ARKANGELO ALI ASSOCIATION-AAA GLOBAL FUND TB ANNUAL REPORT 2016

Transcription

1 ARKANGELO ALI ASSOCIATION-AAA South Sudan GLOBAL FUND TB ANNUAL REPORT 2016

2 Grant TB NFM SR Name Arkangelo Ali Aociation Report for implementation period: 01/01/2016 to 31/12/2016 Fund Allocated TB NFM US Dollar 926, Fund Utilized TB NFM US Dollar 896, Project Area The project i operational in former Fifteen (15) countie, upporting 39 TBMU and located in five different former State in the Republic of South Sudan, namely: Northern Bahr el Ghazal State Aweil town (Aweil Centre County) Gordhim (Aweil Eat County) Nyamlell (Aweil Wet County) Gok Machar(Aweil North county) Panthou( Aweil South county) Wetern Bahr el Ghazal tate Wau ( Wau county) Lake State 2

3 Bunagok (Awerial County Adior ( Yirol Eat County) Yirol (Yirol Wet County Agangrial ( Cueibet county) Wetern Equatoria State Tambura (Tambura County) Warrap State Kuacjok (Gogrial Wet County) Marial Lou( Tonj North County) Tonj, ( Tonj South county) Lounyaker( Gogrial eat county) Contact peron Mr.Natalina Sala Project Adminitrator/Director Dr Callixte Minani Project Manager (TB Coordinator) ACKNOWLEDGEMENT The TB care and prevention programme achievement have been realized becaue of the financial upport and aitance from the Global Fund-GF, and implementation collaboration with the UNDP and the Minitry of Health ROSS, pecifically the National TB, Leproy and Buruli Ulcer Control Program. Arkangelo Ali Aociation (AAA) would alo like to extend incere gratitude to individual and agencie who have contributed toward the attainment of target for the program. Special thank go to the County Health Department in all the AAA area of operation, the Non-governmental organization upporting Primary Health Care activitie and the AAA dedicated member of taff who have been providing eential ervice to diagnoe and initiate TB treatment promptly. Without their crucial upport and commitment, many more live could have been lot. 3

4 ACRONYMS AAA CBO CCM CoS CTB DOTS DOTS GF HHP MDR-TB M&E NFM NTP PHC PHCC RSS TB UNDP Arkangelo Ali Aociation Community Baed Organiation Continuity of ervice Community Baed DOTS Directly Oberved Therapy Short coure Global Fund Home health promoter Multi Drug Reitant Tuberculoi Monitoring and Evaluation New Funding Model National TB Programme Primary Health Care Primary Health Care Centre Republic of South Sudan Tuberculoi United Nation Development Programme 4

5 TABLE OF CONTENTS Executive Summary 6 CHAPTER Background Overall project goal and pecial grant agreement 1.3 Strategie 1.4 Reult.. CHAPTER 2. Current project management arrangement CHAPTER 3. Succee and achievement CHAPTER 4. Challenge and Bottleneck CHAPTER 5. Bet practice 25 CHAPTER 6. Recommendation ANNEXES TB Program activitie in

6 EXECUTIVE SUMMARY The Global Fund TB NFM Grant focue on maintaining the TBHIV ervice in the exiting TB diagnotic and treatment center by puruing high quality DOTS expanion, addreing challenge related to multidrug-reitant TB (MDR TB) and trengthening the national management capacity by etablihing a National TB care and prevention department in the Minitry of Health in the Republic of South Sudan. All thee are aimed toward the reduction of mortality and morbidity caued by both dieae. Thi alo remain a major focu of Arkangelo Ali Aociation (AAA) TB care and prevention Program. All intervention are baed on the revied NSP that identified gap and defined appropriate trategie and ha already been operationalized operational. The program follow the Global Fund performance baed funding where pecific indicator are ued to monitor progre on quarterly bai. During the current reporting period, AAA met mot of it et target a hown in the table 1.4. The trategie applied to meet the project goal include; on Job training of laboratory aitant, training of health worker in all Primary Health Care and trengthening of the PHCC to be able to offer TB DOT ervice o a to carry out putum microcopy with an aim of increaing cae finding and promptly initiating them on treatment with upervied DOT. AAA provided TA to the TB officer and the CHD taff on upportive uperviion and monitoring of programme activitie, treamlining and trengthening the logitic management information ytem (LMIS) and forecating and quantification including the drug ordering ytem, maintaining minimum-maximum (min-max) level and inventory maintenance. AAA ha a team of dedicated taff for TB intervention program with clear term of reference and function. The organizational tructure i hown in the organogram below. All the TB cae regitered for treatment in 2016 are 3693 (with 60% of bacteriological confirmed TB). AAA developed operational guideline for Home Health Promoter and State TB coordinator to enable them have definite reponibilitie and role at their different level of work. 6

