COUNTRY PROFILE SOUTH SUDAN photo Nicola Berti SNAP- A 69-YEARS DOCTORS SHOT HISTORY WITH AFRICA Doctors with Africa CUAMM is 1,800 currently People have left CUAMM operating in Italy and other Angola, Central countries to work African Republic, on projects: Ethiopia, of these, Mozambique, 515 returned Sierra Leone, on one or more South Sudan, occasions Tanzania and Uganda through: 227 Hospitals have 23 been served Hospitals 01 42 08 02 03 64 Countries Districts of intervention 04 (for public health activities, mother-child 05 care, fight against AIDS, 06 tuberculosis 07 and malaria, 01 SIERRA LEONE training) 02 SOUTH SUDAN 03 ETHIOPIA 04 UGANDA 3 05 TANZANIA Nursing 06 ANGOLA schools 07 MOZAMBIQUE 08 CENTRAL AFRICAN REPUBLIC 1 University Doctors with Africa CUAMM (Mozambique) has been the first NGO working VALUES in the international health field – «With Africa»: to be recognized in Italy and the organization works 605 is the largest Italian organization exclusively with African International for the promotion and protection populations, engaging Professionals of health in Africa. It works with local human resources a long-term developmental at all levels. perspective. To this end, in Italy – Experience: CUAMM and Africa, it is engaged in training, draws on over almost research, dissemination of scientific seventy years of work to knowledge, and ensuring support developing the universal fulfilment of the countries. fundamental human right to health. – Specific, exclusive expertise in medicine Doctors with Africa is for everyone and health. who believes in values like dialogue, cooperation, volunteerism, exchange between cultures, friendship between PRIORITY people, the defense of human rights, respect for life, the choice to help ISSUES the poor, the spirit of service, and – Reproductive, maternal, those who support the organization’s newborn, child and action criteria. adolescent health. – Nutrition. – Infectious diseases. – Non communicable diseases (NCDs) and traumas. – Universal Health Coverage (UHC). Doctors with Africa South Sudan p. 2 CUAMM OUR WORK IN SOUTH SUDAN Doctors with Africa CUAMM (CUAMM) has been working in South Sudan since 2006 with SUDAN the aim of increasing access, quality and utilization of health care services. South CUAMM maintains aCENTRAL long-term Liech development perspectiveAFRICAN focusing State REPUBLIC NYAL ETHIOPIA on Health System Strengthening, Gok State promoting integration of primary CUEIBET and secondary care, community- RUMBEK YIROL Western Eastern based initiatives, capacity building Lakes State Lakes State Amadi Maridi State and empowerment of local State stakeholders. MARIDI LUI Juba CUAMM has remained on ground also during the most acute crisis, KENYA gaining communities and DEM. REP. OF CONGO UGANDA counterparts trust. 2006-2012 2013-2015 2015-2017 2017-2018 AT PRESENT YIROL RUMBEK FORMER EMERGENCY CUAMM is supporting 5 State AND LUI NORTH, LAKES STATE RESPONSE Hospitals (Yirol, Cuibet, Lui, HOSPITAL CUIBET (New Western AND FORMER Rumbek, Maridi) and 164 primary In 2006, CUAMM started its health care (PHC) intervention in South Sudan, HOSPITAL Lakes, Eastern WESTERN reactivating Yirol Hospital facilities distributed and gradually expanding its AND LUI Lakes, Gok EQUATORIA over 12 Counties. action to the surrounding In Former Unity emergency Yirol West County (Former setting, CUAMM is Lakes State). Two years HEALTH States) STATE operating through 4 Aid after, it launched its Posts and 1 mobile health program in support of Lui CUAMM expanded its action team. Static services are Hospital (Mundri East SCIENCE to all remaining Counties (New Amadi complemented by County, Former Western constituting Former Lakes outreaches activities, Equatoria State). INSTITUTE States, working in a total of and Maridi bringing primary care up to 8 and started supporting the most remote areas. In In Former Lakes State, Rumbek Hospital as well. each County, referrals are CUAMM reached one of the Nutrition component was States) ensured by free of charge most isolate Counties, integrated to the permanent ambulance Rumbek North, for a interventions already After Famine Declaration in services. The beneficiary comprehensive Primary provided. Former Unity State, CUAMM population is about Health Care Program, while emergency intervention in 1.384.000 million people. upgrading Cuibet Health Nyal (Panyjiar County) The number of local health Center to County Hospital. started. CUAMM reinforced workers that CUAMM is In Former Western the presence in Former supporting is about 1500. Equatoria State, in 2014, a Western Equatoria State, training course for midwives sustaining County Health began at Lui Health Science System in Mundri East, Institute. Mundri West, Mvolo and in Maridi, where it started