WASH sector National coordination meeting Wednesday 4 October 2017 DWSU, Khartoum

Agenda Welcome & action points Modawi 5 min WASH sector emergency updates Modawi 20 min Sanitation options in Sudan Awatif 20 min Trachoma & WASH prevention Mazin 20 min Hand Washing day celebration Asia / Mustafa 10 min AoB

1. Welcome and Introduction Modawi, dwsu

Action points from last coordination meeting AWD Sector to contact partners to have more feedback from AWD response To be carried out – Mid October? IWRM To convene a meeting with UNE and partners interested to develop way forward

2. WASH Sector Emergency Updates Modawi

Emergency update - AWD During week 36 – September 1 to 8 952 new cases, 36 deaths CFR: 3.8% (threshold is 1%) By September 8 AWD is in 17 states (no cases in West Kordofan) and 1,563 sites 33,934 cases, 774 death Attack rate 0,097% CFR: 2.3% Female: 54%, children < 5: 8% High incidence rates in Blue Nile, River Nile, Central Darfur and South Darfur states merit further investigation Within 6-9 months: Expected another 36,000 - 40,000 cases

Emergency update - AWD South Darfur Region stands out!! CFR: 9.09% CFR Requirement: Assessment of AWD treatment facilities, corrective measures East Jebel Marra Recently accessible locality Recent opening of 3 additional CTCs serving the 64,450 people of Liba, Deribat and Fiena FMoH/WHO mission identified urgent response gaps (medicine, medical supplies, emergency health staff training, logistics, improve water supplies, hygiene promotion, etc.) Inaccessible area Suspected many cases Advocacy to have access to those area

Emergency update - AWD River Nile SK & WN Blue Nile

Emergency update – Floods Affected people: 99,000 Death: 24 Houses destroyed: 19,000 Most affected states: White Nile, South Darfur, North Kordofan, Al Gezira, Sennar, West Darfur and Kassala

Emergency update – Floods WASH interventions Chlorination, water quality monitoring, water filter distribution Latrine material distribution Hygiene promotion, soap distribution Partners: Oxfam, CIS, ARC, IOM, HCR, UNICEF, others https://reliefweb.int/sites/reliefweb.int/files/resources/Sudan_Flooding_Snapshot_A4_19_Sep_2017.pdf

Emergency update – East Jebel Marra Inter-agency mission: 10-15 September Deribat, Jabra and Kidineer area: First time agencies have access in several years People in need: 105,000 people in 46 villages Host community: 62,000 people Protracted IDPs: 42,000 Returnees: 1,000 Needs: Provision of basic humanitarian services: health, nutrition, protection, WASH , education, emergency food. Involvement of line ministries to sustain service provision to the reported return cases. Support / establishment of role of law and order mechanisms. Aid organisations are currently working on preparing response plans to assist people in need Humanitarian access State authorities committed to facilitate humanitarian access Local authorities welcome humanitarian actors to have permanent presence Locality commissioner committed to facilitate establishing of humanitarian offices in Deribat town. Key challenges No guest houses, hotels are existing in Deribat (no proper accommodation based UNDSS).

Emergency update – WASH needs of East Jebel Marra Deribat Kidineer Jabbra Water Rehab of existing water sources Drilling new boreholes New water yards Set-up water management committees Water management / treatment training Rehabilitation / new water sources. Water management / treatment Upgrading existing water yards with solar system. Installation of cost recovery systems Rehabilitation of hand pumps Installation of water yards Water management committees Installation of cost recovery systems. Sanitation Implementation of CLTS Hygiene Hygiene kits Hygiene / sanitation / health committee Community hygiene promotors Solid waste management system

Emergency update – Comments & Questions MC Has a presence in Deribat and has secured fund to conduct WASH activities ? As of next year, the newly constructed dam in Ethiopia will reduce the flow of the Blue Nile. Therefore prevention efforts should focus on other area WASH Sector The East Jebel Marra assessment report will be shared with partners

3. Sanitation options in Sudan Awatif, UNICEF

Accelerating the effort to achieve Sudan Free from Open Defecation in Five years(2017-2021) Through The Renewal of High level National Advocacy workshop (Institutional Triggering) Commitment

Context 32.9% of the population has access to an improved latrine and 29.2% practices open defecation 53% of children had their faeces safely disposed of the last time before the survey 28.2% of the population have access to both improved drinking water and improved sanitation

Out of 15,316 villages in 10 States only 291 villages were free from open defecation. No Locality declared as ODF in Sudan

Cont.. Acute Watery Diarrhea was one of the major outbreaks happening in Sudan in the last five years namely in White Nile and Sennar States but spread in many states in Sudan. This year, the outbreak happened again but with clear spread in 16 states out of the 18 states of Sudan. Sixteen (16) states, out of 18, are affected by AWD (Kassala, Blue Nile, River Nile, Gezira, Senar, Khartoum, Gedarif, Red Sea, Northern, White Nile, South Kordofan, North Kordofan, West Kordofan, North Darfur, East Darfur and South Darfur). As of 23 August, 2017 a total of 31,345 cases with 670 deaths ( CFR 2.1) and Attack rate = 9.02/10.000 of population. The AWD outbreak is affecting all demographics, with females constituting 54% of the cases and children below five years of age accounting for 8.1%. 