7 CHAPTER 1: INTRODUCTION 1. 1 BACKGROUND Arkangelo Ali Aociation (AAA) tarted a an indigenou South Sudanee Non Governmental Organization (NGO) founded in November 2006 and regitered under Relief and Rehabilitation Commiion and the Minitry of Legal Affair and Contitutional Development. AAA wa upgraded to International NGO on 27 th January 2012 by the chief Regitrar, Minitry of Jutice following ucceful TB program collaboration and implementation in South Sudan (SSD). Internationally, AAA i a founder member of the Bakhita Conortium along with 7 other Italian organization, Kenyan and South Sudanee NGO/Aociation that work for the development of South Sudan. The miion of AAA i to uplift dignity of diadvantaged people through proviion of ocial ervice with repect of tranparency, quality, equity, availability and acceibility with a viion of a community that believe in repect for human dignity. AAA ha a Regional office in Nairobi, Kenya under the umbrella of Verona Father (Comboni Miionarie Kenya Province) and a country Office in Juba, South Sudan. In 2016 AAA implemented TB prevention, care and treatment in 13 health facilitie(tbmu) and 26 atellite laboratorie that are either diagnotic ite or double a diagnotic and DOT and are pread acro 15 countie and five out of the ten State of South Sudan. The project target a population etimated at 2,577,000 according to the projected 2008 cenu reult factoring in a growth rate of 3% per annum. The Global Fund NFM aim to maintain the exiting TB diagnotic and treatment center by puruing high quality DOTS expanion and enhancement, addreing challenge related to multidrug-reitant TB and trengthening the national management capacity by etablihing a national TB care and prevention department in the Minitry of Health of South Sudan. All thee are aimed toward the reduction of mortality and morbidity caued by TB. The implementation of the TB care and prevention intervention i carried out at variou level within the AAA organizational tructure, right from the headquarter to the health facilitie a hown in the organogram below. 7

8 AAA Organization Structure for TB care and prevention Program Project Manager (TB Coordinator) Project Adminitrator//Direct or Project Accountant Monitoring and Evaluation Officer Field Supervior Logitic/Procuremen t Officer HR/Finance Officer Mobile Cahier TB Unit Officer Field Logitic Officer Field Lab Tech/Nure/Matron Field TB Staff 1. 2: OVERALL PROJECT GOAL AND SPECIAL GRANT AGREEMENT The overall goal for thi Global Fund upported TB project i to reduce mortality and morbidity caued by TB dieae and the prevention of multidrug-reitant TB (MDR-TB) by Expanding and Enhancing Quality TB Prevention, Care and Control in South Sudan. However, TB TFM/NFM Grant mainly focu on the diagnoi of TB through microcopy that reult in mear poitive cae, offering tandardized treatment to all diagnoed TB patient, giving patient upport and trengthening the patient charter by educating 8

9 them on right and reponibilitie following TB diagnoi and the full TB treatment duration, trengthening drug management a part of logitic management information ytem, improving monitoring and evaluation through capacity building and technical aitance a a comprehenive package of human reource development, prevention and controlling Multi-Drug reitant TB (MDR)-TB and trengthening the national TB care and prevention department in the Minitry of Health. The Firt Global Fund Grant Agreement igned for NFM TB Grant between AAA and UNDP wa igned with the United National Development Programme (UNDP) on 09/09/2015. Thereafter, a Second Amendment No.1 of the Firt Signed Global Fund Grant Agreement wa igned on 11/04/2016. The overall NFM Grant will be implemented between 01 t July 2015 to 31 t December : STRATEGIES AND IMPLEMENTATION DURING THE REPORTING PERIOD The TB NFM Grant had a pecific focu which required development of pecific trategie to meet it overall goal. The trategie employed by AAA in collaboration with the PR (UNDP) and the NTP during the reporting period o a to maintain the ervice and achieve deired reult include: Training of the health worker and Home Health promoter on TB management, care and creening of TB among PLHIV. Training of TB Officer and Health worker in TBMU by a Conultant on TB o a to be a ToT for for capacity building the low cadre in their repective health facilitie. Joint Supportive uperviion and monitoring of programme activitie by AAA TB coordinator, M&E officer, the NTP and the PR for on-ite training and data management and validation. Streamlining the drug ordering ytem and inventory to trengthen the LMIS. Health education in the community and mobilization to increae awarene and create elf-agency and demand for TB-DOTS ervice. Thi included chool health, ma media, community theatre and utilizing HHP to educate the community in adminitrator meeting, market, local community court and other organized gathering. Increaing availability and acce to TB DOT ervice by complementing paive TB cae finding through facility baed ervice with active TB cae finding through mobile outreach activitie and incorporating TB care and prevention activitie into the PHC ytem through collaboration with county and tate health ervice in the PHCC. 9

