South Sudan Country Profile

Jhpiego in South Sudan Background Quick Facts Officially formed in July 2011, the Republic of South Sudan is one of the newest Estimated total population:1 members of the global community. Long-term, ongoing conflict has adversely 12.2 million affected the health status of the entire population, but South Sudanese women in particular are impacted by an exceedingly high maternal mortality ratio, a low Maternal mortality ratio:2 rate of skilled attendance at birth and a low contraceptive prevalence rate. One 730 per 100,000 live births out of seven South Sudanese women will die from either pregnancy or childbirth as a result of infections, postpartum hemorrhage or obstructed births. The lack 2 Infant mortality rate: of access to health care facilities and trained health care professionals plays a 67 per 1,000 live births major role in these outcomes.

Under-five mortality rate:2 40 per 1,000 live births With funding from the U.S. Agency for International Development (USAID), Jhpiego is working in South Sudan under the Maternal and Child Health Total fertility rate:1 Integrated Program (MCHIP). Under MCHIP, Jhpiego leads a consortium 6.9 partnership, including Save the Children, John Snow, Inc. and PSI, to implement a five-year project known as the Integrated Service Delivery Project Contraceptive prevalence:1 (ISDP). In addition, Jhpiego is implementing the USAID-funded Strengthening 4% (all methods) the Provision of Primary Health Care HIV Services in South Sudan (SPPHC) 1% (modern methods) Project. Both initiatives are described in more detail below.

3 HIV prevalence: Current Program Highlights 2.7% ISDP Births with skilled provider:2 Under ISDP, MCHIP supports the Government of the Republic of South 19% Sudan in the provision of the minimum package of integrated primary health care services. The project operates in South Sudan’s two most populous states, Sources: Central Equatoria State (CES) and Western Equatoria State (WES). By the end 1 Population Reference Bureau 2015 World Population Data Sheet; of the ISDP, MCHIP will, in collaboration with the Government of the 2 Countdown to 2015 website; Republic of South Sudan and USAID, ensure the presence of standardized, 3 UNAIDS website. equipped, staffed and functional health facilities that are able to provide the minimum package of high-quality primary health care services and increase community access to information and services.

The project is being implemented in the following three phases and is currently in Phase 3:  Phase 1 focused on ensuring the continuation of donor-supported existing primary health care services for a six-month period. In this phase, ISDP continued to support eight counties previously supported either by the USAID-funded Sudan Health Transformation Project (SHTP) II or the Office of U.S. Foreign Disaster Assistance.

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 Phase 2 included the awarding of competitive sub-grants to one implementing nongovernmental organization per county for all 16 counties in the two states. This phase, launched on January 1, 2013, focused on supporting the national Ministry of Health (MOH), state MOH and county health departments to standardize, strengthen and expand both community-based and facility-based primary health care activities.  Phase 3 entails the transitioning of services into a final USAID Health Pool Fund 2 that will help support local health services.

ISDP covers all 16 counties in CES and WES, representing a population of approximately two million. The project supports a total of 364 health facilities, consisting of 81 primary health care centers and 283 primary health care units. This represents approximately 90% of the primary health care facilities in the two states, as the remainder are supported by faith-based organizations or the MOH alone. Through country implementing partners in 16 counties, ISDP supports 70% of the primary health care staff in WES and 30% in CES.

At the national level, ISDP supports two long-term technical advisors embedded Trained community leader disseminating key messages on the importance of within the MOH—one for family planning/reproductive health (FP/RH) and antenatal care. the other for HIV/AIDS monitoring and evaluation. While their primary purpose is to contribute to building capacity at the national level, they also contribute to selected ISDP activities. In addition, ISDP participates in a number of technical working groups contributing to the development of policies, guidelines, data collection tools, etc.

SPPHC With funding from USAID, SPPHC is designed to achieve the following four main results: 1. Strengthen state MOH capacity to effectively plan, manage, implement and coordinate the prevention of mother-to-child transmission of HIV (PMTCT) program; 2. Develop institutional and human resource capacity in comprehensive PMTCT and pediatric HIV care; 3. Provide high-quality, integrated, comprehensive PMTCT services that will reduce new infections among children and keep mothers alive; and 4. Strengthen systems for monitoring and evaluation of PMTCT and pediatric HIV care and treatment services.

At present, the scope of the project is focused on addressing services along the PMTCT continuum and is still in its start-up phase.

