2011 – First Quarter Report

Introduction:

With the continuation of OFDA Grant SMC is continuing Primary Healthcare Program in both Duk and Bor counties of Jonglei State. This year, thanks to our partnership with CRS funding from OFDA has continued. Routine medical care, ANC and EPI are given to beneficiaries (155,451people: 103,100 for Bor and 52,351 for Duk) with some challenges of access due to flooding and poor roads conditions. Rehabilitation of facilities took place starting from February, due to then ongoing Process of Registration for referendum in December and later voting which took place in January. SMC projected activities (delivery of supplies/equipment and construction) from February to April are almost at their completion.

Rehabilitate and construction of health facilities:

Due to the remoteness/vastness of Jonglei State plus bad condition of the roads to area where SMC facilities are, the planned Cui-keer PHCU as a permanent structure was completed in March, being handed Over to SMC by the Constructor and Pending to be Equip adequately.

Rehabilitation of Makuach PHCC/maternity ward and Out Inpatients are currently on going activities with over 85% of materials on site and the constructor having started the Renovation. The Maternity/EPI department is almost completed with new roofing, windows and doors also at the sites. Fencing construction, which will be part of the grant for Makuach, materials will be arriving to Makuach before Weekend; Contractor, already identified will finish the Fencing Work together with the Renovation of the Health Facility, before April 30th. One of the main constraints has been the water sources in the facility; the system has been broken and nonfunctional for more than six month now.

Primary health care in the facilities.

Health workers actively continue rendering health services in all the health facilities supported by SMC, though rainy season is approaching. All the routine services like OPD, IPD, EPI, and ANC are functional. The field Supervisor did a Monitoring/Supervision visit to Bor Program; also a joint visits between SMC and CHD was conducted in February 2011. In march, A three Days field Visit in March (21,22 & 23), was jointly conducted by SMC & CRS and AusAID partners visited most of our health facilities, where they heard from VHCs and Communities members points of views and their Immediate and future Needs. The following are some of the health facilities visited by the Joint team: Makuach PHCC, Cuei-Keer PHCU, Anyidi PHCC and Lualdit PHCU. It was a great experience and chance for our visitors (Partners and Donors) who never been in the area to see the situation on the ground.

Duk Program Field Supervisor was now able to move to locations, which have been inaccessible due to flood, or transportation means and Jointly with the EPI team carrying out Immunization activities in our targeted areas; Though, the bad roads have been hitting the old vehicle, as a result, it was brought twice to Bor for service. A recent field visit with CRS health Program Manager was also successful; this included PAJUT PHCU and consequent visit to partners field offices in Duk payuel.

Delivery of Drug supplies: usually, this activity is done in partnership with County Health departments of Ministry of Health of Jonglei and GOSS Ministry of Health; A three month Drugs supplies distribution was done. Drugs for Duk program were transported by road to Duk and due to the transportation constraints and insecurity most of the Medical supplies were store in Poktap Phcc, till March the CHD is lacking Medical storage facility in Mareng( the CHD head Quarter).

Finance Management: Financial reports have improved much, though there have been some delays on their submission to our partners; Modalities are on discussion on how to improve this aspect on our side. CRS is also projecting some training involving our management soon in May. Additionally, there are funds allocated for field supervisors to improve their mobility and address their challenges at each location.

CRS internal auditor visited our Office and we are discussing the recommendations in order for our management to respond to the report.

Successes:

  • Our field staff continues to provide Primary Healthcare service at very remote areas that are accessible only by foot during rainy season.
  • Improved Communication with Duk and Cuei-keer through provided Communications means (thuraya and HF-Radio) CHF funds.
  • Medical Equipment and Supplies distribution carried out effectively in Bor and ongoing Process in Duk area. We have reached all the health facilities in Bor and most in Duk .
  • Renovation work at Makuach and Kolnyang PHCCs at their final stages
  • A vehicle for Duk Program is currently on in the field. It still having mechanical Problems, but doing the supervisory, Drugs distribution and Immunization activities.  The main challenge will be the vehicle repair due to the High cost and the absent of Mechanics in areas like Duk County, but we acknowledge that it is a Priority need for Duk Program.

