rceCoordination office

South Sudorn Oncho ^{Taslc Fo} rce Coordination office

I I I I i I

COUNTRY/: South Sudan Approval year: 2003

Reporting Period (MonthrYear\: Jan 2007 through Dec

2OO7

Project year of this report: ^(circle) 3) 45 67 8910

\t ^{L2 13 14}

Date submitted: A ugust 6,2008

ORIGINAL:

English

ssoTFrHQ

ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

To APOC Management by 31 Januarry for March TCC meeting To APOC Management by 31 JuIy for Sgptember TCC meeting,

AFRICAN PROGRAN{ME FOR ONCHOCERCIASIS CONTROL

GPOC)

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ANNUAL NOTF SECRETARIAT 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. Sam son

P

y)?fba

signatur.' .b. 5l

Date: oo

NOTI'Chair Name: Dr. Majok Y Signaturs!...

Date:

This i'eport has been prepared _by:

Name: Dr. Baba/Fasil/Lazarus

De

signation: NationaYNGD O rd./TA Signature:

Date...

0

WHO/APOC, December 15, 2004

TABLE OF CONTENTS

FOLLOW UP ON TCC RECOMMENDATIONS.

EXECUTIVE SUMI\,IARY

SE

CTION

^{1 :}

BACKGROUND INFORJ\,IATION...

1.1.

GpNnnaIINFORMATION

1.2. PopulauoNAND Hnelrs

^SYSTEM

SECTION 2: SUMI\{ARY OF CDTI IMPLEMENTATION

2.1. DrsrRreurroN pERIoD... ...7

2.2. AovocecyaNr SBNSITIzATIoN ...7

2.3. INT.onuatToN, EouCATIoN

AND CoMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT

2.4.

Coun,IuNITIES, INVOLVEMENT IN DECISION-MAKING

2.5, CapaCIry

BUILDING

2.6, ^OnopnINC,

^{STORAGE AND DELMERY OF}

IVERMECTIN...

... 11

1 1 2 2 6 7 8 9 9

2.7. TRpervrpNrs 2.8. ^SuponusroN ...13

...18

2.9. ConauuNrry

sELF-MoNrroRING

aNo StaxpHoLDERS MrprINc...

19

SECTION 3: OTHER ACTIVITIES OF THE NOTF ...20

4.7. 4.2. 4.3. 4.4. 4.5. FTNeNcTaL CoNTRIBUTIoNS OF THE PARTNERS

Otupn

FoRMS oF

coMMUNrry suppoRT... Rpsouncp

MOBILIzATION ^EFFORTS

ExpnNoItURE

PER ACTTVITY BY THE

NOTF

SECRETARIAT 25 26 26 26 28

SECTION 5: EVALUATION FOR SUSTAINABILITY OF ^CDTI, INDEPENDEI{T MOMTORING AND OTHER REVIEWS 29 5.1.

INopppNoENTPARTICIPATORYMONITORINC/NVRIUeTTON 29

5.2.

SUSIaINaBILITY OF PROJECTS: PLAN AND SET TARGETS (n,mNoetony

et

Yn

3)

30

5.3. INrpcReuoN

5. 4 OPERATIoNAL RESEARCH

...30

...31

SECTION 6: STRENGTHS, WEAKNESSES, CIIALLENGES AND

oPPORTUMTIES ...31

Acronyms

APOC ATO ATrO CBO CDD CDTI CSM LGA MoH NGDO NGO NOTF PHC REMO SAE SHM SRRC SSOTF TA TCC TOT UNHCR UNICEF USAID

I-]-TG

wHo

African Programme for Onchocerciasis Control Annual Treatment Objective

Annual Training Objective Community-B ased Organization Community-Directed Distributor

Community-Directed Treatment with Ivermectin Community Self-Monitoring

Local Government Area Ministry of Health

Non-Governmental Development Organization Non-Governmental Organization

National Onchocerciasis Task Force Primary health care

Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event

Stakeholders meeting

Sudan Relief and Rehabilitation Commission Southern Sector Onchocerciasis Task Force Technical Advisor(WHO/APOC)

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

United Nations High Commissioner for Refugees United Nations Children's Fund

United States Agency for International Development Ultimate Treatment Goal

World Health Organization

ll WHO/APOC, December 15, 2OO4

Definitions

(ii)

(i)

Total

population: the total population

living in

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

Eligible population: calculated as 84Vo of the total population in meso/tryper-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/tryper 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).