10 Renovation of ome tructure like TB ward,lab o a to create more cro window ventilation for infection control, patient kitchen and in-patient toilet etc in the exiting TBMU. TB enitization in congregate etting like prion, military barrack, police cell, cattle camp, chool, churche and returnee/idp camp. Utilizing HHP for door to door education and creening of contact of mear poitive TB patient and contact of children under 5 year on TB treatment. TB creening among PLHIV in HIV care ite during medicine refill and pychoocial upport group meeting. Community TB-DOT and promotion of treatment adherence through TB treatment upporter and TB club meeting. Monthly feedback meeting were conducted for TB education to patient, continuou couneling and experience haring aimed at promoting treatment adherence. Collaboration with WFP provided food upplement and ration that were ditributed during thee feedback meeting and medicine refill. Continued creation awarene of TB through dramatization by theatre performance by artitic group. Engagement of Ma Media (Radio FM tation) to create awarene in the community a regard TB and availability of ervice. Continued ditribution of IEC material to HW and HHP together with imperative like umbrella, mud boot and bicycle to eae reaching the communitie during rainy eaon. Early retrieval of peron interrupting TB treatment and thoe lot to follow up, through the etablihment of TB club and the involvement of TB ambaador a well a the HHP. The lit of treatment interrupter wa generated and ditributed for tracing during the feedback meeting. AAA developed a TB agenda (Diary for tracing contact of SS+/children under 5 year on TB treatment and TB patient interrupting treatment) for both TB officer and the HHP. The tracing outcome were updated in the TBMU regiter during feedback meeting. TB creening among patient admitted in ward and afe referral of putum to laboratory for microcopy and relaying of reult back to patient for treatment initiation within 48 hour. Support for the EQA ampling and tranportation from the peripheral laboratorie to the Central Reference Laboratory (CRL) in Juba and proviion of feedback by the focal laboratory taff in the Central Reference laboratory to peripheral laboratorie taff with the ole aim of high quality and reliable TB diagnoi. The new WHO pot-2015 global TB trategy, endored in May 2014 by the World Health Aembly (WHA), include the target of a 95% reduction in TB mortality by 2035 worldwide (compared with 2015 level) and a 90% reduction in TB incidence (compared with 2015 level). Thee reduction will require novel tool for TB control allowing quicker and better diagnoi, treatment and prevention, with imultaneou effort to optimize the ue of exiting technologie for TB prevention, diagnoi and treatment 10

11 globally. In thi regard AAA continued to provide p on ue of algorithm to diagnoe clinical TB, utilization of TB creening tool and prompt referral for diagnoi and treatment initiation and promotion of adherence. Due to the limited utilization of GeneXpert machine only available in Juba for molecular diagnoi of TB, AAA continued to provide upport of peripheral laboratorie and clinician to ubmit pecimen from claified patient of retreatment cae and HIV poitive-tb co-infected patient for DST and culture a active urveillance for MDR TB in South Sudan 1. 4 RESULTS a. Programmatic TB NFM Year 2 Indicator Reporting Period Target Reult % Achievement Number of notified cae of bacteriologically confirmed TB, new and relape Number of notified cae of all form of TBbacteriologically confirmed plu clinically diagnoed, new and relape Percentage of TB cae, all form, bacteriologically confirmed plu clinically diagnoed, uccefully treated(cured plu treatment completed)among all new TB cae regitered for treatment during a Pleae include reporting period for indicator which are cumulative annually January- December January- December January - December % % 82% 2977/3292(90%) 110% 11

12 pecified period Percentage of bacteriologically confirmed TB cae uccefully treated (cured plu completed treatment) the bacteriologically confirmed TB cae regitered during a pecified period Percentage of laboratorie howing adequate performance in external quality aurance for mear microcopy among the total number of laboratorie that undertake mear microcopy during the reporting period. Percentage of TB patient who had an HIV tet reult recorded in the TB regiter Percentage of HIV poitive regitered TB patient given ART during TB treatment Percentage of HIV poitive patient who were creened for TB in HIV care or treatment etting Percentage of previouly treated TB patient January - December January - December January- December January - December January - December January - December 82% 1566/1766(89%) 109% 95% 75/75(100% ) EQA concordance of 97% 80% 3286/3693(89%) 111% 70% 149/267 (56%) 80% 50% % 99/187(53%) 106% 12

13 receiving DST(bacteriologically poitive only) Number of cae with drug reitant TB(RR-TB and /or MDR-TB )that began econd line treatment January - December Percentage of HMIS or routine reporting unit ubmitting timely report according to National guideline January - December 100% 39/39*100 (100%) 100% b. Financial-( Budget expenditure per activity) NFM Program Expenditure Amount in USD % Reaon for variance Opening balance in 1 t January , The balance b/f from 2015 for continuation of program activitie Approved budget from 1 t January 892, to 31 t December 2016 Actual diburement 1 t January 891, Diburement/fund received for 13

14 2016 to 31 t December 2016 implementing 1 t January 2016 to 31 t Dec 2016 Total expenditure 1 t January 2016 (896,395.36) to 31 t December 2016 Remaining balance end of 31 t December , The balance open to be carried forward to Q (1 t January to March 2017) Program area Section1:Programme Management Amount allocated in USD 1.1 Salarie-Programme Management 196, , % Planning and Adminitration 1.3 Planning and Adminitration (Ind Cot) 145, , % Amount expended in USD % Reaon for variance See NB on next page explaining the variance Overhead 62, , % Section 2: TB Care and Treatment 2.1 Salarie-TB Care and Treatment See NB on next page explaining 443, , % the variance 2.2 Training on TB Care and Treatment 44, , % NB: The negative variance under Cot Category Section 1 Programme Management related to HR i due to the wrong Budget Allocation by the PR at the beginning of the Program for both Cot Categorie Section 1 Programme Management (HR) and Section 2 TB Care and Prevention (HR). (The PR i aware of thi which wa never rectified including during the Signed Second Amendment) Thi negative variance came about afte0r the introduction of the New Reporting Format in Quarter 2/2016 (April, May, June 2016) by the PR, then wa removed in the Quarter 3/2016 (July, Augut, September 2016) by the PR (otherwie in the old Reporting Format up to March 2016 wa not appear). Thi variance under Cot Category Section 1 Programme Management (HR) i aborbed under Cot Category Section 2 TB Care and Prevention (HR). 14