Description of workshops or special trainings organized:

Refresher training for CHWs, EPI vaccinators and cold chain managers conducted in Bor. A total of 25 health workers were trained and the refresher training for TBAs is to be conducted in April in parallel with Duk Program training schedules. Management training is scheduled to be on first week of May, where a discussion of some of important issues is to be address, emphasis also will be on our current manuals and guidelines Books.

Monitoring and Evaluation:

With the new car (Donate for use by CRS), SMC team mobility has improved greatly with consequents field visits with our partners and a chain of EPI activities carried out at the river sides and Bangachorot areas, bordering Eastern Equatoria. Since December all our facilities have witnessed the presence of Field Supervisor or others SMC managers carrying out supervisory roles as well as the facility assessment. In Duk County also there has been more movement to the field then last year after recovering their old vehicle, though it has been breaking down frequently. A joint field visit between SMC, CRS and IRD took place in March, where our field supervisor was part of the team and the establishment of Health coordination meeting in which a joint monitoring, involving CHD was emphasis. With a new Vehicle for Duk Project, things will improve much by coming year 2012.

Particular Challenges:

  1. Non-functional water system at Makauch PHCC.
  2. Broken old vehicle received for Duk Program; this will be costly, due to the frequent repairs needed. Need for a New Vehicle.
  3. Sanitation facilities in Duk, especially Poktap PHCC.
  4. Unpredictable security in both Bor and Duk counties (some improvement so far). But sporadic incidents are still been reported in both Counties. , There are potential conflicts that may result in security deterioration if the current rebellion is not controlled.
  5. Inadequate medical supplies (quantity and quality) some arrive to our end when they have already expired or are due to in just few months.
  6. Infrastructure/staff: PHCUs in places like Padiet, and Pajut cannot meet the needs of the populated.
  7. Inaccessibility due to bad roads and lacking adequate transportation means.
  8. Insecurity, especially in Duk County

Stakeholder Relations: SMC team members have participated in several stakeholders meetings:

  • SMC continues frequent communication with the main partners CRS either visiting coordination office in Bor Jonglei State, its Head Office in Juba and by emails or telephone communications.
  • 1st Health Coordination Meeting in MARCH, and the 2nd on 5th April, with our Partners CRS, to be chaired by CHD,
  • Meeting of Stakeholders took place in March, a second will be in April 7th and to be chaired by Duk commissioner, and all NGOs operating in Duk County are invited.  SMC –Duk field Coordinator has briefed the Commissioner on Work plan for 2011.
  • The on going training on disease recognition/prevention and VHCs formation is part of our efforts to have joint work with the beneficiaries.

BENEFITS/ NEW INFORMATION:

  1. Our partnership with CRS is fructiferous and we are committed to continue this relation. We hope to continue the funding support from USAID/OFDA on upcoming Grant Proposal Period.
  2. SMC frequent supervision to the health facilities and the good perception by the community has revived our presence in the counties. This is a great boost to our team and will encourage us to improve each day.
  3. New vehicles on this Year plan, to Improve our current challenge related to transportation
  4. AusAid (Caritas Australia) has filled in some gaps such as Fencing of four Facilities, Management training, disease recognition/ awareness activities, Mosquito nets and rehabilitation of one facility. Some activities pending for the funding release.
  5. SMC, management was requested to take over Pariak PHCC, by he SMOH-CHD, with the support from our Donor, we are ready to start managing it as from May 1st, 2011.

Especial request (also on the previous report):

We are asking CRS despite the difficulties to help us by providing 1 vehicle for the Duk projects. We will add it in the next year proposal.

