project Bahr El

South Sudorn Es,st Bahr El Ghozal CDTI project

ORIGINAL:

English

COUNTRY/NOTF: South Sudan Proiect Name: EBEG CDTI Approval vear:2003 ^Launchins yearz 2004

Reporting Period(Month/Year)

:

From: January ^{To: December, 2007}

Proiectyearofthisreport: (circleone)M ^ 4 5 6 7 8 9 ¹⁰

Date submitted:

6tn

August 2008 NGDO partner:

Christoffel Blinden Mission

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For i,,l:.; r.,..:iion

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²⁰⁰⁸

I

WHO/APOC, 24 Novemb er 2004

I I I

h* Ao

rli _-

ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO

TECHNICAL CONSULTATIVE COMMITTEE ^(TCC)

DEADLINE FOR SUBMISSION:

To APOC Management by 3L January ^for March TCC meeting To APOC Management by 31 Julv for September TCC meeting

AFRICAN PROGRAMME FOR

ONCHOCERCTASTS CONTROL ^(APOC)

ll

WHO/APOC, 24 November 2004

ANNUAL PROJECT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT

Please confirm you have read this report by signing in the appropriate

space.

OFFICERS to sign the report:

Country: ^{South Sudan}

National Coordinator ^{Name: Dr Samson Paul Baba}

Signature: .9 2q:g

Date: ...

^rt

Zonal Oncho Coordinator Name: Chol Manyiel

Signature, @;,1

Date: _Oe /o{( l*d

NGDO Representative Name: Fasil Chane Signature:

Date:

^.

Od

rhis reporl has been prepared bv Name;:tXX1ffIi'k"YrHYffii,

:t"ilf,:?woilx

Date.ad,/ahna

I

Table of contents

ACRONYMSVI

DEFINITIONS VII

FOLLOW

UP

ON TCC RECOMMENDATIONS EXECUTIVE SI.JMMARY

2

SECTION

¹ :

BACKGROL]ND INFORMATION

1.I. ^Gexener

INFORMATION

1.1.1

Description of the

project

(briefly)..

1.1.2.

Partnership

t.2

Popur-enoN

SECTION 2: IMPLEMENTATION OF CDTI

8 2.1.

Tnmlu.re

oF ACTryITIES

2.2

Apvocecv

Treatment

fi

gures ...

Wat

are the causes of absenteeism? ...

Wat

are the reasons

for

refusa\s7...

EquntvmNr.

Fnlaxclat-

CoNTRIBUTIoNS oF THE PARTNERS AND COMMUNITIES..

Orrmn FoRMS oF CoMMUNITY SUPPoRT ...

I

3

J 3 4 6

...8 ....10

2,3. Mosn-zRuoN,

SENSITzATIoN AND HEALTH EDUCATION OF AT RISK COMMUTTITMS IO

2.4. CorwrrrNrry Iln/oLvEMENT...

^...12

2.5

Cepecrrv

BUrLDrNG...

t3

2.6 TnrammNTS... .... 15

2.6.4 ^Briefly

describe

all

known and verifted serious adverse events (SAEs)

that...

19 2.6.5. Trend of treatment achievement

from

^CDTI

^project

^{inception to the current}

year2l

2.7

, Onpgnnlc,

SToRAGE AND DELryERY OF WERMECTIN 22

2.8. Corwrulrrry

sELF-MoNrroRING

euo

SrexruoLDERS

Mrrrwc ^'))

....23

2.9.

SweRvrsroN...

2.6.1 2.6.2 2.6.3

2.9.I.

2.9.2.

2.9.3.

2.9.4.

2.9.5.

2.9.6.

15

t9

19

24 26 26 26 Provide a

flow

^chart of supervision

hierarchy...

... 23 What were the main issues identified during supervision? ...24 Was a supervision checklist

used?

...24 What were the outcomes at each level of CDTI implementation supervision? 24 Was feedback given to ^the person or groups supervised?... 24 How was the feedback used to improve the overall performance of the project?

24

SECTION

3:

SIIPPORT TO CDTI

²⁴

3.1 3.2

3.3

3.4.

