AFRICAN PROGRAMME

South Sudorn Upper NiIe CDTI proiect

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COLINTRY/NOTF: South Sudan Proiect Name: Upper Nile Approval year: 2003 Launching year:2006

FROM: _JAN/2006 TO ^DEC|2006

(

MONTH/rEAR)

REPORTING PERIOD:

(MONTH/YEAR)

Proiectyearofthisreport: (circleone) (1) 2 3 4 5 6 7 I 9

¹⁰

Date submitted

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NGDO partner:

Chirstoffel Blinden Mission

ANNUAL ^PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

DEADLII\-E FOR STJBMISSION:

To APOC Management by

31

January ^for March TCC meeting To APOC Management by

31

Julv for September TCC meeting

ORIGINAL : English

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ONCHOCERCTASTS CONTROL ^(APOC)

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^{?i10/ WHO/APOC, 15} November 2006

ANNUAL PROJECT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSE,MENT

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}

Signature 'w ^Baba

Date

Zonal Oncho Coordinator ^Name: Chuol Both

Signature:

Dare: 2}thrc3/2007 NGDO Representative

b/or _/4,oal:

This report has been prepared by ^Name

^:

^Dr. Baba/FasiVOjara

I National/DeputyAlGDO Cord./PCO

Signature

/?.

Date

lt ^WHO/APOC, l5 November 2006

Table of contents

ACRONYMS V

DEFINITIONS VI

FOLLOW

UP ON TCC RECOMMENDATIONS 1

EXECUTIVE SUMMARY

¹

SECTION 1: BACKGROUND

INFORMATION

3 GgNnReI- INFoRMATIoN...

Description of the project (brieJly) Partnership

PopulerroN

SECTION

2: IMPLEMENTATION

OF

CDTI

⁸

2.1.

^TrusLtNe oF ACTrvrrrES

2.2. ^Aovocecv

2.3.

MoarLrzRrroN, sENSrrrzATroN AND HEALTH EDUCATToN oF AT RrsK couuurutuns l1

2.4.

Corrauururry INVoLVEMENT...,...,..

2.5.

^{Cnpecrry BUTLDTNG}

2.6.

TnrerupNrs...

2.6.1.

Treatmentfigures...

2.6.2

^{What are} the causes of absenteeism?

2.6.3

^What are the reasonsfor refusals? ...

2.6.4

Briefly describe all known and verified serious adverse events (SAEs) that....

I9

2.6.5. Trend of treatment achievement from CDTI project inception to the current

year2l

2.7.

ORDERING, sroRAcE AND DELTvERy oF IVERMECTINEnnon!

BoorM,c,nx Nor

DEFINED.

2.8.

CouH,ruNny sELF-MoNrroRrNG nNp SrexrHoLDERS

MBerrNc

...24

2.9.

SupeRvrsroN 25 1 .1. 1.1.1 1.1.2 1.2. 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3 3 5 7 .8 10 .12

.t2

.16 .16 .19 .19 Provide

aflow

chart of supervision

hierarchy.

...25

What were the main issues identified during supervision? ...26

Was a supervision checklist

used?...

...26

What were the outcomes at each level of CDTI implementation supervision? 26 Was feedback given to ^the person or groups

supervised?

...26

How was the feedback ^used to improve the overall performance of the project? 26 SECTION 3: SUPPORT

TO CDTI

26

3.1. EeurprrapNr

...26

3.2.

^FtNRNcrnl coNTRTBUTToNS oF Tm pARTNERS AND coMMUNITrES... ...,27

3.3.

Ornen FoRMS oF coMMUNrry

suppoRT

...28

3.4.

ExpnruorruRE PER

ACTrvrrY

...28

SECTION 4:

SUSTAINABILITY

OF

CDTI

²⁹

4.1.

INrenNnL; INDEpENDENT pARTrcrpAToRy MoNrroRrNG; Ever_uRttoN..,...,,29

4.1.1

^Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are

applicable)...

...29

4.1.2.

What were the

recommendations?

...29

4.1.3.

How have they been

implemented?...

...29

4.2.

