1. South Sudan Integrated Service Delivery
Program
ISDP Semi-Annual Performance
Review Meeting
July – December 2014
Nzara County Presentation
18th-20th/February 2015
By Lodu Moses Wole, PM

2. South Sudan Integrated Service Delivery
OUTLINE OF PRESENTATION:
 County specific highlights
 ISDP/Non-ISDP-supported facilities
 County activities: July – December 2014
 Program implementation challenges
 Key action points to address challenges
 Key priorities for next quarter
 Success story

3. South Sudan Integrated Service Delivery
COUNTY SPECIFIC HIGHLIGHTS:
(Very very sketch map of Nzara County)
3
PHCC
PHCU
Hospital

4. South Sudan Integrated Service Delivery
COUNTY POPULATION
Total & target populations
4
County Payam
Total
Population
(2008)
Mid-year
population
projection (2013) 0-12 months (4%)
6-59 months
(19%)
<5 years of age
(21%)
Estimated # of
pregnant women
(5.6%)
Basukangbi 7160 9432 377 1790 1982 528
Nzara Centre 30754 40514 1621 7698 8509 2268
Ringasi 2214 2917 117 558 614 168
Sakure 14946 19689 788 3740 4136 1106
Sangua 10638 14014 561 2667 2943 786
65712 86566 3464 16453 18184 4856
Target 2013 population is based on 5th Sudan Population and Housing Census 2008, UNHCR, NBS* projections for 2009-2015
Nzara

5. South Sudan Integrated Service Delivery
Unique County Challenge(s)
5
 Very high staff turn-over
 Low HF staff knowledge despite trainings &
technical support during support supervision
 Wooing staff to work in very remote health
facilities has proved futile

6. South Sudan Integrated Service Delivery
ISDP/None-ISDP-supported facilities:
Training title ISDP Non-ISDP Other Total
PHCCs 3 2 0 5
PHCUs 12 3 0 15
Other 0 1 0 1
Total (proportion) 15 6 0 21

7. South Sudan Integrated Service Delivery
County activities performed in Quarter 1 & 2
(July – Sept. and Oct – Dec 2014)
624
1850
2575
494
591
3151
859
634
2508
0
500
1000
1500
2000
2500
3000
3500
DPT3 Vitamin A >5 Consultations
Target (Quarterly) Achievement (July-Sept) Achievement (Oct-Dec)
FIGURE: CHILD HEALTH INDICATORS

8. South Sudan Integrated Service Delivery
County activities performed in Quarter 1 & 2
(July – Sept and Oct - Dec. 2014)
624
499
250
125 136
161
434
139
185
56
144
111
457
248
177
144 145
177
0
100
200
300
400
500
600
700
ANC1 ANC4+ IPT2 SBA Oxytocin FP
Target (Quarterly) Achievement (July - Sep) Achievement (Oct - Dec)
FIGURE: MATERNAL HEALTH INDICATORS

9. South Sudan Integrated Service Delivery
WASH in Health Facilities
 Ensured segregation of waste
 Ensured appropriate waste disposal
 Cleaning equipment and supplies
 Health education
 Hand washing stations installed
 Waste management plan posted
 Pit latrine covers distributed
 Installed 8 water harvest tanks

10. South Sudan Integrated Service Delivery
Technical Trainings
S/no Training(s) No. of pax trained Total
Male Female
01 HMIS 12 8 20
02 SBMR 6 7 13
03 EPI (Pentavalent) 14 5 19
04 BeMONC 1 4 5
Total 33 24 57
Non facility based training(s)
01 SSEPs 4 0 4
02 HHPs 24 25 49

11. South Sudan Integrated Service Delivery
SBMR
 2 more health facilities enrolled for SBMR
 Training on SBMR
 Baseline assessment done for the 2 new HFs
 SBMR team formed in the 2 new HFs
 Assessment done in 3 HFs already practicing
SBMR to ascertain progress

