JAN TO project

South Sudoln Eost Equo;toria CDTI project

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rc COUNTRY/NOTF: South Sudan Proiect Name: EEQ CDTI

Apprqval year: 2003 Launchins vear

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2006

REPORTING PERIOD:FROM: JAN TO DEC, ²⁰⁰⁷

(MONTII/rEAR)

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

Date submitted:

6tn

Augustr2008 NGDO partner:

Chirstoffel Blinden Mission

WHO/APOC, 15 November 2006

I

I

DEADLINE FOR SUBMISSION:

ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

To APOC Management by 3L January for March TCC meeting To APOC Management by 3L .Iulv for ^{September TCC meeting}

AFRICAN PROGRAMME ^FORi

oNcHocERcrASrs coNTRoL ^(APOC)

ii

^{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:

I

Country: ^{South Sudan}

National Coordinator ^Name: Dr Samson Paul Signature

Zonal Oncho Coordinator Name: EmmanuelE.zama Signature: ...-*:-.

Date: ....b.1..2 l.+oo.a.

NGDO Representative Name: Fasil Chane Signature:

Date

?N,

This report has been prepared by Name :Baba/FasillLazarus/Emmanuel Designation

:

Nat CooAtrGDO

Date:

..

o.ef .ox.l.?e:.U,

Coo/TA/PCO p,

Signature

,

ffi

Date ao./a,A::Z

Table of contents

ACRONYMS VI DEFINITIONSVII

FOLLOW

UP ON

TCC RECOMMENDATIONS

1

EXECUTIVE SI.JMMARY

¹

SECTION

1:

BACKGROLIND INFORMATION

²

1.1. ^Gexener

rNFoRMATIoN...

1.1.1

Description of the project

(briefly)

1.1

.2.

Partnership

1.2.

Popur-euoN...

SECTION 2: IMPLEMENTATION OF CDTI

⁸

2.I, Tnmlrxe

oF ACTTVITIES

2.2. ^Apvocecv

2 2 4 6

.8

10

2.3.

Mostr-zRTIoN, SENSITzATIoN AND mALTH EDUCATION OF AT RISK COMMUMTMS 10

2.4.

ComvruurY

IIn/oLVEMENT...

t2

2.5

Capecnv

BUTLDTNG.. ...,.,... 12

... 16

..,.,,.,.,.16 2.6. Tnnartvmvrs..

2.6.1.

Treatmentfigures

2.6.2

^What are the causes of absenteeism? ...

2.6.3

What are the reasons

for

refusals?...

2.6.4 ^Briefly

^describe

all

known and verified serious adverse events (SAEs) that ^...

2.6.5. Trend of treatment achievement

from

^CDTI

^project

inception to the current year

2.7

.

^ORpeRnqG, SToRAGE AND DELIVERY OF TVERMECTIN

2.8. Colryrumry

sELF-MoNrroRrNG eNo SrerrgoLDERS

Menrnvc

2.9.

SupnRvrsroN...

2.9.1.

^Provide

^aflow

^chart of supervision hierarchy.

2.9.2.

What were the main issues identified during supervisionz...

2.9.3.

^Was a supervision checklist used?

2.9.4. Wat

were the outcomes at each level of CDTI implementation supervision? 26

2.9.5.

^Was feedback given to ^the person or groups supervised? 26

2.9.6.

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

27

SECTION

3: SUPPORT

TO CDTI

27

20 20 20 22 24 25 25 25 26 26

3.1.

3.2.

3.3.

3.4.

SECTION

^4:

SUSTAINABILITY OF CDTI

²⁹

4.1.

^INTeRNaU TNDErENDENT pARTrcrpAToRy MoNTToRINc;

EveruerloN...

...29

4.1.1

^Was

Monitoring/evaluation carried

out

during

the reporting

period? (tick

any of the

following

^which are applicable)...

4.1.2.

^What were the recommendations? ...

4.1.3.

^How have they been implemented? ...

4.2. Susrenqasrlrry

oFrRoJECTS: rLAN AND sET TARGETS

(ueNoeroRy

AT

Yn

3)

4.2.1.

^{Planning at}

all

relevant levels..

29 29 29 29 29 30 30 4.2.2. Funds...

1V WHO/APOC, 15 November 2006

4.2.3 4.2.4.

