Minutes of Health Cluster Time Venue Meeting March 11, 2020 09:00- 11:00 hours WHO Conference Room Juba, Agenda Partners Present, MDM-SPAIN, OPEN, HFO, CHADO, UNH, CUAMM, WHO, MENTOR 1. Welcome, introduction of participants INITIATIVE, UNKEA, REACH, CMD, UNICEF, TRI-SS, HAA, ONO AID, RI, MSF-B, MSF-F, 2. Key context Updates: ALIMA, CMA, AGAPE, CORDAID, AAH-I, IR, LIVEWELL, IHO, SP, JDF, HACO, MEDIAR, NAWG/ICCG GOAL, NILE HOPE, IOM, UNIDOR, CARE, THESO, UNPFA, IRC, SPEDP, WVSS, CASS, WR, 3. Technical Update OVCI, HLSS, CRD, WAN, CCM, AHA, CIDO, RHS, PSI, MC, MEDICAIR, CH, HOC, IDSR/EWARS Presentation 4. SSFHSA1 2020 update Health Cluster Team: Magda and Dr David, 5. Formation of Health Cluster TECHNICAL Working groups 6. AOB- TBD Partners Absent: CHEPSS, MSF- HOLLAND, ICRC, ARC, CMMB,

Meeting outcome Action Points Welcome and introduction- The Chair Magda Health Cluster Coordinator welcomed all the partners/participants, introduced herself and requested participants to introduce themselves. The chair then presented the meeting agenda to all participants, agenda approved by UNIDOR. Key context Updates: Dr. David National Public Health Officer of Health Cluster made presentation on the key context update and highlighted: During the last NAWG/ICCG meeting (March 10, 2020), areas for response scale up, close monitoring and assessments among others were discussed.  Response Scale up- particularly Gumuruk and Lekuangole, all clusters to scale up responses to address the humanitarian needs of the affected populations following the intercommunal fighting.  Close monitoring: Torit and Magwi Counties of Eastern Equatoria due to locust infestation.  Areas for assessment: mainly Walgak and its surroundings, County looking at Gorwai; and looking at Duk Padiet.  Areas for common service support focusing on flood affected areas where logistic cluster is needed to transport supplies from Bor to the areas of response, some of the areas have been served, still planning for Pading (Nyirol), Pamai (Uror), Walgak (Akobo), Arkilla/Otalla (Pochalla).  Other areas of concerned discussed during the NAWG/ICCG includes Cubeit and Yirol East in Lakes States, this is due to continued intercommunal fighting. Discussions on some of the areas:  Aburoc: IMC said that they will implement till March 31, 2020, still mobilizing for resources in case no funding then IOM will HC to follow up with IMC on responses. HC to follow up with IMC keeping IOM in the loop to ensure continuity of health services in the area. continuation of health respond beyond March 2020 while  Ayod, Duk, Akobo IPC Phase 4/5, pocket of population about 10% in each of these counties in IPC 5, partners operating in keeping IOM in the loop of the these counties to provide more information and scale up response. communication.  Dry season prepositioning to ensure continuity of services, partners who don’t have supplies to let HC know within 24 hours.

 Bor –Pibor road, the route is still insecure due to the intercommunal fighting that took place along Bor-Pibor road.  Pibor tension; Nile Hope reported that in Akobo the intercommunal fighting has affected their operation, lost one of their staffs, population displaced, health facilities not looted but operating at minimum capacity since most of the staffs displaced. In Pibor UNH reported that two of their facilities in Lekuangole were looted/vandalized, facilities in Gumuruk not looted and resumed

services on Monday- March 9, 2020.  Mundri assessment, there is ICCG assessment ongoing in Mundri, Health partners have to information on the ongoing assessment, discussed and agreed that partners on ground to follow up and provide feedback to HC on the assessment.  Population working group; at OCHA they are forming population working group, health will be part of it.  CUAMM reported that 2 of their PHCUs (Allor and Amok PHCUs) in Rumbek North are closed due to intercommunal fighting. Technical Update IDSR Presentation Sheila of WHO Emergency Rapid Respond Coordinator made presentation on Integrated Disease Surveillance and Response (IDSR) which highlighted:  The report was for Epidemiological week 10, the standard set day for timelines and completeness is Wednesday and Friday respectively however this report was downloaded for presentation before the set hours for timelines and completeness.  The average timeliness and completeness for week 10 stood at 81%, Western Equatoria State being the best with 100% completeness and timelines while Eastern Equatoria the least with 58% completeness and timelines.  IDSR performance by County also presented and discussed.  EWARS reporting by partners for week 10 stood at 92%.  Event-based surveillance: A total of 144 alerts received in week 10, 72% verified, 0% auto-discarded, 2% risk assessed and 2% required response, common alerts generated includes: malaria, AWD, ARI, ABD and measles.  From the analysis of 2020 data from week 1 to week 9, the top 5 commonest causes of morbidity are malaria, ARI, AWD, ABD and Measles. Malaria being the leading causes of morbidity constituting to above 60% percentage of the cases reported followed by ARI, AWD, ABD and Measles.

