Southern Sudan Health Update July Aug 27 ARD, WR Sudan and HQ Delegates Visit to Southern Sudan Highlights Health System Development Nursing and Allied Health Human Resources Emergency Humanitarian Action Health Assistance to Returnees/Community Pre positioning of Health Kits Cholera Preparedness and Prevention Strategy 5 EWARN Update 6 HIV/AIDS Programme 7 Roll back Malaria 9 Polio Eradication Programme Guinea Worm Eradication Program Kalaazar Disease Burden Community Based Initiative (CBI) World Health Organization Southern Sudan Office UN OCHA Compound Juba, Southern Sudan Phone: +249 811 8277 Fax: +249 811 232333 www.who.int www.emro.who.int/sudan 1 2 3 4 1 12 13 27 Aug 27 Assistant Regional Director Dr Abdullah Assa'edi, WHO Representative Dr Mohamed Abdurrab together with HQ delegates visited Southern Sudan to meet with Minister of Health and Director Generals GOSS, to share and finalise the draft Country Cooperation Strategy (CCS) along with NGOs, UN Agencies and other health Health System Strengthening (HSS) WHO has been providing technical support to the Ministry of Health to strengthen the health system in Southern Sudan. In June 27, the Ministry of Health set up a National Health System Steering Committee and a Technical Task Force of the Committee of which WHO is a member. The main activities of the committee have been to focussed on the preparation of an application for the Global Alliance for Vaccines and Immunization (GAVI) fund for Health System Strengthening (HSS). The Ministry of Health has requested WHO to provide technical coordination in the process of developing an application for the GAVI HSS funds, under the overall leadership of the Ministry. For this purpose WHO briefly availed the technical support of the EMRO regional focal person for Health System Strengthening to provide guidance to the Task force in the preparatory stages and to clarify issues in regard to the process of application. The Ministry of Health has also requested WHO to provide technical assistance for the whole period of the preparation of the application and the implementation of the work plan, if such an application is approved. WHO has since provided generic assessment tools, relevant reference materials and terms of reference for the required technical assistance. The task force has continued its work, as the recruitment of the technical assistance progresses. Essential Medicines and Pharmaceutical Policy Subsequent to the assessment of the pharmaceutical stores and hospital pharmacies that was conducted in June 27, WHO has prepared a work plan for the capacity building of the Directorate of Pharmaceutical Services, in Juba and the regional pharmaceutical stores in Wau and Malakal, including development of guidelines, training, provision of office and IT equipment and communication facilities. Implementation of the work plan will be supported by the Italian fund. As part of the strengthening of the pharmaceutical regulatory system in Southern Sudan, WHO organised and funded the training of four Southern Sudanese pharmacists in pharmaceutical regulation in collaboration with the Jordan Pharmaceutical Regulatory Authorities. This three-week course covered theory and basic hands-on training in pharmaceutical inspection and marketing authorization of pharmaceuticals. WHO has started pre positioning inter-
Health System Development agency health kits and diarrhoeal disease kits particularly for flood affected areas. Moreover, WHO has donated, Artesunate based Combination Therapy (ART) medicines and hospital equipment to the Ministry of Health, GOSS. WHO continued to provide technical support for the implementation and monitoring of the Ministry of Health Umbrella Health Sector Programme, financed by the Multi Donor Trust Fund (MDTF). In July 27 WHO participated in the discussions with the MOH and the World Bank and the proposed contractor for the MDTF Component III - Capacitybuilding at Government MOH and State levels to Strengthen Pharmaceutical Practices and Supply Management Component of the programme. Human Resources for Health As a continuation of its support to the pre-service health training institutions in Southern Sudan, WHO donated a 7 KVA generator, seven split unit Air condition systems, additional IT equipment, internet connectivity and other equipment to Juba Health Science Training Institute. WHO is also working with the Ministry of Health in the development of pre-service training curriculum for Public Health Technicians. Monitoring and Evaluation WHO participated in a technical working group meeting on