4.3.2.

4.3.3.

defined.

4.3.4.

Transp o

rt

⁽ replac e ment and maintenance ) ...,.,...

Other resources

30 30

4.2.5.

^{To what} extent has the

plan

been

implemented...

... 30

4.3. INrecRerroN...

^...30

4.3.1.

Ivermectindelivery mechanisms 30

Training....

^....

^Error!

Bookmark not defi.ned.

Joint supervision and monitoring with other

programsError! Boohnark not

Release of _funds

for

^project

activities ^Error!

Bookmark not defi.ned.

4.3.5. Is

CDTI included in the PHC budget?

Error!

Bookmark not defined.

4.3.6.

Desctibe other health programmes that are using the CDTI structure and how this was achieved.

Wat

have been the achievements?...

Enor!

Bookmark not defined.

4.3.7.

Describe others issues considered in the integration of

CDTI. ^Error!

Bookmark not defined.

4.4.

OpenaTToNALRESEARCH

...31

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.

^{... 31}

4.4.2.

^How were the results applied in the

project?....

...

3I

SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND

OPPORTI]I\ITIES

31

SECTION 6: UNIQLIE FEATURES

OF

THE PROJECT/OTHER MATTERS32

WHO/APOC, 15 November 2006

Acronyms/A bbreviations

AAHI

APOC ATO ATrO

Action Africa Hilfe International

African Programme for Onchocerciasis Control Annual Treatment Objective

Annual Training Objective Community-B ased Organ ization Chirstoffel Blinden Mission Community-Directed Distributor

Community-Directed Treatment with Ivermectin Community Health Workers

County OV Supervisor

Comprehensive ^Peace Agreement Community Self-Monitoring Civil Society Organisations Democratic Republic of Congo Government of South Sudan Internally Displaced People Local Government Authority Ministry of Health

Non-Governmental Development Organization Non-Governmental Organization

National Onchocerciasis Task Force Proj ect Coordination Offi cer 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 group) Trainer of trainers

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

CBM CDD CDTI CHWs COS CPA CSM CSOs DRC GoSS IDPs LGA MoH NGDO NGO NOTF PCO PHC PHCC PHCU POS REMO SAE SHM SRRC TCC TOT UNICEF I.]"IG

wHo

V1 WHO/APOC, 15 November 2006

Definitions

(i) Total population: the total population

living in

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

(ii)

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

(iii)

Annual Treatment Objective:

(ATO): the

estimated number

of

^persons

living

in meso/tryper-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 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: 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.

vil

^{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)

I

Number

of

Recommendatio n in the Report

TCC

RECOMMENDATIONS

ACTIONS

TAKEN BY THE PROJECT

FOR TCC/APOC

MGT USE ONLY

Not Appropriate

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 2007 . The project is in its second year of APOC funding ^phase. The project is also being supported by CBM, an lnternational NGDO coordinating CDTI in collaboration with Southern Sudan Onchocerciasis Task Force. There are NGOs such as ZOA, AAH and ARC which are supporting some counties.

The project has a total population of I,133,436 persons, UTG of 952,086 persons and an ATO

of

381,135 persons during the reporting period. It is made up of seven counties and 948 communities.

Data on the number of health staff involved in CDTI shows that only 944(43.6Vo) persons were involved in CDTI activities out of 2164 available health staff in the project areas.

On treatment, only ¹²⁶ communities were treated and thus giving a geographic coverage

of

13.29Vo. A total of 331,588 persons received mectizan treatment during the period under review. This treatment figure represented a therapeutic coverage, UTG ^{coverage and} ATO coverage of ^29.26Vo,

34.83%o and 87 .l%o respectively in 2007 ^.

Population movements are very corrmon in the project area as they are potentially farmer and nomads. This accounted for ^the number of absentees experienced recorded by the project. Influx

of

returnees is continuing in ^the project and thus creates imbalance in the total population.

On training, 717(l2l.5Vo) CDDs (644 males and72 females) were trained out of annual training objective of 590. The population/CDD trained was in a ratio of ICDD to 1581 population. The number of payam supervisors/trealth staff was L66(I24.8Vo) out of 166 targeted persons.

Major challenges in the project during the reporting period include the following.

