Treatment and Prevention of Acute Malnutrition in Jonglei & Greater Pibor Administrative Area, Republic of South Sudan Date: June 13, 2016 Prepared by: Dr. Taban Martin Vitale 1. City & State Bor, Jonglei State and Greater Pibor Administrative Area, Republic of South Sudan 2. Organization: Real Medicine Foundation, South Sudan (www.realmedicinefoundation.org) 3. Project Title: Treatment and Prevention of Acute Malnutrition 4. Reporting Period: January 1 March 31, 2016 5. Project Location (region & city/town/village): Ayod County of Jonglei State and Boma County of Greater Pibor Administrative Area 6. Target Population: Direct project beneficiaries are approximately 140,517 people living in the payams assigned to RMF and indirectly targeting the whole population of the two counties estimated to be 340,661 projected from the 2008 South Sudan Population and Housing Census. The nutrition service centers also receive beneficiaries from neighboring counties and Internally Displaced Persons (IDPs) from various areas of Jonglei and neighboring states. The project aims to provide treatment and multi-micronutrients to about 4,283 Severe Acute Malnourished (SAM) children and to provide Infant and Young Child Feeding (IYCF) messages to 19,632 mothers/caretakers in the two counties. II. Project Information 7. Project Goals: The overall goal of this project is to reduce the Global Acute Malnutrition (GAM) rate to acceptable level of less than 15% in each of the payams assigned to RMF. This will be in line with standards set by the South Sudan National Nutrition Program. 8. Project Objectives: To provide lifesaving nutrition services for acutely malnourished children (boys and girls) less than 5 years of age. To prevent malnutrition in early childhood through promotion of improved infant and young child feeding, care giving and care seeking practices at the facility, community, and family level. To prevent and treat micronutrient deficiency disorders in children through provision of multimicronutrient supplementation, Vitamin A, and deworming campaigns in the assigned areas. To strengthen the capacity of the County Health Department (CHD) and provide appropriate resources for the initiation and integration of nutrition services into existing Primary Health Care as well as linking nutrition interventions in the health system in the targeted counties. 9. Summary of RMF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): Implemented activities in line with RMF-sponsored activities and project objectives include: Prepared and submitted UNICEF proposal for extension of nutrition services in Ayod and Boma, with more focus on improving existing sites and scaling up our strategy in Ayod County.
Facilitated mentorship/supportive supervision activities in all sites during the reporting quarter. Improved the accommodation facilities in Ayod by facilitating construction of grass thatched houses. Continued to support mother-to-mother support groups through provision of basic items like soap and sitting mats. Coordinated and delivered adequate nutrition supplies to all the sites in Ayod and Boma through the logistic cluster and regular UNHAS flights. Continued to support field based RMF nutrition staff through provision of essential foodstuffs. Continued to support satellite phone services through payment of monthly subscription fees, as this is the only means of communication in those hard to reach areas where routine phone service is not available. Continued support of high-speed WIFI internet services in the RMF Juba office to enable easy coordination. Procured and provided desktop computers for Juba based nutrition staff. Continued facilitation of our team to participate in all coordination activities on national and state levels. Prepared and submitted nutrition proposal to CHF, aimed at covering the financial gaps and improving general OTP/SC services. 10. Results and/or accomplishments achieved during this reporting period: 7 Outpatient Therapeutic Programs (OTPs) and 2 Stabilization Centers (SCs) continued to function and provide CMAM services for children under 5 and PLW. 12,153 children under 5 screened for signs of malnutrition during this quarter, cumulatively 28,085 children screened since the initiation of the program. 695 severely acute malnourished (SAM) children referred to OTPs for management during the reporting quarter, cumulatively 2,381 SAM cases referred to OTPs since the inception of RMF nutrition programs in South Sudan in March 2015. 37 SAM children with medical complications referred for management in the two stabilization centers (SCs); a total of 125 SAM cases with medical complications managed at the 2 SCs since their establishment. 526 children received deworming tablets during the reporting quarter; cumulatively 1,957 children dewormed since the initiation of the program. 530 children received vitamin A supplementation according to South Sudan guidelines during the reporting quarter; cumulatively 1,870 children received vitamin A since the initiation of the program. 78% of the admitted SAM cases fully recovered, which is a good indicator as the proportion of recovered children is above the 75% recommended by South Sudan MOH and international protocols. 84 community mobilization sessions conducted during the reporting quarter, cumulatively 318 sessions conducted since the program began. 5 mass screening sessions conducted during the reporting quarter, cumulatively 24 mass screenings conducted. 84 community mobilization sessions conducted during the reporting quarter, and cumulatively 318 community mobilization sessions conducted. 18 community nutrition volunteers received refresher training on screening criteria with more emphasis on application of MUAC tool. 636 mothers and caretakers received appropriate messages on IYCF, strengthening malnutrition prevention measures. 8 mother-to-mother support groups were facilitated and continued to deliver services. Interviewed and recruited local staff from our areas of operation to support the trained CMAM nurses taken from Juba. RMF nutrition staff in Ayod now has adequate accommodation facilities from locally constructed grass thatched houses. RMF nutrition field based teams continued to have clean, safe drinking water through use of provided water purifying equipment.