E><prxoruRs ^pER

AcTrvrry

...

SECTION

4:

SUSTAINABILITY OF CDTI

²⁷

4.L

^INreRNeU TNDEpENDENT pARTrcrpAToRy MoNrroRrNc;

EvaruerroN...

27

4.1.1

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

following

which are

applicable)...

... 27

4.1.2.

^What were the recommendations? 27

IV

WHO/APOC, 24 November 2004

4.2.1. Planning at

all

relevant levels..

4.2.2.

^Funds

...28 4.2.3

4.2.4,

Transp o

rt

⁽ repl ac ement and maint enanc ^e ₎ ...

Other resources

..'.'...,.,28 .'.,.,.,..,28

28

4.2.5.

^{To what} extent has the

plan

been implemented 28

4.3.

Ix-recnRrroN ...

4.3.1.

Ivermectin delivery mechanisms...

Eruor!

Bookmark not defined.

4.3.2. Training...

^...

^Enor!

Bookmark not defined.

4.3.3.

^Joint supervision and monitoring with other

programs....Eruor!

Bookmark

not

defined.

4.3.4.

^Release of funds

for

^project

activities ^Error!

Bookmark not defined.

4.3.5.

^{Is CDTI included in the PHC} budget? ...

Etor!

Bookmark not deft,ned.

4.3.6.

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

Wat

have been the achievements?...

Error!

Bookmark not defined.

4.3.7.

Describe others issues considered in the integration of

CDTI. ^Error!

Bookmark not defined.

4.4. OpBnerroNAL RESEARCH ... 29

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.

... 29

4.4.2.

^How were the results applied in the

project?....

...29

SECTION

^5:

STRENGTHS, WEAKNESSES, CHALLENGES, AND

OPPORTI.JNITIES

29

SECTION 6: LINIQIIE FEATURES

OF

THE PROJECT/OTHER MATTERS

³⁰

,,.'.,,28

WHO/APOC, 24 November 2OO4

Acronyms/Abbreviations

African Programme for Onchocerciasis Control Annual Treatment Objective

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

Community-Directed Treatment with Ivermectin County Health ^Department

Community Health Workers County OV ^Supervisor

Comprehensive Peace Agreement Community Self-Monitoring Local Government Area Ministry of Health

Non-Governmental Development Organization Non-Governmental Organization

National Onchocerciasis Task Force Proj ect Coordination Offi cer Primary health care

Payam OV Supervisor

Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event

Stakeholders meeting Secretariat of Health

South Sudan Oncho Task Force

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

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

ATO ATrO CBO CBM CDD CDTI CI{D CIIWs COS CPA CSM LGA MoH NGDO NGO NOTF PCO PHC POS REMO SAE SHM SOH SSOTF TCC TOT UNICEF UTG

wHo

v1

WHO/APOC, 24 Novembet 2OO4

Definitions

(i) Total population: the total population

living in

meso/hyper-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 Obiective:

(ATO):

the estimated number

of

persons

living

in meso/hyper-endemic areas that a CDTI project intends to

feat

with ivermectin in a

given year.

(iv)

Ultimate Treatment Goal (UTG): calculated as the maximum number of people to

be

treated

annually in

meso/hyper

endemic

areas

within the project

area,

ultimately

to be reached when the project has reached

full

geographic coverage (normally _the project should be expected to reach the

UTG

at the end

of

the 3'd

year of the project).

(v) Therapeutic coverage: number

of

people treated

in a

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

(vi)

Geographical coverage: number

of

communities treated

in

a given year over the total number

of

meso/ttyper-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 corlmunities

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.

vll

WHO/APOC, 24 Novemb er 2OO4

FOLLOW UP ON TCC RECOMMENDATIONS.

Using the table below,

fill in

the recommendations of the last TCC on the project and describe how they have been addressed.

TCC

session

(Please add more rows

if

necessary)

I

Number

of

Recommendation in the Repon

TCC

RECOMMENDATIONS

ACTIONS TAKEN BY THE PROIECT

FOR TCC4APOC MGT USE ONLY

WHO/APOC, 24 November 2004

Executive Summary

This

is the report

of CDTI

activities implemented by East Bahr

El

Ghazal

CDTI

project, Southern Sudan

from

January

to

December 2007.

