JAN TO

M,ST EQUATORIA CDTI PROJECT

I I I I I I I I

ORIGINAL:

English

vuD

CAO

coP

io co

L

I ccr.3

fi Lra

^Baladys Ht

Ero

FO

COUNTRY/NOTF: Southern Sudan Proiect Namp: EEQ CDTI

Approval ^year: 2003 Launchins vear: ²⁰⁰⁶

REPORTING PERIOD:FROM: JAN TO DEC, ²⁰⁰⁸

(MONTrrfrEAR)

Proiectvearof thisreport: (circleone) 1 2 (3) 4 5 6 7 8 9 ¹⁰

Date submittedz 27 July ²⁰⁰⁹ NGDO partner:

Chirstoffel Blinden Mission

ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

DEADLINE FOR SUBMISSION:

To APOC Management by

31.

Januarv ^for March TCC meeting To APOC Management by 31 JuIv for September TCC meeting

AFRICAN PROGRAMME FOR

oNcHocERCrASrS CONTROL ^(APOC)

ll ^{WHO/APOC, 15} November 2006

I

ANNUAL PROJECT TECHNICAL RE,PORT 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: Southern Sudan

National Coordinator ^{Name: Dr.}

^sto

Luga Signature:

..

Date: 23rd July 2009

APOC Technical Advisor :

Lazarus

Nweke

Signature:

Date:

22"d

July,2009 NGDO Representative Name: Fasil

Signature

Date:

22"d

July,2OOg

This report has been prepared by Name :EmmanuelBzema

Designatiofl

I Project Coordinating officer Signature

Date:

l6th

July,

2OOg

Table of contents

ACRONYMS VI DEFINITIONS VII

FOLLOW

UP

ON TCC RECOMMENDATIONS

1

EXECUTIVE SI.JMMARY

3

SECTION

1:

BACKGROLJND INFORMATION

4

1.1.

^GBxenar rNFoRMATroN...

1.1.1

Description of ^the

project (brielly)

1.1.2.

Partnership

1.2.

Popur-euoN...

5 5 7 9

SECTION 2: IMPLEMENTATION OF CDTI

¹⁰

2.t

TnrmI-nrte oF ACTIVITIES .... ... ¹⁰

...,.',..,. 12

2.2. ^Aovocacy

2.3. Monu-zluoN,

SENSITzATIoN AND nEALTH EDUCATToN oF AT RISK coMMuNlrms 13

2.4.

Comr,rrnurYDn/oLVEMENT.

2.5.

CepecmvBUrLDrNG..

2.6.

TnrammNTS...:..

...

l5

...

l5

2.6.1.

Treatmentfigures

...19

2.6.2

What are the causes of absenteeism?

...

...23

2.6.3

What are the reasons

for refusa1s2...

...23

2.6.4 ^Briefly

describe

all

known and verified serious adverse events (SAEs) that

...23

2.6.5. Trend of treatment achievement

from

^CDTI

^project

^{inception to the} current year25

2.7

.

ORpeRnqc, sroRAGE AND DELTvERy oF

TvERMECTTN

...27

2.8.

COMT,TUMTY SELF-MONITORINGENO STETEUOLDERS MTBTNqC

2.9.

SuprRvrsroN...

2.9.1.

^Provide

aflow

chart bf supervisionhierarchy.

28 19

29 29 2.9.2.

2.9.3.

2.9.4.

What were the main issues identified during supervision? ...29 Was a supervision checklist

used?

...29 What were the outcomes at each level of CDTI implementation supervision? 29

FnqaNcmr coNTRIBUTIoNS oF TIIE pARTNERS AND coMMUNITIES..

Orrmn FoRMS oF coMMur.ury suppoRT ...

E>cexotruRp PER ACTryrrY ...

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

3.2.

3.3.

3.4.

SECTION

4:

SUSTAINABILITY OF CDTI

³³

4.I. INrsnNaU

TNDEpENDENT pARTrcrpAToRy MoNIToRTNc;

EvaruarroN...

33

4.1.1

^Was

Monitoring/evaluation

caruied out

during

the reporting

period? (tick

any of the

following

^{which are}

applicable)...

... 33

4.1.2. What were the recommendations? 33

How have they been implemented? ... 33

4.L3

iv

^{WHO/APOC, 15} November 2006

4.2.

Yn 3) 4.2.1.

4.2.3 4.2.4.

4.2.5.

SusrRnrABrLITy oFeRoJECTS: rLAN ^AND sET TARGETS

(ueNonroRY

AT...

