,48} _s0.9

Torit

^{41,9 136} _32.5

Terekeka ^{1.87 89} _47.6

Totd

245L LaOL 49.0

1.1.2. Partnership

Indicate the partners involved in prolect implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, ^etc.J

-

Describe overall working relationship ^among partners, clearly indicating speci/ic areas ^of proiect activities (planning, supertision, advocacy, planning, mobilization, etc) ^where all partners are involved.

-

^State plans, if any, to mobilize the state/regiory'distict/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation.

Indicate the partners involved in ^project

implementation

at all levels [MoH,

^NGDOs

(nationaUinternational), communities, local organizations, ^etc,J

Four main

partners are recognized

which

are

involved in CDTI

implementation

in

East Equatoria.

The

partners are

health

services

(which

comprised GOSS/State

ministries of health, county health department and payam primary health care

centers/units), communities

(532 CDTI villages), CBM (NGDO coordinating CDTI) and

WHO/APOC (external donor).

Virtually all

other NGOs have withdrawn their support to the project.

Describe

overall working relationship

among

portners, clearly indicating specilic

areas

of

project

activities

(planning,

supervision, advocacy,

mobilization,

etc) where all

partners

are involved.

All the partners are working well to ^realize the objective of CDTI in the

affected

communities. WHO/APOC, CBM and health

services

jointly _{carried out} planning

and

advocacy before the distribution. APOC/SSOTF/CBM provided training of

^project

coordinating

officer in

Rumbek.

While

project coordinating

officer

trained other health

staff

mainly county supervisors and supervise payam supervisors training across the project. Health services

and communities

ensured

mobilization of community

members.

Chains of

drug

distribution are followed with the actual drug distribution by communities through

their CDDs. Each health services and community level supervises the one below.

7 WHO/APOC, 15 November 2006

State

plans, if any, to mobilize the state/region/district/LGA

decision-makers, NGDOs' NGOs, CBOs,

to

assist

in CDTI

implementation

There are plans to intensify on advocacy visits to top government decision makers

for

support

to CDTI

especially

in

area

of

integrating

CDTI into ^primary

health care system

from

^state

down to

payam

level in both

Central and East Equatoria state.

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stakeholders meeting

of

partners

will be

organized and

main

issues

of

^concern discussed especially

on

strategy

of

support

to CDTI

implementation. Development

of

the

project plan of

action

will

be

jointly

prepared and specific Elreas

of

supports clearly defined.

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SECTION 2: lmplementation of ^CDTI

2.11. Timellne of activities

Fill

in table 3, tmeline 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.

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2.2. Advocacy

State the number of policy/decision makers mobilized at each relevant level during the current yeor; ^the

reason(s)

for

undeitiking the advocacy and the outcome. Describe dfficulties/constraints ^being faced ^and

suggestions on how to improve advocacy.

State

the number of policy/decision makers mobilized at each relevdnt level during

the

cufient yeor

A

total

of

5 policy/decision makers were mobilized

in

the

two

states that make up the project

at

state

level. This includes the minister of health and the Director

General

of

endemic diseases

in East Equatoria state as well as the minister of health, director of

^disease

surveillance and director of primary health care.

At

the county level, those mobilized were 7 Commissioners andT Executive Directors.

At

payam and

Boma levels,

10 payam administrators

and

105

community

leaders and 28 Boma administrators were sensitized through one day advocacy meeting.

The reason(s)

for undertaking

the advocacy

The primary reason was

to solicit for

support through integrating the

CDTI by

absorbing the

staflinto

the health system.

Most CDTI staff at the

state,

county

and health

facility

levels were not government staff but volunteers

with private

otganizations. Another reason was

for

them to know their roles

in CDTI

activities and importance

of

selecting adequate community distributors and providing them

with

incentives.

The outcome of the Advocacy

The major positive response was

the

absorption

of

^three

CDTI staff into Yei

County health department

and they are now receiving monthly salary from government. Payam

gave instruction to communities

to

select

their

CDDs that would participate

in

the exercise and this led to improved coverage.