(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: The bringing together of two or more health programs, removing barriers between/among them,

in

order

to

maximize cost-effectiveness and permit free ^and equal association. For example 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

maximize 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 CDTL

(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 mobilized by the community and the government.

iii

WHO/APOC, December 15, 2004

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

Overall, CDTI total population

in

the five projects

of

Southern Sudan was 5,853,243

in

2007. This represents a 6l.5%o increase over the 2006 figure. The increase was based on population refinement, inclusion of some county populations mainly in West Bahr El Ghazal project that were not in 2006 and refugees home

fluxing.

West Bahr

El

Ghazal

CDTI

project has the highest

total

population

of

2,670,680 persons.

The Ultimate Treatment Goal

GnG)

and Annual Treatment Objectives (ATO) across the projects within the period were 4,916,720 ^persons and 1,528,967 persons respectively. The total number

of

communities

in all

the projects was

7,

103

in

2007 and this shows an increase

of

31.07o when compared

to

2006.

Of

this number

of

communities, only 6I24(32.L7o) were targeted

for

treatment

(Aro).

Total ^persons that received treatments in 2007 were ^1, 422,325 against 936,375 in 2006 representing 485,950 (51.97o) increase. These treatments occurred

in

1,965 communities compared

to

^1,335

communities

in

2006. Coverage recorded

in

2007 for geographic, therapeutic, UTG and ATO were 27 .68Vo , ^{25 .00Vo} , 84.00Vo and 93.03Vo respectively.

Actual CDTI training and refresher courses started in July through September 2007. 37 project staff, 472 health staff, 151 TOTs and 2,509 CDDs were trained and refreshed in the reporting period. The figure for CDDs trained was less that of 2006. The population/CDD ratio was 1: 2333.

Integration

of CDTI

into PHC has not been

fully

realized. Most CDTI projects operating are not perceived as PHC as staff in ^these projects are not ministry's staff. Project coordinating officers were volunteers and not health staff. Apart from the national coordinator, all other CDTI staff at national and project levels were not part of PHC.

The Strengths of SSOTF lies on easy accessibility of SSOTF office by all projects due to its Strategic location in Rumbek, joint presence of SSOTF and CBM in the same office ^has led to effective CDTI coordination and support from other NGOs in Southern Sudan towards mectizan distribution.

Number

of

Recommendation in the Report

TCC

RECOMMENDATION

ACTIONS TAKEN

BY

THE

^SSOTF

SECRETARIAT

FOR

^TCC/APOC

MGT USE ONLY

NOT APPROPRIATE

WHO/APOC, December 15, 2004 I

The main weaknesses experienced are high attrition rate of project staff at all level, available manpower is not well knowledgeable in CDTI, non payment of salary by the government, census update not completed in virtually all CDTI projects, number of total villages in ^the projects not yet known. Opportunities identified which could improve CDTI include peace and normalcy in project areas, easy and free movement, and improvement

in

the road network in South Sudan.

The challenges facing the CDTI implementation in ^Southern Sudan are low level of available knowledgeable manpower in the project area, high attrition rate of CDDs at community level, ^non integration of the projects and non absorption of CDTI staff into the ministry of health, intensifying health education and community mobilization, non availability of community data base collection,, ratio of CDD to total population in ^the entire country is still high, community census registration is a

still a problem in all the projects, problems of transport due to bad roads conditions and broken bridges account for vehicle wear and tear plus fuel consumption and finally modern communication facilities are not yet available.

Key activities undertaken by the SSOTF during this reporting period are procurement of 4,625,500 ivermectin tablets from Mectizan Donation ^program in collaboration with CBM, training ^and distribution of work support items.

There was no activity on vector elimination ^performed by SSOTF during the period under review

SECTION 1: Background information

1.1.

General information

1.1.1.

