Republic of South Sudan 2011 Appealing Agency Project Title Project Code Sector/Cluster Refugee project VOLUNTEER ORGANIZATION FOR THE INTERNATIONAL CO-OPERATION LA NOSTRA NOTRA FAMIGLIA) Strengthening mother and child basic health care in Juba town and surroundings SSD-11/H/38842 HEALTH No Objectives This project aims to implement a new development plan with a transversal focus, creating an efficient MCH care network around Juba. To develop Usratuna PHCC with ambulatories for pregnant women at risk, a new specialized laboratory, ultrasound testing machine, epilepsy pharmacological treatment service. Taking advantage of the network created during the previous project phase, OVCI will cooperate with the SMoH and all the PHCCs/PHCUs: to reduce the maternal mortality ratio and the<5, infant mortality and disability rates. This purpose will be achieved rationalizing the referral system for pregnant mothers among PHCU, PHCC and hospital, involving the community level, in order to increase antenatal care coverage, proportion of births attended by skilled health personnel, correct referral of pregnant mothers with complications to secondary level services, EPI program coverage, paediatric health care and basic rehabilitation. Hold trainings for enrolled - community midwives, nurses, C.O., improve mother and child care, drug use during the deliveries, partogram and antenatal care. Organize training for laboratory technicians. Building on existing services in place will guarantee the sustainability and the reproducibility of the model created Beneficiaries Total: 64,830 Number of pregnant women visited by skilled midwives: per year: > 2000. Number of mother receiving supplementary food: 1500 per year. Attendances in Usratuna nutritional unit increased from 20.000 to 28.000 per year From 800 to 1200 epileptic people under treatment. N. 12000 outpatient visit in Usratuna PHCC per year N. 20.000 community members participating to awareness on mother/child health education on disability prevention and management. Vitamin A coverage in Juba: 70%. % children 12 to 23 months receiving DPT3/measles vaccine before 12 months age in Juba: 80% at least 50 midwives, 30 nurses, 20 clinical officers and 30 laboratory technicians involved in the training Female: 32,000 Children (under 18): 20,000 Other group: 12,830 Diseble children in charge of Community Based Reahbilitation: 192 - Epileptic patients: 1200 Implementing Partners N/A Project Duration Jan 2010 - Dec 2011 Current Funds Requested $592,295 Location Priority / Category Gender Marker Code Enhanced Geographical Fields NOT SPECIFIED MEDIUM PRIORITY 2a - The project is designed to contribute significantly to gender equality Page 1 of 5
Cash transfer programming Is any part of this project cash transfer programming (including vouchers)? Conditionality: Restrictions: Estimated percentage of project requirements to be used for cash/vouchers: No 0 Needs Since 2007, OVCI has been running the project Strengthening the Basic Health and Community Services in Juba County, in partnership with Ministry of Health GoSS, Ministry of health CES and Juba Catholic Archdioceses. The experience matured during its implementation, underlined that the main issue to be addressed in Juba is the antenatal, postnatal and delivery care, as well as paediatric health prevention and treatment. To bring some examples, below you can find the 2008 WHO/UNICEF statistics for S. Sudan: Maternal mortality ratio of 2054 per 100.000 < 10% of all deliveries in assisted by skilled personnel The generalized acute malnutrition rate (GAM) is 33%, with only 21% mothers. Estimated number of children (0-14 years) with HIV: 30.000. Estimated vaccination coverage, from 10 to 30% (measured by DPT3) <1 mortality rate: 102 per 1.000 live births; <5 infant mortality: 135 per 1.000 live births. Finally, according to a door to door survey held by OVCI/CBM in Kator Payam (Juba) in 2007, the mortality rate of <5 children with disability in the area seems to be very close to the 70%. In November 2009, OVCI was requested by the Ministry to continue with the project with a special focus on mother & child health care. In addition, in March 2010, Juba BSF secretariat invited OVCI to submit a project proposal, especially aimed at: - supporting the health services delivery in Juba urban with special service programs; - continuing specific in-service training of SMoH health professionals with in-service courses, based on priorities of MoH, and increasing the recognition of these courses in coordination with the SMoH, disseminating training information and materials etc. to improve their skills. The project will give a significant contribution to the GoSS indicators nr. 1, 3, 4, 5, 7, 8, 9, 11, 12, 13. In particular, the project will focus on antenatal and postnatal care services by skilled health personnel, on the increase of the % of children receiving DPT3/measles vaccine, on vitamin A coverage, on nutritional services for underweight children and for mothers at risk. The new referral system will also improve the % of skilled birth attendances. Furthermore, continuative training for the health staff will improve the % of PHCUs with at least 2 trained health workers able to manage nutritional interventions. The project will finally guarantee the continuative supply of drugs for delivery care in the main facility of the network. OVCI will strive to link the local communities with the health services provided in Juba through correct awareness information and networking, in order to prevent social exclusion of the most vulnerable population, first and foremost pregnant mothers and disabled children. Juba County is not a priority county, according to MoH GoSS guidelines. Nevertheless, it is to be underlined the crucial role that Juba town has now and will have in the forthcoming future. This is particularly true from the following points of view: - for the importance and for the visibility of the models implemented in the town, which could actually be reproduced all over Southern Sudan - for the current growth rate of the town, due of the many refugees and IDPs returnees, considering that the health system in Juba cannot yet be considered solid. Activities Page 2 of 5
