Republic of South Sudan

Country Overview


Funding Began 2011
MCHIP Partners Involved Lead Organization: Jhpiego, Partners: JSI

Africa Champions Program MCHIP initiated an activity to develop advocates for the achievement of targets for MDGs 4 and 5 in 10 key African countries. The process is being implemented over the course of 18-24 months (2011-2013) by MCHIP in collaboration with USAID/Africa Bureau, WHO/AFRO, and the West African Health Organization (WAHO). South Sudan is one of the participating countries, along with Benin, Guinea, Kenya, Liberia, Madagascar, Mali, Senegal, Uganda, and Zambia.

The initiative’s first major activity was the creation of an Essential Obstetric and Newborn Care (EONC) Resource Kit for the purpose of advocacy and capacity building in EONC. The second activity resulted in the development of a team of health professionals from each country (one obstetrician, one midwife, and one anesthetist or pediatrician) who have been updated in evidence-based clinical knowledge and skills, training skills, and advocacy. These maternal and newborn health (MNH) champions are effectively using the toolkit and the knowledge and skills learned to advocate for government commitment to improved MNH, and are leading efforts to increase availability and use of the life-saving interventions that will help achieve MDGs 4 and 5 in their country and region.

Child Survival Health Grants Program Grantees World Vision – Innovation grantee (2010-2014): The Mother and Child Health Transformation Project (MaCHT) in Gogrial East and West counties of Warab state in the Northern Bahr el Ghazal region of South Sudan has a goal to reduce maternal, neonatal, and child (MNC) mortality by increasing the use of feasible, high-impact, low-cost interventions, strengthening the capacity of the health system to deliver essential health services, and building/strengthening local and national partnerships to sustain MNC health improvements.
 
Technical Scope
  • Maternal health
  • Family planning/reproductive health (FP/RH)
  • Expanded Program on Immunization (EPI)
Scale

National Scale
Two long-term technical advisors are embedded within the Ministry of Health (FP/RH and HIV/AIDS monitoring/evaluation) and charged with building institutional and managerial capacity, which will, in turn, improve the quality of health services in South Sudan.

Targeted Geographic Focus –
The learning phase of a program to prevent postpartum hemorrhage is being implemented in Mvolo County and Mundri East County of Western Equatoria State. Results are expected to inform plans for scale up.
 
Collaboration
  • Republic of South Sudan Ministry of Health
  • Implementing Partners: Save the Children and Mundri Relief and Development Association (previously under SHTP II)
  • Supply and Registration of Misoprostol: Venture Strategies Innovations (VSI)
   

Key Activities:

  • Build capacity for FP/RH
  • Strengthen human resources in the areas of monitoring and evaluation for HIV/AIDS
  • Disseminate national EPI policies and support a national, multi-partner EPI review
  • Support a program for prevention of postpartum hemorrhage (PPH)
Major Results to Date
  • Contributed to the finalization of the RH Policy, Strategic Plan, and the FP Policy.
  • Assisted Ministry of Health HIV/AIDS division staff with compiling, cleaning and analyzing 2010 and 2011 counseling and testing, RH/prevention of mother-to-child transmission of HIV, antiretroviral therapy, blood safety, condoms, and sexually transmitted infections data, which enabled the division to contribute to the South Sudan 2012 Global AIDS Progress Report.
  • Participated in the multi-agency EPI review, providing leadership and guidance in close coordination with the World Health Organization and other partners. Reviewed program performance by reviewing administrative reports and data, and by making visits to review sites. Contributed to a report summarizing the EPI review findings, including recommendations to guide the comprehensive Multi-Year Plan (cMYP) and program implementation. Provided input to the South Sudan cMYP, drawing on the results of the EPI review.
  • Developed the Institutional Review Board protocol and received approval from the the Johns Hopkins School of Public Health IRB for the prevention of PPH learning phase.
  • Developed training materials for home health promoters (HHPs) and trained 260 to counsel pregnant women and their support persons on birth preparedness, complication readiness, and the correct use of misoprostol for prevention of PPH.
  • Developed training materials for health providers and trained 60 in clean and safe birth, including active management of the third stage of labor and immediate newborn care, as well as management of PPH.
  • Launched implementation of the program learning phase in Mundri East and Mvolo counties of Western Equatoria State. As of December 2012:
    - New pregnant women registered for ANC (health facility and community) – 2,441
    - Facility deliveries – 280
    - Women who received oxytocin within three minutes of delivery – 220
    - Clients who received misoprostol (ANC and home) – 485
    - Home deliveries – 354
    - Women delivered at home who took misoprostol – 344
    - Women who delivered in the presence of HHPs – 315
    - Women who returned misoprostol1 – 10
    - Women reporting any adverse effects after consuming Misoprostol – 0
    - Referrals – 0
Country Profile