SusrRrNesrLrry oF ^pRoJECTS: pLAN AND sET TARGETs (MANDAToRy AT ...29

iii

^{WHO/APOC, l5} November 2006

Yn 3)...

4.2.1.

Planning at

all

relevant levels

4.2.2.

^Funds

4.2.3

Transport (replacement and maintenance)

4.2.4.

Other resources

4.2.5.

^{To what} extent has the plan been implemented

4.3.

INrecRnrroN ...

4.3.1.

Ivermectindelivery ^mechanisms

4.3.2.

Training

29 29 29 29 29 29 30 30 30 30 30 30 4.3.3,

4.3.4, 4.3.s,

Joint supervision and monitoring with ^other programs Release of _funds for project activities

Is CDTI included in the PHC budget?

4.3.6.

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

...

...30

4.3.7.

Describe others issues considered in the integration of CDTL...30

4.4. OpBnnuoNAL

RESEARCH..

...30

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...

...30

4.4.2.

How were the results applied in ^the project?

...

...30

SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES,

AND

OPPORTUNITIES

31

SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS

32

lv ^{WHO/APOC, l5} November 2006

Acronyms/Abbreviations

African Programme for Onchocerciasis Control Annual Treatment Objective

Annual Training Objective Communily-Based Organization Chirstoffel Blinden Mission Community-Directed Distributor

Community-Directed Treatment with Ivermectin County Health Department

Community Health Workers Counfy OV Supervisor

Comprehensive Peace Agreement Communi ty Self-Monitoring Civil Society Organisations Democratic Republic of Congo Govemment of South Sudan

Information, Education and Communication Internally Displaced People

Local Government Authority Ministry of Health

Non-Govemmental Development Organization Non-Govemmental Organiza tion

National Onchocerciasis Task Force Project Coordination Officer Primary Health Care Primary Health Care Center Primary Health Care Unit Payam OV Supervisor

Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event

Stakeholders meeting

Sudan Relief and Rehabilitation Commission

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

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

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

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

meso/hyper- endemic communities in the project area.

(iii)

Annual Treatment Objective: (ATO): the estimated number

of

persons living in mesoftryper-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 coverase: number

of

people treated

in

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

(vi)

Geograohical coverase: 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.

VI WHO/APOC, 15 November 2006

FOLLOW UP ON TGC REGOMMENDATIONS

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

Prepare an Executive summary of the report in not more than

Wpage,

l. Background on treatment and population data

- Total communities, comtnunities treated, total population, UTG, ATO and persons treated.

2. Backgrourtd on population movements.

J. Training data

- CDDS, health workers, Total population (community) per CDD trained.

4. Challenges and how they were overcome.

I

Number of

Recommendation in the Report

TCC

RECOMMENDATIONS

ACTIONS

TAKEN BY THE PROIECT

FOR

TCC/APOC MGT USE ONLY

The

Upper

Nile

CDTI project is still in the frrst year of implementation.

WHO/APOC, 15 November 2006

Executive Summaty

Upper Nile CDTI

project

is an

expansion

of an

existing semi

CDTI

program

that

was implemented by health agencies as part of their Primary Health Care activities

in

particular

in

Pochalla and Blue Nile.

It

was mostly clinic-based treatment. From the REMO ^exercise conducted in South Sudan from March

- Iuly

^{2003, 92} villages were selected

in

Upper Nile.

REMO was successfully conducted

in

45 villages; 11 were meso-endemic, 10 were hypo- endemic, 24 were sporadic, 47 not surveyed due to insecurity at the time of exercise and 2 were in accessible due to natural barrier (flooding). It is estimated that ³³² communities

will

be treated

in

the project area, Ratio of CDDs and health staff trained on CDTI to the CDTI population is 7:872 and 7:5,970 respectively.

Therapeutic coverage

for

2006

is

73oh

within

30% geographical coverage

of the

defined meso/hyper endemic population

in

the project area. From ]an ²⁰⁰⁶

-

December 2006,54,756 people have been treated

with no

severe adverse events recorded

during the

course of treatment. 75"/o of the ATO and 13"/o of UTG have been achieved, The total CDTI population is estimated at 405,994 people in the region. This figure has been significantly exceeded due to the on going voluntary repatriation process. The demographic picture is still obscure.

