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

2. 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

3. 1. Welcome and Introduction
Modawi, dwsu

4. 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

5. 2. WASH Sector Emergency Updates
Modawi

6. 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 cases

7. 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

8. Emergency update - AWD
River Nile
SK & WN
Blue Nile

9. 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

10. 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

11. Emergency update – East Jebel Marra
Inter-agency mission: 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).

12. 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

13. Emergency update – Comments & QuestionsMC
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

14. 3. Sanitation options in Sudan
Awatif, UNICEF

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

16. 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

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

18. 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/ 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%. 

19. 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

21. Recommended Action for Accelerating the effort to achieve Sudan Free from Open Defecation in Five years ( )
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 .

22. 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

23. 4. Trachoma & WASH prevention
Mazin, Carter center

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

25. 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.

26. 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

29. 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.

30. Ways trachoma is transmitted

32. 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

33. 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

34. 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

35. 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

36. 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

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

38. 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

39. TT Surgery Camps

40. 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

41. 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.

42. 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...

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

44. 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

45. Face Cleaning Activities

46. Environmental Improvement
A clean environment for better health

47. Improving safe water Availability and intermetal sanitation

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

49. 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.

50. 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.

51. Baseline TF
Current TF

52. Together for a society free of Trachoma

53. 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

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

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

56. 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

57. 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

58. 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

59. 6. AoB

60. Shukran Thanks