The

project

is in its third

year

of

APOC

funding

^phase.

The project is also being

supported

by CBM, an International

NGDO coordinating

CDTI

in collaboration

with

Southern Sudan Onchocerciasis Task Force.

The project has a

total

population

of

972,285 persons,

UTG of

778,920 persons and ^an

ATO of

428,406 persons

during

the reporting period.

It is

made

up of

three states namely Lakes, Warrap and West Equatoria

with

a total

of

four counties and 1001 communities. Some

of

these counties are

joined

together and the community

figure

was not comprehensive. Data

on the

number

of

health

staff involved in CDTI

shows that

only

278(28.37o) persons were involved in

CDTI

activities out of 983 available health staff in the project areas.

On treatment,

only

635 communities were treated and thus

giving

a geographic coverage

of

63.4Vo.

A total of

469,737 persons received mectizan treatment

during

the period under

review. This

treatment

figure

represented a therapeutic coverage,

UTG

coverage and

ATO

coverage

of

50.77o, 60.37o and 92.8Vo respectively

in

^{2007 .}

Population movements are very common in the project area as they are potentially nomads and farmers. This accounted

for

high level

of

absenteeism experienced by the project although actual figures were

not

available

in

the report.

Influx of

returnees is continuing

in

the project and thus creates imbalance in the total population.

On

training,784(7l.3Vo) CDDs

(659 males and 125 females) were trained

out of

annual

training objective of

1100.

The population/CDD trained

was

in a ratio of 1CDD to

1183 population. The number

of

payam supervisors/health

staff

was 79(657o)

out of

120 targeted persons.

Major

challenges

in

the project during the reporting period include the

following.

(1) low level of ^available

knowledgeable

manpower in the project

area.

The

project

intensified efforts to get more CDDs,

^payam supervisors and

county

supervisors and even health workers and also encouraged them

to

remain

in,the project; (2) high attrition

rate

of

CDDs at community level.

This

matter was discussed

with

community members and some

of

those that resigned have been replaced; (3) non integration

of

the

prqect

and non absorption

of CDTI

staff

into

the

ministry of

health.

This

was one issue confronting the project and the project has

tried to

discuss

with

the minister

of

Lakes state ministJy

of

health

on this. It

is

hoped that some staff will be

absorbed

in 2008; (4) intensifying health

education and community mobilization. This was used to defuse beliefs on the mectizan and thus reduce the number

of

refusals

and the project

has planned

to

strengthen

this activity next year;

(5)

identifying

various cattle camps and treatigg the cattle itinerant workers there

with

mectizan.

The project tried to identify

various cattle camp locations

but

due

to

rains/floods and fuel problem

not

much was done

but all

the county supervisors have been

told to

include

this

in

their plan next year to reduce missed treatment among these cattle nomadic; (6)

non

availability

of community data base collection. The project was not able to compile this to due the situation

in

the project areas and

is

on the

top

agenda

in

2008;

(6) ratio of CDD to

total population

in

the

project is still high. More CDDs

were trained

in

2007 than

in

2006. The project made

effort to train

more CDDs

but

many

CDDs

needed

to

be trained and

this

^has been put

in

2008 plan; and

finally

(7) community census registration is a

still

a problem

in

the project. Many returnees affected the whole plan as you need

to

go back several times and the project

will

intensify on this

activity

next year.

2

WHO/APOC, 24 November 2OO4

SECTION ^1: Background information 1.1.

^General

information

1.1.1 Description of

the

project (briefly)

G e o g raphic al locat io n, to po g rap hy, climate

P opulation : act iv itie s, c ultures, language Communication systems ⁽ roads... ) Administ rat ion st ructure

Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available _).

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

Ge o

graphical

lo c atio n, top o graphy, climale

The East Bahr

el

Ghazal

CDTI

project is located on the latitude

of

6.80961o and longitude

of

29.67870". The project has an altitude

of

424m above Sea level.