The majority of the

inhabitants

of the Upper Nile were not able to carry out

their occupational activities as

a

result

of

intemal and extemal conflicts. The communities are cattle keepers practicing subsistence farming. They always migrate

to

grassing area

in

dry

season.

Returnees

from

the Ethiopia, Kenya and from

North

Sudan are receiving Mectizan at the

way

stations

within the

region,

The region also is home to

displaced persons from neighboring country (Ethiopia).

CDTI

training

started

in

the

middle of

_]une 2006,

but

there were

a

number

of

training conducted from March through May 2006. Total

of

500 CDD,

3

COS, 18 POS,

5

TOTs, 68 heolth staff, and ¹⁵⁰ Community leaders I LGA uerc traineil on CDTL Project staffs together

with

selected health staff were coached on APOC philosophy and

its

strategy as

well

^as

management of APOC funds. This training took place

in

Rumbek. In

]uly

^{2006 the Project} coordinating officer was trained

on the

management

of

severe adverse effects following mectizan treatment. Supervision and monitoring exercise were not very effective due to the vast geographical area, insecurity, inaccessibility due

to

natural barriers and inadequate logistical facilities. To overcome the above challenges more health workers and community supervisors

were trained.

Logistical

support for

supervision/monitoring activities ^(e.g.

motorbikes and bicycles)was availed for County/Payam supervisors.

The CDTI office was originally situated

in

Pochalla,

but

due

to

insecurity

in

the area the office was moved to Akobo

until

the situation improves. Akobo County Health Department (CHD) and South Sudan Relief and Rehabilitation Commission ^(SRRC) provided offices.

2 WHO/APOC, l5 November 2006

SEGTION 1: Background lnformatlon

1.1. General information

1.1.1

Description of the project

(briefly)

Geographic'al ktcation, topography, climate Population: activities, cultures, language Communic ation syste ms ⁽ roads... ) Arlmi n i st rat io n s t r uc tu re

Health tystem & health care delivery (provide the number of health posts/centers in the project area d'the inlb rmation is available ).

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

-

Geographical location, topography, climate

East

Upper Nile CDTI is

located

in

the

north

eastem

part of

Southern Sudan along

the Ethiopian highlands. It

composes of three States

(]onglei, North Upper Nile,

and Blue

Nile

₎ and six counties namely, Pibor, Pocholla,

Akobo,

Latjor, Renk and parts

of

Blue

Nile

region.

The Upper Nile CDTI proiect lies in 3

ecological zones.

The western part is flood

Prone ^zones,

the

Eastern

part being

Sudan savannah

on clay and

Guinea savannah,

the eastern part along Ethiopian border is hilly area. The eastern part is

^a

continuation

of the

Ethiopian

plateau

with

fast

flowing rivers

and streams and hence

suitable sites for Similium vector breeding. The Boma plateau to the south

is

mountainous and volcanic in origin.. The

Pochalla,

Akobo and

Rahad

rivers drain

the

Upper Nile

region.

The rainy

season

begins in May and ends in October. The dry

season

is from November to April. The farming activities start with the onset of ^{the rains.}

^The

farming

season

lasts from May to

September.

The length of the growing

seasons varies

fromT -9

^months

ⁱⁿ

^the highlands. The area has an annual

rainfall

of 800- 1000

millimetres or more in the

Sudan-savannah,

guinea -savannah and the

Boma

plateau. Flooding

is common

in

the

flood

prone areas. Due

to

the fast

flowing

rivers

from

the

Ethiopian

highlands. The Boma

highlands

are characterized

by medium wet

seasons

that

are cool

and rainfall

varies

in this

section

from

1000 -1600

millimetres.

During

the

dry

season, the main subsistence

activity

is fishing.