Monitoring and Evaluation held on Aug 21, 27. During this meeting issues related to the development of a national health information system/monitoring and evaluation (M&E) system were discussed. Meeting finished with the following action points: 1. A final M&E draft will be disseminated to partners for input and review. Three additional drafts are envisaged prior to this 2. Reference material will be prepared and disseminated to partners 3. Training and strengthening of M&E state capacity will be undertaken at all state levels 4. An external agency will be contracted to monitor emerging needs and the efficiency of the M&E system 5. Harmonizing of the different M&E tools currently in use in Southern Sudan (within the NGO context) will precede piloting and scaling up of the system. Coordination and interlinkages will be negotiated 6. Memoranda of understanding will be entered between NGOs and MoH (line ministry) in which NGOs will be required to submit quarterly reports Nursing and Allied Health In order to support training of qualified health personnel, a five-day training workshop with the subject of Effective teaching was conducted in Juba. Participants consisted of eight village midwife trainers. The training mainly covered practical methods of teaching skills, knowledge, attitude and different assessment methods. The training took place with active participation of trainees in the learning process. The objective was to prepare the participants so that they would be able to: Participants attending a training session 1. Decide on what has to be taught to the students and apply it in their teaching. 2. Decide on appropriate teaching methods (for different teaching objectives) and apply them in their teaching. 3. Decide on appropriate evaluation methods (for different teaching objectives) and perform them effectively. 4. Develop simple training materials for their training sessions Job descriptions for different categories of nurses in Southern Sudan have been developed, as it didn't exist before. Initially they will be implemented in Juba Teaching hospital and will be rolled out later on. To support newly developed community midwife training programs in Southern Sudan, more than fifty reference books have been procured and provided to Maridi Health Training Institute. Training of nursing teachers of Juba Nursing School in Teaching and evaluation methodology has been completed. A work plan for establishment of an Institute of Health Sciences in Rumbek has been developed. The implementation will soon start. Page 2
Emergency Humanitarian Action Response to Floods Flooding which started from early July, in parts of Unity and Upper Nile States has now been confirmed through interagency assessments in both States and humanitarian interventions are underway. In August however, other States such as Lake and Jonglei reported to have been affected by floods. The primary cause of the flooding in areas assessed so far is due to heavy rainfall compounded by disruption of natural drainage systems as a result of road construction. However, flooding in Renk County the worst affected area - is a result both of heavy rain plus obstructed drainage and of the Khorachil River bursting its banks, causing considerable damage to property, displacement and the loss of two lives. The State governments in both States (Upper Nile and Unity) have established Crisis Committees while the Government of Southern Sudan (GoSS) has formed a Prevention and Preparedness Disaster Committee at the central level led by the Vice President and includes key ministries such as Ministry of Internal Affairs, Information and Broadcasting, Health, Animal Resources and Fisheries, Transport and Roads and the Southern Sudan Relief and Rehabilitation Commission who are the focal point for liaison with UN agencies and NGOs and for conven- ing the government technical committee. The GoSS Disaster Committee visited affected areas in Unity and Upper Nile on 22 and 23 July accompanied by officials from the State authorities and representatives of the UN Resident Coordinator s Office. The Office of the Vice President issued a disaster declaration on 21 st July 27. Government, UN and NGO efforts are underway to assess the extent and impact of flooding in Unity and Upper Nile and to prepare for potential further flooding, which the GoSS has expressed concern, could affect up to six States namely Upper Nile, Unity, Jonglei, Lakes, Warab and Northern Bahr el Ghazal. Health Sector Coordination In response to the floods, WHO as sector lead for Health and Nutrition, has consolidated