The

East

Bahr el

Ghazal

CDTI

^project

office is

based

in the

State

Ministry of Health

and sharing the same block

with

SSOTF secretariat. The project is made up

of

three states, namely Lakes, Warrap and West Equatoria.

It is

bounded

on

the

North by Unity

and Warrap states,

on

the South

by

West and Central Equatoria states, on the East by Jonglei and on the West by West Bahr el Ghazal state.

The topography

of

the project area is made up

of

Sudan savanna and Guinea savannah to the west and

flood

region

to

the eastern part.

In

the western part

of

East Bah

El

Ghazal, the soil type

is

a basement complex resting on

iron

stone plateau.

In

the western part

of

East Bahr El Ghazal, the soil type is made up of superficial clay.

Rainfall

ranges

from

750mm

-

^1200mm. The climate varies

from wet

monsoon

to

medium wet monsoon in the west and dry monsoon to long dry monsoon.

Population : activitie s, culture s, language

The project has an estimated population

of

1r729r275

with

at-

risk

total population

of

927,28s (53.627o)

for

onchocerciasis infection.

This

increase

in

figure was as a result

of

the returnees

from

the neighboring countries. The National census

in

2008

will

^provide a clear picture

of

the population figure.

The dominant ethnic group are the

Dinka

who are agro- pastoralists whereas the

minority

Jur

Bel are agriculturalists. But through

socioeconomic

interactions, the communities

have gradually begun to exert influences on one another.

Languages spoken are

Dinka Agar

^(the

majority), Jur Bel,

Bongo, Juba

Arabic (written

in English alphabets). English

is

spoken as the

official

language.

Kiswahili

is

now

also spoken mainly my returnees, refugees and the traders.

Communication system

(road...)

Roads

in

the project area have been graded and this has resulted to considerable improvement

in

accessibility

to

hitherto

difficult- to-

reach places. There

is

also

now

accessible road

from

the project to northwestern Uganda and West Equatoria.

Air

movement

is available in the project

area.

There are WFP and other private

flights available in the project area which connects Nairobi, Lokichogio in Kenya and Juba.

aJ

WHO/APOC, 24 November 2004

Administratio n structure

The

administrative structure

of the

East

Bahr El

Ghazal State

follows the

Government

of

South Sudan

structures. The

States

form

the

first level of

administration

followed by

the

Counties,

Payams

and Bomas.

States

are

administered

through

Governors,

Counties

by County Commissioners, and payams by Payam administrators, and Bomas by Boma councils.

The project

has

4

counties,

which

are used

as

supervision centers

but

there

is a plan

to increase the number to

five in

very near future for better coverage.

Health

system

& ^health

^care

^delivery

@rovide

the number of health

posts/centers

in

the project _area

if

the

information

is available).

The project has a total

of

115 health

facilities

which composed

of

77 PHCUs, 32 PHCCs, and

5 rural

hospitals and one state hospital. The

five

rural hospitals are situated

in

Billing, Adior, Mapourdit,

Yirol

and Bungagok while the state hospital is based in Rumbek, the capital

of

Lakes state.

The rural

and state hospitals are referral centers

for

PHCCs. The Primary Health care system is gradually developing but

still

experiencing shortage of qualified manpower.

Number of health staff in project

area and

number of health staff involved in CDTI activities.

In the project area, there are ^a total of 983 health staff, of which 278(28.37o) were involved in

CDTI

as shown

in

the Table below.

Table

l:

Number

of

health staff involved in

CDTI

(Please add more rows

if

necessary)

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 Br

Percentage

B.=Brl B, ^*100

YIROL/AWERIAL 219 86 24.6Vo

RUMBEIgCUEIBET 448 100 22.3Vo

TONJ 276 56 20.3Vo

MVOLO 40 36 9l.0Vo

TOTAL 983 278 28.3

There was an increase

in

the number of health facilities, number of health staff as

well

as

number of health staff involved

in CDTI

in East Bahr

el

Ghazal project

in

2007 when compared to 2006 figures.

1.1.2. Partnership

Indicate lhe partners involved in project implementation at all levels IMoH, NGDOs (nationnUinternational), communities, local o rganizations, 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 plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation.