Planning at

all

relevant levels..

4.2.2.

^Funds

33 33 33 33 33 34 34 34 34

T ransp o

rt

⁽ replac ement and maint ^{enanc e} ) ...

Other resources

To what extent has the

plan

been implemented

4.3. IvrrcneuoN

...

4. 3.

1.

Ivermectin delivery mechanisms ...

4.3.2. Training....

^....

Eruor! Bookmark

not defined.

4.3.3.

^Joint supervision and monitoring with other

programsError! Bookmark not

defined.

4.3.4.

^{Release of} _funds

_for

^project

activities ^Error!

Bookmark not d,efined.

4,3.5. ^Is

CDTI included in the PHC budget?'...

Enor!

Bookmark not defined.

4.3.6.

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

Eruor!

Bookmark not defined,

4.3.7.

Describe others issues considered in the integration of

CDTI. Eror!

Bookmark not defined.

4.4.

OpBnaTToNALRESEARCH

^...35

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.

^... 35

4.4.2.

^How were the results applied in the

project?....

... 35

SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTI.]NITIES

³⁵

SECTION 6:

UNIQLJE

FEAJURES

OF

THE PROJECT/OTHER MATTERS36

Ac ro nym s/Ab b revi ati o

n

s

APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective

ATrO Annual Training Obiective 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 Intemally Displaced People LGA ^Local Govemment Authority MoH Ministry of Health

NGDO Non-Governmental Development Organization NGO Non-Governmental Organization

NOTF National Onchocerciasis Task Force PCO Project Coordination Officer PHC Primary Health Care PHCC Primary Health Care Center PHCU Primary Health Care Uni[

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 ⁱ WHO World Health Organization

l

t

vi

^{WHO/APOC, 15 November 2O06}

Definitions

(i)

Total population: the total population

living in

meso/tryper-endemic communities within the project area _@ased on REMO and census taking).

(ii) Eligible

population: calculated as 847o

of the total

population

in

meso/hyper- endemic comniunities 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 ffeat with ivermectin in a

given

year.

i

(iv)

Ultimate Treatment Gbal (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).

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)

Inteeration: 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 pctivities

in

an area are sustainable when they continue to

function effectively fbr 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.

(v)

(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 prograrnme), 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. ,

^,l

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_

1

Number

of

Recommendatian in the Report

TCC

RECOMMENDATIONS

ACTIONS

TAKEN BY THE PROJECT

FOR TCC/APOC

MGT USE ONLY

Report related: 1 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

Iiving

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.

2

Increase

^geographic

and

therapeutic

coverage building

on high level advocacy

This project

is

already working towards this

^and

there is inlrease 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 2I.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)

3 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

prqect

has a total population

of

602,302 persons, UTG

of

505,934 persons and an

ATO of

379,451persons 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(49.0Vo) 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

80.57o.

A

total of 376,045 persons received mectizan treatment during the period under

review.

This treatment figure represented a therapeutic coverage,

UTG

coverage and

ATO

coverage of 62.47o,74.37o and99.l%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.

Ontraining,T63(101.77o)CDDs

(638males

andl25 females)weretrainedoutof

annual training objective of 750. The population/CDD trained was

in

a ratio

of

1CDD to 789

in

2008 as against l CDD: I 58

I

population

in

²⁰⁰⁷ . The number of payam supervisors/health staff was

4O(87 .0Vo) out of 46 targeted ^person$.

Major

challenges in the prqject duhng 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 _qnd

effort on staff

absorption

into

health services

will

be maintained to encourage

CDII

staff to remain

in

the project.

(e) Low level of

education

anibng 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 the 2009 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.

,ii

-tj

SECTION 1: Background information 1.1. ^General information

1.1.1 Description of the project (briefly)

Geographical

location,

topography,

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 degr,ees.

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 charactenzed

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 precisefy because

of

the

climatic

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

fly

thrives

well in

such environment.

Population : activitie s, culture s, 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.

_i

East Equatoria is home to theiBari 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...)

_i

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, 15 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

the year 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,

Zain and others.

Administratio n ^s tru c ture

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

_@rovide

the number of hqalth

postslcenters

in

the project area

if

the

information

is available).

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,

7l

PHCCs, and 13 hospitals including 5 county

hospitals,

4

^state

^hospitals

^and

4

^private

hospitals. The staff were

volpnteers,pr

over twenty years but now

only

ihose

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

activities

Of

245Lhealth staff

in

the

project area,l20l(49.0Vo)

are.involved

in CDTI. This

was a slight increase

of

health staff involvemenQ compared

to

²⁰⁰⁷ . The breakdown based on counties is as shown

in

the table

below.