a flash appeal for health and nutrition in Southern Sudan, addressing various proposed emergency intervention in floods affected areas. A total amount of 2,794,49 USD have been requested to support the on going intervention in floods affected areas for next six months. WHO had secured a grant from the CERF of 295, USD for emergency flooding in Southern Sudan. In order to ensure availability of life- saving supplies at States level, WHO will procure a substantive quantity of Life-saving supplies such as Anti-rabies vaccines, Tetanus Immunoglobulin, and Snake- Anti venom, to be used during the and after the floods. Already Rabies and increasing snakes bite have been reported in Northern Bar El Ghazal and Upper Nile respectively. 3 25 2 15 1 5 Evacuation of flooded houses in Renk town 26 and 27 Rain falls 58.5 11 26 rain gauge records in millimetres mm 45 25 14 253 27 rain gauge records in millimetres mm May June July The chart above depicts the contrast between 26 rainfalls as opposed to 27 according to Oriny Rain Gauge records in Upper Nile State- according to Tear Fund UK. Page 3
Emergency Humanitarian Action Health Actions Health Assistance to the returnees and host community Currently there are no major crisis, however with the passage of time, situation is likely to deteriorate particularly through the upsurge of malaria, dengue fever and diarrhea diseases. State Ministry of Health and NGOs are providing basic health services. Continued need have been carried out, given the fact that the consequences of stagnant water are likely to impact on the health situation. WHO Epidemiologists at floods affected areas have participated in interagency assessment missions. WHO has propositioned NEHK (New Emergency Health kits which will be sent and pre-positioned in various states especially the affected flood areas. Since 1 January to August 27 the repatriation figure reached 54,857, out of whom 36,528 persons (67 %) were organized, 3,964 persons (7%) were assisted self-repatriation and 14,365 persons (26 %) returned home spontaneously. Following reported cases of Marburg fever (VHF) in Western Uganda; and in relation to the population movementsthe Early Warning and Response System have been strengthened; public health information in areas bordering Uganda was disseminated. WHO has also shared the information with all agencies and partners involved in returnee processes to ensure that returnees both IDPs and refugees are medically screened before departure and or in any identified way stations. WHO and the Ministry of Health are coordinating with the health implementing partners, to ensure immediate health assistance to the returnees and host communities are addressed WHO - Medicines & Supplies in Southern Sudan Participants attending a training session Page 4
EWARN Update General Situation July and Aug were marked by small outbreaks of cholera, measles, rabies and whooping cough. However, there have been no reports of significant increases in the incidence of both AWD and ABD from areas that have been seriously affected by the current flooding in the country. Zero reporting has been improved following the distribution of integrated disease surveillance and response (IDSR) data collection tools to most of the health partners on ground. This has resulted in relative increase in the number of reported cases during this month. On the same line, Two States have joined in the regular weekly reporting: Eastern Equatoria State where a fourth WHO epidemiologist was posted and Western Equatoria where IDSR training was conducted in July Cholera Preparedness and Prevention Srategy 1 1 1 1 461 A bid to be in a better state of preparedness for the subsequent epidemic seasons, a draft proposal for cholera preparedness and prevention (long term) strategy is being finalised by a sub committee of the south Sudan epidemic preparedness and response task force. Cases and deaths in south Sudan due to the four disease outbreak conditions from July to Aug 15 28 Cases Deat hs Cas es Deaths Cas es Deaths Cases Deaths AWD/ CHOLE RA ACUT E B LOODY DIARRHEA (A BD) M EA SLE S ME NI NGIT I S 127 3 2 1 Cumulative total cases and deaths in south Sudan of the four outbreak disease conditions from Jan 1 st to Aug 31 27 Acute watery diarrhea (AWD)/Chlra Acute bloody diarrhoea(abd) Measles Meningitis CASES DEATHS CASES DEATHS CASES DEATHS CASES DEATHS 9846 411 85 694 34 11975 672 CFR 4.2% CFR.% CFR 4.9% CFR 5.6% First training for trainers on integrated disease surveillance and response (IDSR) The training for trainers on integrated disease surveillance and response (IDSR) facilitated by MOH/GOSS, CDC and WHO was conducted in (Yambio) western Equatoria state from 18th to 23rd July 27. Nineteen participants from five of ten counties were trained. ToT in WHO (EWARN) office in Juba with the DG preventive medicine during the conclusion of the training The minister western Equatoria state giving a speech during the opening of the IDSR training in Yambio Participants during an exercise in Yambio Page 5