Recent Initiatives to accelerate the Sanitation coverage Establishment of Sanitation and Hygiene Project units at State level State Sanitation Councils (SSCs) have been formed in all States (16) except for Central and North Darfur. 7 States have been approved by the Governor (White Nile; Blue Nile; Red Sea; Kassala; North Kordofan; East Darfur and West Darfur). Developed Sudan National Sanitation and Hygiene Strategic Framework 4 Trainings of Trainers (ToTs) in White Nile State 206 facilitators trained and Master ToT for 50 selected CLTS facilitators (from the 206-people trained). High level advocacy workshop and Institutional triggering of institutional actors. Developed State CLTS rolling plan Committed for 18 ODF localities up to end of Dec, 2017

Recommended Action for Accelerating the effort to achieve Sudan Free from Open Defecation in Five years (2017-2021) Accelerate the implementation of CLTS process in the selected 36 localities( two per states) to achieve ODF status up to 31 Dec, 2017. Develop National Road map for making Sudan ODF and accelerate the implementation (UNICEF is recruiting International consultant to provide support to FMoH) Advocacy workshop and Institutional Triggering at States and locality level. To scale up efforts to ensure that 100% of households in Sudan stop open defecation in the coming five years. Implementation of Sudan National Sanitation and Hygiene Strategic Framework Allocation of resource from the government and development partners for the implementation of the plan Strengthening the capacity of Environmental Health at all level (National, State and locality) for effective coordination, leadership , implementation and monitoring of the Sudan ODF road map . Strengthening the capacity of State Sanitation Councils (SSCs) to coordination and leadership on the implementation of State Sanitation Plan .

Comments & Questions NEF Several colleagues Zoa Plan International How does CLTS address the sanitation needs of migrants, farmers and mine workers? According to Awatif, the Government of Sudan has plan to address AWD and sanitation needs of northern states minors. Several colleagues Sudan aims at ending open defecation by 2020 CLTS and CATS have different methodologies but are integrated and combined community action plans. CLTS: Doesn’t provide subsidies, focus on behavior change, targets residents, build on community experience in building latrines CATS: Provides subsidies, promotes latrine construction, has 5 pilars (water, safe food, hand washing, HH environement, use latrine) MoH has trained CLTS specialist that are available to support WASH partners sanitation programs Zoa As per the national plan, what are the targeted states and localities to be ODF? Plan International ODF protocol and CLTS guidelines will soon be shared

4. Trachoma & WASH prevention Mazin, Carter center

Presented by: Mazin Salih Abdallah Elsanousi Trachoma Presented by: Mazin Salih Abdallah Elsanousi

Trachoma The origin of the word Trachoma is Greek, meaning rough, and known this disease from ancient times in the manuscripts archaeological. Trachoma discovered in 1907 world wild Trachoma of infectious eye diseases All ages can be affected by Trachoma . The disease develops when it starts to grow and lasts for many years, especially in infected areas. The individual may experience more than one sign at the same time.

Definition Infectious chronic diseases affects the eyelid. Is slow in patients and initially appears as a simple infection with conjunctiva with an expansion of the blood vessels of the conjunctiva and severe inflammation of the eyelid and cornea, Fast-spreading

Cause Trachoma caused by an organism called chlamydia trachomatis which is one of the total chlmydia and is distinguished between bacteria and viruses' large size. There is an alveolar and corneal tissue as well as in the mucous membrane of the reproductive system.

Ways trachoma is transmitted

The five stages of trachoma - TF TF: Trachomatous Inflammation – Follicular 5 or more follicles on the flat surface of the upper tarsal conjunctiva Follicles must be at least 0.5mm in diameter Note: when diagnosing, exclude corners of the averted eyelid and the lower edge of the averted conjunctiva

The five stages of trachoma - TI TI Trachomatous Inflammation – Intense Pronounced inflammatory thickening of the tarsal conjunctiva that obscures at least half of the normal deep tarsal vessels Marked papillae are seen and follicles are present This stage is also highly infectious

The five stages of trachoma - TS TS Trachomatous Scarring Scarring of the tarsal conjunctiva, easily visible as white lines, bands, or sheets (fibrosis) Can cause distortion of upper eyelid resulting in trichiasis / entropion TS is usually found in adults

The five stages of trachoma - TT TT Trachomatous Trichiasis At least one eyelash rubbing on the eyeball or recent removal of an in-turned eyelash/ eyelashes TT commonly starts in adolescence though it can start at a very young age It increases with age and is more common in women

The five stages of trachoma - CO CO Corneal Opacity Present over the pupil, sufficiently dense that at least part of the pupil margin is blurred There is significant visual impairment CO usually occurs after 20 years of age

Prevention and Treatment of Trachoma The SAFE strategy Surgery Antibiotics Face washing Environmental Improvement

