8 9 2 (!) 4 5 6 uthern Force

So uthern Sudan Onchocerciasis ^Task Force

ORIGINAL:

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COUNTRY/: Southern Sudan ssoTFrHQ

Approval year: 2003

Reporting Period (MonthrYear\: Jan 2008 through Dec 2008

Project year of this report: ^(circle -Q""mr") 2 (!) 4 5 6 ⁷ 8 9 ^1011L21314

Date submitted: JuIy,29,2009

't{.i\

^'l

ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

To APOC Management by 31 January for Marc]n TCC meeting To APOC Management by 31 July for September TCC meeting

AFRICAN PROGRA}4ME FOR ONCHOCERCIASIS CONTROL

cAPOC)

ANNUAL NOTF SECRETARTAT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSEMENT

Please confim ^you have read this report by signing in the appropriate space.

OFFICERS to sign the report:

(

'\ !. I

Country : ^{South Sudan}

National Coordinator: Name: Dr.

Signature:

Date: 23'd July NOTF Chair: Name: Dr

Signature:

Luga

/TA

unu

Date: 23'd July

20

This report

has

been prepared by:

Name: Dr. Mount

/ F asrl/

Lazarus Designation

Signature:

..

/NG

Date:23'd Jlly

WHO/APOC, December 15, 2004

TABLE OF CONTENTS

ACROI{YMS II

DEFIMTIONS m

FOLLOW UP ON TCC RECOMMENDATIONS. ...ry

EXECUTI\.E SUMI\,IARY V

SECTION

1 :

BACKGROUND INFORI\{ATION...:....

1.1. ^GpNpnel rNFoRMATIoN...

1.2. PopurauoN

AND

Hpelru

SYSTEM

2.4.

CoirauuNITIES' INVoLvEN,IpNt IN DECISIoN'MAKING ^.

2,5. Cepeclry

BUILDING

2.6. ^ORopnINc,

SToRAGE AND DELIVERY oF IVERMECTIN.

1

I

5 6 6 6

SECTION 2: ^{SUMIVIARY OF CDTI} IMPLEMENTATION

2.1. DrsrnrsurroN pERroD...

2.2. AovocacyaNo SpNsrrIzATroN

2.3. INronuauoN, EoucATIoN

AND coMMUNICATIoN STRATEGy AND MATERIALS

DEVELOPMENT

.8

10 10

...

13

2.7. TRsarN,IpNts

2.8. SuppnvrsroN

...15

31

2.9.

ConannuNITY SELF.MoNIToRING

euo StaxpHoLDERS MpprTNc

24

SECTION 3: OTHER ACTTVITIES OF THE NOTF

25

SECTION 4: SUPPORT TO CDTI...

4.I. FINeNcnL

CoNTRIBUTIoNS oF THE PARTNERS

4.2. Otnpn

FoRMS oF CoMMUNITY SUPPoRT

4.3,

RnSoURcpMoBILIZATIoNEFFoRTS

4.4.

ExpBNoTtURE PER ACTTVITY BY THE

NOTF

SECRETARIAT

4.5. EqurrunNr

SECTION 5: EVAIUATION FOR SUSTAINABILITY OF ^CDTI,

INDEPENDEI{T MOMTORING AND OTHER REVIEWS

36

5.1. INnBpptroENT

pARTICIpAToRy

MoNrroRINc/nvRLuarIoN ...

86

5.2. SusrarNeBILITY

QF PRoJECTS: pI"AN AND sET TARGETS (uaNoetoRy ar

yn 3)

37

5.3. INrncneuoN ...:1... ...87

5.4

OppnaTIoNAL

RESEARCH

...38

SECTION 6: STRENGTHS, WEAKNESSES, CTIALLENGES AND

oPPORTUNITIES ...38

2t

31 32 32 32 34

Acronyms

WHOu

#

:

I

ll WHO/APOC, December 15, 2OO4

Definitions

(r)

Total population: the total population living in meso/hyper-endemic communities within the project area ^(based on REMO and

census

taking).