(a)

Problem

of

non conduct

of

census update: The project has started

to

improve on this by informing CDDs to go round and update their household registers during the next treatment cycle to enable the project have a fair knowledge of its total population and drugs required for treatment. (b) Population/CDD ratio

is still

high: With population/CDD ratio

of l58l:1,

the project intends to train more CDDs

in

the coming year. (c) Absorption

of

CDTI staff and CDTI integration into health service system: This issue

will

be taken up next ^year by notifying and submitting the list of CDTI staff to SSOTF office in Rumbek for appropriate action. (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)

Problem

of

having

list of

CDTI communities: The number

of

available

CDTI

communities

is not

known

but

the county supervisors have given directive

to

see that

this list is

obtained

for

proper planning and implementation.

(f) Low

level

of

education amgng

CDTI

personnel especially

at

county, payam and community levels: Continuous training and capacity building of these categories

of

staff has been noted to be critical to the project and it has planned to pursue it during the 2008 distribution. (g) Coping with the poor record keeping of CDTI activities 4t lower levels: This has been emphasis to the county ^and payam supervisors, and change is expected during ^the 2008 treatment year.

(h)

Problem

of

logistic especially vehicle and motorbikes: APOC approved motorbikes to the project during the reporting period. The project has continued to press on the SSOTF to ensure that they are provided to the project in 2008.

(i)

Coping with

low

community participation: Intensive health education, community mobilization and sensitization has commenced

in

some communities and

this will

continue

until

there ^is appreciable improvement in 2008.

SECTION 1: Background information

1.1.

General information

1.1.1

Description of the project (briefly)

Ge o grap hic al locatio n, top o graphy, climate

The East 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.

2 WHO/APOC, 15 November 20O6

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 characteized by fast flowing rivers e.g. Yei, Yale,

lrsi,

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 : activilie s, culture s, language

There are an estimated total

of

1,133,436 people

in

the Eastern Equatoria at risk

of

Onchocerciasis infection. 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 TanTania, 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 increasing and especially in towns. The demographic description of the population is yet obscure.

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

iu.-irg,

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 region is 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 Lokichokio in Northern Kenya and 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.

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 the year mainly ^because

of

the free draining laterite soil. Attacks by the Ugandan rebels (LRA) have esc.alated insecurity along the road connecting ^Juba to Torit ^and Nimule.

Adm inist ratio

n

str u ct ur e

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 948 villages.

Health system

&

healrh care delivery ^(p,rovtde the number of heahh postslcenters in the project area if the information is availnble).

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

163 health facilities which composed

of

¹³⁰ PHCUs, 31 PHCCs, and 3 hospitals.

The hospitals are based in Juba, Yei and Torit. The staff were volunteers for over twenty years but now only those

in

hospitals are being paid. The

CIIW

and the Village Health Council provide and

3 WHO/APOC, 15 November 2006

direct the delivery of health service at the community level. Both local and international organizations are partners in the delivery.

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

There were only 126 health staff involved in CDTI but the data for total number of health staff in the entire project area was not available. The table below shows the staff distribution by county.

Table 1: Number of health staff involved in CDTI

DistricULGA

Number of health staff involved in CDTI

activities.

Total

Number

of health

staff

in the

entire project area Br

Number health involved CDTI

of staff ln

Bz

Percentage

BrBz/

Br *100

Yei 323 119

36.84

Lainya 256 84

32.8r

Juba 56 30

53.57

Kajokeji 686 449

65.45

Magwi 284

t20

42.25

Torit 408 107

26.23

Terekeka I51 35

23.18

Total 2164 944 43.62

1.1.2.

Partnership

Indicate

the

partners involved

in project

implementation

at all

levels

IMoH,

^NGDOs

( n at i onaUint e rnat ion al ), ^{c ommun it i e s, I o c} al ^o r g ani zat ion s, e t c.

l

-

Describe overall working relationshtp among partners, clearly indicating spectftc 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 IMoH,

^NGDOs

(national/international), communilies, local organizations, etc.l

For the CDTI implementation

in

East Equatoria, the partners involved are health services which comprised GOSS/State ministries

of

health, county health department and payam primary health care centers/units, communities which include about 948 CDTI villages directing and implementing the activitiesthe, CBM which is the NGDO coordinating CDTI and APOCiIVHO which is external donor. Other NGDOs that provide logistics supports to different counties

in

the project atea are

AAH

(Action Afrika Hilfe) which covers Yei and Lainya counties, ZOA (South East Asia) covers Lainya,Juba and Terekeka counties, SUHA(Sudan Humanitarian Assistance)

for Kajokeji

and ARC(America Refugee Committee) for Kajokeji, Torit and Magwi counties. The health services are

still weak in integrating CDTI.