Select Health and Demographic Data for South Sudan
GDP per capita (USD) -
Total Population 8,200,000
Maternal Health
Maternal Mortality Ratio (deaths/100,000 live births) 2,054
Percent of maternal deaths due to HIV -
Skilled birth attendant coverage 10
Antenatal care, 4+ visits -
Newborn Health
Neonatal mortality rate (deaths/1,000 live births) 52
Infant mortality rate (deaths/1,000 live births) 102
Child Health
Under-five mortality (deaths/1,000 live births) 135
Treatment for acute respiratory infection 87.8
Oral rehydration therapy for treatment of diarrhea 63.9
Immunizations
Diphtheria-pertussis-tetanus vaccine coverage (3 doses) 24
Percent of districts with >80% DPT3 coverage -
DPT3 coverage equity ratio (wealthiest:poorest quintile) -
Family Planning
Modern contraceptive prevalence rate 5.7
Total fertility rate -
Malaria
Vulnerable populations who slept under an insecticide-treated net (ITN) the previous night** -
Pregnant women receiving 2 doses intermittent preventive treatment for malaria -
Children with fever treated with antimalarials within 24 hours 2.6
HIV
HIV Prevalence, adult 3.1
ART coverage, adult -
Health Systems
Density of physicians (per 1,000 population) -
Density of nurses & midwives (per 1,000 population) -
Total Health Expenditure per capita (USD) -
Sources: Population, Southern Sudan Center for Census, Statistics, and Evaluation 2010; Demographic information and health systems, World Bank; MMR, newborn health, child health, DPT3 coverage, family planning, malaria, SBA, and ANC4, Southern Sudan Household Health Survey 2006; ART coverage and maternal deaths due to HIV, WHO; HIV prevalence, 2010 Sudan United Nations General Assembly Special Session Report
*Calculated from DHS data as number of pregnant women and number of children under five who slept under an ITN the previous night divided by the total number of pregnant women and children under five.


South Sudan Integrated Service Delivery Program (ISDP)


Funding Began 2012
MCHIP Partners Involved Lead Organization: Jhpiego, Partners: Save the Children, PSI, and JSI

Key Partners in Country (County Implementing Partners) Action Africa Help International, Adventist Development and Relief Association, African Medical and Research Foundation, American Refugee Committee, International Medical Corps, Johanniter, Maltesser International, Mundri Relief and Development Association, Norwegian People’s Aid, South Sudan Health Association, World Vision.
Technical Scope
  • Maternal health
  • Newborn health
  • Family planning
  • Child health
  • Control of major communicable diseases
  • HIV/AIDS
  • Water sanitation and hygiene (WASH)
  • Community mobilization
Scale Targeted Geographic Focus – All six counties of Western Equatoria State and 10 counties of Central Equatoria State

Key Activities
  • Standardize, functionalize, equip and staff health facilities that are able to provide a minimum package of primary health care (PHC) services
  • Increase community access to information and services
       Project Phasing
  • Phase 1: Ensure continuation of PHC services
  • Phase 2: Strengthen, standardize and expand PHC services
  • Phase 3: Transition PHC services progressively to the Ministry of Health
Major Results to Date
  • Granted sub awards to six county implementing partners (CIPs) working in Central Equatoria State and Western Equatoria State to support the continuation of health service delivery in 33 PHC centers and 84 PHC units2 (PHCUs)  for a period of six months.
  • Completed project start up.
  • Selected and granted sub awards to 11 CIPs to increase access to the minimum package of community- and facility- based PHC services within the counties to reach all citizens within Central Equatoria State and Western Equatoria State for a period of 12 months.
  • Developed technical strategies for the program, including HIV, maternal and newborn health, FP, quality assurance (Standards-Based Management and Recognition), and WASH.
  • Trained skilled birth providers in clean and safe delivery. The related development of curricula and participation of ISDP staff in the training, ensures that ISDP is well placed to scale up this training with CIPs later in the year.

1 Includes women who returned misoprostol because they delivered in a health facility
2
WES: Mvolo, Mundri West, Mundri East, Tambura, Nagero; CES: Juba, Terekeka, Kajo-keji