15 Important i (a per reult during the dicuion with the PR and SR (AAA) at the Meeting in Nairobi end of September 2016) at the END of the Program in December 2017, the overall HR Section will be Zero between the Two Categorie. c. Procurement and upply Management In the year 2016 there wa no proviion allocated in the budget for procurement of Aet. Therefore no purchae were done. Supply Management for purchae of Dieel, Petrol and Spare Part for the Vehicle ued in the TB program: The Project Manager (TB Coordinator) ha the authority to analyze and approve work plan from different TB Unit o a to authorize together with the Project Adminitrator/Director the procurement of fuel and pare part a well a to check the Logbook and confirm if the uage i in tandem with the activity. CHAPTER 2: CURRENT PROJECT MANAGEMENT ARRANGEMENT Project Management The Global Fund TB NFM Grant i managed by a Project Manager (TB Coordinator). He ha the overall reponibilitie for all programme activitie and upport of the field taff. The Project Manager (TB Coordinator) i reponible for monitoring of the programme activitie to enure that they are in line with the et work plan, prioritizing the activitie for the field taff o a to achieve the et target, he i reponible for recruitment and retention of taff, capacity building, enuring that the programme need are met which may include; timely upply of drug, availing the right equipment and offering technical aitance whenever a need arie. The Coordinator overee the procurement of item and equipment a required and i alo reponible for forging alliance with other agencie involved in health care delivery in the area of integration of TB ervice in the PHCC ytem. The Project Manager (TB Coordinator) i the focal contact peron for the programme and i the link between the donor agency, the Minitry of Health, NTP and the programme. The Project Manager (TB Coordinator) enure proper management of drug upplied a all the field TB officer prepare the drug order uing a tandardized format which i ubmitted to the Project Manager (TB Coordinator) for verification and review. The Project Manager (TB Coordinator) then ubmit the order to the NTP, make follow-up to enure the drug are delivered and contact the field taff regarding delivery and quantitie. The inventorie from the field, conumption record etc are alo ubmitted 15

16 to the Project Manager (TB Coordinator). To enure mooth operation, there i a National Programme Officer baed at the Country office in Juba, the Programme Officer i reponible for all the follow up of programme iue in Juba through the Minitry of Health, NTP, UNDP and other partner. AAA ha a Project Adminitrator/Director reponible for all the fund of the project. The Project Adminitrator/Director in collaboration with the Project Manager (TB Coordinator) enure that the fund are utilized a per the work plan to meet the et target. Approval of the expenditure i done in conultation with the Project Manager (TB Coordinator), Project Adminitrator/Director. The Project Accountant with the Project Adminitrator/Director keep all the financial record and there i periodic audit which i carried out annually. The Regional TB Officer are reponible for all the activity fund dibured and there i a comprehenive accountability ytem in place which involve at leat two National taff to verify all the expenditure in conjunction with the Field Supervior. AAA operate a bank account pecifically for the TB grant a a way of increaing tranparency in the utilization of the fund. The AAA M&E officer in conjunction with the Project Manager (TB Coordinator) are reponible for all the data collection and reporting activitie, monitoring of the programme activitie to enure that it i in accordance with the et work plan, prioritizing the activitie a required, capacity building on M&E, verification, collation and analyi of data and ubmiion of the quarterly report. The TB unit officer alo perform variou M&E activitie uch a data verification, enuring that all taff undertand the data collection tool, compiling data from the facilitie and alo offer ome training to facility lower cadre taff on data collection and verification. Finance Management The Project Adminitrator/Director a the Head of the Finance/Procurement in conultation with the Project Manager (TB Coordinator) i charged with the analyi of all the field requet before the approval and releae of the fund for implementation of program activitie in the field. All financial record are maintained by the Project Adminitrator/Director in conjunction with the other Finance Department taff who are charged with proper follow up of grant fund and preparation of financial report. The AAA Field Supervior i in charge of monitoring that fund were ued in line with what they were approved for during hi field viit to all the TB Unit where he verifie the expenditure. The Project Manager (TB Coordinator) together with the M&E officer alo ait in verifying that approved activitie were actually implemented. For the HR Management the Project Manager (TB Coordinator) with the hel Regional/National TB Officer i reponible for recruitment and retention of the Staff. Job vacancie are advertied locally, the TB Officer have the mandate to elect 16

