Progress Report: 30 November 2013

1. Ministry of health directorate of primary health care, departments of Epi, nutritionCHIld Health, Health Education and Promotion Progress Report: 30 November 2013

2. Department of Child Head: Newly established in 2013

3. Activities of the Year • Establish the Department of Child Health by recruiting a Manager • Review Integrated Management of Child Illness (IMCI) guidelines and training materials • Review training guidelines for Integrated Community Case Management (ICCM) • Oversee the Implementation of IMCI and ICCM • Harness coordination between various child health initiatives in the health sector and beyond

4. Achievements in 2013 • Formation of a National Child Health Forum for coordination of child health initiatives – TORs drafted and being finalized • Formation of IMCI and ICCM technical working groups - ToRs are being finalized • Conducted supervisory field visits to ICCM implementation sites in NBEGS and WES States

5. Achievements in 2013…..continued

6. Up Coming Activities • Launching of ICCM national implementation • ICCM national ToT • Finalization of IMNCI guidelines and IMNCI ToT

7. Challenges • Lack of office space for Child Health Manager • Limited number of partners implementing IMCI/IMNCI and ICCM • Limited financial and logistical support

8. Way Forward • Provide Office Space and logistic support for Child Health Manager • Streamline child health officer position in MoH organizational structure at all decentralized levels and recruit officers • Ensure budgetary allocation and disbursement in Annual MoH budget and donor plans

9. Department of Nutrition

10. Activities of the Year • Measuring the nutritional status amongst children less than five years old across the states • Management (nutrition promotion, continuous case finding, referral, treatment, prevention)of Acute Malnutrition among children less than 5 years , pregnant and lactating mothers • Micronutrient supplementation (routine VitA in nutrition programs and campaigns with EPI) • Training • Managing nutrition information/knowledge • Monitoring and evaluating nutrition programs • Coordination of nutrition action • Continuous expert consultations over thematic technical areas • Continuous review/updating of guidelines, tools and job aids for management of acute malnutrition • Developing national standards/guidelines for nutrition surveys and surveillance • Development of national strategies for infant and young child feeding, and salt iodization, • Supporting in-patient feeding in the three teaching hospitals of Juba, Wau and Malakal • Others

11. Measuring Nutritional Status amongst Children less than 5 years old • This is achieved through regular bi-annual surveys using the Standardized Monitoring and Assessment of Relief and Transition (SMART) Methodology: • Pre-harvest • Post- Harvest • State Nutrition Officers from SMOH have been trained on the SMART methodology in 2012 . Few states and have shown competence in planning and leading SMART surveys. • In 2013 (X) partners have conducted SMART surveys for the pre-harvest season, covering 22 counties across 7states. Next surveys have been planned and will be completed for the post-harvest season.

12. Results of Pre-Harvest Surveys for 2013

13. Very Poor Nutrition Situation in 2013 • Of all 22 surveyed counties only 3 (Maban, Rumbek East and Wulu) have Global Acute Malnutrition rates below the cut-off point of 15%. • 11 counties out of the remaining 19 counties are above 20% with the highest and worrisome GAM rate of 35.6 and Severe Acute Malnutrition (SAM) rate of 13.4% seen in Gogreal East of Warrap state. Note that all Warap state stay way above 15% GAM. • With exception of Rumbek East and Wulu all SAM rates are unacceptably above 2.5%.

14. Who are the Actors in Nutrition Implementation • UN Agencies (UNICEF for SAM and WFP for MAM). WHO largely inactive – no nutrition focal officer. FAO terms of agreement expired in 2012 – await new terms. • Donors – multilateral (excluding the new health financing mechanisms) • A total of 36 reported partners including INGO, NNGO, FBO, CBOs, National level MoH and the Nutrition Cluster • Periodic meetings of the Nutrition Cluster Strategic Advisory Group – 2 conducted in 2013 • Monthly nutrition cluster coordination meetings – so far 11 conducted and last one will be in December • Continues Technical Working Group (TWG) meetings. In 2013 there have been TWGs on Infant and Young Child Feeding (IYCF) – 2 meetings, Nutrition Surveys - 3 meetings; Nutrition Indicators for the BPHNS and HMIS – 2 meetings; Old people’s feeding – 1 meeting. Total 7 meetings and 2 more will be conducted before close of year ( 1 for IYCF; 1 for Indicators) State level MoH and the Nutrition Cluster. Reports indicate that SMOH coordination of nutrition cluster activities has been weak for 2013. Details on next slide.