Description of the country program

-CDTI

^{and vector} eliminalion (brielly)

The South Sudan covers an area of about 640,000 square kilometers and includes stretches of tropical and equatorial forests, wetlands including the Sudd swamps and mountains. The climate

of

South Sudan

is

tropical

with

average annual temperature

of

about

29'C

(about

85F).

The rainy season

months are April-October with annual rainfall

of

more than 1000 mm (40 inches). The vegetation varies from typical rainforest in the southern part to Guinea or derived Savannah in the northern area.

There is a vast swampy region "The Sudd" and or flood plain in the Jonglei area of the Upper Nile.

Human settlement seriously affected

by

many years

of civil

war and is basically rural. The main occupations of the rural communities are farming and livestock production. Exposure to infection in South Sudan is by way of village proximity to breeding sites and occupational activities. The major ethnic groups are the ^Azande, Bari speaking groups, Dinka, Shilluk, Taposa, Lutuho and Nuer people.

The second phase

of

the Onchocerciasis control prograrnme which requires the implementation

of

CDTI strategy was earmarked for five (5) CDTI projects in East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile have all been launched.

Vector eliminotion

The projects have no vector elimination component. However, surveys of breeding sites were being considered.

Status of National plan implementation, population

at

risk, number of projects being implemented, other relevant activities, and infrastructure ^(e.9, Adequate heahh facililies, ^{ts system} decentralized or not, etc), logistics, administrative structure.

The National Plan is being implemented through the involvement

of

national staff (lay people and health workers) appointed by Ministry of Health government of South Sudan, and the State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National

and

lnternational NGOs

and

Community based organizations have

also

been supporting ^the implementation

of

the national plan

by

providing technical assistance/guidance through their field medical coordinators. They also facilitated the logistical needs for the smooth running of the planned activities.

WHO/APOC, December 15, 2004 2

The total population at risk of being infected with onchocerciasis

in

Southern Sudan was 5,853,243 people. There are a total of 5 CDTI ^projects and 1 Headquarter project being implemented in Southern Sudan.

The available statistics on health

facility

situations across the

five

CDTI project areas

in

^Southern

Sudan showed

a total of

589 health facilities which comprised 133 primary health care ^centres (PHCC), 441 pimary health care units (PHCU) and2L rural hospitals.

I,

530 ^(36.2Vo) health workers were involved in CDTI out of 4,223 health staff in Southern Sudan.

The SSOTF headquarters is situated in Rumbek town. Rumbek airstrip is capable of receiving different types

of

aircrafts. This airstrip is currently being ^upgraded to an all-weather airstrip and is a major airstrip for OLS operations in southem Sudan. Rumbek is strategically linked with Western Equatoria, East Equatoria and other parts of Bahr el Ghazal through road network.

The administrative structure ^has four levels

in

Southern Sudan namely: The State, the County, ^the Payam and the Boma at the grassroots level. The States form the first level of administration followed by the Counties, Payams and Bomas. State is administered by governor; county by commissioner, ^the payam by payam administrator, and the Boma by Boma liberation council. The five projects have a

total of 32 counties and 7,103 communities where mectizan treatments were implemented during the period under review.

Health system

&

health care delivery $tate any problems related

to

health system

thal

impede

p r o gram imple m e nt ation).

The PHC system is still emerging from years of conflicts hence health care delivery remains a great challenge

in

Southern Sudan. The coordination

of

the system

is still

poor, lacks adequate trained manpower, medicines and equipment. The CDTI staff non absorption into the health system

of

the Southern Sudan and non budgetary allocation

of

funds

to

run the Primary Health Care (PHC) in general and the

CDTI in

particular were the major issues that impede

CDTI

implementation. For instances, among the SSOTF staff at headquarters' level, only.the national coordinator was absorbed into the ministry of health ,and also at the CDTI level, only one project coordinating officer was part of the ministry in West Bahr El Ghazal project.

3 WHO/APOC, December 15, 2OO4

Provide map localing all projects (CDTI and Vector Control, if any) within country.