17 applicant for interview a well a interview the taff and hare all the document with the Project Manager (TB Coordinator) and Project Adminitrator/Director who approve. TB officer are obligated to evaluate the taff at the end of every contract period before their contract are renewed by the Project Manager (TB Coordinator). Each taff i required to ign the attendance heet on daily bai; the Home Health Promoter ign the attendance heet on monthly bai when they are ubmitting their monthly report. The document are hared with the Project Manager (TB Coordinator) and Project Adminitrator/Director for approval of the payment. TB Officer are alo required to ubmit the Salary Requiition a per their requirement. The HR Officer prepare the payroll which are approved by the Project Manager (TB Coordinator) and Project Adminitrator/Director. a) Training Management In the current grant, Training budget wa approved by GF and the Firt training tarted in July The Training are managed a follow: The Project Manager (TB Coordinator) inform the Training Facilitator on the Training to be done within the year. He get uggetion from them on the No. of attendant that may benefit in each training and why in order to factor in thee while working on the Training Schedule. During thi proce, the STBC and CHD) who are repreentative of the MOH in the county level) are alo involved a they are informed of the Training to be conducted hence they upport in the election of the participant. In ome cae, at the inception phae of the Training, an External ToT i hired to capacitate the TB Officer and other enior HW in the TBMU in order to empower them train low cadre. The Project Manager (TB Coordinator) end to the Technical team in the PR (UNDP) office the breakdown of the budget intended to be utilized within the year. The allocation of amount to be pent per Training are within the approved budget. Alongide the budget breakdown, the Project Manager (TB Coordinator) alo end the Training chedule. Thi document include the Type of Training to be conducted, The TBMU that will conduct the Training, The period of Training (not fixed a change in date may occur during the preparation), The No. of participant to attend the Training and the per diem each attendant will get. o -Per Diem deciion depend on the number of participant to be trained following the need of each TBMU. There i no official training cot per participant from PR/NTP becaue there are different kind of training with different approved budget. However, the rate etablihed for paying out in each training are alway within the range of AAA per diem policy. After preenting the document highlighted in 1 & 2 above, The Project Manager (TB Coordinator) prepare the Requiition for the Location where Training are to take place. The Requiition i accompanied by the Training Schedule 17

18 (which ha the Type of Training to be conducted, the period of Training, The No. of participant to attend the Training and the per diem each attendant) and the Intruction of how the Training hould be done and documented. The Intruction are dipatched earlier to the Facilitator for preparation. The Project Manager (TB Coordinator) preent the document in No.4 to the Project Adminitrator/Director for approval and authorization of the fund to conduct the Training. There follow up of how the Training are being conducted by the Facilitator. Thi include enuring involvement of the STBC and CHD in election of the attendant to be trained. The STBC and CHD are alo involved in the payment a they co-ign the attendance lit and payment heet for authentication. Once the Training are completed, the upport document are ent to the Project Manager (TB Coordinator) and the Project Adminitrator/Director who together with the Technical and elected finance team analyze and verify. The report are alo ent upon completion of each training. They are ent to The Project Manager (TB Coordinator) and M&E Officer for review. The Original copie of the document are retained in the H/O. The replica of all the document in No.9 are preented to The LFA through the PR (UNDP) Office. CHAPTER 3: SUCCESSES AND ACHIEVEMENTS The TB project ha managed to carry out the planned activitie within the time frame and budget limit provided. The project uccee were a a reult of having clear term of reference of the taff, proper delegation of the dutie from the head office to the field taff, having pecific taff reponible for certain activitie and continuou mentoring of the national taff on programme management. The project hierarchy i alo well etablihed a per the organogram hown on page 9 and interlinked with other department uch a procurement and logitic. In order to meet the objective of NFM Grant, AAA embarked on intenive CTB DOT activitie to enure improvement on cae detection and defaulter tracing. DOT upporter were further trained on way of curbing the rate of defaulter. The effort have tarted bearing fruit a AAA reported a defaulter rate of 3% at the end of The number of health facilitie implementing TB care and prevention activitie ha extended it ervice to pecial group uch a jailed peron, cattle keeper, returnee and the military. Other variou trategie were employed.thee include; training of taff on diagnoi, cae holding, treatment and management of TB patient, improving on the drug management through updating of inventorie/tock card, renovation of 18

19 tructure like lab, ward, kitchen and toilet to help ervice TB, intenified health education in the community, etablihment of Internal quality control ytem and ending out of putum mear lide for EQA, engaging a TB conultant to provide technical aitance to the field taff and increaing upport uperviion, creating community awarene, conducting TB club meeting and integrated feedback meeting, theatre/dramatized performance on TB, Continued awarene on TB, Control and Treatment through Radio airing program health education meeting and enitization of community opinion leader to olicit their upport and ditribution of IEC material were uccefully undertaken a upport activitie geared toward improvement of cae detection and treatment outcome. The project ha pecific indicator to meaure it ucce, thee indicator are ued to enure that project tay on track and program activitie are prioritized. During the TB NFM Grant the following key uccee were alo realized: Deliverable Target Achievement (%) Number of Health education beneficiarie 0 374,832 Number of peron with preumptive TB examined for 0 12,607 TB in the lab Number of TB patient diagnoed in the lab /1260(182%) Number of TB patient teted for HIV /3693*100(111%) Number of co-infected TB patient provided with CPT /240*100(62%) Sputum converion rate: 95% 1843/1998*100(92%) Number of upportive uperviion and p conducted to the TBMU 51 51/39*100(131%) The Kwajok HIV room wa rehabilitated and furnihed in order to improve TB/HIV collaboration at Kwajok hopital. The Akon laboratory wa contructed for improving putum microcopy ervice in the area. The patient toilet and kitchen were built for Wau TB department to improve hygiene in the hopital On the 28 th 30 th November 2016MoH-UNDP did a joint monitoring and evaluation of TB program for Wau. The general programme performance wa atifactory apart from the challenge of delayed upplie (TB drug and lab reagent) from NTP. On the 12 th 15 the December CCM Member viited Wau and Kwajok TBMU for having an inight of the TB program activitie being implemented by in by AAA. The team wa impreed by the TB activitie being implemented by AAA. The local authoritie and the 19