 In IDP sites, Malaria still is the leading cause of morbidity constituting to above 40% of the cases reported followed by ARI,

AWD, AWD and Measles.

 When compared the malaria morbidity for 2019 and 2020, the trend for 2020 is higher than that of 2019 for the same period.

 Week 9 of 2020 shows a significant increase in number of malaria cases in Rubkona County. Active Outbreaks as of week 9.  Active measles outbreaks in Aweil East, Maban, Pibor (Jebel Boma), Kapoeta East, Bor South and Tonj South; Hep E in Bentiu PoC, Rubella in Rumbek East and Yirol East of Lakes State.  Reactive campaign ongoing in Jebel Boma which will end today.  For Aweil East, 21 samples collected, 10 turned positive for measles IgM, 2 positive for Rubella. Discussions  CHADO reported that in Guit the reporting stood at 43% completeness and timelines because their M&E is on vacation however their lot coordinator has stepped in and will ensure that all facilities report in time.  In Uror, Nile Hope reported that they have 5 facilities and all their facilities have reported however the overall county performance was at 88% because other partners have not reported.  There was also a suggestion to insert a column where reasons for underperformance can be written as remarks; discussed and 2

agreed that it may not be possible however the reasons given by partners to be captured in the minutes and revisit in the next HC meeting.  Partner reported in week 10, they have reported 10 measles suspected cases (alerts) in Leer County however the presentation shows only 3 measles alerts for the whole State, discussed and WHO clarified that the alerts are captured per county not the actual cases, a number of cases that has passed the threshold in a county will be reported as one so all the cases in Leer is reported as one (01) measles alert.  Analysis of malaria trend shows Rubkona has the highest case in 2020; Mentor Initiative operates in Rubkona, reported that in 2019 they did larvacidal in Bentiu POC in June/July however due to funding gap the frequency of larvacidal has reduced which might have contributed to malaria upsurge in the POC. Outside the POC they conducted Larvacidal in few places.  For this case, partners on the ground are to strengthen their community intervention to enhance prevention and referral of complicated cases to the facilities for proper management.  Partners to consider doing self-assessment/evaluation of the malaria trend in their county to inform the response plan, preposition of supplies and have contingency plan to avoid lapse in responses.  WHO reported that beside Rubkona, Pibor has been reporting high cases of malaria, now the reporting rate for the county has dropped probably due to intercommunal conflicts in the area, partners in Pibor to monitor and strengthen community intervention and case management?  There is also fear that if the rain season starts early then there will be high chance of entering the wet season with high number of malaria cases which may complicate the responses if prepositioning not adequately done.  Discussed and agreed that WHO to do different analysis for the PoCs and outside the PoCs, to also compare the disease trend for each county for same period of time.  Also agreed that WHO to strengthen the communication with partners to enhance reporting and address challenges hindering reporting to improve ISDR performance. CARE international to provide  WHO reported that their RRT went to Kajo-keji following the confirmation of Yellow Fever in neighbouring district of Uganda, preliminary report on the samples collected, samples tested negative in Juba and sent to Uganda for further confirmation where 2 tested positive, now reactive measles campaign have 2 presumptive cases of yellow in Kajo-keji. Plan for preventive campaign in Kajo-keji and later to cover the whole of conducted in Jebel Boma. greater Equatoria.  CARE international reported that reactive measles campaign in Jebel Boma will end today (Mach 11, 2020), will liaise with WHO to conduct the PCE in the coming week. They are strengthening routine immunization through outreaches to provide EPI srvices in hard to reach areas.

 UNICEF reported that they have developed EPI strategy and working with their partners in Jonglei and Upper Nile to

strengthen routine immunization.

Hepatitis E in Bentiu PoC

Dr. Wamala of WHO highlighted on the Hepatitis E situation in Bentiu PoC.