Southern Sudan

Itdql 5: CDTI ar:cas anil frrrccasbd CDTlprujects with thcir rcspectiw coordinrtion and srrycn'ision officce/ccntcs

ffi

ect 2: Bahr El Ghazal ^East ct 1: Bahr E! GhazalWest

P

t

^,to-te

i

,

P 3: West E uatoria

ect 4: East E fla

P

i--

\:\[

Ki, ^llganda

0 100

²⁰⁰

Legend

Erqrty or udntebitetcil zoru Rctr rc

CDTI Priority areas NO CDTIerrcrc REIIO tobeperfrrrncd

Etfriopit

lltnya

WHOIAEEI lJul!2E01

t

Norttrot$ Sudfln

tl,entra t Afrita n Repab lit

OTF HQ, Project Coordination oflice (PCO). Project Surpervision Centre(PSC)

Proiect coordination ofiice (PCO)

I

^Proiect euperuasaon cerrtre (PSC)

lfP}lroDr,ltrr; t<P-PEoIiC Of cOngo

f;

*

fr

t.oi""t Supereision centre (PSCJ only

T,1lr trf lr rcrJudrqrrly lr louro'rr.i ,rlr rlrlE'rf,d.iy d* ^.sS OIFFaTE ^g lI Calslar-dar,.ddt IPOC lw

Indicate the partners involved

in

project implementation

at all

levels

(MoH,

NGDOs -national, international)

1. At MoH level

SSOTF Secretariat

Five CDTI projects. Though they are not fully integrated but still work with ministries 32 county health departments.

l74PHCCIPHCU. The staff are mainly payam supervisors

2.

At community level.7,103 affected communities are involved

3.

At NGDO level:

o

Chirstoffel Blinden Mission. The lead NGDO ^group

4 WHO/APOC, December 15, 2OO4

,,i$

II

{

a o a a a

4. At external support

level.

APOC/WHO

5.

Other level. NGO partners as at2007 are shown in the table below Name Region(s)

:

"'" r' 1

-

^'i

".': ^{l' : ;:,''^}

i'

CoUnfY;i^'' i':q':rr'r,.ii;-'*'

J''

AAH Equatoria ^(West) Maridi, Mundri, Yei

ARC Equatoria ^(East) Kaiokeii, Nimuli

DOR East Bahr el Ghazal Toni, Yirol,

GOAL West Bahr el Ghazal Twic

ICRC consortium East Bahr el Ghazal Yirol

IMC West F4uatoria Tambura, Ezo, Yambio

IRC Bahr el Ghazal (Esat & West) Rumbek, Aweil

World Relief Upper Nile (Jonglei) Bor ^(South)

World

Outreach Ministries Foundation

East Equatoria Yei (Morobo ^payam)

MRDA West Equatoria Mundri

NCA West Bahr elGhazal Gogrial

Samaritans Purse West Equatoria Mundri (Lui only)

SIDF ^Ease Bahr el Ghazal Mvolo

SI.IHA East Equatoria Kaiokeii, ^Juba

ZOA East Equatoria Juba, Terekeka

Describe overall working relalionship among partners, clearly

indicaing

speciftc areas of project activities where all partners are involved (plnnning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or sumeys etc).

The overall working relationship among various partners is satisfactory hence the realization of the basic objectives

of

information dissemination, trainings and mectizan distribution The stakeholders plan, monitor, supervise, mobilize and apprise CDTI activities of the previous year through the below indicated meetings and workshops;

o

Annual SSOTF Meeting

o

Ministry of Health monthly Coordination Meeting

o

_Quarterly operational plans

o

Regional and County Mini SSOTF Meeting

o

County specific planning with NGOs.

o

Village health committee meetings

Annual

SSOTF

Meeting:

members

of the

SSOTF, consists

of the

Health secretariat, County representatives, NGDOs (International and national) The NGDO coalition chair meet annually. The SSOTF appraise the previous year activities

of

CDTI and review and approve the next coming year CDTI activity ^plans.

Ministry

of Health monthly Coordination Meeting: The coordination meetings take place in Juba in which SSOTF

HQ is

represented

by

the National coordinator. There

is

a representation

of

health NGOs in South Sudan, including LINICEF, WHO, UNFPA and the Multi Donor Trust Fund (MDTF).

The SSOTF secretariat has always an opportunity to introduce discussions on OV matters.