20 patient who were around by the time of viiting alo confirmed that AAA wa helping them a lot in term of ervice delivery. "On the 19 th to 20 th December, the CCM had a miion in Rumbek, Lake tate. AAA wa invited a the leading agency in TB ervice implementation. The aim of the viit to Rumbek wa to enitize the former Lake tate SMOH official that AAA wa to integrate TB HIV ervice in 6 new health facilitie in the former Greater Lake tate, uing the propoed NTP hifted fund " -21 Laboratory taff mentored/refreher trained on putum microcopy. 397 (341 male and 56 female) health worker trained on TB/HIV 79Integrated feedback back meeting conducted where all the HHP and health worker met and dicued challenge they faced and alo get lit of name of TB patient from the TBMU regiter who might have required immediate follow-up TB club/ambaador meeting were conducted to enure early retrieval of treatment interrupter which led to adherence hence improved treatment ucce rate among all patient regitered HHP were involved in the TB enitization and door to door creening of contact of mear poitive patient and children under 5 year on treatment quality aurance viit were made to the health facilitie in the periphery o a to mentor the health facility taff on how to deliver quality ervice to the community Record were alway verified and updated accordingly -12 community theatre performance conducted aorted IEC material with baic fact on TB ditributed in the community outreache/mobile lab conducted in remote and hard to reach area HHP involved in the TB contact invetigation hometead viited by HHP for contact invetigation people found at home during contact invetigation TB contact creened during contact invetigation TB contact found with TB ymptom putum ample from ymptomatic TB contact teted in the laboratorie - 91 TB contact confirmed with TB - 87 TB contact with confirmed TB initiated on treatment. Due to ome hortage of lab reagent that occurred in ome location, AAA managed to tep in by purchaing and ditributing lab reagent for thoe TB unit that had dire need. AAA provided a well a fridge to Wau TB department for toring DST ample from urrounding TBMU while waiting for tranportation to Juba CNL. In order to trengthen TB activitie and improve on the quality of the ervice rendered; uperviion activitie for p and on-ite training were carried out by the M&E officer, the Project Manager (TB Coordinator) and a TB Conultant to enure alignment 20

21 to the South Sudan NSP and programmatic and treatment guideline. All the TB were upervied during the year. The uperviory activitie included on-job training, aement of the project activitie, follow-u recommendation from the previou viit and dicuion on the practical way of meeting the et target and alo trategie to accelerate implementation during the dry eaon prior to the prolonged rainy eaon. Thee uperviory viit activitie were carried out uing an approved checklit. During the viit, on job training are conducted with emphai on proper data collection that encompae complete and accurate recording in the variou TBMU regiter, compiling quarterly data, verification of the data and the filing of all upport document required. A filing ytem wa introduced in all the TB center that enure all the programmatic and financial report are inter-linked to enure that the budget i utilized a planned and create a clear account of the expenditure. In concluion the programme taff made a lot of effort to achieve the et target in the year ending. Baed on thi experience, it i important to hire and train more HHP in the programme a they have proved that during the long rain eaon they are at hand to conduct door to door giving health education, creening of TB upect and then tranporting putum ample to the unit for microcopy. The involvement of the HHP in the programme ha been having a poitive impact on the overall programme performance a patient lot to follow up were traced back and re initiated on treatment. There i a need to allocate a budget line for the expanion of TB ervice into the hard to reach area. Regular training hould be offered to all programme taff on TB care and management, which will keep them abreat with the challenging TB world a they trive to offer quality ervice to the community Succe Storie TOPIC: I CAN NOW SMILE What i your name? My name i Abuk Rual Rual. I live in Mawut village, Mawut Payam. I don t know my age becaue I never went to chool. I am married with 7 children. When did the TB dieae tart? My on, I tarted coughing in 2015 but I never bothered to eek treatment becaue ince childhood I have never been injected. 21

22 What happened later? The cough continued, my elder on took me to Kuajok Nuring Home where I wa treated with light improvement. Later, i conulted one of the famou Spear Mater who treated me for 2 month, with no improvement. My huband old 2 cow and all the money wa pent without recovery. My condition worened, i lot weight, fever and coughing blood. Then? One of the village Dr came and aked me about my problem, I narrated my ickne and before I could finih my hitory he immediately gave me a white platic cup to cough putum into it. Later very early in the morning the very young man woke me up and requeted for another ample thi time 2 putum ample were collected from me, after 2 day I wa told to report to Luonyaker TB hopital for treatment.i wanted to refue ince many earlier Doctor had failed to treat my dieae. On arrival to the Hopital I wa told that I had TB dieae. I could not believe becaue I knew TB wa inborn and no one in our family ha ever been treated for TB before. I wa treated very well with tablet which changed the color of my urine. If I wa not warned about the color change, I would have topped treatment becaue I paed real blood which I got ued to later! Were you charged money during the period of treatment? To my urprie I wa not charged money until i completed treatment yeterday. Am very grateful to the village Doctor becaue he ued to viit my home to encourage me to wallow drug a per Dr intruction.my putum wa examined 2 time and to day I have come for the lat examination. On top of treatment we were upplied with free food ration which improved my health.my family member upported me a lot to wallow drug on daily bai. Are you happy with the TB treatment? Am very happy that why you ee me miling. Leon Learned 1. Health promotion through ma media and other communication channel that increaed 22