(iil _Elieible population: calculated as

84o/o

of the total population in meso/hyperendemic communities in

thle

project

area.

(iii) Annual TreatmentiObjective: (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

coverase:

number

of people

treated in

a

given year over the total population (this should

be expressed as a

percentage).

(vil Geosraghical

coverage!

number of communities freated in a given year over the total number of meso/hyper-endemic communities

as

identified

by REMO in the ^project area (tfris should be ^expressed as

^a

percentage).

(vii) Inteeration: The bringing together of two or more health programs, removing bapriers between/among them, in order to maximize

cost-

effectiveness; and -permit free and equal association. For example delivering additional health interventions ^(i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI ^(using the same systems, training, supervision and personnel) in order to maximize cost-effectiveness and empower communities to

solve

more of their health problems. This

does

not include activities or interventions carried out by community distributors outside of CDTI.

(viii) Sustainability: CDTI activities in an area are sustainable when they continue to functio,4 effectively for the foteseeable future, with high treatment coveragd, integrated into the available healthcare

service,

with strong community ownership, using resources mobilized by the community and the government.

lll WHO/APOC, December 15, 2004

FOLLOW UP ON TCC RECOMMENDATIONS

Using the table below, frll in the recommendations of the last TCC on the project and describe how they have been addressed

TCC session 28-

(Please add more rows if necessary)

'i

Number of Recommendation in the Report

TCC

RECOMMENDATION

ACTIONS TAKEN

BY

THE

SSOTF

SECRETARIAT

FOR

TCC/APOC MGT USE ONLY Report related: 1

Information on

funding

should be provided

I

The current report

has addressed this.

2

Provide responses

to

previous

^TCC

recommendations and/or

confirmation that

^the

year

I

report was actually submitted

I

The report

^was

submitted to APOC but

there no

apparent response

or no

further

communication from

APOC.

Proiect related: 1

Training on CSM

^and

SHM should be

carried

out now

as part

of CDTI

training, as

^these

activities are part

and parcel

of CDTI

This is noted

and

would be

incorporated

in

the future training on

CDTI.

Already projects are

being

sensitized on this.

2

Activities should

^be

carried out in ;the

_dry

season

This is very ideal

and

good but it

^would

depend on

^fund

availability during

the period.

lv WHO/APOC, December 15, 2004

Executive Summary

ⁱ

The total population

in

the

five CDTI

projects

of

Southern Sudan was 5,189,269

in

2008. This represents

an ll.37o

decrease

over the

2007

figure. The

decrease was based

on

the census population outcome

in

some areas. The West Bahr

El

Ghazal

CDTI

^project accounted alone

for

5l.5Vo of the total population.

The Ultimate

Treatment

Goal (UTG)

and

Annual

Treatment Objectives

(ATO)

across the projects

within

the

period

were 4,358,982 persons and 2,L77,344 persons respectively. The total number of communities

in

all the projects was 9,429 and this shows an increase

of

32.77o when compared to 2007.

Of

this number

of

communities,

only

6124(321%o) were targeted

for

treatment

(ATO).

Total

persons that received treatments

in

2008 were2,029,828 as against L,422,325

in2007,

thus representing 607,503 (42.7Vo) increase. These treatments occurred

in

6,576 communities compared

to 1,965 communities in 2007.

Coverage

recorded in 2008 for

geographic, therapeutic,

UTG

and

ATO

were 69.8Vo,39.1Vo, 46.6Vo and 93.27o respectively. The greatest achievement on treatment came from West Bahr

el

Ghazal

CDTI

project.

Actual

CDTI

training and refresher courses started in July through September 2008

just like

in

2007. 38 project staff, 494 health staff, 211 TOTs and 6,403 CDDs were trained

and refreshed during the reporting

period.

The

figure for

number

of

CDDs trained increased by

3,894

(155.2Vo)

when

compared

to 2007 figure. There was

general increase

of

trained personnel across

all

categories

in

2008.

The population/CDD ratio

was reduced

by

65.37o from

2333:1in2007

to 810:1

in

2008.

There was an improvement

in

integrating

CDTI into

PHC

in

2008.