-

Population: activities, cultutes, language

There

are

an

estimated

total of

^448,093

people in the

Eastem

Upper Nile at risk of

Onchocerciasis

infection. With

the on going

repatriation

exercise,

this risk population has

increased

significantly. The demographic description of the population is

yet obscure. East

Upper Nile CDTI

is home to

Nuer

^(Lou

Nuer,

_Jikany

Nuer,

Gajak

Nuer

and Gaguang

Nuer), Murle, Anyuak

and

Dinka. Nuer

is the

dominat ethinic group Majority

of the people

in

East

Upper Nile

are subsistence farmers, Cattle keepers, and

hunting and fishing are also important. Due to intemal/extemal conflicts

the

communities

are

not much practicing the

above-mentioned

activities. However,

the GOSS

initiated disarming in some of the counties such as

area

of Akobo,

Sobat,

Maiwut and Renk counties and the other

counties

in the

process

of

disarmament.

J WHO/APOC, l5 November 2006

Recovery

from civil conflict,

the

population

is

now highly

armed

with

guns; a source of

insecurity until demobilization

and disarmament is completed.

Communication system (road,..)

Accessibility

to

Upper Nile region

is

through Lokichoggio in

Kenya

by land or air. It is

also accessible

through Ethiopia. UNICEF and

WFP

flights

operate

in the

region and facilitate movement of health workers

in different

parts of the region.

The

road infrastructure

is

very poor and

some

villages

are

not

accessible

during

the

rainy

season

that is usually in May,

_June,

July, August and

September/octobre.

Movement

and accessibility are

much

easier

during

the

dry

season,

which

lasts

from November to May. Supervision of CDTI communities requires the use of

^4WD

vehicles, motorcycles and bicycles and canoes.

Adminis tra tion ^s truc tute

East

Upper Nile

comprise

of

three

federal

states; Jonglei

and upper Nile and Unity

state. These states are

subdivided in to

counties, counties

into

Payam

and

Payams

into

Boma. The Boma is the lowest level of government

administration.

The states are

administered by Governors, counties by commissioners, Payams by

Payam

administrators

and Bomas

by

Boma

liberation

council. The project covers 6 counties,

which

are used as

supervision

centers.

- Health system & ^health cate delivery (prouide the number of

^health

posts/centers

in

the profect area

if

the information is available).

The

Primary Health

Care system is the

principle

for health care

delivery. Though it

is

well developed it

lacks

the

necessary

drugs, equipment and instruments. The

staffs are

all volunteers for over twenty

years.

The CHW and the Village Health Council provide and direct the delivery of health

service

at the community level. Both

local

and international organizations

are

partners in the delivery. The Govemment skill will introduce in

the near

future.

The East

Upper Nile CDTI

has 28 PHCUs, 4PHCCs

and2 rural Hospitals

(in Boma and

Kurmok)

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

DistricULGA

Number of health stalT involved in CDTI activities.

Total Number of health staff in ^the

entire project area

B1

Number of health stalT involved in CDTI

Bu

Percentage

Br=B/Br ^*100

AKOBO NA 29 NA

POCHALLA NA 18 NA

PIBOR/BOMA NA 2L NA

Total NA 68 NA

4 WHO/APOC, I5 November 2006

1.1.2.

Partnership

- lndicate the partners involved in project implementation at all levels IMoH, NGDOs (nationaUinternational), communities, local organizalions, etc, l

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

- State plan,r, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementatbn.

SSOTF Secretariat (Federal

Ministry

of Health) GoSS:

Dr. Majok Yak, SSOTF Chairman

Dr. Samson Paul Baba, SSOTF Coordinator

Chirstoffel Blinden Mission :( Lead NGDO partner) Mr. Fasil Chane, NGDO Coordinator

Upper

Nile

CDTI Project secretariat

(Ministry

of health):

Mr. Chuol Both, Project coordinating officer Mr. Omot

Ogul,

^secretary

Mr. Yien Chuol, Akobo supervisor Mr. _Jacob Logocho, Pibor supervisor Mr. Nyinginga Okhan Pochalla supervisor NGDOs partners

in

the project areas:

World Relief (WR)

Members of the

Mini

SSOTF at project level:

o

PCO, Finance Assistant

o

^World Relief (WR)

o

County Health Department (1), Akobo

o

County OV Supervisors (2) Akobo, Pibor Members of the

Mini

SSOTF at County level:

o

County OV Supervisor

o

County Medical Officer

o

Partner NGO ⁽¹⁾ International/National/Community based organization

o

Payam Representatives (2),

-Descdbe overall working relationship among partners, cleatly indicating specific areas of profect actiuities (planning, superwision, advocacy, mobilization, etc) where all parmers ate involved.

