Emergency Response Team: Summary Report Health, Nutrition and WASH Assessment Duk County Jonglei state Specific Activity To assess and prioritize multi-sector needs using the Initial Rapid Needs Assessment tool (IRNA) in accessible Payams of Duk County where there is a concentration of IDPs To assess the accessibility to safe water, sanitation and knowledge of good hygiene among the targeted population To determine the support required to facilitate health and nutrition programming in payams where needs are identified Specific locations Region Airstrips Poktap, Ageer Payam Duk County, Jonglei State Panyagor Airstrip (Twic East) Ayueldit, Duk Padiet Payam 7°11'01"N 31°24'50"E Poktap Airstrip (Duk) 7°27.725’N, 31°24.886’E Duk Payuel Airstrip 7°35’54”N, 31°27’03”E Duk Padiet Airstrip 7°44’29”N, 31°23’58”E Dates of activity 2/4/2015-9/4/2015 Demographic Data STATE COUNTY PAYAM POPULATION Jonglei Duk Poktap 12,314 Ayueldit 21,102 TOTAL 33,416 Source: RRC/CRS Office (CRS continues with ongoing registration of new arrivals (IDPs & Returnees)in both locations) The population figures indicated above are based on the on-going registration of individuals in both locations. However, in Poktop, the population is concentrated in the camp, and the team estimated the population seen to be approximately 6,000 to 8,000 people. In Ayueldit, on assessment there were very few people seen in Ayueldit center as the populations are scattered into neighboring villages, most of which are not accessible due to reported insecurity. The JDF team reported that Dorok (2 hours North from Ayueldit), which neighbors Ayod county, is one village with a reported population of approximately 6,000 people. On travel from Poktap to Ayueldit; the bordering villages: Payuel, Mareang, and Padiet are all deserted as residents have fled. www.medair.org Medair South Sudan Medair team Counterparts Others Christine Muthoni, ERT Nutrition Daniel Pisegna – Executive Jacob Akech Deng- Team Leader Director, John Dau Commissioner Duk County Foundation (JDF) Alicia Morcombe, ERT Health Deng Sam Mabok - RRC Manager Peter Lim - Nutrition Officer, Coordinator Duk County JDF Stephen Cressey, ERT WASH Deng Mayom Deng – Executive Manager Joh Deng – Manager, JDF Director, Sudan Medical Care (SMC) Marcello Jerfasio, ERT WASH John Deng - Field Supervisor, Technician SMC James Jok – Program Officer, SMC Taban George – LWF Acting Area Coordinator Lotari Cyprian Peter – LWF WASH Project Coordinator Summary of Objectives Outputs Achieved General Meet with the Duk County Commissioner, The assessment team met with the Duk County Duk County SSRRC, County Health Commissioner and the RRC in Poktap to explain Director for Duk County and local the purpose of the assessment and to find out the authorities in Duk County to explain the current priorities for intervention in the county. Full purpose of the Health and Nutrition cooperation was given to the team for conducting assessment and keep them updated on the assessment. progress and changes Gather security information and Security accessibility of various payams where Security information was gathered through UNDSS IDPs are concentrated and the NGO security forum prior to the visit. The team met with the Twic East County Commissioner and RRC in Panyagor upon arrival to gather information on security and IDP movement in Duk County The RRC in Poktap provided a security update and the team was given a security briefing from CARE and JDF on arrival in Panyagor. The security situation remained stable in the areas assessed throughout the team’s visit. Access The roads are poor quality throughout and in the dry season most vehicles drive inside the dry canal rather than use the adjacent road. In the wet season it is said that the roads become un- navigable by motor vehicle. Travel time in the dry season is: Panyagor to Poktap – 1 to 1.5 hours Poktap to Ayueldit centre – 1.5 to 2 hours Ayueldit centre to Amiel village – 20 minutes Page 2 of 19 Medair South Sudan Summary of Objectives Outputs Achieved Vehicle & Equipment Rental There are no vehicles for rental in Poktap. Vehicle hire in Panyagor is based on a transport rate of 200 SSP/person to travel to Ayueldit in the absence of public transport, i.e. 2800 SSP/day based on 14 passengers. Health & Nutrition Meet with the CHD, JDF, Sudan Medical The team met with the JDF and SMC teams on Care and other partners on ground to ground and visited the accessible health facilities discuss health and nutrition needs in with them. accessible payams, including IDP locations JDF is the lead nutrition partner for treatment of SAM through OTP services in Duk county and currently are operational in 2 locations - Poktap and Ayueldit. There is no partner implementing TSFP for treatment