Describe overall working relationship among partners, clearly indicating specific areas of project activitias (pl.anning, supervision, advocacy, mobiliTation, etc) where all partners are involved.

4 ^{WHO/APOC, 15} November 2006

All the

partners

are working

harmoniously

to

realize

the

objective

of CDTI in the

^affected

communities. NGDO especially CBM and health services carried out planning and advocacy before the distribution. 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.

State plans,

tf any, to

mobilize

the

statelregionldistrict/LGA decision-makers, NGDOs, NGOs, CBOs, to asstst

in

CDTI implementation

The project ^{has plans} to meet the top government decision makers for support to CDTI especially in area of full integration into primary health care system from state down to payam level. A stakeholders meeting

of

partners

will

be arranged and areas of needs

will

be discussed

for

their assistance. The project' plan of action

will

bejointly prepared and areas of supports clearly stated.

5 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.

8 WHO/APOC, 15 November 2006

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2.2.

Advocacy

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

the ^reason(s)

for

undertaking 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 relevant level during the current year The project was able to mobilize 3 policy/decision makers at the state level. This includes the Minister of Health and the Director General for Eastern Equatoria State'and the minister of health for Central Equatoria State.

At

the county level, those mobilized were

3

Commissioners,

5

Executive Directors and

6

County medical Officers.

At

payam and Boma levels,

14

payam administrators and

200

community leaders and Boma administrators were sensitized through one day meeting.

The reason(s)

for

undertaking the a.dvocacy

CDTI strategy is new in the project area and some of the people mobilized were new and therefore

it

becomes necessary to continue to enlighten them on CDTI strategy and philosophy. Also, during the advocacy and mobilization, they were requested

to

support the project and those involved

in

the project particularly at community level, Also, they were pleaded to encourage community members to partake in drug treatment especially those new returnees.

The outcome of the Advocacy

This was good as they gave assurance

of

support to the project and

to

ensuring that communities participate actively

in

the mectizan distribution. The overall outcome is evidenced

in

the improved treatment recorded by the project during the reporting period.

Dffic

ultie slconstraints being faced

The constraints are

difficulty in

meeting

all

county commissioners due

to

problem

of

terrains and logistics as project areas are large. Also, fueling project vehicle and motorbikes become a problem as

visits are sometimes repeated.

Suggestions on how to improve advocacy

l.

Repeated visits and continue soliciting for support to CDTI control.

2. Top APOC officer to assist in advocating for support by meeting the decision makers at the state level and may be also county level.

3. Making allowance for extra fueling of project vehicles for the repeat visits.

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

5.

Providing

the policy

makers

with

update information

on the

project possibly hard copies presentation.

2.3.

Mobilization, sensitization and health education of at risk communities Provide information on:

The use of media and/or other local systems to disseminate information Types of IEC materials used

Mobilization and health education of communities including women and minorities Response of target communities/villages

Accomplishments

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

The use of media andlor other local systems to disseminale information

The project made use

of

spirit and Liberty FM radio stations in Yei and Miraya EM station based in Juba. Also, local based radio station

in

the project area was used

to

^pass on messages across the

10 WHO/APOC, 15 November 2006

people. Other traditional systems include through village chiefs, sub chiefs, and headmen either during the meetings or informal gatherings; church groups, women's groups and village health ^committees (where exist and functional) are used to disseminate information.

Types of IEC materials used

The IEC materials used during the reporting period are posters and flipcharts

Mobilization and health education of communities including ^women and minorities

These were carried out through home visits, focus group discussions in communities and villages, meetings with women groups, during heath education in health units/ centers, market gatherings, during workshop training on CDTI for ^{women leaders.} The central ^issues were on community participation through taking of ^mectizan for many years, selection of CDDs by all communities, providing incentives to CDDs and education on possible reactions after treatment and its management.