The

Upper Nile CDTI

project has good

partnership with

affected communities.

CDTI Programs are based on the principle of community participation and

encourage

community members to take an active involvement in both the planning

and

distribution of mectizan. Community leaders participate during mobilization, planning

and

distribution

of mectizan.

The Project Coordination Office is currently situated within the County Health Department building in Akobo.

Partnership between the

CDTI

proiect office and the

County Medical

Office,

National

and

intemational NGDOs

and SSOTF headquarters

is strong. CDTI is not fully integrated in to the PHC

systems

and the project

office

will emPhasize to include CDTI trainings into CHW training curriculum.

5 WHO/APOC, 15 November 2006

Stakeholders

participate in Operational planning

and

review

meetings together

with the mini OV

task forces

at the regional and county level. Village Health

Committee members and

Community Health

Workers have been responsible

for

the supervision and

mobilization

at the

community

level.

Quarterly operational planning is normally

done

jointly with NGDOs

partners, the

PCO and the

COS.

Supervision at the county level is done by the

COS, NGDOs

partners and the County Health Department. This strucfure extends even to

^the

Payam

and

Boma

level where CHWs

and

other Health

Centre

facility staff

are more

involved in CDTI

activities. Advocacy,

mobilization

and sensitization are carried

out by

the PCO and CHD.

Project

area

and County Mini

SSOTF

meetings are conducted to coordinate

and

plan and review of CDTI activities. During such meetings, support NGOs, CBq

CMO, COS, is

involved

and there is

wide

sharing of

opinion

and consensus

building.

County specific with lead NGO: The CDTI project office works closely with

all partners to

promote CDTI in

the communities. Each endemic

county

has a designate county Onchocerciasis (OV) supervisor. Each Payam (local

district) within

the

county

have a Payam Onchocerciasis supervisor (Payam supervisor/Community supervisor), most of

these

supervisors are already

engaged as

health staff by

the

NGOs. The supervisors are responsible for mobilization and sensitization of

communities.

-

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

The CDTI project plans before the rainy

seasons

to advocate and mobilize

State,

County and

decision makers,

NGOs,

CBO

to

assist

in the implementation of CDTI

activities. This is intended to increase awareness of responsibilities of

all

the partners

and revitalize commitment to CDTL Campaigns are always staged before

any

implementation of the CDTI. Consultation is on going with the Ministry of Health through

the

Director

General

to

have the

CDTI program included in

the

Ministry of Health

budget.

6 WHO/APOC, 15 November 2006

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SEGTION 2: lmplementation of GDTI

2.1. Timeline of activitles

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.

8 WHO/APOC, l5 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.

Prior

to the

launching

the CDTI project

in

Pochalla, the

NationalNGDO

coordinators

paid a

courtesy

call to the local government authorities

such as commissioner, the

Executive Director and the

SRRC

County secretary. Two International and

one

National NGO

operating

in

the

locality

were visited.

Due to lack of flights and the heavy rains the PCO was not able to mobilize policy/decision

makers.

The Executive

Director

and SRRC county secretary

officiated in launching

the

Upper Nile

CDTI project.

At the county level,

26 decision makers

were mobilized and

sensitized

including

¹

Commissioner, 3

^Executive

Directors, and 3 County medical Officers of Health

as

well

as 16 Payam

Administrators.

The PCO

highlighted

the

urgent

need

to support CDTI

activities

in their

counties.

In

the other endemic counties efforts are being made to

highlight

the importance of Onchocerciasis disease.

In April and _June

2006,

at least 150 community leaders were mobilized

and sensitized at the Payam and Boma levels.

Due to lack flights and heavy rains

IECs

materials and others were not

delivered

which, hindered

the

efforts of mobilization and

sensitization.