Transportation means are the back bone of our project for M&E. Currently we have a budget For Two Motorbikes before ($5000 for both Duk and Bor). This amount would at least be enough for only one decent Motorbike that would handle the field condition of the beneficiary area; therefore, SMC consider it appropriate to procure one for Duk now and if we manage to get two Motorbike with our current budget, with a minimum increase or top up, then we will do so. Procurement Process are to be completed and we hope to receive very soon the Motorbike.

Eye Surgical Clinic in Lualdit PHCU 4th -25th March 2011

1 Total patients attendance 898
2 Cataract Operations 120
3 Trachoma Operations 57
4 Others 2
5 Eye glasses Dispensed 46
6 Number of people reached by Health Education Messages 1,666

Bor and Duk Counties Health Facilities Summary Information January-March 2011:

The following is the Epidemiological summary of the all health activities:

Table.1 Epidemiological summary of both counties

Total
Total morbidity 19,976
Total mortality in our facilities 5
Total ANC attendance:                               Bor 417
Total ANC Attendance:                             Duk 55
ANC  1st visit/new cases: Bor 133
Duk 21
Re-Attendance visit: Bor 284
Duk 34
Admission: Bor 89
Duk 109
Ante-partum hemorrhage: Bor 1
Duk 0
Neonatal tetanus: Bor 1
Duk 0
WCBA (women of childbearing age) Vaccinated with TT Bor 243
Duk 127
Total of children Under 5 vaccinated Bor 3,086
Duk 864

The top common pathologies: (Duk & Bor Counties)

  1. Suspected Malaria/FUO: 4,080
  2. Respiratory tract infections including (Pneumonia).  3,622
  3. Eye and skin diseases: 2,351
  4. Acute watery diarrhea.  1,932
  5. Intestinal parasites:  1,557
  6. 6. Anemia/Malnutrition: 869
  7. STDs/Genito -Urinary infections: 1,433
SMC EPIDEMIOLOGICAL REPORT
SUMMARISED January-March 2011.
Disease/Condition Bor Duk
Jan. Feb. March. Total Jan. Feb. March. Total Grant Total
Suspected Malaria/FUO 1208 785 979 2,972 780 328 1,108 4,080
Diarrhea with Blood 144 140 108 392 132 151 283 675
Acute Watery Diarrhea 419 209 485 1,113 541 278 819 1,932
Pneumonia 457 377 518 

 

1,352 266 148 414 1,766
Other Respiratory Infections 425 490 433 1,348 253 255 508 1,856
Eye Diseases 259 400 338 997 170 196 366 1,363
Skin Diseases 266 289 342 897 195 91 286 988
STDs/Genito-Urinary Infection 360 434 428 1,222 114 97 211 1,433
Malnutrition 81 102 79 262 60 68 128 390
Anemia 105 75 83 263 78 138 216 479
Intestinal Parasites 393 356 227 976 339 242 581 1,557
Trauma (Wounds, Burns) 153 114 125 392 82 126 208 600
Measles 0 0 0 0 0 0 0 0 0
Polio 0 0 0 0 0 0 0 0 0
Tetanus 0 0 0 0 0 0 0 0 0
Meningitis 0 0 0 0 0 0 0 0 0
Whooping Cough 0 0 0 0 0 1 0 0 0
Tuberculosis 0 0 0 0 0 10 0 0 0
Cholera 0 0 0 0 0 0 0 0 0
Suspected relapsing fever 0 0 0 0 0 0 0 0 0
Acute Jaundice 8 0 8 16 0 0 0 0 0
Others 506 718 287 1,511 674 450 1,124 2,635
TOTAL 4,784 4,489 4,440 13,713 3,684 2,579 0 6,263 19,976

Summary of Population seen by Sex.

