Provision of Integrated MNCH and PMTCT in Ayod of Fangak State and Pibor County of Boma State Date: Prepared by: May 22, 2017 Dr. Taban Martin Vitale and Richard Anyama I. Demographic Information 1. City & State: Ayod County in Fangak State and Pibor County in Boma State, Republic of South Sudan 2. Organization: Real Medicine Foundation, South Sudan (www.realmedicinefoundation.org) United Nations Children s Fund (www.unicef.org) 3. Project Title: Provision of Integrated MNCH and PMTCT in Ayod and Pibor 4. Reporting Period: January 1, 2017 March 31, 2017 5. Project Location (region & city/town/village): Gorwai in Ayod County of Fangak State and Pibor in Pibor County of Boma State, Republic of South Sudan 6. Target Population: The MNCH (maternal, neonatal, and child health) and PMTCT (prevention of mother to child transmission) program directly targets the estimated populations of Gorwai, 38,817, and that of Pibor, 60,400, projected from the 2008 South Sudan Population and Housing Census. The estimated categories of beneficiaries are tabulated below: County Estimated Population Under-5 (19%) Under-1 (4%) 12-59 Months (15%) Under-15 (21%) Pregnant Women (4%) Women of Childbearing Age (21.5%) Ayod 38,817 7,375 1,553 5,823 8,152 3,105 8,346 Pibor 60,400 11,476 2,416 9,060 12,684 2,416 12,986 Indirectly, the program also targets the whole population of Ayod and Pibor counties and communities from the surrounding counties. II. Project Information 7. Project Goals: The overall goal of this project is to reduce maternal, neonatal, and child morbidity and mortality through strengthening the healthcare system to provide quality maternal, neonatal, and child health services in the assigned counties. During the armed conflict that broke out in Juba mid-december 2013, infrastructure that existed in Ayod was destroyed, while Pibor s healthcare facility was vandalized during the insurgency of February 2016. Coupled with lack of funding, healthcare partners in Ayod and Pibor left these locations, increasing the vulnerability of communities in these two counties who have no access to quality, affordable healthcare services. In September 2016, RMF entered into a partnership agreement with UNICEF to rejuvenate the primary healthcare centers in Gorwai and Pibor in order to provide quality MNCH and PMTCT services for the communities in need. 8. Project Objectives: Rehabilitate the healthcare facilities in Pibor and Gorwai to provide quality healthcare services. Provide essential medical equipment, pharmaceuticals, and consumables. 1
Provide quality, integrated MNCH and PMTCT services in accordance with national MOH (Ministry of Health) and international standards. Build the capacity of the County Health Departments (CHD) and their staff involved in provision of healthcare services. 9. Summary of RMF/UNICEF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): Pibor and Gorwai PHCCs (primary healthcare centers) were maintained and continued to provide quality maternal, neonatal, and child health services. 8 health workers were trained on FANC, PMTCT, and PNC for 5 days in Ayod and Gorwai PHCCs. 3 health workers (midwives, nurses, and clinical officers) were trained for 10 days and are able to provide quality BEmONC services. 7 vaccinators were trained in EPI (expanded program on immunization) services for 3 days in Pibor and Gorwai PHCCs. 4 community committees were formed and trained in Pibor and Gorwai PHCCs on community mobilization and participation. 13 community outreach sessions were conducted in Pibor and Gorwai PHCCs. Facilitated the transportation of pharmaceuticals and consumables to Pibor and Gorwai through regular UNHAS flights. Procured and delivered an adequate amount of essential foodstuffs for RMF s relocated staff (those recruited from Juba and deployed in Gorwai and Pibor), since basic commodities are not available in these areas. The EPI cold chain system in Pibor PHCC was maintained and continued to function throughout the quarter. Facilitated in-country transportation of health staff from Pibor and Gorwai PHCCs to Juba and back through regular UNHAS flights. Continued facilitation of our health team s participation in all coordination activities/meetings at national and state levels. Continued to support satellite phone services through payment of monthly subscription fees, as this is the only means of communication in Gorwai. 10. Results and/or accomplishments achieved during this reporting period: The integrated MNCH/PMTCT program for Pibor and Gorwai has achieved notable milestones during this reporting quarter: Pibor and Gorwai PHCCs, rehabilitated by RMF in the previous quarter, continued to provide quality maternal, neonatal, and child health services. EPI cold chain system, established by RMF in Pibor PHCC during the previous quarter, continued to function and provide safe storage of vaccines to promote effective immunization services for children under five and women of childbearing age. 3 and 5 healthcare workers in Pibor and Gorwai, respectively, were trained on FANC, PMTCT, and PNC for 5 days. 1 and 2 healthcare workers in Pibor and Gorwai, respectively, received 10-day training on BEmONC and are providing quality BEmONC services. 2 and 5 vaccinators in Pibor and Gorwai, respectively, were trained on EPI services for 3 days and quality EPI services are being provided in Pibor. 2 and 2 local committees in Pibor and Gorwai, respectively, were trained during the reporting quarter. 7 and 6 community outreach sessions were conducted in Pibor and Gorwai, respectively. In Pibor PHCC, a total of 3,969 curative consultations were provided. Of these, 2,917 patients were under five and 1,052 above five years of age. In Gorwai PHCC, a total of 3,789 curative consultations were provided. Of these 1,908 patients were under five and 1,881 above five years of age. The table below summarizes some of the major achievements during the reporting quarter: 2