Our nutrition field based teams continued to charge their Thuraya phones by use of provided portable solar lighting systems. Continued provision of essential foodstuffs to all our TFP sites since all our areas of intervention are hard to reach and procuring basic foodstuffs there is not possible. RMF Juba coordination office continued to have a reliable source of power due to a solar system installed as backup, making day to day running of activities easier. RMF Juba based nutrition staff is benefiting from the provided desktop computers, improving coordination and program performance. RMF Juba based staff, visiting nutrition staff from various field locations, and JTH staff are benefiting from the high speed WIFI internet services installed in RMF s office. Monthly payment of Thuraya subscription fees to enable effective communication without interruptions. Continued replenishment of nutrition supplies in all our OTP and SC sites through chartered commercial and UNHAS operated aircrafts. Coordinated RMF nutrition activities with UNICEF, UN agencies, nutrition cluster, and other nutrition partners both at the national and state levels. Coordinated and signed partnership agreement (Field Level Agreement) with World Food Program (WFP) for implementation of TSFP activities in Ayod and Boma counties. 11. Impact this project has on the community (who is benefiting and how): The community in Boma and Ayod in particular are delighted with our services. During the reporting quarter, a total of 732 SAM children enrolled in our feeding program, 526 and 530 children received Albendazole and Vitamin A supplementation, respectively, hence improving the quality of life of children and pregnant and lactating women (PLW). The populations in our catchment areas are benefiting from regular educational information on nutrition, health, and sanitation. The limited resources of the State Ministry of Health and County Health Departments of the selected counties are now channeled to cover other areas, since RMF is providing services in these hard to reach payams. The nutrition project offered employment opportunities for South Sudanese nationals at national, state, county, and village levels. The high speed WIFI internet access enabled easy coordination for the RMF Juba team and visiting nutrition teams from various field locations. 12. Number served/number of direct project beneficiaries: Direct project beneficiaries are approximately 140,517 people living in the payams assigned to RMF projected from the 2008 South Sudan Population and Housing Census. The project aims to provide treatment and multi-micronutrients to about 4,283 Severe Acute Malnourished (SAM) children and to provide Infant and Young Child Feeding (IYCF) messages to 19,632 mothers/caretakers in the two counties. 13. Number of indirect project beneficiaries (geographic coverage): Indirectly targeted is the whole population of the two counties, estimated to be 340,661 projected from the 2008 South Sudan Population and Housing Census. The population of 1,622,242 in Jonglei State and Greater Pibor also benefits from the project indirectly, as there is frequent movement of people across the counties. The nutrition service centers also receive beneficiaries from neighboring counties and Internally Displaced Persons (IDPs) from various areas of Jonglei State and other states in South Sudan. 14. If applicable, please list the medical services provided: N/A at this time. RMF is being considered as possible Healthcare Implementing Partner in assigned counties in the near future.
