Government of Southern Sudan Basic Services Fund (BSF) Health Sector Sub-Committee Meeting 1st December 2010 AGENDA •Introduction •BSF Cumulative Targets and Achievement Table •Grant Recipients •Counties BSF-IA Health •Targets BSF-IA Health •BSF-IA Narrative Progress •AOB Introduction BSF-IA: 1 July 2010 – 31 December 2011 • Round 4: GBP 37,529,543 total grant • Donors: DFID (UK), Netherlands, Norway, Sweden, the European Commission. • Total health component = 18,394,372 GBP • 21NGOs are carrying out health activities • Support to Primary Health Care; PHCU and PHCC infrastructure and services, training of health facility staff and Boma Health Committees, capacity building of CHDs etc. BSF Cumulative Targets and Achievement Table Cumulative BSF-1, -2 BSF-1 BSF-2 BSF-IA and IA CUM CUM Target Achieved % Target Achieved % Target Achieved target achieved Education beneficiaries (students) 28,000 26,800 96% 33,250 25,600 77% 10,600 0 63,000 52,400 1,093,62 1,142,4 Consultations - 168,665 - 5 99 - 2,404,789 1,262,290 PHCC construction 18 13 72% 5 5 100% 11 - 29 18 PHCC services 6 7 117% 21 25 119% 39 - 71 32 PHCU construction 36 23 64% 12 16 133% 47 - 86 39 PHCU services 5 20 400% 75 69 92% 102 - 191 89 Health beneficiaries 1,815,00 1,645,00 2,605,0 2,775,00 4,735,0 (capacity) 0 0 91% 00 0 107% 00 - 9,155,000 4,420,000 Grant recipients Lead NGO Consortium partner(s) State(s) County(ies) Medair Fashoda Youth Forum Upper Nile Melut, Manyo Malaria Consortium Tearfund Upper Nile Fashoda, Manyo GOAL Upper Nile Baliet, Ulang, Akoka ADRA Upper Nile Nasir/Luakpiny Christian Development Services Eastern Equatoria Budi IRD John Dau Foundation Jonglei Duk IMC Nile Hope Development Forum Jonglei Akobo Presbyterian Relief and Development Agency Marie Stopes UNIDO Unity Abiemnhom, Mayom CARE Unity Rubkona, Guit, Mayendit, Pariang ARC Sudan Health Association (SUHA) Eastern Equatoria Magwi Kapoeta Development Initiative (KDI) Kapoeta South Communication for Life Change Program (CLCP) Kapoeta East Grant recipients - cont Merlin Eastern Equatoria Torit, Lopa, Ikotos AVSI Catholic Diocese of Torit Eastern Equatoria Ikotos OVCI Catholic Archdiocese of Juba Central Equatoria Juba CMS-Ireland Episcopal Chuch of Sudan, Yei Diocese Central Equatoria Yei, Lainya Malteser W. Equatoria Maridi CORDAID Catholic Diocese of Tambura / Yambio W. Equatoria Ibba, Nzara World Vision Catholic Diocese of Tambura / Yambio W. Equatoria Ezo, Tambura Healthnet Western BeG Jur River, Raga CONCERN Northern BeG Aweil West Malaria Healthnet Northern BeG Aweil North Consortium Christian Reaching Ministries CCM Warrap Tonj East, Tonj North ZOA Refugee Care COMPASS Central Equatoria Terekeka (Note: watsan; but with 3 health components) 21 contracts 18 consortium partners (16 9 States 37 Counties Sudanese, 2 int.) Counties BSF-IA health Targets BSF-IA health Cat 2 Lead agency Construction and services Services only Beneficiaries PHCC PHCU PHCC PHCU Population * Target consultations ** AVSI 2 1 4 53,012 37,108 CCM 3 2 5 163,896 114,727 CMS Ireland 1 8 80,000 56,000 CONCERN 3 2 6 99,730 69,811 GOAL 1 2 6 82,082 57,457 IMC 2 2 8 68,105 47,674 IRD 1 1 3 32,794 22,956 MEDAIR 1 3 8 81,252 56,876 MERLIN 1 4 5 71,012 49,708 OVCI 1 3 100,000 70,000 TEARFUND 4 2 4 42,518 29,763 WORLD VISION 1 2 1 6 54,271 37,990 TOTAL CAT 2 4 19 23 63 928,672 650,070 * Based on 2008 ** based on Census and average 0.7 actual area data consultations / capita / year Targets BSF-IA health - Cat 1- Lead agency Construction and services Services only Beneficiaries PHCC PHCU PHCC PHCU Population * Target consultations ** ADRA 1 1 16 154,600 77,300 ARC 1 1 4 2 