23 awarene, created demand and promoted healthy behavior change leading to early eeking of diagnoi for TB and adherence to TB treatment. The action utilized radio Nhomlau FM and Werber FM-Gordhim. 2. Community engagement for early retrieval of peron interrupting TB treatment by HHP, TB club and TB ambaador for patient follow up and monthly feedback meeting and enhancement of community DOT through treatment upport promoted adherence to achieve 91% treatment ucce. 3. ENGAGE TB to other partner ha made the program to be known for better TB integration into the community level. CHAPTER 4: CHALLENGES and BOTTLENECKS There were no major challenge in the project management a the ytem tructure are well etablihed and functional at Arkangelo Ali Aociation (AAA). A comprehenive plan with the budget and target are done during propoal development tage, with trict timeline to be followed. Thee are reviewed on a quarterly bai and underperforming activitie that require trengthening are identified and way forward developed. However, ome of the challenge encountered at the implementation tage included: 1. Limited integration of TB into the PHC ytem which i the overall pillar for health ervice delivery in South Sudan. 35% of the countie in South Sudan lack TB ervice, only 31% TBMU coverage. 2. Inadequate implementation of TB prevention, treatment and care ervice in high rik/hard to reach population: 3. Recurrent conflict lead to diplacement and IDP ituation that lead to limited acce. 4. Prioner and military ervice protocol to acce ervice i prohibitive. 5. Poverty/malnutrition: 4.8 million people (about 100,000 children, have evere acute malnutrition) face evere food hortage worening TB pread, delayed diagnoi and poor adherence. 6. Inadequate implementation of TB and HIV ervice: Weak TB and HIV referral linkage, creening and reporting of preumptive TB i ub-optimal. 7. Weak community health ytem: The HHP i enviaged in the country NSP and Boma Health initiative but inufficiently utilized for referral and door-todoor TB creening/tracing. 8. Poor Infratructure, tigma and cultural practice leading to delayed diagnoi Patient trek long ditance or eek traditional treatment due to infratructure detruction by flood, poor road acce, or inter-ethnic/clan conflict. 9. Human Reource and diagnotic capacity challenge of taff and/or ervice. 10. Untimely upply of anti TB drug and lab reagent 23

24 Way Forward Engage TB to be intenified to other partner to be able to upect TB, creen and refer for diagnoi and treatment. More p/field uperviory viit to be made o a to bench train all health worker about TB care and management. coordination with UNDP, NTP, State TB Coordinator and other partner. HHP to be involved in the programme more actively a they play an important role of reaching TB patient for drug refill, putum collection and tranportation and referral of people with preumptive TB to the Tb unit for microcopy during rainy eaon when mot of the village are cut off due to flooding. Chapter 5: BEST PRACTICES The Project Manager (TB Coordinator) focued on improving communication with variou location a a way of enuring that the programme activitie were implemented according to the et work plan. Deviing practical method of meeting the need of the programme uch a tranferring of experienced taff to location where there are weaknee and on-job national taff on programme management. The work plan were dieminated to all the location with clear target to be met in every quarter.there exit a trong link between the finance, logitic and program department to enure that all the activitie are carried out according to the budget and work plan. There are both regional and national taff working in thee program. Regional expatriate taff had pecific management dutie and are deputized by the National taff. The implementation of the programme activitie followed trictly the et work plan and involved all the taff. Information haring among the field taff and the Headquarter wa excellent, depite the exiting challenge. The implementation proce involved advance planning of variou activitie at the field level, making requiition for fund and upplie in advance analyi/approval by the project adminitrator and project manager and finally carrying out the activity and reporting. Monitoring of thee activitie i carried out at variou level, the job decription of ome of the taff were revied to include monitoring and evaluation function. Depite the added reponibility, their main activitie remained uperviion, data collection, verification, quality aurance of the procedure uch a laboratory performance and clinical evaluation. A guideline for M&E wa developed and a tandardized checklit i available for uperviion. The guideline and the checklit are both ued in monitoring of thee activitie. The M&E officer provided regular feedback after the uperviory viit, alway enured that the tool for data collection were provided to all ite and performed on-job p and training a required. The leon learnt during the 24

25 monitoring exercie are alway ued to improve the programme performance. There i efficient data torage and archiving ytem. The ytem enure availability and eay acce of both aggregated and diaggregated data. Bi annual uperviion i done by the M&E officer and the project manager. Other bet practice hould be the door-todoor creening and referral of pecimen and timely treatment initiation. We devolved finance management to the location with budgeting and practical intervention being determined by the location taff. Tranparency i enured by cro-checking and counterigning by two peron the expenditure. An orientation workhop hoted by PR (UNDP), wa well educative to the SR. Quarterly review by the PR (UNDP) alo played an important role in the increaing of knowledge and guidance to the management taff in variou area that need improvement. Chapter 6: RECOMMENDATIONS NTP to come up with away of conducting more training for the TB programme taff, o a to keep themelve abreat with the latet fact about TB care and management. Supply ytem hould be trengthened to avoid TB unit running hort of TB drug and lab reagent The Minitry of Health hould avail policy Guideline a regard TB ervice integration in the Primary Health care acro the country. Global Fund/UNDP hould be releaing the activitie fund timely o that activitie may be accelerated during dry eaon. NTP to ditribute the newly approved reporting and recording tool to all the TBMU. 25