supporting the Hospital as well. In 2017, Lui Health Science Institute graduation ceremony was held in Juba. p. 3 “CONTINUUM OF CARE” MODEL CUAMM INTERVENTION IS FOCUSED ON TWO MAIN COMPONENTS: 1) Service delivery at community, 24/24h free of charge ambulance hospital to communities. Activities primary health care facilities referral system. are specifically designed to tackle the and hospital level. This includes: three types of delays that pregnant prevention, diagnosis and 2) Health system strengthening, women experience everyday: delay treatment of malaria, diarrhoea working aside local health in deciding to seek care, delay in and respiratory infections in authorities and creating their reaching care and delay in receiving children and adults; ante-natal capacities in planning, managing and adequate care (Figure 1). CUAMM’s and post-natal care; delivery monitoring services. Amongst the intervention has been implemented attendance; nutrition screening for key performed activities: peripheral starting from ensuring comprehensive children U-5 and pregnant women; health centres supervision; health health care provision and then going acute malnutrition diagnosis and staff training on the job; regular down incentivizing demand, in this way treatment; vaccinations; health coordination meetings among guaranteeing quality and responsive education; admission of paediatric, stakeholders; distribution and offer to ground needs. Institutional obstetric, medical, surgical cases; monitoring of drugs; health data deliveries in Yirol West County emergency obstetric complication gathering, analysis and reporting. (Figure 2) is a concrete example of management, including caesarean the effective method implemented by section and blood transfusion; Doctors with Africa CUAMM strategy CUAMM; indeed, results from 2009 screening and treatment of HIV/ follows the «Continuum of care» to 2018 show a significant increase in AIDS; management of complicated model, working towards the provision institutional deliveries both at hospital severe acute malnutrition; surgeries; of adequate care at all levels, from and health centres. 24/7 FREE OF CHARGE County Wide • Qualitative Study AMBULANCE SERVICE, Referral System AND THEN direct call • Demand Side 2 Incentives • Outreaches Delay in • Health Promotion reaching care • TBAs involvement • Community Meetings Hospital INFRASTRUCTURE 1 STAFF (recruitment, training, supervision) Delay EQUIPMENT & in decision SUPPLIES MANAGEMENT to seek care Technical Assistance 3 PHC Health Facilities Delay in receiving adequate health care Figure 1: Doctors with Africa CUAMM intervention Rational 1.800 1.600 Demand Side Incentives in PHC HF 1.400 PHC program 1.200 Demand Side Incentives 1.000 800 Ambulance 600 400 200 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Figure 2: Institutional Deliveries in Yirol West Hospital Deliveries PHC Facility Deliveries County (2009-2018) Doctors with Africa South Sudan p. 4 CUAMM EASTERN LAKES STATE, DATA 2018 COUNTIES AND YIROL HOSPITAL MATERNITY 3,241 Total institutional deliveries 1,537 at hospital 1,704 at PHC facilities ANC VISITS 7,819 Total ANC First Visit 4,687 at hospital 3,132 at PHC facilities MATERNAL AND CHILDREN HEALTH 62,955 photo Nicola Berti Out Patients consultations (OP) in U5 children CUAMM started its intervention in Yirol infrastructures (repair, upgrade, Hospital in 2006 answering a request equipment and supplies provision) have 28,354 of support from the local Church produced remarkable results in terms at hospital Authorities. In 2011, CUAMM began to of access increase: work also at community level, in the +7% ANC1 34,601 surrounding Yirol West County and, at PHC facilities in 2014, it was selected to take over +145% institutional deliveries the Primary Health Care program, consisting in supporting 10 facilities, +229% OPD U5. 6,358 working as County Health Department DPT3 vaccine in U1 children technical partner. In 2017, CUAMM expanded the same intervention to Awerial and Yirol East Investments done in these few 1,977 Counties, constituting, together with at hospital years on health staff (recruitment, Yirol West, the recently established retention, training, supervision) and Eastern Lakes State. 4,381 at PHC facilities p. 5 AMADI STATE, DATA 2018 COUNTIES AND LUI HOSPITAL MATERNITY 1,130 Total institutional deliveries 633 at hospital 497 at PHC facilities ANC VISITS 2,849 Total ANC First Visit 1,091 at hospital 1,758 at PHC facilities MATERNAL AND CHILDREN HEALTH 36,137 Out Patients consultations (OP) in U5 children Lui Hospital is the only referral In 2018, CUAMM took over the PHC Hospital of the recently established program in Mundri East County, 9,997 Amadi State, which counts a total managing to gradually reactivate at hospital population