Indicate

the partners involved in project implementation al

all

levels

(MoH,

NGDOs -

n atio

nal,

int e rnatio

nal)

4

WHO/APOC, 24 November 2004

The

partners

involved in CDTI activities in the project

area are

the communities

^(1,001 villages

for now in 5

counties), health services especially

at the county

and health

facility

levels though

partially, NGDO - ^CBM

^and APOC/WHO. The

NGO -

Norwegian Red Cross

(NRC) which is

assisting

Yirol

County

in training of CDTI

staff

including

CDDs as

well

as

supervision and distribution.

Describe

overall working relationship

among

partners, clearly indicating

specific areas

of

project

activities

(planning,

supervision, advocacy,

mobilization,

etc) where

all partners

are involved.

The overall

working

relationship among partners

is

very cordial as

all work

towards ensuring that ivermectin gets

to

communities and that the affected communities select

their own

drug

distributors. Before the

commencement

of mectizan distribution, partners engaged

in

planning,

advocacy

and mobilization. And while distribution of mectizan is

underway, supervisory

visits

are carried out by partners to ensure success

of

the entire project activities.

At

the end, a review meeting is organized to assess activities and then

identify

areas that need improvement.

State plans if any to mobilize the state/region/district/LGA

decision-rnakers, NGDOs, NGOs, CBOs,

to

assist

in CDTI

implementation.

The project intends to

visit

the three ministries of health

officials

such as ministers of health, Director-Generals and public health directors in lakes, Warrap and

[est

^{Equatoria states}

^for

inclusion of

CDTI

staff in the various ministries of health and also begin talks on

full CDTI

integration into the health services. This integration and absorption

will

provide an enabling environment for effective

CDTI

implementation. The commissioners of health in the

five

counties

will

be approached and

mobilizedfor

support to

QDTI

activities

in

various counties, payams and bomas especially directing their communities to provide any kind of motivations to CDDs. The supporting NGDO

- ^{CBM will still}

be requested to continue its assistance to the project. More Local NGOs

will

be contacted to assist especially the Norwegian Red Cross that is known to be assisting

Yirol

County may be asked to expand her support to other counties

in

the project area. Also, the Sudan Relief and Rehabilitation Commission

will

be contacted and involved

in

assisting

CDTI

implementation.

5

WHO/APOC, 24 November 2OO4

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SECTION 2: Implementation of CDTI

2.1. Timeline of activities

Fill in table 3, timeline of activities for ^{areas teated} in current year, indicating when the key activities were implemented by lhe month they began and the month they ended.

8

WHO/APOC, 24 November 2004

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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.

N umb e

r

of p e r s on s mo b ili ^z.e d/ r e a s o n s fo r adv o c ac:t

/

o ut c o me s

The project

conducted advocacy

at

state,

county

and

community

levels.

At the

state level,

minister

and

DG

were updated

on the CDTI

progress and integration

of CDTI

as

well

as

motivation of

CDDs.

They

encouraged the project coordinating

officer to

ensure

that

good coverage is achieved and promised to integrate

CDTI

at the appropriate time

in

future.

At County level, 4

commissioners were

visited to solicit provision of

^security

during

the

training of CDDs at different

venues

of the project

areas.

They

agreed

and

promised to provide policemen during the training

of

CDDs. However,

all

the trainings were later shifted very close to police stations

for

security.

At community level,

some payam administrators/community leaders

were

approached and requested

to talk

to

their

people so that they would not refuse mectizan and to provide a sort

of

incentives

to CDDs. Community

leaders assure them

that would try

and convince their people

to

accept mectizan.

This

led

to

reduced number

of

persons who refused treatment in the project.

D

iffi

cult ie s/c onst raint s b ein g fac ^e

d

r

Not providing the salary to

CDTI

staff and non integration of

CDTI

into

CDTI

t

_{Large areas to cover in the face} of fueling problem of the project vehicle

r

_{Repeated visits} and this exerts on project vehicle

.

_Security

risk visiting

some areas

r

_{Community members not providing} incentives

for

CDDs

on on how to

r

_{Adequate fund}

_for

vehicle fueling as project covers three states and they are far apart.