Two

project coordinating officers and 13 county supervisors were absorbed during the reporting period. The process

of

integrating and absorbing the remaining projects and

tlleir

staff had commenced and there is prospect

of

their

full

integration

in 2009.It

^{would be} recalled,that

CDTI

^projects'

staff

were mere volunteers and not previously

ministry's

staff.

The SSOTF strength lies on both the technical support provided by APOC through the

deployment of technical advisor to SSOTF and projects, sheei determination

of

available staff to get work done, improvement in communication network

in

Southern Sudan and the

continued support of

CBM

to SSOTF.

The main

weaknesses

are the politics of the leadersllip at the national level,

available manpower are

not well

knowledgeable

plus their

inadequacy,

non

government counterpart contribution and delayed

actiyity

fund release to the programme by APOC.

The major challenges facing the prqgramme include the lack of capacity to man

CDTI

project

by

some project coordinating

officers,

inadequate

staffing

and knowledgeable manpower in the project area, non integration

of

all projects and non absorption

of

some

CDTI

staff into the

ministry of health, correct and timely data reporting, and problem of ^handling

^missed

treatment of cattle owners.

The emergence

of NTDs

control programme

in

Southern Sudan offers a potential opportunity

to utilization of CDTI

structure and

thus

leading

to popularity

and prosperity

of

mectizan distribution and coverage.

Key activities undertaken by the SSOTF during this reporting period include participation in

REMO/RAPLOA

exercise,

facilitating

the monitoring of treatment coverage, procurement

of

ivermectin tablets from Mectizan Dohation program

in

collaboiation

with CBM,

holding series of meetings and trainings, printing of IEC materials and ensuring distribution

of

mectizan and work support items to the projects.

Under the vector elimination, SSOTF did not carry out any activity-as this was not applicable in Southern Sudan.

{'

)l

;.

WHO/APOC, December 15, 2004

SECTION 1: Background information

1.1. ^General information

,,,

1.1.1. Description of the'country pnogzam -CDTI and vector elimination

(txeay)

i

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

annual temperature of about 29"C (about S5F). The rainy season months are

April'October with annual rainfall of more than 1000 mm ⁽⁺⁰ inches). The vegetation varies from typical rainforest in ^{the southern part} to ^Guinea or derived Savannah in the northern area. There is a vast swampy region "The Sudd" and or flood plain in'lthe Jonglei ayea of the Upper Nile. ^Human

settlement seriously affected by many years of civil war and is basically rural.

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

The southern Sudan Onchocerciasis control programme consists of frve ^(S) COII

projects namelyi East Bahr El Ghazal, West Bahr El Ghazal, West Equatoria, East Equatoria and Upper Nile. East Bahr el Ghazal and West Equatoria are in their fourth year while E'ast Eqiratoria, West Bahr el Ghazal and Upper Nile are

in third ^year in this present reporting period. Southern Sudan as a country has

ten states and project composition based on states are as follows East Bahr el Ghazal CDTI comprised Lakes, Warrap (one county), and West Equatoria

^(one

county) statesi Upper NiIe has Upper Nile and Jonglei statesi West Equatoria is the only statei East Equatoria has East Equatoria and Central Equatoria states while West Bahr el Ghazal has West Bahr el Ghazal, Northern Bahr el Ghazal and Warrap (three counties) states.

Vector elimination

Presently, there is no vector elimination ^programme in all CDTI project areas in Southern Sudan.

Status of National plan implementation, population at risk, number

of

projects being implemented, other releuant actiuities, and infrastructure G.g. Adequate health facilities, is

system decentralized or

not, etd,

logistics,

administrative structwe.

Basically, the National Plan is implemented by Southern Sudan Onchocerciasis

Task Force, which comprisedr'of national health staff of Ministry of Health government of Southern Sudan, WHO/APOC staff in Juba and Rumbek

as

well

as

Non ' Government developmental Organization (NGDO) which has CBM as lead NGDO. It is also being implemented through various State Ministries of health, local authority at CDTI project level, county, Payam and community levels. The National and International NGOs, and Community based organizations have also been supporting the implementation of the national plan by providing technical assistance/guidance through their field health coordinators. They also provide logistics support to facilitate the smooth running of the planned activities at project and county levels.