Quarterly

operational

planning :(

RegionaUCounty SSOTF meetings) are normally done jointly with partner NGDOs, the PCOs and the COSs and payam representatives. Supervision and monitoring at the county level is done by the COS, partner NGDOs and the County Health Department while at the Payam level is done by Payam

OV

Supervisor and at the community level

is

done by CHWs,

CDDs and the

community leaders.

The

PCOs, COSs, CHWs, and' POS

carry out

^advocacy,

mobilization and sensitization. For the management of SAEs cases the CDDs

will

refer the cases to the nearest level of health facility.

5 WHO/APOC, December 15, 2OO4

County specific planning meeting

with

NGOs: The CDTI project office works closely with these groups

to

promote

CDTI in the

communities. Each endemic county has

a

designated county onchocerciasis

(OV)

supervisor. Each Payam

(local district) within the

county have

a

^Payam

onchocerciasis supervisor who is also known as (Community supervisor). Most

of

these supervisors are already engaged as health staff by the NGOs. The supervisors are responsible for mobilization and sensitization of the communities within their locality.

Village Health Committee meetings

All

plans for implementation and monitoring are developed in close consultation with the Bomas Liberation Councils (communities), these being the grassroots arms

of the

administrative system

of

South Sudan.

All

health and developmental prograrns

in

the communities must receive the formal approval of the Boma Liberation Councils. Community health workers and Traditional birth attendants are the lowest cadre

of

health service providers who are supervised by Village health Committees. The communities elect these groups.

State plans

if

any to solve any issues arising as regards CDTI implementation.

The SSOTF has plans to handle such issues as follows:

a.

^The first step is to investigate the issues and determine the root cause.

b.

Identify appropriate officers and designate such persons to follow up on the issues and then report back.

c.

Maintenance

of

communication channels for quick

flow of

information and reaching out to project staff at all levels both in the field and the office so that quick timely intervention is applied on any issue pertaining to the CDTI implementation.

1.2.

Population and Health system

Table 1: Projects and population

al

risk in the entire country whether they are trealed or not during

the add more rows

NB-The available number of communities in the projects is not yet comprehensive and it is hoped that in the years ahead this

will

be realized.

Source: From Oncho Project reports:

Other source,

specify REMO

Year of source:

@!

UTG: Calculated as the maximum number

of

people to be treated annually

in

meso/tryper 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).

National census:

6

Name of

CDTI

Project

Total

communities

in

meso/hyper-endemic zone

Total population in

meso/hyper-endemic zone

[Jltimate

Treatment

Goal (UTG) by 2010

East Bahr el Ghazal CDTI Project ¹ 00I 927,285 778,920

West Equatoria CDTI Project 697 506,848 425,752

West BEG 3,219 2,670',690 2,243,368

East Equatoria 948 L,133,436 952,086

Upper Nile 1238 614,994 5t6,594

TOTAL

7,103

5,853,243 4,916,720

WHO/APOC, December 15, 2004

Distribution Period

Oct Nov Dec

Project

Name Jan Feb Mar Apr May ^Jun July Aug Sep

x x

East Bahr el Ghazal

x x

West Equatoria

x x x x

East Equatoria

x x

Upper Nile

West

Bahr el Ghazal

x x

SECTION

2:

Summary of CDTI Implementation

2.1.

Distribution period

Chart the actual distributian period

for

^each CDTI Project in the country in ^the table below.

Overview of distribution undertaken insert rows as needed.

Briefly note any problems/issues (one paragraph).

There was no distribution of mectizan in one county in Upper Nile CDTI project due to flooding that cut off the Kormuk County and moreover distribution was generally delayed in all projects due to late transfer of projects funds.

2.2.

Advocacy and Sensitization

a)

^State the number and type of policy

/

decision makers mobilized at the national and lower (stale and district level)

during the

current

year; the

reasons

for ^the

sensitizption and outcome.

Eight

policy/decision makers were mobilized and sensitized

at the

national level. These were undersecretary in the Government of Southern Sudan, five officials of the presidency, director ^general of Primary Health Care in the ministry of health of GOSS and the Minister of Health Government

of

Southern Sudan.