15. Coverage of Nutrition Interventions by State

16. Coverage of Nutrition Interventions by State

17. Coverage Sample by County: Cluster Lead is WV • Good news: Partner presence in all counties & SMART surveys conducted in almost all counties. • Bad news: All counties showed some of the poorest nutrition indicators. • Abyei & Twic: not included in surveys • Gogrial East: GAM – 35.6%; SAM – 13.4% • Gogrial West: GAM – 27.5%; SAM- 7.1% • Tonj East: GAM – 19.2%; SAM – 3.3% • Tonj North: GAM – 20.5%; SAM - 4% • Tonj South: GAM – 16.7%; SAM – 4%

18. Coverage Sample by County: Cluster Lead is ACF • Good news: Partner presence in all counties; SMART surveys in all but one county • Bad news: Poor nutrition indicators: • Aweil South: Not included • Aweil Center: (Apada): GAM – 23.5%; SAM – 5% • Aweil Center: GAM – 24.9%; SAM – 8.2% • Aweil East: GAM – 24.5%; SAM – 6.8% • Aweil North: GAM – 26.4%; SAM – 5.4% • Aweil West: GAM – 17.8%; SAM – 3.6

19. What have we achieved in 2013

20. What have we achieved in 2013

21. CHALLENGES? Key issues • Funding constraints – especially for longer term interventions. Plus affect partners’ ability to up-scale and expand • MoH Budgetary/Capacity/Structural/Prioritization issues – especially at SMOH. REALLY need to recruit COMPETENT nutrition officers especially at county level. How??? • New Health Financing Mechanisms – could have been an opportunity or are they a threat?? Not consulting/never consulted with nutrition in no way what so ever despite several efforts especially from onset in 2011 - 2012. So far causing disharmony and poor implementation of standards. Not clear to the nutrition sector. No idea who is leading what, where, how and doing what in nutrition according to which guidelines and standards and consulting with who for nutrition or not planning to do nutrition?

22. WAY FORWARD • Improve MoH Budgetary allocation for Nutrition especially at SMOH to facilitate recruitement of more personell – with focuss on county and state officers • Improve coordination of funding for nutrition and include/integrate nutrition in all health financing as per health policy, PBHNS and national guidelines for management of acute malnutrition • Improve MoH/SMOH information sharing and coordination of action, achievement and challenges

23. Department of the Expanded Program of Immunization (EPI)

24. Demographic Targets_ EPI South Sudan, 2013

25. DPT-3/Measles Coverage 2012-2013 Sep monitoring C/Equatoria-South Sudan

26. DPT-3/Measles Coverage-2012-2013 Sep Monitoring E/Equatoria-South Sudan

27. DPT-3/Measles Coverage 2012-2013 Sep Monitoring-Jonglei-South Sudan

28. DPT-3/Measles Coverage 2012-2013 Sep Monitoring Lakes-South Sudan

29. DPT-3/Measles Coverage2012-2013 Sep Monitoring NBG-South Sudan

30. DPT-3/Measles Coverage 2012-2013 Sep Monitoring Unity-South Sudan

31. DPT-3/Measles Coverage-2012-2013 Sep Monitoring Upper Nile-South Sudan

32. DPT-3/Measles Coverage 2012-2013 Sep Monitoring Warrap- South Sudan

33. DPT-3/Measles Coverage 2012-2013 Sep Monitoring WBG-South Sudan

34. DPT-3/Measles Coverage 2012-2013 Monitoring W/Equatoria- South Sudan

35. DPT-3/Measles Coverage 2012-2013 Sep Monitoring States of South Sudan

36. DPT-1/DPT-3 Coverage 2012-2013 Sep Monitoring State of South Sudan

37. Challenges • Insufficient human resources • Poor government financial support to EPI operations • Poor transparency and accountability in management of resources • Lack of supervision, monitoring and • Poor data quality due to poor reporting • Dependency on donor support ( audit)

38. Way Forward • Recruitment of staff • Allocation of funds for routine vaccination operations • Ownership and accountability • Supervision and monitoring of vaccination activities, for completeness and timeliness (data quality improvement) • Formation of management committees at all levels

