Juba, Central Equatoria Room

Minutes of Health Cluster Meeting Time Venue May 15, 2019 WHO Conference 0900=1100 Juba, Central Equatoria Room

Agenda Partners Present: AAHI, CARE, CASS, CWW, CORAID, GOAL, HI, IRW, MDM, ,MAGNA, CMD, 1. Welcome, introduction of participants. CRADO, HAA, HCO, HFO, IHO, NILEHOPE, OPEN, 2. Follow up on matters arising/actions points from previous meeting 3. Context update RHS, SMC, MEDAIR, MI, OVCI, WR, MA, PUI, IRC,  ICWG TRISS, UNH, UNIDO, UNKEA, MSF-B, MSF-SW,  NAWG MSF-F, MSF-SP, ACF, UNFPA, WHO, WV-SS, ONO Discussion –AID, ALIMA, Malaria consortium, Samaritan 4. Technical Update Purse, TOCAA, TADO, CHADO, CHSS, HLSS,  IDSR Presentation LIVEWELL, MEDICAIRE, HPF, RRF, SSUHA, PCO,  EVD presentation Discussion Health Cluster Team: David and Naidu 5. Technical Discussion  Measles update Partners Absent: ARC, CMA, CMMB, CUAMM,  SAG Meeting  Health Cluster Update IMC, JDF, HAA,  SAG Meeting- Summary of Minutes and Aps  UNFPA presentation on RH commodities Discussion 6. AOB: TBD

Meeting outcome Action Points Welcome and introduction- Done Presentation of the meeting agenda- Presented by Dr Naidu approved by LiveWell and seconded by IRC. Follow up on matters arising/actions from previous meeting 1. UNPFA to make a presentation in the next HC meeting detailing the available RH commodities UNFPA representative briefed the team about availability of RH commodities, detail captured under section 5 of this minutes.

2. WHO to share the RRM report conducted in Rokon IDP site WHO has already shared the report with HC; HC will share the report with the partners after the meeting.

3. SSUHA to write to HC requesting for need assessment to be conducted in Kajo-Keji with clear justification for the SSUHA to provide clear justifications to assessment. HC for health need assessment to be SSUHA has not written to HC and was not able to provide the justification for need assessment to be conducted in Kajo-Keji during conducted in Kajo-Keji County and also the meeting. provide detail of EPI services in the county since they are the development

health partner under HPF III in Kajo- 4. SSUHA is to provide update on the EPI services in Kajo-Keji County with more focus on the central and eastern parts of the Keji. county. SSUHA representative in the meeting was not aware of this action point as they are not receiving emails from the HC. SSUHA to

Meeting outcome Action Points update their mailing list with the Irfan and provide the required update to the HC.

5. RI to meet HC to discuss on the ongoing Measles respond in Longuchuck where RI has already started the response. Relief International has made HC and updated the cluster on the Measles outbreaks and ongoing response in Longuchuck; 2,128 children under 5 vaccinated, 800 doses available and continuing with the campaign.