Indicator Achievements in Achievements in Pibor (Boma) Gorwai (Ayod) Vaccinators trained on EPI 2 5 Healthcare workers trained on FANC, PNC, & PMTCT 3 5 Healthcare workers trained on BEmONC 1 2 Pregnant women received ANC 4 th visit 22 0 Pregnant women received IPT 3+ 10 0 Pregnant women dewormed 221 52 Pregnant women counseled and tested for HIV 410 114 Deliveries in facility assisted by skilled birth attendant 2 10 Mothers attended postnatal clinic 6 6 Eligible children dewormed 265 506 Eligible children provided with vitamin A supplementation 58 382 11. Impact this project has on the community (who is benefiting and how): The restoration of healthcare services in Pibor and Gorwai has a significant impact on the health and wellbeing of communities in these areas. The communities in both counties are now able to access quality MNCH (maternal, neonatal, and child health) services. The communities in Pibor are now receiving EPI (expanded program on immunization) services. The communities in both counties now have access to quality general health care for all age groups. This project has offered employment opportunities for South Sudanese nationals as both technical and support staff. 12. Number served/number of direct project beneficiaries: The MNCH and PMTCT program directly targets the estimated population of Gorwai, 38,817, and that of Pibor, 60,400, projected from the 2008 South Sudan Population and Housing Census. The estimated categories of beneficiaries are tabulated below: County Estimated Population Under-5 (19%) Under-1 (4%) 12-59 Months (15%) Under-15 (21%) Pregnant Women (4%) Women of Childbearing Age (21.5%) Ayod 38,817 7,375 1,553 5,823 8,152 3,105 8,346 Pibor 60,400 11,476 2,416 9,060 12,684 2,416 12,986 13. Number of indirect project beneficiaries (geographic coverage): Indirectly, the program targets the whole population of Ayod and Pibor counties and communities from the surrounding counties. 14. If applicable, please list the medical services provided: Although the project mainly targets MNCH, general healthcare indicators in Pibor and Ayod are worsening. Hence, RMF is trying to provide comprehensive care in accordance with the South Sudan basic primary care package. The services now provided range from: FANC/PNC/PMTCT Basic Emergency Obstetric and Neonatal Care EPI Services (only in Pibor) Basic Diagnostic Services (through use of rapid diagnostic kits) General Care (both outpatient and inpatient) Community Mobilization and Awareness 3
15. Please list the most common health problems treated through this project. Malaria Diarrheal Diseases Respiratory Tract Infections Urinary Tract Infections Gunshot Wounds The table below shows the common conditions managed at Pibor and Gorwai PHCCs during the reporting period of January March 2017: Conditions Under-5 Deaths Over-5 Deaths Pibor Gorwai Pibor Gorwai Pibor Gorwai Pibor Gorwai Malaria 1,047 650 0 5 581 662 0 0 ARI 954 400 0 0 137 264 0 0 Diarrhea 617 343 0 0 60 255 0 0 Other 299 515 0 0 274 700 0 0 Total 2,917 1,908 0 5 1,052 1,881 0 0 Deaths/Mortality A total of 5 deaths occurred among the under-five patients during this quarter. 60% of the deaths were due to severe anemia and 40% due to severe malaria. The table below provides a summary of OPD curative consultations January March 2017: Curative Consultation Pibor Gorwai Total Children under five 2,917 1,908 4,825 Patients over five years of age 1,052 1,881 2,933 Total 3,969 3,789 7,758 16. Notable project challenges and obstacles: Site Component Technical Challenges and Constraints Laboratory Services Shortage of HIV/AIDS testing kits Pibor Lack of microscope at the PHCC health facility Recommendations/Action Plan RMF to follow up with UNICEF on provision of testing kits RMF to procure a microscope and furnish the lab in Pibor Drugs/Essential Medicines Shortage of all the essential medicines RMF to procure essential medicines and airlift to Pibor Oxytocin Lack of oxytocin at the facility Challenges of transporting oxytocin from Juba to Pibor using the cold chain system Skilled Delivery Low number of deliveries assisted by skilled attendants Misoprostol and methylergometrine are the choice of uterotonics in the absence of oxytocin. RMF to follow up with UNFPA to ensure that oxytocin is taken to the field site using the cold chain system. RMF to consider providing basic foodstuffs for postpartum mothers. RMF clinical staff to engage the community and raise awareness of deliveries at the health facility 4