137,478 68,739 CARE 3 3 134,733 67,367 CORDAID 4 2 2 53,790 26,895 MALTESER Int 1 18 1 82,461 41,231 MARIE STOPES 3 5 137,727 68,864 3 health service components; VCT (static and outreach), community ZOA based malaria control, CHD office and -furnishing TOTAL 4a 6 23 14 25 700,789 350,395 HEALTHNET 1 2 1 7 154,941 77,471 MALARIA CONSORTIUM 1 7 129,127 64,564 TOTAL 4b 1 2 2 14 284,068 142,034 TOTAL 4 (CAT 1 and 2) 11 44 39 102 1,913,529 1,142,499 * Based on 2008 ** based on Census and average 0.5 actual area data consultations / capita / year BSF-IA Narrative Progress Upper GOAL; Baliet, Ulang, Support 2 PHCCs and 8 PHCUs in two Counties. The newly-created Akoka Nile Akoka County is served by 1 PHCU with services but will be handed over. Tearfund; Fashoda, This programme (2 PHCCs and 8 PHCUs) is severely constrained by part of Manyo insecurity since 27-6-2010. Due to confiscation of assets (vehicles, communications equipment etc.), pillage and harassment of staff; great losses have been incurred (200,000 to 250,000 GBP). emergency health services have been provided, out of a temporary base in Malakal Medair; 1 PHCC and 6 PHCUs in Melut; 2 PHCCs and 3 PHCUs in Manyo. Melut and Manyo Much greater CHD engagement and contribution (pay-roll inclusion, support to drugs’ deliveries etc.) in Manyo than in Melut. ADRA; Nasir Construction of 1 PHCC still to start (due to flooding); integrated support with the rehabilitation of EPI logistics, incentices to all HF staff. Jonglei IMC; Akobo Delayed start due to management problems, and lack of effective coordination with two partner NGOs. Lack of effective EPI support during July – November. Planned upgrading of Thokliel PHCU to PHCC. “Crisis management” attention by BSF, in coordination with IMC-UK. IRD; Duk Accessibility constrained, due to flooding up to November, restricting the outreach to 4 PHCUs. Improved program management in the field, compared to BSF-2, with JDF as main implementing partner. Planned CHW trainin re-oriented, with employing additional nurses, CMWs. BSF-IA Narrative Progress, cont. EES ARC; 4 PHCCs in Magwi; 2 PHCCs and 2 PHCUs in Kapoeta East/South Magwi, Construction of 2 PHCCs and 1 PHCU has been prepared in Kapoeta. Kapoeta E, Agreements with 3 CHDs on capacity building and joint supervision. Kapoeta S Planned training of CHWs is now reoriented to training more nurses, and intensified HHP training / outreach . MERLIN, Rehabilitation of buildings (Hyala PHCC mainly). Monthly outreach schedules. Torit, A lack of supervision was observed at Khurmush and Imorok PHCU by MoH-GoSS; this Lopa, Ikotos is addressed by MERLIN with BSF. AVSI; Ikotos Major support provided to St. Theresa PHCC (mission Hospital) by AVSI, as well as 6 MoH PHCUs. The St. Theresa PHCC management and support needs to be strengthened by the Diocese of Torit (with a functional MoU) ADRA; Budi Rehabilitation of 1 PHCC and 10 PHCUs; basic staff, EPI logistics, training of staff etc. Good partnership with CHD. CES OVCI; Juba Maternity network, based on Usratuna as refererral centre; with Juba town-wide epilepsy treatment unit and community-based identification/care of physically disabled. ZOA; By agreement with MoH and SC, thjis program is re-identified as a primarily Watsan Terekeka program. 