EWARN Update AWD/Cholera Fig 1. Weekly reported cases, deaths and CFR due to AWD/Cholera in Southern Sudan 27 A lab confirmed out break of cholera was reported in Alek in Gogrial west county of Warrap state in which 28 cases and 14 deaths were registered. This was brought under control by State Ministry of health (SMoH) Warrap, NGOs operating on the ground and a support team from the Ministry of health Government of southern Sudan (GOSS). Two other outbreaks (in Wau and Gogrial east counties) of acute cholera were reported early in July but the situation was brought under control by the combined effort of MOH/GOSS, WHO, UNI- CEF, World Relief, MEDAIR. The outbreak in Yei has been controlled and the CTC officially closed down at the end of July. CASES 1,4 1,2 1, 8 6 4 2 Wk1 Wk2Wk3 Wk4 Wk5Wk6 Wk7 Wk8Wk9 Wk1 Wk11 Wk12 Wk13 Wk14 Wk15 Wk16 Wk17 Wk18 Wk19 WEEKS Wk2 Wk21 Wk22 Wk23 Wk24 Wk25 Wk26 Wk27 Wk28 Wk29 Wk3 Wk31 Wk32 Wk33 Wk34 4. 35. 3. 25. 2. 15. 1. 5.. CFR cases deaths CFR Fig 3. South Sudan total weekly cases of measles, 27. One of the water sources in Toch village in Gogrial east (Warrap state) where a cholera outbreak was confirmed 1 25 Measles Reports on measles remained sporadic during the month of July and Aug. In Wuror county Jonglei State, measles out break was reported. This was verified (17 cases with no death) and brought under control by the joint efforts from TEAR fund, SMOH Jonglei, world relief and support from UNCEF. In Malakal 26 cases were recorded in Malakal hospital in mid July but after a campaign there, no more cases are being reported. Rabies Cases of rabies were reported in Raga County Western Behr el Ghazal State (9cases with 3 deaths). Case management was under taken but lack of rabies vaccines for dogs and humans remains a challenge to date. There has been an unverified report regarding the same in Western Equatoria State. CASES 9 8 7 6 5 4 3 2 1 WK1 WK2 WK3 Wooping Cough WK4 WK5 WK6 WK7 WK8 WK9 WK1 WK11 WK12 WK13 WK14 WK15 WK16 WK17 The outbreak of whooping cough was reported in Bor county Jonglei state in July. Case management, vaccination of under five children and surveillance was under taken and no more cases have been reported from the 5th of August. WKS WK18 WK19 WK2 WK21 WK22 WK23 WK24 WK25 WK26 WK27 WK28 WK29 WK3 WK31 WK32 WK33 WK34 Suspected Hep E Two suspected cases of hepatitis E virus have been reported in Rumbek- hospital Lakes State. Patients are currently admitted in the hospital. Moreover, 23 unverified cases with 11 deaths were reported during this period. 2 15 1 5 CFR CASES DEATHS CFR Page 6
HIV/AIDS Programme Developing the National Strategic Framework and Policy review for Southern Sudan From the 2 nd to the 6 th of July, WHO joined the Prevention team that went to Yei as part of the State visits organized by The Southern Sudan AIDS Commission (SSAC) The Prevention team met various stakeholders at Yei County, including local authorities and organizations including PLHIV. The multi sectoral team included the Ministry of Health, International consultants, lead agencies and NGOs, all together are contributing for the development of the National HIV/AIDS Strategic Framework lead by SSAC. Following the State visit all stakeholders met in Rumbek in order to attend the Policy development and National Strategic framework workshop. The National Strategic Framework (NSF) for HIV/ AIDS is one of the three components of the Three Ones Principle (The other Two are One National Coordinating Mechanism and One National Monitoring and Evaluating System) required worldwide to garner National response to HIV/AIDS pandemic. It is the only document recognized by the Donor community including Global Fund and the MDTF in committing resources to fight HIV/AIDS. Through its defined thematic areas it focuses the service providers towards standardized goals and strategies thus avoiding duplications and gaps in interventions. Mothers attending VCT group session Focus group session with PLHIV in Yei Assessing and preparing ART site in Yei According to the GFATM Round 4 work plan, WHO is a sub-recipient for the following service delivery areas: counselling