WHO/APOC, December 15, 2004 I

The total population at risk of being infected with onchocerciasis in Southern Sudan was 5,189,269 people. There are a total of 5 CDTI projects and

¹

Headquarter project in Southern Sudan.

The total number of health facilities across the five CDTI project areas in Southern Sudan was 933 and this comprised 213 primary _health care centres (pUCC), ₆₈₄ primary hehlth care units ^(pUCU) urrd gZ rural hospitals. 2, 540 (Sg.gX) health workers i*.r"'involved. in CDTI out of 6,386 health staff in Southern Sudan.

^:

The SSOTF headquarters is situated in Rumbek town. Rumbek airstrip is capable of receiving different types of aircrafts. This airstrip is currently being upgraded to an all-weather airstrip and is a major airstrip for OLS operations in southern Sudan. Rumbek is in the middle of Southern Sudan and it has road connection with ^Western Equatoria, East Equatoria, Central Equatoria, and other parts of Bahr el Ghazal and Warrap states.

The administrative structure has four levels in Southern Sudan namely: fhs

State, the County, the Payam and the Boma at the grassroots level. The States

form the first level of administration followed by the Counties, Payams and Bomas. State is administered by governori county by commissioner, the payam by payam administrator, and the Boma by Boma liberation council. Boma consists of several villages and mectizan distribution is based on villages in Southern Sudan. The five projects have a total of 33 counties and 9,429 communities where mectizan treatments were implemented during the

period.

und.er review.

Health system & ^health ,u3 delivery ^(srtatu any prublems related to health system that impede program iuplementation).

PHC remains the cornerstone of the health system and needs to receive more

political commitment and support for its successful implementation. The health system and health care delivery in Southern Sudan focused on five levels of facilities/services and these are community based health activities, primary health care unit, primary health care

centres.,

county hospital and county health department. The long standing civil war in Sudan has affected the health systems and infrastructure in Southern Sudan hence health care delivery remains a great challenge. Tiie health system is fragmented, few functional health facilities but in poor condition, lack of basic facility equipments, Iimited trained manpower, medicines and poor and irregular salaly and general lack of motivation to attract the few qualifred staff to work in government institutions..

The above rehearsed problem thus impedes CDTI as most'of CDTI staff have not been absorbed into the health system of the Southern Sudan due to non budgetary allocation of funds to run the Primary Health Care (PHC). For instances, among the SSOTF staff at headquarters' level, only the national coordinator was a staff of the ministry of health ,and also at the state CDTI level and county level, only tw6 proj6ct coord.inating officers and

13

county supervisors were

absorbed.

into the health slstem respectively..

2 WHO/APOC, December 15, 2004

houide map locating all ^{prujects (COru} and Vector Control, if any) within country.

Southern Sudan

lVIry 5: CDTI anas and frrrccasbd CDTlprrjects with tftcir rrspcctirrc coordinrtion ani srpcnrision ofEbes/ccntrce

ir

Pro ect 1: Bahr El GhazalWest P ect 2: Bahr El Ghazal East

mre

rr ,

etc 3: West E fla

4: East uatoria

P

KM ^lJgtnda

0 100

²⁰⁰

Legend

Errryty or uninhebitatcd zoru RGfirrc

CDTI Priority arrces

NO CDTIarres REIIO to tc pcrfrrmcril

Etkiopit

ftenya

WIOTAFE]l lJul!20!l

I

l{ofthetn Sudan

t )' E t r,] I Atr ica tt RepE b |ir

O ^{SSOff HQ,} Project Coordinalion office (PCO), Project Surpervision Centre[PSCJ

f

^Proiect coordindion office (PCo)

I

Project superuisionocerrtr*er1[i!]rr_

of

Co*so

fa ^roject Supervision centre (PSC)only

Itl, pS ,i ErrudE ry l, .bour6.rD.9, ,rl9.lr!or-nd!y dr. SS OIF,ESE ^g ltr CoItlaEdarr drr IrOC H

3 WHO/APOC, December 15, 2OO4

I

iII

%

' -i''

I

't, +,.