26 Annex 1 AAA -TB UNITS -39 STATE COUNT Y TB UNITS Remar k Actio n taken for no perfo rming TB unit Way forward Aweil Aweil tate hopital TB unit NORTHERN BAHR EL GHAZAL Aroyo Diagnotic and treatment Centre Poorly perfor ming of PHCC due to low motiva tion of taff under MoH uppor ted by HPF Infor ming CHD and STC - taff - CHD and STBC to involve MoH Aweil Eat Gordhim TB unit Akuem Diagnotic and treatment Centre Poorly perfor ming of PHCC due to low motiva tion of taff Infor ming CHD and STC - taff - CHD and STBC to involve

27 Malual Baai Diagnotic and treatment Centre Malualkon Diagnotic and treatment Centre Omdurman Diagnotic and treatment Centre under MoH uppor ted by HPF Poorly perfor ming of PHCC due to low motiva tion of taff under MoH uppor ted by HPF Poorly perfor ming of PHCC due to low motiva tion of taff under MoH uppor ted by HPF Lab no functio ning Infor ming CHD and STC Infor ming CHD and STC Lab taff not yet recrui ted by the CHD MoH - taff - CHD and STBC to involve MoH - taff - CHD and STBC to involve MoH Dicuing with the CHD and STBC if the Unit can be replaced with a buy 2

28 Wunyik Diagnotic and Treatment Centre Panthou Diagnotic and Treatment Centre Very low cae finding Very low cae finding and hence all TB upe ct are referr ed to Gord him. CHD and STBC till worki ng on that witho ut ucce PHCC taff taff Aweil Wet Nyamlell TB unit Chelkou Diagnotic and Treatment Centre Gok Machar Diagnotic and Treatment Centre Very low cae finding Very low taff 3

29 Marial Baai Diagnotic and Treatment Centre Udhum Diagnotic and Treatment Centre Wedwil Diagnotic and Treatment Centre Nyinbouli Diagnotic and Treatment Centre Mayen Ulem Diagnotic and Treatment Centre cae finding Very low cae finding Very low cae finding Lab tempor ally cloed due to Lab peron nel who dicon nect hi contra ct Very low cae finding Very low cae finding Infor ming CHD and STBC for lookin g anoth er one taff taff taff Advertie ment done but nobody howed up Rotating Lab taff of Nyamlell for doing TB microcop y at Wedwil taff taff 4

30 WESTERN BAHR EL GHAZAL Wau Wau TB unit Yirol TB Unit Mapourdit TB unit LAKES Yirol Wet Ateriu Diagnotic and Treatment Centre Wou Wou Diagnotic and Treatment Centre Cloe d due to intert ribal inec urity and patie nt prefe r to go to Mapu ordit due to poorl y mana ged perip heral healt h Cente r Nyang PHCC in Yirol Eat wa found to be uitable to replace thi unit and provide microcop y ervice intead of Atirieu PHCC for the time being Yirol Eat Adior TB unit Very low cae finding taff Awerial Bunagok TB unit Very 5

31 Awerial Cuiebet Mingkaman Diagnotic and Treatment Centre Agangrial TB unit low cae finding High default er rate Involv ed STBC taff Opening Bor TBMU a oon a poible to limit cro river TB patient WESTERN EQUATORIA Tambur a Tambura TB unit Mupoi Diagnotic and Treatment Centre Source Yubu Diagnotic and Treatment Centre Very low cae finding Very low cae finding Dicu ed with CHD and STBC about inec urity affect ing the progr am Dicu ed with CHD and STBC about inec urity affect ing the progr taff if the ecurity allow taff if the ecurity allow 6

32 Nagero Diagnotic and Treatment Centre Namutina Diagnotic and Treatment Centre Very low cae finding Very low cae finding am Dicu ed with CHD and STBC about inec urity affect ing the progr am Dicu ed with CHD and STBC about inec urity affect ing the progr am taff if the ecurity allow taff if ecurity allow WARRAP Gogrial Wet Gogrial Wet Gogrial wet Kuacjok TB unit Alek Diagnotic and Treatment Centre Akon Diagnotic and Treatment Centre taff 7

33 Gogrial Eat Gogrial Eat Tonj North Tonj North Tonj South Luanyaker TB unit Liethnom Diagnotic and Treatment Centre Marial Lou TB unit Warrap Tonj TB Unit taff taff taff Annex 2: Some photo that were taken when TB activitie were being carried out in

34 A treatment upporter helping her grandmother take the TB drug (DOTS) 9

35 2. Health education to the patient and her treatment upporter before a patient i initiated on TB treatment 10

36 3. An HHP paing TB meage to the WFP food beneficiarie in Mingkaman IDP camp 11

37 4. A health education eion in Mingkaman IDP camp, Awerial county 12

38 13