and testing (HTC), STI management, blood safety, PMTCT and ART. The establishment of four new VCT/ART sites services in Southern Sudan is one of the main activities planned. Yei County has been considered a priority area for scaling up ART services and enhancing knowledge, practice and access to HIV/ AIDS services by the general adult population, youth and vulnerable groups including populations of humanitarian concern in Southern Sudan. All efforts have been put in place for having a func- tional site by the end of the 3 rd quarter of 27. Although there is less information on prevalence rates in the Country, the available information provides enough evidence for considering Yei a priority area. According to studies done between 1998 and 2 the prevalence found in Yei Town was 4.4% in adults between 15 and 49 years, it makes Yei one of the areas with the higher prevalence ht-out as a key area for continuing scaling up HIV/AIDS services in Southern Sudan. WHO assessed the site, and met different stakeholders during a visit to the County, including the County AIDS Commission, Yei Hospital in charge, INGOs and local NGOs, as well as PLWHV organizations in the county. Information was gathered from key informants and interviews, visit to the Hospital, VCT and PMTCT centers. WHO is closely working with partners to have a VCT/ART site functional by Oct 27. Page 7
HIV/AIDS Programme Inaugurating the UN Joint HIV/AIDS team The goal and purpose of Joint UN team on AIDS is to improve support to the national response, and contribute to expanding HIV prevention, care and treatment leading to reduced HIV vulnerability and infections. Strengthening the integration of HIV programming within existing frameworks and processes will be the key for effective and sustained support of the national response according to the UN team proposed working mechanism. What is different is the simplification and harmonization of UN support to national response, the definition of accountability line, the clarity on roles and responsibilities, by allowing the partners to access services for provision of technical support, unifying and integrating it, as well as evolution and strengthening of the HIV/AIDS component of UN Development Assistance Framework. WHO is contributing as focal point for the health and nutrition. Endorsing Sudan National Sero-behavioural Survey The government of National Unity and Government of South Sudan, in collaboration with multiple international stakeholders, WHO, UNAIDS,UNFPA, UNDP, UNICEF, CDC and others interested parties seek to conduct a nationwide HIV prevalence survey in 27-28. Southern Sudan AIDS Commission invited all Steering Committee and Technical working group members to attend a one day meeting. The purpose of the meeting was to endorse final draft of survey. This was a unique opportunity for all members of both committees to actively participate in the process News from the WHO HIV/AIDS programme team Dr. Emmanuel Lino has been appointed as HIV/AIDS focal point at the Ministry of Health GoSS. Dr. Claudia Vivas and Shashu Zegeye have joined the team as part of the scaling up of HIV/AIDS services for populations of humanitarian concern and VCT and PMTCT services respectively Page 8
Roll Back Malaria Training of Trainers on Case Management in Aweil State Responding to the request of the MoH-GOSS on technical assistance for training on the malaria case management, WHO/RBM office in collaboration with MoH/GOSS, conducted a Training Of Trainers course on Management of uncomplicated falciparum malaria with focus on Artemisinin based Combination Therapy (Artesunate + Amodiaquine) and Rapid Diagnostic Test (RDT). The training was conducted in Aweil town from 6 rd to 11 th August 27 through RBM partnership including MoH/GOSS IRC. Twenty Six (26) participants from the five countries of Aweil State attended the training. The objective of this training was to provide knowledge and skills to the senior health workers on malaria case management by us- ing ACT and RDT. The training was organized by Dr. Jeylani from RBM/WHO and was facilitated by Dr. Othwon Thabo, National RBM Focal Point for MOH/GOSS, Dr. Thomas Grang, the Hospital Director in Aweil town, Mr. Yusuf, WHO Laboratory Technologist, Mr. Solemon, IRC senior health worker. Facilitators collaborated with Participants attending a training session Instructor conducting a training session the participants to achieve the learning objectives of each subject outlined in the training manual. The outcome of the training was to develop a training plan of action of each county for their health workers at the PHCUs. GFATM Proposal In July 27, technical working group for malaria concluded and submitted the GFATM proposal on round 7. Before submission, the following issues were discussed in order to finalise the proposal: Malaria, Africa s Biggest Killer 1. Review of the current work a. Calculation of population figures for the basis of the financial gap analysis b. Discussion on formulation of calculations for net coverage 2. Further work required for gap analysis a. Follow-up with agencies regarding their activities b. M&E framework was referred c. Follow-up with agencies and donors for figures on the gap analysis Page 9