12. South Sudan Integrated Service Delivery
Supportive supervision using QSC (Oct-Dec 2014)
QSC % SCORE
S/N Health facility Infrastructure Equipment HR &
mgt
HMIS Pharmacy Service
provision
Demand
for service
Average
1 Sangua. II PHCU 60 90 50 80 90 90 80 77%
2 Bureangburu PHCU 30 50 60 40 10 80 20 41%
3 Nangirimo PHCU 30 10 40 60 70 40 0 36%
4 Namaiku PHCU 50 75 70 60 90 100 20 66%
5 Kpasua PHCU 60 75 40 80 80 100 60 71%
6 Dingapai PHCU 50 75 20 60 30 90 40 52%
7 Yabwa PHCU 70 100 90 60 80 90 100 70%
8 Ngbamgbia PHCU 50 70 45 60 90 50 0 52%
9 Napkazigi PHCU 60 85 70 80 100 100 20 74%
10 Sangua. I PHCU 30 50 50 80 30 60 0 43%
11 Yabongo PHCU 50 100 70 60 100 80 40 71%
12 Basukagbi PHCC 60 90 50 80 90 90 60 74%
13 Nzara PHCC 70 95 75 80 75 90 80 81%
14 Ringasi PHCC 55 65 85 100 70 85 100 80%
15 Ndoromo PHCU Joint supportive supervision visit to this health facility was not done due to limited access

13. South Sudan Integrated Service Delivery
Community mobilization activities (CMTs and
B/VHCs)
 Experience sharing forum (25pax)

14. South Sudan Integrated Service Delivery
CMTs/B/VHC cont’d
 Met all the Payam CMTs, B/VHC for
coaching on the CM check list
 Identified strengths, gaps and constraints in
CM process and gave O-J-T
 Assessment done to ascertain progress of
CM activities

15. South Sudan Integrated Service Delivery
Community mobilization activities-HHPs (Oct-Dec
2014)

16. South Sudan Integrated Service Delivery
WASH cont’d
• One of the many tippy taps
constructed in Yabua

17. South Sudan Integrated Service Delivery
Other community activities_ ICCM
 Recruited 2 CBD supervisors
 iCCM introductory meeting done in 2 bomas
 Identification of potential CBDs
• iCCM introductory meeting in Nangirimo boma

18. South Sudan Integrated Service Delivery
Program Implementation Challenges
 Limited staffing & high staff turn over
 Low HF staff knowledge
 Dilapidated health facility infrastructure
 Data quality still a challenge
 Transport limitation
 Stock outs of drugs, 2 HFs missed EMF
drugs
 Over expectation by community volunteers

19. South Sudan Integrated Service Delivery
Program Implementation Challenges
 Limited accessibility
 Poor community participation
 Delayed rollout of iCCM

20. South Sudan Integrated Service Delivery
Key Actions to Address Challenges
 Continue to source for more staff
 Continue with on job mentoring and coaching
 Minor renovation of health facilities
 MCHIP to provide additional transport means
 Follow up on EMF missed health facilities

21. South Sudan Integrated Service Delivery
Key Priorities in the Next Quarters
 iCCM scale up
 PPH start up
 MOU renewal
 Minor renovation
 Impant ToT
 Procure HHP work material
 Complete BEmONC in Ringasi PHCC
 DQA
 Recruitment

22. South Sudan Integrated Service Delivery
Suggestions and ideas to improve implementation
 Stake holders should clearly understand
ISDP’s mandate(s)
 Minimize drug stock outs
 Harmonize ISDP staff currency/salary
 Renovations

23. South Sudan Integrated Service Delivery
Success Story
Deliveries increased in Ringasi PHCC Following recruitment of HHPs
 Initially, before recruitment of HHPs in Ringasi boma, Ringasi PHCC
had been conducting very few deliveries.
 With introduction of ISDP’s CAC to Ringasi boma, HHPs were
compelled, using the problem tree, to find out why deliveries were very
low in the health facility.
 Findings pointed to having a male registered midwife carrying out ANC
and conducting deliveries. The community said “it was against their
norm(s) that another male person saw the nakedness of somebody
else’s wife”; therefore many mothers stopped coming to deliver in the
health facility.

24. South Sudan Integrated Service Delivery
Success story continued
 ISDP having received this feedback as a result of the exploration phase
done by HHPs, a second midwife (female) was hired.
 Meanwhile HHPs continued sensitizing community members;
– about the need to deliver under assistance of skilled birth
attendant(s),
– also about the availability of female midwife in the health facility
and
– why it does not matter whoever (male or female) skilled birth
attendant does the delivery.
And as a result, deliveries greatly improved in the health
facility especially during the reporting period as shown in the
graph below.

25. South Sudan Integrated Service Delivery
Success story continued
1 1 1
2
5
7
5
7
5
7
8
21
0
5
10
15
20
25
Deliveries before exploration by HHPs Deliveries after exploration by HHPs

26. South Sudan Integrated Service Delivery
Thank you/tambwahe/tinate/shukran