^'

I

I

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

BrBl

^{81 *1.00}

Yei 454 179

39,4

Lainya 352 146

41.5

]uba ^{275 1,32} 48.0

Kaiokeji 473 377

78,4

Magwi 29t t48

50.9

Torit

479 1,36

32.5

Terekeka 1,87 89

47.6

Total 2451

t20t

49.O

1.1.2. Partnership

Indicate the partners involved in project implementation at all lq)els [MoH, NGDOs (natiotaUinternational), communities, local organizations, etc.

l

-

Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy,lplanning, mobilizntion, etc) where all panners are involved.

-

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

Indicate the pafiners involved in ^project

implementation

at all kvels [MoH,

^NGDOs

(national/internalional), communities, local organizations, etc.l

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 payan 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

partners, clearly indicating

specific areas

of

project

activities

(planning,

supervision, advocacy,

mobilizatian,

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 ^prqect

coordinating

officer in

Rumbek.

While

project coordinating

officer

trained other health staff mainly county supervisors and supet'vise payam supervisors training across the project. Health services

and communities

qirsured).

mobilization of community

members.

Chains of

drug

distribution are followed with the actual drug distribution by communities through

their CDDs. Each health services and conimunity 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

implementatian

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.

A

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 areas

of

supports clearly defined.

\o Ocl k0)

.o o

z

o

\n U

^

*

s i

_o

p g

(g

q FJ U]

d(6

hF

(:Ei

d/1

O' Fz

\<

i:F

IF,.

h.o :(^

*(n

\w

xo Joo

E .i-l

s8

q)<

t:

\H_sH

i.e-

^s

rh

_d

^e

>HO .a '!J

s!

_b'!9C E=

$trO.(6

oo+. a

B><L

=o

^>ra.

bH

^E

SP

_s.ic)

:

. H

sls ^F

v'(J'Ft

$o)h-

.s hHL.Ttt

qiE iS tr

s*e I

-{Lcd

i oS

E

EESe

^H

E (\ H

^E

S(ES:E_+HttsU!

i;N'S ^SE

N'r I i ^S;

^irlllt:9

s"5t.s'sg EE 8.S+E

S ^S *: ^{I ;}

.E

_S

_{E *.5 i} P I x*

^E

i.s.[S9E

E

S x$ s's.E 3.E .s $t

^E

F H - $ p=

$ / +i- ** v

t E'sbgo=

T _{E E +.S} I .sSsEsE ? t P Eor.t:

i E I<o'r

iorl

_-+.q)

S-.saaa

SH

99qr

^E

o a

N

I

S

o

N

LB

o *

E]

&

€

tro

E

(!

(€

H &

.h

o\)

*

\t

q L\)

a 8

q

p

s

B

= ;

_p

a4o

*

-7

q .q) N.

q)

t

Fi :p\

tl

^q,

\>

-SiqrH

Ss tg

UG

sT

th' 5';

\. I s8

L$

3.3 oi

Bd.

3E

=b

o\

4

'8.!i

$)

\)

\) o p .s\) o

=.t) B IS

s) ^(.) :lI

q'i

'5

u\

q)

XS

qQ' E(J

*r

e\)

'!

_'n

-qr.4 .S

NB

:\)

$B

bl)

\s

ar \)

>9 _qt

$-

s>

.sP 16o

ltlx

tF s

ls 9

t:$

dqj Eo\JN

hr:

$S

.so st

\)O

$'+ \\

\-$

.s= bs

SN =\

\o

s.E

!ooIqr R r(S$

:i uo

.9

\T ds.

_{$) Oo}

li ^q)

(_)

\

o\Id

\JAt\B

\U

%

\)\)

q>

:, p o

t

_v

\)4

q

\0

otr O.o

o0 tr OiC)

fr o

DOtr tr

! o lro

O do tr

C)li

(n

C)

LrO

0)

B c!

€)li

cE

Ie)

L

q)

,

q)

o .\iCA

l- (!

(!

a.o o.

! (!

.ho

trtr

U

oirol -ol _(€l ^,

Fll

E

o

a-fl

-I t! c

E o N

a_I

F

o

= F

otr

c!q

._EEr

No, o.(t)

N

c/)@

@(O

N

o

ro

o

(r) N ro

€

@

N(t)

o- ro

No, N(r) cr)

@

a

Nrr) rJ)

s

(r)

o,rr)

O1/)

+ il5

q,)

:N

! (.)