Polio Eradication Programme Polio Program and EPI Activities In early July, 2 cases of wild polio virus were identified in neighbouring Chad of which one was very close to the Sudan border. This situation brought fear of a repeat of the 24 importation. An immediate alert was transmitted to all focal points and EPI operation officers in all states. At Juba level the following actions were taken: An urgent meeting was held between MOH/GOSS, WHO and UNICEF where the implication of the isolation of WPV1s was discussed and steps to be taken im- mediately were outlined All focal points in all States were notified and they relayed the alert to all field staffs Message was passed through local radio stations about the isolation of wild virus in Chad, bordering Darfur, so that the public be aware of the potential risks and implications for the neighbouring counties/communities and report all cases of paralysis to the near by clinic or polio field assistants. The teams in the states did similar meetings with counter parts in the state ministries and partner agencies and NGOs. They all revised and submitted micro plans for SIAs in all accessible areas. However taking into consideration the rainy season and the floods in some parts of the country, it was decided to do the SIAs in the northern states including Darfur as the risk is higher in those areas. Southern Sudan will conduct the next SIAs in October and will be synchronized with Northern Sudan. Refresher Training on AFP Surveillance The yearly refresher training on AFP surveillance has started and is on going. Few states have completed the training. The refresher training is conducted for 2 days for field staffs and health personnel and a 1 day orientation/training for key community informants Table below shows the number of personnel trained in each training site. state Training site Number trained CEQ Yei, Kajokeji 45 EEQ Torit, Kapoeta 4 Jonglei Ayod, Bor, Boma, Pochalla 66 Lakes Rumbek, Yirol, Tonj 59 Page 1
Polio Eradication Programme The map above shows the distribution of AFP cases identified this year with the silent counties in color. Polio Program Achievements At the end of July 75 AFP cases were reported and investigated. The annualized non-polio AFP rate was 2.2 and the stool adequacy rate is 9.7%. There is a concern on the surveillance performance of Eastern Equatoria, Northern BEG and Upper Nile states, however every effort is being made to enhance surveillance through refresher training and community awareness creation. Hence preparedness and response plans for importation are being put in place in all states. 3.5 3 2.5 2 1.5 1.5 2 21 22 23 24 25 26 27* 1 9 8 7 6 5 4 3 2 1 Non-polio AFP Rate % Adequate Specimens The chart above shows surveillance performance indicators since 2 against the expected standard rates of 2 and 8% respectively. Page 11
Neglected Tropical Diseases Guinea Worm Eradication Programme The mid-year review for the Southern Sudan Guinea Worm Eradication Program (SSGWEP) took place in Juba from 31-July to 2-August. Reports received for the period January June 27 show that there has been a reduction of 69.6% in the number of cases, from 1,812 in 26 in the same period to 3,286 in 27, with a report rate of 73%. The number of cases contained has increased from 41% in 26 to 46% in 27. Five counties account for 79% of the cases and all of them have reported a reduction compared to the previous year: Kapoeta North (1,57 cases; -79%), Kapoeta East (943 cases; -56%), Ayod (274 cases; -49%), Kapoeta South (214 cases; - 61%) and Duken (12 cases; -18%). The program has decentralized management of stocks in all areas of Southern Children using pipe filters in a Guinea worm endemic area Sudan before onset of 27 peak transmission season. In close coordination, SSGWEP and Sudan GWEP have established surveillance for Guinea worm disease in border areas (e.g. transitional area such as Abyei). Filed Supervision