3 supportive health components; community-based malaria control with LLITNs and -awareness, VCT (static and mobile) and construction of CHD office/stores. CMS; Yei, Outreach (weekly) out of Martha PHCC to 5 rural PHCUs in collaboration with CHD; Lainya essential equipment / drugs’ supplementation, training, coaching. BSF-IA Narrative Progress, cont. WES Malteser; Maridi Integrated services’ support to all 22 PHCCs and PHCUs in the County. Construction and rehabilitation of all buildings; weekly outreach with staff training, EPI support, drugs and equipment. CORDAID / Diocese Outreach to 8 PHCCs / PHCUs. Tambura-Yambio; No access to Nabanga PHCC in Ibba, due to LRA threat, but support and Ibba and Ezo training provided from distance. Support to EPI, health staff training, complementing of essential drugs and equipment. World Vision; Restricted access to several facilities, due to LRA threat, in Ezo County. Ezo and Tambura Need for effective EPI implementation in Ezo County, and for better drugs’ management etc. (addressed by World Vision). WBeG Healthnet; Jur River Extension of services in Jur River. No CHD is effective on the ground in and Raga Jur River but housed in Wau, with inadequate support to the field. New programme in Raga, in collaboration with CHD; taking over previous support by Red Cross societies etc. Useful PBF approach to health services in Jur River. BSF-IA Narrative Progress, cont. NBeG CONCERN; Limited accessibility due to flooding up to November. Aweil West Integrated services’ outreach continuing, with weekly EPI schedules. Malaria Cons.Teething problems; taking over facilities previously supported by CORDAID, with Aweil North high expectations on the side of CHD and SMoH. Limited accessibility to outlying PHCUs, due to flooding. Warrap CCM; Tonj Ananatak PHCU and zone affected by inter-clan conflict since Dec. 2009, while East, Tonj insecurity in August required temporary staff withdrawal from CCM base in Kacuat. North Limited accessibility due to flooding. Gradual improving capacity of Tonj East CHD, but not yet of Tonj North. Unity CARE; Need for rehabilitation and maintenance of many buildings. (Pariang, Integrated weekly supervision, with EPI support, but inadequate EPI outreach to Rubkona, Guit, communities. Mayendit) Health-preparedness for influx of returnees from Northern Sudan. Marie Stopes Limited accessibility, due to flooding, up to November; prepositioning of supplies in (Abiemnhom, Bentiu. Mayom) Strong program focus on Reproductive Health with training of health staff. Need for preparedness for returnees’ influx. General monitoring observations CHD • A great range of organisational capacity of County Health Departments; a few are active County Health teams, with annual workplans, supervision schedules, MoUs with NGO partners (e.g. Maridi, Magwi), but most are one / two person establisments, without supervision schedules (worst cases; Akobo, Tonj North). Need for proactive NGO engagement with CHDs! General monitoring observations Payroll • The payroll efficiency and -management varies greatly from State to State. In EES no payments between Jan. – Oct. 2010, while in WBeG all months were paid in first week of next month. Payroll inclusion is often contested and a “work in progress”. Need for transparency and further capacity building. General monitoring observations CHW/MCHW • The phasing out of CHW / MCHW training puts a lot of strain on existing health facilities. There are simply not enough nurses and Community Midwives to fill posts, leading to employment of even less qualified staff. General monitoring observations TBA • The training and support of community- based TBAs needs attention. The sole training message of TBAs is referral to health facilities, but these are far and few in between. The provision of delivery kits (UNFPA) gives another message. Need for practical TBA support to reduce maternal mortality! Thank you • Questions? • Comments?
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