Context update- ICWG  IRNA mission is ongoing in Ibba and Maridi Counties of Maridi State following report of more than 5,000 IDPs in the area. HC to follow up the ongoing discussion  Health staff on strike in Panyijar, Mayom and Bentiu state hospitals due to adoption of MOH harmonized incentives for the in Unity State concerning the health government staffs. This is affecting health facilities supported through donors (HPF). Most of the staffs have refused to sign workers’ strike and MOH harmonized contract with the reduced incentives. Partners operating in Nyirol, Uror, Akobo and Fangak also reported that their health incentive and provide feedbacks to the staffs have resigned due to MOH harmonized incentives. For instance CHD of Panyijar has contacted HC to replace the partners after the discussions between HPF selected partner following the application of MOH harmonized incentive, we have explained to them the strategy of the the military commander and the MOH and replacing a partner will not address the ongoing concerns. commissioners and CHDs.  HC had contacted the State MoH, Commissioners and CHDs in former Unity State and the no consensus reached to ensure continuity of health services. HC to provide feedback to the partners  HC focal person on the ground had met the military commander in Southern Unity, briefed him about the MOH after meeting with the Donors and harmonized incentive, the military commander will discuss with the governor, commissioners and CHDs and will National MOH concerning the MOH revert to HC in the coming week. incentives and the ongoing health workers’ strike.  HC and Donors including HFP have agreed to follow the leadership of National MOH and go with MOH harmonized health workers’ incentive.  HC will have a meeting with Donors and MOH concerning the MOH harmonized incentives and ongoing strike next week and will provide feedback to the partners. UNICEF to provide update on  HC to encourage the MOH to disseminate the MOH harmonized health workers incentives to the SMOH, CHDs and launching the health project in Jonglei talk to them to enhance implementation. and Upper Nile, detailing which partner is where for easy mapping and follow  The process of contracting health IPs for former Upper Nile and Jonglei States is ongoing with UNICEF and not up on health issues and also updating certain whether UNICEF will adopt the MOH harmonized incentives or not; therefore it’s imperative to get an update the partners whether MOH harmonized from UNICEF about their plan for the two states. incentives apply to the two states or  It is noted that the number of people living in Bentiu PoC is reducing as people are moving out and going into the not. communities.  There was a report of Inter-communal conflict in Wathmuok County in Aweil South. Partners operating in Aweil South not presence to provide more detail of the current situation on the ground.

 More civilians continue to flee from the ongoing clashes in Jur River State. Cordaid is in Jur River under HPF III providing

entire HPF health packages and the health response is ongoing. 2

Meeting outcome Action Points  Renewed fighting between Murle and Jie in the eastern part of Boma State in Jonglei. LiveWell reported that the nature of the conflict is complex as it involves the Murle, Jie and Kachipo, one of the PHCUs (Koradep) has been burnt down and LiveWell is responding through provision of essential health care services in the functional health facilities. ICRC is informed and plan is underway to airlift the wounded patients to Juba for further management. Incident reports from OPEN and LiveWell already shared and presented during NAWG.

NAWG On June 11, there will a full day workshop on countrywide NAWG. Materials will be provided in advance for background reading to ensure the process is more qualitative this time around. This takes place after every three months, partners with regional expertise are encouraged to participate in the meeting. HC will choose a partner per region (Greater Equatoria, Bahr el Ghazal and Upper Nile). Areas for response scale up taking into account the January 2019 IPC analysis. Kajo-Keji county; Korijo is the area focus, health response is ongoing through TRI-SS.

Cuibet in Lakes, areas bordering Tonj South. AVSI reported high crude death rate (0.7) in the areas. WHO IDSR team analyzed their report from 2016 to date and the report doesn’t correlate with the report from AVSI. The result of recently conducted nutrition SMART Survey released yesterday by nutrition cluster puts the GAM rate at 12% below the WHO critical threshold.

Yirol West, area of focus is Mapourdit Payam. The need is more of NFI, Shelter and Protection and concern clusters will respond.

Pigi/Cannal/Panyikang; Nutrition SMART survey released yesterday shows GAM rate of 22% above WHO threshold, respond is ongoing however the situation is not improving. Health Care Foundation is responding through two mobile clinics. Partners (HCF, HAA and Nile Hope) responding in the area are requested to remind behind to have a discussion with HC.

Pibor; Response ongoing in Gumuruk, Lekuangole and Verteth Payams. (UNH responding in Gumuruk and Lekuangole while CRADA in Verteth).

Nasir / Maiwut: Returnees are coming from Ethipioa, response prioritized- Health is responding well.

Assessment_ Ulang IRNA has been conducted in Ulang following a report from local authority of 51,000 IDPs (11,200 HH – none verified) in Ulang County reported arrived between December 2018 and March 2019. Prioritized areas are NFIs, shelter and protection.

Meeting outcome Action Points UNICEF: RRM conducted in Ulang- the team returned last week and draft report already shared this morning with HC. While RRM team in Ulang, UNKEA health team went onto strike due to the issues of MOH harmonized incentives.