'r-it.'.'x'

-!:

.I-

"

l(

Indicate the partners involved in ^pruject implementation at aII levels

^(tVton,

NGDOI -national, internationaD

1.

At MoH level

. SSOTF Secretariat

. Five CDTI projects.

o 33 county health departments.

. 897 PHCC/PHCU. The staff in these facilities are mainly payam

. .rr""risors

2. At community level ^g,42g affected communities are involved.

3. At NGDO level:

a

Chirstoffel Blinden Mission. The lead NGDO group

4.

At external support level. WHO/APOC

5. Other level. NGO partners as at 2008 are very limited

Describe overall working relationship among partners, clearly indicating

specific

areas of project actiuities where all partners' are involved (planning,

superuision, advocacy, resounces

mobilization, endemicity

mapping

/

assessment, development of

IEC materials,

studies or surveys etc).

The overall working relationship among various partners is satisfactory hence the overall improvement in all activities such as advocacy, trainings and

mectizan

distribution.

The stakeholders

plan,

mobilize,

train

and supervise

CDTI activities

as

well

as

retrieve report.

Before commencement of

this year distribution, there

was

training of project coordinator at

SSOTF

secretariat in Rumbek

organized

by

SSOTF, WHO/APOC

and NGDO. The same activities were replicated at all levels. The partners jointly participated in conducting REMO mapping in all five projects and also

assessment

of household treatment coverage in two projects with APOC providing all the

^funds.

Resource

mobilization for projects in terms of meeting with the authorities of MOH

by WHO/APOC and NGDO over

soliciting for counterpart contribution

was

intensified..

State plans if any to solve any issues arising

as

regards CDTI implementation.

The SSOTF has plans to solve any issues that may arise in the course of implementing CDTI activities

as

follows:

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

as finding out why some people refused treatment with ivermectin or reasons for absenteeism.

b. The second step will ^be to identifr appropriate officers to deal with the issues.

c. The third step is to empower such offi.cer through providing necessary means to the task.

d. The fourth step is to report back after investigation.

e. Finally, maintenance of communication channels for quick flow of information and reaching out to project staff at all levels both in the field

I

4 WHO/APOC, December 15, 2OO4

L.2. Population and Health system

Table 1: hojects and populatiqn at risk in the entire.country whether they are treated or not during the reporting period. ^(Please _add more mws if

and the office so that qirick timely intervention is applied on any issue pertaining to the CDTI implementation.

NB-The line listing of villages project by project is still ongoing and this would provide information on the actual number of communities existing per project.

Currently only two projects have

a

comprehensive village list.

Source:

From

Oncho Project

reports:

./

National

census!-

Other

source,

specify REMO

^{Year of}

^source:

²⁰⁰³

UTG: Calculated as the maximum number of people to be treated annually in meso/hyper endemic

areas

withiu the project area, ultimately to

be reached

when the project has reached full gebgraphic

coverage

(normally the project should

be expected

to reach the UTG at the

end of

the

3.d

year

of

the project).

5

I

I

Name of CDTI Project Total communities

in meso/h;ryer' endemic

zone

Total ^population

in meso/h5per' endemic

zone

Ultimate

Tleatment

Goal (UTG)

East Bahr el Ghazal CDTI Proiect

25t3

927,285 778,919

West Equatoria CDTI Project

683 506,847

425,75r

West BEG i

_2,518

_2,670,680

_2,243,369

East Equatoria

532 602,302 505,934

Upper Nile

³,

I

80 482,155 405,010

TOTAL

9,429

5,189,269 4,358,992

WHO/APOC, December 15, 2004

SECTION 2: Summary of CDTI Implementation

2.L. Distributionperiod

Chart the actual distibition )eriod for each CDTI Project in the country in the table below.

:

Overview of distribution undertaken ct (insert rows

as

needeil

Briefly

note any problemslissues (one paragraph).