Taking advantage of the network created during the previous project, OVCI will cooperate with the SMoH and with all the PHCCs and PHCUs of the area, in order to achieve: 1. Solid network among PHCU, PHCC, Usratuna and Hospitals to refer pregnant mothers at risk, children with impairment and/or disability (including epilepsy). The above described network will be built on the result of the last project phase, in collaboration with the SMoH Maternal Care Supervisor, held several training sessions for the midwives, nurses and clinical officer of Juba, involving all the main facilities of the area. 1.1. Comprehensive survey of the main health facilities of Juba town and surroundings, hosting antenatal and/or delivery care services, in partnership with SMoH. This means: assessing in depth the conditions of the structures, the basic services rendered, their efficacy, and the current level of staff after downsizing and reshuffling by SMoH. 1.2. Special training sessions for the personnel of the selected Centers in the diagnosis and referral of pregnant women at risk. The training will be aimed at guaranteeing quality antenatal care and safe hygienic delivery, emphasizing on early recognition of complications and live-saving interventions. 1.3. Special training sessions will even be held in early screening, treatment and referral of children impaired, disabled (including epileptic) or at risk of disability. 1.4. In collaboration with the SMoH, a secondary level referral system will be established with the Hospitals in Juba, to guarantee a safe delivery for mothers with severe complications. Agreements with the two main hospitals will be signed on this purpose. 1.5. Common referral forms and procedures will be standardized with the SMoH and distributed, to create a rational referral system from the main outreach facilities to Usratuna Centre, and from Usratuna to the Hospitals. 1.6. Periodical meetings will be organized with the Community Health Committees on mother & child care and prevention, to guarantee correct information on antenatal, safe-delivery & postnatal services in place, and on disability management. 2. Usratuna PHCC specialised, and integrated with services for pregnant mothers: a new specialized laboratory, an ultrasound testing service, drugs store & epilepsy diagnosis & treatment. 2.0. Building up of 4 rooms in Usratuna Centre, for the new services to be established. 2.1. Strengthening of the Usratuna Centre laboratory on serology and biochemistry, including new tests for mother at risk as HIV, sickle cells anemia, syphilis etc. 2.2. Specialization of health technicians in ultra-scan gynecological diagnosis and labor monitoring 2.3. Starting-up of the 1st public ultra-scan pregnancy and gynaecologic testing service. 2.4. Strengthening of the outpatient service for epilepsy diagnosis and treatment. The service will be upgraded at diagnostic, therapeutic and referral levels. It is to be underlined the one in Usratuna is the only epilepsy pharmacological treatment service in the whole Southern Sudan. 3. Improve basic paediatric treatment & disability prevention in Juba. The 27-year OVCI experience in the paediatric field will be further developed, according to the BPHS (p.15 and p. 24), with medical and community-based approaches. Outcomes Page 3 of 5
1.1. Produce a report on the survey of 20 health facilities with antenatal and/or delivery care services in Juba town and surroundings. 1.2. Training in the diagnosis and referral of pregnant women at risk (mechanical, infectious, physio-pathologic) involving at least 50 midwives, 30 nurses, 20 clinical officers and 30 laboratory technicians 1.3. Training of the personnel in early screening, treatment and referral of children impaired, disabled (including epileptic) or at risk of disability involving at least 50 midwives, 30 nurses, 20 clinical officers and 30 laboratory technicians. 1.4. Development of a secondary level referral system with the Hospitals in Juba; number of first antenatal visits provided by skilled midwives: per year: > 2000 1.5. Creation of a network from the outreach facilities to Usratuna and from Usratuna to the Hospitals in Juba, involving the GoSS and CES MoH; % of correctly referred pregnant women at risk (from PHCCs & PHCUs to Usratuna, and from Usratuna Centre to the Hospitals): 80% 1.6 Health committee awareness on mother and child care and disability management; n. of meetings with health committee: 25 2.0. Building up of 4 rooms in Usratuna Centre 2.1. Number of specific laboratory tests performed in Usratuna new laboratory: 3.000 2.2. Training of 3 specialized technicians in ultra-scan. 2.3. Establishment of a public service of ultra-scan pregnancy and gynecologic testing. 2.4. Strengthening of the outpatient service for epilepsy management (diagnosis and treatment) with 1200 epileptics under treatment 3.1. Training of 50 midwives, 30 nurses, 20 clinical officers and 9 CBR workers, 4 CDOs on postnatal, disability prevention, early screening, referral & basic home treatment 3.2 EPI program in Juba and neighborhoods: % children 12 to 23 m. old who received DPT3/m. v. before age 12 m. in Juba: 80% 3.3 Supplementary food distribution: attendances in Usratuna nutritional unit from 20.000 to 28.000 per year; mothers receiving supplementary food: 1500 per year 3.4. Community-based rehabilitation interventions: 192 3.5. Community awareness on health & disability issues; vitamin A coverage 70%; knowledge of health workers in managing important ailments as judged by c. vignettes 40% Juba; N. 20.000 community members participating to awareness programs for disability prevention, mother & child care and health education 3.1. Special training of midwives, C.O. nurses, CBR workers and CDOs on postnatal care, disability prevention, early screening, referral & basic home treatment 3.2. EPI program in Juba town and surroundings underserved areas 3.3. Out-reach Supplementary-Feeding Program with powder milk distribution 3.4. Community-Based Rehabilitation package in the most underserved zones of Juba 3.5. Community awareness on health & disability related issues. Page 4 of 5
Volunteer Organization for the International Co-operation la Nostra Famiglia(OVCI la Notra Famiglia) Original BUDGET items $ Human Resources 36,084 Travel and Per Diems 21,252 Equipments and Supplies 3,300 Project office 45,698 Direct Service Delivery Costs 485,961 Total 592,295 Volunteer Organization for the International Co-operation la Nostra Famiglia(OVCI la Notra Famiglia) Current BUDGET items Human Resources 36,084 Travel and Per Diems 21,252 Equipments and Supplies 3,300 Project office 45,698 Direct Service Delivery Costs 485,961 Total 592,295 $ Page 5 of 5