Dffic

ulties/c onst

raints

^{be in g}

faced

Mostly

the logistics

is

the

major

constraints

particularly

as relate

to

shortage

of fuel,

project vehicle frequent breakdown.

Also

motorbikes have all broken down.

Suggestions on how to improve advocacy

1. More appeal during the

visits in

soliciting

for

support to

CDTI

activities.

2.

Official

^letter and

work

plan could be prepared handy and shown

to

them during any

visit

which

will

indicate their roles and areas of needs.

3. Making

allowance

for extra fueling of project vehicle

and motorbikes

for the

advocacy visits.

4. Providing motorbikes to the remaining counties to improve advocacy at this level.

5. IEC materials like t-shirts, calendars and posters should produce and used during advocacy.

2.3.

Mobillzation, sensitization and health education of at ^risk

communlties

Provide information on:

-

The use of media qnd/or other local systems to disseminate information

-

^{Types of IEC materials used}

-

ttlobtlization and health education of communities includingwomen and minorities

-

Response of target communities/villages

-

Accomplishments

-

Suggest ways to improve mobilization and sensitization of the target communities.

The use of media and/or other local systems to disseminate

information

The project utilized

FM

radio in

Torit

in East Equatoria state,

Spirit

and

liberty FM

stations

in Yei

and Miraya

FM

station

in

Juba

in

Central Equatoria state. The project local

based

^radio

station was used

to

pass on messages across the people. Other

traditional

systems used were

through village chiefs, sub chiefs, and

^headmen

either during the ^meetings or

^informal

gatherings; church groups,

women's

groups and

village

health committees

to

pass messages in the communities

within

the project areas.

Types of

IEC

materials used

ftrt fpC

materials used during the reporting period are laminated posters and flipcharts.

Mobilization

and health educution of communities

including

women and

minorities

Community members were

well

mobilized through holding talks

with

them during home visits, meetings

with

women groups, heath education in health units/ centers, market

gatherings and workshop training on

CDTI

^for women leaders. The topics discussed during health education were on community involvement and participation in mectizan distribution which include the issue

of

CDDs selection by all communities and

providing

them

with

incentives. Other issues related to mectizan such long term treatment, possible side effects after treatment and its management, dosage and

eligibility

^criteria were explained. In

Magwi

county, during one of the

mobilization

campaigns, CDDs performed a drama on

how

^a

blind

person walk thus illustrating the importance of taking of mectizan every year

for

several years by household member in the community to avoid blindness'

Resp onse of target communities

/aillages

The response was encouraging and many were asking

for

mectizan

during the

distribution'

Also community

members selected

their CDDs and

even

had to

replace those

who

were

unwilling

to continue

distribution.

Many people now realized that Onchocerciasis is a disease of public health concern.

New

retumees

following

war cessation participated

for

the

first

time and they were happy. Drugs were not enough to go round the eligible persons.

Accomplishments

-

^{Tum up}

^for

treatment was very high to the point that mectizan was not enough.

-

Villages which did not participate

in2007

now participated

by

selecting their CDDs ^.

13 WHO/APOC, 15 November 2006

More enthusiasm among community members.

More female CDDs are involved in mectizan distribution than

in2007.

Community members understand more the dangers of not taking mectizan yearly.

Suggest ways to improve

mobilization

of the target communities.

-

Provision of more logistics support to county level for wider coverage

- Identifying

and

Involving influential

persons at local settings

- Provision of ^more IEC materials such as posters and flipcharts to reach

^all

communities

-

^{Use of megaphone during the community}

mobilization

-

Production of more

T-

shirts or face caps to reach some coflrmunity leaders.

-

Extra budget allocation

for

fueling of the project vehicle and motorbikes

- Intensiff effort

in community mobilization and health education.