Technical Update IDSR Presentation  Completeness and timeliness for weekly IDSR reporting at county level for week 19 is 40%. This report was prepared last night however our timeline for reporting is Wednesday 10am, more partners may have reported this morning and this will be updated later today.

 EWARS rolled out at health facilities in 7 main hubs meaning 70% of the country is now covered.  Completeness and timelines for EWARS is at 67%.  58 alerts generated through EWARS (13- Measles , 13- AWD, 10- malaria and 9- bloody diarrhea among to alerts generated

Measles update

Aweil East IRC to develop a microplan for reactive New outbreaks declared in Aweil East, 3 samples tested positive as of May 13, 2019. CHD with IRC to develop a response plan and Measles campaign for Aweil East and will share the plan with HC to identify a partner to lead the campaign. share it with HC for decision making.

Bentiu and Malakal POCs HC to choose a lead partner for the Confirmed Measles outbreaks in Bentiu and Malakal POCs. IOM will lead the campaign in Bentiu while MSF-France will lead that in Measles reactive campaign to be Malakal POCs. The two partners are to update WHO and HC on when the campaign will start. conducted in Aweil East County.

Aweil West The cases are from Aweil West not Aweil Centre. MSF France is the IP in Aweil West and is to provide an update about their MSF-France to provide update about response plan. their response plan for the Measles outbreaks in Aweil West. Tonj North UNKEA is still working on the RRF proposal to conduct the campaign in Tonj North and they are to update WHO and HC on the UNKEA is to response to the Measles status of the funding. outbreaks in Tonj North, they are to update the HC and WHO on the status

of proposal submitted to RRF for the Gogrial East funding for the campaign. Campaign is ongoing being led by Mediar and UNKEA. The target was 62,000 children under 5.

Meeting outcome Action Points Juba For Juba campaign completed on May 12, 2019. The partners were IOM, Save the Children, UNH, TRI-SS and ONO Aid. WHO and IOM and Save the Children to provide MOH will conduct the PCE next week. coverage report for the Measles campaign conducted in Juba. Partners having outbreaks/suspected cases in their areas of operations are encourage to attend EPR meeting today at 2pm.

Suspected measles outbreaks:  Longechuk; 1 confirmed measles case and 3 confirmed rubella cases  Aweil North; 2 confirmed cases  Wau; 1 confirmed measles case  Jur River; 1 confirmed measles case Recommendations: Partners working in these areas to continue to collect more samples

MSF-France started Measles reactive campaign in Aweil Centre on this Monday May 13 and the response is ongoing.

EVD presentation DRC situation, a total of confirmed cases/reported as of May 6 was 1,585 and 1,055 deaths. South Sudan is amongst the 8 risk States. In South Sudan, we have task force at National (NTF) and State levels (7 priority state). The main achievements:  Costed Six month National EVD preparedness plan (78% funded)  National and state TF and TWGS established and functional  SOPS prepared for all thematic areas  Alert Toll-free 6666 strengthened and functional  Capacity built for GenXpen  Screening points established and screening ongoing in main ports of entry  19 alerts reported from the screening points, only 6 met case definition Suspected alerts in South Sudan 45 Alerts reported, 25 met the case definition, all tested and negative

Vaccinations 5

Meeting outcome Action Points 2,374 HCWs/FKW vaccinated until May 9, 2019, targets is 3,000, the exercise is ongoing. One team has 50 people

Good practices  Resources mobilization- 78% funded  Inclusive planning process  Self-assessment  Rapid response team capacitated and available  Strategic advisory groups available

Challenges  Limited access due to ongoing conflicts  Rapid staff turnover of trained personnel  Weak and fragile health system  EVD resources do not match the needs of the country  Inadequate EVD preparedness, IPs (INGOs) to bridge the gaps in the geographical locations were limited at the begining Technical Discussion Measles update

Series of meetings took place- conducted by HC involving State MOH, UNICEF, IOM, WHO and IPs. The purposes of the meetings were:  Deciding on the precise locations for reactive vaccination depending on the line lists  Deciding on the age group to be vaccinated  Discussions on the funding issues  Selection of leading partners and other partners Roles and responsibilities of different actors  Social mobilization- UNICEF and MOH  Vaccines and Cold Chains- UNICEF, MOH and partners  Human Resources-SMOH and partners  Training- lead partners  Preparatory meeting- ERM 6