and Training In July a supervision visit and a training session were conducted in Narus, Kapoeta East County, Eastern Equatoria State by WHO staff. The training focused on the needs identified during the field visit namely the laboratory diagnosis of Kala Azar using the Dipstick method and proper collection and storage of DAT samples, identification and diagnosis of Post Kala Azar Dermal Leishmaniasis, discussions on the diagnostic algorithm and completion of forms. In August WHO conducted a supervision visit in Malakal, Upper Nile. It was noted that the laboratory hospital is not routinely testing for kala azar since the NGO that was providing support left in mid-26. Currently patients treated at the hospital are being diagnosed at the private clinics in town and drugs are supplied by WHO. It was recommended an implementing partner to provide continuous support to the kala azar program and WHO to conduct training to set up a comprehensive system for diagnosis, treatment, record keeping and data collection. Administration of SSG using a cannula in Narus, Eastern Equatoria Kalaazar Disease Burden Over the period January June 27 a total of 434 cases of primary kala azar were reported from implementing partners. Over the same period last year a total of 73 cases were reported. Since the year 23 the number of cases has continuously decreased from 5,722 in 23 to 1,117 in 26. The five locations accounting for 74% (322/434) of the cases are Malakal (83), Ulang (72), Nasir (63), Kiechkuon (25) in Upper Nile State and Lankien (79) in northern Jonglei State. Page 12
Community Based Initiative (CBI) Activities of CBI/BDN, MPS and IECHC Community Based Initiative (CBI) is a comprehensive approach which targets on solving the most Basic Development Needs, which are not properly and universally fulfilled such as Basic Education, Adequate Income, Housing, Clean water, Food, and Healthy Environment through creating partnership with the community that can be built upon gradually into community leadership. The community members identify their priority needs, concerns, wants and ambitions. As the programme progresses the level of needs is raised and the level of community role is increased. The major stakeholders of CBI are developmental sectors and agencies, community and the civil society at large. In July 27, WHO provided the Deng Nhial CDC in Rumbek with the following items for carrying activities within the BDN Village. These items are: 1. Bicycle for the CHW to facilitate health visits within the village. 2. 3 Plastic chairs for Adult literary centre 3. 6 plastic tables for Adult literary centre 4. Hand washing buckets for school hygiene campaigns 5. Plates and water cups for the school feeding program 6. wheelbarrows, shovels, slashers for school hygiene campaigns Chairman of CDC chairing a meeting of CDC Handing over BDN items to the Chairman of CDC and community Making Pregnancy Safer MPS Making Pregnancy Safer is a worldwide effort that aims to reduce number of deaths and illnesses associated with pregnancy and childbirth. This training was organized by Making Pregnancy Safer and Allied Health programmes in collaboration with the state Ministry of Health for Central Equatoria State. Duration of the training was five days and was attended by nine participants. 1. This training course has been designed to train tutors/supervisors in south Sudan on teaching methodologies, tools and materials to teach CHWs/MCHWs and VVs on general danger signs, cough or difficult breathing, diarrhoea, malaria, malnutrition, anaemia, teach and advise child's mother. Furthermore, this training course will enable trainers to train other tutors. 3. Provision of IECHC training materials for GOLD Ireland to train CHWs on management of children between 2 months and 5 years. Training Report Summary (IMCI/IECHC) Integrated Management of Childhood Illness is a horizontal approach. IECHC module is actually the modified form of IMCI for Community Health Workers and Maternal and Child Health Workers (CHWs/MCHWs) and Village Volunteer (VV) who are in the front line of health service delivery in the PHCUs where patients first come in contact with the health system. The number of participants was 5. These were sector heads of health programmes being run by TEARFUND Organization Participants attending a training session 2. To enable tutors to transfer their knowledge and information on teaching methodologies, tools and materials to other tutors, in order to create a cascade process. Group Picture of TEARFUND Participants, Health Coordinator and Tutor Page 13