Unity

1. Unity 2nd South Sudan Health Sector Summit December 2013 Presented by : Dr. Manong T. Teny

2. Contents • Introduction and Overview of State • Health Indicators • Health Management Information System and Integrated Disease Surveillance and Response • Number of Health Workers and Facilities • Gaps in Infrastructure and Workforce • Human Resources: South Sudan Electronic Payroll System & Human Resource Information System • Pharmaceuticals and Medical Supplies • County Health Departments and Conditional Transfers • NGO County Partners and Donors • Problems faced by State Ministry of Health • Suggestions, Recommendations and Innovations 2nd South Sudan Health Sector Summit

3. UNITY STATE MINISTRY OF HEALTH • The Unity province was upgraded into a State in 1994. it has 9 counties. • Bordering Abyei Area,South Khordofan and Upper Nile in the north , Warap in the west, Jonglei in the east, and Lakes in the south. • 588,801 people Based on 2008 census • Estimation for 2013 is 693,584 plus the returnees 150,000 2nd South Sudan Health Sector Summit

4. Health Indicators 2nd South Sudan Health Sector Summit

5. Health Management Information System / Integrated Disease Surveillance & Response • The State has an officers for each HMIS and the IDSR • The state submit its reports based on the existing IDSR and HMIS Tools . • Data from the counties are collected on weekly or monthly basis despite some challenges ( means of communication and transports ) • The state HMIS officer is no longer available, therefore training of new one is required. 2nd South Sudan Health Sector Summit

6. Health Facilities and Human Resources Around 45% of the Facilities are not functional though PHCUs. Most qualified Health Personnel are in the State Hospital and SMOH-HQs. No consultant in the State Hospital. Very few Nurses are Registered Nurses. No single registered midwife 2nd South Sudan Health Sector Summit

7. Gaps in Facilities and Workforce No Medical Doctors at county level. No Registered Midwife in the State. The State Hospital and PHCCs Needs renovation, furniture's and Equipment and some payams need construction of PHCCs and PHCUs. Most Facilities lack incinerators. No Mortuary in the State Hospital. 2nd South Sudan Health Sector Summit

8. South Sudan Electronic Payroll System & Human Resource Information System No, Some Health facilities are being run by volunteers CHWs. Yes, SSEPS has been centralized at State Ministry of Labour ,Public Service and Human Resource Development and it’s being uploaded every Month. . The counties and the State share the same pay roll which is being managed by the state ministry of labour Above 80% of the SMOH Staff are already in the HRIS, All Staff will be in the System by the first quarter of 2014. Updating HRIS was problematic. E.g. Frequent staff screening, staff turn over. This was overcome by staff headcount from the field and a final version of staff list was identified . Hence regular staff capacity building on HRIS is required. 2nd South Sudan Health Sector Summit

9. Pharmaceuticals and Medical Supplies The state has one medical store ,no stores at counties level. Last round of supplies received by the state was July 2012 as push system Pharmaceutical staff were trained on the pharmaceutical management system , but tools have never been provided to the state , the expired drug s are recalled from the facilities for disposal Other major sources for the drugs supplies: WH0, UNICEF, UNFPA, & NGOs which are running the facilities. No pharmacist by profession at the state level Supplies gaps are addressed only for the State Hospital, extra support needed is provision of supplies to the functioning health facilities. 2nd South Sudan Health Sector Summit

10. County Health Departments and Conditional Transfers SMOH prepares the whole budget , no specific counties monitoring committee in place yet. the CHDs are supervised by the SMOH The CHD and the implementing partners drafted the budget , which was not revised by the SMOH, some counties have no budget for the running cost of the CHD or even under budgeted for the Key staff in the health facilities . Some CHDs get support from the partners, Yet there are some dalay in the disbursement of funds. Yes, the SMoH is fully a ware of the transfer as per the guidelines. The transfer didn’t fill in the resource s gap. E.g some health facilities were not budgeted for . Shortage of staff is prominent , the only way is to train the CHD staff . 2nd South Sudan Health Sector Summit

11. NGO County Partners and Donors • Are the County Partners working with the County Health Departments and SMoH? Yes county health partners are coordinating with the SMOH. • Are they supporting capacity development at CHD? Some CPs have start to identify training areas of facility staff for short terms & long term training • Are CHDs and CPs budgeting together? In most counties they have budgeted together although some have forgotten some key budget lines which are concerning the CHD. • Are there any problems with the CPs or issues that need to be addressed? Issues concerning delay of fund disbursement to the HFs and CHDs( salaries Delay ) • Are there aspects which have been omitted from the major donor programmes which may limit the effectiveness?. Some health facilities which were not budgeted for in the last round need to be included in the coming budgeting process. 2nd South Sudan Health Sector Summit

12. Problems Faced by the State Ministry of Health • In adequate Qualified health staff. • High turnover of health staff. • Inadequate referral Means. • Poor health Infrastructure (some health facilities are temporarily constructed ). • Irregular pharmaceutical supplies & Equipment. • Lack of training facility for Midlevel Cadres in the State. 2nd South Sudan Health Sector Summit

13. Suggestions, Recommendations and Innovations • Recruitment of medical staff and plan for long term training. • Motivation of staff, by training, work benefit policies applied. • Provide ambulances at least one for each counties. • Construct a PHCC for each payam and PHCU for each Buma. And Renovate the existing health facilities. • Renovation of the state store and construction of new stores for the counties to accommodate Preposition of supplies to the state. • midwifery and nursing school is constructed since 2010 , needs renovation , expansion, equipment and staff . 2nd South Sudan Health Sector Summit