Three major problems that affected distribution in the projects are insecurities, flooding and delay in remitting fund. Insecurities hampered smooth distribution of mectizan in East Bahr el Ghazal (in Wulu and Yirol of lakes state, Tonj East and North of Warrap state), West Bahr el Ghazal (in Gogrial East and Gogrial West), East Equatoria (Maguri and Terekekd and West Equatoria (Mundri _and Maridi counties). Flooding restiicted flight from landing in Akobo of Upper Nile resulting to misplacement of mectizan and thus eventual non distribution. Non release of projects' second installment within the reporting period is a factor.

2.2. Advocacy and Sensitization

il ^State the number and tspe

of

policy /

decision

makers mobilized at the national and lower ^(state and district leveD during the'cunent yeari the

reasons

for the sensitization

and outcome.

At the national level, 5 key officials of ministry of Health of Government of Southern Sudan were mobilized and sensitized. Amongst them are the Undersecretary, three Director Generals of the Primary Health Care, the

External assistance and coordination, and the Preventive Medicine. The Undersecretary and the DG for External assistance and coordination further mobilized the Minister of health through a letter sent by the Technical Advisor on absorption of CDTI staff and integration of all CDTI staff from SSOTF level to county level.

6

Distribution Period Project

Name Jan

Feb

Mar Apr May Jun JuIy Aue

Sep

Oct Nov

Dec

East Bahr

el Ghazal

x x x x x x

West

Equatoria

x x x ^X x

East

Equatoria

X x x x ^X

Upper Nile

x x x ^X x

West Bahr

el Ghazal

x x

X

x x

WHOiAPQC, December 15, 2004

I

I

At the State level, four ministers of health of Lakes, West Equatoria, West Bahr el Ghazal and Northern Bahr el Ghazal states including their Director Generals and their Directors of primary health care were visited once or more regarding CDTI projects in their various states.

The reason for undertaking the advocacy and mobilization exercise anchored on absorption and integration of CDTI staff into the health system of Southern Sudan in order to facilitate their getting government salary instead of over dependence only on APOC top

r1p.

It would be recalled that most of CDTI staff in Southern Sudan are not ministry of health staff. Provision of ^government

counterpart funding to CDTI activities was addressed at the meeting and a

copy

of budget plan for 2009 for both SSOTF and CDTI projects were made available to them.

The major outcome was the absorption of some CDTI staff in their states especially in West Bahr eI Ghazal and West Equatoria where the ^project

coordinating officers ^(pCO) were absorbed. Additionally, 13 county supervisors were absorbed in four out of five projects. There was also assurance that more

staff would be absorbed in 2009 as government budget and allocation to states improved. Earlier the whole Iist of CDTI staff was given blanket approval by the Council of Ministers while the frnal approval by the National Assemble was still

being awaited. The government has understood that CDTI should no longer

be

regarded as

a

vertical project in the Ministry of health.

b)

State progress made towards

internal

resource

mobilization.

Within the reporting period, efforts were made towards getting the ^government to understand their roles rega[ding counterpart contribution to onchocerciasis control and there was a follow up to submitted budget plan but fund was not internally generated.

c)

Describe any

policy-related constraints

being faced

by

any

particular pruject and

describe

what

was done to

assist

the

pruject (outcomd. Explain anyplans

on

how

to

improve

advocacy.

The major policy related constraint faced by all projects was the issue of CDTI staff absorption into the ministry of health system. Sending letters, emailing and

physical visiting and following up to key government officials were the approaches adopted and this worked out in

^some

projects suoh as West Equatoria

and West Bahr el Ghazal projects where their- coordinating officers were absorbed. Lakes state has promised to absorb all CDTI staff in 2009.

Also states where CDTI offices are not located don't understand the structure of CDTI and thus no least of support to onchocerciasis control. This is applicable to projects that cover more than one state like Upper Nile with two states, East Equatoria with two state3, East and West Bahr el Ghazal with three states

each.