DistricULGA

Number

of

communities/villages with community members as suPervisors

Number of CDDs and the communities involved

Number

of

communities /villages with female CDDs

Total

^no.

communities

in

the entire project area B.

Number with community

members

^as

supervisors B.

Percentage

Be=

BJ Bo *100

Male CDDs

B7

Female CDDs

Br

Total

Bs= Bz+Br

Number

^of

communities

with

^female

CDDs Bro

Percentage

Blr=

B','/8.* 100

Yei 110 61 55.5 ^{160 34} 794 ^{JJ 30.0}

Lainya 53 37 _69.8 ^{54 6} 60 ⁶ 11.3

Juba 59 25 _42.4 ^{54 12} ₅₆ ¹¹ 18.6

Kajokeji 1,04 47 _45.2 ^{110 35} _L45 ³¹ 29.8

Magwi ₆₁ 27 _44.3 ^{65 15} ₈₀ ^1.4 23.0

Torit 70 29 _4L.4 ^{72 10} ₈₂ ¹⁰ 14.3

Terekeka 75 35 _46.7 ^{123 13} 136 ¹¹ t4.7

Total

532 ^{232 43,6 638 1,25} 763 ^{1.16 21.8}

2.4. Gommunl$l lnvolvement

Table 4: Communities participation in the

CDTI

^(Please add more rows

if

necessary)

Comment

on:

Attendrnce offemale

members of the community ut health education meeting

Although the-number

of

female members who attend health education meetings has improved, men

still

dominate.

In general, how do you rate the participation of female ^members of the

community

meitings

when

CDTI

issues are

being

dkcusses (attendance,

participation in

the discussion etc).

The participation and attendance could be described ^as very

fair

^as evidenced in the number

of

villages

with

female CDDs and also

total

female CDDs

in CDTI. Key

decision makings ^are by men.

Incentives provided by

communitiesfor

^{the CDDs}

Communities have

not

come up

with

any incentive

for

CDDs except appreciation

from

some households.

Attrition of CDDs. Is attrition

^a

problemfor

the

project? If

yes, how is

it

addressed?

This

is stiil

a problem

in

the project but communities have resolved

to

replace those who are

unwilling

to continue and project is quick

in

reminding them do replacement

for

continuation of treatment in their communities.

Other issues

- The level

of

general education and awareness among women is very

low

2.5. ^{Capacity building}

Describe the adequacy

of

available knowledgeable manpower at

sll

levels.

The available

knowledgeable

manpower is still

inadequate

at all level. The number of

knowledgeable

staff

at the project

level is

also

not

enough.

Additional

county

suPervisor

^is

needed in Morobo County

^at

county level. Health facility stafflpayam suPervisors

at

15

^{wHo/APoC, 24} November 2003

payam

level are also

inadequate

and

some

of them are still new. For

instance,

2

county

iupe*isors of Torit

^and

Terekeka,26

^health

facility

staff/Payam supervisors and more than natf

of

CDDs trained are

new in CDTI. Apart from this,

^many

villages don't

have adequate number

of

^CDDs as stipulated

by

APOC based on total population. Even the PCO ^is

just

_one old on the

job

and thus not too knowledgeable and also needs an assistant.

ll/here

frequent

^transfers

of

trained

staff

occur, state what the

project

is doing,

or

intends to do,

to

remedy

the situation. ^(The

^most

important

issue

to

describe

is what

measures were

faken to ensure adequate CDTI implementation where not enough

knowledgeable manpower was

svailable or if staffs

are

frequently

transferued

during the

course

of

the campaign).

There was no

CDTI

staff transfer ^as they almost

all

of them are integrated

into MOH'

The two things the project is doing are: (1) making effort to ^see that

CDTI

staff are absorbed in the

MOH andto

appeal to communities to provide incentive to reduce

attrition

or desire

for

departure for greener pasture and (2) urgent replacing those who have

left

and also sharing works among the remaining pending effecting the replacement.