39. Planned Activities 2013-14 • Preparatory activities for Introduction of new vaccines ( Pentavalent), February 2014 • MNTE (TT) - campaign ( WBG, NBG, Jonglei and Lakes) states • NIDs campaigns on Polio • Measles follow up campaign • Meningococcal Meningitis vaccination campaign • Strengthening routine vaccination through intensive support supervision

40. Department of Health Education and Promotion

41. Social and Behavior Change CommunicationDriving the change Health Promotion Rebecca Alum William 2-5 December, 2013

42. Outline of the Presentation • Achievements for 2013 • Gaps and Challenges • Lessons Learnt • Priorities for 2014

43. Outline of the Presentation • Strengthen Health Promotion structures at the state and national levels • Develop South Sudan health Promotion Strategy • Strengthening Routine Immunization • Polio Eradication Initiative • Supplementary Immunization Activities (Measles and MNTE)

44. HEP Accomplishments 2013 • Supplementary Immunization Activities (SIAs) • Polio SIAs including Vitamin A supplementation and Outbreak Response activities-3 NIDs,2 SNIDs • MNTE Campaign in Jonglei, Warrap. Upper Nile, WES and CES • Advocacy – Hon Right. V.President’s and Health Ministers’ Launched the NIDs • Participation of the WHO Regional Director for AFRO and the Minister of Health in the Polio SNIDs . • Provided strategic guidance to State EPI/ polio on communication • Developed strategic guidelines & concept notes for cross border communication activities - Trained 1638 social mobilizers in communication activities for SIAs • Supported all SIAs with social mobilization (Advocacy, Radio & SMS Messaging, Traditional & Community Media, Community & Household Engagement) • Supported SIAs with development of IEC materials (Banners, Posters, Folders, T-shirts, Aprons, Caps, Stickers, Posters and Flipcharts) in 2013 • 30 billboards mounted in all six counties on Polio & RI in CES… Planned to extend other states. Over 35Radio stations used in 10 states reaching more than 700,000 people (particularly for Polio Comms.)

45. EPI Accomplishments 2013 • Routine Immunization - Trained 60 women volunteers in Juba CES to create sensitization awareness on routine immunization - Designed, Printed & disseminated 7000 routine immunization posters in the ten states • Spear headed the design of RI flip charts – 8000 copies to be printed & disseminated soon. • Supported advocacy, sensitization and awareness activities in support of the vaccination week • Over 25 networks of partnership initiated in 7 of 10 states to create awareness and intensify social mobilization • Trained 52 EPI supervisors on community mobilization and sensitizations in 3 states

46. Other Accomplishments 2013 • PSA, Factual Programme & radio Drama on MCH broadcast on 16 radio stations nationwide since January 2013 • Capacity building for journalists from 8 partner radios of the Catholic Radio Network stations in 7 states. • Supported World malaria Day with the production & distribution of IEC materials (T-shirts, Banners etc) and advocated for high level visibility. • Supported world Blood donor day with sensitization campaigns, as a result over 300 volunteers donated blood • Advocacy visits to strengthen HEP focal persons initiated and accomplished in five states and follow up to strengthened capacities.

47. Other Accomplishments 2013 • Developed and rolled out a strategy in support of global hand washing day. • Responded to Humanitarian crisis/Hepatitis E outbreak in Maban in which a communication strategy for emergency was rolled out. • Conducted a comprehensive situational analysis for Health promotion, report generated and shared. This will be used as guide for the development of a HEP strategy for South Sudan. • Developed and rolled out tools for first aid in all ten states

48. Other Accomplishments 2013 • A total of 3,671 trained on awareness on communicable and non-communicable diseases • 1,985 households were visited by trained volunteers • A Total of 170 new volunteers trained • 15,171 people received hygiene promotion education during NFI distributions (Wau, Aweil, Warrap and Renk). • Thirty (30) Volunteers and 300 members of Health Clubs received training on malaria causes and malaria prevention in eight communities in Wau. • 2,436 households reached with hygiene messages • 5,694 individuals were educated on good hygiene practices

49. Other Accomplishments 2013 • A total of 30 Volunteers and 300 members of Health Clubs received training on malaria causes and malaria prevention in eight communities in Wau.

50. Sample Flipcharts