An Overview of Health Situation

1. An Overview of Health Situation Dr. Lul P. Riek DG. Internatinal Health & Coordination 4th December, 2013

2. Outline • Introduction • Situational analysis (child, maternal and HR) • Diseases burden • HSDP and some selected targets • Health financing analysis • Existing coordination mechanisms • Conclusion

3. The Republic of South Sudan Western Bahr el Ghazal Upper Nile Unity Warrap Jonglei Lakes Western Equatoria Eastern Equatoria Central Equatoria 2nd South Sudan Health Sector Summit

4. Introduction • 5 decades of liberation war from 1955-2005 has disrupted all infrastructure & social services including health system • more than 2.5 million have died & 4 million displaced • NGOs & FBO assumed responsibility for health service provision in liberated areas • CPA signed in 2005 till July 2011 when RSS attained independence, assuming full responsibility for service delivery • Administrative organization • 10 states, 80 counties and 517 payams

6. Infant Mortality (SHHS 2010) Infant Mortality Rate: 75/1000 per live birth

8. Percentage of children aged 12-23 months currently vaccinated against Childhood diseases (Fully Immunized Children)

9. Under-Five Mortality Rate (SHHS 2010) • Under Five Mortality Rate 102/1000 per Live Birth

10. Situation AnalysisChild Health Indicators SHHS 2006 • Infant Mortality Rate was 102/ 1000 per live birth. • Under Five mortality was 135/1000 per live birth. SHHS 2010 • Infant Mortality Rate has decreased slightly is now = 75/1000 per live birth. • Under Five Mortality Rate is now=105 /1000 per live birth.

13. Antenatal care coverage (ANC),Percent distribution of women aged 15-49 who gave birth and received at least one antenatal care service

14. Antenatal care coverage (ANC),Percent distribution of women aged 15-49 who gave birth and received antenatal care service (at least 4 visits)

15. Percentage of Women Given Birth in health Facility

16. Contraceptive Prevalence Rate,Percent Distribution of Women who use contraception

17. Unmet Need for Family Planning,Percent Distribution of Women who with unmet need

18. Transportation of a Patient with Impending Uterine Rupture

21. Human Resources for Health • Acute shortage of qualified staff • 0.5 medical officer per100,000; 2 MWs/Nurses per 100,000 • Disproportionately distributed in urban areas • Community Health Workers constitute biggest proportion • Weak HR management system • Lack of retention policy • Limited capacity for production in terms of numbers & categories of health cadres

22. Why Poor health indicators • Inaccessibility of health facilities • Weak public health system and management • Extreme shortage of health workforce • Poor health infrastructure • Lack of well equipped facilities to address pregnancy related complications • Limited awareness on health issues • Lack of transport to facilitate referrals for obstetric care incase of emergency, among others

23. Disease Burden Con’ • High burden of neglected tropical diseases: are endemic in South Sudan and account for a considerable proportion of the disease burden. • Leishmaniasis, Onchocerciasis;Trypanosomiasis;Schistosomiasis; Guinea worm; Trachoma; and Nodding disease syndrome • Epidemic prone diseases • Diarrheal diseases, Cholera, Measles, Meningitis; Hepatitis E;; and Yellow Fever • Non Communicable Diseases are on the rise

24. Disease burden con’t • Cardiovascular diseases, Diabetes; Injury due to road traffic accidents and gun shots are very common. • Environmental health concerns are widespread, including lack of personal hygiene, poor liquid and solid waste management, water pollution and poor excreta disposal

25. FromHumanitairanto Development Now: • Expensive approach: implementationbyNGOs -overhead • Multiple players (toomany?) • Little involvementgovernment (at all levels) • Dramaticshortage human resources • Weak systems (despite investment)

27. Health Sector Development Plan • HSDP Objective 1:To increase the utilization and quality of health services • -To contribute to achievement of the above HSDP objective, the health development partners will improve access, use, and quality of primary health care (PHC) services and Emergency Obstetric and Newborn Care services (EmONC). • HSDP Objective 2:To increase health promotion and protection • -To contribute to achievement of the above HSDP objective, the health development partners will increase equity and effectiveness through work with community mechanisms for health and health education.

28. Cont’ • HSDP Objective 3:To strengthen institutional functioning, including governance and health system effectiveness, efficiency and equity • -To contribute to the above HSDP objective, the donors will strengthen key stewardship functions of the MoH with a particular focus on governance, leadership, and health systems strengthening, particularly at State Ministries of Health (SMoHs), and County Health Department (CHDs) level. This will include management systems, capacity development, and monitoring and evaluation (M&E).

29. Targets by 2015

30. Priority intervention BPHS Child health services: • Integrated Management of Childhood Illness including referral of sick children • Routine immunization and support for immunization campaigns • Vitamin A supplementation • Promotion of early initiation and exclusive breastfeeding and adequate infant and young child nutrition • Promotion of hygiene at health facilities and in the household, including use of safe drinking water and improved sanitation Reproductive health: • Family Planning/Birth Spacing • Antenatal care • PMTCT for HIV and other STIs • Safe and hygienic delivery • Comprehensive basic and emergency obstetrical and neonatal care and referral, including at the county hospital level • Post natal care • Treatment and control of STIs Control of major communicable diseases: • Support to infectious disease outbreak preparedness and response • Diagnosis and treatment of malaria • Promotion and distribution of long lasting insecticide treated nets (LLINs); • Intermittent preventative treatment of malaria in pregnancy • Support WASH in health facilities • Integrated case management of diarrhea, malaria and pneumonia financial and technical support to implementation HSDP workshop 29-30 November 2011

31. High Impact Interventions • Vaccination. • ANC • Delivery services. • Post Natal services. • FP Services. • Growth Monitoring Services • Treatment of Under five children. • Emergency Obstetric care (PHCCs).

32. 4 5 Managing for Results Mutual Accountability Ownership (Partner countries) 1 Countries set the agenda Aligning with country’s agenda Using country’s systems Alignment (Donors - Country) 2 Establishing common arrangements Harmonization (Donors - Donors) Simplifying procedures Sharing information 3 5 Aid Effectiveness Principles Development Results

33. WHO building blocks Goals/outcomes System building blocks Improved health (level and equity) Service Delivery Access, Coverage, Equity Health Workforce Responsiveness Information Medical products, Technologies Social & financial risk protection Quality Safety Health Financing Improved efficiency Leadership / Governance - Each of these involve govt systems at different levels - Multiple, dynamic interactions between the systems

34. Coordination

36. Conclusion • The transition from humanitarian to development planning will be guided by the HSDP • All stakeholders should align their assistance to the HSDP • We need to invest on health system strengthening, human resources for health and provision of appropriate, acceptable and accessible services delivery facilities • we are asking true partnership that respect compliment HSDP (planning, implementation and cooperation)

37. Thanks for Listening Let us all join hands in Building a modern health system in South Sudan that provides quality services through adequate and skilled human resources for Health.