->

^Gt!?otr

-o9E

Ftrq)

o

(oN

s

(\I

(f)

t

coN

$(o o)@ (r)

(oo) o,(\t

o

\t

(\l

@

@

@(o

o

lO

F

o)ro Nro (o

N

o

(f)^

(\l

o

(o

8g

, ^.9.E :

hE

^!,1

X oi o.l

ffE5[;

$(o

o

(o co

$

ol

@ (o

@(o

@ro r

o,

€ s

N roN

CB

e

o A

o EG'q)!)

?E

o -. ^0,)

E E'E

>SE.

o

(oN sf

(\,I c.)sf (\l@ ^(o_o)

o)N

o

roo)

t-

to (o

(t)(r)

@

s s

CO

I q)

e

>a

o0

o0)

N

.= .9 cg ⁶⁾ Fq)

+ ll

ri cO

rO o\ro

<i

Fi ti

\o

o

_N ^ro_N

ol(f)

rO

Iq)

9'=CL

E9

&g

^e

>aX P

rrNCE

o)rO rl

(o O

t-

o

ct)t-{

qq) 0xcl

q)

I o

q)

z

q)

oq)

?E

o-.6)

I ^H'e

>SE.

F-{

r{ Io

.+O

r-{

rIitr-

c\.+

ca

tr9)

5 _t€g

EOSJ .i! :e I

?=

^.sl

I *cr

^9'

_v9Fl

F AE A

o

F

(oN

$ N(f)

$

o

N

s

(o o)(o

(f)

(o

O)o) N

o

s

ot

@

@

@(o

@lf)

F

rr)o)

NrO

(o ot

o

(r)-

ot

o

(o

.!

q)

>tr

.9or-

g€

^g

=tr€!

-o!?

t- <.=

ar rh O

651

^o

(!>\

(!

FJ

s

6

x 'il

'a

o

v

'5

bD(6 I

tro

F

J6_q,) J_q) tr

F

OJ

Fl

3 o

E<

SECTION 2: lmplementation 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 intplemented by the month they began and the month they ended.

tI

r

\o

C.l

-oo o

z

ra)

A

o

B

CA

tro tr ()

t<

q)

P

tiz

-(J

;

CE

a

x

e)

oth c!q)

r.=

a

EH Eo

_o)e

Ee ctE

E5

ahd

cEEF(B

?E 9a

r6 be

0)6)

b'

ie

.9

.hE^c.>

.- ₀₎

.E>

9u) c!=

-2

_{GI C)}

qH()

gE

Glw9C

'6t

(aO) 6l o.

ivt

O=t

h

!q

v,

\)\)

q>

o

q)

o

!

\)q

!\)

[.

lr

C6o

9)F

o

O

!_q)

(go

lr (t)

ot<

do

Lro

(n

O

()(!

(:

o o

C)

F

c.it

o.ll

-oldl

FI

ah

Lq)

a

0)

=+j _Y=

9E

h()

p

o)()

a

o)

fr0)

-o ()

a

0)

'r p0)

tr o

I z

fr0)

p

C)

I z

L 0)

c)

a

l{

C)

q)o

a

tr0)

-o

o)

z

o 0!

c, U)

n

^Fi

>r

h

x n

l{

0)

€0)

a

0)

t{0)

I

C)

0.o

a

h

o L t) 0(

L o

EIE6)

5E

rr0)

0)

a

0) h

-o

0)I

0.)

l-.t

!

o) E 0)

z

t{0)

0)

z

'r

0)

0)

a

0) l<

-o0) o)

a

0)

t{o -o

0)

z

BO

Lt=cqo

u)tr n

ch bD

o

bo

o

bo tro -o

0)

p.

a

0)

t{

C)

-o

C)

o.

v)0)

€_o

b!

q,) cg

t) (h q)

U

o

q)

=-E=ri

5E

oa

bo

oa

bo

o

bD

o

bD

fr

p0)

o

o

o tr0)

p

P Ia

bo

0!

rrtr

cqo

AE

h

n

>r

x

h ,.o p

0)

qa

a

f.

Ec) 0)

a

0)

x

OI

CEL

Er

C)

=-c x=

IJE a

bo

oa

bo

aa

bo

oa

bn t{o

po

o

t{o

p

o o

ho

o0

LEGlo AE

h h

x

ts?

Fr

p0)

tr

€0)a

a

!0)

C)

a a

o

n

EE

s=

<{o otr

a9

o o

q)q

(.)