of MAM in Duk county. SMC is the designated health partner for Duk County and is currently supporting two health facilities, Poktap PHCC and Ayueldit PHCU. Their primary concern is lack of PHCC inpatient capacity and the structures of the PHCC and PHCU. They plan to recruit a midwife or TBA to start ANC services in Ayueldit PHCU. JDF are running ANC services in Poktop. Both agencies expressed concern at the lack of a referral centre and means of transportation, especially in anticipation of the upcoming rainy season and the impact it will have on road accessibility. Since the burning of the PHCC in Panyagor (8 hours walk) the nearest referral centre is in Bor, a 3 hour drive from Panyagor. Assess access to Primary Health Care and Poktap PHCC;supported by SMC nutrition services for the affected population The only PHCC in Duk County, easily including distances travelled, services accessible for surrounding population, located provided and staff availability in the centre of IDP settlement Acts as referral centre for outlying villages, Visit Poktap and Ayueldit health facilities to including Ayeuldit (7 hour walk) assess health and nutrition needs using the Referrals from Poktop –closest surgical IRNA tool referral facility 3-4 hour drive to Bor for obstetric emergency One of two health care facilities and the only PHCC in Duk County 1-2 months stock of all essential medications present. Planned delivery of next 3 months supply before rainy season (SMC/CHD) Functioning out of a small mud building with five rooms There is a functioning incinerator for waste management 12 staff including 1 Clinical Officer, 1 CHW, 2 lab Assistants, 1 Pharmacy Assistant, 2 EPI vaccinators, 1 Cold Chain Manager, 1 Clerk, 3 support staff Page 3 of 19 Medair South Sudan Summary of Objectives Outputs Achieved Only MSF Guidelines available at PHCC others reported stolen Health services include; OPD consultation, 2 bed capacity inpatient room for observations and IV therapy, EPI, basic laboratory services to test for Malaria EPI services began in March following cold chain installation; 103 children have received measles, pentavalent and BCG vaccinations Static EPI services provided on Mondays and Fridays. TT vaccine not available Fridge, no freezer available therefore no EPI outreach 30-50 patients seen per day SMC staff provide supervision from Panagor 2-3 times per week to collect reports and toprovide training Poktap Health and Nutrition Services; by JDF Laboratory with 1 technician (able to diagnose malaria, pregnancy, Kala-azar, Hb) ANC provided by midwife, functions from tent across from PHCC. Ultrasound available and midwife trained ultrasound technician. Automatic BP, weighing scales, essential RH emergency obstetric drugs available Stored in the EPI fridge. ANC opened in Jan, since then total 103 ANC visits (29 ANC2, 3 ANC3), 11 deliveries OTP functioning and services provided under a tree Monday through Friday. JDF in process of relocation and planning infrastructure for the nutrition services. Therapeutic foods are stored in a lockable container and a stabilisation centre (SC) tent has been set up. Nutrition staff include: 1 Nutrition Officer, 2 Nutrition Assistants, 1 SC nurse, 1 data manager Weekly house to house MUAC screening of children and PLW is done to identify new arrivals in the camp. SAM cases are referred for admission to the OTP, however MAM cases are not referred as there is no TSFP IYCF messaging—during the weekly house to house screenings JDF staff conduct IYCF messages to the households.. During the MUAC screening on the assessment week: 129 males, 137 females were reached with IYCF messages. No IYCF at the community level. Did not see IYCF at OTP, however upon suggestion by team, nutrition staff began IYCF messaging with the caregivers and children on the spot.No partner on ground implementing Therapeutic Supplementary Feeding Program (TSFP) for the treatment and management of Page 4 of 19 Medair South Sudan Summary of Objectives Outputs Achieved the moderate acute malnourished (MAM) cases Ayueldit PHCU; supported by SMC Ayueldit has a small population, the PHCU and school both operate out of the school building. Tents for NFIs (CRS) and PHCU supplies are available Only other health facility in Duk County No access to any form of communication. Without SMC supervisory visits, no report mechanism for routine HIS, emergency referrals or outbreaks Beneficiaries travel from nearby villages (between 30 min– 2 hr walk) Referral option - 7 hours walk to Poktop, for surgical intervention nearest facility Bor, 6 hour drive Services provided; OPD consultation, basic ANC, consisting of ferrous sulphate and folic acid, Fansidar distribution and early referral when able, no family planning or condoms