Gorwai PHCC Health Infrastructure Inadequate structures for OPD consultations and short stays MNCH Equipment and Delivery Equipment Most essential supplies for MNCH and delivery out of stock Insecurity Staff were evacuated from field sites to Juba due to the fighting that took place March 6 7. This affected the implementation of the health project for at least 2 weeks. Requisition order placed to UNICEF for one tent to replace the small tent used for consultations. Supply is awaited from the store. RMF to follow up with UNICEF and airlift the item to Pibor. Order placed to UNICEF and RMF to follow up. UNICEF and MOH authorities informed of prevailing security situation, relocation of Juba recruited staff, and its effect on the project implementation. The staff have returned to field sites to resume implementation. Cold Chain System and Vaccines No EPI services due to lack of cold chain system at health facilities in Ayod. MOH EPI and UNICEF were informed, and RMF made a proposal to the Ministry of Health through UNICEF for installation of a solar fridge. This was declined due to insecurity. RMF to continue lobbying for approval from MOH. Acute Diarrhea Outbreak Watery (AWD) Serious outbreak of AWD put constraints on the health supplies Difficulty in transporting stool specimens for confirmation WHO was informed about the outbreak and support for our response to AWD was requested through the WHO office in Juba. However, supplies have taken longer than anticipated. Staff was trained on management of AWD. RMF is putting together a proposal for Rapid Response Fund to IOM. Lack of Essential Medicines Challenge of airlifting some in-kind donations from UNICEF and UNFPA to Gorwai Long process of getting approval from the government to ship medical supplies to the opposition controlled areas RMF to procure essential medicines at least quarterly to support the site. RMF to consider airlifting some of the supplies to Gorwai through chartered flight. RMF to engage UNICEF to support the process of getting approval from the government to ship supplies to Gorwai. Infrastructure Inadequate room for consultations for maternity and OPD cases Lack of drug storeroom Famine The community move away from the PHCC catchment RMF placed requisition order to UNICEF for supply of one large tent, which will temporarily solve the issue of inadequate infrastructure. This is beyond the mandate of RMF. 5
area to Fangak and Sudan in search of food and livelihood 17. If applicable, plans for next reporting period: Follow up with UNICEF on the requested essential medicines, laboratory testing kits, and tents. Follow up with WHO on the delivery of cholera kits to Gorwai. RMF to airlift supplies from our Juba storeroom to Gorwai and Pibor. RMF to consider procuring essential pharmaceuticals and consumables for Gorwai and Pibor PHCCs quarterly. RMF headquarters to draft a security plan for the in-country team detailing the organization s plan on evacuation of the field teams and Juba team in case of threatening security situation. Start engaging UNICEF on the renewal of the current PCA for Pibor and Ayod counties. Support M&E visit to the sites to improve program performance. RMF to consider providing basic foodstuffs for postpartum mothers. RMF clinical staff to engage the community and raise awareness of deliveries at the health facility. Continue to lobby for more financial support to cover the gaps in providing quality healthcare services. Support the Boma State Ministry of Health in transporting Boma Health Initiatives commodities. Continue to coordinate health activities with the MOH, UNICEF, Health Cluster, UN, and other partners. 18. If applicable, summary of RMF/UNICEF-sponsored medical supply distribution and use: See Annexes 19. Success story(s) highlighting project impact: See Annexes III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file attachment is fine). Please note any changes from plans. Provided separately Annex 1: Project Photos Dr. Lohide, RMF nutrition/health officer conducting continuous medical education for the health/nutrition team in Gorwai Simon, a lab technician, in Gorwai PHCC training the healthcare workers on basic lab diagnosis 6
Gorwai health/nutrition team conducting health/nutrition education Healthcare workers in Gorwai conducting health/nutrition education during an antenatal visit Dr. Lohide performing abdominal palpation during an ANC visit A midwife in Pibor PHCC listening to a fetal heartbeat during an ANC visit A clinician in Gorwai seeing patients at the OPD Dr. Lohide in Gorwai PHCC seeing patients at the OPD 7
RMF registered nurse (center) seeing a child at the OPD and mentoring RMF locally recruited staff (CHW) Dr. Lohide in Gorwai PHCC seeing patients at the OPD A clinical officer in Gorwai examining a patient with swelling A patient with abdominal ascites, secondary to liver problems, receiving care at RMF Gorwai PHCC RMF lab technician in Gorwai taking a blood sample from a patient for malaria testing RMF lab technician in Gorwai performing a urine dipstick test while mentoring the lab assistant 8
Beneficiaries receiving medications as inpatients in RMFsupported Gorwai PHCC RMF registered nurse (right) together with a CHW (left) dispensing drugs in Gorwai PHCC RMF registered nurse (right) together with a CHW (left) dispensing drugs in Gorwai PHCC RMF registered nurse (right) together with a CHW (left) dispensing drugs in Gorwai PHCC Donation received from Direct Relief International (DRI) DRI donation in Juba waiting to be airlifted to Gorwai & Pibor 9
Annex 2.1: In-Kind Donation from Direct Relief International 10
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Annex 2.2: In-Kind Donation from UNICEF 13
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