This will

be

improved by pre-positioning of required

materials once a secure

office availed. Improvement on advocacy at all levels may be achieved through constant involvement of

^the

policy/decision

makers

in all

activities

pertaining

to CDTI

implementation.

a

l0

^{WHO/APOC, l5} November 2006

2.3. Mobilization, sensitization and health educatlon of at risk communities

Provide information on

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

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.

There are no mass media services in the project area to

disseminate

information. 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 are used to disseminate

information.

a

Mobilization

and health education of women and minorities -Method and response

Re sp on s e of targe t co mm uni tie s

/uill

^{age s}

o The method used to sensitize and mobilize the women and minorities

is

through

home

visits to the community

and focus

group

discussion

in

village.

Health

education

is

a continuous process organized

in

schools, churches, and

market

places

and during clinics in the health facilities.

Special

attention

^is

paid

to the men to sensitize them so as to understand the role that

women

and

minorities

can

play in

the control and eventual eradication of OV.

o Communities

appreciate

the fact that mectizan is

safe

and has other

health benefits.

o Communities know that

Onchocerciasis

is

a disease

of public health

concem

and have

accepted

full participation and contribution in all

Onchocerciasis treatment activities

Accomplishments

o

Females make 36Vo of the CDDs, which, is acceptable in the first year of CDTI implementation.

o

Communities have known and accepted the drug to control Onchocerciasis.

o

The East Upper Nile CDTI Project launched and coordination office consolidated

o

Health staff and CDDs trained on CDTI trainings and health Education and data collection.

Suggest ways to improve mobilization of the target communities.

o

Increased educational sessions

in

the communities where

by

the project

didn't

reach

in

2006

o Train

more TOTs and

County

project staff

in

CDTI.

o

Provision of IECs materials at all levels.

o

Encourage the

involvement

of women

in

CDTI

o

Reduce the

ratio

of CDD to the reasonable

number

of

Ivermectin

recipients.

11 WHO/APOC, l5 November 2006

2.4. Gommunity lnvolvement

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

Comment on:

- Attendance ol Jbmale members of the community at health education meetings

- ln 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).

- lncentiyes provided by communities for ^{the CDDs}

- Attntnn o.f CDDs. Is attritnn a problemfor the project? If yes, how is it addressed?

- Olher ts:;ues

. The attendance of females in the health education meetings is low.

The

participation of female members when CDTI issues discussed are not encouraging since female prefer to ^{listen instead} of participating in

^a

discussion.

o Majority of the Community Health Workers are men. Women have

more

family

responsibilities and

fully

engaged

in

the domestic issues.

o The project

has

not yet reported attrition

since

it's in the first year of CDTI implementation.

-

Other issues

High

rate of school

drop

out

by girls

The level of education and awareness among women

very low Low enrollment

of

girl child in

schools

Young

girls

are often

married off through

arranged marriages.

Girls

are seen as source of

wealth through

marriage (Bride price) Some communities

look

at women as personal

property

2.5. Gapacity building

- Describe the adequacy ol available knowledgeable nanpower at all levels.

Knowledgeable manpower is very in adequate to cover the entire project

area.

Training at various levels of CDTI whether for management, mobilization, distribution of drugs

and data collection is

very

crucial.

To that

effect

CDTI training takes a lot of logistics, coordination and time input. In most

cases

NGO

health

workers,

teachers,

county OV

supervisors,

project-coordinating officer,

are used as

TOTs. Training and re-training is almost an ongoing

process

especially that

the

education level of the communities is very low. The project-coordinating officer

a

a a a

o a

Number

of

communitieVvillages with community members as supervisors

Number of CDDs and the communities involved

Number

of

communities /villages with female CDDs

Total

^no,

Communities

in

the ^entire

project area B,

Number with community

members as

supervisors Bi

Percentage

Br=

BJ B, ^,i1OO

Male CDDs

B7

Female CDDs

Bg

Total

Bs= BzfBn

Number

^of

communities

with

^female

CDDs

Bro

Percentage

Btt=

Blry'Br*100

Pochalla 60 5 \oo/o 734 66 200 20 33%

Pibor/Boma 48 5 l0o/o 90 60 150 16 33o/o

Akobo 224 7 3"/o 97 53 150 32 74lo

Total 332 ^{18 5.4Vo} 327 179 ⁵⁰⁰ 58 20"/"

L2 WHO/APOC, 24 November 2003

needed

strengthening by

selective package

for data

management,

compilation

and analysis. This has already been planned

will

conducted soon.