SURGERY When the eyelashes scratch on the eye an operation is needed to prevent further loss of vision and pain The operation takes place on the eyelid and not in the eye It is done under local anesthetic The patient can go home the same day and come back for check up the next day

TT Surgery Camps

What can the community do? What could be the obstacles to lid surgery? Who can be involved? medical assistants and doctors can be trained in eyelid surgeries What can the community do? Encourage affected people in the neighborhood and family to go for surgery Make sure someone in the community is trained and equipped for eyelid surgery What could be the obstacles to lid surgery? Fear, patients are suspicious of the surgery People don’t know that trachoma can lead to blindness Health staff is not motivated to perform surgeries Costs are too high or hospital is not equipped Distance to care

Antibiotics The whole community will receive a single dose of azithromycin (Zithromax) for three years The dosage is according to height, which will be measured with a stick. The village-based community workers and other volunteers will be trained how to administer and how to record the drugs.

What can the community do? Who can be involved? Health workers, community volunteers, teachers, midwives, community leaders What can the community do? Inform everybody about the dates of distribution Make sure the children are at home so that they can receive their treatment Make sure that the registration cards are at hand What are additional benefits of taking azithromycin? Upper respiratory infections Skin infection Sexually transmitted diseases such as gonorrohea What could be the obstacles to drug distribution? Suspicions of the new drug People are scared because they heard rumors of bad side effects The wrong time of distribution, harvest, planting...

FACE WASHING As a habit in schools and at home….

Mothers, grandmothers, fathers Who can be involved? Mothers, grandmothers, fathers Older children who take care of the younger ones Teachers Who can promote face washing in the community? Everyone!! Community workers, traditional healers, teachers, midwives, village health committees Local radio, local papers, churches, mosques What could be the obstacles? Shortage of water People don’t see the benefit in keeping children’s faces clean

Face Cleaning Activities

Environmental Improvement A clean environment for better health

Improving safe water Availability and intermetal sanitation

Maintain the cleanliness of the house and surrounding environment to prevent the breeding of flies and harmful insects

Proper disposal of human waste by the establishment and use of latrines while maintaining their cleanliness contributes to reducing the number of flies which reduce the disease.

Proper disposal of human waste by the establishment and use of latrines while maintaining their cleanliness contributes to reducing the number of flies which reduce the disease. Establish animal pens outside the home. Proper disposal of animal manure away from homes by placing it in dedicated containers or burying it away from dwellings and water sources, to prevent the formation of the appropriate environment for the multiplication of flies (humidity and warm air) Use insecticides if necessary.

Baseline TF Current TF

Together for a society free of Trachoma

Comments & Questions UNICEF Mazin Modawi It is recommended to encourage both face and hand washing together. Mazin There will be a workshop on trachoma environemental sanitation in December Modawi The WASH sector has collaborated with Carter Center to eradicate guinea worm and it will continue tu support against trachoma

5. Hand washing day celebration Asia, FMoH – Mustafa, DWSU

Federal Ministry of Health WASH SECTOR Sanitation Programme Sunday, October 15 Global Handwashing Day 2017 Asia Azrag Dahab National Sanitation Coordinator

Global Hand Washing Day (Oct 15th) Relevance of Hand Washing with Soap AWD outbreak in all 18 states The trend is going down  in order to eradicate the disease, Hand Washing is the KEY PRACTICE Global Hand Washing Day (October 15th) This year’s global theme is “Our Hands, Our Future!” - However, for Sudan, FMoH-DWSU recommend more suitable theme in Arabic: Strong encouragement for ALL sector partners to celebrate the day Please share your plan with the F/SMoH team

GHWD Planned Activities National celebration at White Nile State (date TBD) High level officials attendance Reflect on the successful containment of AWD outbreak since April and ensure sustainability Charity run at Khartoum Public event: 5km run on the Nile Street (plan: 28th Oct) Awareness raising on hand washing with soap at critical times Fundraising from the sale of the ticket Encourage participation from all the sector partner staff (All country) Promotion message dissemination sessions Schools (MoE) Mosques/ churches Hospital/ health centre Universities MoH staff sessions Media campaign Cell phone SMS Radio messages TV spots Newspaper Celebration plans from the states Football matches Public celebration Mobile drama Construction of hand washing facilitiesState GHWD2017 activity plans.xls

Action points CLTS Plan International and UNICEF: To release and share CLTS guidelines and protocol UNICEF: To share the contact of CLTS coordinators / facilitators in each state / localities Revive the sanitation & hygiene working group with partners such as HCR, Zoa, Adra, Al salam, SYPW, ASSIST, GHA, FPDO, Goal, Plan, WV, Triangle, IAS, UNICEF, CIS, UPO, ARC Trachoma Mazin to share the contact of Trachoma state coordinators Global handwashing day Partners to inform the WASH sector of their activities and forward pictures and video Share the contacts of NewTech (sector reform) Mazin, trachoma specialist

6. AoB

Shukran Thanks