Provision of Integrated MNCH and PMTCT in Ayod County of Fangak State and Pibor County of Boma State Date: Prepared by: February 13, 2017 Dr. Taban Martin Vitale 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: October 1, 2016 December 31, 2016 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. 1
8. Project Objectives: Rehabilitate the healthcare facilities in Pibor and Gorwai to provide quality healthcare services. Provide essential medical equipment, pharmaceuticals, and consumables. 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): Conducted rapid health needs assessment in Pibor and Gorwai (refer to detailed assessment report). Facilitated and signed MOU with Boma State MOH, giving RMF the mandate to operate in Pibor and any other county in the state. Rehabilitated the health facility s infrastructure in Pibor. Installed solar system together with solar fridges to enable EPI (expanded program on immunization) services in Pibor. Improved Pibor PHCC (primary healthcare center) compound, including fencing the compound to avoid unnecessary movement. Installed WASH equipment, including pit latrines, in both the Pibor and Gorwai healthcare facilities. Procured and installed staff tents for accommodation in staff compound annex to the facilities in Pibor and Gorwai. Procured essential pharmaceuticals and consumables to start active implementation in Gorwai. Chartered UNHAS-operated helicopters and fixed wing aircraft and delivered medical equipment and pharmaceuticals to Gorwai and Pibor. The Boma SMOH/CHD continued to provide the Pibor PHCC with essential pharmaceuticals after our coordinated collaboration. Facilitated the transportation of medical supplies and movement of the health team through regular UNHAS flights. Initiated and signed MOU with the UNFPA for provision of reproductive health commodities. Procured and provided essential foodstuffs for the team in Pibor and Gorwai. Conducted training on community mobilization, FANC/PNC, BEmONC, and PMTCT in Gorwai and Pibor. Continued to support satellite phone services through payment of monthly subscription fees, as this is the only means of communication in Gorwai. Printed and provided the facilities with antenatal cards. Procured and provided the facilities with scholastic materials. Continued facilitation of our team to participate in all coordination activities at national and state levels. 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 PHCC (primary healthcare center) successful refurbished, furnished, and providing comprehensive basic care for the population. EPI equipment installed in Pibor and the facility now providing quality EPI services. Gorwai PHCC rejuvenated through installation of tents, furnished, and providing primary healthcare services. Coordinated with WASH partner and installed WASH equipment, including pit latrines, in the facilities in both Pibor and Gorwai. Technical and professional health team recruited, trained, and deployed to Pibor and Gorwai providing quality healthcare services. 2
Coordinated and received reproductive health (RH) commodities from UNFPA to support the RH component of the program in Pibor and Gorwai. Airlifted health commodities and other essential supplies, including foodstuffs, through chartered UNHAS-operated helicopter and fixed wing aircraft to Pibor and Gorwai. The table below summarizes some of the major achievements during the reporting quarter: Indicator Achievements in Achievements in Pibor (Boma) Gorwai (Ayod) Vaccinators trained on EPI 3 3 Healthcare workers trained on FANC, PNC, & PMTCT 5 4 Healthcare workers trained on BEmONC 5 5 Pregnant women received ANC 4 th visit 10 0 Pregnant women received IPT 3+ 10 0 Pregnant women dewormed 41 62 Pregnant women counseled and tested for HIV 68 62 Eligible children dewormed 25 295 Eligible children provided with vitamin A supplementation 12 290 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) 3
Community Mobilization and Awareness 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 2-3 weeks at the end of quarter when active implementation started: Conditions Under-5 Deaths Over-5 Deaths Pibor Gorwai Pibor Gorwai Pibor Gorwai Pibor Gorwai ARI 44 149 0 1 8 83 0 0 Diarrhea 65 128 0 1 14 44 0 0 Malaria 178 338 0 0 61 369 0 0 Other 5 142 0 0 0 789 0 0 16. Notable project challenges and obstacles. The project has made notable progress during this reporting quarter, but has faced challenges in the following areas: Project Mobilization and Setup Activities Startup of the provision of services at the PHCC in Pibor was delayed until December 19, 2016, because refurbishment of the facility took longer than expected; funding was only mobilized by RMF, as UNICEF did not budget for renovation. Gorwai PHCC started the provision of services in the first week of December 2016; this delay was due to logistic challenges in transporting supplies from Juba to the site. High cost of setting up and rehabilitating of the PHCC infrastructure. Cost of renovation leveraged from RMF headquarters, which was not planned. This delayed the