At

the State level the National/NGDO coordinators met with four Ministers and their four Director Generals of Health on matters pertaining to CDTI in East Equatoria, East Bahr el Ghazal, West Bahr El Ghazal and West Equatoria States.

Basically, the reason

for

mobilization was

to

solicit

for

support

to CDTI

especially

in

areas

of

providing salary to CDTI staff ^and counterpart funds to CDTI implementation.

Although no fund was released, the officials expressed willingness to work closely with the SSOTF and the projects. They promised to ^assist in controlling onchocerciasis when the situation in Southern Sudan improved.

b)

^{State progress} made towards internal ^resource mobilization.

The SSOTF followed up the budget submitted to the Government

of

Southern Sudan since 2006 for implementation

of CDTI

activities. Unfortunately there was

no

positive outcome as

it

was not approved within ^the reporting period.

7 WHO/APOC, December 15, 2004

c)

Describe any policy-related constraints being faced by any particular project and describe what was done

to

assist the project (outcome). Explain any

phns on

how

to

improve advocacy.

The only major policy related constraint faced by the all projects was the issue of absorption of CDTI staff into the ministry

of

health system. SSOTF made effort to present this

to

health authority but without success. The issue

will

still be followed up and addressed in 2008.

To improve on the advocacy, SSOTF has planned to involve all key members of SSOTF in the next meeting with the Government

of

Southern Sudan and to make use

of

new WHO/APOC technical Advisor being proposed for the Southern Sudan CDTI projects.

2.3.

Information, Education and communication strategy and materials development Brtelly describe the IEC strategy being used in the country

for

^CDTI.

Note

if

any new IEC materials were developed or revised, the type of the material, the ^message and target audtence, and where they were distributed.

SSOTF coordination office

in

Rumbek produced a number of IEC materials for the Southern Sudan Oncho Control Program

in

2007.

The

materials were distributed

to

Project offices

for

onward distribution

to 32 CDTI

counties

for

further distribution

to lower

cadres.

The following

were produced:

o

Manual for CHW's and PHC for the control of onchocerciasis with Mectizan'"

o

Manual for CDTI provided by WHO/APOC and distributed to partners

o

Illustrated OV training flip charts (OV Oncho in Sudan)

.

OV ^{poster sets} (3 posters per set; "What is OV", "How do you get OV", and "How to treat OV").

These posters are laminated in plastic for durability under field conditions.

.

Simplified CDTI instruction manuals for community distributors.

How were the IEC materials developed?

o

These materials were

initially

developed by Health Net International and

in

2007 reviewed and reproduced by SSOTF coordination office.

Are

the malerinls reviewed

to

address upcoming ^rsszes (like decreasing refusals, sustainability, maintaining compliance to long-term trealment, SAEs)?

o

Yes, the materials were reviewed

with

emphasis on maintaining compliance

to

long term treatment and other upcoming issues such as sustainability.

-

Report

if

any KAP surveys have been done and how their resuhs were used?

o

No KAP surveys have been conducted in the whole project areas in 2007.

Summar ize info rmation o n :

-

The use of appropriate and innovative media and/or other strategies to disseminate information among the projects;

o

Modern media such as local radio stations are now available

in

some project areas. For instances, East Equatoria project made use of Spirit ^and Liberty FM radio stations in Yei and Miraya FM station based in Juba, East Bahr el Ghazal project uses FM radio in Rumbek and West Bahr el Ghazal relies on FM and radio station in Wau. Upper Nile and West Equatoria projects have no FM ^and radio station.-

o

In addition, East Equatoria and East Bahr el Ghazal have based project radio.

o

[n most cases, information is passed by word of mouth through traditional systems of village chiefs, sub chiefs, and headmen. Church groups, women's groups, village health committees (if exists and functional) are used to disseminate information.