SSOTF has proposed thht eadh state should have a focal person for effective CDTI implementation and this new category of staff are expected to liaise with

the project coordinating offrcer.

I

7 WHO/APOC, December 15, 2004

('

The new SSOTF leadership that would be in place in 2009 and the WHO/APOC Technical Advisor are to be utilized to stimulate and intensify the advocacy.

AIso at the ^meeting betwegn the SSOTF and top functionaries in ^the

Government of Southern Sudan such importa4t policy matters are to

be

presented and discussed.

2.3. Information, Education and communication strategy and materials development

Briefly describe the IEC strategy being

used

in the country for CDTI.

Note if any new fEC materials were developef, or reuised, the tspe of ^the

material, the message and target audience, and where they were distributed.

SSOTF coordination offiJe in _{,umbek ^prod.uced a number of IEC materials for

the Southern Sudan Oncho Oontrol Program in 2008. The materials were distributed to Project offi.ces for onward distribution to 33 CDTI counties for

further distribution to health facilities and communities. The following were produced:

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

. Manual for CDTI provided by APOC through the technical advisor and distributed to five project coordinating offrcers.

. Illustrated OV training flip charts (OV

Onchc,

in Sudan)

. OV poster sets (3 posters per seti "What is O\I', "IIow do you get O\I', and

"How to treat O\f'). Thesel posters are laminated in ^plastic for durability under field conditions.

. Simplified CDTI instruction manuals for community didtributors.

. On the spot training guide for health workers and CDDs

o T' shirts for health workers and other partners with inscription'OV control in Southern Sudan'

How were the IEC materials'developed?

. Most of the IEC materials were developed during the time of Health Net

International and! laterl reviewed ,rrd ,.p*oduced in 2008 by SSOTF coordination office and while one originated from freld situation and APOC manual.

Are the ^materials reuiewed to address upcoming issues Qi*e decreasing refusals, sustainability, maintaining compliance

to

long'term treatment, SAEil?

. Yes, they were reviewed with emphosis on mointoining complionce to long term treotment ond other upcoming

issues

such os sustoinobility,

- ^Report if ony KAP surveys hove been done ond how lheil ^{rcsults werc}

used?

. There wos no

KAP

surver/ in

ott

the projects in

2008.

Summorize informotion

on :

- ^{The use} of opptoptiote ond innovolive medio ond/ot other strolegies to disseminote informolion omong the prciecls;

o Modern medio such os locol rodio stotions ore ovoiloble in most project oreos. For instonces, Eost Equotorio project mode use of Spirit ond Liberly FM rodio stotions in Yei ond Miroyo FM stotion bosed in Jubo, Eost Bohr el Ghozgl Orqiect ^{uses FM} rodio in Rumbek ond West Bohr el

1' 8

wHo/Apoc, December r5,zoo4

i

I

Ghozol relies on

FtV

ond rodio stotion in Wou. Upper Nile mokes use of Molokol

FM

while West Equotorio project hos no

FM

ond rodio stotion,

ln oddition, Eost Equotorio ond Eost Bohr el Ghozol hove bosed project rodio,

At community level, informotion is possed by word of mouth through troditionol systems of villoge chiefs, sub chiefs, ond heodmen. Church groups, women's groups, villoge heolth committees (if exists ond functionol) ore used to disseminote informotion,

Mobilizption

and health education of communitics

including

women and

minorities The five projects corried out this octivity before mectizon distribution to creote oworeness obout the mectizon, its ovoilobility, ond selection of CDD. Community leoders were responsible in contocting ond orronging for the meeting with community members whicfr involved the porticipotion of men ond women including the blind people ond other minorities. Key

messoges included couse of onchocerciosis, heolth/sociol/economic implicotions, symptoms, ^r,riho should not toke mectizon os well os the dosoges ond possible side effects ofter toking the drugs by individuols with

heovy infection. Community members were encouroged not to be obsenting themselves during the distribution or refusing the drug outright, Also benefits of mectizon were oddressed during such mobilizotion.

Re s p ons e of target c ommunitic ^s /villag ^e s

There was high

response

of community

members

during the

mectizan

distribution

as

those

who previously refused treatment turned up.