Accomplishments As of June 30, 2015, ISDP had accomplished the following results:  Service delivery. Maintained delivery of primary health care services within all 16 counties in CES and WES. Services continue despite conflict.  Capacity building. From October 1, 2013, to June 30, 2015, ISDP trained 1,145 health personnel from the two states in various technical areas, ranging from basic emergency obstetric and neonatal care (BEmONC) to integrated management of childhood illness.

 Quality assurance. ISDP formalized Jhpiego’s Standards-Based Management and Recognition (SBM-R®) as a quality improvement approach used by the MOH. Quality and performance standards were developed for infection prevention, focused antenatal care, normal labor, delivery, BEmONC and postpartum care, and have been approved for nationwide use.  HIV/AIDS. ISDP also supports provider-initiated testing and counseling. In total, ISDP has assisted in testing and counseling more than 47,000 individuals.  Community mobilization. By establishing and training Community Mobilization Teams that use the Community Action Cycle approach, ISDP was able to mobilize and organize communities to take ownership for their health.  Family planning. ISDP has been active in supporting the national FP program and ensuring that FP services are included in routine service provision. As a member of the MOH-led FP Technical Working Group, ISDP contributed to the revision of the FP training of trainers curriculum for South Sudan. The project also introduced three additional FP methods to the training (lactational amenorrhea method, progestin-only pills and emergency contraception) that previously were not well-used or well-understood in South Sudan. To ensure contraceptive supply, ISDP developed a memorandum of understanding with the United Nations Population Fund (UNFPA) for the provision of essential maternal health drugs and FP commodities for the 16 counties and ISDP country implementing partners. ISDP trained 476 providers in FP/RH, and built on this training to introduce the contraceptive implant at the primary health care center level to increase women’s access to long-acting methods in the two states. ISDP provided services to more than 15,000 new users of modern FP methods, providing over 4,000 couple years of protection.  Water, sanitation and hygiene. At the facility level, activities include general cleanliness, waste management, and promotion of safe drinking water and infection prevention measures like handwashing. ISDP ensured handwashing stations at every service delivery point and a continuous supply of bleach. In response to a cholera outbreak, 1,500 Aquatabs, handwashing containers, handwashing posters and cholera posters were distributed to facilities in Juba County.  Child health. ISDP supports child health services including: Integrated Management of Childhood Illness, routine Expanded Programme on Immunization services and National Immunization Days.  Maternal and newborn health. MCHIP completed a learning phase of a

program to prevent postpartum hemorrhage (PPH) in two counties. The Training in clean and safe birth, program included advance distribution of misoprostol to pregnant women for newborn care and resuscitation, and self-administration at home delivery and promotion of clean and safe delivery at management of postpartum hemorrhage. the facility level. In Mundri East County, 94% uterotonic coverage was achieved, and 99% of women with home births who had misoprostol reported taking it. Before the intervention, there was limited use of uterotonics for PPH prevention in the hospital and no use in health centers. ISDP expanded the program to three additional counties in WES and is preparing to introduce the program in three counties in CES. From October 1, 2013, to June 30, 2015, 9,960 women received uterotonics immediately after birth across the two states.

Partners and Donors Jhpiego’s donor in South Sudan is USAID. The main partners include: John Snow Inc., Save the Children International and PSI. In addition, ISDP works closely with the following country implementing partners: Adventist Development and Relief Agency, South Sudan Health Association, Mundri Relief Development Association, Catholic Medical Mission Board, Action Africa Help International, Johanniter International Assistance, International Medical Corps, American Refugee Committee and World Vision.

References Countdown to 2015: Maternal, Newborn and Child Survival. Fulfilling the Health Agenda for Women and Children: The 2014 Report (South Sudan). At: http://www.countdown2015mnch.org/documents/2014Report/SouthSudan_Country_Profile_2014.pdf Government of Southern Sudan. Official Website: History of Southern Sudan. At: http://www.goss.org Human Security Baseline Assessment for Sudan and South Sudan. Women’s Security in South Sudan: Threats in the Home. January 17, 2012. At: http://www.smallarmssurveysudan.org/facts-figures-women-security-south-sudan.php Joint United Nations Programme on HIV/AIDS (UNAIDS) website. At: http://www.unaids.org/en/regionscountries/countries/southsudan Population Reference Bureau. 2015 World Population Data Sheet. Washington, D.C.