CDTI TRAINING:

The

below table shows the number of male and

female

county

supervisors, Payam

supervisors and CDDs trained by the project office and partner NGDOs

between February and March 2005.

COUNTY COUNTY

SUPERVISORS

PAYAM SUPERVISORS TOT Health Staff

Male Female Male Female

Pochalla 1 0 134 66 ^1, 18

Boma/?ibor 1 0 90 60 1 20

Akobo 7 0 97 53 ^{J 30}

TOTAL _{321 179} 5 68

Community leaders trained

COUNTY TARGET ACHIEVED

Pochalla ⁵⁰ 20

Boma/?ibor 59 75

Akobo ¹⁰⁰ 55

TOTAL 209 1s0

Where.frequent lranskrs of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The ntosl importanl issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable nnnpower was available or iJ staff.s arefrequently transferredduring the course of the campaign).

Since its

launching in

March2006, the project has lost an Assistant Finance

Officer. A significant number of lower

cadres

of already trained staff like

POS

and CDDs

are

either being

attracted

to other

organizations

or the armed

force

at

a

high

rate.

New

finance assistant to be

appointed

and more

Community

supervisors and CDDs to be

trained. The

greatest challenge

is the disjointed salary

scales

provided by different NGOs operating in the

project area,

which

are

much higher than the APOC top

up.

Up

to

now

the Government salary are

not

realized. There is no concrete action

plan

at the project Ievel to overcome

this attrition but training

is

underway for

the new ones.

13 WHO/APOC, l5 November 2006

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z

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00 6l

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o 6

A

0)

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x

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L

z

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? U

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t

6

at

0r

t

6 E

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-oE

3_o

JI N

Trainees

Tlp.

of trainrng

CDDs

Other Community members e.g Commuruty supefvlsors

Health Workers (frontline health facilities)

MOH staff or Other

Politrcal

Leaders Others(specify) Program

management How conduct Health education

to

Management of SAEs CSM SHM Data collecuon Data analysis Report wfltlng Others (specifl)

Table 6: Tvoe of trainrnp undertaken

(lick the boxet where tpecfic training was caried oat during the reportingpeiod)

- Ary other conmenls

Community

Self

Monitoring

and stakeholders meeting

will

be emphasized

in

the next treatment cycle.

The

number

of people

trained in

the

different

categories above is

still

small.

More training

have already been planned on data collection and data analysis

a

a

15 WHO/APOC, 15 November 2006

2.6. Treatments

2.6.1. Treatmentligures

UPPER

NILE

If the project is not achieving l00Vo geographical coverage and a minimum of 65Vo therapeutic coverage or

the coverage rate is lluctuating, state the reasons and the plans being made to remedy this

-

therapeutic coverage or the coverage rate is fluctuating, ^state the reasons and the plans being made to remedy this.

The project

area

has not achieved the above-mentioned figures for the following

reasons:

The project has initiated treatment only in three counties of

Pochalla, Pibor and

Akobo.

The

CDTI

project is

planning

to expand

in

the

remaining

counties

in

the year 2007.

a

O

a

Accessibility towards

the project area was

very difficult.

Some

of

the area was

not

treated due to floods.

The

area

is very

vast.

This is

confounded

by insecurity and limited

logistical facilities.

The Population

characteristic

of the CDTI

area

is being updated and

correct mectizan request

will

be made

for sufficient

therapeutic coverage.

The CDTI project is in the first year treatment cycle based on CDTI principle.

a

o

PERSONS TREATED %ATO ACHIEVED %UTG ACHIEVED

Pochalla 15,065 75% 27%

Akobo 21,848 87% 33o/o

Pibor/Boma 16,153 65% 1,90h

Blue Nile 1,700 57o/o

SW-TOTAL

54,766 75% ' _t3%

t6

^{WHO/APOC, l5} November 2006