Major accompli shm en ts

i

o More communities participated in the treatment with Ivermectin in 2008 than in 2007.

. More persons came out for treatment with meciizan in 2008 than in 2007

. Community selected more CDDs than in any other year.

o More women were involved as well as increase in female CDDs in ²⁰⁰⁸

than in

2007 .

Weaknesses/Constraintsi

i

. Community support to CDD is still ^poor.

. Community mentality oniCDTI ownership is quite low.

. _Health education posters are very limited given the number of communities that need them.

. Inadequate number of health staff and CDDs to provide information to community members.

. High rate of absenteeism due to involvement and occupation in ^grazing

cattle by adult men and male teenagers resulting in missed mobilization and health education.

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

o

a

9

i

t,

WHO/APOC, December 15, 2004

. Availability and use of more posters during mobilization and also their placement in eaclr viIIEge and strategic places to attract community members is highly suggested.

. Engaging more health workers by integrating them into the health systems is ideal.

. There is need to recruit more CDDs and community supervisors in order to facilitate health education and mobilization activity in the communities.

. Women groups, youth and religious groups should be involved in ^the

campaign.

. Health education

messages

should

be

intensified in all communities

. More funds should be allocated for this activity.

o Mounting of billboard in

strategic

positionb in each

state

urging people to

take mectizan once a year

for

25 years.

o

Regular radio programme on disease situation and on treatment

with

mectizan

2.4. Communities' involvement in decision'making

Comment on community

participation

making comparisons among projects

Participation of female and youth

^members

of the community at health

education

meetings;

ⁱ

In geniral,

how do you rate the"participation of

minority

groups

andfemale

members

in

community meetings, decision-making, (attendance,

participation in

the discussion etc.) other issues.

In

2008,

there

was a general

improvement in community participation

as reflected

in the total number of people treated

across

the five projects. This may have

been

attributed to

more

involvement

and

participation

of female members.

The number of villages with

female members and also female CDDs had increased. The

report

shows

that

percentages of

villages with

female CDDs

arc

2.8%o

in Upper Nile,

21.8%

in East Equatoria, Ll.lyo in

West

Bahr el Ghazal,

14.7o/o

in

West

Equatoria

and 5.1%

in East Bahr eI Ghazal. Overall, female and youth

attendance

including minority is fairly

commendable given the previous high dominance by men

in

participation

in

discussion in matters of

CDTI.

However, important decision making

still

lies

with

men.

2.5. Capacity building

Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.)

Briefly

describe

any training dong by the SSOTF/NOTF for ^{specific CDTI} or

Vector

Control

Proiects (Objectives;rparticipants, outcomes, any

follow-up

^needed).

A three - ^{day training was ofganized by SSOTF for five project} coordinating officers including some of their county supervisors in Rumbek. The objectives of

the training were to ^improve the performance of participants on ^project

management, to ^provide them with capacity to apply basic CDTI strategies, process and APOC philosophy, to acquaint them with partnership between the communities and the health services, and to maintain community information data base. There was an improvement in the understanding the basic CDTI strategies but there is still a long way in meastiring up with data management and report writing due mostly to their low level education and therefore a serious

10 WHO/APOC, December 15, 2004

need for regular follow up and closer coaching and a general training on TCC report writing for all

PCOs.

Table 3: Type of training undertaken at national level by the GTNO/NOTF (Tick the boxes where was caruied out the

Brietly describe any techiTical assistance pruuided to the CDTI projects.

The key technical matters on CDTI were provided to them. These are

determining population/CDD ratio, maintaining community information data base, data calculation and analysis, monthly report writing, annual technical report writing, field supervision using checklist and accurate and complete filling

of all field forms.

Type of

training

^projecdl

staff

MOH staff

Opinion

Leaders

Others

^(specify) Program

management

How to

^conduct

Health

education

of Management

SAEs

CSM

SHM

Data

collection

Data

analysis Report

writing Others

^(specify)

i

1

ll

WHO/APOC, December 15, 2004 I

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