30-11-10 health Sub-C'ttee presentation

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					   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




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