15. Please list the most common health problems treated through this project. This project targets mainly the management of Severely Acute Malnourished Children under 5, however many children and adults come to our units due to health related problems, since there are no health care services in all our areas of operations. Some of the conditions our team sees are: Malaria Respiratory Tract Infections Diarrheal Diseases Intestinal Worm Infestation Skin Infections Gunshot Wounds Enteric Fever MAM (Moderate Acute Malnutrition) cases. RMF s proposal to WFP was accepted, and we started implementing for WFP, treating children with MAM (Moderate Acute Malnutrition). 16. Notable project challenges and obstacles: Irregular UNHAS flights to our areas of operation making routine M&E visits very difficult. All our areas of operation in Ayod are under the Opposition forces and the security situation remains volatile despite signing of the peace agreement in August 2015. The population continues to be fluid as people keep moving from one location to another in search of safety. Pipeline management of supplies from Juba to our areas of operation is a significant logistical challenge because we are to only hire helicopters operated by UNHAS; this is very expensive, and we are not able to fly to other areas without getting security clearance from the UN security department. Commercial fixed wing aircrafts are not able to land in all our areas in Ayod. Roads are not passable and worsened by the deteriorating security situation. There is basically no infrastructure in those areas; infrastructure that was in existence previously was destroyed during the fighting, this in turn makes the cost of establishing OTPs and SCs expensive as we are to procure tents for storage, clinic and accommodation, and fly in all items by air. South Sudanese Pound (SSP) depreciation; there is significant devaluation of the South Sudan Currency against USD, hence prices of basic commodities have increased more than fivefold. Deteriorating economic crisis in the country; commercial banks are not able to provide adequate amount of USD to their clients, making it difficult for RMF staff to be paid in USD. Lack of health care services in our areas of operation makes it very difficult to help patients of all age groups who arrive with medical conditions; it is unethical that health partners that have resources from donors are only providing services in the big centers and neglecting the communities at village level. 17. If applicable, plans for next reporting period: To integrate TSFP services into already existing OTPs in Ayod and Boma. To finalize the process of nutrition PCA renewal with UNICEF. To refurbish an office space allocated to RMF by the Jonglei State Ministry of Health to act as a sub-coordination office at state level. To continue implementing our activities based on our quarterly plan. RMF to solicit for more financial resources to cover the gaps since operational cost is very expensive. Need to procure additional office laptops for all the technical staff both at Juba and field level. RMF aims to lobby for resources to procure a car for Juba office. To follow up health care implementation with UNICEF and IMA in Boma and Ayod. 18. If applicable, summary of RMF-sponsored medical supply distribution and use: RMF procures basic medical supplies to take into our areas of operation.
19. Success story(s) highlighting project impact: Please review photo Annex. III. Financial Information 20. Detailed summary of expenditures within each budget category as presented in your funded proposal (file attachment is fine). Please note any changes from plans. Detailed financial reports sent separately on a monthly basis. Project Photos Food items procured, delivered to RMF Juba coordination office for shipping to various field sites Unpacking food items delivered to RMF Juba coordination office for shipping to various field sites A tent donated by UNICEF in Juba for shipping to Jiech, Ayod County Geoffrey, a RMF nutrition coordinator, conducting refresher training on CMAM protocol in Mogok
Mother-to-mother support group conducting their regular meeting, supported by RMF nutrition staff RMF nutrition nurse (in RMF T-shirt) distributing incentives to the mother-to-mother group Jubilant members of the support group after receiving bars of soap as incentives A mother feeding her SAM child in the feeding program RMF nutrition nurses in the Mogok SC (Stabilization Centre) discussing patient management Charles, a nutrition nurse in the Mogok SC, measuring the blood pressure of a severely malnourished child in treatment
Severely acute malnourished child with medical complications in treatment at the SC Severely acute malnourished child with medical complications in treatment at the SC A nutrition nurse feeding a SAM child through a nasogastric tube, admitted to the SC with medical complications A nutrition nurse feeding a SAM child through a nasogastric tube, admitted to the SC with medical complications SAM children with medical complications in treatment at the Stabilization Centre A nutrition staff member with a megaphone, going to mobilize the community for screening
Mobilized community ready to receive health/nutrition information before screening RMF nutrition staff conducting nutrition/health education RMF nutrition staff conducting nutrition/health education RMF nutrition staff conducting screening through MAUC Community awareness through health/nutrition education RMF s Boma team sharing their experience with our Juba team during a supervisory visit to Boma
Dell desktop computers procured and delivered to RMF s Juba office A logistics intern happily using a newly installed desktop computer