0)

n

0)

h

0)

h

0)

i a0)

n

0)

n

C)

-

a0

6!o V)E

C! (!

a A

x

d ^>,Cd (g

(, rl

9 L

(t)

I ⁶⁾

q,

>' E Fl6

Eq,

a J(0)o

'e

M l

E ho6

I tro

E{

Jdo Tok o

E<

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 dfficuhies/constraints being faced ^and

suggestions on how to improve advocacy.

State

the number of policy/decisinn tnakers mobilized at each relevant level during

the current

year

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 stut" ds 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 and 7 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

staff into

the health system.

Most CDTI staff at the

state,

county

and health

facility

levels were not government staff but volunteers

with

private organizations. 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

govemment.

Payam

gave instruction to communities to select their CDDs that would participate

in

the exercise and this led to improved

coverage.

:

Difficultie

s/constraints being

facet.

Mostly

the logistics

is

the mhjor cohstraints

particularly

as relate

to

shortage

of fuel, prqect

vehicle frequent breakdown. Also motorbikes have all broken down.

Suggestions on how to improve advocacy

l.

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

rshirts,

calendars and posters should produce and used during advocacy

2.3. Mobilization, sensiti2ation 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 heahh education of communities including women and minorities Response of target c ommunities/villag es

Accomplishments

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

The use of medi.a and/or other local systems to dissentinate

information

The project utilized

FM

radio in

Torit in

East Equatoria state,

Spirit

and

liberty FM

stations in

Yei

and Miraya

EM

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 I

^\

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

Mobilization

and health education 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 relatqd to mgctizan 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.

Respon s e of target

communities/uillages

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

nowrealized

that Onchocerciasis is a disease of

public

health concern. New returnees

following

war cessation participated

for

the

first

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

Accomplishments

-

^Turn up

for

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

-

Villages which did not participate

in

2007 now participated

by

selecting their CDDs

-

More enthusiasm among community members.

a

t3

^{WHO/APOC, 15} November 2006

More female CDDs are invol,ved 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-

shirtsior face caps to reach some community leaders.

-

Extra budget allocation for fueling of the project vehicle and motorbikes

-

^Intensify

effort

in community mobilization and health educatidn.

2.4. Gommuni$l involvement

Table 4: Communities participation

in

the

CDTI

(Please add more rows

if

necessary) 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

Ba

Number with community

members

as supervisors Bs

Pqrcentage

Bo=

BJ B, ^*1.00

Male CDDs

Bu

Female CDDs

B*

Total

Bo= BztBc

Number

^of

communities

with

^female

CDDs Bro

Percentage

Brr=

Blo/84*100

Yei ₁₁₀ 67 55.5 ^{160 34} 194 ³³ 30,0

Lainya ₅₃ 37 69.8 ^{54 6} 60 ⁶ r 1.3

Juba ₅₉ 25 42,4 ^{54 12} 66 ¹¹ 18,6

Kajokeji ₇₀₄ 47

45,2 ^{110 35} 145 ³¹ 29,8

Maglri _61, 27 _44.3 ^{65 15} ₈₀ ⁷⁴ _23.O

70 29 41.4 ^{72 10} 82 ¹⁰ 14,3

75 35 46.7 ^{123 13} 136 ¹¹ 14.7

Total

532

232

43,6 638 125 763

I6

^21,8

Torit Terekeha

Comment

on:

Attendance

of female

^{members of the} commun@ at 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 meetings when

CDTI

^issues are being discusses (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 communities

for

^{the CDDs}

Communities have not come up

with

any incentive

for

CDDs except appreciation

from

some households.

Attrition of CDDs. Is attrition

a problem

for

^the

^project? If

^yes, how is

it

a"ddressed?

This is still

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 educatibn and]awareness among women is very

low

ri

2.5. Capacity building

Describe the adequacy of availnble knowledgeable ma.npower at

all

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

WHO/APOC, 24 November 2OO3

15i

payam

level are also

inadequate and some

of them are still new. For

instance,

2

county supervisors

of Torit

and Terekeka,

/6

^health

^facility

staff/Payam supervisors and more than

half 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.

Where

frequent

transfers of

trained

staff occur, stale what the

project

is doing,

or

intends to do,

to

remedy

the siluation. ^(The

most

important

issue

to

describe

is

what tneasures were

taken to ensure

a.dequate

CDTI implementati.on where not enough

knowledgeable

manpower

was

available or iI

staf{s are

frequently transfened during the

course

of

the

campaign). :

^,i

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

and to 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.