Mobilizatton and heahh education of communilies including wotnen and minorities

This was carried out

in all

projects before mectizan distribution

to

create awareness about the mectizan. Community leaders were contacted

to ilrange for the

meeting

with

community members which comprised men and women including the blind ^people. Key messages were on the cause

of

onchocerciasis, symptoms, who should not take mectizan as

well

as the dosages and

8

WHO/APOC, December l5,2OO4

possible side effects after taking the drugs by individuals

with

heavy infection. Such meetings were organized in all projects. In some areas, women attendance surpassed that of men especially

in

^{Mvolo and Yirol counties of East Bahr el Ghazal.}

Response of target communitie s/village s

A lot

of people participated in receiving the mectizan tablets to the extent that the entire drugs allocated were all ^used apart from unused drugs in four counties of West Bahr el Ghazal.

M aj o r ^{ac c ompli s} hment s ;

o

More communities participated in the treatment with Ivermectin in 2007 thanin2006.

o

Increase in the number of CDDs.

o

The negative attitude towards the usage of Ivermectin ^has reduced

o

Increase in the number of Female CDDs that participated in drug distribution in 2007.

Weakne s s e s/Constraints ;

.

High attrition rate for CDDs due to non-support and also due to attractive incentives paid by NGO's and UN agencies for special campaigns

o

The number of female CDDs still low

o

There is frequent turn over of project field staff ^{and at} SSOTF coordination office.

o

lnformation dissemination is still inadequate.

Suggest ways to improve mobilization of the target communities among projects.

.

Integrating CDTI into ^the ministry of Health.

o

Full participation by local authorities ^and support from the Government organs.

o

Involvement of women groups, youth and religious groups in campaigns.

o

Increased health education sessions in the communities

o

Increased training and refresher courses for CDDs, CHWs and OV supervisors.

2,4.

Communities'involvementindecision-making

Comment on cotnrnuntty participation making comparisons among proiects

-

Pafiicipation of female ^and youth members of the community al health education meetings;

- In

^general, how do

you rale

the participation

of

minority groups and female ^members in community meetings, decision-making, (attendance, participalion

in

the discussion etc.) other issues.

o

Youth attendance

is fairly

commendable

in

public gatherings

in all CDTI

projects. They actually form the most influential entity in terms of mobilization and implementation.

o

The youth tend to pick up messages faster than the rest of the community and this is obviously due to their age learning capacity.

o

The youth disseminates information much faster and effectively to their parents and siblings

o

Women attend public information sharing meetings in fair numbers in all CDTI ^projects.

o

Members of the village health committees are predominantly men

o

Women's participation at decision-making meetings is very low as men dominate decision- making process in all CDTI projects.

o

Comparison of various projects shows that female participation

ii

^{rated 45Vo} in East Bahr El Ghazal,low in ^East Equatoria, fair in Upper Nile, very low in West Bahr El Ghazal and low in West Equatoria.

2.5.

Capacity building

Training of

national,

district

^level

staff in CDTI and

general management

skills

(computer applications, project planning, etc.)

Briefly

describe any

training

done

by the

SSOTF/NOTF

for

^specific

^CDTI or

Vector Control

P r oj e ct s ( O bj e ctiv e s, particip ants, o ut c om e s, any follow ^- up n e e de d ).

9 WHO/APOC, December 15, 2OO4

Though there was high attrition

of

all types

of

staff from the various project locations, SSOTF ^has continued to train staff at all levels in CDTI strategy in 5 CDTI project ^areas. The main objective

of

the above mentioned trainings are to build capacity at the national, county, payam levels. The ^other objective

is to

inculcate

into the staff the

importance

of

the principles

of CDTI, the

required managerial capacity

for

implementation including participation and ownership. This has resulted in marked improvement in terms of participation and commitment.

Table 3: Type of training undertaken at national level by the GTNO/NOTF

the boxes where was carried out ^the

Type of training Project staff

MOH staff Opinion Leaders

Others (specify) Program

management

How to

^conduct

Health education Management SAEs

of

CSM

SHM

Data collection Data analysis Report writing Others (specify) Computer training

Briefly describe any technical assistance provi.ded to the CDTI projects.

Efforts were made to provide projects with various assistances among which

are

data collection and analysis, development of work plans, mectizan estimation based on population, establishing ultimate treatment goal(UTG), drawing up timeframe

of

activities(plan

of

action) and imparting programme management skills and mechanism

of

Mectizan@ distribution.

10 WHO/APOC, December 15, 2OO4

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