 Bentiu PoC has been experiencing sustained transmission of HeP E for the past 5 years- since 2016.

 Over 800 cases reported with 10 deaths. The cases has been reducing each year since 2016 however there was upsurge at the

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beginning of 2020 but below the minimum threshold.  Children age 1- 4 years and individual between 15 to 45 years are most affected; in 2020 most of the cases are children below 4 years. Sector 1 and 2 most affected.  In comparison, the cases reported in 2020 (9 weeks) higher than that for 2019 and 2018 but lower than 2017 and 2016.  The main risk factors for the upsurge in 2020 includes  Increase population in the PoC  Broke down of borehole in sector 4  Delay in distribution of soaps at the beginning of the 2020  Delay in dislodging of latrines leading to open defecation  Inconsistent water chlorination; now there is an active follow up however still challenges in maintaining the recommended level  The main root cause is the oxidation of water points which are being used as sources of recreation for children and washing/bathing by the adults. What is ongoing  Weekly meeting ongoing by all the partners  Hygiene promotion in community and schools HC to follow up with MSF-H on  Distribution of hygiene kits status of Hep-E case  Chlorination of water points management in their facility in  Moving water from sector 5 to 4. Bentiu PoC- Sector 1 and share Discussion the details with HC partners. IRC reported that they do refer all the cases to MSF-H clinics in sector 1 for case management. Discussed and agreed that HC to have a bilateral discussion with MSF-H to know more about the case management. SSHFSA1 2020 update The Chair HC Coordinator Magda made a presentation on 2020 South Sudan Humanitarian Fund First Standard Allocation and highlighted:  HC is well aware that OCHA had conducted training for partners in the past week and partners are now well versed with the strategy however would like to touch on some key areas to enhance your proposal development.  Use HC PIN and targets per location to derive numbers you intend to reach- reference HNO, under this allocation HC goes for 11 counties (4 singles and 7 multisectoral)  Cost per beneficiary for this response as reflected in the health cluster strategy  All indicators are in the GSM, partners do not customize indicators  Stay within the focus of the strategy  HC encourages partners to negotiate well and go into consortia for multisectoral applications Discussion  Generally most of the health partners are disappointed with the multisectoral approach which may favour organizations with

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wider scope of sectors, such approach would have been first tested as a pilot.  Partners are concern why only 4 counties allocated for single application for health, discussed and noted HC negotiated for 25 counties however based on selection criteria only 4 have been selected.  For the past years, integrations were done in paper however the approach this year is focusing on the beneficiaries so that they get all the services needed in integrated manner through the multisectoral approach. Formation of Health Cluster TECHNICAL Working groups The Chair HC Coordinator Magda made a presentation on Health Cluster Technical Working Groups to be formed and guided the formation of the different TWGs which included: 1. Health Information Monitoring and Evaluation Technical Working Group; partners who volunteered to be part of this TWG includes TRI-SS, UNH, GOLD, MDM-Spain, MSF-F, CARE, IRC and REACH. 2. Access/Surveillance Systems and attacks on health care (health care in danger); HFO, HAA and TRI-SS volunteered to lead this TWG. 3. Disability Working Group /AAP; This now includes AAP; DWG exists but need strengthening; partners OCVI, HI, CMB, ICRC HC to organize for the and CIDO formed this TWG. orientation of the members of 4. TB/HIV TWG; IOM agreed to lead this TWG and will invite partners who are interested to be part of this TWG. different TWGs to enable them 5. EP&R/ERM TWG: HC has a body- ERM partners (will select few partners). know their ToRs to start full HC Focal Points, under this, we will not form a group but use the existing structure engagement. 1. Maternal Child Health/RH/Protection/SGBV subcluster; UNFPA and SGBV subcluster coordinator assigned to HC are the focal points. 2. Mental Health(MPHSS); there is already existing platform for MPHSS, Mediar is the focal point 3. EPI focal Point; there exist EPI TWG, so UNICEF (Dr. Gaba) is the focal point. Discussed and agreed that each TWG to have maximum of 5 members with exception of Health Information Monitoring and Evaluation TWG which may go beyond 5. The TWGs will work on the week when no HC meeting and their discussion will be presented in next HC meeting. AOBs  UNFPA reported that they will receive RH commodities this month and will be ready for prepositioning towards the end of this month.  ERM after this meeting and EP&R at 2:00pm in EoC.

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