These cut across all including women and minorities

-

^{widows, sick} persons and blinds etc in the communities. Ineligible persons such as lactating mothers, pregnant women, sick persons and under five years were told to receive treatment after the period of exclusion has passed. People were also encouraged not to refuse mectizan.

Re sp o ns e of tar get c ommunitie s /village s

The

response was

fair

as people are

still

emerging

from war.

Communities have realized that Onchocerciasis is a disease

of

public health concern. They have accepted to participate

in

ensuring successful CDTI campaign through selection of CDDs and replacing any unwilling ones. There ^was no refusal among the population during the reporting period.

Accomplishments

-

No case

of

refusals to mectizan treatment was reported

-

More people received treatment more other ^years.

-

The negative attitude, rumour and fear due to effect of mectizan have reduced.

-

More female CDDs are involved in mectizan distribution than in the previous years

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 to reach all communities

-

Availability and use of megaphone during the community mobilization

-

Provision of more fueling to the project vehicle and motorbikes

-

Increased educational sessions in the communities

11 WHO/APOC, 15 November 2006

2.4.

Community involvement

Table 4: Communities participation in the CDTI (Please add more rows if necessary)

Juba

Kajokeji

Comment on:

Attendance of female ^members of the community al heahh education meeting

Fewer female members attend health education meetings compared to men who dominate

In

general, how do you rate the participation of female ^members of the.oommunity meetings when CDTI issues are being ^discusses (attendance, participation in the discussion etc).

This is not impressive and

it

is rated low. Attendance, participation and decision making in all matter related to CDTI are men dominance. This accounted for low female CDDs.

Incentives provided by communities

for

^{the CDDs}

There was no clear incentive being provided by ^the communities to CDDs. However, some households appreciate CDDs after receiving treatment informs of giving minerals, food or saying thank you.

Attrition of CDDs. Is attrition a problem

for

^{the project?}

^If

^{yes, how is it addressed?}

CDDs attrition in the project area is still a problem. For instance, CDDs who are soldiers have been recalled and have gone back to barracks. The project has planned to select more CDDs through their communities and train them in the next treatment cycle.

Other issues

- The level of education and awareness among women is very low

2.5.

Capacity building

Describe the adequacy of available knowledgeable manpower at all levels.

The available knowledgeable manpower

is still

inadequate

in

the projegt area most especially at community level. The number of knowledgeable health facility staff/payam supervisors at payam level has remained a problem. The PCO left the project including other office staff and county supervisors particularly in Torit and Lainya and thereby creating more staff inadequacies.

District/LGA

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.

communitie

s in

^the

entire project area Br

Number

with

community members as supervisors Bs

Percenta

ge

Bo=

Bsl

^Ba

*100

Male CDDs

Bt

Female CDDs

B3

Total

Bs= Bz*Bs

Number of

communities

with

female CDDs Bro

Percentag

e

Brr=

Bro/84*10 0

Yei 240 55

22.9 170 30 200 30

12.5

Lainya 54 35

64.8 52 0 52 0

0.0

64 16

25.0 ^{28 2 30 2} 3.1

300 60

20.0 ^{180 30}

2t0

70

23.3

Magwi 84 18

2t.4 ^{32 8 40 8} 9.5

Torit t02

0

0.0 0 0 0 0

0.0

Terekeka r04 48

46.2

t82

² 185 J

2.9

Total

948 232 24.5 644 72 717 ¹¹³ 11.9

t2

WHO/APOC, 24 November 2OO3

Where frequent ^transfers of trained staff occur, stale whal the project is doing, or intends to do, to remedy the siluation. (The most important ^issue to describe is whA measures were taken to ensure adequale

CDTI

implementation where not enough knowledgeable manpower was available

or if

staffs are frequently transferred during the ^course of the campaign).

There was no actual transfer emanating from the ministry of health for ^the project staff. Virtually all project staff are non staff of ministry of health. The project had serious attrition ^at all levels occasioned by propensity for ^{greener pastures.}

SSOTF overcame this by appointing a new PCO to replace the former PCO who left for a greener pastures. In the same vein, other county supervisors who left were replaced by recruiting and training new ones. In ^some situation, SSOTF reassigned more responsibilities to few available staff to cushion the effect of ^labour mobility.

l3

^{WHO/APOC, 15} November 2006

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