' ^{Providing a kind of T-shirts or face}

^caps

^or

^calendars

^{to policy makers}

^during

advocacy visit.

.

Displaying the current

CDTI

report

of

the project to

policy

makers

for

them to see the gaps.

2.3. Mobilization,

sensitization and

health

education

of at risk communities

P rov ide info rmation on:

-

^The use of media and/or other local systems to disseminate idormation

-

Mobilization and health education of communities including women and minorities

-

Response of target communities/villages

-

Accomplishments

-

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

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

infonnation

The project used its

based

radio in Rumbek to

communicate

to county and

payam supervisors

for

collection

of

their mectizan allocation

in

Rumbek and

in

different counties respectively as

well

as other information pertaining to training.

Also

the project made use

of

Radio

FM in

lakes state

to invite county

supervisors

in

one

of their

meetings. The methods

used were home visits to the communities and focus group

discussions in villages, health centers, prayer places, and market gathering.

Types of

IEC

materials used

l0

WHO/APOC, 24 Novemb er 2004

The only IEC

materials used

during

the reporting period

by

the

project

were laminated posters, flipcharts and T-shirts.

Mobilization

and health education of communitics

including

women and

minorifies This

was carried out

in

the project before mectizan distribution to create awareness about

the mectizan. Community

leaders

were

contacted

to

arrange

for the meeting with

community members

which

comprised men and women

including

the

blind

people. Key messages were the cause

of

onchocerciasis, symptoms,

who

should

not

take mectizan as

well

as

the

dosages and possible side effects after

taking the

drugs

by individuals with

heavy

infection.

Such meetings were organized

in all

the counties

in

the project area. In some areas

women

attendance surpassed

that of men

especially

at Mvolo and Yirol

counties.

Re s p o ns e of targ et c ommunifie ^s /village ^s

A lot of

people participated

in

receiving the mectizan tablets to the extent that the entire drugs allocated were

all

used and no unused drug was returned. Even those who refused in the previous year received treatment.

Accomplishments

.

There was higher therapeutic coverage than

in

2006.

.

_{Reduced number of} refusals than

in

previous years.

.

More communities selected CDDs than before.

.

There were more female CDDs than in the previous year.

Suggest ways to improve

mobilkation

of the target communitics.

o

More women should be encouraged to involve

in

mectizan distribution as CDDs.

o

Communities should be made to own the project to ensure their

full

participation.

o

There

is

need

for

more health education sessions

in

the communities

particularly for

the returnees.

o

More Information, Education and communication (IEC) materials be made available to the target communities. These materials include T-shirts, face caps, posters and handbills.

11

WHO/APOC, 24 November 2004

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2.5. ^{Capacity building}

Describe the adequacy of available knowledgeable manpower at

all

levels,

The project

still

lacks adequate available knowledgeable manpower at

all

levels. Most cogent reason

being non

payment

of

^salary

by the

government as

the current top

ups

could

not sustain them.

At

the state level, the project lacks secretary and assistance finance officer.

At

the county

level,

there was

no

supervisor

for Yirol

County.

At

health

facility level,

very

few health facility staff were available except community health workers and

payam supervisors.

At community level, the number of

available Knowledgeable

CDDs was very poor

due incessant attrition occasioned by zero motivation and high

illiteracy

rate.

Where

frequent

transfers of

trained

staff occur, state what the

project

is doing,

or

intends to do,

to

remedy

the situation. (The

most

impofiant

issue

to

describe

is what

measures were

taken to ensure adequate CDTI implementation where not enough

knowledgeable

manpower

was

available or if staffs

are

frequently transferred during the

course

of

the campaign).

No transfer

of

staff rather they resigned and joined

UN

agencies and NGOs

for

greener pastures.

The measures taken to overcome the situation were that PCO conducted training of payam supervisors in

Yirol

County and supervised the training of CDDs by payam supervisors ^at payam level.

More new CDDs selected by communities were trained but high level

illiteracy

among them was a major.

It will

take the project a long time to have sustainable CDDs.

t3

WHO/APOC, 24 November 2003

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