Meeting outcome Action Points  Surveillance, Technical guidance and Supervision on the ground- WHO and Partners  Post Campaign Evaluation – WHO and MOH Reactive Campaigns  For Jubek state: 5 Payam & Mangateen IDP camp selected, IOM worked with TRI-SS in Rajaf, Northern Bari & Mangateen IDP camp while Save the Children worked with UNH and ONO AID in Juba, Kator and Munuki Blocks, vaccination completed. Juba POC: IMC – Vaccination campaign is completed.  Gogrial East: MEDAIR worked with UNKEA, campaign is completed  Malakkal POC & Town: MSF Spain - vaccination Campaign is ongoing  Aweil Town (E&W) : MSF France – vaccination Campaign is ongoing  Bentui POC: IOM Preparations ongoing for vaccination Campaign.  Tonj North: UNKEA - Preparations are ongoing for vaccination Campaign.

Challenges for the implementation of reactive Measles campaign  Vaccines and cold chain items not arriving in time at different locations  HR challenges mainly due to low incentives  Challenges related to the training of the teams due to limited time since the team were occupied for the NID  Social Mobilization: insufficient time for social mobilization and community engagement.  No time gap between Polio vaccination and Measles vaccination campaigns resulted in adequate availability of human resources.  Funding challenges:

Best Practices  Support from state ministry and CHD contribute to a successful campaign with an expected coverage.  Coordination with the partners at the ground level – Essential for achieving the targets.

ERM Weekly Emergency Responders Meeting is created by Health Cluster and works under the umbrella of HC to coordinate with partners on the ground for emerging acute emergencies. IOM is chairing now – but chair will be rotating every six months

SAG Meeting Below is the what was presented at SAG meeting; 7

Meeting outcome Action Points  54 HRP partners for 2019; 4 UNs, 24 INGOs and 26 NNGOS  59 Counties covered by HRP partners Irfan to circulate an email requesting partners to update the funding status in  19 counties supported by SSHF SA1 FTS.  35 HRP partners funded under SSHF SA1

 HC objectives, key indicators and targets for 2019.

Main highlights on the discussions

 HC to clarify how the target for the HRP been calculated  Encountered funding gaps in responses- Measles  HFP III has funds for emergency response  All partners to update their FTS  MOH to widely circulate the harmonized salary scale  HC to provide the list of all the HFs , indicating the donors, partners, location, levels and gaps UNFPA to share the status of RH commodities, reporting template and UNFPA presentation on RH commodities the presentation with HC for wider circulation. Have prepared the status of available RH commodities, will share the list with HC so that will be circulated to all HRP partners and UNFPA will equally circulate to non HRP partners to ensure wider circulation. UNFPA will receive clean delivery kits today and partners are encourage to request based on the clinical packages and estimated populations. UNFPA always preposition supplies in HC to update the partners running Bor, Wau, Bentiu, Malakal and Wau and partners in the catchment area are to get supplies from these locations however they do mobile clinics on their discussion with consider releasing supplies from Juba to partners on case to case basis. Toward the end of March 2019, UNFPA conducted two UNFPA whether they are eligible to days training for partners of rational use of RH commodities and still having challenges with partners due to lack of reporting- from receive clean delivery kits to enhance January 2019, given RH commodities to 25 partners however only 13 submitted reports. Partners are encourage to submit clean community deliveries where consumption report timely. Partners providing mobile clinics in hard to reach areas wish to get clean delivery kits to support BEmONC centres not available. community deliveries since most of the areas have no nearby BEmONC centers. HC will discuss with UNFPA on the modalities this request and will provide feedback to the partners running mobile clinics where BEmONC centers are not available. AOB: Medicair, UNIDOR, CHADO, CMA, WV to stay behind to meet with WHO Core pipeline manager to discuss about prepositioning of supplies.