January February March Total
Sex M F M F M F M F
Bor 2,181 2,602 2,353 2,136 2,060 2,380 6,377 7,353
Duk 1,307 1,272 1,804 1,880 3,111 3,152

Assisted deliveries

Delivery Total Male Female
Bor Duk
Live birth 66 125 94 97
Still birth 4 7 7 8
Abortion 8 9

Extended Program of Immunization-EPI (Bor County)

 

vaccines

Age  Groups GRANT TOTAL
< 1 year 1-4 Years > 5 years
 

BCG

Jan. Feb. March. TOTAL Jan. Feb. March. TOTAL Jan. Feb. Marc TOTAL
17 186 263 466 BCG: 466
OPV0 17 56 70 143
POLIO1 40 177 207 424
POLIO2 34 155 215 404
POLIO3 28 129 186 343
Polio: 1,314
DPT1 40 177 207 424
DPT2 34 155 215 404
DPT3 28 129 186 343
DPT: 1,171
VITAMINE A 0
MEASLES 27 145 98 135 Measles: 135
TOTAL 3,086

 

Tetanus toxide vaccination
Women of child-bearing age(Bor County)
Jan. Feb. March.
VACCINES Pregnant Non-Pregnant Pregnant Non-Pregnant Pregnant Non-Pregnant Total
TT1 37 98 135
TT2 16 51 67
TT3 9 20 29
TT4 1 8 9
TT5 3 3
Total 0 63 180 243

 

 

 

 

 

 

Extended Program on Immunization-EPI (Duk County)

 

vaccines

Age Groups GRANT TOTAL
< 1 year 1-4 Years > 5 years
 

BCG

Jan. Feb. Marc TOTAL Jan. Feb. Marc TOTAL Jan. Feb. Mar. TOTAL
16 16 123 155 155
OPV0 7 9 28 44
POLIO1 9 16 138 163
POLIO2 15 17 46 78
POLIO3 11 7 34 52
Polio: 337
DPT1 9 16 138 163
DPT2 15 17 46 78
DPT3 11 7 34 52
DPT: 293
VIT. A 0 0 0 0
MEASLES 0 0 79 79 79
TOTAL 864

 

Tetanus toxide vaccination
Women of child-bearing age(Duk County)
VACCINES January February March Total
TT1 3 11 73 87
TT2 3 1 11 15
TT3 1 0 14 15
TT4 2 2 5 9
TT5 0 0 1 1
Total 9 14 104 127

 

 

 

 

 

 

 

Summary:

Planned activities such as rehabilitation of Kolnyang, Makuac and small rehabilitation of Poktap PHCCs, are either completed or on progress. Accommodation site for Health staff in Duk area, behind Poktap PHCC is among our pending activities for completion, this will help us attract more qualified health professional, by resolving the accommodation issue in Duk County. Completion of Cuei-ker PHCUs is one of our achievements this year. The procurement of equipment and other activities pending for completion are due to be finalized in April, as from now most of the activities are almost completed. April 30th will mark the end of all our planned activities for 2010-11 Grants.

Medical supplies delayed from MOH-GOSS and we coordinating with the SMOH- through the Office of DG to help on accelerating this Process of Predisposing Medical supplies ahead of coming rainy season. Several joint visits to our operational areas as well as coordination meetings were held in March in Duk and Bor counties, where our partners and donors had a chance to see the realities on the ground.

The flood and inaccessibility were the main reason delaying Drugs supplies reallocation from Poktap to Mareng, though the County health department is lacking storage facilities and transportation means; As a result, supplies for the whole county are stored at Poktap PHCC due to difficult access to the others locations, even in the late December, areas such as Mareng, Payuel and Pajut, were not accessible by vehicle.

Finally, should any other opportunities for funding arises, SMC prioritize storage facility and inpatient block for Poktap area.

Immunization activities are improving with the provision of Bicycles to the team Members this month and the current availability of Kerosene (for Kerosene fridges) in our health facilities as static focal points for Immunization. From March 4th -25th, CMA in collaboration with SMC-SMOH-CHD held an eye surgical clinic at Lualdit PHCU with huge turn out of patients which at the same time benefits from our clinic services.

 

From: Dr.Deng Mayom Deng
SMC, Executive Director
Dengmayom@gmail.com