startup of service provision. Delay in implementing the PCA activities, two months from the signing, due to renovation of the facilities. Medical Equipment and Supplies Medical equipment and supplies provided are not based on needs, thus most of the essential equipment and supplies for MNCH are missing at the PHCC sites (Gorwai and Pibor). Additional PHCC equipment and supplies are needed to support full implementation of primary health care activities, MNCH, and PMTCT. All the medical equipment and supplies at the PHCC were looted and vandalized during the armed conflict, hence leaving a very large gap. Drugs and Supplies Most of the essential medicines and supplies are in short supply. Medicine and supplies stock-out experienced in both locations (Pibor and Gorwai PHCC). Lack of medicines and supplies for conducting deliveries. Provision of Services No basic primary health care services were existing at either of the two PHCCs, thus affecting timely implementation as planned. Late start of the provision of basic and MNCH/PMCT services affected achievement of the planned quarter s results. Implementation of PCA on MNCH/PMCT services as standalone programs was a challenge because the communities need a comprehensive package of care. 4
EPI Services No functional EPI services exist at Gorwai; they have not been in place for the last three years. Stock-out of vaccines. Logistics/Pipeline Transportation of medical equipment/supplies/pharmaceuticals to Ayod and Pibor is challenging. UNHAS flights are unreliable, and commercial aircraft can only land in Pibor, not Ayod, and again are very expensive. Ayod can only be served by helicopter, which is only operated by UNHAS at a cost of about $16,000 per charter. Security clearance: Our area of operation in Ayod is controlled by the SPLA opposition, hence taking medical supplies to the area requires security clearance, which in most cases is challenging and takes a long time. These delays interfere with program preparations. 17. If applicable, plans for next reporting period: Renegotiation of the PCA to include the actual cost of revitalizing the primary health care activities in Pibor and Gorwai PHCCs. Provision of more tents for Gorwai and Pibor PHCCs. Provision and equipment of the PHCCs with MNCH/PMTCT based on the program s needs and requirements. Leveraging of more resources for provision of basic primary health care activities. Provision of medicine and supplies for MNCH and PMTCT services. Provision of EPI facilities to Gorwai PHCC. Increase provision of essential basic drugs for clinical services and MNCH. Facilitate airlifting of the medical supplies through the logistic cluster. More tents required for patients (OPD, delivery, etc.). Semi-permanent fence in future for the PHCC and staff quarters to improve security for the staff. 18. If applicable, summary of RMF/UNICEF-sponsored medical supply distribution and use: See Project Photos 19. Success story(s) highlighting project impact: See Project Photos 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 Project Photos 5
Medical equipment and pharmaceuticals collected from UNICEF to be transported to Pibor and Gorwai Tents and mattresses to be transported to Pibor and Gorwai Pharmaceuticals and consumables procured by RMF for Gorwai PHCC Loading medical equipment and pharmaceuticals from RMF s storeroom to be taken to Juba airport for airlifting to Gorwai RH kits received from UNFPA, transported to Pibor and Gorwai Chartered airline company carrying essential medical supplies to the Juba airport for transportation to Pibor 6
Chartered fixed wing aircraft arrived in Pibor with RMF supplies Supplies unloaded at the Pibor airstrip waiting to be transported to the RMF-supported facility James (R), RMF state coordinator, assembling the equipment Some of the assembled equipment Local materials (poles) procured for building a fence around the Pibor health facility Hired laborers preparing the ground for installing the poles for the fence 7
Building of the fence in progress Fencing the facility and staff quarters with local materials Staff accommodation tent installed in the annex to the PHCC in Pibor Causal labourers digging pit latrine in Pibor, one for RMF staff and another for the PHCC James (R) supervising the welder working on the main gate of the Pibor PHCC A technician preparing to install the solar power system and fridges in Pibor PHCC to enhance EPI services 8
A technician installing the solar power system A technician installing the solar power system Refurbished Pibor PHCC prefab structures Installed tent to serve as ANC RMF PHCC supervisor (William) checking the installed fridge Boma Minister of Health Dr. Simon (center) speaking to UNICEF health representative during a visit to Pibor PHCC 9
RMF PHCC supervisor (William) checking some of the received essential medicines RMF PHCC supervisor (William) checking some of the received essential medicines Communities gathered at the Pibor PHCC at the time of the facility s opening One of the vandalized structures which requires refurbishment 10